Awareness, knowledge and attitude on cleft lip and palate among antenatal clinic attendees of tertiary hospitals in Nigeria.

BACKGROUND: Adequate knowledge and awareness of cleft lip and palate (CLP) deformity may help to counter the negative beliefs and attitudes toward the condition. The objective of this study was to assess the level of awareness, knowledge and attitude of women attending antenatal clinics about CLP. MATERIALS AND METHODS: A cross-sectional descriptive study with the aid of a structured interview administered questionnaire was conducted among 200 women attending antenatal clinics in three Federal Government Teaching Hospitals in the Northern and Southwestern regions of Nigeria. The main outcome measure was the level of awareness and the mean cumulative knowledge score. RESULTS: The mean age of the subjects was 28.9 ± 5.1 years (age range: 16-42 years). Half of the women (50.5%) reported that they had seen or heard about CLP. The mean cumulative knowledge score was 6.9, with only 19.8% having adequate knowledge. Many respondents had neither read an article on CLP nor participated in any public enlightenment program, and 31.5% indicated that they would like to know more about the condition. Level of educational attainment had a statistically significant effect on the level of awareness and knowledge on CLP, as more educated respondents tend to be more aware and knowledgeable ( P < 0.001). CONCLUSION: There is need for increased public enlightenment/health education to increase awareness and subsequently help develop more positive attitudes toward children with CLP. Such programs should include distribution of pamphlets on CLP at clinics, especially antenatal clinics, media campaigns on radio, TV and newspaper as well as establishment of cleft support groups by the relevant governmental and professional organizations.

Comparison of short versus long term antibiotic prophylaxis in elective caesarean section at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria.

AIMS AND OBJECTIVES: This study was to determine any significant difference between the incidence of infectious morbidity with the use of a 24 hour antibiotics regimen compared to a 7-day course of antibiotics following elective caesarean section using a cheap and easily available combination of Ampicillin/Cloxacillin and Metronidazole. PATIENTS AND METHODS: Two hundred patients planned to have elective caesarean section for various indications and who satisfied the inclusion criteria were enrolled in the study in two groups of 100 patients each between the period of January to June 2010. Patients were randomized to receive either Ampiclox as 4 intravenous doses of 1g stat and 500 mg each 6 hourly and Metronidazole as 3 intravenous doses of 500 mg each 8 hourly both for 24 hours or same combination intravenously for 48 hours and subsequent oral use for 5 days. RESULTS: The mean maternal age, parity, gestational age and indication for caesarean section were similar in the two groups of participants. There was no statistical difference in the incidence of febrile morbidity (17%/18%, p=0.852), urinary tract infection (6%/4%, p=0.196), wound infection (4%/3%, p=0.056) and endometritis (3%/2%, p=0.367). The mean cost of antibiotics per patient (N730/$4.65) in the short term prophylaxis group was half that of the long term prophylaxis group (N1, 540/$9.81). CONCLUSION: There was no difference in the incidence of infection related morbidity when short term prophylactic antibiotics was used at elective caesarean section compared to long term prophylactic antibiotics.

HELLP syndrome: the experience at Ile-Ife, Nigeria.

Between 1 January and 31 December, 2006, 34 consecutive cases of severe pre-eclampsia (12), imminent eclampsia (10) and eclampsia (12) who were admitted at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife in the south-western part of Nigeria, were investigated for the development of HELLP (haemolysis, elevated liver enzymes and low platelet count) syndrome in a prospective study. The ages of the women ranged from 18 to 38 years, parity 0-5 and the estimated gestational age from 18-41 weeks at presentation. A total of 26 (76.5%) of the patients were unbooked, six (17.6%) of the 34 cases developed HELLP syndrome. Four (33%) of the 12 eclamptics developed HELLP syndrome, while only one (10%) of the cases of imminent eclampsia and 1 (8.3%) of severe pre-eclamptic cases developed the syndrome. Using the Mississippi Triple class system, none of the HELLP syndrome cases belonged to Class I; 4 were categorised in Class II while 2 were in Class III. All of the four eclamptic cases with HELLP syndrome died giving a 100% fatality rate while none of the imminent eclamptic and severe pre-eclamptic patients with the syndrome died. Furthermore, there were six (15.8%) perinatal deaths among the 38 infants delivered by the 34 mothers with severe pre-eclampsia/eclampsia. Our data suggest that the development of HELLP syndrome is more likely in eclamptic patients and when it occurs in them, it is highly fatal. Most of the cases in this study were unbooked. Substandard care may have contributed to the progression of the disease state and consequently, to maternal mortality. It is imperative to draw up an action plan for the identification of the risk factors for the development of pre-eclampsia/eclampsia at peripheral hospitals and maternity centres and for prompt referral of such cases afterwards. Efforts should also be geared towards the minimising of treatment delay in all phases, so as to minimise both perinatal and maternal morbidity and mortality.

