Preterm births in a resource constrained setting: sociobiologic risk factors and perinatal outcomes

Background: To determine maternal risk factors and perinatal outcomes of preterm births in south-western Nigeria.Methods: A retrospective study of preterm and term deliveries in a tertiary hospital in Nigeria. The delivery records were reviewed and case files of preterm births were identified and retrieved. Perinatal outcomes were determined by review of the postnatal and special care baby unit records. Multivariate logistic regression was carried out to determine factors independently associated with preterm births. Adjusted odds ratios and confidence intervals were determined.Results: The preterm birth rate was 5.7%. Prelabour rupture of membranes was the leading cause of preterm birth, while a third of them were unexplainable. Age >35yrs (AOR 2.16(1.36-3.42)), the unbooked status (AOR 2.52(1.76-3.61)), Previous history of preterm delivery (AOR 6.41(2.48-16.60)), pre-labour rupture of membranes (AOR 11.08(6.01-18.56)), antepartum haemorrhage (AOR 10.91(4.94-24.09)), multiple gestations (AOR 32.23(13.07-79.50)) and hypertension in pregnancy(AOR6.42(3.79-10.88)) were independently associated with preterm delivery. Low birthweight, asphyxia, neonatal intensive care unit admission and perinatal mortality were common among preterm births. The perinatal mortality rate among the preterm neonates was 14.5%.Conclusion: Preterm birth remains a significant cause of perinatal deaths. Strategies addressing potentially modifiable risk factors will reduce the incidence and improve the perinatal outcomes associated with preterm births.Keywords: preterm delivery, prematurity, perinatal mortality, Nigeria

Effect of intermittent preventive treatment of malaria on the outcome of pregnancy among women attending antenatal clinic of a Nigerian Teaching Hospital

Background: Malaria is a public health problem globally especially in the Sub-Saharan Africa and among the under five children and pregnant women. Malaria in pregnancy is well known to be associated with a lot of maternal and fetal complications. Intermittent Preventive Treatment with Sulphadoxine-Pyrimethamine is the currently recommended regimen for prevention of malaria in pregnancy in the endemic areas.Objective: The study was on the effect of intermittent preventive treatment of malaria in pregnancy on the prevalence of malaria in pregnancy and the outcome of pregnancy.Method: It was a prospective descriptive cross-sectional study and a semi-structured questionnaire was administered to women in the lying in ward University Teaching Hospital, Ado-Ekiti, who booked in the hospital, attended at least two antenatal clinic visits and delivered in the hospital.Results: The study revealed that about 75% of the pregnant women studied had access to intermittent preventive treatment of malaria and also that among the women attending the antenatal clinic that received the IPT, about 78% of them took the recommended dose of the IPT. The prevalence of malaria was statistically higher in women who did not receive intermittent preventive treatment with sulphadoxinepyrimethamine during pregnancy (44.7% vs 31.3%, p=0.0001) and among women who had one dose of the drug instead of two doses (40.0% vs 28.7%, p= 0.0001). There was no statistical significant difference in the mean age in years (31.53±5.238 vs 31.07±4.751, p= 0.09 and the gestational age at delivery (38.76±1.784 vs 38.85±1.459, p= 0.122) between the women who did not receive IPT and those who had it. There was a statistical significant difference in the outcome of pregnancy among women who had IPT and those who did not viz a viz in the duration of labor (8.6±1.491 vs 8.7 ± 1.634, p= 0.011) and the birth weight of the babies (3.138 ±0.402 vs 3.263± 0.398, p=0.0001)Conclusion: Intermittent preventive of malaria with Sulphadoxine-pyrimethamine in pregnancy is effective as a prophylaxis against malaria and improves the outcome of pregnancy in malaria's endemic areas.Keywords: Pregnancy, Malaria, Intermittent preventive treatment, sulphadoxine-PyrimethamineTrop J Obstet Gynaecol, 30 (1), April 201

