Differences in burn injury knowledge among reproductive-age women attending an urban and a semi-rural hospital in Northwest Nigeria: A cross-sectional study.

OBJECTIVES: To assess burn injury knowledge and its predictors among reproductive-age women attending an urban and a semi-rural hospital in Northwest Nigeria DESIGN: A descriptive cross-sectional study SETTING: It was conducted in the general and paediatric outpatient clinics of Aminu Kano Teaching Hospital in Kano (urban setting) and the general outpatient, paediatric outpatient and antenatal clinics of Federal Medical Centre Birnin Kudu (semi-rural setting). PARTICIPANT: In 2021, 362 women aged 18-44 years were randomly selected from clinic attendees over six weeks. Of them, 217 were from the urban hospital. Data regarding their sociodemographic characteristics and knowledge of burn injuries was collected using a pretested, semi-structured interviewer-administered questionnaire. OUTCOME MEASURE: Knowledge of burn injuries RESULTS: About 83.4 %, 77.1 % and 77.6 % of respondents had adequate general, primary prevention and overall knowledge of burn injuries, respectively. Their mean overall knowledge score was 18.6 out of 24, but only 55.5 % had adequate first-aid knowledge. The study sites did not significantly differ in burns first-aid, prevention and overall knowledge scores. However, urban respondents were more ignorant about the cause of burns and knew that burn injuries could be fatal. More semi-rural respondents knew that flames and chemicals cause burn injuries. Predictors of overall knowledge were age, educational level, number of children in their household, previously seeing a burn-injured child, and primary source of burns-related information. CONCLUSIONS: The proportion of respondents with adequate overall burn injury knowledge was high; however, knowledge gaps exist among them. Overall, their first-aid knowledge was relatively low. The urban and semi-rural respondents had no significant differences in first-aid, prevention, or overall knowledge of burn injuries. However, knowledge of the causes of burns and burn complications differed between the urban and semi-rural study locations. Therefore, the clinical settings of this study present opportunities for similar burn-related educational interventions.

Domestic violence against women with infertility attending gynaecological clinics in Northern Nigeria: A multi-centre study.

Background: Due to the high premium placed on childbearing, infertility puts a lot of stress on the family which may result in aggressive and irrational behaviour if not properly managed. Domestic violence (DV) against infertile women is a public health issue but under-reported especially in northern Nigeria. Objectives: This study sought to identify the prevalence, pattern, and response to DV. Materials and Methods: This was a descriptive cross-sectional study carried out at three tertiary health facilities; one in each of the geopolitical zones in northern Nigeria. Using a pretested interviewer-administered questionnaire; the prevalence, pattern, and response to DV were determined among 422 respondents who were attending the gynaecological clinics of the three health facilities. The data obtained was entered into SPSS version 22.0 and analysed. Results: The prevalence of DV among women with infertility in the previous year was 39.8% (167/422). Among the survivors, 92.8% (155/167), 35.3% (59/167), and 10.7% (18/167) had experienced psychological aggression, physical assault, and sexual violence, respectively. A significant number of respondents who reported DV were Christians (P = 0.01). Of them, 77 (46.1%) never discussed the issue with anyone, 72 (43.1%) informed their family, and 30 (18.0%) sought help from the husband's family. Conclusion: The prevalence of DV among women with infertility is high, psychological aggression is the most typical form of DV experienced while about half have never reported the incidence to anyone. Screening infertile women for DV during their visit to the gynecological clinics would be beneficial; those found to have experienced DV should be counselled and supported appropriately.

Predictors, prevalence and outcome of hypertensive disorders in pregnancy in Nigerian tertiary health facilities.

