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

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

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

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

Elemental profile in amniotic fluid of some Nigerian pregnant women.

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

Oral misoprostol versus intramuscular oxytocin in the active management of the third stage of labour.

INTRODUCTION: Although the third stage of labour is usually uneventful, several significant complications may be encountered that may lead to maternal morbidity and mortality, especially primary postpartum haemorrhage. The objective of this study was to compare 400 ug oral misoprostol with 10 IU intramuscular oxytocin in the active management of the third stage of labour. METHODS: This was a prospective randomised controlled clinical trial in which 200 parturients at term who had vaginal delivery were randomly assigned into two groups: oral misoprostol and intramuscular oxytocin, after the delivery of the baby and the clamping of the umbilical cord. The primary outcome was the incidence of primary postpartum haemorrhage. Secondary outcomes included a drop in haemoglobin concentration 48 hours after delivery, the need for extra oxytocics, duration of the third stage of labour and side effects of the oxytocics. These results were subjected to statistical analysis using chi-square test or student's t-test. RESULTS: No occurrence of primary postpartum haemorrhage or significant difference in the drop in haemoglobin concentration levels was reported after delivery (p-value is 0.49), and no significant differences were observed in other secondary outcome measures with the exception of nausea, which occurred solely in the misoprostol group (4 percent, p-value is 0.04). CONCLUSION: Oral misoprostol appeared to be as effective and as safe as intramuscular oxytocin in the active management of the third stage of labour.

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

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

Comparison of ceftriaxone versus triple drug regimen in the prevention of cesarean section infectious morbidities.

OBJECTIVE: To compare the effectiveness of single dose ceftriaxone versus multiple doses of ampiclox, gentamicin, and metronidazole to prevent infectious morbidity at elective cesarean section. METHODS: This was a randomized clinical trial involving 200 pregnant women who had an elective cesarean section for various reasons during the study period. Outcome measures included endometritis, urinary tract infections, febrile morbidities, wound infections, duration of hospital stay, and cost of antibiotic therapy. Data were managed using SPSS. RESULTS: There was no statistically significant difference in the mean duration of hospital stay between the two groups, but a significant statistical difference was found in the mean cost of antibiotic treatment ($15 for the combination and $9 for ceftriaxone; p = 0.000), with the group of patients taking a single dose of ceftriaxone (ROPHEX) having a lower mean cost of treatment than those taking a combination of ampiclox, gentamicin, and metronidazole. The study groups did not differ significantly in the incidence of endometritis (14% versus 15%), urinary tract infection (11% versus 15%), wound infections (7% versus 8%), febrile morbidity (7% versus 6%), and peritonitis (0% versus 0%). CONCLUSION: Single dose ceftriaxone was as effective as a combination of ampiclox, gentamicin, and metronidazole in preventing post-elective cesarean section complications.

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

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

Comparative study of the impact of past pregnancy outcome on future fertility.

INTRODUCTION: The impact of previous pregnancy outcome on future fertility in Nigeria has not been appreciated, hence the continued neglect of the adoption of safe motherhood measures in this sub-region. The objective of this study was to compare the past pregnancy outcomes among fertile and infertile patients in a Nigerian population. METHODS: An institutional-based comparative case-controlled study of past pregnancy outcomes among infertile and fertile women was conducted. The data was managed using Epi-Info and the Statistical Package for Social Sciences. RESULTS: 708 patients consisting of 472 pregnant women (fertile) and 236 infertile women were investigated. Infertile women were at a significant risk of having an adverse pregnancy outcome, such as induced abortion (p-value is 0.0001), postabortal sepsis (p-value is 0.0001), postpartum infection (p-value is 0.001), manual removal of the placenta (p-value is 0.0005) and prolonged unsupervised labour (p-value 0.0001), compared to pregnant fertile women. Logistic regression analysis of variables at 95 percent confidence intervals showed that the adjusted odds ratio for prolonged labour, prolonged rupture of membranes, postabortal sepsis and postpartum infection still remained significant. CONCLUSION: Previous mismanaged pregnancies impacted negatively on future fertility. Efforts should be directed towards the prevention of unplanned pregnancies. Motherhood must be made safer in planned pregnancies by prevention of complications, and aggressive and prompt treatment of any complication if and when it occurs.

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

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

The effect of amniotomy on the outcome of spontaneous labour in uncomplicated pregnancy.

The objective of this study is to determine the effect of amniotomy on the outcome of spontaneous labour in uncomplicated pregnancy. A prospective randomised study of low-risk parous women with spontaneous onset of labour at term with singleton fetus in cephalic presentation and intact amniotic membranes and a cervical dilatation between 4 and 5 cm were randomly assigned to have amniotomy (Case) or no amniotomy (Control) during the course of labour. Maternal demographics, labour-delivery data and newborn outcome were compared. A total of 128 women were studied. The duration of labour was significantly shorter in the amniotomy group than the control group (208 vs 292 min; p < 0.05) with the only difference being in the first stage of labour. There was however no difference on the oxytocin requirement for labour augmentation, caesarean section rate, incidence of suspected fetal distress or instrumental delivery in both groups. Newborn outcome measured by Apgar scores at 1 and 5 min showed no significant difference. In conclusion, amniotomy significantly reduced the duration of the first stage of labour without affecting the oxytocin requirement, the rate of caesarean section and newborn outcome.

