Adekanle, DA

Adeyemi, AS

Afolabi, AF

English

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47INTRODUCTIONLadoke Akintola University of Technology(LAUTECH) Teaching Hospital (LTH), Osogbo,jointly owned by Oyo and Osun states, wasestablished in 1998 as the teaching hospital complexfor the college of health sciences, LAUTECH,Osogbo, and it had since been accredited for thetraining of both undergraduates and postgraduates.It is a 280-bedded hospital, which serves Osun stateand its neighboring states. The Obstetrics andGynaecology department provides services in theareas of general gynaecology, includingreproductive health and infertility, gynaecologicaloncology, urogynaecology and family planning. Thegeneral gynaecology clinics are run twice weekly,while emergency gynaecology clinic is run 24-hour.Additional clinics for family planning are held dailyat the family planning clinic.Being a young teaching hospital there is need for areview of pattern of gynaecological consultation toprovide the necessary data needed for planning,budgeting, and effective running of the hospitalgynaecological services.The objectives of this descriptive study, therefore,are to determine the pattern of gynaecologicalCorrespondence: Dr ASAdeyemiE- mail:ourgodreigns2004@yahoo.co.ukconsultations during the period between 1 January,2004 and 31 December, 2005, and the factors thatdetermine the pattern, as well as the outcome of suchconsultations.The case notes of the patients that attended thegynaecology clinic during the period 1 January, 2004and 31 December, 2005 were retrieved from themedical records department of the hospital. Relevantinformation were extracted from the case notes andrecorded in a data sheet for the individual patient. Thedata was entered into SPSS work sheet and analyzedusing SPSS version 11.Two hundred and fifty patients attended thegynaecology clinic during the study period, but208(83.2%) case notes were available for analysis.The age range of the patients was between 1 and 76years, with a mean age of 34.8±9.7 years; 111(53.4%)of the patients were Christians, while 96(46.2%) wereMoslems. 183(88.0%) of the patient attending thegynaecology clinic were married, while 17(8.2%),and 7(3.4%) were single and widowed, respectively.Twenty-eight (15.7%) of the patients had no formaleducation, 19(10.7%) had primary education,ststststMETHODSRESULTSNigerian Journal of Clinical PracticeMarch 2009 Vol.12(1) :47-50PATTERN OF GYNAECOLOGICAL CONSULTATIONS AT LADOKEAKINTOLA UNIVERSITY OF TECHNOLOGY TEACHING HOSPITALAS Adeyemi, DA Adekanle, AF AfolabiABSTRACAims:Material and Methods:Results:Conclusion:Key WordsDepartment of Obstetrics and Gynaecology, College of Health Sciences, Ladoke Akintola University ofTechnology, Osogbo, Nigeria.(Accepted 29 October 2007)TA descriptive study to determine the pattern of gynaecological consultations at Ladoke AkintolaUniversity of Technology Teaching Hospital, and to know the factors that determine the pattern as well as theoutcome of such consultations.The case notes of all the patients that attended the gynaecology clinic between 1January 2004 and 31 December 2005 were studied.Two hundred and fifty patients attended the gynaecology clinic during the study period, however,208(83.2%) case notes were available for analysis. Most of the patients that had gynaecological consultationsduring the study period were married (88.0%), and infertility (48.1%) was the commonest reason for theconsultations. Many of the patients (60.1%) did not receive definitive treatment for their consultation.Infertility being the commonest reason for gynaecological consultations, and tubal factor thecommonest cause of infertility, there is need to establish assisted reproductive technology in public healthinstitutions to render services at a highly subsidized rate in helping this population of patients who could notafford this treatment which is presently being offered by private health institutions.: Gynaecology, Consultations, Pattern, Outcome.ststNigerian Journal of Clinical Practice March 2009, Vol.12(1) Pattern of Gynaecological Consultations Adeyemi et al25(14.0%) had secondary education, and106(59.6%) had tertiary education. One hundred andone (48.8%) of the patients were self employed,74(35.7%) were government employed, 11(5.3%)were unemployed, and students constituted14(6.8%) of the patients (Table 1). Nulliparouspatients were 81(38.9%), patients with paritybetween 1 and 4 were 99(47.6%), and 27(13.0%)were para 5 and above. (Table 2)The gynaecology department received most,118(56.7%) of the referral from within the hospital,especially from the general outpatient department,12(5.8%) patients were referred from private healthinstitutions within Osogbo, 9(4.3%) each werereferred from government and private healthinstitutions outside Osogbo, while only 4(1.9%)patients were referred from government healthinstitutions within Osogbo. Many, 