Effect of Frequency of Antenatal Care Contacts on Maternal and Fetal Outcome in Low-Risk Pregnancies at Federal Teaching Hospital Gombe, Nigeria.

BACKGROUND: The frequency of antenatal care (ANC) contacts for low-risk pregnancies has been a subject of debate. OBJECTIVE: To determine the effect of frequency of ANC contacts on pregnancy outcomes amongst low-risk pregnancies and the reasons for the low antenatal visits at the Federal Teaching Hospital, Gombe, Nigeria. METHODOLOGY: This was a cross-sectional study of 510 low-risk pregnant women. They were divided into two groups; group I consisted of 255 women that had eight or more ANC contacts with at least five contacts in 3rd trimester, and group II consisted of 255 women that had seven or fewer ANC visits. Socio-demographic characteristics, haemoglobin levels at delivery, mode of delivery, maternal satisfaction, and birth outcomes were compared between the two groups. Reasons for the low antenatal visits were also documented. RESULTS: The prevalence of anemia was higher in group II compared to group I {29.4% versus 18.8% with OR 1.80 (95% CI 1.19-2.72)} while caesarean section rate was higher in group I compared to group II {16.9% versus 9.4% with OR=1.96 (95% CI: 1.11-3.48)}. There was no statistically significant difference in the fetal outcome between the two groups. Women with eight or more ANC contact were more satisfied with the ANC than those with fewer visits (OR=2.20, 95%CI 1.52-6.24). Late booking and facility-based lapses were mainly responsible for the fewer contacts. CONCLUSION: Having eight or more ANC contacts is associated with decreased maternal anaemia, better maternal satisfaction, and increased risk of caesarean delivery compared to women that have fewer ANC contacts.

CONTEXTE: La fréquence des contacts de soins prénatals (CPN) pour les grossesses à faible risque a fait l'objet d'un débat. OBJECTIF: Déterminer l'effet de la fréquence des contacts de soins prénatals sur les résultats de la grossesse parmi les grossesses à faible risque et les raisons pour lesquelles les visites prénatales sont peu nombreuses au Federal Teaching Hospital, Gombe, Nigéria. MÉTHODOLOGIE: Il s'agit d'une étude transversale portant sur 510 femmes enceintes à faible risque. Elles ont été divisées en deux groupes : le groupe I comprenait 255 femmes ayant eu huit contacts ANC ou plus, dont au moins cinq au cours du troisième trimestre, et le groupe II comprenait 255 femmes ayant eu sept visites ANC ou moins. Les caractéristiques sociodémographiques, les taux d'hémoglobine à l'accouchement, le mode d'accouchement, la satisfaction maternelle et les résultats de l'accouchement ont été comparés entre les deux groupes. Les raisons des faibles visites prénatales ont également été documentées. RÉSULTATS: La prévalence de l'anémie était plus élevée dans le groupe II que dans le groupe I {29,4 % contre 18,8 % avec un OR de 1,80 (IC à 95 % : 1,19-2,72)}, tandis que le taux de césarienne était plus élevé dans le groupe I que dans le groupe II {16,9 % contre 9,4 % avec un OR de 1,96 (IC à 95 % : 1,11-3,48)}. Il n'y a pas eu de différence statistiquement significative entre les deux groupes en ce qui concerne l'issue fœtale. Les femmes ayant eu huit contacts ou plus avec la CPN étaient plus satisfaites de la CPN que celles ayant eu moins de visites (OR=2,20, 95%CI 1,52-6,24). La prise de rendezvous tardive et les défaillances au niveau de l'établissement étaient principalement responsables du nombre inférieur de contacts. CONCLUSION: Le fait d'avoir huit contacts CPN ou plus est associé à une diminution de l'anémie maternelle, à une meilleure satisfaction maternelle et à un risque accru d'accouchement par césarienne par rapport aux femmes qui ont moins de contacts CPN. Mots-clés: Anémie, Anténatal, Résultat de l'accouchement, Contacts, Effet, Fréquence, Satisfaction maternelle.

Prevalence and risk factors of hypocalcemia among pregnant and non-pregnant women in Maiduguri, Nigeria: A cross-sectional study.