Maternal views and experiences regarding repeat Caesarean section

Objective: The aim was to determine maternal views and experiences regarding repeat caesarean section.Methods: A pretested and validated semi‑structured questionnaire was administered to women with prior cesarean section by trained research assistants and resident doctors; anonymity and confidentiality were strictly observed. The questionnaire comprised information reflecting patients’ sociodemographic structure, level of education, number of previous cesarean section, maternal complications following previous cesarean and opinions about acceptance and refusal of cesarean section.Results: Two hundred and twenty‑seven women participated in the study out of which 157 (69.2%) would accept a repeat cesarean section and 70 (30.8%) would not accept. Significant proportion of respondents above 35 years of age would refuse a repeat cesarean section (58.6%). Religious belief (39.7%) and pain (26.5%) were the most common reasons for refusal of cesarean section.Conclusion: Appreciable proportion of women with previous caesarean section will decline a repeat cesarean section. Re‑orientation, reappraisal and appropriate corrective action in the areas of religious belief and postoperative pain management will positively influence our women’s acceptance of a repeat cesarean section.Keywords: Experiences, maternal views, Nigeria, repeat caesarean sectio

Adolescent prostitution in south-western Nigeria: demographic characteristics and risk factors.

Context: Adolescent prostitution, an interesting area of reproductive health focus, is of great socioeconomic and medical burden in Nigeria.Objective: This study aims to determine the demographic characteristics and risk factors for adolescent prostitution in NigeriaMethod: This was a cross- sectional study using ethnographic method of in-depth interview based survey of adolescent sex workers in Oyingbo and Yaba communities of Lagos State, Nigeria. This study was conducted between 1st of April, 2014 and 30th of September, 2014. The interview was conducted face to face.Result: A total of 290 adolescent sex workers were interviewed. The mean age of adolescent prostitutes in the study was 16.9 years. While 97.9% of the respondents were of Christian faith, 1.7% belonged to Islam. Financial gain was the commonest reason (90.7%) for involvement in adolescent prostitution in the study.Conclusion: Adolescent prostitution is a significant social and medical problem in Nigeria. Prompt and holistic multidisciplinary approach is required to address this social problem.Keywords: Adolescent, prostitution, reproductive health, demographic characteristics, risk factors, Nigeri

Pattern and determinant of violence against women attending antenatal clinic of University Teaching Hospital, Ado-Ekiti

Introduction: Domestic violence against women especially in pregnancy is a major social and public health problem occurring globally.Objectives: To determine the prevalence of domestic violence against women in pregnancy, the pattern of violence, its determinant (risk) factors and the perpetrators of the violence.Method: It was a prospective descriptive cross-sectional study and a semi-structured questionnaire was administered to pregnant women attending the antenatal clinic of the University Teaching Hospital, Ado-Ekiti.Results: A total of three hundred and fifty women participated in the study after giving their consents and 34 women out of them had experienced domestic violence during pregnancy giving a prevalence of 9.7%. The husbands of the women were the sole perpetrators of the violence against them. Low educational attainment of the women (p = 0.0043) and their husbands (p = 0.001) and spousal alcoholic social habit (p = 0.006) were significantly associated with violence against women in pregnancy. Majority 29 (85.3%) of the women suffered physical abuse while 13 (30.2%) ofthe women suffered verbal abuse. Frequent demands for money by the unemployed women from their husbands and spousal alcoholic social habit were mostly responsible for violence against the women each accounting for 13 (38.2%) of cases. Other reasons for violence in this study include refusal of spousal sexual advances, sudden change in religious beliefs, spousal unemployment and having only female children. Only 4 women did not state the reason for violence against them from their partners. Cultural acceptability of violence against women in 13 (54.2%) women andthe fear of stigmatization in 20 (80%) women were the commonest reasons why women who experienced violence did not confide in someone else and report in the hospital respectively.Conclusion: Violence against women especially in pregnancy is common in this environment but a lot of such women keep this to themselves thus suffering in silence due to the culture and the assumption of the unfriendly health system. Health education of the populace about the danger of violence against women and the training of health workers about this public health condition are highly essential.Keywords: Violence, Women, Pregnancy, Antenatal clini