Akinyemi Akinsoji Akintayo

Prevalence of and risk factors for gestational diabetes using 1999, 2013 WHO and IADPSG criteria upon implementation of a universal one-step screening and diagnostic strategy in a sub-Saharan African population

OBJECTIVES To investigate the impact of the new consensus diagnostic criteria on the prevalence of gestational diabetes, evaluate risk factors, and missed opportunities for diagnosis if selective screening strategy was employed. STUDY DESIGN A prospective observational data of 1059 women with singleton pregnancy screened for gestational diabetes between 24 and 32 weeks gestation in a universal one-step screening and diagnostic strategy using 75-g oral glucose tolerance testing in an obstetric unit in Nigeria. Logistic regression was used to identify risk factors for GDM. RESULTS The prevalence of gestational diabetes in accordance with 1999 WHO, new 2013 WHO modified IADPSG and IADPSG criteria was 3.8%, 8.1%, 7.5%, and 8.6%, respectively. Overt diabetes was diagnosed in 1.03% of the study population. Using the new consensus criteria, approximately 20% of GDM cases would have been missed if selective screening strategy was employed. Using multivariable analysis, glycosuria [aOR 8.60 (3.29-22.46)] and previous poor obstetric outcome [aOR 3.01 (1.23-7.37)] were significantly associated with GDM on 1999 WHO criteria. Glycosuria [aOR 2.54 (1.10-6.42)] was the only risk significantly associated with increased risk of developing GDM diagnosed based on new 2013 and IADPSG criteria. CONCLUSION Using the new consensus screening and diagnostic guidelines, gestational diabetes is prevalent in our obstetric population. Missed opportunities exist with selective screening approach.

Combined Foley's catheter with vaginal misoprostol for pre‐induction cervical ripening: A randomised controlled trial

Pre‐induction cervical ripening greatly influences the outcome of induction of labour (IOL).

Reshaping maternal services in Nigeria: any need for spiritual care?

BackgroundHigh maternal and perinatal mortalities occur from deliveries conducted in prayer houses in Nigeria. Although some regulatory efforts have been deployed to tackle this problem, less attention has been placed on the possible motivation for seeking prayer house intervention which could be hinged on the spiritual belief of patients about pregnancy and childbirth. This study therefore seeks to determine the perception of booked antenatal patients on spiritual care during pregnancy and their desire for such within hospital setting.MethodA total of 397 antenatal attendees from two tertiary health institutions in southwest Nigeria were sampled. A pretested questionnaire was used to obtain information on socio-demographic features of respondents, perception of spiritual care during pregnancy and childbirth; and how they desire that their spiritual needs are addressed. Responses were subsequently collated and analyzed.ResultsMost of the women, 301 (75.8%), believe there is a need for spiritual help during pregnancy and childbirth. About half (48.5%) were currently seeking for help in prayer/mission houses while another 8.6% still intended to. Overwhelmingly, 281 (70.8%) felt it was needful for health professionals to consider their spiritual needs. Most respondents, 257 (64.7%), desired that their clergy is allowed to pray with them while in labour and sees such collaboration as incentive that will improve hospital patronage. There was association between high family income and desire for collaboration of healthcare providers with one’s clergy (OR 1.82; CI 1.03-3.21; p = 0.04).ConclusionOur women desire spiritual care during pregnancy and childbirth. Its incorporation into maternal health services will improve hospital delivery rates.

Pattern and medical care of child victims of sexual abuse in Ekiti, south-western Nigeria

Abstract Background: Child sexual assault (CSA) is a global health problem which affects many children and is often under-reported in developing countries. Data on CSA are few in these countries. Aims and Objectives : This study aimed to review the pattern and medical care of victims of CSA in a tertiary hospital over a 39-month period. Methods: This is a retrospective, descriptive study. Case files of 28 cases of CSA were retrieved from those of 6535 patients seen in the paediatric out-patient department of Ekiti State University Teaching Hospital between 1 January 2010 and 31 March 2013. Results: Victims of CSA accounted for 0·43% of new patients seen during the period under review with a yearly increase over that time. Victims were all female with a median age of 11·5 years and the age range was 4–17. They all had genito-urinary findings and 3·6% had an anal tear. The assailants were all male, mostly adults. A school-teacher and school-friends were the perpetrators in 3·6% and 10·8% of cases, respectively. All were screened for HIV, but only 60·7% were screened for hepatitis B and C. Only 60·7% received HIV post-exposure prophylaxis and none was given prophylaxis against viral hepatitis B and C. Of those eligible for post-exposure emergency contraception, only 43·8% received it. Antibiotics and analgesics were routinely given in 89·3% cases. Only one of the patients attended for follow-up. None had repeat serological screening tests. The police were involved in 60·7% of cases but there was no prosecution. Conclusion: Perpetrators of CSA are protean and, in the study area, there are gross inadequacies in the care provided for victims. Standard treatment protocols and additional training for health-care providers involved in the management of CSA victims are required.

