C. O. Aimakhu

Current causes and management of violence against women in Nigeria

Violence against women is an important health and human rights issue. It carries with it both short- and long-term sequelae for women that can affect both their physical and psychological wellbeing. Every day obstetric providers treat patients who have been assaulted. Timely identification can interrupt the cycle of violence, prevent further injury and initiate the help-seeking process. The objectives of this study were to survey how often Nigerian obstetrician – gynaecologists see these patients in their practice and to describe the demographics and management of their most recent case so as to give an idea of the extent of the problem. This is especially important as abuse is grossly under-reported because the victims are afraid to report it because of male dominance in society and the fear of losing their homes. We used a self-administered questionnaire survey of 138 practising obstetricians and gynaecologists in Nigeria. Questions were asked about the yearly estimation of cases seen and how recently a case was seen. The type of abuse, risk factors and management of their most recent case was also documented. Most (98.6%) obstetricians surveyed had previously managed a case of violence. The mean estimate of abused women seen was 7.0 per year. Details of the last case managed were recollected by 91.3% of respondents. The majority (51.6%) of patients were pregnant. The assailant was the husband in 69.8% of cases and the most common factor for abuse was as a result of women requesting money for the family needs from their husbands. The most common type of abuse was physical (79.4%), with 34.9% of patients sustaining cuts. Treatment and counselling were the forms of management in most cases. The police were informed in 9.5% of cases and one obstetrician had to give evidence in court. Of the pregnant abused women, 73.8% had live births. Better job opportunities and female empowerment can reduce the risk of violence. Obstetricians should screen routinely for battery, provide education about violence, assess the danger, review safety plans and refer women appropriately. We cannot solve the problem alone, but sensitivity and commitment can begin to make a difference.

Ovarian cancer in Ibadan: characteristics and management*

Ovarian cancer has the highest case fatality rate among gynaecological cancers worldwide because of lack of effective screening methods and non-specific early warning symptoms with late presentation. A reinvigorated study is necessary in the developing countries because of a projected increase in its incidence. The decreasing fertility rate and increasing use of ovulation induction drugs are some of the reasons. The Ovarian Cancer Service of the Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Oyo State, Nigeria commenced the first longitudinal study of this malignancy from 1 December 1998 in order to establish a regional management and research centre. It is a questionnaire survey detailing the demography, clinical and staging laparotomy findings and histology of all confirmed cases. Twenty-one staging laparotomy and histologically confirmed ovarian cancer cases were managed from 1 December 1998 to 31 July 2002, about 1.5% of the 1387 gynaecological admissions. It is the third most common of the gynaecological cancers, representing 9.8% of the 214 cases. More than 60% of the patients were 50 years or younger. Only 19% were nulliparous, with 47.6% having had five or more deliveries. Only two patients (9.5%) had used the oral contraceptive pill, for a maximum period of 1 month. Only one patient (4.8%) had a positive family history of cancer. Abdominal swelling was the most common presenting symptom. Eighty-one per cent of the patients presented in Stages III and IV. Epithelial ovarian cancer constituted about 76.2% of the cases. Only 23.8% had adjuvant therapy, consisting of combination chemotherapy using cisplatin-based regimes. The case fatality rate 6 months after surgery was 76%. The ovarian cancer patients in this environment are younger and of higher parity than expected. The risk factors for this disease require further study.

Determinants of pain perception in labour among parturients at the University College Hospital, Ibadan

This cross-sectional study of one thousand parturients aims to evaluate the factors, which are associated with pain perception in labour and to identify women who will benefit most from analgesia in labour. The instrument applied was a structured questionnaire incorporating the Box numerical scale (BNS) for pain assessment. Patients who delivered by elective or emergency caesarean section and women who did not give informed consent were excluded from the study. Spearmans and Pearsons correlational analyses were applied. Pain scores showed significant correlation with age (r =  − 0.087, p < 0.01), parity (r =  − 0.226, p < 0.01), gestational age at delivery (r =  − 0.074, p < 0.05), onset of labour (rho = 0.195, p < 0.01), mode of delivery (rho = 0.160, p < 0.01), booking status (rho =  − 0.070, p < 0.05) and educational status (rho = 0.182, p < 0.01). Certain groups of patients would benefit from obstetric analgesia. These patients include, nulliparous patients, young patients, patients who have had labour induced, those with preterm deliveries and those with an assisted vaginal delivery especially if they are well educated.

Pattern of chloroquine-induced pruritus in antenatal patients at the University College Hospital, Ibadan

The importance of Malaria, especially in pregnancy, cannot be over-emphasised. A major determinant of compliance with treatment in this environment is the pruritus chloroquine induces when ingested. This cross-sectional study of 200 antenatal patients was aimed at obtaining the pattern of the pruritus in antenatal patients. The prevalence of chloroquine-induced pruritus was 64.5%; 76.3% of the patients experienced the itching within 24 hours of ingestion of the drug and 60% of the patients still use the drug in spite of the itching for various reasons. Among the indices of severity, the frequency of itching with chloroquine use was the only factor that correlated with continuation of use (P < 0.01).