OBJECTIVE: Determine prevalence, risk factors and outcomes of hypertensive disorders in pregnancy (HDP). DESIGN: Cross-sectional analysis of data captured in the Maternal and Perinatal Database for Quality, Equity and Dignity (MPD-4-QED) between September 2019 and August 2020. SETTING: Fifty-four referral level facilities in Nigeria. POPULATION: Women whose pregnancy ended (irrespective of the location or duration of pregnancy) or who were admitted within 42 days of delivery. METHODS: Descriptive statistics and multilevel mixed-effects logistic regression models. MAIN OUTCOME MEASURES: Prevalence of HDP, sociodemographic and clinical factors associated with HDP and perinatal outcomes. RESULTS: Among the 71 758 women 6.4% had HDP and gestational hypertension accounted for 49.8%. Preeclampsia and eclampsia were observed in 9.5% and 7.0% of all pregnancies, respectively. The predictors of HDP were age over 35 years (OR1.96, 95% CI 1.82-2.12; p < 0.001), lack of formal educational (OR 1.18, 95% CI 1.06-1.32; p = 0.002), primary level of education (OR 1.20, 95% CI 1.03-1.4; p < 0.002), nulliparity (OR 1.21, 95% CI 1.12-1.31; p < 0.001), grand-multiparity (OR 1.36, 95%CI 1.21-1.52; p < 0.001), previous caesarean section (OR 1.26, 95%CI 1.15-1.38; p < 0.001) and previous miscarriage (OR 1.22, 95% CI 1.13-1.31; p < 0.001). Overall 3.7% of the patients with HDP died, with eclampsia having the highest case fatality rate of 27.9%. Stillbirth occurred in 11.9% of pregnancies with hypertensive disorders. CONCLUSIONS: Hypertensive disorders in pregnancy are not uncommon in Nigeria. They are associated with adverse outcomes with over one-quarter of women with eclampsia dying. The main predictors include older age, poor education, extremes of parity and previous CS or miscarriage. Maternal and perinatal outcomes are poor with about a quarter developing complications and about 1 in 10 having stillbirths.

Management of anastomotic biliary stricture after liver transplantation: metal versus plastic stent.

BACKGROUND: Post-transplant anastomotic biliary strictures remain refractory to endoscopic therapy in a considerable number of cases. The aim of this meta-analysis was to compare fully-covered self-expandable metal and plastic stents in the management of post-transplant biliary strictures. METHODS: A meta-analysis was performed using a random effects model; results were expressed as odds ratio (OR) and mean standardized difference. The primary outcome was stricture resolution, while recurrence rate after stent placement, treatment time, and safety of the procedure were the secondary outcomes. RESULTS: Through a systematic literature review until October 2017, we identified 7 studies, of which 4 were randomized controlled trials. Stricture resolution was slightly higher with metal stents, with no statistical difference between the two procedures (OR 1.38, 95% confidence interval [CI] 0.60-3.15; P=0.45) and low heterogeneity (I2=6%). Stricture recurrence showed a non-significant trend in favor of plastic stents (OR 1.82, 95%CI 0.52-6.31, P=0.35). Endoscopic retrograde cholangiopancreatography with placement of metal stents offered a significant improvement in terms of reduced treatment time (mean standardized difference: -3.58 months, 95%CI -6.23 to -0.93; P=0.008), but with more frequent complications, although not significantly so (OR 2.34, 95%CI 0.75-7.25; P=0.14). Sensitivity analysis confirmed all the findings. CONCLUSION: Metal stents appear to be a promising tool that can decrease treatment time, although there is still no clear evidence of their superiority over plastic stents in terms of efficacy.

An assessment of serum prolactin levels among infertile women with galactorrhea attending a gynecological clinic North-West Nigeria.