Evaluation of health workers' training in use of the partogram.

OBJECTIVE: To assess the impact of training on use of the partogram for labor monitoring among various categories of primary health care workers. METHODS: Fifty-six health workers offering delivery services in primary health care facilities were trained to use the partogram and were evaluated after 7 months. RESULTS: A total of 242 partograms of women in labor were plotted over a 1-year period; 76.9% of them were correctly plotted. Community health extension workers (CHEWs) plotted 193 (79.8%) partograms and nurse/midwives plotted 49 (20.2%). Inappropriate action based on the partogram occurred in 6.6%. No statistically significant difference was recorded in the rate of correct plotting and consequent decision-making between nurse/midwives and the CHEWs. CONCLUSION: Lower cadres of primary health care workers can be effectively trained to use the partogram with satisfactory results, and thus contribute towards improved maternal outcomes in developing countries with scarcity of skilled attendants.

A randomised controlled trial of uterine exteriorisation and non-exteriorisation at caesarean section.

BACKGROUND: There is not enough information to evaluate the routine use of exteriorisation of the uterus for repair of the uterine incision and further studies are needed to examine the value of exteriorisation of the uterus at caesarean section as against non-exteriorisation. AIMS: To assess intraoperative and postoperative morbidity following exteriorisation of the uterus at caesarean section as compared to those with non-exteriorisation. METHODS: A randomised controlled trial at Obafemi Awolowo University Teaching Hospital, Ile Ife, Nigeria. Two hundred and ten women were randomised to either exteriorisation (N = 105) or non-exteriorisation group (N = 105). Statistical analysis using SPSS compared intraoperative and postoperative outcome. The outcome measures include intraoperative blood loss, number of analgesic dose, difference in operating time, febrile morbidity, intraoperative complications, and duration of hospital stay. RESULTS: There were significant reductions in intraoperative blood loss (P < 0.05), number of analgesic dose (P < 0.05) and duration of hospital stay (P < 0.05) in the uterine exteriorisation group as compared to those in the non-exteriorisation group. There was no significant difference in operating time, febrile morbidity, intraoperative complications and operating time. The period for return of bowel function was significantly longer in the exteriorisation group. CONCLUSION: Exteriorisation of uterus at caesarean section is associated with less intraoperative blood loss, less number of analgesic dose and shorter hospital stay.

Rate of increase in oxytocin dose on the outcome of labor induction.

OBJECTIVE: To compare the efficacy and safety of arithmetic and geometric increases in oxytocin infusion dosage during induction of labor. METHODS: A total of 120 pregnant women requiring induction of labor at term were randomly assigned to receive oxytocin at dosages increasing arithmetically or geometrically. Maternal demographics, labor delivery data, and newborn outcomes were compared. The setting was the maternity unit of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. RESULTS: The mean maximum rates of oxytocin delivery needed to achieve adequate uterine contractions were similar in the 2 groups (24.66+/-8.34 mU/min vs. 26.38+/-8.77 mU/min, P=0.24). Labor duration was significantly shorter in the geometric progression group (496.33+/-54.77 min vs. 421.34+/-63.91 min, P<0.001). There were no differences in the rates of cesarean sections, vaginal deliveries, or uterine hyperstimulation, or in neonatal outcomes. CONCLUSION: A geometric rise in the rate of oxytocin infusion delivery reduced the duration of labor without affecting the rates of cesarean sections and uterine hyperstimulation, or newborn outcomes.

Contraceptive awareness and use among sexually active breast feeding mothers in Ile-Ife, Nigeria.

OBJECTIVE: To assess the level of awareness and correlates of use of family planning services among sexually active breastfeeding mothers attending an infant welfare clinic. DESIGN: Cross-sectional descriptive design. SETTING: Infant welfare clinic of the urban comprehensive health centre, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria. SUBJECTS: Mothers of breast feeding infants aged 8-11 months attending the infant welfare clinic. RESULTS: Awareness of family planning was quite high (95.5%) while current family planning use was quite low (13%). Although the proportion of women who planned for future use of family planning in the sample was high (64%), all current non-users (86.6%) met the criteria for unmet need for family planning. Parity and the number of living children were the only socio-demographic correlates of the respondents that significantly influenced family planning acceptance (P < 0.05). CONCLUSION: There is a high level of contraceptive awareness but low contraceptive use among breast feeding mothers in Nigeria, with a majority of non-users depending on the perceived contraceptive effects of breastfeeding.

