Antenatal Clinic Waiting Time, Patient Satisfaction, and Preference for Staggered Appointment-A Cross-Sectional Study.

Time spent in the antenatal clinic (ANC) is a major disincentive for pregnant women and constitutes a barrier to the utilization of ANC. Long waiting time and poor patient satisfaction may contribute to poor utilization. This study assessed waiting time, patients' satisfaction, and preference for staggered ANC appointments. A cross-sectional study was conducted; information obtained includes sociodemographic and obstetric characteristics, and time spent at ANC service points. Data were analyzed using International Business Machines (IBM) Statistical Products and Service Solutions (SPSS) software version 23. Descriptive statistics and chi-square test were conducted. Level of significance: P < .05. One hundred and twenty-two participants were interviewed. Mean age was 30.52 (±4.65) years, they were mostly multi-gravid, married, and with tertiary education. Mean time spent in ANC and waiting time were 191 min and 143 min, respectively. Waiting time was longest at doctor's consultation (59 min), laboratory services (38 min), and the cash pay-point (18 min). About 68.9% were satisfied with services and highest at doctors' consultation. Satisfaction was associated with waiting time of <45 min. Dissatisfaction was high at the cash pay-point (28.7%), followed by the laboratory (16.4%). About 56.5% preferred staggered appointments. Time spent in ANC should be reduced and staggered appointments may be a useful strategy to reduce waiting time and patient load.

HEALTHCARE FINANCING FOR ANTENATAL CARE AND DELIVERY SERVICES IN A TERTIARY HEALTH FACILITY IN SOUTH-WEST NIGERIA.

Background: Universal health coverage and healthcare financing for maternal health services are essential for quality care, prevention of complication and a reduction in maternal morbidity and mortality. Objective: To evaluate the modes of healthcare financing for antenatal and delivery care among pregnant women in a tertiary health facility in South-West Nigeria. Methods: This is a four-year retrospective review of maternal healthcare financing models adopted by pregnant/postpartum women at the antenatal clinic and labour/delivery unit. Data for health financing in antenatal booking clinic for a four-year period from 2016-2019 and labour & delivery for a two-year period from 2018 and 2019 were reviewed. The information collected were - number of women that paid out-of-pocket for services, number of women that paid for services using health insurance and other means of payment during the period. Data were analysed using SPSS version 23. Result: A total of 7,129 women accessed antenatal care services during the period under review. About 58.9% of the women paid for antenatal care services out-of-pocket, 36.6% were covered under the health insurance (social and private health insurance). A total of 2,881 women accessed delivery services at the health facility. About 66.4% of the women paid out-of-pocket for both caesarean section and vaginal delivery. Prepaid health insurance was used by about 31% of the women. Conclusion: Health insurance has been available for over a decade; however prepaid healthcare financing model remains less popular. Out-of-pocket payment constitutes the predominant mode of healthcare financing for maternal healthcare among pregnant women at the tertiary health facility. The out-of-pocket payment exposes the pregnant women and her family to financial burden and catastrophic spending especially in obstetric emergency.

ACCIDENTAL INTRAOPERATIVE FINDING OF PARASITIC FIBROIDS IN THE MESENTERY OF A MIDDLE-AGED WOMAN.

Fibroid (myoma) is the most common benign tumor of the female genital tract. The tumour may occur in the uterine corpus as intramural, submucous, subserous, cervical fibroid; or in the broad ligament as intraligamentary fibroid or outside of uterus as parasitic fibroid. Parasitic fibroid is rare as a primary or secondary tumour. It is commonly diagnosed as an incidental finding during radiologic or abdominal surgical procedures. This was a case report of histologically confirmed multiple parasitic fibroids in a 39-year-old woman coexisting with primary uterine fibroids. The woman presented with a history of progressive abdominal swelling and associated lower abdominal pain of 8 years duration. There was an antecedent history of exploratory laparotomy with excision of uterine mass. Abdominal ultrasonography revealed multiple uterine fibroid nodules in the submucous, intramural and subserous layers of the uterus with bilateral normal ovaries. She had abdominal myomectomy. The intraoperative findings revealed multiple uterine fibroid nodules with a total weight of 1670g. There were multiple parasitic fibroid nodules attached to the serosa of the colon with the largest measuring 3.5 x 2cm. We discussed the management and associated challenges of unanticipated parasitic fibroids at surgery. We highlighted the role of multi-disciplinary care and advocated for a high index of suspicion while preparing for surgical intervention in women with multiple uterine fibroids.

Resumption of Sexual Intercourse and Family Planning use Among Postpartum Women Attending Infant Welfare Clinics in Ibadan, Southwest Nigeria - A Cross-Sectional Study.

