Prevalence and Determinants of Female-Perpetrated Intimate Partner Violence against Heterosexual Men Living with HIV in a Semi Rural Community, Northern Nigeria.

BACKGROUND: Globally, female-perpetrated IPV has been well studied among various groups but little is known about IPV against heterosexual men living with HIV. This study sought to identify the prevalence and determinants of female-perpetrated IPV among heterosexual HIV-positive men in Birnin Kudu, Jigawa State, Nigeria. MATERIALS AND METHODS: This was a descriptive crosssectional study carried out at one secondary and tertiary health facility respectively, both situated in Birnin Kudu. Using an intervieweradministered pre-tested questionnaire, the prevalence and determinants of female-perpetrated IPV was assessed among 322 heterosexual HIV-positive men attending the anti-retroviral therapy clinics at the two health facilities. Data was entered into and analyzed using statistical package for social sciences version 25. RESULTS: The prevalence of IPV in the last year was 45% (145D 322). Out of the survivors of IPV, 143 (98.6%), 75 (51.7%), and 51 (35.2%) had experienced psychological aggression, physical assault and sexual coercion respectively. The number of children fathered, experience of childhood violence, and marital status were significantly associated with IPV (p< 0.05) However, they remained significant determinants of IPV after controlling for confounders (ethnicity, marital status, educational status ) {Adjusted Odds ratio (aOR) = 7.34 and 95% confidence interval (C.I.) = 1.49 - 35.4; aOR= 1.84 C.I. 1.33 - 2.80; aOR = O.51 (0.29 - 0.90) respectively}. CONCLUSION: This study identified a high prevalence of femaleperpetrated IPV against heterosexual men living with HIV and emphasizes that exposure to childhood violence and being childless are determinants of IPV. Efforts should be made to screen for IPV among men living with HIV so as to optimize their health and wellbeing.

CONTEXTE: Globalement, la VPI perpétrée par les femmes a été bien étudiée dans divers groupes, mais on sait peu de choses sur la VPI à l'encontre des hommes hétérosexuels vivant avec le VIH. Cette étude visait à identifier la prévalence et les déterminants de la VPI perpétrée par les femmes parmi les hommes hétérosexuels séropositifs à Birnin Kudu, dans l'État de Jigawa, au Nigéria. MATÉRIELS ET MÉTHODES: Il s'agit d'une étude descriptive transversale menée dans un établissement de santé secondaire et tertiaire, tous deux situés à Birnin Kudu. À l'aide d'un questionnaire pré-testé administré par un enquêteur, la prévalence et les déterminants de la VPI perpétrée par les femmes ont été évalués parmi 322 hommes hétérosexuels séropositifs fréquentant les cliniques de thérapie antirétrovirale dans les deux établissements de santé. Les données ont été saisies et analysées à l'aide de la version 25 du logiciel statistique pour les sciences sociales. RÉSULTATS: La prévalence de la VPI au cours de la dernière année était de 45% (145D 322). Parmi les survivantes de VPI, 143 (98,6 %), 75 (51,7 %) et 51 (35,2 %) avaient subi respectivement une agression psychologique, une agression physique et une coercition sexuelle. Le nombre d'enfants engendrés, l'expérience de la violence dans l'enfance et l'état matrimonial étaient significativement associés à la VPI (p<0,05). Cependant, ils restaient des déterminants significatifs de la VPI après contrôle des facteurs de confusion (ethnicité, état matrimonial, niveau d'éducation) {Ratio de probabilité ajusté (RNA) = 7,34 et intervalle de confiance à 95 % (IC) = 1,49 - 35,4 ; RNA = 1,84 IC 1,33 - 2,80 ; RNA = O,51 (0,29 - 0,90), respectivement}. CONCLUSION: Cette étude a mis en évidence une forte prévalence de la VPI perpétrée par des femmes à l'encontre d'hommes hétérosexuels vivant avec le VIH et souligne que l'exposition à la violence pendant l'enfance et le fait de ne pas avoir d'enfants sont des facteurs déterminants de la VPI. Des efforts devraient être faits pour dépister la VPI chez les hommes vivant avec le VIH afin d'optimiser leur santé et leur bien-être. Mots clés: Prévalence, Violence entre partenaires intimes, Déterminants, Hommes, Femmes, Coercition, Infection par le VIH, Survivants, Nigeria.

Predictors of Satisfaction with Wound Care Services in an Outpatient Setting in Kano, Nigeria.