Obstetric performance of women aged over forty years.

BACKGROUND: Advanced age and parity constitute two major factors in the outcome of pregnancy and labour management both in the developed and developing countries. OBJECTIVE: To examine pregnancy outcomes in women aged 40 years and above with the view of proffering solution to some of the problems encountered. DESIGN: A case control retrospective study. SETTING: Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria from 1st January, 1995 to 31st December, 1999. SUBJECTS: Three hundred and three women who delivered at 40 years of age or above. The control group comprised of 303 women who delivered between 20 and 29 years during the five years period. MAIN OUTCOME MEASURES: Gestational age at delivery, birth weight, mode and type of delivery, pregnancy and birth outcome. RESULTS: This showed a significant increase in prematurity, low birth weight, medical complications, operative deliveries (Caesarean section, vacuum and forceps), birth asphyxia and perinatal deaths all at P < 0.05. CONCLUSION: There is a poor pregnancy outcome at fourty years and above. Patients need to be counselled for care in a specialised centre.

Planned vaginal delivery versus Caesarean section for breech presentation in Ile-Ife, Nigeria.

BACKGROUND: The optimum mode of breech delivery remains a matter of controversy among obstetricians worldwide. OBJECTIVE: To determine whether term breech babies born by planned vaginal delivery are at higher risk of neonatal mortality and morbidity than those born by planned caesarean delivery. DESIGN: A hospital based non-experimental comparison of outcome of breech delivery. SETTING: Ife State Hospitals Complex, Ile-Ife. SUBJECTS: Two hundred and fourty four singleton breech deliveries occurring at term. MAIN OUTCOME MEASURES: They include low 5-minute Apgar score, birth trauma, maternal and perinatal morbidity and mortality. RESULTS: The perinatal mortality was not significantly different in both groups: OR 2.7 (95% C.I. 0.3-26.8). The low 5-minute Apgar scores were higher in the planned vaginal delivery OR 9.0 (95% C.I. 1-73.4), but the traumatic morbidity was not (OR 1.8, 95% C.I. 0.2-20.1). Maternal morbidity occurred more in the planned Caesarean delivery group OR 0.4 (95% C.I. 0.2-0.9). CONCLUSION: Given appropriate selection criteria and management protocol, the outcome from elective caesarean section might not be better than from planned vaginal delivery.

Contraceptive practice among married market men in Nigeria.

BACKGROUND: Until recently, family planning researchers and service providers had focused almost exclusively on women. Men are often seen as uncooperative and uninterested in family planning or reproductive health. OBJECTIVE: To investigate the contraceptive knowledge, attitude and practice among married market men. DESIGN: A cross-sectional survey. SETTING: llesa Main Market, Osun State, Nigeria. SUBJECTS: Four hundred and fifty married market men were interviewed between November 2000 and January 2001. MAIN OUTCOME MEASURES: Level of awareness and utilisation, reasons for non-use, influence of socio-demographic variables. RESULTS: All the men were aware of family planning and 60.9% are currently using a form of contraception with their spouse. Reasons for non-contraceptive use by 39.1% of the respondents include: family size not yet complete, religious opposition, afraid of contraceptive failure, still searching for a male sex. Christianity and education were significantly associated with contraceptive use and knowledge (p < 0.05). CONCLUSION: Men favour contraceptive use in Nigeria. Involving men by family planning providers is a winning strategy with benefits to both men and women.

Effect of prolonged birth spacing on maternal and perinatal outcome.

