Adeniran O. Fawole

Determinants of perinatal mortality in Nigeria

To determine risk factors for perinatal mortality among hospital‐based deliveries in Nigeria.

Clients’ Perceptions of the Quality of Antenatal Care

OBJECTIVES To assess perceptions of pregnant women about quality of antenatal care. METHODS Descriptive cross-sectional study in a developing country setting. Three-hundred-ninety-five previously booked pregnant women randomly selected from private and public health facilities at the 3 levels of care were interviewed using a 52-stem interviewer-administered, semistructured questionnaire. The questionnaire sought information about bio data, health information and services, interpersonal communications, amenities and constellation of services. RESULTS Mean gestational age at booking was 18.5 +/- 6.3 weeks. Only 25.8% of respondents booked in the first trimester. Mean number of antenatal visits was 4.0 +/- 2.4. Mean time spent during clinic visits was 3.9 +/- 1.4 hours. Waiting time was rated as appropriate by most women (67.1%). Women with high education and in upper socioeconomic class tended to rate the waiting time as too long. Counseling for HIV was the predominant health education subject. More than half (53.9%) of respondents did not receive information about cervical cancer. About 10% of patients did not receive information about danger signs during pregnancy, breast self-examination, family planning and prevention of sexually transmitted infections. Clinic amenities and constellation of services were rated highly. Most women (96.5%) were satisfied with the care received, would use the same facility in future pregnancies and would recommend it to friends. CONCLUSIONS The majority of pregnant women were satisfied with the care they received. However, frequent antenatal visits and long waiting times are the norm of our antenatal service. Measures for improving elements of quality of antenatal care are imperative.

Prevalence of violence against pregnant women in Abeokuta, Nigeria

Aim:  To determine the prevalence of violence to pregnant women within 12 months prior to and during the current pregnancy.

National data system on near miss and maternal death: shifting from maternal risk to public health impact in Nigeria

BackgroundThe lack of reliable and up-to-date statistics on maternal deaths and disabilities remains a major challenge to the implementation of Nigerias Road Map to Accelerate the Millennium Development Goal related to Maternal Health (MDG-5). There are currently no functioning national data sources on maternal deaths and disabilities that could serve as reference points for programme managers, health advocates and policy makers. While awaiting the success of efforts targeted at overcoming the barriers facing establishment of population-based data systems, referral institutions in Nigeria can contribute their quota in the quest towards MDG-5 by providing good quality and reliable information on maternal deaths and disabilities on a continuous basis. This project represents the first opportunity to initiate a scientifically sound and reliable quantitative system of data gathering on maternal health profile in Nigeria.ObjectiveThe primary objective is to create a national data system on maternal near miss (MNM) and maternal mortality in Nigerian public tertiary institutions. This system will conduct periodically, both regionally and at country level, a review of the magnitude of MNM and maternal deaths, nature of events responsible for MNM and maternal deaths, indices for the quality of care for direct obstetric complications and the health service events surrounding these complications, in an attempt to collectively define and monitor the standard of comprehensive emergency obstetric care in the country.MethodsThis will be a nationwide cohort study of all women who experience MNM and those who die from pregnancy, childbirth and puerperal complications using uniform criteria among women admitted in tertiary healthcare facilities in the six geopolitical zones in Nigeria. This will be accomplished by establishing a network of all public tertiary obstetric referral institutions that will prospectively collect specific information on potentially fatal maternal complications. For every woman enrolled, the health service events (care pathways) within the facility will be evaluated to identify areas of substandard care/avoidable factors through clinical audit by the local research team. A summary estimate of the frequencies of MNM and maternal deaths will be determined at intervals and indicators of quality of care (case fatality rate, both total and cause-specific and mortality index) will be evaluated at facility, regional and country levels.ManagementOverall project management will be from the Centre for Research in Reproductive Health (CRRH), Sagamu, Nigeria. There will be at least two meetings and site visits for efficient coordination of the project by regional coordinators and central coordinating staff. Data will be transferred electronically by hospital and regional coordinators and managed at the Data Management Unit of CRRH, Sagamu, Nigeria.Expected outcomesThe outcome of the study would provide useful information to the health practitioners, policy-makers and international partners on the strengths and weaknesses of the infrastructures provided for comprehensive emergency obstetric care in Nigeria. The successful implementation of this project will pave way for the long-awaited Confidential Enquiries into Maternal Deaths that would guide the formulation and or revision of obstetric policies and practices in Nigeria. Lessons learnt from the establishment of this data system can also be used to set up similar structures at lower levels of healthcare delivery in Nigeria.

A double-blind, randomized, placebo-controlled trial of misoprostol and routine uterotonics for the prevention of postpartum hemorrhage

To assess the effects of 400‐μg sublingual misoprostol plus routine uterotonics on postpartum hemorrhage.