BACKGROUND: Pregnancy is a period of heightened calcium demand necessary for the optimum growth and development of the fetus and placenta. Women with low calcium intake may manifest with hypocalcemia in pregnancy. OBJECTIVE: The aim of this study was to determine the prevalence and risk factors of hypocalcemia among pregnant and non-pregnant women in Maiduguri, Nigeria. SUBJECTS AND METHODS: A comparative cross-sectional study was conducted at the University of Maiduguri Teaching Hospital, Maiduguri from 1st January 2017 to 31st December 2018. For each patient, sociodemographic and clinical characteristics were noted. Serum calcium, phosphate, total protein, and albumin were determined using spectrophometric methods with their specific reagents. The data obtained was analyzed using the SPSS statistical software for windows version 20. Chi-square test, Student t-test and ANOVA were used as appropriate. Odd ratio with multiple logistic regression was used to determine risk factors for hypocalcemia. P value < 0.05 was considered statistically significant. RESULTS: A total of 1,500 (1,000 pregnant and 500 non-pregnant) women were analyzed. The mean age, total protein, and albumin were similar in the pregnant and non-pregnant women. However, the non-pregnant women were of higher parity than the pregnant women (3.75 ± 2.79 versus 2.45 ± 2.24, P < 0.001). The staple food of both group were mainly high carbohydrate diets. The prevalence of hypocalcemia was 29.20% among the pregnant women and 14.20% among the non-pregnant women (X2 = 64.34, P < 0.001). The mean serum calcium was lower among the pregnant compared to the non-pregnant women (2.08 ± 0.22 mmol/L versus 2.2 ± 0.19 mmol/L, F = 5.73, P = 0.02). There were no statistically significant differences in the mean serum calcium across the trimesters of pregnancy (F = 1.58, P = 0.21). CONCLUSION: Hypocalcemia in pregnancy is common in our environment and it is associated with anemia in pregnancy, anorexia, and primigravidity while attainment of at least basic education is protective. We recommend routine calcium supplementation in pregnancy and preconception period.

Gender attitude to the empowerment of women: an independent right to contraceptive acceptance, choice and practice.

Multiple factors influence the acceptance, choice and utilisation of contraceptive. The objective of the study is to identify individual attitude towards the empowerment of women to an independent right to accept, choose and utilise a contraceptive method of their choice without recourse to their male partners. This is a cross sectional study of men and women of different socio-cultural background working or utilising the services of the Federal Medical Centre Gombe, Nigeria. There were 554 respondents. Only 187 (34.4%) respondents thought that all women, irrespective of marital status, should have an independent right to contraceptive acceptance, choice and practice. Significantly more men (85.4%) than women (61.8%) rejected that women should have an independent right to contraceptive acceptance, choice and practice. Majority of both gender favoured male influence in the acceptance and choice of method of contraception. Our study has re-echoed the importance of male involvement in contraception decision-making.

Prevalence of utero-tubal infertility.

SUMMARY: Tubal factor infertility is the commonest cause of infertility seen in gynaecological clinics in Nigeria. This, to a large extent, is a preventable cause of infertility. The objective of the study was to determine the prevalence of utero-tubal factors in the causation of infertility. This is a prospective descriptive study of infertile women seen at the gynaecological clinic of the Federal Medical Centre Gombe from June 1999 to May 2002. A total of 229 infertile women were studied. The prevalence of primary and secondary infertility was 37.1% and 62.9%, respectively. Tubal factor was the cause in 67.2% and cervical factors contributed to 19.2%. The women were aged 17-44, with a mean of 28.6 +/- 5 years. There were four (1.7%) teenagers and eight (3.5%) women were aged 40 years or above. The majority, 55% (126), were in their third decade, with those aged 20-34 years constituting 86% (197) of patients. The high prevalence of tubal factor infertility in our environment is unacceptable. Primary prevention of reproductive tract infections and syndromic management of STD will go a long way in reducing the high prevalence of tubal factor infertility.

Attitude of Nigerian women to contraceptive use by men.

