Reproductive and sexual health implications of illegal migration among young adults in Benin Metropolis, Edo State, Nigeria.

Reproductive and sexual health implications of illegal migration among young adults encompass a range of complex and interconnected challenges that demand attention and comprehensive solutions. This study is aimed at determining the reproductive and sexual health implications of illegal migration among young adults in Benin metropolis. Analytical cross-sectional study design was adopted. A purposive sampling technique was used to select a sample size of three hundred and forty-four participants. A one-time-survey method was adopted for the study as the questionnaire was administered on a face-to-face basis. Simple frequencies, percentage, charts, and graph were used to analyze the data, with the statistical package for the social sciences (SPSS) version 22. The results showed that majority of the respondents were sexually abused which resulted in unwanted pregnancies, when travelling through an illegal route. Majority of irregular migrants were doing so for socio-economic reasons in search of greener pastures. It was concluded that most of the respondents were faced by unethical challenges while travelling through the route like sexual harassment and robbery.. Most returnees are likely to contact STD/STIs including HIV/AIDs, as well as engage in abortion especially among the young adults, which may have some adverse effects on their reproductive and sexual health later in the future. It is recommended that there is a need to enlighten the young adults who want to migrate illegally on the implication of the illegal migration on their reproductive and sexual health. Campaigns against illegal migration/trafficking should be conducted regularly, stressing the negative effects such as the risks to which victims are exposed along the routes.

Les implications de la migration illégale chez les jeunes adultes sur la santé reproductive et sexuelle englobent une série de défis complexes et interconnectés qui nécessitent une attention et des solutions globales. Cette étude vise à déterminer les implications sur la santé reproductive et sexuelle de la migration illégale chez les jeunes adultes de la métropole béninoise. Un plan d'étude analytique transversale a été adopté. Une technique d'échantillonnage raisonné a été utilisée pour sélectionner un échantillon de trois cent quarante-quatre participants. Une méthode d'enquête ponctuelle a été adoptée pour l'étude puisque le questionnaire était administré en face à face. Des fréquences simples, des pourcentages, des tableaux et des graphiques ont été utilisés pour analyser les données, avec le progiciel statistique pour les sciences sociales (SPSS) version 22. Les résultats ont montré que la majorité des personnes interrogées ont été victimes d'abus sexuels, ce qui a entraîné des grossesses non désirées, lors de voyages à travers le pays. un itinéraire illégal. La majorité des migrants irréguliers le faisaient pour des raisons socio-économiques, à la recherche de pâturages plus verts. Il a été conclu que la plupart des personnes interrogées ont été confrontées à des défis contraires à l'éthique lors de leur voyage, comme le harcèlement sexuel et le vol. La plupart des rapatriés sont susceptibles de contracter des MST/IST, y compris le VIH/SIDA, et de se livrer à l'avortement, en particulier parmi les jeunes adultes. , ce qui pourrait avoir des effets néfastes sur leur santé reproductive et sexuelle plus tard dans le futur. Il est recommandé d'éclairer les jeunes adultes qui souhaitent migrer illégalement sur les implications de la migration illégale sur leur santé reproductive et sexuelle. Des campagnes contre l'immigration clandestine/le trafic devraient être menées régulièrement, en soulignant les effets négatifs tels que les risques auxquels les victimes sont exposées le long des routes.

Maternal near-miss and death among women with rupture of the gravid uterus: a secondary analysis of the Nigeria Near-miss and Maternal Death Survey.

OBJECTIVE: To investigate the burden of maternal near-miss and death due to rupture of the gravid uterus, the indicators of quality of care, and avoidable factors associated with care deficiencies for ruptured uterus in Nigerian tertiary hospitals. DESIGN: Secondary analysis of a nationwide cross-sectional study. SETTING: Forty-two tertiary hospitals. POPULATION: Women admitted for pregnancy, childbirth or puerperal complications. METHODS: Cases of severe maternal outcome [SMO: maternal near-miss (MNM) or maternal death (MD)] following uterine rupture were prospectively identified over 1 year. MAIN OUTCOME MEASURES: Incidence of SMO, indicators of quality of care, and avoidable factors associated with deficiencies in care. RESULTS: There were 91 724 live births and 3285 women with SMO during the study period. SMO due to uterine rupture occurred in 392 women: 305 MNM and 87 MD. Uterine rupture accounted for 11.9, 13.3, and 8.7% of all SMO, MNM, and MD, respectively. SMO, MNM, and intra-hospital maternal mortality ratios due to uterine rupture were 4.3/1000 live births, 3.3/1000 live births, and 94.8/100 000 live births, respectively. Mortality index (% of MD/SMO) was 22.2%, and MNM:MD ratio was 3.5. Avoidable factors contributing to deaths were related to patient-orientated problems, especially late hospital presentation and lack of insurance to cover life-saving interventions. Medical personnel problems contributed to care deficiencies in one-third of women who died. CONCLUSION: Uterine rupture significantly contributes to SMO in Nigerian tertiary hospitals. Strategies to improve maternal survival should address avoidable institutional factors and include community-based interventions to encourage skilled attendance at birth and early referral of complications. TWEETABLE ABSTRACT: Uterine rupture remains an important cause of maternal death in Nigerian tertiary hospitals.

