Babagana Bako

Sociocultural factors influencing decision-making related to fertility among the Kanuri tribe of north-eastern Nigeria

ABSTRACT Background The Kanuri tribe is found in the Lake Chad basin. However, the majority of the tribe lives in Borno State, Nigeria. Before this study was undertaken, factors related to fertility decisions among the tribe were not known. Objectives This study is aimed at describing and documenting the sociocultural factors affecting decisions related to fertility among the Kanuri tribe. Method The study applied the qualitative research method. In-depth interviews and focus-group discussions were used as data collection methods. Analysis was done manually. Results Children among the Kanuri were highly valued and desired irrespective of their gender. The ideal family size, according to most of the respondents, was 16 children. Kanuri men are polygamous and can marry up to four wives in order to form large families. However, it is an abomination among Kanuri women to fall pregnant in quick succession; a phenomenon they termed konkomi. Other reasons for child-spacing were related to child welfare and maternal well-being. Methods for child-spacing included prolonged breastfeeding (Nganji yaye), ornaments in various forms and shapes, spiritual invocations and dried herbs (Nganji Yandeye). Few Kanuri women practiced modern methods of family planning. Conclusion Trends in fertility among the Kanuri tribe need to be monitored regularly and appropriate measures be taken to introduce and promote modern family planning and child health services to ensure a healthier family life.

Epidemiology of vesico-vaginal fistula : No longer a calamity of teenagers

Vesico-vaginal fistula (VVF), an abnormal communication between the vagina and the urinary bladder, leads to continuous leakage of urine that is not just a severe medical problem but a great social embarrassment to the patient. It is the commonest fistula encountered as a consequence of poor or lack of appropriate obstetric interventions (Kelly 2004). Beyond their medical problems, VVF patients have unpleasant experiences in the community. These are often associated with serious psychosocial consequences and unaffordable economic burdens on the patients. Such women face a triad of embarrassment from continuous leakage of urine, bereavement from losing her child and the loss of her husband due to the social stigma of the condition. It is one of the most dehumanising conditions that afflicts women (Ekewempu 1988; Inimgba et al. 1999; Waaldijk and Armayau 1993). It is also usually associated with other morbidities such as foot drop, ammenorrhoea and gynaetresia. A total of 88 cases of VVF managed from January 1995 to December 2004 in the University of Maiduguri Teaching Hospital, Maiduguri, Nigeria were analysed. Data pertaining to age, parity, literacy level, possible aetiologic factors and outcome in terms of cure were collected. VVF constituted 1.4%, of the total gynaecological admissions and 8.0% of the major gynaecological surgeries performed during the period. Illiteracy was a major problem – 68% were uneducated. Table I shows that majority (76.2%) were over 20 years, with a peak-age specific prevalence rate of 33.8% at the 20– 24 years age group. Teenagers only accounted for 23.8%. Most patients sustained the VVF during their first childbirth (51.3%), by the second delivery 78.8% were involved and 2 (2.5%) occurred after the fifth delivery. All the teenagers had only one delivery, while all the grandmultipara were 40 years and above. A total of 72 (90%) of them had no supervised antenatal care and had their deliveries at home under untrained traditional birth attendants (TBAs). The only eight patients that were delivered in the hospital all had laboured at home before later recourse to the hospital. Prolonged obstructed labour was the leading cause with 68 (85%) patients, while instrumental vaginal delivery was identified as a cause in eight (10%). Gishiri cut and cervical cancer each accounting for two (2.5%) patients. Some 60 patients had successful repair and were discharged in good condition, while 18 were unsuccessful at both first and second attempts (Table II). VVF in developed countries are gynaecological in origin; they are almost exclusively obstetric fistulas in developing countries. Obstetric fistulas accounted for 97% and 98% of fistulas in previous studies reported from Ethiopia and Nigeria, respectively (Kelly et al. 1992; Waaldjik et al 1993), compared with 5% from England (Kelly 2004). This reflects the poor obstetrics care in the developing countries. This is the consequence of a high prevalence of poorly managed prolonged obstructed labour (Waaldijk and Armayau 1993), the leading cause of obstetric VVF in this study. Early marriage with subsequent teenage pregnancy is a common finding among VVF patients, but accounted for only 23.8% of cases in this study, showing a shift of preponderance from teenagers to older women who would have already attained their optimum pelvic size. Other factors such as socio-cultural practices and religion that limit the woman’s access to appropriate healthcare may therefore become more important in developing VVF. In traditional African society, the husband’s consent is paramount before the women can access any type of healthcare and home deliveries under the supervision of traditional birth attendants, who are often untrained is common, as seen in this study. In addition, virtually all VVF patients are afflicted by a crunch of economic incapability due to their poor and uneducated background, into which they also marry and continue in the vicious circle of ignorance and poverty. Hence, they do not and cannot afford to access good obstetric services. Childhood malnutrition might have prevented adequate pelvic development, resulting in short statured women with small pelves, even after they have achieved their maximum growth potential. Those with the potential for large family sizes and increased birth weight, would invariably give rise to the disease even among older patients, thus shifting the epidemiology towards older women and no longer the hitherto reported teenager.

