Quality of reproductive health care in Nigeria: A critical appraisal

Introduction: Reproductive Health is a concept that caters for the complete health of humans from conception to the grave. Currently, the concept has undergone an expansion of its scope beyond the elimination of mortality and physical morbidity:Methods: Issues such as respect for women's autonomy; rights, preferences, dignity and right to informed choice, as well as shared decision-making process were brought under the spotlight. The quality of reproductive health services available in a nation reflect on the overall health of the citizens and assesses the relationship between the three key components of health care, including the Client, Healthcare providers, and the relationship between the two. Indeed, the technical aspect of medical practice (diagnosis and treatment) is as important as the human, physical and the contextual setting in which the health care service is rendered. Developing countries like Nigeria must start to look beyond addressing morbidity and mortality in quantitative forms and consider the mental and psychological wellbeing of their citizens as well.Outcome: The Structures, Processes and Outcomes of reproductive health care in Nigeria were critically appraised, and suggestions for improvement were made as appropriate in this article. Keywords: Quality of care; Reproductive health; Maternal mortality; Maternal morbidity; Standards of care

Outcomes and challenges in the management of gestational trophoblastic disease in a tertiary institution in Nigeria

Context: Gestational Trophoblastic Diseases are a spectrum of interrelated diseases disorders that arise from abnormal pregnancy and are characterized by excessive elevation of Human Chorionic Gonadotrophins. They include both benign and malignant forms; hydatidiform mole, Invasive mole, Placental Site Trophoblastic (PSTT) tumour and Choriocarcinoma.Objective: The objective of this study was to present the outcomes and challenges encountered in the management of GTDs in a tertiary centre in South-western part of Nigeria.Study Design, Setting and Subjects: This was a retrospective study of the cases of gestational trophoblastic disease managed at Obafemi Awolowo University Teaching hospitals complex, Ile Ife between 2009 and 2013. Data were retrieved from the case records and telephone calls were put across the patients to enquire about the state of health of the patients. Data was analysed using SPSS version 20.Main Outcome Measures: The main outcome measures were the incidence of GTDs, outcomes and challenges encountered in the management of patients with gestational trophoblastic disease.Results: A total of 27 women were managed for GTDs; 22 had hydatidiform moles and 5 were managed for choriocarcinoma. The mean age of the patients was 31.9 years SD 6.94, mean parity 2 SD 1.53; mean duration of amenorrhoea was 15.7 weeks SD 4.92. The most common presenting symptom was vaginal bleeding in 81.5% of cases. Non-adherence to prescribed treatment was high as over half of the patients with molar pregnancy was lost to follow up after molar evacuation. Mortality was also high among patients with GTDs as 60% of the patients with choriocarcinoma died during treatment

Social meaning and consequences of infertility in Ogbomoso, Nigeria

Background: This study examined the meaning of infertility from layman’s perspective, and experiences of women suffering from infertility among reproductive age women seeking care at the gynaecology unit of the Bowen University Teaching Hospital, Ogbomoso, Nigeria.Materials and Methods: It was a cross-sectional study. Quantitative and qualitative data collection methods were employed. Quantitative data collection was by the aid of a structured interviewer-administered questionnaire among 200 women seeking care for infertility at the hospital. Qualitative data collection was by Focus Group Discussions (FGDs) and Key Informant Interviews (KIIs).Result: Approximately 40% and 60% of the respondents seeking care for infertility were suffering from primary and secondary infertility respectively. Perceived meaning and etiologies of childlessness were multidimensional, but 33% of the respondents not sure of the causal factor. Seventy-nine percent were under pressure to become pregnant. The high premium placed on fertility within marriage has placed a larger proportion of them under pressure from their husbands (25%), their mother-in-laws (40%), and the community (14%).Conclusion: This study concluded that women regard infertility to be caused by multiplicity of factors. Most of these etiologies were unscientific and unverifiable. Fruitful expectations also put enormous burden on those women suffering from infertility including adverse psychosexual effects. The unceasing pressure due to infertility in this group of patients calls for urgent intervention as most of these women become susceptible to high risk sexual behavior, depression and other severe consequences.Keywords: Social meaning, consequences, infertilit