When getting there is not enough: a nationwide cross-sectional study of 998 maternal deaths and 1451 near-misses in public tertiary hospitals in a low-income country.

OBJECTIVE: To investigate the burden and causes of life-threatening maternal complications and the quality of emergency obstetric care in Nigerian public tertiary hospitals. DESIGN: Nationwide cross-sectional study. SETTING: Forty-two tertiary hospitals. POPULATION: Women admitted for pregnancy, childbirth and puerperal complications. METHODS: All cases of severe maternal outcome (SMO: maternal near-miss or maternal death) were prospectively identified using the WHO criteria over a 1-year period. MAIN OUTCOME MEASURES: Incidence and causes of SMO, health service events, case fatality rate, and mortality index (% of maternal death/SMO). RESULTS: Participating hospitals recorded 91 724 live births and 5910 stillbirths. A total of 2449 women had an SMO, including 1451 near-misses and 998 maternal deaths (2.7, 1.6 and 1.1% of live births, respectively). The majority (91.8%) of SMO cases were admitted in critical condition. Leading causes of SMO were pre-eclampsia/eclampsia (23.4%) and postpartum haemorrhage (14.4%). The overall mortality index for life-threatening conditions was 40.8%. For all SMOs, the median time between diagnosis and critical intervention was 60 minutes (IQR: 21-215 minutes) but in 21.9% of cases, it was over 4 hours. Late presentation (35.3%), lack of health insurance (17.5%) and non-availability of blood/blood products (12.7%) were the most frequent problems associated with deficiencies in care. CONCLUSIONS: Improving the chances of maternal survival would not only require timely application of life-saving interventions but also their safe, efficient and equitable use. Maternal mortality reduction strategies in Nigeria should address the deficiencies identified in tertiary hospital care and prioritise the prevention of severe complications at lower levels of care. TWEETABLE ABSTRACT: Of 998 maternal deaths and 1451 near-misses reported in a network of 42 Nigerian tertiary hospitals in 1 year.

Asymptomatic malaria parasitaemia using rapid diagnostic test in unbooked pregnant women in rural Ondo-south district, Nigeria.

BACKGROUND: Malaria is a major contributor of maternal and peri-natal morbidity and mortality. The disease may be asymptomatic despite sequestration of parasitized red blood cells in the placental micro-circulation with antecedent complications. In such condition, it may also be difficult to identify the malaria parasite by the peripheral blood film microscopy, thus the need for use of simple but reliable tool for malaria parasite diagnosis. OBJECTIVE AND METHOD: To determine the prevalence of asymptomatic malaria parasitaemia using the Rapid Diagnostic Test in pregnant unbooked women seen in a primary health centre during a malaria control campaign programme in rural Ondo-south, District Nigeria. RESULTS: Prevalence of asymptomatic malaria parasitaemia was 25.9%. Only 3 (3.5%) of the 85 women had the long lasting insecticide-treated nets. There was no significant association between malaria parasitaemia, and the age group, parity and gestation age. CONCLUSION: Given the high prevalence of asymptomatic malaria in pregnancy, routine screening for malaria at booking and scaling-up of other malaria control strategies such as the use of long lasting insecticidal-treated nets and intermittent preventive therapy for pregnant women are recommended.

Iatrogenic urological injuries complicating obstetric and gynaecological procedures.

