Ibrahim Garba

Contraceptive choices among grand multiparous women at Murtala Mohammed Specialist Hospital, Kano

Background: Grand multiparity is known to be associated with pregnancy complications. Nigeria with a contraceptive prevalence of <15% and culture of early marriage in the northern part of the country, many women get to grand multiparity early in their obstetric carriers. These women contribute significantly to the bad obstetric performance indices in the country. The present study was to explore the contraceptive choices among grand multiparous women. Methods: This study was a descriptive cross-sectional study among grand multiparous women attending an antenatal clinic. Data were collected on sociodemographic characteristics, contraceptive choices, and factors that influence such choices. The data were analyzed using Statistical Package for the Social Sciences version 18. Results: There were 219 respondents. The mean age was 33.05 ± 3.17, and the mean parity was 6.48 ± 1.83. Most of the respondents (208, 95.50%) were aware of modern contraceptive methods, and oral contraceptive was the method of most of the respondents (197, 90.00%). Only 92 (42.00%) were currently using a modern contraceptive method. Being convenient for the lifestyle was the reason for the choice of a contraceptive method by many of the respondents (42, 19.10%). Conclusion: There was high awareness of modern contraceptive methods; however, there was low use prevalence among respondents, and the desire for more pregnancy was the reason for the nonuse.

Cancer of the Cervix in Unscreened West African Women

Background: Cancer of the cervix remains an important health problem amongst women worldwide. Widespread comprehensive cervical cancer control programs have resulted in a marked reduction in the incidence and mortality in most developed countries. Developing countries bear over 80% of the global burden, with only 5% of the global resources for the control of cancer. Majority of the cases in these countries present late and are incurable at the time of diagnosis. Aim: To review the presentation and histopathological types of cervical cancer cases seen in Aminu Kano Teaching Hospital Kano, over a sixteen-year period (1995– 2010). Materials and Methods: Case records of histopathologically diagnosed cases of cancer of the cervix were retrieved. Demographic data, stage of the tumor at presentation, and histopathologic type were extracted. The results were analyzed using descriptive statistics. Results: Six hundred and sixty gynecological cancers were seen during the study period, with cancer of the cervix accounting for 58.5% (386/660) cases. Among these cases with cancer of the cervix 71.1% (275/386) were grand multiparous and majority 89.7 % 346/386 presented with advanced disease. Squamous cell carcinoma (SCC) accounted for 86.3% (333/386) of the cancers, adenocarcinoma contributed 12.4%,(48/386) and others contributed 1.3% (5/386). Conclusion: Cancer of the cervix is the commonest gynecological cancer at Aminu Kano Teaching Hospital, Kano, Nigeria. SCC is the commonest histological type.

Low back pain in pregnant women attending antenatal clinic: The Aminu Kano teaching hospital experience

Background: The profound physiologic effects of pregnancy affect the musculoskeletal system. Pregnant women are at increased risks of low back/pelvic girdle pains. Objective: To determine the incidence of low back/pelvic girdle pains among pregnant women. Materials and Methods: This was a cross-sectional study conducted from May 1 to June 30, 2016, among consenting pregnant women at Aminu Kano Teaching Hospital. Ethical approval was obtained from the Hospital Ethics Committee. Information was obtained in a questionnaire on consecutive pregnant women. Data obtained were analyzed using SPSS version 18 (SPSS Inc., Chicago, Illinois, USA, 2012). Fishers exact test was used for categorical data, and P ≤ 0.05 was considered statistically significant. Results: A total of 309 pregnant women were recruited from May 1 to June 30, 2016. The mean age ± standard deviation was 28.4 ± 5.86 years. The incidence of low back pains (LBPs) and pelvic girdle pains among the pregnant women was 106 (34.3%) and 178 (57.6%), respectively. The pain was severe among 26 (9.2%) pregnant women, which warranted analgesic usage. Pain radiation was reported in >50% of cases. There was an incidental finding of urinary incontinence in 36 (12.6%) cases. Low back/pelvic girdle pain was not associated with body mass index (BMI) (P = 0.390). Conclusion: The incidence of LBPs and pelvic girdle pains was high and found to be 34.3% and 57.6%, respectively. Analgesics were used especially among those with severe pains. There was an incidental finding of urinary incontinence among pregnant women with complaints of low back/pelvic girdle pains. There was no statistically significant association between LBPs and maternal BMI.

Ritual hot bath (wankan jego) in Kano: Are they still practicing? What are the implications?

Background: Postpartum ritual hot bath is one of the harmful cultural beliefs commonly practiced in Northern Nigeria. It is linked with health hazards especially among women with hypertensive disorders of pregnancy. Methodology: It was a cross-sectional study conducted among 199 pregnant women over the period of 3 months. Ethical approval was obtained from The Kano State Ethical Committee. Questionnaire was administered among consenting pregnant women. Information on sociodemographic characteristics and practice of hot bath was obtained. Data were analyzed with SPSS version 17 computer software (SPSS Inc., SPSS Statistics for Windows, Chicago, IL, USA). Results: One hundred and ninety-nine pregnant women were recruited for the survey. The mean age ± standard deviation was 28.09 ± 5.55 years. The rate of hot bath was 56.80% and the days spent taking the hot bath ranged from 4 to 40 days. An average of 195.41 ± 96.050 Naira was spent on firewood per day for the hot bath. The method of boiling the water was mainly the use of firewood 87 (78.40%). They mainly used leaves 76 (68.50%) and towel 35 (31.50%) for bathing. The responsibility of the cost of the hot bath was mainly on husband 102 (91.90%). The hot bath was enforced mainly by the parents 68 (61.30%). Up to 82 (73.90%) of the respondents were ready to abandon the hot bath if alternatives such as drugs are provided. Conclusion: The prevalence rate of hot bath was 56.80%. The burden of its financial implications lies mainly on husbands leading to other social and financial problems.

