The epidemiology of, and risk factors for, oro-genital and anal human papillomavirus infections among sexually active Nigerians in Ibadan: a mixed methods study

Background: Human papillomavirus (HPV) is primarily transmitted by unprotected sexual behaviours, and persistence of this virus is associated with HPV-related cancers of the cervix, anus, vulvar, oral cavity and penis. Nigeria has one of the highest burdens of cervical cancer, but there is a paucity of data on other HPV-related cancers. Research objectives: To describe the epidemiology of HPV and the pattern of genital, oral and anal sexual intercourse and their association with the prevalence of genital, oral and anal HPV infections among adolescents and young adults and female sex workers (FSWs) (18-45 years) in Nigeria. Methods: First, a systematic review of reported oral and anal sex among heterosexual adolescents and adults in sub-Saharan Africa (SSA) was conducted. Second, a qualitative study that enrolled adolescent girls and young women in the community and in brothel-based FSW in Ibadan, Nigeria was conducted. The study used focus group discussions and in-depth interviews to collect data on definitions or meanings, attitudes and interpretations of different sexual behaviours. Third, a cross-sectional survey was conducted in Ibadan amongst girls and young women and FSWs to measure the prevalence and risk factors of oral, vulvar, cervical and anal HPV infections. Participants were interviewed, had a clinical examination and samples were collected for HPV genotyping. Blood samples were also collected for human immunodeficiency virus testing. Results: The systematic review showed that oral and anal sex are commonly practiced in SSA, particularly among adolescents, young adults and FSWs. In the qualitative study, most participants had heard of oral and anal sex; more adolescents and FSWs had heard of these practices than adults. Local terminology/slang terms for oral and anal sex were acceptable to adolescents and FSWs but adults in the community often disapproved of these terms for framing interview questions. The most common motivations for practicing oral and anal sex were protection of sexual relationships and financial benefits. Concerns about these practices included fear of acquiring diseases and physical injury. For the prevalence survey, 310 women, and 315 FSWs participated. Ever having practised oral sex was three times more frequently reported by FSWs than general population girls and women. Only one woman in the general population and eight FSWs had ever engaged in anal sex. The prevalences of any HPV genotypes were higher in FSWs than in general population 4 girls and women in the vulva (88% versus 69%), cervix (84% versus 60%), anal cavity (75% versus 57%) and oral cavity (24% versus 16%). The prevalence of HPV was significantly higher in adolescents and young adults than in adults in the cervix, vulvar and anal cavity in the two surveys. In the adjusted model, there were higher odds of cervical HPV infection among women with concomitant vulvar (Adjusted odds ratio (aOR)= 12.85, 95% CI, 5.70-28.99), oral (aOR= 4.37, 95% CI, 1.50-12.71) and anal (aOR=3.48, 95%CI, 1.74-6.96) HPV infection while women with concomitant cervical (aOR=22.19, 95 %CI 7.85-62.72) and anal (aOR=6.68, 95% CI 2.44-18.26) HPV infections had higher odds of vulvar HPV infection. The odds of having anal HPV infection was associated with history of concomitant cervical (aOR=4.10, 95% CI, 1.85- 9.11) and vulvar (aOR=5.47, 95% CI, 2.11-14.20) HPV infection. Only the history of concomitant cervical HPV (aOR=4.81, 95% CI, 1.58-14.62) was associated with a higher odd of oral HPV. Among the FSWs, history of concomitant vulvar HPV infection was associated with higher odds of cervical (aOR=16.60, 95% CI, 5.08-47.54) and anal (aOR=10.55, 95% CI, 3.67- 30.31 HPV infection, whereas history of concomitant cervical (aOR=6.48, 95% CI, 2.70-15.57) and anal (aOR=8.88, 95% CI, 3.66-23.28) HPV was associated with higher odds of vulvar HPV infections. The socio-demographic, behavioural and other biological factors that were associated with any HPV infections in specific anatomic sites are presented in the relevant chapters. Conclusion: Adolescents and adults, including FSWs in Ibadan, frequently engaged in different sexual behaviours, which might predispose them to sexually transmitted infections. HPV infection was found to be common among sexually active girls and women, with a higher prevalence among FSWs

Maternal mortality audit in a tertiary health institution in Nigeria: Lessons from direct causes and its drivers

Introduction: Nigeria has the second highest number of maternal deaths in the world.The study aimed at determining the causes of and non-obstetric contributors to maternal mortality at a tertiary referral hospital.Materials and Methods: It was a prospective audit of all consecutive maternal deaths in the hospital over a three-year period. Immediately after the death,information was retrieved via a data collection form.Data were analysed with SPSS-20.Results: Seventy deaths were examined over the study period. Maternal mortality ratio was 1,265/100,000 live births.The annual ratio decreased steadily over the study period.Most of the deaths were of multiparous women who had not received any antenatal care,and were mostly postpartum, within 24 hours of delivery.Most of them were critically ill on admission to the hospital. Major causes of death were haemorrhage (36%), sepsis (17%) and hypertensive disorders (16%).Delays were identified in 34.3% of cases;most (70.1%) were Phase III delays.Discussion: Direct causes of maternal mortality are consistent with those found in literature. Steps which the centre has been taken to counter direct and non-obstetric causes are discussed. Possible strategies to improve health financing and referral system are proffered.Keywords: Maternal mortality,delay