INTRODUCTION: Urinary tract injuries are known complications of pelvic surgeries. Although a few instances have been noted, they remain a source of great concern to surgeons due to their associated morbidity and occasional mortality. We report our experience with the management of iatrogenic urological injuries that complicated obstetric and gynaecological surgeries over a five-year period. METHODS: We reviewed all cases of urological injuries managed in our unit that were deemed to be of obstetric and gynaecological origins within the study period. RESULTS: A total of 16 patients were identified as having iatrogenic urological injuries following obstetric and gynaecological surgeries. Only four patients presented early. Five patients had injuries to the bladder, while 12 had ureteric injuries; one of the 16 patients had both types of injuries. Seven cases of ureteric injuries affected only the left ureter, while three were bilateral and two affected the right ureter. One patient with a vesicovaginal fistula (VVF) was successfully managed by urethral catheter drainage alone. Three patients had transabdominal repair of the VVF, while ten had ureteroureterostomy and one had diversion procedure. Simple nephrectomy was performed for one patient with a non-functioning kidney. CONCLUSION: Iatrogenic urological injuries are still common in our environment. In order to reduce the risk of injury, adequate preoperative preparation is recommended and meticulous surgical technique based on proper understanding of the anatomy of the urogenital system should be practised by the surgeon.

HIV-AIDS related maternal mortality in Benin City, Nigeria.

OBJECTIVE: To determine the causes and characteristics of maternal deaths in HIV-infected women. DESIGN: A retrospective study of maternal deaths in a cohort of HIV-infected women. SETTING: A facility-based maternal death review using case records and mortality summaries. METHODS: Thirty seven maternal deaths which occurred in HIV-infected women were reviewed in a university teaching hospital in southern Nigeria over a 4-year period. Causes and circumstances surrounding each maternal death were identified. RESULT: One in every four maternal deaths occur in women with HIV infection. Majority (64.9%) of the women presented in advanced stage (WHO stage III/IV) of HIV syndrome while 86.5% had missed opportunities for antiretroviral programme. Pregnancy-related sepsis was the commonest cause of maternal death. Other common causes were death from tuberculosis and pneumonia. CONCLUSION: HIV-related maternal death is emerging as a leading cause of pregnancy related death in Nigeria. There is need to scale-up preconception care and ensure comprehensive and sustainable prevention of mother -to-child transmission service for all pregnant women throughout Nigeria to reduce the burden of HIV/AIDS infection and minimize avoidable deaths from opportunistic infections.

Spousal disclosure of HIV serostatus among women attending antenatal care in urban Nigeria.

About 80% of HIV-positive pregnant women in our unit have a seronegative spouse. The prevalence, pattern and determinants of spousal disclosure of HIV serostatus was evaluated among 166 HIV-positive pregnant women receiving antiretroviral treatment. Although 146 women (88%) disclosed their HIV serostatus, 20 women (12%) did not disclose their status to their spouse. Non-disclosure was significantly associated with nulliparous (p=0.024) and unmarried women (p=0.026). Fear, regarding spread of the information (57.8%), stigmatisation (53%) and deterioration in the relationship with the spouse (47%) were the three commonest reasons for non-disclosure. Disclosure of HIV-positive status remains a sensitive issue among infected pregnant women. Strategies to reduce the stigma associated with HIV infection, appropriate management of the information following disclosure of seropositive status by HIV-infected persons are necessary to encourage disclosure to sexual partners and ultimately prevent new HIV infections.

Plasma vitamin C levels and risk of preterm prelabour rupture of membranes.

PURPOSE: Preterm prelabour rupture of membranes (PPROM) is a leading cause of preterm births. Its attendant contribution to maternal and perinatal morbidity and mortality makes it imperative to identify factors that may help prevent this condition. This study examined the association between plasma vitamin C concentration and the risk of (PPROM) amongst pregnant women in a tertiary hospital setting. METHODS: This was a prospective cross sectional study conducted at the Obstetric and Gynaecology Department of University of Benin Teaching Hospital (UBTH), Benin City. The study was in two phases, first a pilot study to determine baseline plasma vitamin C concentration amongst pregnant women in UBTH was conducted. In the main study 80 pregnant women were recruited into two groups of those with PPROM (40 cases) and those without PPROM (40 controls) matched for gestational age. Plasma vitamin C concentration was determined for all study participants and their sociodemographic characters were used to generate a database for analysis. RESULTS: In the pilot study, plasma vitamin C concentration decreased with increasing gestational age of pregnancy. In the main study plasma vitamin C concentration was significantly lower in women with PPROM than controls without PPROM, 0.53 ± 0.05 vs. 0.58 ± 0.05 mg/dl; P = 0.0001. Both groups (case and control) were comparably matched in age, parity and social class. There was a significant association between low vitamin C levels and the occurrence of PPROM (95% CI 1.53-11.88; P = 0.008). CONCLUSION: Plasma vitamin C was found to be lower in women with PPROM. Low plasma vitamin C concentration may thus be an associated risk factor for PPROM. Hence improved dietary or drug supplements may be a useful adjunctive strategy to reducing the incidence of PPROM and its attendant adverse sequelae. While this intervention is advocated, further multicentre investigation of the effects of vitamin C on risk of preterm PROM is suggested.