Attitude of Nigerian women to contraceptive use by men

Summary 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.

The benefit of myomectomy in women aged 40 years and above: Experience in an urban teaching hospital in Nigeria

Background: Abdominal myomectomy remains the mainstay of surgical management of uterine fibroids in our environment. However, its benefit in women aged 40 years and above remains debatable. Materials and Methods: An 11-year prospective study was conducted involving 98 women, aged 40 years and above, who had abdominal myomectomy for the treatment of uterine fibroid at the University of Maiduguri Teaching Hospital, Maiduguri. They were followed up regularly for 1–6 years to detect conception, resolution of symptoms and obstetrics performance. Data were analyzed using SPSS version 13. Results: The mean age of the patients was 42.6±2.9 years and 77 (78.6%) of them were nulliparous. Lower abdominal swelling was the commonest clinical presentation and the mean uterine size was 18.6±8.5 weeks. Infertility with uterine fibroids was the indication for myomectomy in majority of the cases [48 (48.9%)], while pregnancy complications accounted for 11.2% (11) of the cases Fertility restoration was 10.4% among the infertile patients. There was complete resolution of symptoms in 35.9% of those who required symptomatic relief, and term pregnancies were recorded in 72.7% of patients with pregnancy complications. Conclusion: Myomectomy is the recommended treatment of uterine fibroids in women aged 40 years and above with infertility and who wish to become pregnant. If there is no need for further fertility preservation, hysterectomy should be offered.

Indications and outcome of abdominal myomectomy in University of Maiduguri Teaching Hospital: Review of ten year

Background: Abdominal myomectomy is a common modality of treatment for large and symptomatic uterine fibroid in women who wish to retain their fertility. Though frequently performed the procedure may still be associated with complications. Materials and Methods: A retrospective review of all patients who had abdominal myomectomy from January 1999 to December 2008 at the University of Maiduguri Teaching Hospital. Information on the Sociodemographic characteristics, indication for the myomectomy, uterine size, pre and post operative packed cell volume (PCV), intraoperative findings, cadre of surgeon, duration of hospital stay and complications were obtained. Results: The rate of abdominal myomectomy was 3.34%. Majority of the patients (79.8%) aged 30–49 years, and most (58.9%) were nulliparas. Abdominal mass (63.7%), menorrhagia (57.7%), and subfertility 55.2% were the leading indications for abdominal myomectomy. Complications were seen in 10.9% of the cases, 55.5 % of which were wound infections. Clinical and intra operative factors associated with complications included menorrhagia (P=0.003), estimated blood loss (EBL) ≥500mls (P=0.005) and post operative PCV of <30% (P=0.081). Conclusion: Complication rate after myomectomy was low with menorrhagia and EBL ≥ 500 mls being significantly associated with development of complication.

Microbial Isolates in Puerperal Sepsis and their in vitro Antibiotic Sensitivity in North Eastern Nigeria

Purpose: To determine the microbial isolates and their in vitro antibiotic sensitivity in puerperal sepsis. Methods: Two years records of all requests for endocervical swab microbial culture and antibiotic sensitivity tests for suspected cases of puerperal sepsis at the University of Maiduguri Teaching Hospital, Maiduguri, Borno state and Federal Medical Centre Azare, Bauchi state, both in North-East geopolitical zone of Nigeria were retrieved and analysed using the SPSS statistical package. Results: One hundred and thirty nine patient’s records were analysed. The most frequently cultured organism was Staphylococcus aureus in 43/139 (30.9%), followed by Eschericia coli which was isolated in 22/139 (15.8%) and Streptococcus Species in 8/139 (5.8%). Pseudomonas Species was cultured on one occasion only. Mixed growth occurred in 13 specimens (10.8%). In 30 cases (21.6%) there was either no growth (12/139) or the growth was not significant (18/139). Overall, the isolated micro-organisms had high susceptibility of >93% to Ofloxacin, Ciprofoxacin and cefuroxime while the susceptibility to Gentamycin and Augmentin were 68.8% and 51.6% respectively. In over 80% of the specimen there was marked resistance to Nalidixic Acid, Co-trimoxazole, Ampiclox and Amoxicillin. Conclusion: Staphylococcus aureus, Escherichia coli and Streptococcus species are the common bacteria isolates in puerperal sepsis in north-eastern, Nigeria and they are highly sensitive to Ofloxacin, Ciprofoxacin and Cefuroxime. Prompt treatment of cases with appropriate antibiotics will go a long way in reducing the associated morbidity and mortality.