137(65.9%) ofthe patients attending the gynaecology clinic had oneor more investigations done, while 71(34.1%) hadno investigation done. Infertility, 100(48.1%) wasthe commonest diagnosis, this was followed bybenign gynaecological tumours 34(16.3%),menstrual disorders constituted 23(11.1%), whileabortions accounted for 13(6.3%), pelvic infectionswas the diagnosis in 11(5.3%) of the patients;malignant gynaecological tumours, utero-vaginalprolapse, vesico-vaginal fistula accounted for9(4.3%), 7(3.4%) and 3(1.4%), respectively;others(vulva itching, non-specific vaginaldischarge, urethral mass) constituted 8(3.8%). (Fig1)Many of the patients 125(60.1%) did not receivedefinitive treatment, while only 83(39.9%) receiveddefinitive treatment; of those who had treatment,45(54.2%) had surgical treatment, and 38(45.8%)had medical treatment.Univariate analysis showed that patients who weremarried and widowed were more unlikely to receivetreatment compared to those who were not married(OR=3.1, 1.83, 95% CI, 1.10-8.76; 0.33-10.10).Patients with the diagnosis of infertility andgynaecological tumours were unlikely to receivetreatment compared to patients with othergynaecological problems (OR=6.0, 1.19; 95%CI,2.99-12.05, 6.54-2.59). Those who hadinvestigations done were more likely to get treatedcompared to those who had no investigations done(OR=17.45, 95%CI=6.62-46.02). Patients who wereself employed, government employed, privateemployed and unemployed were unlikely to gettreated compared to those who were schooling (OR5.65, 2.64, 3.75; 95%CI, 1.64-19.40, 0.76-9.17 and1.14-38.83, respectively). Multivariate analysisrevealed that patient with infertility and those whohad no investigations done were unlikely to receivetreatment compared with patients with othergynaecological problems and those who hadinvestigations done, respectively (OR=8.14, 17.75,95% CI=3.24-20.46, 6.22-50.66). (Table 3).Table 1:Figure 1:Table 2:Nullipara 82 39.4Para 1 44 21.2Para 2 21 10.1Para 3 19 9.1Para 4 15 7.2Para 5 andAbove 27 13Socio-Demographic Status of PatientsSeeking Gynaecological Consultations.Parity of the Patients SeekingGynaecological ConsultationsParity Number Percentage4849Table 3:*P< 0.05**P< 0.01***P< 0.001The pattern of gynaecological consultation in thisstudy reflects the pattern of diseases among womenin the community because the bulk of the femalehealth problems (with the exception of a few medicaland surgical conditions) are tackled by thegynaecologist . Infertility was the commonest reasonfor gynaecological consultation during the studyperiod; this follows the trend in other tertiaryinstitutions where infertility had been the reason forconsulting a gynaecologist , and it had beenestimated that 40-50% of women attending thegynaecology clinic in Nigeria gave the complaint ofprimary and secondary infertility . This is notsurprising, because the traditional African societyplaces high premium on child bearing, andchildlessness is regarded as an affliction, and theaffected individual is viewed with disdain .Benign gynaecological tumours (mostly made up ofuterine fibroids) followed infertility as the reason forgynaecological consultation. Uterine fibroid is thecommonest tumour of the female genital tract , andit had been observed that fibroid occurs morecommonly among infertile women; hence it is notsurprising that uterine fibroid was next to infertilityin terms of frequency.Menstrual disorders, which often times is associatedwith infertility was also a common presentation;irregular menses had been shown to be a majorsource of concern to women, especially those in thereproductive age groupAbortions and pelvic infections accounted for asmall proportion of the reason for gynaecologicalconsultation; this was the finding in a similar study atanother tertiary institution in Nigeria, in whichabortions contributed a small proportion ofadmission to gynaecological ward . The smallcontribution of abortions may be due to the fact thatLogistic Regression on FactorsAssociated with Failure to Receive Treatment.DISCUSSION123, 4, 56, 7, 89, 10111there are many private specialist clinics where someabortion cases presented for treatment. Therestrictive abortion law in Nigeria might preventsome patient from presenting in public hospitals .The little contributions made by conditions such asmalignant lesions, utero-vaginal prolapse, andurinary incontinence as was evident in this study maybe due to improved obstetric care in the community(as in the case of vesico-vaginal fistula), lowsocio-economic status coupled with ignorance andthe fact that these conditions are often not fatal untilthe late stages.The mean age of the patient in this study is the periodof reproductive activity for women, and thisobservation is further buttressed by the fact thatcomplaints relating to reproductive organ and/or itsfunctions were the most commonly found amongpatients within this age group. The