Abdullahi Randawa

Qualitative assessment of women’s satisfaction with maternal health care in referral hospitals in Nigeria

BackgroundAvailable evidence suggests that the low use of antenatal, delivery, and post-natal services by Nigerian women may be due to their perceptions of low quality of care in health facilities. This study investigated the perceptions of women regarding their satisfaction with the maternity services offered in secondary and tertiary hospitals in Nigeria.MethodsFive focus group discussions (FGDs) were held with women in eight secondary and tertiary hospitals in four of the six geo-political zones of the country. In all, 40 FGDs were held with women attending antenatal and post-natal clinics in the hospitals. The questions assessed women’s level of satisfaction with the care they received in the hospitals, their views on what needed to be done to improve patients’ satisfaction, and the overall quality of maternity services in the hospitals. The discussions were audio-taped, transcribed, and analyzed by themes using Atlas ti computer software.ResultsFew of the participants expressed satisfaction with the quality of care they received during antenatal, intrapartum, and postnatal care. Many had areas of dissatisfaction, or were not satisfied at all with the quality of care. Reasons for dissatisfaction included poor staff attitude, long waiting time, poor attention to women in labour, high cost of services, and sub-standard facilities. These sources of dissatisfaction were given as the reasons why women often preferred traditional rather than modern facility based maternity care. The recommendations they made for improving maternity care were also consistent with their perceptions of the gaps and inadequacies. These included the improvement of hospital facilities, re-organization of services to eliminate delays, the training and re-training of health workers, and feedback/counseling and education of women.ConclusionA women-friendly approach to delivery of maternal health care based on adequate response to women’s concerns and experiences of health care will be critical to curbing women’s dissatisfaction with modern facility based health care, improving access to maternal health, and reducing maternal morbidity and mortality in Nigeria.Trial registrationTrial Registration Number NCTR No: 91540209. Nigeria Clinical Trials Registry. http://www.nctr.nhrec.net/. Registered April 14th 2016.

Pattern of serum total alkaline phosphatase activity in different stages of normal third trimester pregnancy in Zaria, Northern Nigeria

Background: There are reports from many parts of the world on the increased activity of serum total alkaline phosphatase (TALP) in pregnant women, especially during the last half of pregnancy. There is no such documented finding in this environment. There is the need to determine the serum TALP activity in different stages of normal 3 rd trimester pregnancy in Zaria to allow for proper interpretation of this analyte at this stage of pregnancy. Subjects and Methods: A cross sectional descriptive study carried out among 100 healthy pregnant women in their 3 rd trimester. They were randomly selected from the antenatal clinic of Ahmadu Bello University Teaching Hospital, Zaria. Serum TALP activity was measured using the 4-Nitrophenylphosphate (4-NPP) method. Socio-demographic and obstetrics characteristics were obtained using an administered questionnaire. Microsoft Excel (Microsoft office, 2003) was used for data analysis. Distributions of ALP activities were found to be skewed; hence, non-parametric analyses using percentiles were used in measuring the variation. A P-value of equal to or less than 0.05 (P ≤ 0.05) was considered as statistically significant. Results: The serum TALP activity in normal 3 rd trimester pregnancy was found to be higher when compared to the normal population, with a gradual increase with advancing gestational age. Subjects in the gestational age group of 28 to 30 weeks had a serum TALP activity of 46-138 IU/L, with a continuous increase of up to 213 IU/L at 39 weeks of gestation. A sudden drop in activity was observed at the gestational age of 40 weeks and above. The overall serum TALP activity in normal 3 rd trimester pregnancy was found to be 41-206 IU/L. Conclusion: A higher serum TALP activity for normal 3 rd trimester pregnancy was confirmed for this environment, as has been found elsewhere. There is the need to interpret serum TALP activity in pregnancy with caution.

Views of senior health personnel about quality of emergency obstetric care: A qualitative study in Nigeria

Background Late arrival in hospital by women experiencing pregnancy complications is an important background factor leading to maternal mortality in Nigeria. The use of effective and timely emergency obstetric care determines whether women survive or die, or become near-miss cases. Healthcare managers have the responsibility to deploy resources for implementing emergency obstetric care. Objectives To determine the nature of institutional policies and frameworks for managing obstetric complications and reducing maternal deaths in Nigeria. Methods Thirty-six hospital managers, heads of obstetrics department and senior midwives were interviewed about hospital infrastructure, resources, policies and processes relating to emergency obstetric care, whilst allowing informants to discuss their thoughts and feelings. The interviews were audiotaped, transcribed and analyzed using Atlas ti 6.2software. Results Hospital managers are aware of the seriousness of maternal mortality and the steps to improve maternal healthcare. Many reported the lack of policies and specific action-plans for maternal mortality prevention, and many did not purposely disburse budgets or resources to address the problem. Although some reported that maternal/perinatal audit take place in their hospitals, there was no substantive evidence and no records of maternal/perinatal audits were made available. Respondents decried the lack of appropriate data collection system in the hospitals for accurate monitoring of maternal mortality and identification of appropriate remediating actions. Conclusion Healthcare managers are handicapped to properly manage the healthcare system for maternal mortality prevention. Relevant training of healthcare managers would be crucial to enable the development of strategic implementation plans for the prevention of maternal mortality.

