Obstetric analgesia for vaginal birth in contemporary obstetrics: a survey of the practice of obstetricians in Nigeria

BACKGROUND: Contemporary obstetrics in sub-Saharan Africa is yet to meet the analgesic needs of most women during child birth for a satisfactory birth experience and expectedly, obstetricians have a major role to play in achieving this. METHODS: This was a questionnaire-based, cross-sectional study of 151 obstetricians and gynecologists that attended the 46th Annual General Meeting and Scientific Conference of the Society of Gynaecology and Obstetrics of Nigeria (SOGON) held in Abakaliki, southeast Nigeria in November, 2012. SOGON is the umbrella body that oversees the obstetric and gynecological practice in Nigeria. Data was collated and analyzed with Epi-info statistical software, and conclusions were drawn by means of simple percentages and inferential statistics using Odds Ratio, with P-value < 0.05 at 95% Confidence Interval (CI) taken to be statistically significant. RESULTS: Of the 151 participants, males predominated; 110 (72.9%) practiced in government-owned tertiary hospitals in urban locations. Only 74 (49%) offered obstetric analgesia. Among users, only 20 (13.3%) offered obstetric analgesia routinely to parturients, 44 (29.1%) sometimes and 10 (6.6%) on patients’ requests. The commonest analgesia was opioids (41.1%). Among non-users, the commonest reasons adduced were fear of respiratory distress (31.1%), cost (24.7%) and late presentation in labour (15.6%). CONCLUSION: The routine prescription and utilization of obstetric analgesia by obstetricians in Nigeria is still low. Obstetricians are encouraged to step up its use to make childbirth a more fulfilling experience for parturients

Burns in pregnancy: Five-year experience in a tertiary hospital in southeastern Nigeria

BackgroundBurns in pregnancy is often associated with high maternal and fetal morbidity and mortality especially when the total burn surface area (TBSA) involved is high. This study aims to review management outcome of cases of burns in pregnancy at Alex Ekwueme Federal University Teaching Hospital Abakaliki (AE-FUTHA).MethodsA five year retrospective study of all pregnant women that presented at AE-FUTHA with burn injury between April 2014 and March 2019. Information was collected from the medical records using a proforma and analyzed with IBM SPSS Statistics version 20.0 (IBM Corp., Armonk, NY, USA) using descriptive statistics.ResultsA total of 222 cases of burns were managed but only 8 were pregnant, giving an incidence of 3.6%. The commonest causes were flame (62.5%), scald (25%) and friction (12.5%) occurring mostly during the harmattan season. The median age of participants was 25-34 years. The burns affected 12.5% of the patients in the first trimester and 62.5% and 25% in the 2nd and 3rd trimesters respectively. Most patients (62.5%) had superficial burns while 25% had other associated injuries in addition to burns. About 87.5% had term spontaneous vaginal delivery. There was no maternal death but, there was an early neonatal death.ConclusionThe good outcome observed in this study with a 100% survival, could be explained by inter-disciplinary management approach given, even as most cases were minor degrees of burns. Early involvement of obstetricians in all burns affecting pregnant women is advised especially in burn centres where obstetricians are hardly in the employ

Tranexamic acid for reducing blood loss following vaginal delivery: a double-blind randomized controlled trial

Abstract Background Postpartum haemorrhage (PPH) is a major cause of maternal morbidity and mortality worldwide. Tranexamic acid (TXA) is a useful drug for prevention of PPH and merits evaluation in Nigeria, where PPH is the leading cause of maternal death (25%) and severe maternal morbidity. This study evaluates the efficacy of TXA in reducing blood loss following vaginal delivery. Methods This was a double-blind randomized placebo-controlled study on the efficacy and safety of intravenous TXA in reducing blood loss in women undergoing vaginal delivery in a tertiary hospital. Data analysis was conducted with IBM SPSS software (version 20, Chicago II, USA). P-value < 0.05 was considered statistically significant. Results The mean estimated blood loss was lower in TXA compared with the placebo group. (174.87 ± 119.83 ml versus 341.07 ± 67.97 ml respectively; P  500 ml) was 5.13% in the study arm compared to the control arm 7.14%- risk ratio (RR) 0.71; 95% CI: 0.38–1.79, p = 0.5956]. Additional uterotonics was required more in the control group compared to the treatment group 14(16.67%) versus 3(3.85%), p-value= 0.007. There were no major complications noticed in the treatment group. Conclusion This study demonstrated that intravenous administration of TXA reduced blood loss following vaginal delivery. It also reduced the need for additional uterotonics. However, blood loss greater than 500 was not significantly reduced. Trial registration This trial was registered retrospectively. Pan African Clinical Trial Registry: PACTR202010828881019 on 12/10/2020.

