Pregnancy Outcome Following Treatment of Premalignant Lesion of the Cervix in Southeast Nigeria; A Retrospective Case-Control Study.

BACKGROUND: Treatment of cervical pre-cancers involves ablative and excisional therapies, and these have the potential to affect future pregnancy outcomes of women. Understanding the impact of the various treatment modalities on the outcome of pregnancies can motivate the development of interventions to improve pregnancy outcomes in women who had cervical pre-cancer treatment. AIM: We aimed to the effect of cervical pre-cancer treatment on second-trimester miscarriages and preterm births. MATERIALS AND METHODS: Matched case-control study in which 373 women who had a pregnancy after cervical pre-cancer treatment were matched with 373 controls. McNemar Chi-square was used to compare the prevalence of second-trimester miscarriage and preterm birth between the study group and the matched controls. Conditional logistic regression analysis was done to determine the risk factors for second-trimester miscarriage and preterm birth. RESULTS: Second-trimester miscarriages and preterm births were higher in women who had cervical pre-cancer treatment (AOR: 2.05, 95% CI: 1.174 - 3.693, p: 0.01) and (AOR: 2.74, 95% CI: 1.591 - 4.902, p: 0.0001) respectively. In addition, large loop excision of the transformation zone (LLETZ) of the cervix increased the odds of second-trimester miscarriage (AOR: 1.22, 95% CI: 1.034 - 1.441, p: 0.019) and preterm birth (AOR: 2.98, 95% CI: 1.793 - 3.965, p: 0.001). Cryotherapy and thermocoagulation were not associated with increased miscarriage and preterm birth. Treatment to pregnancy interval of ≥ 12 months decreased the odds of second-trimester miscarriage (AOR: 0.605, 95% CI: 0.502 - 0.808, p: 0.031) and preterm birth (AOR: 0.484, 95% CI: 0.317 - 0.738, p: 0.001). CONCLUSION: There is an increased odds of second-trimester miscarriage and preterm birth in women treated with LLETZ. A treatment-to-pregnancy interval of ≥ 12 months reduces this odd. Ablative therapies do not increase the odds of miscarriages and preterm births. This information could guide decisions on the choice of method of treatment for cervical pre-cancer in women of childbearing age.

Prevalence and risk factors associated with musculoskeletal disorders among pregnant women in Enugu Nigeria.

BACKGROUND: Pregnancy usually triggers a wide range of changes that result in a variety of musculoskeletal disorders (MSDs). The scope and burden of these disorders in Nigeria are not known. AIM: The study aimed to determine the prevalence and risk factors of pregnancy-related MSDs in Enugu. PATIENTS AND METHODS: A cross-sectional study of pregnant women attending antenatal clinics at three tertiary hospitals in Enugu, Nigeria, was done using an observer-administered questionnaire. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 22. RESULTS: A total of 317 participants were studied. A majority of the participants (93.1%) had one or more MSDs. Low back pain (LBP) and muscle cramps were the two most common pregnancy-related MSDs with prevalence rates of 56.8 and 54.8%, respectively. Increasing gestational age (P = 0.001), previous pregnancies (P = 0.027), and occupation (P = 0.018) were associated with increased risk of MSDs. A majority of the MSDs were of mild and moderate severity and 10.4% of the participants had significant impairment of their daily activities. CONCLUSION: MSDs are common in pregnancy with LBP and muscle cramps as the most prevalent conditions. Increasing gestational age, multigravidity, and occupation increased the risk of MSDs among our cohorts. Preventive and therapeutic measures should be instituted when necessary to ensure optimal maternal health during pregnancy.

The Impact of Infertility on the Sexual Life of Infertile Women in Enugu, South East Nigeria.