Maternal obesity in early pregnancy and subsequent pregnancy outcome in a Nigerian population.

Despite a rising prevalence worldwide, there is limited data on pregnancy outcome among African women with prepregnancy or early pregnancy obesity. This was a case-control study to determine the prevalence of maternal obesity in early pregnancy and compare the subsequent pregnancy outcome between 201 women with obesity and 201 non-obese controls in a University Teaching Hospital in Nigeria. The prevalence of obesity in early pregnancy was 9.63%. Obesity was significantly associated with advanced maternal age and parity > or =1. It was also a risk factor for pregnancy induced hypertension, admissions during pregnancy, caesarean delivery and associated with 5th minute apgar score < or =3 (0.044). Obesity in early pregnancy is a risk factor for adverse pregnancy outcome among pregnant Nigerian women. This information should be utilised by physicians to improve the outcome of pregnancy and promote safe motherhood.

Influence of maternal height on mode of delivery in Nigerian women.

AIMS AND OBJECTIVES: To determine the influence of maternal height on the mode of delivery even when matched for maternal characteristics. The study is a prospective cohort study comparing the mode of delivery in 57 short stature women (d"150 cm) with age and parity-matched, taller control women (n = 57). MATERIALS AND METHODS: A total of 114 parturients were studied, 57 of whom had a height of 150 cm or lower and constituted the study group, while the other 57 taller women were matched with respect to parity (i.e. belonging to same parity group of either nulliparity, para 1-3, para 4+) and maternal age group (i.e. <20, 20-34, 35+ years) to the shorter women and constituted the control group. Patients were also matched by gestational age (28-37 weeks, 38-42 weeks, 42+ weeks) and birth weight (<2500g, 2500-3999g, 4000+) groupings. RESULTS: Caesarean section rate in the short women was higher (42.1%) than in taller women (21.1%), P= 0.016, as was the incidence of cephalopelvic disproportion (35.5% versus 10.3% respectively, P = 0.010). Nevertheless, neonatal outcome remains good; the 5-min Apgar score <7 was 21.1% versus 15.8% respectively, P =0.469, while the stillbirth rate was 10.5% versus 7.0), P = 0.508. CONCLUSION: Short stature is independently associated with an increased risk of intrapartum caesarean section in Nigerian women and advocate early recourse to caesarean section to avoid undue delay.

Induction of labour: determinants and implications of failure to keep an initial appointment in a developing country.

The objective of this study was to determine why parturients in a low resource setting fail to keep an appointment for induction of labour and evaluate the subsequent pregnancy outcome. The method used was a prospective matched case control study. Results showed that women with only primary school education were significantly more common in the study group (8% vs 1%; p < 0.05). The main reason for failing to keep the appointment was because they preferred spontaneous onset of labour (56.6%) and the 'spousal factor' (23.9%). Patients who were counselled by the consultant obstetrician were less likely to decline compared with those counselled by the resident doctors. Although the pregnancy outcome was comparable, failed induction of labour leading to caesarean section was significantly commoner among the study group (p < 0.05). It was concluded that social and cultural factors affecting the utilisation of health services should be considered by obstetric care providers in developing countries, to promote safe motherhood.

Demand and utilisation of labour analgesia service by Nigerian women.

This study sought to determine the clinical correlates of the demand and utilisation of labour analgesia resources by Nigerian women in labour. All consenting women were interviewed on arrival at the Unit and while in labour. Biodata, options for relief of labour pain, request for analgesia, method of analgesia, VAS score and cervical score at time of request for analgesia were obtained. A total of 288 women in labour were studied. Of these, 108 (37.5%) patients were aware that the pain of labour can be relieved but only 26.0% had prenatal information on labour analgesia. However, 85.1% of the patients would want their pain of labour relieved. A total of 112 (38.9%) did receive analgesia during labour. Cervical dilatation of <4 cm at presentation to the Unit and nulliparity were likely factors for pain treatment during labour (p = 0.001, chi2 test). There is poor utilisation of labour analgesia services. Improved antenatal information on labour analgesia may boost the utilisation of these resources by Nigerian women in labour.