The influence of westernisation on pain perception in labour among parturients at the university college hospital Ibadan

Summary Pain perception as perceived by the parturient is determined by physical and psychological factors. The interplay of these factors is important to the healthcare professional who will be managing these women in labour. We therefore set out to assess the influence of educational attainment as a proxy for westernisation on pain perception by parturients. This was a cross-sectional study conducted among 765 parturients using a questionnaire with the Box Numerical Scale to assess pain score within 48 h of delivery. We studied women in labour at the University College Hospital Ibadan Nigeria from August 2003 to July 2004. A total of 1,000 consecutive parturients were enrolled into the study but 765 were included in the analysis after excluding women requiring caesarean section. Multiple linear regression with robust estimation of the Standard Error of the Mean (SEM) was utilised. The main outcome studied was the pain score obtained within 48 h of delivery using the Box Numerical Scale (BNS). The pain scores were highest among ethnic groups other than the predominant ethnic group (Yoruba) 9.13 (95% CI 8.13 – 9.33), it was lowest among those with no formal education. Multivariate analysis revealed educational attainment as a significant predictor of BNS. An interaction between age and educational attainment; only women between the ages of 25 – 30 had lower mean pain scores when educated compared with those without formal education −3.56 (95% CI −4.28, −2.87). In conclusion, findings in this study support the hypothesis that westernisation through education tends to increase perception of pain by parturients in this environment.

Vulval carcinoma in pregnancy

Vulval carcinoma has a relatively low incidence worldwide compared to other genital tract tumours. In Nigeria between 1960 and 1966 it constituted 5.85 per cent of the total gynaecological cancers recorded at the Ibadan Registry (Babarinsa et al. 1999). Corresponding reports from Enugu Eastern Nigeria (Megafu 1977) 2.66 per cent Vulval cancer has a consistently low incidence across Africa (Megafu 1977; Doh et al. 1988; Rogo and Orero 1988; Bassett et al. 1992). It is extremely rare to have the condition in pregnancy as most sufferers are either at the end of their reproductive lives or beyond it. This case report represents an unusual occurrence. It also had the unique feature of having the vulvar cancer develop from within a histologically confirmed condylomatous lesion. It also occurred at a much earlier age than is usually reported (Babarinsa et al. 1999). (excerpt)

Correlates of knowledge of antenatal patients about HIV transmission in Ibadan, Nigeria.

The HIV pandemic started in about 1981 and in recent times no single disease has attracted as much attention in the international community as this. Several studies have addressed the use of antiviral drugs and other strategies for preventing or at least reducing perinatal transmission. It is also essential to assess the level of knowledge of transmission and the determinants of this level among antenatal patients. There have been a few reports about determinants of knowledge of transmission among antenatal patients. This study aims to evaluate the determinants of knowledge of transmission of HIV among an African population of antenatal patients. (authors)

Ultrasound assessment of the effect of parity on postpartum uterine involution.

A longitudinal study of 300 women in the puerperium was undertaken in an African population. The aim was to determine the influence of parity on postpartum uterine diameters during involution. The patients were divided into two groups, nulliparous and multiparous based on parity. The uterine diameters were larger in the multiparous group when compared with the nulliparous group. Further analysis revealed positive (Pearsons) correlation between parity and uterine diameters and uterine volume. There was no significant correlation between parity and uterine volume on the 42nd puerperal day. In conclusion, Negroid patients have large uteri, which correlate in size positively with parity.A longitudinal study of 300 women in the puerperium was undertaken in an African population. The aim was to determine the influence of parity on postpartum uterine diameters during involution. The patients were divided into two groups, nulliparous and multiparous based on parity. The uterine diameters were larger in the multiparous group when compared with the nulliparous group. Further analysis revealed positive (Pearsons) correlation between parity and uterine diameters and uterine volume. There was no significant correlation between parity and uterine volume on the 42nd puerperal day. In conclusion, Negroid patients have large uteri, which correlate in size positively with parity.

Microbiological pattern of the contents of pelvic abscess at the University College Hospital, Ibadan, Nigeria

A retrospective analysis of 49 cases of pelvic abscess over a 10-year study period spanning 1 January 1989 to 31 December 1998 was undertaken. Forty-one patients had laparotomy to drain the pelvic abscess, while eight had colpotomy. The volume of pus drained at surgery ranged between 10 ml and 3.5 l for laparotomy, with a median value of 500 ml and 100 ml to 1 l with a median of 200 ml for colpotomy. There was no significant difference in these values. Swabs for bacteriological cultures were taken at surgery and results available in 18 patients. In two patients (11%) the cultures were sterile. In the positive cultures, Esherichia coli was isolated in seven patients. Klebsiella species and Staphylococcus aureus were isolated in four patients each. It is important to know the causative organisms for this infection in our environment because pelvic abscess is the end stage in the progression of a treatable genital tract infection and is frequently an unnecessary complication that is very expensive to treat.

Blood loss at fibroids surgery: myomectomy versus total abdominal hysterectomy

Two hundred and fifty patients with uterine fibroids were reviewed to compare operative outcomes and blood loss.