Psychiatric morbidity among pregnant and non pregnant women in Ibadan, Nigeria.

A comparative cross-sectional study was conducted among 991 pregnant and 674 non-pregnant women of reproductive age attending healthcare facilities in Ibadan, Nigeria using the General Health Questionnaire-12 (GHQ), and WHO self-reporting questionnaire (SRQ). Logistic regression analysis was conducted to identify predictors of psychiatric morbidity at p < 0.05. A significantly higher proportion of pregnant women experienced psychological distress on the GHQ (51.8%) and psychiatric morbidity on SRQ (33.3%) compared with 28.6% and 18.2% of non-pregnant women, respectively. Predictors of psychiatric morbidity among pregnant women were the type of facility, poor satisfaction and communication with partners, the experience of violence in the home, previous abortions, and previous history of depression. Psychiatric morbidity among non-pregnant women was predicted by younger age, previous history of depression, poor satisfaction and communication with partners. There is a need for early identification of psychiatric morbidity among women of reproductive age, to ensure early interventions and prevent long-term disability.Impact statementWhat is already known on this subject? Psychiatric morbidity has immense effects on a woman's quality of life, social functioning, obstetric outcome, and economic productivity.What do the results of this study add? Psychiatric morbidity among women of reproductive age is high. Pregnant women when compared to non-pregnant women had significantly higher rates of psychiatric morbidity. This high prevalence of psychiatric morbidity in both groups was predicted by poor satisfaction and communication with partners, and a previous history of depression.What are the implications of these findings for clinical practice and/or further research? Simple screening for women of reproductive age attending healthcare facilities may help with the early identification of psychiatric morbidity leading to prompt interventions, and preventing long-term disability.

Outcomes of surgical treatments for acquired gynatresia in a tertiary institution in Ibadan, Nigeria.

A 16-year review of causes, clinical presentation and management outcomes of Acquired gynatresia (AG) at University College Hospital, Ibadan, Nigeria. Information was obtained using a proforma and data analysed using SPSS version 20.0. The mean age of the 31 women with AG was 35.6 ± 6.2 years. The majority (90.3%) were married and had a tertiary level of education. The mean parity was 0.74 ± 1.1 and 54.8% were nulliparous while 29.0% were primiparous women. The commonest cause of AG was the insertion of caustic substances into the vagina and this was mainly for the treatment of uterine fibroid (68.2%) and infertility (54.5%). Over three-quarters presented with dyspareunia while 54.8% had infertility. A majority (87.1%) had one-stage surgery with dissection/excision of fibrotic tissue being the commonest (45.2%) and sigmoid vaginoplasty the least performed. Postoperative complications were seen in 29.0% of cases. Acquired gynatresia remains a condition of public health interest despite an increase in female education and relatively improved health care in Nigeria.Impact statementWhat is already known on this subject? Acquired gynatresia (AG) could be of chemical and non-chemical origin and result from certain cultural beliefs and practices.What do the results of this study add? Irrespective of the women's level of education, there is inadequate awareness of the implications of inserting caustic materials into the vagina. However, there is a high success rate of treatment of AG.What the implications are of these findings for clinical practice and/or further research? There is a need to increase health education and awareness of the populace on the causes of AG and its associated complications.

A clinical audit of the patterns of presentations and complications of abdominal myomectomy at the University College Hospital, Ibadan, Nigeria.

Abdominal myomectomy is a common modality of treatment for large and symptomatic uterine fibroids in women who wish to retain their fertility. Black women have higher rates and larger sizes of uterine fibroids. We aimed to determine the presentation patterns, peri-operative complications, and determinants of complications in patients who underwent abdominal myomectomy. This was a retrospective review of women who had abdominal myomectomy between July 2016 and June 2019. There were intra-operative complications and post-operative complications in 25% and 29.3% of patients respectively. There were higher odds for developing intra-operative complications among those who had general anaesthesia [OR = 3.514, 95%CI (1.951-6.331)], more than 10 fibroid nodules enucleated [OR = 4.917, 95%CI (2.600-9.298)], pre-operative Packed cell volume (PCV) < 30% [OR = 4.831, 95%CI (2.370-9.880)], presence of adhesions [OR = 2.680, 95%CI (1.510-4.730)], fibroids larger than 10 centimetres [OR = 1.98, 95%CI (1.13-3.49)], previous pelvic surgery [OR = 2.68, 95%CI (1.52-4.63)]. Post-operative complications were higher in those who had general anaesthesia or pre-existing medical conditions.IMPACT STATEMENTWhat is already known on this subject? Abdominal myomectomy is a major surgical procedure globally with a significant morbidity rate. Sufficient evidence relating to the determinants of peri-operative complications are lacking.What do the results of this study add? Our results highlight the factors associated with increased odds of developing complications following abdominal myomectomy.What are the implications of these findings for clinical practice and/or further research? Our study complements existing data on the peri-operative complications following abdominal myomectomy. It also reflects the possibility of mortality albeit a rarerity. A retrospective multivariate analysis like this, while classifying morbidities into intra-operative and post-operative complications, is required to start an audit cycle. Knowing these determinants will help improve patient optimisation for surgery, identify high risk women and enhance more directed counselling. The results from this pilot study will also be used to design a prospective study to be undertaken by the authors.