This study was aimed at finding the attitude of Nigerian women to contraceptive use by their male partners. A total of 417 women received the questionnaire; 71% of these were sexually active and 34.8% were not aware of any male contraceptive method. Only 1.7% reported regular use of condoms by their spouses, however this was significantly higher if the women were better educated. Most of the women had a positive attitude to contraceptive use by their spouses, as 54% (225/417) of them showed preference to male dependant contraceptives in their relationship. However, only 32.3% (135/417) of the women had ever-requested their spouse to use a condom and in just 18.5% (25/135) was such a request regularly complied with. Significantly more Muslim women prefer their partners to use a contraceptive rather than themselves (p = 0.001), but the condom usage by their spouses is significantly lower than their Christian counterparts (p = 0.000). There is a need to offer counselling on male contraceptives to both genders so that they can make an informed choice, especially with the dual protection offered by the use of condoms.

Risk factors for obstetric fistulae in north-eastern Nigeria.

This prospective comparative study of obstetric fistulae (OF) was aimed at identifying risk factors. A total of 80 obstetric fistulae treated at the gynaecological unit of the FMCG, and 80 inpatients without fistulae recruited randomly as controls formed the basis of this study. Through interview and case record review, information on age, parity and marital status was collected. Other features were educational status, occupation and booking status of the pregnancy that might have led to this condition. The duration of labour, place of birth and mode of delivery, including its outcome were also collected. The data were analysed using the Epi Info. The majority of the patients were Hausa/Fulani 87.5%, Muslims 91.2%, with large vesicovaginal fistulae (average size 5.0 cm) mainly resulting from obstructed labour (93.7%). Major risk factors included early age at first marriage (average 14 years), short stature (average height 146.2 cm) and illiteracy (96.3%). Also low social class and lack of gainful employment were factors. Failure to book for antenatal care (93.7%), and rural place of residence (95%) were also factors associated with acquiring the fistulae. Living far away (>3 km) from a health facility also contributed or predisposed to the development of an obstetric fistula. Social violence and stigma associated with the fistulae included divorce, being ostracised as a social outcast, and lack of assistance from relations in terms of finding and funding treatment. This study supports improved access to basic essential obstetric care, family planning services, and timely referral when and where necessary. Universal education will provide a long-term solution by improving the standard of living and quality of life. Especially important are media- and community-based programmes on the ills of teenage marriage and child pregnancy using cultural and religiously-based values to give sound advice. In a male dominated society, reaching out to men with traditionally palatable messages that will change their attitude and practices to taking responsibility in reproductive health could be a winning strategy.

Lysosomal enzymes in preeclamptic women in northern Nigeria.

BACKGROUND: The incidence of preeclampsia is high in northern Nigeria, as it is in many other developing countries, and preeclampsia is associated with significant maternal and fetal morbidity and mortality. We inquired if proteinuria or hypertension alone could account for the altered concentrations of urinary lysosomal hydrolases that have been reported in preeclamptic women and pregnant women without preeclampsia. METHODS: The activities of urinary beta-hexosaminidase and beta-galactosidase were determined fluorometrically in pregnant women assigned to one of four groups: Group I: 41 preeclamptic women; Group II: 31 hypertensive aproteinuric women; Group III: 44 normotensive proteinuric women; and Group IV: 52 healthy pregnant women (controls). RESULTS: The urinary beta-hexosaminidase concentrations were decreased in the preeclamptic women (P<0.005) and proteinuric women (P<0.001) when compared to the healthy pregnant controls. There was no significant difference in beta-hexosaminidase concentrations between the hypertensive women and the healthy pregnant controls. The urinary beta-galactosidase concentrations for preeclamptic, hypertensive, and proteinuric women did not differ significantly versus healthy pregnant controls. CONCLUSIONS: The reduced urinary excretion of beta-hexosaminidase in preeclamptic women is associated with proteinuria, but not hypertension. Measuring urinary concentrations of lysosomal hydrolases alone or in conjunction with urinary protein concentrations is not likely to be useful in predicting or monitoring the clinical course of preeclampsia; however, it might prove important in gaining a more complete understanding of the pathogenesis of renal tubular epithelial cell injury and proteinuria that occurs in preeclampsia.

Heterotopic pregnancy in a natural conception cycle. A case report.