Viral infections among couples for assisted reproduction in a fertility clinic in Nigeria

Context: The risk of laboratory cross‑contamination may limit the availability of assisted conception for couples infected with chronic viruses. However, assisted conception is the standard of care for people living with human immunodeficiency virus (HIV) to minimize risk of transmission or reinfection.Aims: To assess the burden of viral infection among couples that present for assisted reproductive technology (ART) with a view to evaluating implications for their care.Settings and Design: A cross‑sectional descriptive study carried out among 138 couples at a private fertility clinic in Nigeria.Materials and Methods: Screening for HIV, hepatitis B virus (HBV) and hepatitis C virus were carried out among these clients. The males’ seminal parameters were analyzed according to World Health Organization (WHO) criteria.Statistical analysis Used: Statistical Package for Social Sciences was employed. Analysis was by Chi‑square test; statistical significance was set at 0.05.Results: Viral infections were found in 10/138 women (7.2%) and 15/138 (10.9%) men. The most prevalent infection was HBV. Twenty‑one couples were sero‑discordant. Two couples had concordant HIV and HBV infections, respectively. There was no significant association between sperm quality and chronic hepatitis infection.Conclusion: Nearly a fifth of the couples had at least one partner infected with a chronic virus – a proportion significant enough to demand attention. Apart from separate laboratory and storage facilities, basic principles to minimize transmission are recommended: HBV vaccination in sero‑discordant partners of HBV carriers (and immunoprophylaxis for the baby) and antiretroviral therapy for HIV‑positive partners to reduce the viral load before fertility treatment is commenced.Key words: Assisted reproduction, hepatitis B virus, hepatitis C virus, human immunodeficiency viru

Surgical Patients\' Knowledge and Acceptance of Autologous Blood Transfusion.

Background: Homologous blood transfusion carries a well-documented array of risks especially in an HIV endemic environment like Nigeria. It is therefore imperative to consider other forms of restoring blood volume in surgical patients. Autologous blood transfusion (ABT) is one of the ways the problem of HIV transmission can be reduced among surgical patients. The knowledge and acceptability of ABT among surgical patients about ABT, especially pre-donated ABT were assessed. It also assessed whether or not surgeons inform elective surgical patients about this alternative Materials And Methods Questionnaires were distributed among elective surgical patients that presented during the study period. The knowledge, willingness and the factors influencing the willingness of the patients to participate in ABT were investigated. The data were analyzed with SPSS Version10. Results Of the 116 patients [71 males; 45 females] interviewed, 29 (25.0 %) had heard about ABT, 80 (69.0 %) patients had never heard about ABT while 7 (6.1 %) were not sure. Of the 29 respondents who had heard about ABT, only 2 had had ABT. Of the 48 patients who needed blood for current surgical problems, only 4 (9.3 %) would have ABT. There was a significant difference in the number of respondents who believed that ABT is better than homologous transfusion (x2 = 69.11, p < 0.001). Conclusion The knowledge of ABT is low among our surgical patients and surgeons should present this alternative to their patients. The acceptance of ABT may also help in reducing or eliminating HIV transmission via blood transfusion. Keywords: homologous, hepatitis, surgical procedures, blood volume.Sudan Journal of Medical Sciences Vol. 3 (2) 2008: pp. 109-11

Obstetric fistulae repair in a Nigerian Tertiary Health Institution; Lessons learnt from the outcome of care

This was a hospital based retrospective study of one hundred and fifty-five women managed for obstetric vesicovaginal fistula at the University College Hospital, Ibadan Nigeria from 2000 till 20006. The objective of the study was to document the types of obstetric vesico-vaginal fistula and also describe factors that may influence the outcome of successful repair.The pattern of the fistulae managed were Midvaginal (45.8%),  juxtacervical (38.7%) and juxtaurethral (15.5%). Gynaecologists performed 61.7% of cases using the vaginal route while urologists repaired the rest abdominally. Bivariate analysis showed that younger age at presentation, gravidity, VVF type (Anatomic and Kees Waaldijk), number of previous repairs, and presence of rectovaginal fistula and duration of urinary incontinence prior to repair were statistically significantly related to outcome of repair. Multiple logistic regression models revealed age at presentation (95% CI OR = 1.18 – 9.09) and duration of incontinence (95% CI OR = 1.39 – 13.64) as significant predictors. It is recommended that early presentation for repair and capacity building of specialist trainees will assist in the effective management and other interventions to eliminate obstetric fistula. Above all, governments at all levels should either subsidize or make antenatal care free so as to reduce the incidence of childbirth complications including vesico-vaginal fistula.Keywords: Obstetric fistula, vesico-vaginal fistula (VVF), obstructed labou