Retrograde ejaculation related infertility in Ile-Ife, Nigeria

Background: Globally, the incidence of male infertility is on the increase1,2. However, the contribution of retrograde ejaculation to this increasing incidence of male infertility is not known locally.Objectives:1. To determine the incidence of retrograde ejaculation by using the WHO criterion among male partners of patients who were being managed for infertility at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria between 1st of February and 31st of August 2006 . 2. To determine the Retrograde-ejaculation ratio (RER) of each subject by a proposed formula as an extension of the WHO criterion.3. To highlight the risk factors and the management options available for the treatment of retrograde ejaculation.Subjects and methods: During the study period, 71 male partners of consecutive female patients who reported at the Infertility clinic were recruited. However, the specimens of 70 male partners were analyzedbecause one of them inadvertently spilled his post-ejaculatory urine specimen and consequently was excluded from the study. Prior to the collection of ejaculatory fluid and post-ejaculatory urine specimens foranalysis, they were instructed to abstain from sexual intercourse for at least 3 days and to collect the first post-ejaculatory urine specimen for analysis. The WHO criterion 1 states that a cloudy urine specimen with the presence of a total number of spermatozoa in urine equal to or exceeding the number of spermatozoa in semen, strongly supports the diagnosis of retrograde ejaculation. The sperm counts in seminal fluid and urine for each subject were determined. Thereafter, the sperm concentration in urine (SCU) and sperm concentration in seminal fluid(SCSF) were determinedrespectively thus: sperm count in urine/volume of urine; sperm count in seminal fluid/ volume of seminal fluid. The Retrograde ejaculation ratio (RER) was calculated thus: sperm count in urine / sperm count inseminal fluid. A questionnaire containing the bio-data and risk factors associated with retrograde ejaculation was completed for each subject.Results: Of the 70 cases included in the analysis, 32(45.7%) had primary infertility while 38(54.3%) had secondary infertility. The age range was 28-65(mean for primary and secondary infertility were 36 and 42.1respectively) years. The duration of infertility ranged from 1-16 years (mean4+ 2.92). Based on the WHO criterion previously stated, only 1/70(1.42%) of the cases was positive with a retrograde ejaculatory ratio(RER) of infinity as he had azoospermia. This was in a 47 year old man with secondary infertility who had no identifiable risk factor prior to the study. There were 8/70(11.42%) of the cases studied with azoospermia but only 1/8 (12.5%) of those azoospermic had retrograde ejaculation.Conclusion: To make a diagnosis of male factor infertility, semen analysis remains the cornerstone of all the laboratory assays. However, to make acategorical diagnosis of retrograde ejaculation, focused laboratory testing is imperative. The incidence of retrograde ejaculation appeared low (1.42%) in our environment but this is in consonance with studies elsewhere. It is strongly advisable that cases of azoospermia and severe oligozoospermia be screened for retrograde ejaculation as there are manymodalities of therapy to aid the affected males fulfil their wishes of becoming fathers. Lastly, when the retrograde ejaculation ratio (RER) is > 1 with the presence of a cloudy urine, the diagnosis is highly probable.Key words: Retrograde ejaculation, azoospermia, male infertility

Social Meaning and Consequences of Infertility in Ogbomoso, Nigeria

Background: This study examined the meaning of infertility from layman's perspective, and experiences of women suffering from infertility among reproductive age women seeking care at the gynaecology unit of the Bowen University Teaching Hospital, Ogbomoso, Nigeria.Materials and Methods: It was a cross-sectional study. Quantitative and qualitative data collection methods were employed. Quantitative data collection was by the aid of a structured interviewer-administered questionnaire among 200 women seeking care for infertility at the hospital. Qualitative data collection was by Focus Group Discussions (FGDs) and Key Informant Interviews (KIIs).Result: Approximately 40% and 60% of the respondents seeking care for infertility were suffering from primary and secondary infertility respectively. Perceived meaning and   etiologies of childlessness were multidimensional, but 33% of the respondents not sure of the causal factor. Seventy-nine percent   were under pressure to become pregnant. The high premium placed on fertility within marriage has placed   a larger proportion of them under pressure from their husbands (25%), their mother-in-laws (40%), and the community (14%).Conclusion: This study concluded that women regard infertility to be caused by multiplicity of factors. Most of these etiologies were unscientific and unverifiable. Fruitful expectations also put enormous burden on those women suffering from infertility including adverse psychosexual effects. The unceasing pressure due to infertility   in this group of patients calls for urgent intervention as most of these women become susceptible to high risk sexual behavior, depression and other severe consequences

Maternal deaths in Sagamu in the new millennium: a facility-based retrospective analysis

BACKGROUND: Health institutions need to contribute their quota towards the achievement of the Millennium Development Goal (MDG) with respect to maternal health. In order to do so, current data on maternal mortality is essential for careproviders and policy makers to appreciate the burden of the problem and understand how best to distribute resources. This study presents the magnitude and distribution of causes of maternal deaths at the beginning of the 21st century in a Nigerian referral hospital and derives recommendations to reduce its frequency. METHODS: A retrospective descriptive analysis of all cases of maternal deaths at Olabisi Onabanjo University Teaching Hospital, Sagamu, Southwest Nigeria between 1 January 2000 to 30 June 2005. RESULTS: There were 75 maternal deaths, 2509 live births and 2728 deliveries during the study period. Sixty-three (84.0%) of the deaths were direct maternal deaths while 12 (16.0%) were indirect maternal deaths. Major causes of deaths were hypertensive disorders in pregnancy (28.0%), haemorrhage (21.3%) and sepsis (20.0%). Overall, eclampsia was the leading cause of deaths singly accounting for 24.0% of all maternal deaths. Abortion and HIV-related mortality accounted for 1.3% and 4.0% of maternal deaths, respectively. The maternal mortality ratio of 2989.2 per 100,000 live births was significantly higher than that reported for 1988–1997 in the same institution. Up to 67/794 (8.4%) patients referred from other facilities died compared to 8/1934 (0.4%) booked patients (OR: 22.1; 95% CI: 10.2–50.1). Maternal death was more likely to follow operative deliveries than non-operative deliveries (27/545 vs 22/2161; OR: 5.07; 95% CI: 2.77–9.31). CONCLUSION: At the middle of the first decade of the new millennium, a large number of pregnant women receiving care in this centre continue to die from preventable causes of maternal death. Adoption of evidence-based protocol for the management of eclampsia and improvement in the quality of obstetric care for unbooked emergencies would go a long way to significantly reduce the frequency of maternal deaths in this institution