BACKGROUND: Infertility is a common gynecological problem in sub-Saharan Africa, including Nigeria. It tends to affect the sexual life of couples and may affect their quality of life. OBJECTIVE: The study was aimed to assess the impact of infertility on the sexual life of women with infertility seeking care in Enugu, South-East Nigeria. METHODS: A questionnaire-based, multicenter cross-sectional study of women with infertility managed at the Gynecology units of the two government-owned tertiary hospitals in Enugu over a 2 months period. The relevant data were obtained and analyzed using SPSS version 20.0. RESULTS: Three hundred and sixty female respondents participated in the study. Their mean age was 35.23 ± 5.7 years. The majority of them were married (98.3%) and attained a tertiary level of education (69%). The number of respondents that reported adequate sexual intercourse dropped from 33.9% before the diagnosis of infertility to 12.2% after the diagnosis. Almost two-thirds of the respondents (65%) reported that they no longer enjoy sex with their husband/partner, whereas 38.9% of them feel they were no longer attracted to their partners. CONCLUSION: Infertility seems to have a negative effect on the sexual life of women. Addressing this identified negative effect may improve the outcome of infertility management and also may improve the quality of life of women with infertility in the region.

Impact of perceptions of body size on obesity and weight management behaviour: a large representative population study in an African setting.

BACKGROUND: Perception of body size is an important psycho-cultural cause of obesity with wide racial and ethnic variations. METHOD: Cross-sectional household survey using multistage cluster-randomised sampling. Prevalence estimates were weighted. Logistic regressions were done to determine the impact of perception of large body size on obesity and the impact of perception of own body size on weight-management behaviour. Adjusted odds ratios (AOR) were reported. RESULTS: The survey involved 6628 adults from 2843 households. More than a quarter of the population is either obese or overweight. Nearly half, 44.07% (95% confidence interval [CI]: 42.48-45.66%) of the population perceive large body size as desirable. Positive perception of large body size significantly increases the odds of obesity by 1.5 (AOR: 1.45; 95% CI: 1.09-1.9). Some 42.03% (95% CI: 35.52-48.55%) obese persons misperceive their weight to be normal. Perceiving own body size as normal decreases the odds of weight-losing behaviour (AOR: 0.019; 95% CI: 0.014-0.026). CONCLUSION: There is a high level of veneration of large body size in southeast Nigeria, and this has a significant impact on obesity burden. Perception of own body size has a significant impact on weight-management behaviour. Health-promotion policies aimed at changing the social desirability of large body size and misperception of body size are recommended.

Impact of abortion laws on women's choice of abortion service providers and facilities in southeastern Nigeria.

BACKGROUND: The liberalization of abortion laws in Nigeria has been an interesting debate for a long time. Both proponents and opponents have defended their positions with similar vigor. However, the opinion of the Nigerian woman on the subject matter has received little attention. It is important to understand the opinion of the Nigerian woman, especially with regard to the potential impact of any abortion law on unsafe abortion. OBJECTIVE: The objective of this study is to determine the impact of abortion laws on women's choice of abortion service providers and facilities in Southeastern Nigeria. METHODS: Women attending the gynecological clinics of two tertiary hospitals in Southeastern Nigeria were interviewed with interviewer-administered questionnaires. Questions were asked on awareness of abortion laws, opinion on liberalization of abortion laws, and the impact of abortion laws on women's choice of abortion service providers in situations of unwanted pregnancies. RESULTS: A total of 1120 women were interviewed. More than half (57.7%) of respondents were aware of the abortion laws of Nigeria. About 59.2% of respondents had previously done abortion for unwanted pregnancies. Some (78.3%) of respondents indicated that abortion laws will not influence their choices of abortion service providers in cases of unwanted pregnancies. Majority (78%) do not support liberalization of abortion laws. CONCLUSION: The abortion laws in Nigeria do not influence women's choice of abortion service providers and facilities. Factors other than the contents of abortion laws influence women's choices. The findings of this study open a new vista toward the search for the factors that drive unsafe abortion in Nigeria.

Impact of visual inspection with acetic acid plus cryotherapy "see and treat" approach on the reduction of the population burden of cervical preinvasive lesions in Southeast Nigeria.

