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.

Temporal relationship between Women's empowerment and utilization of antenatal care services: lessons from four National Surveys in sub-Saharan Africa.

BACKGROUND: In November 2016, the WHO four-visit focused antenatal care (FANC) model adopted in sub-Saharan Africa (SSA) was reverted to eight contacts or more as a response to reducing the global perinatal and maternal deaths and in achieving the sustainable development goal (SDG) 3. Women's empowerment, which connote the social standing, position and the ability of women to make life decisions and choices has been associated with the maternal health seeking behaviour and outcomes. This study examined the association between women's empowerment and the WHO ANC model of eight visits or more, and early first antenatal visit among pregnant women. In addition, we explored the association between women's empowerment and the WHO FANC model to allow for comparison for countries that have not adopted the recent WHO ANC model. METHODS: The most recent (2018) Demographic and Health Survey (DHS) datasets conducted in SSA were used for analyses. We used all available indicators of women's empowerment captured in the DHS. The 30 variables on women's empowerment were classified into eight components using exploratory factor analysis. We fitted separate ordinal logistic regression to assess association between antenatal care utilization (number of visits and time of first antenatal visit) and women empowerment factors while adjusting for other covariates. Analysis was performed with STATA 15.0 and adjusted for complex survey design, p-value< 0.05 were used for interpretation of results. RESULTS: The proportion of women who attended eight or more ANC visits were 1.4, 2.7 and 3.5% in Zambia, Guinea and Mali, respectively. Zambia had the lowest prevalence of 8 or more ANC visits also had the highest prevalence of at least 4 visits (63.8%) and early first ANC visit (38.2%), while Nigeria with the highest prevalence of women with at least 8 visits (17.7%) had the lowest prevalence (17.6%) of women that attended ANC visit in their first trimester. Women's empowerment was associated with more ANC visits and attending first ANC visit in the first trimester. However, these association with the women empowerment components varied significantly across the four SSA countries. CONCLUSION: This study highlights the significant impact of women's empowerment as a key factor for improving maternal health outcomes in SSA. It is imperative that government and development partners invest more on empowerment of women as part of strategic intervention to improve maternal health outcomes.

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.

Effect of COVID-19 on sexual function and activities among reproductive-age women in Ibadan, South-West Nigeria.

Background: Since the outbreak of COVID-19 disease, the environment, families, individuals, and their ways of living have been affected. Social distancing was one of the strategies for the prevention of SARS-CoV-2 infection. It led to limited social interactions for fear of contracting the infection, which ultimately affected relationships, among which is sexual health. Aim: To determine the risk of female sexual dysfunction and the effect of the COVID-19 pandemic on sexual function and activities among women of reproductive age in Ibadan, South-West Nigeria. Methods: This cross-sectional study of 218 reproductive-age women evaluated the sexual function before, during, and after the COVID-19 disease pandemic and lockdown. Pretested semistructured self-administered questionnaires with the Female Sexual Function Index (FSFI) were used for data collection. Information collected included sociodemographic and gynecologic characteristics and COVID-19 experiences, as well as sexual history and function before, during, and after the COVID-19 pandemic lockdown. The level of significance was set at P < .05. Outcomes: Respondents were aged 20 to 50 years (95%) with a mean ± SD age of 34.82 ± 8.52 years; the majority were married (75.58%); one-fifth (21.9%) tested positive for COVID-19 infection; and participants who tested positive for COVID-19 infections were mostly health care workers. Results: An absence of sexual activity was reported in 9.18% of participants during lockdown, 7.73% before lockdown, and 4.18% after lockdown. The risk of female sexual dysfunction was prevalent among participants, especially those who tested positive for COVID-19 infection. The prevalence was worse during the pandemic lockdown (53.57%) than before (48.39%) or after (51.61%), and a similar pattern was seen among those who tested negative. There was no statistically significant difference in risk of developing sexual dysfunction during the COVID-19 pandemic between those who tested positive and negative to COVID-19. The arousal and desire domains contributed the highest proportion of low FSFI scores. Clinical Implications: Nationwide lockdowns, which may be a method of control for pandemics, may result in psychosocial complications such as female sexual dysfunction. Strength and Limitations: Most respondents had tertiary education and were able to respond to self-administered questionnaires, yet the risk of recall bias remains a concern whereas the pandemic met the world unprepared and baseline FSFI prior the pandemic was not available for participants. There are no local validation studies for the FSFI in Nigeria, which could have aided interpretation of results. Conclusion: A low FSFI score is prevalent in Ibadan, South-West Nigeria, with a higher incidence reported during the COVID-19 pandemic lockdown.

Inflammatory cytokines in maternal serum between women with threatened miscarriage and normal pregnancy.