BACKGROUND: Galactorrhea is a common manifestation of hyperprolactinemia but may not always be present in women with hyperprolactinemia. This study was, therefore, undertaken to assess the serum prolactin levels of infertile women presenting with galactorrhea and to determine the prevalence of hyperprolactinemia among them. MATERIALS AND METHODS: This was a retrospective study of serum prolactin levels of 63 female partners of infertile couples attending the gynecological clinic of Federal Medical Centre, Birnin Kudu, Jigawa State, Nigeria, who were found to have galactorrhea from January 1, 2012, to December 31, 2013. Ethical clearance was obtained. Solid phase enzyme-linked immunosorbent assay was used to measure serum prolactin. Sociodemographic characteristics were determined. The data obtained were analyzed using SPSS version 17.0 statistical software. Absolute numbers and simple percentages were used to describe categorical variables. Similarly, quantitative variables were described using measures of central tendency (mean, median) and measures of dispersion (range, standard deviation) as appropriate. RESULTS: The average age of the women was 27.9 ± 5.6 years. In half of the cases (50%), galactorrhea was associated with menstrual disturbances, mainly amenorrhea (23.3%). Although most (63.3%) of the clients had normal serum prolactin level despite being galactorrheic, averagely there was a marked elevation in serum prolactin of as high as 40.3 ± 52.3 ng/mL. CONCLUSION: We conclude, therefore, that the prevalence of hyperprolactinemia in this study was low when compared with other studies and that galactorrhea does not always indicate raised serum prolactin levels.

Prevalence and predictors of female genital mutilation among infants in a semi urban community in northern Nigeria.

OBJECTIVES: To determine the prevalence, predictors, of female genital mutilation (FGM) among infants and ascertain if their mothers knew what was done to them in Birnin Kudu northern Nigeria. METHODS: Cross sectional study which utilised a pretested interviewer administered semi-structured questionnaire to assess occurrence of FGM with physical examination of the infants. Logistic regression analysis was used to assess the relative effect of determinants, after adjusting for other predictor variables. RESULTS: Of the 450 infants, 215(47.8%) (95% Confidence Interval [CI]: 43.1%-52.5%) had experienced one form of FGM. The ages at genital mutilation ranged from 1 to 50 days with a median of 4 days and interquartile range of 7 days. Maternal occupation, education and religion and type of facility accessed were significantly associated with occurrence of FGM in infants (p ≤ 0.05). After controlling for confounders, having a mother without formal education [AOR = 6.39 and 95% CI = 3.99-10.23] (p = 0.001) and one who was employed [Adjusted odds ratio (AOR) = 2.89 and 95% CI = 1.66-5.03] (p = 0.001) increased the likelihood of infant FGM remarkably while utilising tertiary institution for health care reduced the risk by about half [AOR = 0.49 and 95% CI = 0.26-0.92] (p = 0.03). Of the 215 infants that had undergone FGM, there was correlation between the reported and the observed forms of FGM in 16 (7.4%) of the cases. CONCLUSION: The prevalence of FGM is high with mothers' educational status, type of health facility utilised and occupational status being predictors of FGM among infants in Birnin Kudu. Majority of the mothers are not aware of what was done. Strategies aimed at discouraging this dangerous practice in the community should include female education, involvement of the men as husbands, fathers, traditional and religious leaders.

Caesarean section and perinatal outcomes in a sub-urban tertiary hospital in North-West Nigeria.

OBJECTIVES: This study was undertaken to review the caesarean section rate and perinatal mortality in Federal Medical Centre, Birnin Kudu from 1(st) January 2010 to 31st December, 2012. MATERIALS AND METHODS: This was a retrospective study involving review of 580 case files. Ethical clearance was obtained. The records of labour ward, neonatal intensive care unit (ICU) and operating theatre were use. Information extracted includes age, parity, booking status, total deliveries, indications for caesarean section and perinatal outcome from 1(st) January 2010 to 31(st) December 2012 at Federal Medical Centre, Birnin Kudu. The data obtained was analysed using SPSS version 17.0 statistical software (Chicago, Il, USA). Absolute numbers and simple percentages were used to describe categorical variables. Association between caesarean section and perinatal mortality was determined using Pearson's Coefficient of correlation and student t- test. P - value < 0.05 was considered statistically significant. RESULT: This study reported a caesarean section rate of 17.69 % and a perinatal mortality rate of 165.6 per 1000. Majority of the babies (78.2%) were within normal weight. The mean age of the women was 25.9 ± 6.2 years and mean parity was 4 ± 3. Majority of them were uneducated and unemployed. Obstructed labour was the commonest indication for emergency caesarean section accounting for 31.7% of caesarean sections and foetal distress was the least at 2.6 %. Two or more previous caesarean section was the commonest indication for elective caesarean section (17.1%) and bad obstetrics history the least indication (1.4%). There is a weak positive correlation (r = 0.35) between caesarean section rate and perinatal mortality and this association was not statistically significant (P = 0.12). CONCLUSION: Caesarean section and perinatal mortality rates in the present study are comparatively high. Absence of significant correlation means that a high caesarean section rate is not likely to improve perinatal outcomes in babies of normal weight; therefore the caesarean section rate in this centre should be reduced. Measures to reduce perinatal mortality such as skilled attendant in labour and training of medical staff in neonatal resuscitation should be adopted.