BACKGROUND: Women may resume sexual intercourse anytime during the postpartum period with little consideration for contraceptive. AIM: To determine factors associated with resumption of sexual activity, explore FP practices and influence on sexual resumption among postpartum women. SUBJECT AND METHODS: A cross-sectional study of postpartum women at the infant-welfare clinic of Adeoyo Maternity Teaching Hospital and University College Hospital, Ibadan between July and October, 2014. Data on socio-demographic characteristics, contraceptive use, and sexual behavior were collected using interviewer-administered semi-structured questionnaires. Associations were tested using Chi-square tests and Logistic regression analysis for crude and adjusted odds ratios. Level of significance was 5%. RESULTS: There were 256 women with mean age of 29.1 years(SD = 5.2). Majority had tertiary education; were currently married in monogamous marriages and had 1-3 children. Ninety-one(38.7%) had started sexual intercourse at the time of interview. Among those who had not started having sex, about a quarter (24.2%) gave no reason and 20% felt it was too early. The fear of pain and child-spacing were reasons given by 5.7% and 5.1% respectively. Current use of contraceptive method was 20.7% among women and 36.4% among women who had resumed sexual activity. On multiple logistic regression, Family-planning users were about five times more-likely than non-users to resume sexual intercourse (Odd Ratio = 5.66, 95% Confidence interval = 2.61 - 12.28). CONCLUSION: Women commonly resume sexual intercourse during postpartum period without contraceptive use. Interventions during antenatal and early postnatal periods are needed to improve early adoption of Family planning by postpartum women.

Pattern of Oral Health Among a Population of Pregnant Women in Southwestern Nigeria.

Oral health in pregnancy is important to the health of the pregnant woman; and good oral health plays a role in the outcome of pregnancy. However, many pregnant women and healthcare providers are either unaware of this or accord this less attention. The study was designed to describe pattern of oral health among a cohort of pregnant women. Seventy-seven pregnant women attending antenatal care at a secondary healthcare facility were evaluated in third trimester following written informed consent. Each participant had a structured data collection form administered and clinical examination conducted. Information on socio-demographic characteristics, dental and obstetric history and examination were obtained. Dental assessment involved the use of the oral hygiene, gingival, periodontal and caries indices. The data collected was entered and analysed using IBM SPSS Statistics version 20. The mean age of the participants was 29.90 (± 4.38) years and all women were in the third trimester of pregnancy. Only 6.5% of the participants had dental complaints, 26% indicated brushing twice a day and 96.1% never had dental health check in the past. A good oral hygiene score was found in 40% of participants; 6.5% and 10.4% had a healthy periodontal and gingival status respectively and only 8 (10.4%) had caries. Less than half of the pregnant women had good oral health status. The antenatal care period may be an opportunity to identify oral diseases; counsel and introduce positive oral health behaviours and enhance improved personal oral hygiene.

Knowledge and use of emergency contraception by medical doctors on internship in a tertiary healthcare facility in Nigeria.

CONTEXT: Emergency contraception (EC) is widely used to prevent unwanted pregnancy and it is largely adopted in many countries as over the counter drug to improve access. AIMS: To determine and compare the correct knowledge, attitude and current use of EC among newly graduated medical doctors (MDs). SETTINGS AND DESIGN: A cross-sectional study conducted among 255 newly graduated MDs at the University College Hospital, Ibadan, Nigeria. MATERIALS AND METHODS: A pretested self-administered questionnaire was used to obtain data from consenting participants. STATISTICAL ANALYSIS USED: Descriptive, bivariate, and multivariable analyses were performed, and statistical significance was set at 0.05. Statistical Package for Social Science version 15.0 (Chicago, IL, USA) software was used. RESULTS: The mean age of the respondents was 27.2 years (standard deviation = 2.1). The commonest indication for emergency contraceptive use mentioned was rape-96.5%. About 70% support EC in Nigeria, while about a quarter (26.9%) routinely counsel women about ECP use. About 21% of respondents currently use EC. Logistic regression analysis revealed significant results for gender [odds ratio (OR) =3.64; 95% confidence interval (CI) OR = 1.31-10.01), religion (OR = 0.26; 95% CI OR = 0.11-0.630) and marital status (OR = 0.19; 95% CI = 0.07-0.56). CONCLUSION: The correct knowledge and professional disposition toward EC as a form of contraception is low. We recommend that in-service training should focus more on EC to improve the quality of their knowledge and attitude towards it.

Metachronus endometrial carcinoma in a seventy five year old woman with carcinoma of the left breast treated with tamoxifen.

BACKGROUND: A second cancer is a different type of cancer than the original cancer. It is diagnosed after a completed treatment for the first cancer. Second cancers occur in only one to three percent of survivors. The level of risk is very small. In general, greater numbers of cancer survivors are living longer due to improvements in treatment. Whether or not a second cancer develops is dependent on many factors. These include the age of the patient when treated, the treatment received, the genetic make-up and family history. The actual number of people who will get a second cancer is relatively small. Each cancer survivor's experience is unique. The aim of this report is to call attention to what might be an emerging place of secondary malignancies in cancer survivors in our setting. METHOD: We report a case seen in our practice of a seventy five year old woman who was treated for invasive ductal carcinoma of the left breast and developed invasive endometrial carcinoma about 4 years later. CONCLUSION: There is a need to be on the lookout for possible second malignancies in cancer survivors. Examination and tests for second malignancies should be part of the routine follow up procedures in this group of patients.