Severity of intrauterine adhesions and pregnancy success rates after treatment: Comparison of adhesions obtained from open myomectomy versus uterine curettage

Intrauterine adhesions (IUA) are rare. A retrospective comparative study was conducted between January 1, 2015, and December 31, 2018. Group A comprised 117 women who developed IUAs after open myomectomy, while Group B comprised 113 women who developed IUAs following uterine trauma caused by uterine instrumentation after a termination of pregnancy (TOP) or spontaneous miscarriage. The IUA grade and pregnancy rates and outcomes were compared using the March classification system. All patients underwent hysteroscopic adhesiolysis. The adhesions tended to be more severe (45/117, 38.5%) in Group A than in Group B (29/113, 25.7%); however, this difference was not statistically significant (Chi-Suare 5.047; p = .080). The period of observation was 24 months from the last hysteroscopy. The pregnancy rate in Group A (26, 22.2%) was significantly lower than in Group B (46, 40.7%) (OR: 2.403, 95% CI: 1.352–4.271; p = .003). Open myomectomy was the preceding aetiological factor in a greater proportion of women with IUA in our study. In cases where pregnancy is desired after open myomectomy, especially where the endometrial cavity is breached, postoperative hysteroscopy to exclude IUAs is recommended. (Afr J Reprod Health 2022; 26[12]: 90-96). Les adhérences intra-utérines (IUA) sont rares. Une étude comparative rétrospective a été menée entre le 1er janvier 2015 et le 31 décembre 2018. Le groupe A comprenait 117 femmes ayant développé des AIU après une myomectomie ouverte, tandis que le groupe B comprenait 113 femmes ayant développé des AIU à la suite d'un traumatisme utérin causé par une instrumentation utérine après l'arrêt d'une grossesse (TOP) ou fausse couche spontanée. Le grade IUA et les taux de grossesse et les résultats ont été comparés à l'aide du système de classification de mars. Tous les patients ont eu une adhésiolyse hystéroscopique. Les adhérences avaient tendance à être plus sévères (45/117, 38,5 %) dans le groupe A que dans le groupe B (29/113, 25,7 %); cependant, cette différence n'était pas statistiquement significative (Chi-Suare 5,047 ; p = 0,080). La période d'observation était de 24 mois à partir de la dernière hystéroscopie. Le taux de grossesse dans le groupe A (26, 22,2 %) était significativement plus faible que dans le groupe B (46, 40,7 %) (OR : 2,403, IC à 95 % : 1,352–4,271 ; p = 0,003). La myomectomie ouverte était le facteur étiologique précédent chez une plus grande proportion de femmes avec IUA dans notre étude. Dans les cas où une grossesse est souhaitée après une myomectomie ouverte, en particulier lorsque la cavité endométriale est percée, une hystéroscopie postopératoire pour exclure les IUA est recommandée. (Afr J Reprod Health 2022; 26[12]: 90-96)

Strengthening surgical healthcare research capacity in sub-Saharan Africa: impact of a research training programme in Nigeria

BackgroundLimited research capacity has contributed to the lack of high-quality research from low-and middle-income countries. This is compounded by limited research training opportunities. Research capacity scale-up training was deployed as part of the implementation of the National Surgical, Obstetrics, Anaesthesia, and Nursing Plan for Nigeria. We report the impact of this locally contextualized efforts to scale up research capacity in sub-Saharan Africa.MethodsThis is an evaluation of the training of 65 participants in research, grant writing and manuscript writing and publication. Pre- and post-training surveys using a 5-point Likert scale and open-ended questions were administered to evaluate the impact of the programme.ResultsThere were 39 (60%) males and 26 (40%) females aged 26–62 years (median 42 years). Thirty-nine (60%) participants had previous training in research, but only 12 (18.5%) had previously received grant writing training, and 17 (26.2%) had previously received manuscript writing and publishing training. Following training, 45 (70.3%) participants agreed that the training was relevant. The research, grant writing and manuscript writing, and publication components of the training were rated high by the participants (45–59, 70.3–92.2%). However, 41.2% felt that there was not enough time, and 32.4% felt that the training was too comprehensive. Nearly all the participants agreed that the training had improved their skills in research, grant writing and manuscript writing and publication, and more than two-thirds subsequently engaged in informal mentoring of others. Overall, participants achieved success in designing their own research projects and publishing manuscripts and grants. Three (4.6%) of the participants had gone on to become faculty for the research training programme. The three top barriers encountered following training were time constraints (67.3%), lack of funding (36.5%) and not being able to find research collaborators (25%).ConclusionOutcome of this training programme is encouraging and highlights the feasibility and potential impact of deploying such programmes in low and middle income countries (LMICs). Despite the positive outcomes, barriers including time constraints, funding limitations, and difficulties in finding research collaborators remain to be addressed. Such training programmes need to be supported to strengthen the research capacity in this and similar settings