Prevalence and predictors for domestic violence among pregnant women in a rural community Northwest, Nigeria.

OBJECTIVE: Domestic violence (DV) against women constitutes a violation of human rights. This study aimed at determining the prevalence and predictors for DV among pregnant women in a rural community northwest Nigeria. MATERIALS AND METHODS: A descriptive cross-sectional study which utilised an interviewer-administered semi-structured pretested questionnaire. This assessed the type of DV experienced, the perpetrators and the trigger factor. Logistic regression analysis was used to assess the relative effect of determinants, adjusting for other predictor variables. The dependent variable was the occurrence of DV classified as Yes or No and the covariates included variables that were significantly associated with DV. RESULTS: Of the 314 respondents, 108 (34.3%) had experienced at least one form of DV and the types observed are: Verbal violence 79(68.5%); psychological violence72 (66.7%) and physical violence 55(50.9%). The perpetrators were the current husband in 40 (37.0%); co-wives in 33 (30.6%) and in-laws in 25 (23.1%). Of the cases, domestic issues were the trigger factor in 69 (63.9%) of cases and 54 (50%) of, the incidence was never reported. Ethnicity and type of marriage were significantly associated with occurrence of DV ( P ≤ 0.05) and both remained predictors for DV after controlling for confounders [Adjusted odds ratio (AOR) = 2.20 and 95% C.I = 1.42-11.9; AOR = 4.2 and 95% C.I = 1.36-3.57, respectively]. CONCLUSION: The prevalence of DV in pregnancy is high with women of Hausa/Fulani ethnicity and those in polygamous relationships at a higher risk. Effort should be made to screen pregnant women for DV during antenatal care.

Prevalence, reasons and predictors for home births among pregnant women attending antenatal care in Birnin Kudu, North-west Nigeria.

OBJECTIVE: To determine the prevalence, reasons and predictors for home birth in a rural community. METHOD: Descriptive cross sectional study which utilised a pretested interviewer administered semi-structured questionnaire to assess the place of delivery in their last childbirth among 410 pregnant women attending antenatal care in Birnin Kudu, Nigeria. Logistic regression analysis was used to assess the relative effect of determinants. PREVALENCE: Of the 410 women, 248 (60.5%) delivered at home in their last childbirth. Self reported reasons: Home birth was opted for because of: lack of transportation 113 (45.6%), onset of labour was at night 104 (41.9 %), preferred birthing position 72 (29.0%), tradition 60 (24.2%), fear of surgery 42 (16.9%) and poor attitude of health workers 32 (12.9%). PREDICTORS: The odds of giving birth at home was 3.88 times higher in women with informal education (adjusted OR 3.88; 95% CI: 2.51, 6.00) and the odds of giving birth at home was 0.27 for women with less than 5 deliveries compared with women with 5 or more deliveries (adjusted OR 0.27; 95% CI: 0.15, 0.49) after controlling for confounders. CONCLUSION: The prevalence of home birth is high in Birnin Kudu and according to our respondents the main reasons for this practice are onset of labour late at night with lack of transportation and a limited choice of birthing positions. Provision of training and retraining of skilled birth attendants to assist women birthing in squatting positions would encourage women to deliver in the hospitals.