Determinants of correct knowledge of coronavirus infection and COVID-19 disease pandemic among pregnant women in South-West Nigeria.

BACKGROUND: As the spread of COVID-19 continues, the disease and its sequels affect antenatal, intrapartum and post-partum care, thus making pregnant women and their babies vulnerable. This study assessed the knowledge of COVID-19 disease and determinants of correct knowledge among pregnant women at the University College Hospital, Ibadan, Nigeria. METHODS: A cross-sectional study was conducted among pregnant women. Data collected were analysed with STATA 16.0 software. Descriptive, bivariate and multinomial regression analyses were performed. The primary outcomes were awareness of COVID-19 (yes/no), correct knowledge, and determinants. RESULTS: Three hundred and eighty participants were interviewed. The mean age was 32 years (±4.78). A little over a third (37%) were aged 30-34 years, married (97.1%), Yoruba (86.6%), had tertiary education (89.0), in skilled occupation (54.6%) and not well-exposed to media (56.7%). The knowledge of COVID-19 was good (15%), fair (79%), and poor (6%). About 19.6%, 66.7% and 13.7% of participants who had poor, fair and good knowledge, respectively, believed that COVID-19 exists (P = 0.007). The factors associated with good knowledge include occupation, income, level of education and exposure to media (P value <0.05). On multinomial logistic regression, occupation was significantly associated with good knowledge, while being less exposed to media was significantly associated with having poor knowledge. CONCLUSION: Pregnant women had fair knowledge of COVID-19 disease; occupation, level of education, exposure to media and income are associated with having correct knowledge. Misinformation and misconception about COVID-19 disease may affect maternal health utilization and pregnancy outcomes. Antenatal care presents an opportunity to provide health education and increase the knowledge of COVID-19 among pregnant women.

Knowledge and attitude of women on genital cosmetic surgery at University College Hospital, Ibadan, Nigeria.

BACKGROUND: Female genital cosmetic surgery (FGCS) is performed in other to restore or enhance the female genitalia. MATERIALS AND METHODS: This is a cross-sectional study assessing the knowledge and attitude of 310 women attending gynaecology clinic towards FGCS at University College Hospital, Ibadan, Nigeria. Data were analysed using SPSS 20. RESULTS: Mean age of respondents was 33.28 ± 7.68 years. Majority were married (76.1%) in monogamous family (87.7%) and almost half (49.7%) were multipara. About 56.1% had vaginal delivery of which 84.5% had perineal tear or/and episiotomy. Overall, 27.7% had heard about FGCS and 84.2% had positive attitude towards the procedure. Respondents' age, marital status and occupation were associated with their knowledge and attitude to FGCS. Women with skilled occupation were more likely to have the knowledge and positive attitude to FGCS. CONCLUSION: The knowledge of FGCS was low; however, majority had positive attitude towards it because of its associated sexual and psychological satisfaction.

Utilizing the Robson 10-Group Classification System as an Audit Tool in Assessing the Soaring Caesarean Section Rates in Ibadan, Nigeria.

Background: The caesarean section (CS) is the most common operation performed globally with increased incidence worldwide. Aim and Objectives: Using the Robson 10-Group Classification System (RTGCS), we aimed to identify women who were the main contributors to the high CS rate (CSR) over a 3-year period at a foremost tertiary health facility. Settings: This study was conducted at the Department of Obstetrics and Gynecology, University College Hospital, Ibadan, Nigeria. Materials and Methods: This study is a retrospective study of all women who delivered by CS at the University College Hospital, Ibadan, Nigeria from January 2017 to December 2019. Data were obtained using a structured proforma and women were categorized according to the RTGCS. Data were analysed using SPSS version 21. Descriptive statistics (frequency, percentage, mean) carried out were presented in tables. Results: The CSR was 46.9%. Women in Group 5 (parous women >37 weeks with previous CS and a single foetus in cephalic presentation), Group 1 (nulliparous women >37 weeks with a single foetus in cephalic presentation and spontaneous labour), and Group 10 (women <37 weeks with a single foetus in cephalic presentation) were major contributors to the CSR, with 30.9%, 17.7%, and 13.7%, respectively. Stillbirth rates were highest in Groups 10 (30.3%), 3 (24.4%), and 8 (16.8%). Apgar score <7 at the 5th minute was highest in Groups 5 (29.7%), 10 (17%), and 1 (16.6%). Conclusion: In a bid to reduce caesarean deliveries, efforts should focus on increasing the proportion of vaginal deliveries in these identified groups, especially in women with a history of one CS.

COVID-19 and its implications for obstetrics and gynecology practice in Africa.

