Determinants of Choice of Facility-Based Delivery among Mothers in Kwara State, Nigeria.

BACKGROUND: Nigeria has the highest number of maternal deaths in the world, which is a major public health problem. One of the major contributory factors is high prevalence of unskilled birth attendance from low facility delivery. However, the reasons for and against facility delivery are complex and not fully understood. OBJECTIVE: The objective of this study was to identify the facilitators and barriers to facility based deliveries (FBD) among mothers in Kwara state, Nigeria. METHODS: The study was carried out among 495 mothers that delivered in the five years prior to the study in three selected communities from the three senatorial districts of Kwara state using mixed methods. The study design consisted of a cross-sectional study with mixed data collection involving qualitative and quantitative methods. Multistage sampling technique was employed. Primary outcome measures were place of delivery, reasons for and against FBD. RESULTS: Of the 495 respondents that had their last delivery during the study period, 410 respondents delivered in the hospital (83%). Common reasons for hospital delivery were ease and convenience (87.1%), safe delivery (73.6%) and faith in healthcare providers (22.4%). The common barriers to FBD included high cost of hospital delivery (85.9%), sudden birth (58.8%) and distance (18.8%). Other important barriers were availability of cheaper alternatives (traditional birth attendants and community health extension workers practising at home), unavailability of community health insurance and lack of family support. Parity, level of education of respondents and husband had significant influence on choice of delivery (p<0.05). CONCLUSION: These findings provided a good insight into the reasons for and against facility delivery among Kwara women, which can assist policy makers and program interventions that can improve facility deliveries and ultimately improve skilled birth attendance, reduce maternal and newborn morbidity and mortality.

CONTEXTE: Le Nigeria compte le plus grand nombre de décès maternels au monde, ce qui constitue un problème majeur de santé publique. L'un des principaux facteurs contributifs est la forte prévalence de l'assistance à l'accouchement non qualifiée due à un accouchement dans des établissements de faible qualité. Cependant, les raisons pour et contre la prestation en établissement sont complexes et ne sont pas entièrement comprises. OBJECTIF: L'objectif de cette étude était d'identifier les facilitateurs et les obstacles aux accouchements en établissement (FBD) chez les mères de l'État de Kwara, au Nigeria. METHODES: L'étude a été menée auprès de 495 mères qui ont accouché au cours des cinq dernières années précédant l'étude dans trois communautés sélectionnées des trois districts sénatoriaux de l'État de Kwara en utilisant des méthodes mixtes. La conception de l'étude consistait en un entretien avec des informateurs clés et une étude transversale avec une collecte de données mixte impliquant des méthodes qualitatives et quantitatives. La technique d'échantillonnage à plusieurs degrés a été employée. Les principaux critères de jugement étaient le lieu d'accouchement, les raisons pour et contre le FBD. RESULTATS: Parmi les 495 répondantes qui ont eu leur dernier accouchement au cours de la période d'étude, 410 répondantes ont accouché à l'hôpital (83 %). Les raisons courantes de l'accouchement à l'hôpital étaient la facilité et la commodité (87,1 %), la sécurité de l'accouchement (73,6 %) et la confiance dans les prestataires de soins de santé (22,4 %). Les obstacles courants à la FBD comprenaient le coût élevé de l'accouchement à l'hôpital (85,9 %), l'accouchement soudain (58,8 %) et la distance (18,8 %). D'autres obstacles importants étaient la disponibilité d'alternatives moins chères (accoucheuses traditionnelles et agents de vulgarisation de la santé communautaire exerçant à domicile), l'absence d'assurance maladie communautaire et le manque de soutien familial. La parité, le niveau d'éducation des répondants et le mari ont une influence significative sur le choix de l'accouchement (p<0,05). CONCLUSION: Ces résultats ont fourni un bon aperçu des raisons pour et contre l'accouchement en établissement chez les femmes Kwara, ce qui peut aider les décideurs politiques et les interventions de programme qui peuvent améliorer les accouchements en établissement et, en fin de compte, améliorer l'assistance qualifiée à l'accouchement, réduire la morbidité et la mortalité maternelles et néonatales. Mots clés: Prestation en établissement; Facilitateurs; Barrières; État de Kwara; Nigeria.

Bridelia ferruginea promotes reactive oxygen species detoxification in N-nitrosodiethylamine-treated rats.

This study was aimed at investigating the in vitro and in vivo reactive oxygen species (ROS) scavenging and detoxification potentials of aqueous extract of Bridelia ferruginea (B. ferruginea). Reactive oxygen species scavenging potentials of the aqueous leaf extract of B. ferruginea (0.2-1.0 mg/ml) was investigated using 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical, superoxide ion, hydrogen peroxide, hydroxyl radical, and ferric ion reducing system. The detoxification of ROS was evaluated in N-nitrosodiethylamine-induced redox imbalance in the liver of rats. B. ferruginea extract at 1.0 mg/ml scavenged the DPPH, superoxide ion, hydrogen peroxide, and hydroxyl radical at 87%, 83%, 92%, and 86%, respectively, it also reduced ferric ion significantly. ROS detoxifying enzymes (superoxide dismutase (SOD), catalase, glutathione peroxidase, glutathione reductase, and glucose 6-phosphate dehydrogenase) activities were significantly (p < .05) induced by B. ferruginea. These inductions significantly (p < .05) attenuated the N-nitrosodiethylamine-mediated decrease in ROS detoxifying enzymes and compared favorably with Vitamin C. N-nitrosodiethylamine-mediated elevation in the concentrations of malondialdehyde, conjugated dienes, lipid hydroperoxides, protein carbonyl, and percentage DNA fragmentation were significantly (p < .05) lowered by B. ferruginea extract. Overall, the results of this study show that B. ferruginea leaf extract possess ROS scavenging and detoxification potentials.