Sexual behaviour of in-school adolescents in Ibadan, South-West Nigeria

This study was a crossectional survey conducted among 716 senior secondary school adolescents in Ibadan from March to August 2005. The result of 695 that was analyzed revealed that the mean age of 15±2.6years. 28.3% of the respondents had previous sexual exposure with higher proportions being male (p=0.00043). Majorities\' first sexual exposure was unplanned. Family settings and educational level do not have significant influence on the previous sexual exposure. The methods of sexual activity were mainly through vagina route while some had also practiced oral and anal sex. Most of those that are sexually exposed had more than one partner. About half of the respondents learn about sex from their friends while others through their parents and media. We conclude that in-school adolescents practiced unsafe sexual activity and they are therefore predisposed to STI/HIV and other reproductive health risks. Keywords: Adolescents, In- School, Sexual activity, Sexual exposure, NigeriaAfrican Journal of Reproductive Helath Vol. 12 (2) 2008: pp. 89-9

Determination of post-caesarean wound infection at the University college hospital Ibadan Nigeria

No Abstract

Knowledge and use of emergency contraception by medical doctors on internship in a tertiary healthcare facility in Nigeria

Context: Emergency contraception (EC) is widely used to prevent unwanted pregnancy and it is largely adopted in many countries as over the counter drug to improve access.Aims: To determine and compare the correct knowledge, attitude and current use of EC among newly graduated medical doctors (MDs).Settings and Design: A cross.sectional study conducted among 255 newly graduated MDs at the University College Hospital, Ibadan, Nigeria.Materials and Methods: A pretested self.administered questionnaire was used to obtain data from consenting participants.Statistical Analysis Used: Descriptive, bivariate, and multivariable analyses were performed, and statistical significance was set at 0.05. Statistical Package for Social Science version 15.0 (Chicago, IL, USA) software was used.Results: The mean age of the respondents was 27.2 years (standard deviation = 2.1). The commonest indication for emergency contraceptive use mentioned was rape.96.5%. About 70% support EC in Nigeria, while about a quarter (26.9%) routinely counsel women about ECP use. About 21% of respondents currently use EC. Logistic regression analysis revealed significant results for gender [odds ratio (OR) =3.64; 95% confidence interval (CI) OR = 1.31.10.01), religion (OR = 0.26; 95% CI OR =  0.11.0.630) and marital status (OR = 0.19; 95% CI = 0.07.0.56). Conclusion: The correct knowledge and professional disposition toward EC as a form of contraception is low. We recommend that in.service training  should focus more on EC to improve the quality of their knowledge and  attitude towards it.Key words: Emergency contraception, knowledge, Medical Doctor, Nigeri

Misconception about ultrasound among Nigerian women attending specialist and tertiary health institutions in Ibadan

Background: In women health, ultrasound is well established as a safe tool, and it is often the first imaging modality employed in the, screening, investigation and treatment of conditions in obstetrics and gynaecology. However, women's misconceptions about health issues, aetiology and treatment of diseases conditions may have negative impact on their health care seeking behaviour. Client's perspective of diagnosis including investigation process is therefore crucial in health care. This study aimed at finding out the misconceptions expressed by clients about ultrasound, and the potential predictors associated with this attitude among women in Nigeria.Method: A descriptive cross-sectional survey was conducted among 3137 women who presented for transabdominal ultrasound scan between August and November 2010 in two referral hospitals in Nigeria. Data were obtained using a questionnaire. Descriptive and multivariate analysis was performed applying logistic regression analysis; predictors of misconceptions  expressed by clients about ultrasound, and misconceptions among women in Nigeria were identified using SPSS Statistics (SPSS Inc, Chicago, IL) version 17 software.Results: The mean age of the women was 33.8 years (standard deviation = 7.9), with 88.8% currently married. More than half of the responders had tertiary education (56.6%), followed by secondary school education  (34.5%), primary education (7.8%) and no formal education (1.1%). There were 59 women who held the misconception that ultrasound was dangerous to health accounting for 1.9% of the study population. The reasons given by this group of women Included; 'ultrasound can kill or destroys the body cells' (35.6%); it can cause cancer (15.3%); 'the radiation is only dangerous to some organs of the body' (6.8%); it can harm or deform the fetus (6.7%); it is only dangerous when exposure is frequent (5.1%); and only dangerous when handled by unskilled medical personnel (1.7%).Conclusion: This study provides insight to the wide range of issues about clients' perception and misconception regarding ultrasound safety. These issues have to be addressed to improve better compliance and patronage about ultrasound scans in Nigeria. We suggest that robust counseling session is imperative to address all the views and possible concerns of clients to improve better service delivery

Short CommunicationAttitude of Infertile Women to Child Adoption in Nigeria

Infertility has serious consequences especially in Africa where a high premium is place on child bearing. An interviewer-administered questionnaire was administered on 396 consenting women seeking infertility treatment at the gynaecological clinic of the University College Hospital, Ibadan in an attempt to assess the attitude of infertile women in Nigeria to child adoption and its acceptability as a management option for infertility. Most (64%) believed its culturally unacceptable and only 17% will try it as an option. Sustained advocacy, community mobilization and enactment of supportive laws were some of the suggestions made by respondents to improve its uptake.Keywords; Infertility, Adoption, Assisted ConceptionNig. J. Physiol. Sci. 25(2010) 47 – 4