Trends in maternal mortality in a tertiary institution in Northern Nigeria

Objective: To look at the trends in maternal mortality in our institution over 5 years. Methods: Records of 112 maternal deaths were retrospectively reviewed to determine the trends and the likely direct cause of each death over the study period. Results: There were a total of 112 maternal deaths, while 3931 deliveries were conducted over the 5-year period. The maternal mortality ratio (MMR) was 2849/100,000 deliveries. The highest MMR of 6234/100,000 was observed in 2003, with remarkable decline to 1837/100,000 in 2007. Eclampsia consistently remained the leading cause, accounting for 46.4% of the maternal deaths, followed by sepsis and postpartum hemorrhage (PPH) contributing 17% and 14.3%, respectively. There were no statistically significant differences in the corresponding percentages of maternal deaths between various age groups (\u3c72=6.68; P =0.083). Grandmultiparas accounted for a significant proportion of maternal deaths as compared to low parity, with \u3c72=10.43; P =0.00054. Lack of seeking antenatal care (unbooked) and illiteracy were observed to be significant determinants of maternal mortality (\u3c72=64.69, P =0.00000; and \u3c72=18.52, P =0.0000168, respectively). Conclusion: In spite of decrease in the maternal mortality ratio over the years, it still remains high, with eclampsia persistently contributing most significantly. Community enlightenment on the need to avail of antenatal care and hospital delivery services, and improvement in the quality of skilled maternity care will, among other factors, drastically curtail these preventable causes of maternal death and reduce MMR

La perception de membres communautaires de mortalité maternelle au Nord-est du Nigeria

This study was conducted to find out community’s knowledge and perceived implications of maternal mortality and morbidity. The community members’ perception on ways to prevent the scourge was also explored. It was a population- based qualitative study which took place in two urban and two rural communities in Borno state, Nigeria. A total of one hundred and sixty eight (168) community members participated in Focus Group Discussions (FGD) and in-depth interviews. Most agreed that there were maternal deaths in the communities. Many of the respondents identified at least two of the five main direct causes of maternal mortality that are universal. But many have misconceptions about the causes of maternal mortality. There were many implications narrated by the respondents and various suggestions made to improve on the poor Maternal Health in the areas. The knowledge and implications of maternal mortality was good in the areas and therefore intervention programs should exploit and capitalize on the linkages between the perceived implications and the causes of maternal deaths (Afr J Reprod Health 2008; 12[3]:27-34).Cette étude a été menée afin de rechercher la connaissance de la communauté et les implications perçues de la mortalité maternelle et la maladie. Les solutions/conseils des membres communautaires sur la prévention de la maladie ont été explorés. C’était une étude de qualité basée sur la population qui a eu lieu dans deux communautés rurales de l’Etat de Borno, au Nigeria. Un total de cent soixante-huit (168) membres communautaires ont participé dans un Groupe de Discussion Cible (GDC) et des interviews minutieuses. Plusieurs s’accordent sur l’existence des mortalités maternelles dans les communautés. Maints des défendeurs ont identifié au moins deux des cinq causes principales directes de la mortalité maternelle qui sont universelles. Mais plusieurs ont des idées fausses sur les causes de la mortalité maternelle. Il y a plusieurs implications narrées par les personnes interviewées et plusieurs suggestions ont été proposées pour améliorer les pauvres soins médicaux dans les régions. La connaissance et les conséquences de la mortalité maternelle a été bien dans les regions, ainsi, les programmes d’intervention doivent exploiter et tirer parti de liens entre les conséquences perçues et les causes des mortalités maternelles (Afr J Reprod Health 2008; 12[3]:27-34)

