Poor availability of skilled birth attendants in Nigeria: a case study of Enugu state primary health care system

Background: The Government of Enugu State plans to offer free perinatal services at the primary health care (PHC) centers in order to improve perinatal outcomes in the state, but it was not clear whether there are skilled birth attendants (SBAs) at the PHC level to implement the program. Aims: To determine whether there are sufficient numbers of SBAs in the public PHC system in Enugu State of Nigeria. Subjects and Methods: This cross‑sectional survey involved enumeration of health workers who worked at each public PHC facility in Enugu State and included verification of the qualifications and trainings of each health worker. Data analysis was performed with the help of Stata statistical package version 13 and results were presented in tables and as simple proportions. Results: There were 55 nurses and no midwife or doctor in the 152 PHC clinics studied. This number represents 0.36 nurses per health facility or about 9% (i.e., 55/608) of a minimum of 608 SBAs required for 24‑h perinatal services at the 152 PHC clinics. There were 1233 junior community health extension worker/community health extension workers (JCHEW/CHEWs), averaging 8.1 JCHEW/CHEWs per PHC clinic. Conclusions: Enugu State has an acute shortage of SBAs. We recommend employment of qualified SBAs and in‑service training of the JCHEW/CHEW and nurses to upgrade their midwifery skills. Incorporation of competency‑based midwifery training into the pre‑service training curricula of nurses and JCHEW/CHEW would provide a more sustainable supply of SBAs in Enugu state.Keywords: Maternal neonatal and child health care, Nigeria, Primary health care, Skilled birth attendan

Presence of chaperones during pelvic examinations in southeast Nigeria: Women’s opinions, attitude, and preferences

Objectives: To assess the opinions, attitude, and preferences of Nigerian women to the presence of chaperones during pelvic examinations.Materials and Methods: A cross‑sectional survey of first time gynecology clinic attendees on their opinions, attitudes, and preferences with respect to the presence of chaperones during their pelvic examinations. The interview was conducted with the aid of semi‑structured, researcher‑administered questionnaires. Results: One hundred and nineteen (51.7%) of the respondents preferred female physicians for pelvic examination, 23 (10%) preferred male physicians and 88 (38.3%) had no gender preference. When the examining physician is a male, 124 (53.9%) respondents would like to have chaperones during pelvic examinations while 106 (46.1%) would not. Eighty‑three percent of respondents preferred nurse chaperones. Age, level of education, and parity did not have any significant relationship with the attitude of the respondents toward the presence of chaperones (P = 0.503, 0.525, and 0.605 respectively).Conclusions: We conclude that most southeastern Nigerian women would prefer their pelvic examinations to be done by a female physician or to be attended by a nurse chaperone if the examining physician is a male. We recommend a routine offer of chaperones during such examinations while respecting the patients’ right to refuse the offer.Keywords: Attitudes, chaperone, pelvic examination, preferences, southeast NigeriaNigerian Journal of Clinical Practice • Oct-Dec 2013 • Vol 16 • Issue

A 10-year appraisal of cesarean delivery and the associated fetal and maternal outcomes at a teaching hospital in southeast Nigeria

Robinson Chukwudi Onoh,1 Justus Ndulue Eze,2 Paul Olisaemeka Ezeonu,1 Lucky Osaheni Lawani,1 Chukwuemeka Anthony Iyoke,3 Peter Onubiwe Nkwo3 1Department of Obstetrics and Gynaecology, Federal Teaching Hospital Abakaliki, Abakaliki, 2Department of Obstetrics and Gynaecology, College of Health Sciences, Ebonyi State University, Abakaliki, 3Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Enugu, Nigeria Background: The global rise in cesarean delivery rate has been a major source of public health concern. Aim: To appraise the cesarean deliveries and the associated fetal and maternal outcomes. Materials and methods: The study was a case series with data collected retrospectively from the records of patients delivered by cesarean section at the Ebonyi State University Teaching Hospital, Abakaliki over a 10-year period, from January 2002 to December 2011. Ethical approval was obtained. Results: Of 14,198 deliveries, 2,323/14,198 (16.4%) were by cesarean deliveries. The overall increase of cesarean delivery was 11.1/10 (1.1%) per annum from 184/1,512 (12.2%) in 2002 to 230/986 (23.3%) in 2011. Of 2,097 case folders studied, 1,742/2,097 (83.1%) were delivered at term, and in 1,576/2,097 (75.2%), the cesarean deliveries were emergencies. The common indications for cesarean delivery were previous cesarean scars 417/2,097 (19.9%) and obstructed labor 331/2,097 (15.8%). There were 296 perinatal deaths, giving a perinatal mortality rate of (296/2,197) 134.7/1,000 births. Also, 129/2,097 (6.1%) maternal case fatalities occurred, giving a maternal mortality rate of 908.6/100,000 total births. Hemorrhage 57/129 (44.2%) and sepsis 41/129 (32.6%) were the major causes. Conclusion: The study recorded a significant increase in cesarean delivery rate. Previous cesarean scars and obstructed labors were the main indications. Perinatal and maternal case fatalities were huge. Hence, there is need for continued community education for its reduction. Keywords: cesarean delivery rate, unbooked, previous scar, cases fatality, hemorrhage&nbsp