Prevalence, risk factors, and outcomes of obstructed labor at the University of Maiduguri Teaching Hospital, Maiduguri, Nigeria

Introduction: Obstructed labor is a common cause of feto-maternal morbidity and mortality in Maiduguri, Nigeria. This study aimed to determine the prevalence, causes, risk factors, and outcome of obstructed labor at the University of Maiduguri Teaching Hospital (UMTH). Materials and Methods: This was a retrospective observational study of all cases of obstructed labor managed from January 2012 to December 2014 at the UMTH, Maiduguri, Nigeria. For each case, the next woman who delivered without obstruction was used as a control. Data were analyzed for sociodemographic variables, labor, delivery and postdelivery events using SPSS version 20.0. The Chi-square test and odds ratio (OR) were used and statistical significance set at P < 0.05. Results: The prevalence of obstructed labor was 2.13%. Cephalopelvic disproportion, persistent occipitoposterior position, and malpresentation were seen in 65.37%, 16.58%, and 11.71%, respectively. The risk factors were teenage pregnancy (χ2: 26.96, P < 0.0001, OR: 4.44, 95% confidence interval [CI]: 2.45–8.05), nulliparity (χ2: 50.70, P < 0.0001, OR: 4.63, 95% CI: 2.99–7.15), illiteracy (χ2:53.91, P < 0.0001, OR: 5.26, 95% CI: 3.31–8.33), and unbooked status (χ2: 113.26, P < 0.0001 OR: 11.9, 95% CI: 7.24–19.61). Complications were observed in 37.56% of the women with obstructed labor. The common morbidities were wound sepsis, ruptured uterus, and puerperal sepsis, seen in 16.59%, 13.17%, and 7.81%, respectively. The case fatality rate was 0.98% and perinatal mortality was 34.15%. Conclusion: Obstructed labor is common in Maiduguri. We recommend amelioration of the risk factors through advocacy, girl child education, and public enlightenment on the need for antenatal care and hospital delivery, identification, and referral of high-risk patients.

Awareness and utilization of emergency contraception among female undergraduates in a Nigerian University.

Background: Many women are not aware of emergency contraception, which limits its use. Because increased risk of unwanted pregnancy and subsequent unsafe abortion have been well-documented, research on the knowledge and usage of emergency contraception is appropriate. Materials and Methods: The present study was a descriptive cross-sectional study conducted among 450 female undergraduate students of a University in northeast Nigeria from November to December 2014. Results: The age range of the respondents was 19-30 years, with a mean age of 21.4 ± 2.1 years. Most of them, 308 (68.4), were between the ages of 20 and 24 years. Majority of the students, 321 (71.3%), were single. Overall, 295 (65.5%) students were aware of emergency contraception, and 211 (71.5%) had utilized them. Among those who had utilized them, 174 (82.4%) were singles. The most common source of initial information about emergency contraception was health personnel, 148 (50.1%), followed by friends, 107 (36.3%). School, 11 (3.7%), and parents, 4 (1.4%), were the least utilized sources of information. Information from health personnel, news media and schools were the major influences of emergency contraceptive utilization. Levonorgestrel only pills (Postinor-2 R ) and combined pills (Yuzpe) were the most commonly utilized emergency contraception by 91 (43.1%) and 85 (40.3%) of the respondents, respectively. Conclusion: There was good level of awareness and utilization of emergency contraception among female undergraduates. However, there is a need to educate the parents, students and staff or counselors at the family clinic section of the university health clinic on its importance to improve the awareness of the students.

Idiopathic thrombocytopaenic purpura in pregnancy presenting with life-threatening epistaxis

She was started on phenoxybenzamine and propranolol and her symptoms, especially palpitation, resolved. As vaginal delivery is associated with high morbidity and mortality (Harper et al. 1989) a caesarean section was planned at 38 weeks in collaboration with senior anaesthetists under general anaesthesia. She was admitted 3 days before caesarean section in order to give intravenous phenoxybenzamine blockade to reduce the risk of intraoperative hypertensive crisis. Intraoperative and postoperative periods were uneventful. An uncomplicated adrenalectomy was performed at 3 months postpartum and both mother and child remain well.