BACKGROUND: Researchers have held varied opinions on the effect of prolonged birth spacing on maternal and perinatal outcome. OBJECTIVES: To determine the reasons for prolonged birth spacing and to compare the maternal and perinatal outcome compared to shorter normal birth spacing. DESIGN: Comparative case - controlled study between January 1st, 2001 to December 31st, 2002. SETTING: Obstetric Unit of Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria. SUBJECTS: Fifty cases consisted of multiparae with prolonged birth spacing (> or =6 years) and controls consists of similar number of multiparae with shorter normal birth spacing (2 - 5 years) matched for age, parity and socio-economic status. MAIN OUTCOME MEASURES: Labour outcome, Apgar scores, operative and vaginal delivery rates, perinatal and maternal outcome, reasons for prolonged birth spacing. RESULTS: There was no significant difference observed with respect to spontaneous onset of labour, induction or argumentation of labour, duration of labour, spontaneous vaginal delivery rates, Caesarean section rates, instrumental vaginal deliveries, analgesic requirement, postpartum haemorrhage, and Apgar scores in both groups. There were no perinatal or maternal deaths. The commonest reason adduced for prolonged birth spacing is failed contraception (56%), followed by secondary infertility (24%) and to a lesser extent re-marriage, improved income and sheer desire. CONCLUSION: There was no significant difference in maternal and perinatal outcome in pregnancy between women with prolonged birth spacing and those with normal shorter birth spacing.

Decision-intervention interval in ruptured uteri in Ile-Ife, Nigeria.

OBJECTIVE: To determine the decision-intervention interval in ruptured uterus with a view of overhauling the management strategy thereby improving the maternal and perinatal outcome. DESIGN: Cross-sectional survey based on secondary data done between 1990-1999. SETTING: Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria. SUBJECTS: One hundred and two consecutive women who had uterine rupture. RESULTS: The decision-surgical intervention interval ranged from 30 minutes to 4.5 hours. The major reason for delay was unavailability of compatible blood (88.2%), followed by lack of electricity (4.9%), unsterile instruments (3.9%), waiting for ambulance to get senior obstetricians (2.9%), delay in arrival of anaesthetist (1.9%) and neonatologists (1.9%). The peri-natal mortality rate (PNMR) was 843 per 1000 total births and maternal mortality rate (MMR) 4902 per 100,000 births. CONCLUSION: The maternal and perinatal outcome in uterine rupture would be improved by early diagnosis and avoidance of preoperative delay through availability of essential obstetric services.

Uncomplicated Caesarean section: is prolonged hospital stay necessary?

BACKGROUND: Caesarean section among the Yoruba of western Nigerian is surrounded by a lot of fears, miseries, aversion, guilt and misconceptions for reasons varying from the desire by women to have a natural vaginal birth, fear of surgery, morbidity and deaths from the operation and prolonged hospital stay. OBJECTIVE: To examine issues of reduced hospital stay following Caesarean section with a view of making the operation more acceptable and proffering solution to some of the problems faced by women when Caesarean section is indicated. DESIGN: A prospective case control study. SETTING: Wesley Guild Hospital, Ilesha, Nigeria from 1st July, 1997 to 30th June, 1998. SUBJECTS: One hundred consecutive patients who had uncomplicated Caesarean section, randomised into two groups of short (three days) and prolonged (seven to eight days) hospital stay respectively. MAIN OUTCOME MEASURES: Observations of patients in both groups were made by an independent observer on day seven post-operation and the main outcomes measured included: wound infection rates, ability to maintain erect posture, mood changes, neonatal sepsis rate, immunisation rate of the neonates and average hospital bills. RESULTS: The findings revealed that wound infection rates of six per cent and ten per cent among the short and prolonged hospitalised patients respectively are not significantly different. Patients with short stay have better erect posture, lower incidence of depressive mood, lower neonatal sepsis rate, lower hospital bill and are more satisfied with early home discharge. CONCLUSION: Embracing the concept of early home discharge after Caesarean section in uncomplicated cases may remove some of the psychological upsets and economical impediments associated with the operation and make the operation more acceptable.

Orofacial injuries in eclamptic Nigerians.

A retrospective review of one hundred and seventy three cases of eclampsia seen between 1994 and 2002 was conducted. Twenty one patients (12.1%) whose ages ranged from 18 to 35 years sustained orofacial injuries during the course of their eclamptic fits. Lacerations and bruises on the tongue, gingivae and lips accounted for injuries in all the patients. Temporomandibular joint dislocation was also recorded in one patient. Tongue lacerations were mainly due to tongue biting. Forceful insertion of objects during convulsive episodes was responsible for the bruises and deep lacerations at the ventral surface of the tongue in two patients. Two patients died from severe and uncontrolled bleeding complicated by renal failure and aspiration pneumonia from lacerations on the tongue and gingivae. Vigorous campaign should be carried out to encourage antenatal care attendance by pregnant mothers so that potential cases of eclampsia could be nipped in the bud before progressing to frank eclampsia. Furthermore, additional injuries usually inflicted on pregnant women by anxious relatives from forceful insertion of unpadded objects as mouth props should be discouraged through public health promotional campaigns. Obstetricians should be aware of the possibility of these injuries in an unconscious eclamptic patient and their life-threatening consequences if not promptly diagnosed and managed. The need to seek appropriate and early dental or maxillofacial consultation where such injuries are suspected and where services are available is imperative.