Prevalence and risk factors of cervical cancer among women in an urban community of Kwara State, north central Nigeria.

BACKGROUND: Cervical cancer is the second most common malignancy in women worldwide with a high incidence in under-developed countries and Nigeria is one of these countries. This study aimed at screening for cervical cancer using Papanicolaou smear and to identify risk factors for cervical cancer among women in Olufadi community, Kwara State, North-central Nigeria. METHODS: This was a cross-sectional study involving the screening of women aged 25-64 years for cervical cancer using Papanicolaou smear. Respondents were selected through systematic random sampling of households. Interviewer- administered questionnaire and clinical report form were also used to collect data. In addition, Pap smear samples were taken. Data was analyzed using SPSS version 15. RESULTS: Only 10 (5.0%) respondents had positive cytology result, while the rest were normal. Of the 10 positive cytology results, 1 (10.0%) was high grade squamous intraepithelial lesion (HGSIL) while the remaining 9 (90.0%) were low grade squamous intraepithelial lesion (LGSIL) which corresponds to 0.5% and 4.5% of the total respondents respectively. Risk factors for cervical cancer identified included coitarche, tobacco smoking, number of sexual partners and family history of cervical cancer. CONCLUSION: The findings from this study attest to the increasing burden of cervical cancer. The high number of positive results obtained from the study coupled with the presence of risk factors was an indication of how useful regular screening will be in the early detection of cervical cancer.

Vesicovaginal fistula: a review of nigerian experience.

BACKGROUND: Vesicovaginal fistula is a preventable calamity, which has been an age-long menace in developing countries. OBJECTIVE: To review the causes, complications, and outcome of Vesicovaginal fistula in Nigeria. METHODS: Studies on Vesicovaginal fistula were searched on the internet. Information was obtained on PubMed(medline), WHO website, Bioline International, African Journal of Line, Google scholar, Yahoo, Medscape and e Medicine. RESULTS: Many Nigerian women are living with Vesicovaginal fistula. The annual obstetric fistula incidence is estimated at 2.11 per 1000 births. It is more prevalent in northern Nigeria that southern Nigeria. Obstetric fistula accounts for 84.1%-100% of the Vesicovaginal fistula and prolonged obstructed labour is consistently the most common cause (65.9%-96.5%) in all the series. Other common causes include caesarean section, advanced cervical cancer, uterine rupture, and Gishiri cut. The identified predisposing factors were early marriage and pregnancy, which were rampant in northern Nigeria, while unskilled birth attendance and late presentation to the health facilities was common nationwide. Among the significant contributory factors to high rate of unskilled birth attendance and were poverty, illiteracy, ignorance, restriction of women's movement, non-permission from husband and transportation. All but one Nigerian studies revealed that primiparous women were the most vulnerable group. Pregnancy outcome was dismal in most cases related to delivery with still birth rate of 87%-91.7%. Stigmatization, divorce and social exclusion were common complications. Overall fistula repair success rate was between 75% and 92% in a few centres that offer such services. CONCLUSION: Vesicovaginal fistula is prevalent in Nigeria and obstetric factors are mostly implicated. It is a public health issue of concern.

Clinical experience with injectable progestogen- only contraceptives at University of Ilorin teaching hospital: a five year review.

OBJECTIVES: This is a retrospective study of 1,042 new acceptors of injectable progestogen-only contraceptives at the family planning clinic of the University of Ilorin Teaching Hospital over a five year period from 1st January 2001 to 31st December 2004. The total number of new clients seen during this period was 4,752. 41.1% of these new clients chose condoms as a contraceptive method, 32.2% accepted IUCD, 21.9% accepted injectable progestogen-only contraceptive 08% accepted implants, 3.9% combined oral contraceptive pills and 0.1% bilateral tubal ligation. Of the acceptors of injectable progestogen, 59.5% used depo medroxyprogesterone acetate while 40.5% used norethisterone enanthate. 59.5% of the acceptors belonged to the 30 - 39 years age bracket and 36.2% were grandmultiparous women Injectable progestogen-only contraceptives are among the safest and most effective contraceptive methods available. The two commonly available types are Depot Medroxyprogesterone acetate and Norethisterone enanthate. This study looked at the clinical experience with this form of contraceptive at University of Ilorin Teaching Hospital (UITH). METHOD: The case notes of new clients that accepted injectable progestogen-only contraceptive at the family planning clinic of the UITH between June 2001 and December 2004 were analysed. RESULTS: Injectable progestogen-only contraceptive was the third most commonly accepted method of contraception at UITH during the study period. 59.5% of clients belonged to the 30-39 year age group, 63.5% of them were para 1-4 and 36.2% were grandmultiparous women. 59.8% of the clients were educated up to the secondary level or above. There was no pregnancy reported during the study period. 29.9% of clients experienced various forms of side effects, the commonest of which was menstrual irregularities. CONCLUSION: Injectable progestogen-only contraceptive is widely accepted by women in this centre. Its use cuts across women of all age groups, parities, religion and level of education.

Rectovaginal fistula following sexual intercourse: a case report.

Female genital fistula is an important feature of the developing countries gynecology. Most of the rectovaginal fistulae encountered in the tropics are due to obstetrics causes and genital malignancies. In developed countries, radiation injury and Crohn's disease are also common etiological factors. The index case is reported to highlight the rare situation, where a 24-year old married nullipara sustained low rectovaginal fistula following normal coitus. She was later divorced by her husband.