The role of universal health coverage in the eradication of obstetric fistula in Nigeria-A commentary.

Obstetric fistula is a serious public health problem affecting women in low- and middle-income countries. It is characterized by continuous leakage of urine and/or feces from the vagina as a result of injuries sustained from childbirth. It has continued to exist in Nigeria because the publicly funded health-care system has failed to provide quality, equitable, accessible, and affordable maternal health care. It is largely a problem of poor, young, uneducated, and rural women who lack access to quality maternity care. Universal health coverage implies a system which provides quality health-care and financial protection to all citizens of a country. This is attained when all citizens have the needed health services without being subjected to out-of-pocket expenditure. Universal health coverage is currently not obtainable in Nigeria. When implemented, it will eliminate the existing inequality in access to health care, thereby allowing the poor and vulnerable citizens access to quality maternity care and safe delivery. A comprehensive health insurance cover for all pregnant women regardless of socioeconomic status, priority setting in resource allocation, and public-private partnership are advocated for eradication of obstetric fistula in Nigeria.

Misoprostol versus manual vacuum aspiration for treatment of first-trimester incomplete miscarriage in a low-resource setting: A randomized controlled trial.

BACKGROUND: Manual vacuum aspiration is a safe and effective technology for the treatment of incomplete miscarriage but it is not widely available and affordable in rural areas particularly in low-resource countries. Misoprostol is an alternative to manual vacuum aspiration for the treatment of incomplete miscarriage. AIM: To compare the effectiveness, client acceptability and satisfaction, and cost-effectiveness of misoprostol with manual vacuum aspiration for the treatment of the first-trimester incomplete miscarriage. SUBJECTS AND METHODS: This study was conducted between February 1, 2018 and August 31, 2018 at Alex Ekwueme Federal University Teaching Hospital Abakaliki, Nigeria. 100 participants were randomized to treatment with either manual vacuum aspiration or 600 µg oral misoprostol. The main outcome measures assessed at 1-week follow-up were complete uterine evacuation, client acceptability and satisfaction, and cost-effectiveness. Data were analyzed using SPSS version 25. Sociodemographic characteristics, treatment outcomes and other variables were summarized by descriptive statistics. Chi-square test was used for comparison between groups as regard categorical data while Student's't' test was used for comparison between groups for continuous data. P value of <0.05 was regarded as statistically significant. RESULTS: There was a higher failure rate in the misoprostol arm when compared with MVA. Although this difference in complete uterine evacuation rate did not reach statistical significance (81.3% versus 95.7%, RR = 4.3, 95% CI 0.98-18.9, P value = 0.05), more participants in the misoprostol arm would choose the method again when compared with women in the MVA group (47 versus 30, X[2] = 16.95, P < 0.001). The mean client satisfaction score was significantly higher among women in the misoprostol arm compared to MVA group (13.2 (2.1) versus 7.3 (4.6), P < 0.001). The mean cost of primary treatment was higher in the MVA group compared with misoprostol arm ($67.8 (8.9) versus 14.4 (4.0), P < 0.001). There was no significant difference in the mean cost of repeat uterine evacuation in both study arms (MVA, $64.9 (6.3) versus misoprostol, $65.76 (6.6), P = 0.86). CONCLUSION: Although medical treatment was associated with a higher failure rate, there was no statistically significant difference in the effectiveness of both treatment methods. However, medical treatment was associated with higher client acceptance and satisfaction and was more cost-effective than surgical treatment.

Birth preparedness and complication readiness among women of reproductive age group in Abakaliki, Southeast Nigeria.

BACKGROUND: Birth preparedness and complication readiness (BPCR) reduces delays in obstetric care, improves health-seeking behavior during an obstetric emergency, and improves knowledge on danger signs of pregnancy. AIMS: To assess the knowledge, perception, and practice of women on BPCR. SUBJECTS AND METHODS: This was a cross-sectional study conducted at Federal Teaching Hospital in Ebonyi state, Nigeria at the postnatal ward from June to December 2016. Women who delivered were recruited consecutively on discharge from the postnatal ward. Their knowledge, perception, and practice of BPCR in the last pregnancy were sought. Information obtained were analyzed using 2008 Epi-info™ software version 3.5.1 (Atlanta Georgia USA). RESULT: A total of 438 of 445 questionnaires were correctly filled and analyzed giving a response rate of 98.4%. Most of the women knew about birth preparedness 384 (87.7%) and complication readiness 348 (79.5%). A significant number of women did not access antenatal care within the first trimester 236 (53.9%), did not know that family planning is important in BPCR 216 (49.3%), and did not identify means of transport in the event of emergency 354 (80.8%). No provision of blood during antenatal care for the blood banking system was a common finding 258 (58.9%). In multivariate logistic regression analysis, choosing a health care provider was a common finding among literate mothers (OR = 2.8,95% CI = 1.02,7.72), woman within 25-29 years (OR = 1.09, 95%CI = 1.02,1.16), and multiparas (OR = 0.82, 95% CI = 0.67,0.99). CONCLUSION: There is increased knowledge and awareness of BPCR but the comprehensive components and practices of BPCR are still not optimal in our setting.

