Prevalence and determinants of use of traditional methods of infertility treatment among women attending infertility clinic in Southeast Nigeria

Infertility, an obstacle to healthy living, makes its victims patronize traditional methods of infertility treatment (TMIT) in spite of associated complications. They turn to hospitals when this method fails. This is actually a serious issue because the presence of contaminated herbal products and the relationship between the use of TMIT and noncompliance with biomedical treatment regimens constitutes a major concern in medical practice. And the use of traditional methods of infertility treatment has been correlated with severe and fatal consequences. Therefore, the study assessed prevalence/determinants of TMIT use among patients visiting the gynaecology clinic at Alex Ekwueme Federal University Teaching Hospital Abakaliki (AE-FUTHA). Descriptive cross-sectional design was adopted for the research. Only 263 women took part in the study. The research instrument was questionnaire. Data were analyzed using descriptive statistics. Findings revealed that 95.4% of these women have used traditional methods for infertility treatment and factors influencing infertile women’s use of TMIT are demographic characteristics, infertility duration, husbands’ relatives’ pressure and cheap cost of traditional medical treatment. Again, inability of infertile women to disclose TMIT use to healthcare providers makes effective treatment difficult. Therefore, these impediments expose infertile women to use TMIT. The result is a guide to healthcare providers who are expected to know the extent of their parents’ use of TMIT

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Population and vaccine hesitancy: a demographic and Socio-behavioural examination of a barrier to Covid-19 herd immunity in Nigeria

The theme of the 76th session of the United Nations (UN) General Assembly (2021) stresses on the need to tackle the global coronavirus pandemic and other challenging issues presently staring our world in the face. World leaders have tried to contribute their own quota towards changing the present narrative by vaccinating a large portion of their population. However, vaccine hesitancy has served as a barrier to achieving herd immunity in nations-Nigeria inclusive. The sociological theory of phenomenology and the concept of ‘‘sick role’’ were employed as the theoretical framework upon which the study was anchored. Descriptive cross-sectional survey and purposive sampling were used in the work. Data for the study was generated through primary (online survey of 150 respondents) and secondary sources. The content and thematic techniques were used to analyze the data so gathered. The causal factors of vaccine hesitancy in Nigeria were uncovered to include: ‘negative human awareness’, lack of or low public knowledge/agreement on public health need of the vaccine, disconnect (public mistrust of government) between the people and government and lack of awareness/proximity of vaccination points, among others. The paper recommends strategies for massive advocacy/social mobilization to counter negative social interaction and narratives making the rounds on the intake of the COVID-19 vaccine by the Nigerian populace to build general consensus on the need for the vaccine and adoption of the Nigeria Polio vaccination model of taking vaccine down to the people

The practice of spinal anaesthesia in two tertiary hospitals in South-East Nigeria - review of 100 cases

Background: Spinal anaesthesia is very important as it avoids the numerous complications that could arise from general anaesthesia including airway problems. It is cost effective and can be used for surgeries of up to two hours duration.Objectives: To evaluate the practice of spinal anaesthesia in South-East Nigeria and document the intraoperative complications as was observed in our centre.Methodology: The study is a prospective multi-centre study carried out at the University of Nigeria Teaching Hospital (UNTH) Enugu and the National Orthopaedic Hospital Enugu (NOHE). Patients who were scheduled for surgery under spinal anaesthesia were recruited into the study. Demographic data, type of operation done, American Society of Anesthesiologists (ASA) physical status classification and intra-operative complications were recorded using a proforma. Also, recorded were the size and type of spinal needle and site of injection of local anaesthetics.Results: A total of 100 patients who met the inclusion criteria were simultaneously recruited into the study. They were between the ages of 18 and 75years with a mean age of 40.2 ± 14.5years. They were 50 males and 50 females. The mean weight was 76.0 ± 13kg and the height was 168 ±11.7cm. The mean duration of surgery was 83.3 ± 26.3minutes. Most of the operations done were orthopaedic surgery 46%. The most common intra-operative complication was hypotension with an incidence of 28%, followed by shivering 21%. Other intra-operative complications included pain 9%, nausea 3%, respiratory difficulty 2%, bradycardia 1% and failed spinal anaesthesia 1%. The hypotension observed during caesarean section was significantly higher than in orthopaedic patients (X2=4.060, p = 0.044).Conclusion: In this series no mortality or permanent morbidity was recorded. The practice of spinal anaesthesia is safe.Keywords: Caesarian section, hypotension, intra-operative complication, orthopaedic surgery, safe anaesthesi