The case against mandatory preoperative HIV screening in Africa.

Surgeons are treating an increasing number of HIV-infected patients for surgical problems both related and unrelated to HIV infection. There had been vehement debate surrounding the question of preoperative HIV testing of patients. Supporters of preoperative HIV testing argued that members of the surgical team had the right to know whether they were at risk for acquiring a fatal infection after exposure to a patient's blood. However, the testing was opposed by many because of the civil rights implications of a positive HIV test result and the fear that HIV-positive patients would receive sub-optimal treatment. This paper reviewed available literature and made recommendations based on available scientific evidence with particular emphasis on the situation in Africa.

Attitude of Abeokuta pregnant women to routine human immunodeficiency virus screening.

The attitudes of 200 pregnant women at the antenatal clinic, Federal Medical Centre, Abeokuta to routine HIV Screening for pregnant women were obtained between January and February 2000. One hundred and ninety six (96%) supported routine screening while 8(4%) did not. Reasons for supporting routine screening include protection of unborn baby (70%), initiation of early treatment if positive (50%), protection of other patients (40%) and protection of health care workers (20%). Reasons given by 8 (4%) who opposed routine screening include fear of a positive result 6(3%) and fear of societal discrimination 2(1%). If tested positive, 60% will request for medical treatment, 50% will inform their husband, 40% will seek divine intervention in the church, 20% do not know what to do while 10% will be isolated till death comes. The ethical, legal, emotional and societal implication of routine screening were discussed and recommendations based on available scientific evidence were made.

Jehovah's Witnesses and blood transfusion revisited: a review of the benefits and risks.

Physicians face a special challenge when treating Jehovah's witnesses. As a result of Jehovah's witnesses rigorous pursuit of medical alternatives to blood, many cardiac, obstetric and gynaecological, orthopaedic and urological surgeries that traditionally require blood transfusion can now be performed successfully without using blood or blood products. Despite the obvious advantages of this bloodless surgery, blood transfusion remains are important life saving procedure. Respecting the religious consciences of Jehovah's witnesses may challenge our skills. Though their reason for refusing blood transfusion may seem controversial, physicians should be careful to avoid being held liable in view of the laws that accommodate their belief. This paper attempts to give an overview on this issue.

Male contribution to infertility in Ile-Ife, Nigeria.

This is a retrospective study of 350 cases of male partners of infertile couples who presented at the gynaecological and urological units of Ife State Hospital branch of Obafemi Awolowo University Teaching Hospital complex Ile-Ife, Nigeria within a five year (1993-1997) period. Of the 350 cases reviewed, 200 (57.6%) had normal seminal fluid parameters while 27.7% had oligozoospermia and 15.2% had azoospermia. The age and past history of sexually transmitted diseases (STDs) had significant effect on the result of seminal fluid analysis (p < 0.05 respectively) while the occupational status had no significant effect (p > 0.05). Most of the infertile couple presented with secondary infertility (62%) with a significant past history of sexually transmitted diseases (STDs) (p < 0.05). Efforts directed to the prevention of STDs should be pursued vigorously by health care providers. Education of the populace on responsible sexual habits cannot be overemphasized.

Elemental profile in amniotic fluid of some Nigerian pregnant women.

In this study concentration level of calcium, cadmium, copper, iron, magnesium, manganese, nickel, lead and zinc were determined in the amniotic fluid of pregnant women, aged 15 - 45 years enrolled at the Obafemi Awolowo University Teaching Hospitals Complex Ile - Ife. This was with a view to predict the body burden of the metals in the pregnant women and assess the health implications of the toxic elements to the pregnant women and their fetuses. Fifty samples of the amniotic fluid were collected from the pregnant women. The efficiency of extraction of trace metals using conventional wet acid digestion method (CDM) and microwave induced acid digestion method (MWD) was determined by recovery experiments. Levels of trace metals were determined using Atomic Absorption Spectrophotometry. The high percentage recoveries obtained from MWD made it a more efficient method than the CDM and hence its adoption for sample digestion. Statistical analysis of data using descriptive and inferential statistics revealed that age; education and profession have effects on the levels of the trace metals. The mean levels of most of the toxic metals obtained in this study were lower than the recommended limits of trace metals in women whole blood.