OBJECTIVE: The aim of this study is to determine the impact of visual inspection with acetic acid (VIA) plus immediate cryotherapy on the prevalence of VIA-detected cervical squamous intraepithelial lesion (SIL). METHODS: Women in four rural communities in Southeast Nigeria were screened with VIA. Women who tested positive to VIA were offered either immediate cryotherapy or large loop excision of the transformation zone based on predetermined eligibility criteria. Cervical biopsies were taken before cryotherapy and examined by consultant histopathologists. All participants were rescreened 1 year later. The main outcome measures were population prevalence of cervical precancers before and after intervention, cure rates, and over-treatment rates. RESULTS: A total of 653 women participated in the study. The prevalence of cervical SIL before the intervention was 8.9% (58/653). The prevalence 1 year later was 1.4% (9/649). This gave an 84.3% reduction in the population prevalence of SIL. The reduction in cervical SIL prevalence was statistically significant (P = 0.0001). The prevalence of high-grade SIL reduced significantly from 4.1% (27/653) preintervention to 0.5% (3/649) 1 year postintervention (P = 0.0001). This gave an 87.8% reduction in the population prevalence of high-grade SIL. Cryotherapy provided a cure rate of 87.9% (95% confidence interval: 76.82-94.33). CONCLUSION: Population cervical cancer prevention using VIA plus immediate cryotherapy leads to significant reduction in the population prevalence of cervical SIL. This has the potential of being an acceptable supplement to cervical cytology for cervical cancer prevention in low-income populations.

Presence of chaperones during pelvic examinations in southeast Nigeria: women's opinions, attitude, and preferences.

OBJECTIVES: To assess the opinions, attitude, and preferences of Nigerian women to the presence of chaperones during pelvic examinations. MATERIALS AND METHODS: A cross-sectional survey of first time gynecology clinic attendees on their opinions, attitudes, and preferences with respect to the presence of chaperones during their pelvic examinations. The interview was conducted with the aid of semi-structured, researcher-administered questionnaires. RESULTS: One hundred and nineteen (51.7%) of the respondents preferred female physicians for pelvic examination, 23 (10%) preferred male physicians and 88 (38.3%) had no gender preference. When the examining physician is a male, 124 (53.9%) respondents would like to have chaperones during pelvic examinations while 106 (46.1%) would not. Eighty-three percent of respondents preferred nurse chaperones. Age, level of education, and parity did not have any significant relationship with the attitude of the respondents toward the presence of chaperones ( P = 0.503, 0.525, and 0.605 respectively). CONCLUSIONS: We conclude that most southeastern Nigerian women would prefer their pelvic examinations to be done by a female physician or to be attended by a nurse chaperone if the examining physician is a male. We recommend a routine offer of chaperones during such examinations while respecting the patients' right to refuse the offer.

Effect of the Foley catheter and synchronous low dose misoprostol administration on cervical ripening: a randomised controlled trial.

This randomised controlled trial was carried out over a 14-month period in a tertiary health institution in Nigeria, to determine the effectiveness of Foley catheter and synchronous low dose misoprostol for pre-labour cervical ripening. Term pregnant women with unfavourable cervices (Bishop's score < 6) requiring cervical ripening/induction of labour were assigned randomly into three groups: Group A, transcervical Foley catheter was used synchronously with low dose intravaginal misoprostol; Group B, transcervical Foley catheter alone was used and Group C, low dose intravaginal misoprostol alone was used. The time to achieve a favourable cervical status as well as vaginal delivery was significantly shorter in the synchronous group than in the control groups (p < 0.05). The synchronous use of Foley catheter and misoprostol is very effective in cervical ripening and should be considered in clinical situations where there is need to hasten vaginal delivery in the presence of an unripe cervix.

Anaemia in pregnancy: a public health problem in Enugu, southeast Nigeria.