Instrumental vaginal deliveries at the University of Maiduguri Teaching Hospital

Context: Appropriate anaesthesia, efficient blood transfusion services, efficacious antibiotics and qualified personnel are not readily available for safe caesarean section in most developing countries. There is therefore, the need to promote the practice of instrumental vaginal delivery. Consequently, this review is intended to awaken interest in the practice of instrumental delivery. Objectives of the Study: To determine the extent of use and complications associated with the use of obstetric forceps and ventouse in a teaching hospital. Setting and Subjects: All cases of instrumental deliveries (obstetric forceps and vacuum extraction) at the University of Maiduguri Teaching Hospital, Maiduguri, between 1 of January 1993 and 31 of December 2000 were reviewed. Results: Out of a total of 10 881 deliveries recorded, 181 (1.67%) were by vacuum extraction and 33 (0.30%) were by forceps. The common indications for forceps deliveries and vacuum extraction were delay in the second stage of labour and medical conditions, including pre-eclampsia, eclampsia and cardiac disease. The main maternal complications were lacerations of the genital tract. One maternal death was recorded. The most frequent fetal complication was birth asphyxia. Fresh stillbirth was found in 7 (2.21 per cent) of vacuum extraction, and 2 (6.06 per cent) of forceps deliveries. Other foetal complications noted were cephalhaematoma and intracranial haemorrhage.Conclusions: Training of resident doctors and other medical staff in charge of deliveries and the use of less traumatic devices are essential in the effort to promote the correct use of the instrument and the avoidance of complications.Keywords: vacuum, forceps, instrumental Vaginal delivery Tropical Journal of Obstetrics and Gynaecology Vol. 22(1) 2005: 42-4

Synchronous multiple primary carcinomas of ovary and cervix: a case report

A patient with synchronous multiple primary carcinoma of cervix and ovary is described. A 50 year old patient presenting with abdominal pain and distension over the last four months and two months history of offensive vaginal discharge, weight loss and no contact bleeding. The patient had total abdominal hysterectomy and bilateral salpingoophorectomy. Microscopic examination of the uterus and ovary revealed moderately differentiated squamous cell carcinoma and serous cystadenocarcinoma respectively. This suggests multiple primary malignancies. The follow-up of the patient was unremarkable. There is need to differentiate between primary and metastatic tumour, especially when they involve multiple organs. Keywords: carcinoma, ovary, cervix, metastasis Tropical Journal of Obstetrics and Gynaecology Vol. 23(1) 2006: 75-7

Social and health reasons for lime juice vaginal douching among female sex workers in Borno State, Nigeria

Background: Vaginal douching with lime juice and other agents has been perceived to enhance sexual excitement through sensations of vaginal dryness, tightness or warmth, as well as prevent sexually transmitted infections and restore and tighten the vagina after delivery. Its effectiveness as a contraceptive has also been reported. However, the social and health reasons/consequences of such a practice have not been adequately documented in the communities of Borno State, Nigeria. Objectives: This study aimed to determine the extent of, reasons for, and the reproductive health effects of, the use of lime juice for vaginal douching among the commercial sex workers (CSWs) in selected areas of the three senatorial regions of Borno State, Nigeria. Method: This was a community-based descriptive study conducted among female CSWs in selected communities of Borno State, Nigeria. A sample of 194 CSWs were randomly selected and interviewed on their sexual history and douching practices. Results: One hundred and twenty (62%) respondents admitted practicing vaginal douching with lime juice, with 85% having been CSWs for a period greater than three years. More than half douched for sexual pleasure, hygiene and contraception. Significantly more lime juice users had increased susceptibility to sexually transmitted infections (STIs) than non-users. Users had a higher prevalence of HIV infection than non-users. The Papanicouleaua (pap) smear test for cervical lesions also showed that moderate to severe dysplastic changes were more prevalent among limejuice users. Conclusion: Many CSWs in this community use lime juice for douching, for various reasons. Indications are that its use is associated with a higher prevalence of sexually transmitted diseases, including HIV infections and dysplastic cervical changes. Owing to confounding issues, such as the number of sexual partners, frequency of sexual exposure per day and the duration of exposure, it cannot, therefore, be deduced that douching with lime juice is the only reason for the higher prevalence of STIs and HIV. Nevertheless, there is an obvious need to mount extensive campaigns to educate the CSW on the possible risks of using such a practice