same explanationholds for the fact that more married women wereseeking gynaecological consultations than theunmarried women.Many of the gynaecological consultations did not endin definitive treatment; this is similar to a study doneat the University College Hospital, Ibadan in which79.1% of the patients attending the gynaecologicalclinic did not receive definitive treatment . This mayreflect the restless nature of the infertile women(which constituted largest proportion of theconsultations). Also one would have expected thatemployment of whatever form would be an importantfactor in receiving treatment, but this study showedthat students were more likely to receive definitivetreatment, compared to the patients withemployment; this might be because students wereunder parental care, who would ensure that theirchildren or wards get treated.The population size of 250 patients (over the 2 yearperiod) that had gynaecological consultations at theLAUTECH Teaching Hospital belies the tertiary andspecialist nature of the institution. This may be due tothe presence, in the same town, as the teachinghospital, of the state specialist hospital, where freehealth is being provided, and patients only come tothe teaching hospital as a last resort. However, withincreased awareness of the specialist nature of theinstitution, and quality of services, it is believed thatmore patients will be patronizing the teachinghospital.In conclusion, infertility still remain the commonestreason for gynaecological consultations, and tubalfactor, being the commonest cause of infertility in ourenvironment , there is need for the establishment ofassisted reproductive technology in public healthinstitutions at subsidized rate to help this populationof patients who could not afford this treatment whichis presently being offered by private healthinstitutions at a very high cost. However pending the1213,141536Nigerian Journal of Clinical Practice March 2009, Vol.12(1) Pattern of Gynaecological Consultations Adeyemi et al50time this will be feasible, there is need to layemphasis on prevention and prompt treatment ofsexually transmitted infections, safe deliverypractice, educating the health care givers on dangersof unnecessary vaginal instrumentation which hasbeen used in the treatment of menstrual disorders.Pattern andOutcome of Gynaecological admissions at aNigerian Tertiary Care Centre. TropicalJournal of Obstetrics and Gynaecology. 2004;21(1): 52-55.Aetiological Classification and Socio-cultural Characteristics of Infertility in 25Couples. Int. J. Fertility. 1984; 29: 104-108.Laparoscopy versus Hysterosalpingographyin Infertility. Nig. Med. Journ. 1977; 7: 452-455.The male factor inInfertility: Nigerian experience. Int. J. Fert.1978; 23:238-239.Evaluation of the infertilecouple. Nig. Med. Pract. 1981; 1: 20-23.The prevalenceof infertility in a rural Nigerian community.Afri. J. Med & Med. Sci. 1991; 20(1): 23-27.Socio-biologicalfactors influencing infertility in a ruralN i g e r i a n c o m m u n i t y . I n t . J .Gynecol.Obstet.1990; 33(1): 41-47.The management of infertilityin Africa. Proceeds of the 1997 AnnualSymposium of DOKITA editorial board,University College Hospital, Ibadan.REFERENCES1. Lamina MA, Odusoga OI.2. Giwa-Osagie OF, Ogunyemi D, Emuvyan EE, et al.3. Ladipo OA, Adeleye JA, Ojo OA.4. Chukwudebelu WO.5. Otolorin EO.6. Adetoro OO, Ebomoyi EW.7. Ebomoyi EW,Adetoro OO.8. Okonofua FE.9. Fox H, Buckey CH (Ed).10. Ogunniyi SO, Fasuba O.11. Silberstein T.12. Oye-Adeniran BA, Adewole IF, Umoh AV,Iwere N, Gbadegesin A.13. Gharoro EP,Abedi HO.14. Katton SA.15. Adeyemi AS.Benign neoplasm ofthe genital tract. In: Pathology forGynaecologists. 2 edition. London Chapmanand Hall. 1991: 95-101.Uterine fibromyomatain Ilesha, Nigeria. Nig. Med. Pract.1990; 19:93-95.Complications of Menstruation;Abnormal Uterine Bleeding. In: CurrentObstetric and Gynecologic Diagnosis andTreatment. DeCherneyAH, Nathan L(editors).McGraw-Hill Companies, Inc. 2003; 9: 37-70Induced Abortion inNigeria: Findings from Focus GroupDiscussion. Afr J Reprod Health.2005; 9(1):133-141.Vesico-vaginal Fistulain Benin City, Nigeria. Int. J. Gynecol.Obstet.1997; 64(3): 313-314.Maternal Urological InjuriesAssociated with Vaginal Deliveries: Change ofPattern. Int. Urology & Nephrology. 1997;29(2): 155-161.One- Year Review of the Patternof Gynaecological Consultations at theUniversity College Hospital, Ibadan. WestAfrican College of Surgeons Part 11Gynaecological Long Commentary. 2003ndNigerian Journal of Clinical Practice March 2009, Vol.12(1) Pattern of Gynaecological Consultations Adeyemi et al

Pattern of gynaecological consultations at Ladoke Akintola University of Technology Teaching Hospital

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Pattern of gynaecological consultations at Ladoke Akintola University of Technology Teaching Hospital

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