Perception and attitude of pregnant women in a rural community north-west Nigeria to female genital mutilation.

PURPOSE: Nigeria has the highest absolute number of residents who have undergone female genital mutilation (FGM) and most are carried out during infancy; however most reports on FGM are from urban based facilities hence we sought to know the perception and attitude of pregnant women residing in a rural community in northern Nigeria to FGM. METHODS: A descriptive cross sectional study utilized a pretested structured interviewer administered questionnaire to assess the types of FGM known, reasons for performing it and willingness to support or perform FGM among 323 pregnant women attending antenatal care in two different health facilities. RESULTS: Of the 323 respondents, 256 (79.3%) were aware of the practice and the common varieties of FGM known to them were Gishiri cut in 137 (53.5%) and Angurya cut 113 (44.1). The notable reasons for carrying out FGM in the community were tradition 88 (34.4%), to ease difficulty in childbirth 69 (26.9%) and better marriage prospect in 55 (21.5%). Of the respondents that were aware of FGM; 100 (39.1%) have experienced it and 55 (21.5%) of those aware of it would subject their daughters to the procedure. There was statistically significant association between willingness to mutilate daughters by the respondents type of education (p = 0.014) and the type of facility they were receiving antenatal care (p = 0.001). CONCLUSION: FGM is prevalent in this community with Gishiri cut being the commonest variety. It is often associated with difficult childbirth and many women would subject their daughters to this practice. Female education and empowerment is crucial to discontinuation of this practice.

Estimation of fetal weight before delivery in low-resource setting of North-west Nigeria: can we rely on our clinical skills?

OBJECTIVE: To compare the accuracy of sonographic versus clinical methods of fetal weight estimation in a low-resource setting. METHODS: This was a prospective study. Ethical clearance and informed consent were obtained. Two hundred (200) women admitted for delivery were assessed. Questionnaires and data collection forms were used to obtain socio-demographic and other clinical information. The actual weight was determined at birth. Estimated fetal weight (EFW) was compared with the actual weight (BW). The data obtained were analyzed using SPSS version 16.0 statistical software. The accuracy of clinical and sonographic fetal weight estimation was compared using Students' t-test, Chi-square test and Pearsons' coefficient of correlation and p < 0.05 was considered statistically significant. RESULTS: The mean of absolute percentage error was smaller for ultrasonic (9.8 ± 7.2) than clinical (10.5 ± 7.5) estimation, but the difference was not statistically significant (p = 0.083). In the 2.5-3.99 kg group there was no statistically significant difference between the mean absolute percentage errors for the two methods (p = 0.096). In the <2.5 kg group, clinical method overestimated birth-weight while in ≥4.0 kg, the sonographic method underestimated the birth weight. For birth weight 2.5-3.99 kg, sensitivity, specificity, positive predictive value and negative predictive value were 96.9, 76.9, 98.1, 66.7% and 96.8, 75, 96.8, 75% for sonographic and clinical estimates, respectively. The predictive powers of sonographic and clinical methods were better for low birth weight and macrosomic fetuses, respectively. CONCLUSION: Clinical method of fetal weight estimation can only be recommended for use as screening tool for normal weight and macrosomic fetuses.

Oxidative stress and antioxidant status of pregnant rural women in north-west Nigeria: prospective cohort study.