Having to cope with corona virus disease 2019 (COVID-19) is likely to create imbalances in health care provision in the obstetrics and gynecology practices in Africa where most countries still battle with high rate of maternal morbidities and mortalities as well as poor or inadequate quality gynecological care. COVID-19 has spread to the continents of the world including all African nations since it was first reported in Wuhan, China in December 2019. Its impact and implications on the obstetrics and gynecology practice in Africa are yet to be fully explored. Routine essential services are being disrupted; therefore, giving rise to the need to redeploy the already limited health personnel across health services in Africa. This is an attempt to discuss the potential implications for obstetrics and gynecologic practice in Africa.

Health Workers' Awareness and Knowledge of Current Recommendation of Intermittent Preventive Treatment in Pregnancy in South-Western Nigeria.

BACKGROUND: Malaria in pregnancy is of public health significance because of its associated maternal and fetal complications. This study aimed to assess health workers' awareness and knowledge of the current World Health Organisation (WHO) recommendation of intermittent preventive treatment in pregnancy with Sulfadoxine-Pyrimethamine (IPTp-SP). METHODS: A cross-sectional study among 148 health workers who offer obstetrics care in selected health facilities in Ibadan, Nigeria using a self-administered questionnaire to evaluate their awareness and knowledge of the current WHO IPTp-SP. Information on their socio-demographic and professional characteristics, awareness, knowledge and practice of the current IPTp recommendation were obtained. Data analysis involved descriptive and bivariate analyses using SPSS version 20.0 with level of significance set at p<0.05. RESULTS: The majority, 85(57.4%), of the health workers had been providing obstetrics care for less than 5 years with most of them, 114(77.0%), practicing at tertiary health facility. More than half, 92(62.2%), of them were aware of the current WHO IPTp-SP recommendation while about two-fifth (39.1%) had its correct knowledge. Of the health workers who were knowledgeable of the current IPTp-SP recommendation almost three-quarter, 29(72.2%) of them prescribed it. The health workers' professional cadre (p<0.001) and duration of providing obstetrics care (p=0.012) were significantly associated with their awareness and correct knowledge of the current IPTp-SP recommendation. CONCLUSION: Most of the health workers are aware but not knowledgeable of the correct administration of the current IPTp-SP recommendation. Likewise, many of them do not prescribe it. This calls for regular training and update of health workers and institutional protocol so as to effectively reduce the prevalence of malaria in pregnancy and its complications.

Nigeria, a high burden state of obstetric fistula: a contextual analysis of key drivers.

Obstetric fistula (OF) remain a source of public health concern and one of the most devastating maternal morbidities afflicting about two million women, mostly in developing countries. It is still prevalent in Nigeria due to the existence of socio-cultural beliefs/practices, socio-economic state and poor health facilities. The country's estimated annual 40,000 pregnancy-related deaths account for about 14% of the global maternal mortality, placing it among the top 10 most dangerous countries in the world for a woman to give birth. However, maternal morbidities including OF account for 20 to 30 times the number of maternal mortalities. This review substantiates why OF is yet to be eliminated in Nigeria as one of the countries with the largest burden of obstetric fistula. There is need for coordinated response to prevent and eliminate this morbidity via political commitment, implementation of evidence-based policy and execution of prevention programs.

Awareness and practice of dual contraception among female tertiary institution students in Ibadan, Nigeria.

PURPOSE: To determine the knowledge, awareness, and factors associated with the practice of dual contraception among female undergraduates in Ibadan, Nigeria. MATERIALS AND METHODS: This is a cross-sectional study using a semi-structured self-administered questionnaire to assess the knowledge and practice of dual contraception among female undergraduates in the University of Ibadan and The Polytechnic, Ibadan. A total of 1,200 undergraduate students were interviewed, and data obtained were analyzed with SPSS Version 18.0. RESULTS: The mean age of the respondents was 22.57±3.43 years. Among the respondents, 900 (84.6%) were unmarried, 871 (77.9%) have been sexually exposed, 793 (70.9%) had heard of dual contraception, and 659 (58.9%) had knowledge of dual contraception. Majority (66.8%) of the participants used effective contraception, of whom 423 (56.3%) used condom, while others used other short- or long-term reversible contraception. More than two-thirds (79.2%) of the sexually exposed respondents were aware of dual contraception, but only 465 (41.6%) had practiced it. The main sources of information about dual contraception were from friends and radio (45.3% and 36.1%, respectively). Those who had multiple sexual partners and early coitarche were more likely to use dual contraception (P<0.05). History of previous sexually transmitted infection (odds ratio =3.06, 95% confidence interval [CI] =2.03-4.62) and unwanted pregnancy (odds ratio =3.53, 95% CI =2.62-4.74) were strongly associated with the use of dual contraception. CONCLUSION: Uptake of dual contraception among the students was low. Efforts need to be concentrated on determining and addressing the challenges that are responsible for the lower uptake of dual contraception among female undergraduates who are at higher risk of unwanted pregnancy and sexually transmitted infections. Promotion of consistent use of dual contraception is pertinent in maximizing the benefits of dual contraception in our environment.