A Survey of Community Opinion and Perceptions toward Gamete Donation in North Central Nigeria

Background: Gamete donation supports in vitro fertilization services. Donation of gametes began in the developed world in 1884, but there is no documentation of when it started in Nigeria. The donors may be sourced from the community where such services are available. The objectives of this study are to determine the opinion of a community in north-central Nigeria toward gamete donation and determine the factors that influence their opinion. Materials and Methods: This is a cross‑sectional survey of 300 individuals in a community regarding their opinions and perceptions about gamete donation in the setting. The survey involved using a questionnaire with the questions structured in a Likert format. Results: Two hundred and four (68%) of the respondents had knowledge of gamete donation, and 96 (32%) had none. Fifty‑five (18%) respondents did not support gamete donation, whereas 153 (51%) did. Fifty‑five (18%) disagreed and 158 (52.7%) agreed that gamete donation is justified. Forty‑one (14%) disagreed, while 201 (67%) agreed that financial gain is the reason for gamete donation. One hundred disagreed (33.3%) and 113 (37.7%), respectively, agreed that religious beliefs prevent people from donating or receiving gametes. Forty‑seven (16%) agreed, and 180 (60%) disagreed that donation can lead to childlessness in the future. Ninety‑three (31%) agreed while, 130 (43.3%) disagreed with the possibility of their acceptance of gamete donation if needed. Eighty (2.6%) will not while 149 (49.6%) will support a friend/acquaintance who wants to donate their gamete. Significantly, more males agreed that religion forbids donating or receiving gametes (P = 0.047). Conclusion: There is a high awareness and favorable predisposition toward gamete donation but a low willingness to donate or accept same. More advocacy and enlightenment are needed to increase the participation of this community in gamete donation. Keywords: Advocacy, community opinion, gamete donatio

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Computer knowledge amongst clinical year medical students in a resource poor setting

Objective: To study the computer knowledge and desires of clinical year medical students at one of the oldest and largest medical schools in Nigeria. Design: A survey using validated structured questionnaires. Setting: Medical school of Ahmadu Bello University, Zaria, Nigeria. Subjects: Two hundred and thirty seven clinical year (4th, 5th and 6th years) medical students. Outcome measures: Computer knowledge, mode of acquiring computer knowledge, regular access to computer, desire for inclusion of computer training in curriculum. Results: One hundred twenty (50.6%) students had knowledge of computer technology and it use. Of these, 108 (90%) had no regular access to a computer and none owned a computer; only 32 (26.7%) were sufficiently familiar with computer tools to perform advanced tasks, but 72 (60%) were comfortable with word processing. Seventy two of the 120 students acquired their computer knowledge through self-learning efforts while 45 (37.5%) attended short periods of formal training. Overall, 45.7% of males and 64.5% of females had computer knowledge. The main reason for lack of computer knowledge was lack of time and lack of access to a computer. Eighty percent of all students would like computer education to be included in medical school curriculum. Conclusion: Knowledge and use of computers amongst clinical year medical students in this setting is low. It is important that computer education be taught to the students to enhance their ability to use electronic information and communicate more effectively using computer resources

Application of queuing theory to patient satisfaction at a tertiary hospital in Nigeria