Assessment of delays in receiving delivery care at a tertiary healthcare delivery centre in Nigeria.

This study reviewed the causes of delays when patients were admitted with obstetric emergencies in Ife-Ife, Nigeria.

A randomised controlled study of non-closure of peritoneum at caesarean section in a Nigerian population.

A prospective randomised study of 54 patients undergoing caesarean section was carried out to determine if non-closure of peritoneum at lower segment caesarean section has advantages over suture peritonisation with regard to postoperative morbidity. A total of 27 women were randomised to closure and 27 to non-closure of peritoneum. Management decisions were made without reference to treatment groups. Statistical analysis compared the outcome between the two groups. The results revealed that anaesthesia and operating times were significantly shorter in patients that had the peritoneum left open. The incidence of febrile morbidity, wound infection, duration of postoperative and duration of hospital stay were not significantly different in both groups ( p < 0.05). The study concludes that non-closure of peritoneum is associated with significantly reduced operation and anaesthesia time with a non-significant difference in immediate postoperative outcome. Non-closure of peritoneum should be adopted at caesarean delivery.

Sexual behaviour and contraceptive use among secondary school students in Ilesha south west Nigeria.

Data from several parts of Nigeria point to increasing sexual activity among single adolescents of both sexes with progressive decreasing age at initiation and poor contraceptive use. This paper investigates the sexual behaviour and contraceptive use among teenage secondary school students in Ilesha, southwest Nigeria. This is a cross-sectional population survey of 300 male and female secondary school students within the age group of 13-19 years. The setting is secondary school coaching classes in Ilesha, southwest Nigeria. The outcome measures include prevalence of sexual activity, age at first sexual debut, circumstances leading to first sexual debut, number of sexual partners and family planning use. The result shows that out of the 300 studied, 50% were sexually active, the predominant age at first coitus was 15-19 years, and circumstances leading to sexual debut included mutual agreement, coercion and curiosity. Predominant proportion of sexually active teenagers (86.7%) did not use contraception at the time of first coitus and most of them had more than one sexual partner. The conclusion from this study is that 50% of teenage secondary school girls in this part of Nigeria are sexually active; 68.7% whom, have multiple sexual partners, and 86.7% of them did not use contraception at sexual debut. This unsafe sexual behaviour therefore put them at a great risk of acquiring STDs including HIV infection, and unwanted pregnancy. This study therefore recommends sex education/family life education for young people to encourage them to delay sexual activity as much as possible and practice safe sex when it eventually commences. There is also the need to sensitise the young people, parents, teachers, the community and all stake holders on the magnitude of the problem and to open up dialogue that will break the social, cultural and other mysteries hindering adolescents and youth reproductive health education and services in Nigeria.

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

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

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

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

Prevalence of sexual activity and family-planning use among undergraduates in Southwest Nigeria.

OBJECTIVE: To assess the prevalence of sexual activity and family-planning use among undergraduates in a private tertiary institution in Nigeria. METHODS: A cross-sectional survey of 283 undergraduate students. RESULTS: Out of 283 students, 245 (86.6%) are sexually active in the last month. Out of these 245, 219 (89%) are currently using a family-planning method. In the study population, the percentages of awareness, ever use, and current users are 89%, 77%, and 75%, respectively. The most commonly known, ever used, and currently used contraceptive is condom followed in descending order by calendar method, oral pills, coitus interruptus, injectable contraception, emergency contraception, intrauterine contraceptive device, and diaphragm. Unmarried students and male gender show statistical significance with condom use. The reasons for preferring the current contraceptive method, among 219 current users, include safety, cost, ready availability, and partner's preference, among others. Most of the nonusers gave no reason for a failure to use a contraceptive, but others felt that contraceptives are dangerous, while a minority were ignorant of any method. Though many use a condom, this use is inconsistent. CONCLUSION: There is a high level of sexual activity among these undergraduates. Many are aware of family planning, and the condom is the most commonly known and used method, though not consistently. Reproductive-health education should be promoted among youths in Nigeria.

Effect of prolonged birth spacing on maternal and perinatal outcome.

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

Obstetric performance of women aged over forty years.

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

Female genital mutilation: an analysis of 522 cases in South-Western Nigeria.

This study was conducted at three teaching hospitals in South-Western Nigeria. Paturients were examined to find out if they had had female genital mutilation. Those who did were given a self-administered questionnaire. Results show that all the patients had either Type I (69%) or Type II (31%) mutilation (using WHO classification). The average age at which the procedure was performed was 6.9+/-2.9 years, with 4% of women having the procedure performed in pregnancy. The majority of the procedures were performed by medically untrained personnel (89%). Up to 67% of the women reported complications following the procedure. Severe pain and bleeding were the most common (69%) of the complications reported. The most common reason given for the procedure is cultural/traditional (63%). About a fifth of the women want their female child to undergo female genital mutilation. This study highlights the need for further interventions aimed at discouraging the practice of female genital mutilation.