Health workforce and governance: the crisis in Nigeria

Background In Nigeria, several challenges have been reported within the health sector, especially in training, funding, employment, and deployment of the health workforce. We aimed to review recent health workforce crises in the Nigerian health sector to identify key underlying causes and provide recommendations toward preventing and/or managing potential future crises in Nigeria. Methods We conducted a scoping literature search of PubMed to identify studies on health workforce and health governance in Nigeria. A critical analysis, with extended commentary, on recent health workforce crises (2010–2016) and the health system in Nigeria was conducted. Results The Nigerian health system is relatively weak, and there is yet a coordinated response across the country. A number of health workforce crises have been reported in recent times due to several months’ salaries owed, poor welfare, lack of appropriate health facilities and emerging factions among health workers. Poor administration and response across different levels of government have played contributory roles to further internal crises among health workers, with different factions engaged in protracted supremacy challenge. These crises have consequently prevented optimal healthcare delivery to the Nigerian population. Conclusions An encompassing stakeholders’ forum in the Nigerian health sector remain essential. The national health system needs a solid administrative policy foundation that allows coordination of priorities and partnerships in the health workforce and among various stakeholders. It is hoped that this paper may prompt relevant reforms in health workforce and governance in Nigeria toward better health service delivery in the country

Male involvement in birth preparedness and complication readiness for emergency obstetric referrals in rural Uganda

<p>Abstract</p> <p>Background</p> <p>Every pregnant woman faces risk of life-threatening obstetric complications. A birth-preparedness package promotes active preparation and assists in decision-making for healthcare seeking in case of such complications. The aim was to assess factors associated with birth preparedness and complication-readiness as well as the level of male participation in the birth plan among emergency obstetric referrals in rural Uganda.</p> <p>Methods</p> <p>This was a cross-sectional study conducted at Kabale regional hospital maternity ward among 140 women admitted as emergency obstetric referrals in antenatal, labor or the postpartum period. Data was collected on socio-demographics and birth preparedness and what roles spouses were involved in during developing the birth plan. Any woman who attended antenatal care at least 4 times, received health education on pregnancy and childbirth danger signs, saved money for emergencies, made a plan of where to deliver from and made preparations for a birth companion, was deemed as having made a birth plan. Multivariate logistic regression analysis was conducted to analyze factors that were independently associated with having a birth plan.</p> <p>Results</p> <p>The mean age was 26.8 ± 6.6 years, while mean age of the spouse was 32.8 ± 8.3 years. Over 100 (73.8%) women and 75 (55.2%) of their spouses had no formal education or only primary level of education respectively. On multivariable analysis, Primigravidae compared to multigravidae, OR 1.8 95%CI (1.0-3.0), education level of spouse of secondary or higher versus primary level or none, OR 3.8 95%CI (1.2-11.0), formal occupation versus informal occupation of spouse, OR 1.6 95%CI (1.1-2.5), presence of pregnancy complications OR 1.4 95%CI (1.1-2.0) and the anticipated mode of delivery of caesarean section versus vaginal delivery, OR 1.6 95%CI (1.0-2.4) were associated with having a birth plan.</p> <p>Conclusion</p> <p>Individual women, families and communities need to be empowered to contribute positively to making pregnancy safer by making a birth plan.</p

Medical teachers and teaching qualification.

Medical Education' is the study, research and application of educational processes employed in the training of physicians for continuous quality and standard in the production of competent physicians for improvement of healthcare delivery. It has evolved into a discipline with its own specializations such as Curriculum Development, Educational Foundations and Theory, Assessment Techniques, and Educational Methodology among others. Worldwide, high quality training and education of physicians is increasingly being recognised as critical to global health and emphasis is being made that the training of these physicians be done by professionally competent medical teachers. Medical school teachers should therefore be trained in educational foundations and theory as well as in modern educational instructional methodologies. Expertise does not automatically translate to effective teaching. In Nigeria, nearly all medical school teachers have no professional or formal training in teaching though they are experts in their fields (i.e. content experts). Evidences from research show improved learning of medical trainees when instructed by teachers trained in pedagogy and other educational processes. Teacher evaluation though alien to the Nigerian medical schools system, is an integral aspect of pedagogy and should be undertaken to ensure that teaching quality and facilitation of learning are enhanced. However such evaluation makes sense only when the teachers have been trained. There is a real necessity that medical school teachers be trained through short term courses,workshops and seminars so that the quality of teaching and imparting knowledge can be improved and sustained. Invariably, this is a call also for the establishment of departments of Medical Education in our Medical Schools across the country