Background: Queuing theory is the mathematical approach to the analysis of waiting lines in any setting where arrival rate of subjects is faster than the system can handle. It is applicable to healthcare settings where the systems have excess capacity to accommodate random variations. Materials and Methods: A cross‑sectional descriptive survey was done. Questionnaires were administered to patients who attended the general outpatient department. Observations were also made on the queuing model and the service discipline at the clinic. Questions were meant to obtain demographic characteristics and the time spent on the queue by patients before being seen by a doctor, time spent with the doctor, their views about the time spent on the queue and useful suggestions on how to reduce the time spent on the queue. A total of 210 patients were surveyed. Results: Majority of the patients (164, 78.1%) spent 2 h or less on the queue before being seen by a doctor and less than 1 h to see the doctor. Majority of the patients (144, 68.5%) were satisfied with the time they spent on the queue before being seen by a doctor. Useful suggestions proffered by the patients to decrease the time spent on the queue before seeing a doctor at the clinic included: that more doctors be employed (46, 21.9%), that doctors should come to work on time (25, 11.9%), that first‑come‑first served be observed strictly (32, 15.2%) and others suggested that the records staff should desist from collecting bribes from patients in order to place their cards before others. The queuing method employed at the clinic is the multiple single channel type and the service discipline is priority service. The patients who spent less time on the queue (<1 h) before seeing the doctor were more satisfied than those who spent more time (P < 0.05). Conclusion: The study has revealed that majority of the patients were satisfied with the practice at the general outpatient department. However, there is a need to employ measures to respond to the suggestions given by the patients who are the beneficiaries of the hospital services.Keywords: Hospital, patients, queue, satisfactionNigerian Medical Journal | Vol. 54 | Issue 1 | January-February | 201

Outcome Following Ovarian Drilling in Nigerian Women with Polycystic Ovary Syndrome: A Systematic Review

Background: Polycystic ovary syndrome (PCOS) is a common condition characterized by endocrinopathies which can lead to infertility. Various modalities of treatment have been employed including ovarian drilling, but the outcome of such ovarian drilling in Nigerian women is not known. Aim: This is a systematic review of the outcome of ovarian drilling on the menstrual pattern and pregnancy rate in Nigerian women. Materials and Methods: Google scholar and PubMed databases were searched for studies that relate to PCOS management using ovarian drilling and other modalities in Nigeria. The citation lists of relevant articles and studies were also searched. Case reports, retrospective studies, and prospective studies were included. Review articles, systematic reviews, and meta‑analysis were excluded. Six studies were found to be suitable and consisted of two case reports and prospective studies each, respectively, and one clinical trial and retrospective study each, respectively. Results: There were a total of 107 patients aged 17–49 years. While all the patients presented with a complaint of abnormal menstruation, 50%–70% complained of inability to conceive. All the patients had used clomiphene citrate as first‑line drug to manage their complaints. Ovarian drilling was carried out using the conventional unipolar diathermy and 4 or more drills per ovary. Following the procedure, 76% resumed normal menstruation and 30% conceived. Conclusion: Reports of ovarian drilling in Nigeria reveal a positive outcome but the number of published studies are few and quality of evidence low. Further well‑designed studies including randomized controlled trials are needed to make definite conclusions

Knowledge and attitude towards child adoption among women in Zaria, northern Nigeria

Background: The success of marriages has largely been premeditated on child bearing in most African society and oftentimes women are at the receiving end of childlessness with possible psychological and physical torture. Objective: To assess the knowledge and attitude of women of reproductive age towards child adoption in Zaria, Northern Nigeria. Methodology: A cross-sectional descriptive study, structured closed and open ended questionnaires was administered to 200 consenting consecutive women aged 15-49years to obtain information on socio-demographic characteristics, reproductive profile, knowledge and attitude towards child adoption. Data was analysed using SPSS V17 with p value set at 0.05. Results: The majority 89.4% of respondents have heard and are aware of child adoption and 77% agreed it is a good practice. The most prevalent source of information is the Mass media in 35.0% of respondents. The female gender is preferred by majority 64.2% of respondent if they will adopt. There is a strong association between numbers of living children and willingness to consider child adoption with P value < 0.05. Conclusion: There is a high level of knowledge and acceptability of child adoption practices in our environment. Child adoption institutions should therefore be supported to meet the need of the infertile couples