OBJECTIVE: To compare the levels of proinflammatory cytokines in women with threatened miscarriage and normal pregnancy. METHODS: This study was a longitudinal study. Consenting women with normal pregnancy and those admitted on account of threatened miscarriage at an estimated gestational age of 6-10 weeks were included in the study. The proinflammatory cytokines interleukin-2 (IL-2) and interferon-γ (IFN-γ) and the anti-inflammatory cytokines IL-4 and IL-13 were measured at the diagnosis of threatened miscarriage (baseline) and in the 13th week of pregnancy. The χ2 test of association was used to examine the relationship between the pregnancy type and demographic characteristics; clinical history and gynecologic history. Student t test was used to compare the selected cytokine between women with threatened miscarriage and normal pregnancy. RESULTS: There was a significantly higher IL-2 (P = 0.033), IFN-γ (P < 0.001), and IL-13 (P < 0.001) in women with threatened miscarriage than in women with normal pregnancy at the baseline. At the follow up, the results revealed a significantly higher IFN-γ level (P < 0.001) and IL-4 (P = 0.019) in women with threatened miscarriage than in women with normal pregnancies. CONCLUSION: Proinflammatory cytokine profiles were associated with a higher risk of threatened miscarriage.

Incidence of postpartum urinary retention in a tertiary hospital in Ibadan, Nigeria.

OBJECTIVE: To determine the incidence of postpartum urinary retention (PUR) after vaginal delivery and associated risk factors. METHODS: A total of 250 women were recruited following vaginal delivery at the UCH, Ibadan. Sociodemographic and obstetrical data were collected using a pro forma. Transabdominal ultrasound scan of the urinary bladder was performed 6 hours after delivery to estimate the post-void residual bladder volume (PVRBV) of participants. PVRBV was compared with obstetrical characteristics and labor events. Data collected were analyzed using SPSS 17.0. The level of statistical significance was set at P value less than 0.05. RESULTS: The incidence of PUR was 17.6%. Women with PUR, had longer duration of first stage (591 versus 501 minutes; P = 0.001), and second stage (50 versus 32 minute; P < 0.001) of labor compared with those without PUR. There was evidence that augmentation of labor (P < 0.01), catheterization during labor (P < 0.01), perineal injury (P < 0.01), and episiotomy (P < 0.01) were associated with developing PUR. Also, women with PUR were more likely to experience storage and obstructive urinary symptoms than those without PUR. Resolution of PUR occurred within 24 hours. CONCLUSION: This study showed that postpartum urinary retention is relatively common following vaginal delivery. Awareness of risk factors will increase index of suspicion especially in women with storage and obstructive symptoms.

Assessment of anxiety and depression, and coping mechanisms during COVID-19 lockdown among pregnant women.

Background: COVID-19 lockdown was associated with disruption of daily life, economy, essential health services including maternal health service, and psychological reflexes such as panic, sleep disorders, fear, anxiety, and depression. Aim: To assess the perception of pregnant women on the COVID-19 pandemic lockdown and the prevalence of common mental health disorders (CMHD) among pregnant women. Methods: A cross-sectional study was conducted among 380 pregnant women at the University College Hospital (UCH) Ibadan; participants were enrolled using a simple random sampling technique. Data was collected using pretested interviewer-administered questionnaire. Information obtained - sociodemographic and obstetric characteristics, perception and reaction to the COVID-19 pandemic and lockdown, effect on ANC, coping mechanisms, and presence of CMHD (anxiety and depression) were measured using Hospital Anxiety and Depression Scale (HADS). Data were analysed using STATA 16.0 Software. Descriptive and bivariate statistics were performed. The level of significance was p-value < 0.05. Results: The mean age was 32 ± 4.78 years, most respondents were <35 years (75%), married (97.1%), had a higher education (89%) and multiparous (70%). About 43.9% were worried that COVID-19 would affect pregnancy care, 42.9% reported it affected care and 81.6% were not worried it would affect the delivery care. Among respondents, 96.6% were able to cope with the effects of the pandemic and 96.8% enjoyed good social support. Respondents did not have CMHD (88.16%), 7.9% had CMHD (4.74% had depression and 3.16% had anxiety) and 3.95% had co-morbid depression and anxiety. On multinomial regression analysis, relative to anxiety or depression only, respondents with combined depression and anxiety had higher odds of having no delivery plan and thought COVID-19 may affect their delivery. Conclusion: Only a few women reported anxiety and depression symptoms during the lockdown and those with anxiety or combined symptoms of anxiety and depression had no birth plan and believed that COVID-19 would affect their delivery.

Assessing the role of the non-pneumatic anti-shock garment in reducing mortality from postpartum hemorrhage in Nigeria.