The challenges of adherence to infant feeding choices in prevention of mother-to-child transmission of HIV infections in South East Nigeria

Lucky O Lawani,1 Azubuike K Onyebuchi,2 Chukwuemeka A Iyoke,3 Robinson C Onoh,2 Peter O Nkwo31School of Postgraduate Studies, Department of Community Medicine, University of Nigeria, Enugu Campus, Enugu State, Nigeria; 2Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria; 3Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Enugu, Enugu State, NigeriaBackground: Global and national efforts in the 21st century are directed toward the elimination of new pediatric HIV infections through evidence-based infant feeding interventions for the prevention of mother-to-child-transmission, with patient preference, motivation, and adherence identified as key factors for success.Objectives: This study assessed the challenges faced by HIV-infected parturients in adhering to the national infant feeding recommendations and their infant feeding preference for prevention of mother-to-child transmission in South East Nigeria.Methods: This is a cross-sectional, descriptive, questionnaire-based study of 556 parturients infected with HIV/AIDS.Results: The mean age of the participants was 28.0±5.3 years. The infant feeding choices were made jointly by both partners (61.1%) in the antepartum period. The HIV status disclosure rate was 89.2%. A large proportion (91.7%) practiced exclusive breastfeeding with highly active antiretroviral therapy, and 7.6% practiced mixed feeding because of nonadherence to their choice and national/international recommendations on infant feeding in the context of HIV/AIDS. This was mainly a result of pressure from family members (42.8%) and cultural practices (28.5%). Multivariate logistic regression analysis indicates that adherence was strongly associated with age, marital status, and employment status, but not with residence, educational status, or parity.Conclusion: Exclusive breastfeeding is predominately the infant feeding choice among HIV-infected parturients in South East Nigeria, but there is still a gap between infant feeding preference and adherence to standard practice as a result of sociocultural challenges associated with risk for mixed feeding and the risk for mother-to-child-transmission of HIV by nursing mothers.Keywords: PMTCT, HIV, infant feeding, challenges, HAART, adherenc

Determinants of decision-to-intervention time in the management and therapeutic outcome of emergency gynecological surgeries in south east Nigeria

Azubuike Kanario Onyebuchi,1 Lucky Osaheni Lawani,2 Peter O Nkwo,3 Chukwuemeka Anthony Iyoke,3 Robinson Chukwudi Onoh,1 Leonard O Ajah1 1Department of Obstetrics and Gynecology, Federal Teaching Hospital Abakaliki, Ebonyi State, Nigeria; 2School of Postgraduate Studies, Department of Community Medicine, University of Nigeria, 3Department of Obstetrics and Gynecology, University of Nigeria Teaching Hospital, Enugu, Enugu State, Nigeria Background: Prompt and timely response in the management of gynecological surgical cases can significantly affect the therapeutic surgical outcome of patients in emergency situations. The aim of this study was to evaluate the decision-to-intervention time (DIT), its determinants, and the significance in the therapeutic outcome of emergency gynecological surgeries managed at a federal teaching hospital in south east Nigeria over an 18-month period. Methods: This was a prospective descriptive study of 105 emergency gynecological cases managed at a federal teaching hospital over an 18-month period. Patients were recruited at the point of admission and followed up until discharge for outcome. Data were abstracted with a data entry pro forma and then analyzed with the Epi Info™ statistical software version 7.0. Results: The incidence of gynecological surgical emergencies was 5.1% of the total gynecological cases managed during the study period. The mean DIT was 4.25 (range 1.45–5.50) hours with delay in intervention, mainly due to delays in securing blood/blood products and other materials for resuscitation (46.7%) and a lack of finance (15.2%). Six maternal deaths were recorded, giving a case fatality ratio of 5.7%, while the commonest maternal complications associated with the delays were hemorrhage (61.9%) and the need for blood transfusion (57.1%), respectively. The risk ratio of losing ≥1,000 mL of blood, anemia, hemorrhagic shock, and wound infection in those with DIT ≥120 minutes was statistically greater and significant at 95% confidence interval. Conclusion: Inadequacies in health care services and policies due to poor infrastructure, organizational framework, and financing were the major determinants of the prolonged DIT and therapeutic outcomes. Keywords: determinants, decision-to-intervention time, emergency, therapeutic outcome, gynecological surgeries, clinical ris