BACKGROUND/OBJECTIVE: This research was undertaken to determine the oxidative stress and antioxidant status of pregnant northern Nigerian women. METHODS: Prospective cohort study. The study was done at General Hospital, Dawakin Kudu LGA, Kano. Kano has a population of 9.2 million and predominantly Muslims. Two hundred consecutive women presenting for antenatal care and 100 apparently normal controls. Ethical approval was obtained. Socio-demographic and clinical information were obtained via interviewer-administered questionnaires from 200 consecutive pregnant women who presented for antenatal care. Serum levels of vitamins A, C, E and malondialdehyde were determined. Data was analyzed with SPSS version 16.0 statistical software. Descriptive statistics was used. Means were compared using analysis of variance (ANOVA). Associations between trimesters and oxidative stress/antioxidant status were tested using chi-square test and p < 0.05 was considered statistically significant. RESULT: The mean serum vitamin A, E and C levels were 13.39 ± 9.44 µg/dl, 0.35 ± 0.51 mg/dl and 5.99 ± 3.95 µ/dl respectively (below normal limits). The prevalence of vitamins A, C and E deficiency were 65.5%, 79.5% and 51% respectively. The mean serum levels of malondialdehyde was 4.04 ± 0.91 nmol/l (pregnant) and 1.84 ± 0.40 nmol/l (non-pregnant) (p = 0.001). There was strong negative correlation between serum levels of malondialdehyde and vitamins A, C and E. CONCLUSION: Vitamins A, C, E deficiency and oxidative stress is a problem among Northern Nigeria pregnant women, therefore the value of antioxidant vitamin supplementation should be explored.

An assessment of stillbirths in a tertiary hospital in northern Nigeria.

OBJECTIVE: This study was undertaken to determine the stillbirth rate and causes in Birnin Kudu, North-west, Nigeria. METHOD: This was a retrospective study. It involved 705 women who presented for delivery in Federal Medical Centre, Birnin Kudu and had stillbirths. The hospital maternity and theatre registers were used to identify the women who had stillbirth during the study period from 1 January 2008 to 31 December 2012. The data obtained were analyzed using SPSS version 16.0 statistical software. Significant association between socio-demographic/obstetrics factors and stillbirth were tested using the chi-square test and p < 0.05 was considered significant. RESULT: The stillbirth rate was 170 per 1000 births. Most of the women who had stillbirths (29.1%) were aged 20-24 years, followed by those aged ≥35 years (27.1%). The uneducated women were more than those who had only primary education and this was statistically significant (p = 0.001). The mean parity of the women was 5 ± 3. Obstructed labour was the common cause of stillbirth followed by placental abruption (17.73%) and pre-eclampsia/eclampsia (13.33%). CONCLUSION: The stillbirth rate reported in this study was higher than those reported from other regions of Nigeria and obstructed labour was the common cause.

Poor semen parameters among infertile couples presenting at a gynaecological clinic of Federal Medical Centre Birnin Kudu North-west Nigeria.

BACKGROUND: Male partners contribute significantly to infertile couple problem. The present study was undertaken to review the seminal fluid analysis (SFA) of couples presenting with inability to conceive at the gynecological clinic of Federal Medical Centre, Birnin Kudu, Jigawa State using World Health Organization 2010 criteria, identify the correlation between poor semen quality and age and to identify culture and sensitivity patterns of isolates. MATERIALS AND METHODS: This was a retrospective study. The sample size was 63 Ethical clearance was obtained. Patients' case records and laboratory registers were retrieved. The volume, viscosity, pH, sperm count, motility, and the morphology of the seminal fluid were determined. Semen m/c/s was done. Data were analyzed by using SPSS version 16 (SPSS Inc., Chicago, Il, USA). Descriptive statistics was used. Association between age and semen parameters were determined using Pearson's coefficient of correlations and Chi-square test and P < 0.05 was considered statistically significant. MAIN OUTCOME MEASURES: The proportion of infertile male with abnormal semen parameters. RESULTS: Of the 308 couple presenting for infertility evaluation, only 63 male partners presented for SFA. This is 20.5% of the couples. After analysis, 52.38% were normospermic while 26.98% and 20.64% were azoospermic and oligospermic, respectively. Asthenospermia was the commonest motility/morphology abnormality occurring in 60.3%. The mean volume, sperm count, motility, morphology, and pH were 2.8 ± 1.8, 40.1 ± 52.3, 28.2 ± 27.7, 46.1 ± 35.6, and 8.3 ± 0.67, respectively. The volume, motility, morphology, and pH showed weak correlations with age. CONCLUSION: Male partners are significant contributors to the infertile couple problems in this study; therefore awareness is needed in order to engage more males in evaluation and treatment of infertility.