BACKGROUND: With the global increase in chronic wounds and the paucity of studies on patient experiences at wound care facilities, we assessed the factors associated with satisfaction with wound care services among patients or their caregivers in a Northwest Nigerian outpatient setting. METHODS: Participants were systematically selected from patients or their caregivers attending the General Outpatient Clinic of Aminu Kano Teaching Hospital, Kano, for wound dressing. A structured self-administered questionnaire was used to obtain information regarding their sociodemographic and clinical characteristics and satisfaction with service domains. Data were analyzed using descriptive and inferential statistical methods. RESULTS: There were 170 participants. Their mean age was 31.9±11.4 years, and they were mainly female (55.3%). The overall satisfaction rate was 85.9% (146/170); however, 51.8% and 55.3% of participants were dissatisfied with the advice on home wound care and waiting time, respectively. Employment status, wound location, having sickle cell disease, needing a wheelchair to reach the wound dressing room and perceived availability of a wheelchair were associated with overall satisfaction (P<0.05). The predictors of overall satisfaction were chronic wounds, wound in areas other than the lower limbs/buttocks, and perceived availability of wheelchairs. CONCLUSION: The overall satisfaction rate was high despite service gaps. However, future improvement in patient satisfaction will require addressing challenges such as the waiting time before wound dressing, equipment (e.g., wheelchairs), and staffing.

CONTEXTE: Avec l'augmentation mondiale du nombre de plaies chroniques et le manque d'études sur les expériences des patients aux centres de soin des plaies, nous avons évalué les facteurs associés à la satisfaction des services de soins des plaies chez les patients ou leurs soignants dans une établissement de soins ambulatoires du nord-ouest du Nigeria. MÉTHODES: Les participants ont été systématiquement sélectionnés parmi les patients ou leurs soignants fréquentant la clinique externe générale de l'hôpital universitaire d'Aminu Kano à kano, pour le traitement des plaies. Un questionnaire structuré auto-administré a été utilisé pour obtenir des informations sur les caractéristiques sociodémographiques et cliniciques et leur satisfaction à l'égard des services. Les données ont été analysées à l'aide de méthodes statistiques descriptives et inférentielles. RÉSULTATS: Il y avait 170 participants. Leur âge moyen était de 31,9±11,4 ans, et ils étaient principalement des femmes (55,3 %). Le taux de satisfaction global était de 85,9 % (146/170) ; cependant, 51,8 % et 55,3 % des participants étaient insatisfaits des conseils sur le traitement des plaies à domicile et du temps d'attente, respectivement. Le statut professionnel, l'emplacement de la plaie, le fait d'avoir une drépanocytose, besoin d'un fauteuil roulant pour atteindre la salle de pansements et la disponibilité perçue d'un fauteuil roulant étaient associés à la satisfaction globale (P<0,05). Les facteurs prédictifs de la satisfaction globale étaient les plaies chroniques, les plaies situées dans des zones autres que les membres inférieurs/fesses et la disponibilité perçue des fauteuils roulants. CONCLUSION: Le taux de satisfaction globale était élevé malgré les lacunes des services. Cependant, l'amélioration future de la satisfaction des patients nécessitera relever des défis tels que le temps d'attente avant le pansement des plaies, l'équipement (p. ex., les fauteuils roulants) et la dotation en personnel. MOTS-CLÉS: Patients externes, Caractéristiques des patients, Satisfaction des patients, Soins des plaies, Pansements.

Maternal near-miss and death among women with hypertensive disorders in pregnancy: a secondary analysis of the Nigeria Near-miss and Maternal Death Survey.

OBJECTIVE: To investigate life-threatening maternal complications related to hypertensive disorders of pregnancy (HDP) in Nigerian public tertiary hospitals. DESIGN: Secondary analysis of a nationwide cross-sectional study. SETTING: Forty-two tertiary hospitals. POPULATION: Women admitted for pregnancy, childbirth or puerperal complications. METHOD: All cases of severe maternal outcome (SMO: maternal near-miss or maternal death) due to HDP were prospectively identified using the WHO criteria over a 1-year period. MAIN OUTCOME MEASURES: Incidence of SMO, health service events, case fatality rate, and mortality index (% of maternal death/SMO). RESULTS: Out of 100 107 admissions for maternal complications, 6753 (6.8%) women had HDP. Pre-eclampsia (PE) (54.5%) and eclampsia (E) (30.4%) were the most common HDP recorded. SMO occurred in 587 women with HDP: 298 maternal near-misses and 289 maternal deaths. The majority (93%) of the women with SMO due to HDP were admitted in a critical condition. The median diagnosis-definitive intervention interval was over 4 hours in a quarter of women who died from HDP. For PE and E, case fatality rates were 1.9 and 10.4%, respectively, although both conditions had a similar mortality index of 49.3%. Lack of antenatal care and place of residence further than 5 km from the hospital were associated with maternal death. CONCLUSIONS: Severe maternal outcomes from HDP were due to late presentations and health system challenges. To reduce maternal deaths from HDP, health system strengthening that would engender early hospital presentation and prompt treatment is recommended. FUNDING: The original research that generated the data for this secondary analysis was funded by the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a co-sponsored programme executed by the World Health Organization (WHO). We have no other funding issue to declare for our study. TWEETABLE ABSTRACT: Eclampsia is the leading cause of maternal death in Nigerian hospitals.