Perceptions and attitudes of Nigerian women about the menopause

The attitudes of women to the menopause are strongly influenced by social, cultural and economic settings in which they live and may also reflect the differences in modes of treatment for or perception of its symptoms. The object of this study was to determine the perception and attitude of post-menopausal Nigerian women to the menopause. We interviewed 676 women who had experienced at least 24 months of amenorrhoea using a structured questionnaire. Menopause was considered a normal physiological manifestation of the ageing process by 95.56% of the respondents while 2.66% believed it was a disease condition. The majority of the women had a positive attitude to the menopause and indicated that it did not affect their relationships with their spouses or children. For most of the women (71.13%), sexual life ended with menopause. None of the women was on hormone replacement therapy but among those sexually active, reduced libido/frequency and vaginal dryness were reported by 24.59%. The most commonly reported advantage of menopause was freedom from cyclical bleeding. We conclude that although Nigerian post-menopausal women have a positive disposition towards menopause, they may have a significant reproductive health burden which has been tolerated for so long. It is important to determine the influence of sociocultural belief on sexuality after menopause and also evaluate the benefits of hormone replacement therapy in our environment.The attitudes of women to the menopause are strongly influenced by social, cultural and economic settings in which they live and may also reflect the differences in modes of treatment for or perception of its symptoms. The object of this study was to determine the perception and attitude of post-meno pausal Nigerian women to the menopause. We interviewed 676 women who had experienced at least 24 months of amenorrhoea using a structured questionnaire. Menopause was considered a normal physiological manifestation of the ageing process by 95.56% of the respondents while 2.66% believed it was a disease condition. The majority of the women had a positive attitude to the menopause and indicated that it did not affect their relationships with their spouses or children. For most of the women (71.13%), sexual life ended with menopause. None of the women was on hormone replacement therapy but among those sexually active, reduced libido/frequency and vaginal dryness were reported by 24.59%. The most commonly reported advantage of menopause was freedom from cyclical bleeding. We conclude that although Nigerian post-menopausal women have a positive disposition towards menopause, they may have a significant reproductive health burden which has been tolerated for so long. It is important to determine the influence of sociocultural belief on sexuality after menopause and also evaluate the benefits of hormone replacement therapy in our environment.

Female genital mutilation - postcircumcision vulval complications in Nigerians

Female genital mutilation is a cultural practice that can adversely affect the health of women. Vulval complications of female circumcision in 39 patients managed at the University College Hospital, Ibadan, Nigeria over a period of 10 years were reviewed. The complications were: labial adhesions of varying degrees (51.3%) and clitoral retention cysts (48.7%). However, both types of complications occurred concurrently in two (5.1%) patients. All patients were treated surgically with good outcome. The only immediate complication of treatment was secondary haemorrhage in one patient with clitoral cyst. Regrettably, one patient with labial adhesion required a repeat surgical procedure 2 months later. The histological examination of all the retention cysts revealed epidermal inclusion cysts. Emphasising the reproductive health implications of female genital mutilation may prove an effective strategy towards eradication of the practice.

Misoprostol as first‐line treatment for incomplete abortion at a secondary‐level health facility in Nigeria

To determine the feasibility of introducing misoprostol as first‐line treatment for incomplete abortion at a secondary‐level health facility.

Effectiveness of a structured checklist of risk factors in identifying pregnant women at risk of gestational diabetes mellitus: A cross.sectional study

BACKGROUND Gestational diabetes mellitus (GDM) is associated with increased risk of mortality and morbidity for pregnant women and newborns. Identifying pregnant women with risk factors for GDM based on the clinical suspicion is a popular approach. However, the effectiveness of the use of a structured checklist of risk factors is yet to be evaluated. This study assessed the effectiveness of a structured checklist of risk factors in identifying pregnant women at risk of GDM at the University College Hospital, Ibadan. MATERIALS AND METHODS It was a comparative cross-sectional study implemented in two phases. The first phase (Group A) of the study was a prospective study that involved 530 pregnant women who presented at the booking clinic. A structured checklist containing risk factors was used to identify women at the risk of GDM. The second phase (Group B) was a retrospective study of 530 pregnant women managed 2 years previously who were selected by systematic random technique. RESULTS The mean age, gestational age at booking, gestational age at delivery and birth weight were 30.2 ± 5.2 years, 21 ± 10.8 weeks, 38.7 ± 2.7 weeks and 3.1 ± 0.7 kg respectively. The prevalence of GDM in Group A and B were 4.9% and 1.6% respectively ( P < 0.05). There was about three fold increase in identification of women at risk of GDM by use of a checklist. CONCLUSION Identification of women at risk of GDM was approximately 3-4 fold higher with the use of checklist of risk factors. Exhaustive clinical identification with a checklist of risk factors for GDM should be encouraged.

Serum copeptin and pregnancy outcome in preeclampsia.

Background: A number of biochemical predictors of preeclampsia have been reported, but little is known about their possible relationship with maternal and fetal outcomes. This study determined serum copeptin in pregnant women with preeclampsia and assessed its relationship with pregnancy outcomes. Materials and Methods: Thirty women with severe preeclampsia (SP), 30 with mild preeclampsia (MP), and 30 with uncomplicated pregnancy were enrolled into this study. Serum copeptin, creatinine, and liver function were determined using enzyme-linked immunosorbent assay and colorimetry as appropriate. Pregnancy outcomes, both maternal and fetal, were taken using standard methods. Results: Copeptin was significantly elevated in preeclampsia subjects compared with controls and in SP compared with MP. Assessing the diagnostic property of copeptin for preeclampsia, the area under the curve for copeptin was 0.99. Nine (30%) and 3 (10%) of SP and MP, respectively had abruptio placenta while 6 (20%), 2 (6.7%), and 1 (3.3%) still births were recorded in SP, MP, and controls, respectively. Neonates of mothers with preeclampsia had significantly lower birth weight, infant length, ponderal index, and head circumference compared with neonates of the controls. Copeptin had a significant inverse relationship with birth weight, ponderal index, head circumference, Apgar score, and infant length in neonates of mothers with preeclampsia. Conclusion: Serum copeptin level in the third trimester could predict preeclampsia and its elevation is associated with adverse perinatal outcome.