A multicentre study on knowledge and attitude of nurses in northern Nigeria concerning female genital mutilation.

OBJECTIVE: To determine the knowledge and attitude of nurses in northern Nigeria concerning female genital mutilation (FGM). METHODS: Cross-sectional study in which 350 nurses working in three tertiary health institutions in northern Nigeria were assessed, using a self-administered questionnaire, with regard to their knowledge of, and attitude to, FGM. RESULTS: Two hundred and sixty-five respondents (76%) were female, 190 (54%) were married. Most (249; 71%) were Muslims, and 228 (65%), of Hausa/Fulani ethnicity. Their ages ranged from 18-60 years with a mean of 29.3 ± 8.9. Among the respondents, 318 (91%) had heard of FGM; of these 127 (40%) knew no particular type of FGM. Only 155 (49%) could identify 'Angurya' and 'Gishiri' cuts as forms of FGM. Two hundred and forty-five (77%), 231 (73%) and 200 (63%), respectively, identified haemorrhage; risk of HIV, hepatitis, and tetanus; and painful sexual intercourse as possible complications of FGM. Thirteen (4%) would perform it and also would have it done on their daughters. CONCLUSION: The nurses studied had a high level of awareness of FGM and a good general knowledge of complications associated with FGM. However, only half knew what 'Angurya' and 'Gishiri' cuts were. A few would perform FGM.

A prospective surveillance of ruptured uterus in a rural tertiary health facility in northwest Nigeria.

OBJECTIVE: To determine the frequency, cause and management outcome of ruptured uterus at a rural tertiary hospital. METHODS: Cross sectional study which utilized a prospective surveillance of all cases of ruptured uterus that presented to the hospital from 1 April 2010 to 31 March 2013. RESULTS: Frequency: Over the study period there were 3001 deliveries and 44 cases of ruptured uterus; however, three died before surgery and 41 cases had exploratory laparatomy giving a prevalence of 14.7/1000 deliveries or 1 in 68 deliveries. Their ages ranged from 18 to 45 with a mean of 28.3 ± 6.6 years and parity varied between 1 and 13 with majority (62.7%) being grand multiparous. Twenty-five (61.0%) lived over 50 km away from the hospital. Causes: Prolonged/obstructed labour accounted for 33 (80.5%) cases, 23 (56.1%) had previous caesarean sections, while injudicious use of oxytocin was observed in 17 (41.5%). Management outcome: All the women who had surgery survived but 16 (39.0%) had anaemia, 10 (24.4%) had wound infection, three (7.3%) developed burst abdomen and 11 (26.8%) had prolonged hospital stay. There were 40 (97.5%) stillbirths of which 25 (61.0%) were fresh. CONCLUSION: The prevalence of ruptured uterus is high especially among women with prolonged/obstructed labour and previous caesarean section with associated high perinatal mortality.

Scaling up prevention of mother to child transmission of HIV infection to primary health facilities in Nigeria: findings from two primary health centres in Northwest Nigeria.

Nigeria is scaling up prevention of mother-to-child transmission (PMTCT) of HIV interventions to primary health care centres (PHCs). This retrospective study of PMTCT was at two PHCs in Northwest Nigeria with the main outcome measure being HIV infection rate of exposed infants at 6 weeks of life. Of 10,289 women who had antenatal HIV test, 74 had positive results. This gave a prevalence of 0.7%. The uptake of antenatal (99.8%) and intrapartum (97.3%) tests was high at both centres. 30% of HIV infected mothers and 25% of exposed infants were lost to follow-up (LFU). Most women (85.7%) had highly active antiretroviral therapy (HAART) and vaginal delivery (98%). Perinatal mortality rate was 66/1000 births and 95.3% of exposed infants had negative HIV-DNA polymerase reaction test at 6 weeks of life. Despite a high LFU, a new vista has been opened to attaining a zero infection rate.