When getting there is not enough: a nationwide cross-sectional study of 998 maternal deaths and 1451 near-misses in public tertiary hospitals in a low-income country.

OBJECTIVE: To investigate the burden and causes of life-threatening maternal complications and the quality of emergency obstetric care in Nigerian public tertiary hospitals. DESIGN: Nationwide cross-sectional study. SETTING: Forty-two tertiary hospitals. POPULATION: Women admitted for pregnancy, childbirth and puerperal complications. METHODS: All cases of severe maternal outcome (SMO: maternal near-miss or maternal death) were prospectively identified using the WHO criteria over a 1-year period. MAIN OUTCOME MEASURES: Incidence and causes of SMO, health service events, case fatality rate, and mortality index (% of maternal death/SMO). RESULTS: Participating hospitals recorded 91 724 live births and 5910 stillbirths. A total of 2449 women had an SMO, including 1451 near-misses and 998 maternal deaths (2.7, 1.6 and 1.1% of live births, respectively). The majority (91.8%) of SMO cases were admitted in critical condition. Leading causes of SMO were pre-eclampsia/eclampsia (23.4%) and postpartum haemorrhage (14.4%). The overall mortality index for life-threatening conditions was 40.8%. For all SMOs, the median time between diagnosis and critical intervention was 60 minutes (IQR: 21-215 minutes) but in 21.9% of cases, it was over 4 hours. Late presentation (35.3%), lack of health insurance (17.5%) and non-availability of blood/blood products (12.7%) were the most frequent problems associated with deficiencies in care. CONCLUSIONS: Improving the chances of maternal survival would not only require timely application of life-saving interventions but also their safe, efficient and equitable use. Maternal mortality reduction strategies in Nigeria should address the deficiencies identified in tertiary hospital care and prioritise the prevention of severe complications at lower levels of care. TWEETABLE ABSTRACT: Of 998 maternal deaths and 1451 near-misses reported in a network of 42 Nigerian tertiary hospitals in 1 year.

Pregnant women's knowledge and attitude to mother to child transmission of human immuno-deficiency virus in a rural community in Northwest Nigeria.

BACKGROUND: The high seroprevalence of HIV in Nigeria contributing to a huge burden of paediatric infection and with wide disparities in the various zones of the country needs to be addressed. The main strategy involves the prevention of mother to child transmission (MTCT) of HIV which remains the cornerstone of preventing the next generation from acquiring HIV. OBJECTIVES: To ascertain the knowledge and attitude of pregnant women in Northwest Nigeria to HIV and MTCT despite the low literacy level in the rural community. METHODS: This was a cross sectional study in which 450 pregnant women attending the booking clinic of a tertiary institution were recruited and interviewed using an interviewer administered semi-structured pre-tested questionnaires. The questionnaire assessed the pregnant women's knowledge related to HIV, MTCT of HIV, its prevention and respondents' attitude towards it. RESULTS: Of the 450 respondents, majority (96.2%) were aware of HIV. Most of them (78%) had adequate knowledge of MTCT of HIV. About half of the respondents knew that MTCT of HIV could be prevented by not breastfeeding, few agreed with taking of antiretroviral during pregnancy (28%) and giving new born antiretroviral (20.2%) as ways of preventing MTCT. CONCLUSION: The respondents in this study had a high level of awareness of HIV/AIDS, a good general knowledge of MTCT and attitude towards PMTCT but a below average knowledge of specific interventions on prevention of MTCT of HIV.

A multicentre study of advanced abdominal pregnancy: a review of six cases in low resource settings.