Association of the client-provider ratio with the risk of maternal mortality in referral hospitals: a multi-site study in Nigeria

BackgroundThe paucity of human resources for health buoyed by excessive workloads has been identified as being responsible for poor quality obstetric care, which leads to high maternal mortality in Nigeria. While there is anecdotal and qualitative research to support this observation, limited quantitative studies have been conducted to test the association between the number and density of human resources and risk of maternal mortality. This study aims to investigate the association between client-provider ratios for antenatal and delivery care and the risk of maternal mortality in 8 referral hospitals in Nigeria.MethodsClient-provider ratios were calculated for antenatal and delivery care attendees during a 3-year period (2011–2013). The maternal mortality ratio (MMR) was calculated per 100,000 live births for the hospitals, while unadjusted Poisson regression analysis was used to examine the association between the number of maternal deaths and density of healthcare providers.ResultsA total of 334,425 antenatal care attendees and 26,479 births were recorded during this period. The client-provider ratio in the maternity department for antenatal care attendees was 1343:1 for doctors and 222:1 for midwives. The ratio of births to one doctor in the maternity department was 106:1 and 18:1 for midwives. On average, there were 441 births per specialist obstetrician. The results of the regression analysis showed a significant negative association between the number of maternal deaths and client-provider ratios in all categories.ConclusionWe conclude that the maternal mortality ratios in Nigeria’s referral hospitals are worsened by high client-provider ratios, with few providers attending a large number of pregnant women. Efforts to improve the density and quality of maternal healthcare providers, especially at the first referral level, would be a critical intervention for reducing the currently high rate of maternal mortality in Nigeria.Trial registrationTrial Registration Number: NCTR91540209. Nigeria Clinical Trials Registry. Registered 14 April 2016.

Prevalence and risk factors for maternal mortality in referral hospitals in Nigeria: a multicenter study

Introduction While reports from individual hospitals have helped to provide insights into the causes of maternal mortality in low-income countries, they are often limited for policymaking at national and subnational levels. This multisite study was designed to determine maternal mortality ratios (MMRs) and identify the risk factors for maternal deaths in referral health facilities in Nigeria. Methods A pretested study protocol was used over a 6-month period (January 1–June 30, 2014) to obtain clinical data on pregnancies, births, and maternal deaths in eight referral hospitals across eight states and four geopolitical zones of Nigeria. Data were analyzed centrally using univariate, bivariate, and multivariate statistics. Results The results show an MMR of 2,085 per 100,000 live births in the hospitals (range: 877–4,210 per 100,000 births). Several covariates were identified as increasing the odds for maternal mortality; however, after adjustment for confounding, five factors remained significant in the logistic regression model. These include delivery in a secondary health facility as opposed to delivery in a tertiary hospital, non-booking for antenatal and delivery care, referral as obstetric emergency from nonhospital sources of care, previous experience by women of early pregnancy complications, and grandmultiparity. Conclusion MMR remains high in referral health facilities in Nigeria due to institutional and patient-related factors. Efforts to reduce MMR in these health facilities should include the improvement of emergency obstetric care, public health education so that women can seek appropriate and immediate evidence-based pregnancy care, the socioeconomic empowerment of women, and the strengthening of the health care system.

Seroprevalence of brucellosis among women with miscarriage at Ahmadu Bello University Teaching Hospital, Zaria