The aim of the study was to determine the prevalence of anaemia in pregnancy at booking and to determine factors associated with its occurrence in order to proffer solutions. This was a 12-month cross-sectional study of pregnant women attending the antenatal clinic for the first time (booking visit) at ESUTTH, Enugu, Nigeria from 1 April 2009 to 31 March 2010. Sociodemographic characteristics of the mothers were extracted using an already prepared proforma. The blood haemoglobin concentration and HIV status of the women were determined and the results were analysed. The prevalence rate of anaemia in pregnancy was 64.1%. Based on severity, 94.6%, 4.3%, 1.1% of them had mild, moderate and severe anaemia. The mean age of the anaemic women was significantly lower than that of the non-anaemic women (p = 0.0001). Those that had no formal education and those that booked for antenatal care in the 3rd trimester had a significantly higher prevalence of anaemia. HIV-positive pregnant women had a significantly higher prevalence of anaemia than HIV-negative pregnant women (p = 0.0072, odds ratio 2.37). It was concluded that the prevalence of anaemia in pregnancy from the study is unacceptably high. To achieve Millennium Development Goals 4 and 5, efforts must be geared towards its prevention to ensure a healthy baby and mother.

Presence of Chaperones during Pelvic Examinations in Southeast Nigeria: Women's Opinions; Attitude; and Preferences

Objectives: To assess the opinions; attitude; and preferences of Nigerian women to the presence of chaperones during pelvic examinations.Materials and Methods: A cross-sectional survey of first time gynecology clinic attendees on their opinions; attitudes; and preferences with respect to the presence of chaperones during their pelvic examinations. The interview was conducted with the aid of semi-structured; researcher-administered questionnaires.Results: One hundred and nineteen (51.7) of the respondents preferred female physicians for pelvic examination; 23 (10) preferred male physicians and 88 (38.3) had no gender preference. When the examining physician is a male; 124 (53.9) respondents would like to have chaperones during pelvic examinations while 106 (46.1) would not. Eighty-three percent of respondents preferred nurse chaperones. Age; level of education; and parity did not have any significant relationship with the attitude of the respondents toward the presence of chaperones (P = 0.503; 0.525; and 0.605 respectively).Conclusions: We conclude that most southeastern Nigerian women would prefer their pelvic examinations to be done by a female physician or to be attended by a nurse chaperone if the examining physician is a male. We recommend a routine offer of chaperones during such examinations while respecting the patients' right to refuse the offer

Survey of Women's Opinions on Female Genital Mutilation (FGM) in Southeast Nigeria: Study of Patients Attending Antenatal Clinic

Background: Female genital mutilation is known to exist especially in many third world countries including Nigeria with many women being victims of this harmful practice and its complications. The practice is rife in Southeast Nigeria and efforts have been made to discourage it. Objective: To determine women's views on aspects of female genital mutilation and the prevalence among the study population. Method: Women attending the antenatal clinics of two university teaching hospitals in Southeast Nigeria were interviewed by means of structured pre-tested interviewer- administered questionnaires. The data obtained were analysed using SPSS version 10.0 and the results expressed in descriptive statistics as percentages. Results: The prevalence of FGM was 42.1. However; only 14.3of the respondents circumcised their own daughters or showed willingness to circumcise their daughters indicating considerable reduction in uptake of the practice. A larger proportion (63.7) would support legislation against FGM. Conclusion: There is a high opinion against the practice of FGM in Southeast Nigeria; with the majority of the women showing support for legislation

Obstetricians' attitudes to caesarean delivery on maternal request in Nigeria.