Abdominal pregnancy has remained a big challenge worldwide especially in developing countries where there are limitations in diagnostic resources. The most important approach is to be vigilant for the unexpected as most patients present with no specific symptoms or clinical signs. It also poses great challenges in diagnosis and management, and is associated with a lot of morbidity and mortality. This series of six cases, each presenting in a peculiar way, typically illustrates these issues. The cases were managed in three different hospitals in the last 15 years. These series is aimed at highlighting the atypical presenting features of advanced abdominal pregnancy and the need for vigilance when there is suspicion of a case. It is also aimed at showing the difficulty of diagnosis and management of advanced abdominal pregnancy in low resource environment.

Grand multiparity: obstetric performance in Aminu Kano Teaching Hospital, Kano, Nigeria.

OBJECTIVE: The objective was to review the obstetric performance of booked grand multiparae. DESIGN AND SETTING: A 5-year prospective observational study of cases between January 1, 2002, and December 31, 2006, was conducted in Aminu Kano Teaching Hospital, a tertiary institution, in Kano, Nigeria. MATERIALS AND METHODS: The antenatal complications and pregnancy outcomes among booked grand mulitparous women (pregnancy after fifth delivery), who delivered in our labor ward, were compared with those of the booked mulitparae (parae 1-4) who delivered immediately after a grand multipara. OUTCOME MEASURES: These were obstetric factors of maternal age and parity, antepartum hemorrhage, fetal malpresentations, and multiple pregnancy. Medical complications were gestational diabetes, hypertension, anemia, and heart disease. Pregnancy outcomes measured were gestational age at delivery, birth weight, mode of delivery, postpartum hemorrhage, and maternal and perinatal mortality. RESULTS: The age range of the grand multiparae was between 22 and 43 years, with a mean age of 29.72 + 2.07 years. The parity range was between 5 and 15, with a mean parity of 7.78 + 0.63. There was increased occurrence of gestational diabetes mellitus (OR = 12.55, CI = 6.72-23.91), hypertension (OR = 3.07, CI = 2.07-4.59), heart disease (OR = 2.01, CI = 0.70-6.08), anemia (OR = 3.16, CI = 1.42-7.24), antepartum hemorrhage (OR = 2.18, CI = 1.22-3.92), fetal malpresentations (OR = 3.04, CI = 2.38-3.88), cephalopelvic disproportion (OR = 2.09, CI = 1.33-3.29), and fetal macrosomia (OR = 2.27, CI = 1.72-3.00) among the grand multiparae compared with multiparae. CONCLUSION: The effects of these complications were minimized by good antenatal care.

Grand multiparity: Obstetric performance in Aminu Kano Teaching Hospital; Kano; Nigeria

Objective: The objective was to review the obstetric performance of booked grand multiparae. Design and Setting: A 5-year prospective observational study of cases between January 1; 2002; and December 31; 2006; was conducted in Aminu Kano Teaching Hospital; a tertiary institution; in Kano; Nigeria. Materials and Methods: The antenatal complications and pregnancy outcomes among booked grand mulitparous women (pregnancy after fifth delivery); who delivered in our labor ward; were compared with those of the booked mulitparae (parae 1-4) who delivered immediately after a grand multipara. Outcome Measures: These were obstetric factors of maternal age and parity; antepartum hemorrhage; fetal malpresentations; and multiple pregnancy. Medical complications were gestational diabetes; hypertension; anemia; and heart disease. Pregnancy outcomes measured were gestational age at delivery; birth weight; mode of delivery; postpartum hemorrhage; and maternal and perinatal mortality. Results: The age range of the grand multiparae was between 22 and 43 years; with a mean age of 29.72 + 2.07 years. The parity range was between 5 and 15; with a mean parity of 7.78 + 0.63. There was increased occurrence of gestational diabetes mellitus (OR = 12.55; CI = 6.72-23.91); hypertension (OR = 3.07; CI = 2.07-4.59); heart disease (OR = 2.01; CI = 0.70-6.08); anemia (OR = 3.16; CI = 1.42-7.24); antepartum hemorrhage (OR = 2.18; CI = 1.22-3.92); fetal malpresentations (OR = 3.04; CI = 2.38-3.88); cephalopelvic disproportion (OR = 2.09; CI = 1.33-3.29); and fetal macrosomia (OR = 2.27; CI = 1.72-3.00) among the grand multiparae compared with multiparae. Conclusion: The effects of these complications were minimized by good antenatal care

Grand Multiparity: Obstetric Performance in Aminu Kano Teaching Hospital; Kano; Nigeria