Maternal perspectives on gestational weight gain: Critical information on developing weight control interventions

Background: Our aim was to demonstrate what women reported being counselled about weight gain in pregnancy, their perceptions of inappropriate gestational weight gain (GWG), and plans for weight gain in pregnancy. Materials and Methods: A cross-sectional survey of perceptions of prenatal attendees about inappropriate GWG was conducted at the prenatal clinic of a referral tertiary health facility in south western, Nigeria, between January 1, 2013 and June 30, 2013. Primary outcomes were the perceptions of women about risks involved with inappropriate weight gain and the proportion of women who self-reported being counselled at all on GWG, and had the right knowledge of risk(s) involved with inappropriate weight gain during pregnancy. Results: Of the 348 women who completed the survey, approximately four-fifths (82.8%) reported GWG being discussed at all by health care provider. Fewer women (29.3%) believed there were maternal risks with excess weight gain compared to inadequate weight gain (34.8%). With respect to perception of risks of inappropriate weight gain to infants, 23.65 and 18.4%, respectively, believed there were infant risks with excess and inadequate GWG. Overweight women [OR 0.39 (95% CI 0.16-0.98)] and those who received GWG information from more than one type of health care provider [OR 4.71 (95% CI 1.64-13.78)] had significant increased rate of correct knowledge of risks involved with inappropriate GWG. Conclusion: The lack of awareness of risks involved with inappropriate GWG by over half of respondents underscores the need for improvement in educational intervention on GWG in our environment.

Obstetric outcome of twin gestations in a tertiary hospital South-western Nigeria.

Abstract Background: Twin pregnancy is considered a high risk pregnancy due to associated adverse obstetric outcomes. The objective was to determine the prevalence, complications and the obstetric outcomes of twin deliveries in EKSUTH. Material and methods: A retrospective analysis of twin gestations managed at the Ekiti State University Teaching Hospital, Ado-Ekiti between January 2009 and December 2012 was done. Results: The prevalence of twin deliveries was 1 in 23 deliveries (4.3%). Increasing age and parity and Yoruba ethnicity were associated with higher twinning rate. The mean gestational age at delivery was 36.6 ± 2.9 weeks and the mean birth weight was 2.47 ± 0.49 kg with first twins having higher birth weight. Spontaneous vaginal delivery was the most common mode of delivery accounting for 52.6% and 49.3% in twin 1 and twin 2, respectively, and majority (39.5%) of the twins were in cephalic–cephalic presentation. The most common indication for caesarean delivery was breech presentation in the first twin. Preterm labour was the commonest maternal complications occurring in 25.7% of cases. The perinatal mortality rate was 105 per 1000 deliveries and this was significantly associated with unbooked patients, p = 0.001. There were no maternal deaths. Conclusion: Preterm labour remains the commonest complication with associated high perinatal mortality.

Prevalence of and risk factors for domestic violence among pregnant women in Nigeria.

Violence against women is defined as any act of gender-based violence that results in any kind of harm or suffering to women and has negative emotional and physical impacts on women’s health. According to studies from several parts of the world the prevalence of domestic violence varies widely. In low-resource countries studies conducted reveal a prevalence of 4%-29% while local studies from various parts of Nigeria have reported values ranging from 11%-59%. The aim of this present study was to determine the prevalence of and the risk factors for domestic violence among patients receiving prenatal care at a teaching hospital in south-western Nigeria. Using a modified WHO questionnaire to assess the occurrence and pattern of domestic violence findings affirmed that domestic violence before pregnancy is a risk factor for domestic violence during pregnancy. The findings indicate that domestic violence is prevalent in the obstetric population of southwestern Nigeria. Screening for violence should become a component of comprehensive maternity care in addition to rehabilitation for women and behavioral counseling for their spouses. [excerpt] Copyright

Birth preparedness and complication readiness among prenatal attendees in a teaching hospital in South West Nigeria

To assess birth preparedness and complication readiness (BPCR) as well as knowledge of danger signs during pregnancy, labor/delivery, and the postpartum period.

Gestational age at initiation of antenatal care in a tertiary hospital, Southwestern Nigeria.

CONTEXT Antenatal care utilization has been shown to be associated with reduction in maternal and perinatal morbidity and mortality while early initiation provides an opportunity for optimum utilization of this care with improved maternal and fetal outcomes. AIM This study seeks to determine the time of initiation of antenatal care among pregnant women and possible factors influencing such timing. SETTING A cross-sectional study involving 530 pregnant women was carried out at the booking clinic of the Ekiti State University Teaching Hospital, Ado-Ekiti, between September 03, 2013, and March 04, 2014. SUBJECTS AND METHODS A pretested questionnaire was administered to them to obtain information on their sociodemographic characteristics and factors influencing their timing of antenatal care initiation. RESULTS The prevalence of early booking in this study was 22.7%, and the mean gestational age at booking was 21.09 ± 6.98 weeks. The age, parity, and occupation of the women and counseling on early booking were significantly associated with early booking among the respondents with P value of 0.010, 0.006, 0.011, and 0.009, respectively while on logistic regression, the occupation of women was the only significant association with early antenatal care initiation (adjusted odd ratio 0.388; confidence interval 0.212-0.710; P = 0.002). Complications experienced in previous pregnancies did not predict early initiation of care. More than half of the respondents (50.9%) gave early monitoring of their pregnancy as the reason for initiating the care. CONCLUSION Late initiation of antenatal care is still prevalent in our environment. Therefore, pregnant women should be adequately informed about the concept of early antenatal registration.