The study was done to determine obstetricians' attitude to and factors predicting obstetricians' acceptance of caesarean delivery on maternal request in Nigeria. Nigerian obstetricians were asked to respond to case scenarios depicting caesarean delivery on maternal request without medical indications and the reasons for their responses. The case scenarios were designed from previously published reasons for caesarean delivery on maternal request from Nigeria. Multiple logistic regressions analysis was done to determine factors predicting obstetricians' acceptance of caesarean delivery on maternal request out of respect for maternal autonomy. The majority (53.1%) of the respondents would accept caesarean delivery on maternal request out of respect for maternal autonomy. Caesarean requests backed up by social mitigating circumstances of previous childlessness and previous negative labour experience received significantly higher acceptances than requests with no back-up mitigating circumstances (p < 0.0001). A good proportion (48.8%) of Nigerian obstetricians had performed at least one caesarean on maternal request. Obstetricians' bio-professional characteristics do not influence their attitude to request caesarean delivery on maternal request. Some obstetricians expressed fear of legal consequences from caesarean delivery on maternal request.

Women in southern Nigeria with change in paternity do not have increased incidence of pre-eclampsia.

This was a prospective cohort study of women in their second pregnancies aimed at determining if there was a difference in the incidence of pre-eclampsia between those with changed paternity and those without change in paternity in an entirely black African population. Women in their second pregnancies receiving antenatal care between September 2006 and August 2007 were recruited into the study between 10 and 20 weeks' gestational age and followed up until 37 weeks' gestation. The main outcome measures included incidence of pre-eclampsia in relation to change in paternity at second pregnancy, incidence of pre-eclampsia in relation to duration of sexual cohabitation among those with changed paternity and inter-pregnancy interval. There was no significant difference in the incidence of pre-eclampsia between women who had changed paternity and those without change in paternity (3.5% vs 3.1%, p=0.835). The inter-pregnancy interval was also similar in both groups. The mean duration of sexual cohabitation was similar between women who had changed paternity that developed pre-eclampsia and those that did not develop pre-eclampsia (7.9+/-1.3 vs 7.5+/-2.1 months, p=0.531). It was concluded that Southern Nigerian women with change in paternity in their second pregnancies do not have increased incidence of pre-eclampsia.

The burden of caesarean section refusal in a developing country setting.

OBJECTIVE: To investigate the prevalence, aetiology and outcomes of caesarean section refusal in pregnant women. DESIGN: A prospective controlled study. SETTING: University of Nigeria Teaching Hospital and Aghaeze Hospital, Enugu, Nigeria. POPULATION: A total of 62 Nigerian women who declined elective caesarean section. METHOD: Interviewer-administered questionnaires at the time of caesarean section refusal and postdelivery. The delivery outcomes of the subjects were compared with that of a matched control group of women who accepted caesarean section. MAIN OUTCOME MEASURES: Prevalence, maternal reasons for caesarean section refusal and the resultant maternal and perinatal mortality. RESULTS: The prevalence of caesarean section refusal was 11.6% of all caesarean deliveries. Maternal reasons for refusing caesarean section include fear of death, economic reasons, desire to experience vaginal delivery and inadequate counselling. Outcomes were significantly worse among women who refused elective caesarean section than in the controls with a maternal mortality of 15% (versus 2%, P = 0.008) and a perinatal mortality of 34% (versus 5%, P < 0.001). CONCLUSION: There is a high prevalence of caesarean section refusal in south-eastern Nigeria. Women declining caesareans have very poor maternal and perinatal outcomes and need extra support.

A 4-year analysis of caesarean delivery in a Nigerian teaching hospital: one-quarter of babies born surgically.

Between January 2001 and December 2004, a total of 2,922 deliveries were conducted at the University of Nigeria Teaching Hospital , Enugu. Caesarean section accounted for 740 deliveries, an incidence of 25.3%. A total of 62.2% of caesarean sections were done as emergencies, while 37.8% were done as elective procedures and 64.8% were booked patients. Repeat caesarean sections accounted for 59.2% of elective cases and 18.7% of emergency cases. Fetal distress was responsible for 11. 6% of emergency cases, however 35.6% of babies delivered for clinically diagnosed fetal distress had Apgar scores 7 and above. A total of 85.6% of patients were between 25 - 29 years of age; 31% were primigravida, while 54.4% were Gravida 2 - 4. There were seven (0.6%) maternal deaths and 73 (9.2%) stillbirths. It was concluded that reduction of primary caesarean section rate and repeat caesarean rates should be the main target of any strategy to reduce caesarean section rate. Other measures to reduce the caesarean section rate and recommendations are discussed.