BACKGROUND/AIMS: Postpartum hemorrhage (PPH) is the leading cause of maternal mortality. The non-pneumatic anti-shock garment (NASG), a first-aid lower-body pressure device, may decrease mortality. METHODS: This pre-intervention/NASG study of 288 women was conducted in four referral facilities in Nigeria, 2004-2008. Entry criteria: women with PPH due to uterine atony, retained placenta, ruptured uterus, vaginal or cervical lacerations or placenta accreta with estimated blood loss of ≥750 ml and one clinical sign of shock. Differences in demographics, conditions on study entry, treatment and outcomes were examined. t tests and relative risks with 95% confidence intervals were calculated for primary outcomes - measured blood loss and mortality. Multiple logistic regression analysis was performed to examine independent association of the NASG with mortality. RESULTS: Mean measured blood loss decreased by 80% between phases. Women experienced 350 ml of median blood loss after study entry in the pre-intervention and 50 ml in the NASG phase (p < 0.0001). Mortality decreased from 18% pre-intervention to 6% in the NASG phase (RR = 0.31, 95% CI 0.15-0.64, p = 0.0007). In a multiple logistic regression model, the NASG was associated with reduced mortality (odds ratio 0.30; 95% CI 0.13-0.68, p = 0.004). CONCLUSION: The NASG shows promise for reducing mortality from PPH in referral facilities in Nigeria.

Hierarchical modelling of factors associated with the practice and perpetuation of female genital mutilation in the next generation of women in Africa.

Despite a total prohibition on the practice of female genital mutilation (FGM), young girls continue to be victims in some African countries. There is a paucity of data on the effect of FGM practice in two generations in Africa. This study assessed the current practice of daughters' FGM among women living in 14 FGM-prone countries in Africa as a proxy to assess the future burden of FGM in the continent. We used Demographic and Health Surveys data collected between 2010 and 2018 from 14 African countries. We analyzed information on 93,063 women-daughter pair (Level 1) from 8,396 communities (Level 2) from the 14 countries (Level 3). We fitted hierarchical multivariable binomial logistic regression models using the MLWin 3.03 module in Stata version 16 at p<0.05. The overall prevalence of FGM among mothers and their daughters was 60.0% and 21.7%, respectively, corresponding to 63.8% reduction in the mother-daughter ratio of FGM. The prevalence of FGM among daughters in Togo and Tanzania were less than one per cent, 48.6% in Guinea, with the highest prevalence of 78.3% found in Mali. The percentage reduction in mother-daughter FGM ratio was highest in Tanzania (96.7%) and Togo (94.2%), compared with 10.0% in Niger, 15.0% in Nigeria and 15.9% in Mali. Prevalence of daughters' FGM among women with and without FGM was 34.0% and 3.1% respectively. The risk of mothers having FGM for their daughters was significantly associated with maternal age, educational status, religion, household wealth quintiles, place of residence, community unemployment and community poverty. The country and community where the women lived explained about 57% and 42% of the total variation in FGM procurement for daughters. Procurement of FGM for the daughters of the present generation of mothers in Africa is common, mainly, among those from low social, poorer, rural and less educated women. We advocate for more context-specific studies to fully assess the role of each of the identified risk factors and design sustainable intervention towards the elimination of FGM in Africa.

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.

Knowledge of front-line health workers on the role of urethral catheterization for primary prevention of obstetric fistula in Ibadan, Nigeria.

BACKGROUND: Obstetric fistula (OF), a preventable debilitating condition is mostly caused by prolonged obstructed labour (POL). The aim of bladder catheterization is to allow for healing process by preventing tension to adjoining tissues and improve blood supply. This study assessed the knowledge of catheterization in the prevention of OF among health workers in Ibadan, Nigeria. METHODS: A cross sectional study among 147 health workers providing obstetric care in the labour and post-delivery wards using a self-administered questionnaire in 10 selected primary health centres was conducted. The knowledge of catheterization for primary prevention of OF was assessed on a three-point scale. Data was analysed using SPSS version 20. Logistic regression was used to determine the association between health workers socio-demographics and professional characteristics and their knowledge of catheterization for OF prevention. RESULTS: The mean age of participants was 41.6 (SD =8.9) years. Fifty-six (38.1%) of the participants had good knowledge of catheterization for OF prevention. Higher proportion (41.3%) of registered nurses and/or midwives had good knowledge of catheterization for OF prevention compared to those who attended school of hygiene. Health workers who had practiced for between 7-9 years were about seven times more likely to have good knowledge of catheterization compared to those who had worked for less than 3 years (OR =6.929, 95% CI, 1.755-27.357). CONCLUSIONS: Majority of health workers had poor knowledge of catheterization in OF prevention. There is need for training and re-training of health workers in primary health care centres (PHC) on the vital role of bladder catheterization following prolonged/obstructed labour so as to reduce the burden of OF.