Background: Brucellosis in animals has been identified as a common cause of miscarriage. It is the most common zoonotic disease that leads to considerable morbidity in humans. It is rarely diagnosed in hospitals in Nigeria, and debate exists as to whether it is a more common cause of miscarriage in humans compared to other infective agents, especially with the finding of antibrucella activity in human amniotic fluid. Brucellosis in humans is a treatable disease and risk factors for transmission are prevalent in Zaria. Objective: The objective of this study was to determine the seroprevalence of brucellosis among women with miscarriage. Materials and Methods: This was a descriptive cross-sectional study involving 121 women aged between 15 and 49 years with miscarriage who presented to Ahmadu Bello University Teaching Hospital (ABUTH), Zaria from August 2014 to May 2015. Information on socio-demographic characteristics, reproductive profile, and risk factors for contracting Brucella infection were obtained using a questionnaire. Blood samples were obtained and analysed for Brucella IgG and IgM using indirect enzyme-linked immunosorbent assay kits. The data was analysed with SPSS, version 20.0. Results: The mean age of the participating women was 29.07 years [standard deviation (SD) ±6.74]. The seroprevalence of brucellosis was 19.0%; 17.4% of the women had a recent infection, and 1.7% had a chronic infection. Age, history of previous miscarriage, consumption of milk products and consumption of roasted meat/barbecue had positive relationships with recent Brucella infection (χ2 = 9.706, P = 0.046; χ2 = 7.300, P = 0.026; χ2 = 3.169, P = 0.049; χ2 = 3.012, P = 0.050, respectively). Chronic Brucella infection had a positive relationship with number of pregnancies (χ2 = 8.036, P = 0.018). Regression analyses showed that age, history of previous miscarriage and history of recent miscarriage in animals reared were positively correlated with Brucella seropositivity and miscarriage (χ2 = 13.200, P = 0.022; χ2 = 9.795, P = 0.007; χ2 = 7.890, P = 0.005, respectively). Conclusion: There is a high prevalence of brucellosis among women with miscarriage in Zaria. The burden of the disease should be appreciated and routinely tested to prevent reoccurrence.

Abstract B27: Assessment of chemotherapeutic responses to neoadjuvant FOLFOX and Aspirin on BIRC7 in colorectal adenocarcinoma cells induced in Albino rats

Chemotherapeutic resistance is a problem in the management of malignant tumors especially colorectal adenocarcinoma. Overexpression of Baculoviral IAP repeat-containing protein-7 (BIRC7) was previously reported by this study group to limit the cytotoxic efficacy of neoadjuvant folinic acid, 5-fluorouracil and oxaliplatin (FOLFOX) chemotherapy regimen on human colorectal cancer cells in-vivo. And a significant inhibitory effect of Aspirin on the BIRC7 protein in p53 mutant SW480 colon cancer cells in-vitro was also found. Our aim now is to access the efficacy of the addition of Aspirin to neoadjuvant FOLFOX-chemotherapy on colorectal cancer cells in-vivo using the N-methyl-N-nitrosourea (NMU) carcinogen-induced model on albino rats per rectum. A total of 180 male Albino rats whose weight falls between 110-150g will be used. They will be grouped into 18 sets of 10 rats each and a three staged study will be performed. Namely, assessment of health parameters before the cancer induction, assessments on confirmation of cancer induction and assessments after chemotherapeutic intervention. The chemotherapeutic intervention will be further subdivided into mono, bi or tri therapy in various combinations with and without the addition of the Aspirin. The addition of Aspirin to the chemotherapy regimen will be further divided into concurrent and sequential addition. NMU will be administered at a dose of 2 mg/kg intra rectally every other day until the development of colorectal cancer which, will be confirmed by barium enema and histological analysis. Aspirin will be administered at a dose of 25 mg/kg or 12.5 mg/kg. Folinic acid will be administered at a dose of 7 mg/kg or 3.5 mg/kg intraperitoneally (i.p). Oxaliplatin will be dministered at a dose of 3 mg/kg or 1.5 mg/kg i.p. And 5-FU will be administered at a dose of 50 mg/kg or 25 mg/kg i.p. The animals9 hemogram and other pertinent investigations will be done ultimately including culling for histological assessment of tumors. The tumors will be processed for HE May 16-19, 2016; Miami, FL. Philadelphia (PA): AACR; Clin Cancer Res 2017;23(1_Suppl):Abstract nr B27.

Abstract 4918: Is Livin a protagonist of mucinous adenocarcinoma histology in colorectal cancer