Women's experiences following failed vaginal birth after cesarean delivery.

OBJECTIVE: To assess the experience of women in whom a trial of vaginal birth after cesarean (VBAC) has failed. METHODS: Pretested self-administered questionnaires containing both open- and closed-ended questions were given to the participants while they were waiting for an antenatal check-up. The responses to the closed-ended questions were analyzed with descriptive statistics. Content analysis was used for the responses to the open-ended questions. RESULTS: The women with a history of a successful vaginal delivery reported a positive experience whereas those with no history of vaginal delivery reported a negative experience. The women found the limited options available to them the most dissatisfying aspect of attempting a VBAC. CONCLUSION: An unsuccessful trial of VBAC could have significant adverse effects on women, especially on those who have never given birth vaginally. Adequate antenatal education for women planning a trial of VBAC, postdelivery support following an unsuccessful trial of VBAC, and research aimed at expanding the options available to women as they are attempting VBAC are recommended.

Induction of labor on request in a resource-poor setting.

OBJECTIVE: To determine the prevalence of and reasons for induction of labor on maternal request in a setting where aversion to induction of labor is the norm. METHOD: Women undergoing induction of labor on maternal request at three maternity centers in Enugu, Nigeria were interviewed by means of pre-tested self-administered questionnaires. The outcomes of labor in these women were also compared with those of a control group consisting of women who had induction of labor for medical reasons. RESULTS: The prevalence of induction of labor on maternal request was 7.4%. Maternal convenience was the commonest reason for request induction. The outcomes of labor were similar between the subjects and their controls. CONCLUSION: Nigerian women are beginning to request induction of labor without medical indications and have comparable outcomes with those who have medical indications. There is need for appropriate regulatory guidelines.

Cesarean section on request in a developing country.

OBJECTIVE: To assess the prevalence of cesarean sections (CSs) and women's reasons for requesting the procedure in a developing country. METHOD: Pregnant women scheduled for elective CS were interviewed to determine whether the procedure was requested by them or suggested by a physician. The women who personally requested a CS filled out questionnaires before surgery and at the postnatal visit 6 weeks later, and their answers were analyzed. RESULTS: The prevalence of CS on request was 4.4%. Previous infertility and advanced maternal age at first pregnancy were the most common reasons for requesting a CS, but most women said they would prefer a vaginal delivery in subsequent pregnancies. CONCLUSION: The women who requested a CS in this study did so for reasons different from those put forth by women in developed countries. The view that a CS is the surest way toward a live birth was the critical factor underlying their choice.

Juxtacervical vesicovaginal fistulae: outcome by route of repair.

Vesicovaginal fistula is a major public health problem in Nigeria with diverse medical, psychological and social consequences for the patient. This study compared the outcome of vaginal vs abdominal repair of juxtacervical vesicovaginal fistulae. It was a retrospective review undertaken at the University of Nigeria Teaching Hospital, Aghaeze Hospital and Mbanefo Hospital, all in Enugu, Nigeria, from 1 January 1992 to 31 December 2004. The outcome measures were primary repair success rate, blood transfusion, postoperative urinary tract infection rate and duration of hospital stay. Abdominal repair of juxtacervical vesicovaginal fistula was associated with a significantly higher need for blood transfusion when compared with vaginal repair. Both routes of repair had similar primary repair success rates, postoperative urinary tract infection rates and duration of hospital stay. It was concluded that the route of repair of juxtacervical vesicovaginal fistula should be determined by accessibility of the fistula and whenever possible, the vaginal route should be preferred.