We report a case of combined intrauterine and tubal pregnancy in a 32 year old para. The patient presented at the Gynaecological emergency unit, with lower abdominal pain, and vaginal bleeding. A pelvic scan confirmed an intrauterine pregnancy. While being managed as a case of threatened abortion, her condition deteriorated and the likelihood of an ectopic pregnancy was entertained. A repeat scan revealed significant peritoneal collection. suggestive of haemoperitoneum, and laparotomy confirmed heterotopic pregnancy. She had a right salpingectomy without complications. The patient had a supervised antenatal care and safe delivery of the intrauterine pregnancy.

The analysis of eclamptic morbidity and mortality in the Specialist Hospital Gombe, Nigeria.

A retrospective review of 302 cases of eclampsia treated at the Specialist Hospital Gombe (SHG), between January 1st 1997 and December 31st 1999 is presented. Intrapartum eclampsia was the commonest presentation, occurring in 166 (55.0%) patients. Headache, blurred vision, and epigastric pain preceded the first episode of seizure in 272 (90.0%) of the cases. The diastolic blood pressure of 110 mmHg or more was recorded in 102 (33.8%) of the study group. Eclampsia was more common among teenage mothers 202 (66.9%), and primigravidae 222 (73.5%). Spontaneous vaginal delivery occurred in 159 (52.6%) of the patients. Caesarean section was performed in 122 (40.4%) of the cases. Pyrexia was the commonest morbidity. There were 35 maternal deaths giving a case fatality rate of 11.6%. There were 111 (36.8%) perinatal deaths during the study period. Expanded sections in mass media education of the general populace and counselling young women on care during pregnancies are suggested. The provision and use of life-saving treatment is paramount, at the same time efforts towards eliminating the conditions that created the unbooked emergencies are crucial.

Obstructed labour: a public health problem in Gombe, Gombe State, Nigeria.

This study reviewed retrospectively the cases of obstructed labour as seen at the specialist Gombe Hospital (SHG), Gombe State, over a period of 5 years. The incidence of obstructed labour was 4.0%. There was a progressive decline in the time trend over the study period. About 80.3% of the patients were unbooked emergencies and 99.5% of them had been in labour elsewhere before presenting at the hospital. The leading cause of obstructed labour was cephalopelvic disproportion (83.0%). Caesarean section (72.2%) was the most common method of delivery. Puerperal sepsis was the most frequent morbidity. However, the longest duration of hospital stay was as a result of a bedsore. The maternal mortality for cases of obstructed labour was 7605/100,000 and the perinatal mortality was 628/1000 births. The study aims to reinstate public interest in this health problem and offers suggestions on how to curb this human tragedy.

Prevalence of rubella-specific IgG antibody in non-immunized pregnant women in Maiduguri, north eastern Nigeria.

The prevalence of IgG antibody specific to the rubella virus was assessed in 207 consenting pregnant women. The women were in the age range of 14 to 40 years (mean 25.8 years) and parity range of 0 to 8 (mean para 4), in their first and second trimesters of pregnancy. All attended the antenatal clinic of a tertiary health facility (University of Maiduguri Teaching Hospital) in northeastern Nigeria. Of the 207 serum samples tested, 112 (54.1%) were positive for rubella IgG antibody. In this area therefore, the proportion of susceptible pregnant women to rubella virus is up to 46%. The results from this study also indicated that with increased maternal age the percentage of immune women increased significantly (P = 0.04382) from 23.8% in the 14 to 19 years age group to 74.4% in the age group of 30 to 40 years. There was again a gradual increase in rubella seroprevalence from 43% amongst primigravidae to 59% and 78% in multiparous and grandmultiparous women respectively. The pregnancy outcome was normal in 27% of the women studied, with miscarriage occurring in 24.6% and 24.2% each had a premature delivery and stillbirth. There were 30 (58.8%) miscarriages, 27 (54%) premature deliveries and 30 (60%) stillbirths, with no clinically detectable malformations in 25 (44.6%) of all the deliveries from the immune women. There is therefore, an increase in the number of rubella immune women with each of the pregnancy outcomes compared to the non-iminune ones. Hence, the need to protect children of these susceptible women from contracting congenital rubella and its sequelae by including routine rubella vaccination of all women of childbearing age in the current programme on immunization.