Nigerian Lawyers and Reproductive Health Rights: A Survey of Knowledge, Practices and Opinions on Law Reforms among the Bar and Bench in North Eastern Nigeria

The objective of this study was to determine the knowledge and attitudes of practicing Nigerian lawyers towards issues relating to reproductive health and reproductive rights, and their opinions about abortion law reform. It was a population- based study which consisted of interviews with practicing lawyers in north-east Nigeria. The results showed poor knowledge of issues related to reproductive health and reproductive rights among the lawyers. However, the majority (56.9%) disagreed that a woman can practice family planning without the consent of her husband. The prevalence of contraceptive use among the lawyers was low and attitude to abortion law not satisfactory. Only few lawyers (22.4%) supported safe abortion in cases of failed contraception. We conclude that reproductive health advocates must target legal professionals with a view to educating them on issues relating to sexual and reproductive health and rights. Lawyers in Nigeria should undergo capacity building in reproductive health laws and be encouraged to specialize in reproductive rights protection as obtainable in other developed countries Keywords: Reproductive health, Nigerian lawyers, Northeastern Nigeria, Knowledge, PracticeAfr J Reprod Health 2012; 16[1]:69-74

Les Avocats et les droits de santé de la reproduction: Enquête sur la connaissance, l’usage et les opinions sur la reforme de la loi au sein des barreaux et des juges au nord-est du Nigéria

The objective of this study was to determine the knowledge and attitudes of practicing Nigerian lawyers towards issues relating to reproductive health and reproductive rights, and their opinions about abortion law reform. It was a population-based study which consisted of interviews with practicing lawyers in north-east Nigeria. The results showed poor knowledge of issues related to reproductive health and reproductive rights among the lawyers. However, the majority (56.9%) disagreed that a woman can practice family planning without the consent of her husband. The prevalence of contraceptive use among the lawyers was low and attitude to abortion law not satisfactory. Only few lawyers (22.4%) supported safe abortion in cases of failed contraception. We conclude that reproductive health advocates must target legal professionals with a view to educating them on issues relating to sexual and reproductive health and rights. Lawyers in Nigeria should undergo capacity building in reproductive health laws and be encouraged to specialize in reproductive rights protection as obtainable in other developed countries (Afr J Reprod Health 2012; 16[1]:69-74).Cette étude a comme objectif de déterminer la connaissance et des attitudes des avocats nigérians en exercice par rapport aux problèmes relatifs à la santé de la reproduction et leurs opinions sur la reforme de la loi de l’avortement. Il s’agissait d’une étude basée sur la population qui comprenait des interviews auprès des avocats en exercice au nord-est du Nigéria. Les résultats ont montré une faible connaissance des problèmes relatifs aux droits de santé de la reproduction chez les avocats. Néanmoins, la majorité (56,9%) n’était pas d’accord qu’une femme puisse pratiquer la planification familiale sans le consentement de son mari. La prévalence de l’utilisation du contraceptif chez les avocates était faible et leur attitude envers la loi de l’avortement n’était pas satisfaisante. Il n’y avait que peu d’avocats (22,4%) qui aient soutenu l’avortement sans danger au cas de la contraception ratée. Nous concluons que les champions de santé de la reproduction doivent viser les avocats en vue de les éduquer par rapport aux problèmes relatifs aux droits de santé sexuelle et da la reproduction. Il faut que les avocats au Nigéria subissent un renforcement des capacités en ce qui concerne les lois de santé de la reproduction et il faut les encourager à se spécialiser dans la protection des droits de reproduction comme c’est le cas dans les pays développés (Afr J Reprod Health 2012; 16[1]:69-74)

A Shortened versus Standard Matched Postpartum Magnesium Sulphate Regimen in the Treatment of Eclampsia: a Randomised Controlled trial.