Two vaginal deliveries after a classical caesarean section--case reports.

It is standard practice to offer a parturient who has had a classical Caesarean section an elective repeat Caesarean section due to the fear of uterine rupture. The strong aversion of our women to operative delivery does not allow an appreciable number to avail themselves of hospital delivery even after Caesarean section. We report the case of a booked patient who had a classical Caesarean section but defaulted in two subsequent pregnancies to have vaginal deliveries in a private hospital. We therefore suggest a more liberal attitude to allowing attempt at vaginal delivery as an informed decision in well-equipped facilities capable of easy and prompt resort to appropriate intervention.

Myomectomy during cesarean section.

OBJECTIVES: To assess the intra- and post-operative complications of cesarean myomectomy. METHODS: The study design was descriptive, and the setting was the Department of Obstetrics and Gynaecology, University of Benin Teaching Hospital and two private consultant units, all in Benin City. The subjects were 25 pregnant women undergoing elective or emergency cesarean section at these units. The outcome measures were blood loss and need for blood transfusion, intra- and post-operative complications and duration of hospital stay. RESULTS: Eighty-four fibroids of various sizes (2-10 cm) were removed from the 25 women. The fibroids were on the anterior uterine wall with most (94.8%) being sub-serous or intramural, and only few (five) sub-mucous. The mean blood loss was 876+/-312 ml, range 400-1700 ml. Five patients (20%) had two units of whole blood transfusion. There was no case of severe hemorrhage necessitating hysterectomy. Eighteen patients (72%) had post-operative morbidities mainly of anemia [15 (60%); hematocrit 26+/-2.9%). The average duration of post-operative hospital stay was 7.4+/-2.2 days (range 3-12 days). Three (12%) patients have subsequently become pregnant, two (66.7%) of whom had normal vaginal deliveries, while the third had a repeat elective cesarean section. CONCLUSIONS: With adequate experience and the use of high dose oxytocin infusion (intra- and post-operatively), myomectomy at cesarean section is not as hazardous as many now believe.

Anaesthesia related complications following caesarean delivery necessitating intensive care unit admissions in a tertiary centre.

To determine the anaesthesia-related complications after caesarean section in a tertiary hospital, the hospital records of parturients admitted to the Intensive Care Unit (ICU) after caesarean section were studied. In a ten-year period, 2,686 women were delivered by caesarean section at the University of Benin Teaching Hospital, Benin City. Two thousand one hundred and two (78.3%) had emergency caesarean section while 584 (21.7%) had elective caesarean section. Of these, 2597 (96.7%) had general anaesthesia (GA) and 89 (3.3%) regional anaesthesia (RA). Within this period, 30 paturients (1.1%) were admitted to the ICU; one was after elective caesarean and 29 (96.7%) were after emergency caesarean section. Fifteen patients were admitted for anaesthesia-related complications, of which all were after caesarean section done under GA. The incidence of a major anaesthetic complication resulting in ICU admission was 15 in 2597 GA while it was zero in 89 RA (p < 0.01). Total maternal deaths in the ICU admissions were 11(36.7%); anaesthesia being directly the cause of death in 3 (27.3%) while non-anaesthetic factors accounted for 8 (72.7%) deaths. Emergency caesarean section and GA, were risk factors for anaesthesia-related morbidities after caesarean section. Preventable deaths due to poor laboratory support services and inadequate anaesthetic materials accounted for the anaesthesia-related mortalities.

Experience with ambulatory anaesthesia in gynaecological patients.

Ambulatory surgical care is becoming a common feature in Nigeria. Reports on the role of anaesthesia on outcome of surgery in ambulatory setting are rather scanty. In a 24-month period all patients who had gynaecological operations on ambulatory setting were identified and their hospital records reviewed. Sociodemographic characteristics, intraoperative variables, postoperative outcome and postoperative pain management were studied. A total of 28 patients had anaesthesia for various gynaecological procedures. All the patients were in the age range of 20-41 years and American Society of Anaesthesiologists physical status 1. Majority of the patients (71.4%) arrived for day care admission. General anaesthesia with relaxant technique of anaesthesia was the most commonly used technique of anaesthesia (75.0%). Late completion of surgery accounted for 70% (n = 7) of late discharges. Postdural puncture headache (PDPH) was the only adverse outcome seen in our study. Ambulatory anaesthesia is safe, efficient and promising for gynaecological day care procedures.