Preference for anonymity in sperm donation for artificial insemination: an experience from low-resource settings in Nigeria

Euzebus Chinonye Ezugwu,1,2 George U Eleje,3,4 Chukwuemeka A Iyoke,1,2 Sunday G Mba,5 Henry C Nnaji,2 Chukwunonso I Enechukwu,4 Peter O Nkwo1,2 1Department of Obstetrics and Gynecology, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Ittuku Ozalla Campus, Enugu State, Nigeria; 2Department of Obstetrics and Gynecology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State, Nigeria; 3Department of Obstetrics and Gynecology, Faculty of Medicine, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria; 4Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria; 5Department of Obstetrics and Gynecology, Enugu State University Teaching Hospital, Enugu State, Nigeria Objective: Anonymous sperm donation is a common practice in Nigeria with its associated legal and ethical challenges. This study aimed to investigate infertile couples’ opinions about issues of sperm donor anonymity and to determine factors that might influence their preferences.Methods: A cross-sectional, multicentered, questionnaire-based study was conducted among infertile couples attending infertility clinics in three tertiary hospitals in the south-eastern region of Nigeria over a period of 6 months.Results: A total of 450 infertile couples were recruited consecutively from the three study centers. However, 450 females and 352 males (total=802) participated in the study. The level of awareness of artificial insemination using donor sperm for the management of male infertility among the respondents was 69.2%, while its acceptability rate was 62.7%. The majority of the respondents indicated their preference for secrecy and anonymity in sperm donation. Approximately 84% of the respondents indicated that the mode of conception should never be disclosed to the donor-conceived child, and ~92% of them indicated that the identity of the sperm donor should never be revealed to the donor-conceived child. Fear of adverse effect of such disclosure on the child and the possible of rejection of the father in order to seek for the donor were the major reasons for their preference for anonymity.Conclusion: Although it has been argued that every child has a right to know their genetic parents, the reasons proffered by the respondents for their preference for anonymity cannot be totally ignored. Establishing a regulatory body and enacting laws that will address both the ethical and legal issues associated with gamete donation in the developing world will go a long way in promoting openness and honest communication with donor-conceived children. Keywords: disclosure, anonymity, artificial insemination, donor sperm, infertile couple, Nigeri

Case Report: Placenta Percreta in a Booked Multiparous Woman with Minimal Risk Factors and Challenges of Management in a Low Resource Setting

No Abstract

A Ten-Year Review of Ovarian Cancer in Enugu, South East Nigeria

Objective: To review the pattern and management of ovarian cancer over a ten-year period at the University of Nigeria Teaching Hospital, Enugu. Methods: A retrospective review of cases of histologically diagnosed primary ovarian cancers from January 1, 2000 to December 31, 2009. Results: Out of 20,227 gynaecological admissions during the study period, 200 cases of primary gynaecological cancers were involved. Ovarian cancer constituted 25.0% of all gynaecological malignancies giving an incidence rate of 1 per 405 gynaecological admissions per year. The mean age of cases at presentation was 45.4 ± 17.1years. Epithelial ovarian cancer constituted 68.0% of ovarian cancer. Approximately 60.0% of women who had epithelial ovarian cancer were aged 50 years or below. Parous women constituted 72.4% of epithelial ovarian cancer out of which 38.0% were grandmultiparous women. All the cancers in pre-menarcheal girls were germ cell tumours. Most of the cases had surgery and adjuvant chemotherapy. However, most patients (68.0%) had only one or two courses of cisplatinum based combination chemotherapy only to abandon further treatment. Conclusion: This study supports an emerging pattern of early onset of, and substantial involvement of multiparous women in, epithelial ovarian cancer among patients treated at the study centre. The management challenge posed by the pattern of presentation of a majority of cases is compounded by a trend towards abandonment of chemotherapy by most patients. Key Words: Review, Ovarian cancer, Enugu. Afrimedic Journal 2011;2(1):8-1