Perception and attitudinal factors contributing to periodic deworming of preschool children in an urban slum, Nigeria

Abstract Background Over 20 million preschool-age children (PSAC) in Nigeria require periodic chemotherapy (PC) for soil-transmitted helminth (STH) infections. Persistently low coverage for this age group threatens the World Health Organization (WHO) 2030 target for eliminating STH infections. Current strategies for targeting PSAC have been largely ineffective. Hence, PSAC are mostly dewormed by their parents/caregivers. However, little is known of the perception and attitude of parents/caregivers of PSAC to deworming in this setting. Methods A mixed methods design, combining a community-based interviewer-administered questionnaire-survey (n = 433) and focus group discussions (FGD) (n = 43) was used to assess the perceptions and attitudes of mothers to periodic deworming of preschool children aged 2–5 years in Abakpa-Nike, Enugu, Nigeria. Results Coverage of periodic deworming in PSAC is 42% (95% CI: 37.3–46.8%). There is significant difference in the specific knowledge of transmission of STH (AOR = 0.62, 95% CI: 0.48–0.81, p = 0.000), complication of STH infections (AOR = 0.77, 95% CI: 0.61–0.98, p = 0.034), accurate knowledge of deworming frequency (AOR = 0.41, 95% CI: 0.18–0.90, p = 0.026), and knowledge of PC drug, mebendazole (AOR = 0.28, 95% CI: 0.09–0.90, p = 0.031), and pyrantel (AOR = 8.03, 95% CI: 2.22–29.03, p = 0.001) between mothers who periodically deworm their PSAC and those who do not. There is no significant difference in specific knowledge of the symptoms of STH infections (AOR = 0.76, 95% CI: 0.57–1.02, p = 0.069) and PC drug, Albendazole (AOR = 1.00, 95% CI: 0.46–2.11, p = 0.972). FGD revealed misconceptions that are rooted in stark ignorance of the disease. Overall attitude to deworming is positive and favourable. Conclusions Poor coverage of periodic deworming for STH infections in PSAC in this setting are primarily driven by poor specific knowledge of the risks and burden of the infection. Focused health education on the burden and transmission of STH infections could complement existing strategies to improve periodic deworming of PSAC in this setting

Experiences and challenges of gynecological endoscopy in a low-resource setting, Southeast Nigeria

Background: The scope of endoscopy is expanding more and more as experience is gained with training and collaborations, however, these expansions could be slowed by challenges. Objectives: To determine the experiences and challenges of gyne-endoscopic surgery. Materials and Methods: This study was a prospective analysis of all women undergoing gynecologic endoscopy at Federal Teaching Hospital Abakaliki (FETHA), Nigeria from 2012 to 2014. Patients were recruited based on eligibility for endoscopy surgery. Written informed consent was obtained before any of the gyne-endoscopic surgery. Ethical approval for the study was given by the ethics and research committee of FETHA. Laparoscopy and hysteroscopy were performed by the managing team. EPI Info version 3.5.1 statistical software (Atlanta, GA, USA) was used for data analysis. Results: Seventy-three different gyne-endoscopic surgeries were done, with dye test accounting for majority 28 (77.8%). The duration of surgery ranged from 23 to 248 minutes, and the surgery with the longest duration was total laparoscopic hysterectomy while laparoscopy and dye test had the shortest operating time. The mean duration of hospitalization was 20.3 ± 14.4 hours. There were 2 (5.6%) conversions to open surgery. Most common complication was abdominal pain 26 (72.2%). The challenges include third party partnership, lack of vital equipment, poor maintenance, epileptic power supply, late presentation of cases, and misconception. Conclusion: Gyne-endoscopy is essential in contemporary medicine. Reduction in operating time occurs as skills and experience improve; the challenges are many

Utilisation of preconception care services and determinants of poor uptake among a cohort of women in Abakaliki Southeast Nigeria

Preconception care (PCC) is a preventive strategy for maternal and perinatal morbidity and mortality. This study aimed to assess the level of awareness and utilisation of PCC services. A descriptive cross-sectional survey was conducted at a teaching hospital. Interviewer-administered questionnaires were used to extract information. A total of 450 participants responded; 44.2% (190/450) were aware, 31.7% (143/450) had good knowledge, while only 10.3% (46/450) received PCC. Health care providers were the main source of information (77.9%). There was statistically significant correlation between awareness and participants’ level of education (p < .001) and residence (p < .001), as well as between utilisation and education (p < .001), and information from doctors (p < .001). There was a low level of awareness and poor utilisation of PCC, underpinning the need to scale up health education, establishment of functional PCC clinics and formulation of evidence-based guidelines to improve uptake and pregnancy outcome.Impact statement What is already known on the subject of the paper? PCC has been known in high-income countries as a prevention-based strategy, which aims at improving obstetric outcomes. However, the level of utilisation in low-income countries like Nigeria is either unknown or far too low. What do this study add? This work has provided local data on PCC; clearly indicating that the awareness and utilisation of PCC services in Abakaliki, Nigeria is very low when compared with other regions of the world, and this was influenced by the socio-demographic factors – particularly education and place of residence (for awareness), and level of education and information from health care providers (for utilisation), thus suggesting that enlightenment and improvement in social infrastructures could improve awareness, access and utilisation of PCC. What are the implications for clinical practice and/or further research? The implications of these findings in low resource settings like ours will include introducing interventions to scaling up health education, universal establishment of functional PCC units and formulation of evidence-based guidelines aimed at improving the uptake of PCC and pregnancy outcome. Further research will also be needed in future to assess the impact of such interventions and how to sustain potential benefits