Objective: The objective was to review the obstetric performance of booked grand multiparae. Design and Setting: A 5-year prospective observational study of cases between January 1; 2002; and December 31; 2006; was conducted in Aminu Kano Teaching Hospital; a tertiary institution; in Kano; Nigeria. Materials and Methods: The antenatal complications and pregnancy outcomes among booked grand mulitparous women (pregnancy after fifth delivery); who delivered in our labor ward; were compared with those of the booked mulitparae (parae 1-4) who delivered immediately after a grand multipara. Outcome Measures: These were obstetric factors of maternal age and parity; antepartum hemorrhage; fetal malpresentations; and multiple pregnancy. Medical complications were gestational diabetes; hypertension; anemia; and heart disease. Pregnancy outcomes measured were gestational age at delivery; birth weight; mode of delivery; postpartum hemorrhage; and maternal and perinatal mortality. Results: The age range of the grand multiparae was between 22 and 43 years; with a mean age of 29.72 + 2.07 years. The parity range was between 5 and 15; with a mean parity of 7.78 + 0.63. There was increased occurrence of gestational diabetes mellitus (OR = 12.55; CI = 6.72-23.91); hypertension (OR = 3.07; CI = 2.07-4.59); heart disease (OR = 2.01; CI = 0.70-6.08); anemia (OR = 3.16; CI = 1.42-7.24); antepartum hemorrhage (OR = 2.18; CI = 1.22-3.92); fetal malpresentations (OR = 3.04; CI = 2.38-3.88); cephalopelvic disproportion (OR = 2.09; CI = 1.33-3.29); and fetal macrosomia (OR = 2.27; CI = 1.72-3.00) among the grand multiparae compared with multiparae. Conclusion: The effects of these complications were minimized by good antenatal care

Scottish survey of public place defibrillators.

BACKGROUND: Public place defibrillators can reduce delays to defibrillation but their cost-effectiveness has not been evaluated in randomised trials. In Scotland, unlike England, no health sector funding has been provided. Nonetheless, anecdotal evidence suggests they are increasing in number. METHODS: A cross-sectional survey was conducted of all airports, shopping malls, leisure centres, and major train and bus stations to determine whether defibrillators had been purchased and by whom, the training and maintenance arrangements, and whether they had been discharged. RESULTS: Of the 183 eligible sites, 153 (84%) participated. 33 (22%) had at least one defibrillator. Those in airports and shopping malls were purchased privately. Those in leisure centres were bought by charities or local authorities. The majority (97%) provided training to existing staff, but 6 (18%) provided no training to new staff. Only 6 (18%) had a maintenance agreement and 8 (24%) a replacement policy. Only one site permitted public access. Defibrillators had been discharged in 10 (30%) sites. Of the 32 people shocked, 23 (72%) survived until the ambulance arrived. CONCLUSIONS: Despite absence of health sector funding, defibrillators are located in 22% of high footfall public places. Those purchasing defibrillators need to ensure adequate maintenance, replacement and training arrangements.

Spontaneous pre-labour rupture of membranes at term: immediate versus delayed induction of labour.

BACKGROUND: Spontaneous pre-labour rupture of membranes (SPROM) at term is one of the most common complications of pregnancy. It is an important cause of perinatal morbidity and mortality, particularly because it is associated with a latency period from membrane rupture to delivery. OBJECTIVE: To compare the outcome of labour in women who had immediate induction of labour, with those who had delayed induction following SPROM at term. METHODS: A prospective case control study of 200 women who had either immediate induction of labour with intravaginal misoprostol tablets, or delayed induction with intravenous oxytocin infusion after an expectant period of 12 hours, at Aminu Kano Teaching Hospital, Kano, Nigeria. The outcome of labour was compared in the two groups using the Z test and Chi square test, while, p-value of less than 0.05 was taken as significant. The odds ratio (OR) and 95% confidence interval were also determined where appropriate. RESULTS: Immediate induction of labour with intravaginal misoprotol resulted in lower rates of caesarean section and operative vaginal delivery, with a higher rate of spontaneous vaginal delivery. The duration of latent phase of labour and hospital stay before delivery was statistically significantly shorter in the immediate induction group. Neonatal and maternal morbidity were insignificant and comparable between the two groups. CONCLUSION: Immediate induction of labour with intravaginal misoprotol resulted in significantly lower rates of intervention without compromising fetomaternal outcome. We recommend the immediate induction of labour with proper use of intravaginal misoprotol in women with SPROM at term.

Ruptured tubal gestation: an unusual presentation of Schistosoma haematobium infection of the fallopian tube.

An unusual mode of presentation of schistosomiasis in the form of a ruptured tubal pregnancy in a previously asymptomatic 23-year-old woman is described. Histological examination of the salpingectomy specimens demonstrated Schistosoma haematobium ova.