The mechanism of cancer resistance to chemotherapy regimen remains uncertain. Colorectal mucinous adenocarcinoma is one of the distinct histological subtypes of the disease implicated in chemotherapeutic resistance associated with nodal and peritoneal metastases and worse disease-free survival as an index of poor prognosis. One of the important acquired capabilities used by the cancer cells to resist anticancer therapies is evasion of apoptosis possibly via inhibitor of apoptosis proteins for which Livin is one. This protein contains baculoviral IAP repeat domains in addition to a RING finger, a protein-protein motif important for binding and inhibition of active caspases that interfere with intrinsic and/or extrinsic pathway and the ensuing blockade of apoptosis. Thus, understanding the molecular events on how cancer cells of mucinous histology evade apoptotic death may provide a novel paradigm for a molecular targeted therapy in the management of colorectal mucinous adenocarcinoma. In this study, the expression pattern and prognostic value of IAP family protein, Livin, in colorectal cancer patients with mucinous histology pre and post-chemotherapy regimen was investigated. Tissue sections from advanced stage colorectal cancer patients who were treated or untreated with neo-adjuvant FOLFOX chemotherapy before curative resection were included in this study. The tissue sections were grouped according to colorectal adenocarcinomas showing mucinous histology and non-mucinous component. Histological study including Haematoxylin and Eosin, and immunohistochemistry for Anti-Livin and DNA mismatched repair proteins were carried out. Immunofluorescence study was performed to clarify the expression pattern of the protein using Anti-Livin antibody. Protein expression quantification study was also used. Results show significant cytoplasmic localisation and expression of Livin protein in the colorectal cancer cells. The Livin protein expression was found to be increased by more than a one-fold post-chemotherapy treatment when compared with pre-chemotherapy treated patients with mucinous histology of colorectal cancer. Younger patients were found to have a greater probability of colorectal mucinous adenocarcinoma diagnosis and worse prognosis. Our findings show that Livin-induced inhibition of apoptosis activity can be a target for novel approaches to treatment and prevention of chemotherapy associated drug resistance in mucinous histology colorectal cancer since Livin overexpression has been associated with metastases and worse disease-free survival. More study is needed Citation Format: Mohammed Faruk, Abdulmumini Hassan Rafindadi, Sani Ibrahim, Surajo Mohammed Aminu, Surajo Mohammed Aminu, Ahmed Adamu, Ahmed Adamu, Yawale Iliyasu, Adamu Abdullahi, Mohammed Sani Shehu, Abdullahi Mohammed, John Idoko, Abdullahi Jibril Randawa, Abdullahi Jibril Randawa, Atara Ntekim, Saad Aliyu Ahmed, Aishatu Suleiman Maude, Almustapha Aliyu Liman, Abubakar Sani, Khalid Zahir Shah, Yahaya Ukwenya, Yahaya Ukwenya, Cheh Augustine Awasum, Kasimu Umar Adoke, James Olowu Enemari, James Olowu Enemari, James Olowu Enemari, Andrew Jonathan Nok. Is Livin a protagonist of mucinous adenocarcinoma histology in colorectal cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4918. doi:10.1158/1538-7445.AM2017-4918

Prevalence of obesity and outcome of weight loss on reproduction: A study among women attending infertility clinic in Zaria, Northern Nigeria

Objective: Obesity is rising in the developing countries because of changing life style, and this has its burden on fertility and its management. This study determined the prevalence of obesity and clinical correlation of obesity with menstrual abnormalities, as well as the rate of spontaneous conception among obese infertile women on nonsurgical weight loss therapy. Methodology: A cross-sectional longitudinal study was done among women that presented with infertility to the gynecology clinic. The main outcomes measured were percentage of infertile women that are obese, menstrual pattern of these women, and spontaneous conception among obese infertile women following weight loss therapy. Results: Of the 205 patients, 68 (33.2%) were found to be obese; there was a significant association between obesity and abnormal menstrual pattern (P = 0.0002). Oligomenorrhea and hypomenorrhea were also found to be significantly associated with obesity (P = 0.009 and P = 0.022, respectively). Following average of 12-month follow up, spontaneous conception among obese infertile women while on weight loss therapy was 21.1%. Conclusion: The prevalence of obesity was high with a significant association between obesity and menstrual abnormalities. Weight loss among obese infertile women led to improvement in spontaneous conception.

Prevalence of hyperprolactinemia among infertile patients with menstrual abnormalities and/or galactorrhea at a University Teaching Hospital, North West Nigeria

Objective: Hyperprolactinemia may be associated with galactorrhea, menstrual abnormalities, and infertility. When diagnosed and appropriate treatment instituted, there may be early relief of these symptoms and pregnancy rate may increase. This study determined the prevalence of hyperprolactinemia among infertile patients with menstrual abnormalities and/or galactorrhea. Patients and Methods: A cross-sectional study of women attending the infertility clinic who had galactorrhea and/or menstrual abnormalities. Menstrual abnormalities for this study refer to those with oligomenorrhea and amenorrhea. Results: Out of the 207 women studied, 75 of them have hyperprolactinemia, giving a prevalence of 36.2%. Galactorrhea has higher sensitivity (68%), a higher positive predictive value (39.5%), and a higher negative predictive value (69.3%) when compared with menstrual abnormalities which had sensitivity of 44%, positive predictive value of 29.7%, and negative predictive value of 56.3%, respectively. They, however, have the same specificity of 40.9%. Conclusion: The prevalence of hyperprolactinemia is high in this study. Galactorrhea is a better clinical indicator of hyperprolactinemia when compared with menstrual abnormalities.