Magnesium sulphate is currently the most ideal drug for the treatment of eclampsia but its use in Nigeria is still limited due its cost and clinicians inexperience with the drug. The purpose of this study was to determine whether a shortened postpartum course of magnesium sulphate is as effective as the standard Pritchard regimen in controlling fits in eclampsia. Between January and June 2011, 98 eclamptic mothers presenting at the labour ward of the University of Maiduguri Teaching Hospital were randomised to receive either the standard Pritchard regimen of magnesium sulphate or a shortened postpartum course in which only two doses of intramuscular magnesium sulphate is given four hours apart. The maternal and fetal outcomes were compared. The primary outcome measure was recurrence of fits. The recurrence of fits and other maternal complications were similar in the two groups. The total dosage of magnesium sulphate in the shortened group was reduced by 40% in 66% of patients. The shortened postpartum course of magnesium sulphate is as effective as the standard Pritchard regimen in the management of eclampsia.Le sulfate de magnésium est actuellement le médicament le plus idéal pour le traitement de l'éclampsie, mais son utilisation au Nigeria est encore limitée en raison de son coût et des cliniciens inexpérience avec la drogue. Le but de cette étude était de déterminer si un cours du post-partum raccourcie de sulfate de magnésium est aussi efficace que le traitement standard de Pritchard dans le contrôle unique de l'éclampsie. Entre janvier et juin 2011 98 mères éclampsie qui se présentent à la salle de travail du Centre Hospitalier de l’Université de Maiduguri ont été randomisés pour recevoir soit le traitement de Pritchard standard de sulfate de magnésium ou d'un cours du post-partum raccourci dans lequel seulement deux doses de sulfate de magnésium par voie intramusculaire sont données quatre heures d'intervalle. Les résultats maternels et foetaux ont été comparés. Le critère de jugement principal était la récurrence de crises. La récurrence des crises et autres complications maternelles étaient similaires dans les deux groupes. La dose totale de sulfate de magnésium dans le groupe raccourci a été réduite de 40% à 66% des patients. Le cours du post-partum abrégée du sulfate de magnésium est aussi efficace que le traitement standard de Pritchard dans la gestion de l'éclampsie

Violence sexuelle contre les étudiantes Nigérianes.

Sexual assault is a common social disorder among students in our tertiary institutions. This study ascertains the extent and effect of sexual assault among Nigerian students. Two hundred and Sixty Eight structured questionnaires were distributed to randomly selected students in 4 tertiary institutions, information on socio demography, sexual history and consequences of their exposure were obtained for analysis and interpretation. Thirty seven (13.8%) of the respondents were sexually assaulted as a student and 19 (7.1%) were assaulted by their lecturers and fellow students, Younger age at coitarche, history of forced coitarche, marriage, coitarche with relations and unknown persons, significantly influenced subsequent risks of sexual assault. Improve security, moral behaviours enforcing dress code and stiffer penalties were suggested ways to prevent sexual assault among the students. Sexual assault is still a common finding in our institutions; effort should be made by all stake holders to prevent this social embarrassmentLa violence sexuelle est un désordre social commun chez les étudiants dans nos institutions tertiaires. Cette étude vérifie l'ampleur et l'effet de la violence sexuelle chez les étudiants nigérians. Deux cent soixante-huit questionnaires structurés ont été distribués aux étudiantes qui ont été sélectionnées au hasard dans quatre institutions tertiaires. Nous avons collecté, analysé et interprété les données sur la socio-démographie, le passé sexuel et les conséquences de leur exposition. Trente-sept (13,8%) des interviewées ont été sexuellement agressées en tant qu' étudiantes et 19(7,1%) ont été agressées par leurs professeurs et leurs condisciples. Le fait d'avoir eu des rapports sexuels à un plus jeune âge, une histoire d'avoir eu un rapport sexuel forcé, le mariage, des rapports sexuels avec des relations et avec des inconnus, ont influencé de manière importante, les risques de la violence sexuelle. Comme manière de prévenir la violence sexuelle à venir parmi les étudiants, nous avons suggéré l'amélioration de la sécurité, du comportement, la mise en application d'un code vestimentaire et des pénalisations plus strictes. La violence sexuelle est toujours commune dans nos institutions. Il faut que tous les intéressés fassent l'effort pour prévenir cet embarras socia