Prevalence and antimicrobial susceptibility of asymptomatic bacteriuria among women with pelvic organ prolapse in Abakaliki, South-East Nigeria.

BACKGROUND: Pelvic organ prolapse (POP) is the herniation of pelvic organs from its anatomical confines, and it is of considerable importance to the practicing gynaecologist in middle and low income countries. It is commonly associated with, urinary tract infection (UTI), both symptomatic and asymptomatic due to anatomical and physiological changes. The aim of this study was to determine the prevalence of asymptomatic bacteriuria among women with pelvic organ prolapse, to know the organisms commonly implicated and the sensitivity pattern. METHODS: This study was conducted among 96 women with POP at the National Obstetric Fistula Centre Abakaliki. A cross sectional descriptive study was done. Standard microbial technique was used to analyze the urine. Data was analysed using the Statistical Package for Social Sciences version 17. RESULTS: Out of the 96 patients, 76 were found to have asymptomatic bacteriuria giving a prevalence of 79.2%. Nine different bacteria species isolated include E. Coli (34.2%), Streptococcus pneumonia (23.7%), Staphylococcus aureus (7.9%), Proteus Spp (7.9%) others (5.3%). The highest level of microbial sensitivity to the antimicrobials was with Ciprofloxacin. CONCLUSIONS: This study suggests that prevalence of asymptomatic bacteriuria is very high among women with POP. More than 50% of the bacterial isolates were mainly E.coli and Streptococcus pneumonia. The highest level of microbial sensitivity was with ciprofloxacin while the least was with cotrimoxazole.

Audit of mammography requests in Abakaliki, South-East Nigeria.

BACKGROUND: Breast cancer is the leading cancer in women in both developed and developing countries. Screening mammography detects breast cancer even before a lump can be palpated, with better prognosis. The introduction of mammographic technique for screening breast cancer, despite its importance, has been slow to adopt and virtually non-existent in many parts of Sub-Saharan Africa including Nigeria. For this reason, the indications of mammography have not been well defined in our setting. The aim of this study was to audit our mammography requests, with a view to improving its application in our setting. METHODS: This is a descriptive study carried out on 69 female patients who had mammography at the National Obstetric Fistula Centre, Abakaliki, from January 2014 to December 2015. Findings on clinical examination were entered in a proforma. Mammography was performed in craniocaudal and mediolateral views using the Lorad M-IV (film-screen) mammography machine. Data was analysed using the Statistical Package for Social Sciences (SPSS) version 21. RESULTS: All 69 patients were females. Their mean age was 42.1 ± 11 years. Majority of the patients (69.6%) were between 30 and 49 years. The commonest indication for mammography was breast lump which was found in 46 patients (66.7%). Breast pain was present in 36 (52.2%) of patients. The different Breast Imaging Reporting and Data System (BIRADS) categories were BIRADS 0: 20 (28.99%), BIRADS 1: 8 (11.59%), BIRADS 2: 9 (13.04%), BIRADS 3: 4 (5.8%), BIRADS 4: 19 (27.54%) and BIRADS 5: 9 (13.04%). CONCLUSIONS: Diagnostic mammography remains the commonest indication for mammography in our setting. Public awareness, poverty reduction and ready availability of mammography facilities are required to improve screening mammography in our setting.

Determination of antioxidant status of pre-eclamptic and normotensive sub-rural Nigerian pregnant women at the Irrua Specialist Teaching Hospital, Irrua, Edo State.

OBJECTIVES: To determine the antioxidant levels of subrural Nigerian population where pre-eclampsia and eclampsia is the leading cause of maternal mortality. METHODS: Prospective case control study done at Department of Obstetrics and Gynaecology, Irrua Specialist Teaching Hospital Irrua, Edo State, Nigeria. Plasma level of vitamin C and E were evaluated in 80 pre-eclamptic patientswhich were compared with normotensive 80 pregnant women matched as controls. RESULTS: Pre-eclampsia was associated with significant reduction in levels of vitamin C and E (p < 0.05). However, the correlation between the blood pressure (severity) and reduction in antioxidants level was not statistically significant. CONCLUSION: Pre-eclampsia at Irrua in Nigeria is associated with significant reduction in plasma antioxidants level similar to some reports from the other parts of the world.