The influence of reproductive and marital factors on cervical dyskaryosis.

Five hundred sexually active women attending various clinics in the Department of Obstetrics and Gynaecology of the University of Maiduguri Teaching Hospital had questionnaires on their reproductive and marital characteristics randomly administered. Their 'Pap' smears were then taken for cytological examination. The aim was to determine the influence of marital and reproductive factors on the occurrence of cervical dyskaryosis and how these may be used to develop a risk-scoring criteria that could target selectively the population most at risk. Late marriage, early age at first pregnancy and grand-multiparity significantly influenced the occurrence of cervical dyskaryosis. These factors may be valuable in developing a risk score that could target women at higher risk of developing cervical dyskaryosis.

Caesarean morbidity and mortality at Maiduguri, Nigeria.

A total of 2456 deliveries took place at the University of Maiduguri Teaching Hospital, Maiduguri, between January 1995 and December 1996 inclusive. Two hundred and five women were delivered by caesarean giving a caesarean section rate of 8.3%. One hundred and ninety-eight (96.6%) case records were retrieved for analysis. Eighty-eight patients (44.4%) had one or more intra- and/or postoperative complications. Sepsis was the commonest complication involving 62 (70.4%) women. All were cases of emergency caesarean section. The incidence of other complications were anaemia, 59 (67%); hemorrhage, 38 (43.2%); and wound dehiscence, 11 (12.5%). There were two maternal deaths (2.3%) due to an anaesthetic accident and septicaemia respectively. The factors resulting in complications of the caesarean deliveries were prolonged obstructed labour, prolonged rupture of fetal membranes, previous caesarean sections, antepartum haemorrhage and severe pre-eclampsia and eclampsia. A review of the use of prophylactic antibiotics in selected cases, early recourse to operation in cases with cephalo-pelvic disproportion, and the acquisition of trained anaesthetists are advocated.

Knowledge and attitude to cervical cancer screening among women in Maiduguri, Nigeria.

Five hundred women were studied to determine their knowledge of cervical cancer. Less than 10% of the women were aware of the disease or its symptoms. Even fewer were aware of cytological screening, the good results obtained in the premalignant stage and early invasive stages of the disease. Simple explanation showed a good recall at 4-6 weeks. At that time women would accept screening and understood its importance. This study shows clearly that education must precede a screening programme if it is to succeed.

Sexual attitudes and their relation to cervical intraepithelial neoplasia in Maiduguri, Nigeria.

Five hundred randomly selected sexually active women attending antenatal, postnatal, family planning and gynaecological clinics in the Department of Obstetrics and Gynaecology, University of Maiduguri Teaching Hospital, had questionnaires administered on their sexual attitudes/ behaviour and their 'pap'smears taken for cytological assessment. The aim was to identify any significant association between sexual attitudes/behaviour and cervical intraepithelial neoplasia (CIN) for the purpose of targeting the population most at risk. Ninety-one women had varying degrees of CIN, a prevalence rate of 18.2%. However, multiple sexual partners was the only factor incriminated to significantly increase the risk of occurrence of CIN. Targeting women with multiple sexual partners may help in directing limited screening resources to those more likely to be positive.

Perceived causes of eclampsia in four ethnic groups in Borno State, Nigeria.

This study was conducted among the four major ethnic groups(Kanuri, Babur, Shuwa and Marghi) of Borno State, North-east Nigeria. The aim of the study was to identify the perceived causes of eclampsia, a leading cause of maternal death in the State. The data were obtained through focus group discussions (FGDs), questionnaires and in-depth interviews. A total of 16 FGDs and 1,167 questionnaire interviews were conducted among the rural populace. In-depth interviews were conducted on relatives of thirty eclamptic patients admitted to the University of Maiduguri Teaching Hospital. The findings revealed that evil spirits/witches and wizards, poor nutrition, heredity early marriage, destiny from God and machinations of co-wives are the perceived causes of eclampsia in the area. These perceptions result in the use of the following as means of treatment: drinks of various concoctions, inhalation of smoked herbs in rooms, potash drinks, and the wearing of talisman around the neck. These perceptions and traditional medications have implications for design of educational and informational messages aimed at reducing maternal mortality from eclampsia in Borno State.