Perceptions and attitudes of a rural community to abortion in the Niger-delta region of Nigeria

To determine the perceptions and beliefs relating to unwanted pregnancy, family planning and abortion, and identify issues that can be leveraged to initiate positive attitudes towards family planning and abortion in the area. Focus group discussions (FGDs) and in-depth interviews (IDIs) were conducted in Amukpe, Delta State, Nigeria. A highly motivated and well-trained team versed in the local language and culture conducted the FGDs and IDIs. Therewas unanimity that unwanted pregnancies was quite common amongstwomen of reproductive age group and constitute a significant problemin the community.Abortion, particularly in the hands of quacks was amajor option to handling an unwanted pregnancy.Almost all agreed that their culture and religion abhors abortion, yetwidely practiced because of the odium associatedwith an unwanted pregnancy in the community. The knowledge of the Nigeria National abortion law even amongst the health workers and teachers was generally poor. The participants agreed that there were problems and complications (often severe) including death associatedwith abortion in the community. Itwas largely agreed that contraceptive knowledge and usage was poor. The reasons adduced for this include lack of knowledge, lack of spousal consent, socio-cultural taboos andmisconceptions, aswell as economic reasons. Itwas suggested that imbibing positive family values by parents in theirwards and government leveraging the socio-economic status of the communitywill go a long way to stemming the tide. Unwanted pregnancy, unsafe abortion and abortion complications are reported to be commonamongst women of reproductive age group inAmukpe community, whilst contraceptive awareness and usage is poor.Keywords: Perception and attitudes, rural community,Abortio

Factors associated with the knowledge, practice and perceptions of contraception in rural southern Nigeria

Background: Significant proportion of maternal deaths in Nigeria is due to complications of unsafe abortions, and these abortions are responses to unwanted pregnancies that could have been prevented by effective contraceptive programming. Despite intense programmatic efforts by the Nigerian government and various non-governmental agencies toreverse the trend, there has been little evidence to suggest a systematic improvement in these indicators. Methodology: A household random survey of 1,528 women aged between 15-49 years was undertaken at Amukpe community in Nigeria, to determine theirknowledge, practice and perceptions of contraception. Results: The results showed that 86.2% of the respondents had secondary or less level of education and 19.2% of the respondents were single parents. The level of contraceptive awareness was high (92.3%) and88% of the respondents became aware of contraception in the last 14 years. Friends/relatives (40.6%), followed by nurses (31.7%) and then doctors (17.3%) were the common sources of contraceptive awareness. The most  widely known contraceptive methods were injectables,condoms, POP and OCP. The specific knowledge of emergency contraception was poor. The factors associated with low contraceptive usage were poor level of training and ineffective conveyance of relevant information to clients by health personnel, low literacy levels,extremes of reproductive age and extremes of parity. Others were fear of side effects, lack of knowledge, and lack of spousal consent.Conclusion: Contraceptive usage remain poor despite high level of awareness. Effective educational and counseling interventions are likely to improve providers’ and consumers’ knowledge and subsequent uptakeof contraceptive usage

Cost-effectiveness of external cephalic version for term breech presentation

<p>Abstract</p> <p>Background</p> <p>External cephalic version (ECV) is recommended by the American College of Obstetricians and Gynecologists to convert a breech fetus to vertex position and reduce the need for cesarean delivery. The goal of this study was to determine the incremental cost-effectiveness ratio, from society's perspective, of ECV compared to scheduled cesarean for term breech presentation.</p> <p>Methods</p> <p>A computer-based decision model (TreeAge Pro 2008, Tree Age Software, Inc.) was developed for a hypothetical base case parturient presenting with a term singleton breech fetus with no contraindications for vaginal delivery. The model incorporated actual hospital costs (e.g., $8,023 for cesarean and$5,581 for vaginal delivery), utilities to quantify health-related quality of life, and probabilities based on analysis of published literature of successful ECV trial, spontaneous reversion, mode of delivery, and need for unanticipated emergency cesarean delivery. The primary endpoint was the incremental cost-effectiveness ratio in dollars per quality-adjusted year of life gained. A threshold of $50,000 per quality-adjusted life-years (QALY) was used to determine cost-effectiveness.</p> <p>Results</p> <p>The incremental cost-effectiveness of ECV, assuming a baseline 58$7,900/QALY. If the estimated probability of successful ECV is less than 32%, then ECV costs more to society and has poorer QALYs for the patient. However, as the probability of successful ECV was between 32% and 63%, ECV cost more than cesarean delivery but with greater associated QALY such that the cost-effectiveness ratio was less than $50,000/QALY. If the probability of successful ECV was greater than 63%, the computer modeling indicated that a trial of ECV is less costly and with better QALYs than a scheduled cesarean. The cost-effectiveness of a trial of ECV is most sensitive to its probability of success, and not to the probabilities of a cesarean after ECV, spontaneous reversion to breech, successful second ECV trial, or adverse outcome from emergency cesarean.</p> <p>Conclusions</p> <p>From society's perspective, ECV trial is cost-effective when compared to a scheduled cesarean for breech presentation provided the probability of successful ECV is > 32%. Improved algorithms are needed to more precisely estimate the likelihood that a patient will have a successful ECV.</p

Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P &lt; 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P &lt; 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

The Patient With Obstructed Labour (A Review Article)

Advanced obstructed labour is probably the leading cause of maternal and perinatal mortality in the West African sub region. Options for delivery of the patient are destructive operations on the fetus, abdominal delivery or symphysiotomy followed by vaginal extraction. Uterine rupture in the multiparous patient is a frequent complication. The operative treatment options of repair or hysterectomy should be individualized. The puerperal complications include anaemia, sepsis, the development of vesicouterine or vesico vagina fistulae and neonatal complications. Early referral of cases of prolonged labour from peripheral to tertiary centers is advocated. Followed by extraction vaginally, abdomenial. KEY WORDS: Advanced obstructed labour, Destructive, operations, Hysterectomy, Sepsis. Journal of Medical Investigation and Practice Vol. 4: 2003: 30-4

Operative vaginal delivery: Role in obstetric practice in west Africa sub region

No Abstract.JOMIP Vol. 5 2004: pp. 42-4

Sociobiological associations of bacteriuria in pregnancy in Aba

No Abstract.JOMIP Vol. 5 2004: pp. 12-1

Socio economic implication of septic abortion in Aba

No Abstract.JOMIP Vol. 5 2004: pp. 16-1

The story of abortion: Issues, Controversies and a case for the review of the Nigerian National Abortion Laws

Abortion continues to be a major public health issue that evokes social, political, legal, cultural and religious sentiments and debates in all societies. This is particularly so in countries with restrictive abortion laws. It is one of the leading causes of maternal mortality and morbidity. Despite variations in the legal status of abortions in favor of restrictiveness in developing countries compared with developed countries, overall rates are quite higher in the developing countries13. This review article therefore, examines the historical perspectives of induced abortion as well as the issues and controversies associated with induced abortion. Also, a review of the Nigeria national abortion law is made. We believe that this is capable of identifying useful interventions for designing programs that will lead to a reduction in the burden of unsafe abortion in developing countries

Factors associated with the knowledge, perception and practice of Pap smear screening for cervical cancer in Southern Nigeria

No Absterc