Surgical management of uterine fibroids at Aminu Kano Teaching Hospital

Background: Uterine fibroid is one of the most common pelvic tumours of the female genital tract. Surgery offers long-term relief of symptoms but is associated with complications, hence, the aversion for it in our environment. Therefore, understanding the factors associated with the complications will help to reduce morbidity and mortality. Objective: To determine the surgical options, socio-demographic characteristics, clinical presentations and post-operative complications associated with uterine fibroids at Aminu Kano Teaching Hospital, Kano. Methods: A retrospective review of case notes of 132 surgically managed cases of uterine fibroids at Aminu Kano Teaching Hospital over the study period. Results: Surgical operations for uterine fibroids constituted 21.4% of all gynaecological operations. Most of the cases were seen in 30–39 age group (41.5%) and 51.2% of them were nulliparous. Menorrhagia (53.7%), infertility (26.3%) and abdominal swelling (40.4%) were the common presenting symptoms. Myomectomy was performed in 75.6% of the cases while abdominal hysterectomy accounted for 24.6% of cases. Anaemia was the most common post-operative complication seen in this study (31.7%). Conclusion: Uterine fibroid is common in our environment. The main-stay of management of uterine fibroid is surgery which is associated with post-operative complications. The surgical options used in the management of uterine fibroids in this study were hysterectomy and myomectomy due to lack of requisite skills for the more technical procedures. Improvements in surgical skill will help reduce the frequency and severity of the complications.

Obstetric outcome of teenage pregnancy at Aminu Kano Teaching Hospital: A 3-year review

Background: Teenage pregnancy is generally considered to be a high-risk event. Teenage mothers are physically and psychologically ill-prepared for reproduction. Low socioeconomic status and lack of prenatal care are among the factors influencing pregnancy outcome in these patients. Objective: To assess the obstetric outcome of teenage pregnancy, its current trends, sociodemographic determinants, and incidence in Aminu Kano Teaching Hospital. Materials and Methods: A retrospective study of 540 teenage primigravidae who delivered in Aminu Kano Teaching Hospital between 1st of January 2009 and 31st of December 2011. Results: The incidence of teenage pregnancy over the study period was 5.8% (58/1000 deliveries). Majority of the patients (78.9%) belonged to low socioeconomic class. Pregnancy complications prevalent in these patients included anemia (33.5%), low birth weight (17.8%), preeclampsia/eclampsia (12.4%), preterm labor (11.5%), and stillbirth (2.5%). Cesarean section rate among them was 18.9%. Conclusion: Teenage pregnancy is a high-risk pregnancy because of the associated pregnancy complications which are more prevalent in the unbooked patients. Access to health care services, girl-child education, and improvement of the socioeconomic status of the patients will reduce its incidence.

Age at first pregnancy among primigravidae attending antenatal clinic at a Tertiary Hospital in Kano

Background: The first pregnancy marks a transition into motherhood and influences the number of children a woman bears throughout her reproductive period, and consequently the size, composition, and future growth of the population in a community. The aim of this survey was to determine the average age at first pregnancy among primigravidae attending antenatal clinic in Aminu Kano Teaching Hospital, Kano. Patients and Methods: This was a retrospective study among women who booked for antenatal care at Aminu Kano Teaching Hospital over a 1 year period. Data were retrieved from case files and analyzed using the Statistical Package for the Social Sciences, version 17 (SPSS Inc., Chicago, IL, USA). Result: The mean age at first pregnancy was 23.9 ± 4.27 years. Teenage women accounted for 10.2% of the total population. Majority of the women were Hausas (71.8%), Muslims (86.1%), unemployed (80.9%), and had formal education (92.4%). Ethnicity (Hausas versus other tribes), religion (Islam versus Christianity) and occupation (employed versus unemployed) were not statistically associated with the age at first pregnancy above teenage age group (X2= 2.578, P = 0.108; X2 = 1.788, P = 0.181; X2 = 3.350, P = 0.067, respectively). However, formal education was statistically associated with average age at first pregnancy (X2= 13.486, P = 0.001). Conclusion: The age at first pregnancy was found to be 23.9 ± 4.27 years. This was within the recommended age of 20–35 years. Women with formal education were more likely to delay the age at first pregnancy until after teenage years. Formal education will certainly contribute to reducing maternal mortality and morbidity associated with teenage pregnancies.

Episiotomy at Aminu Kano Teaching Hospital, Kano, Nigeria: A 3-Year Review

Background: Episiotomy continues to be increasingly performed in our labor wards despite current scientific evidence restricting its use. The objective of this study was to determine the incidence, indications, and establish reference point for future studies on episiotomy in Aminu Kano Teaching Hospital. Patients and Methods: This was a 3-year retrospective study of vaginal deliveries in Aminu Kano Teaching Hospital, Kano, from January, 1, 2010 to December 31, 2012. The parturients who had episiotomy were identified from the labor ward register and the following information was extracted: Parity, type of vaginal delivery, gestational age at delivery, birth weight, Apgar scores, and estimated blood loss. The information obtained were analyzed and presented. Results: The episiotomy rate was 41.4%. Episiotomy was commonly performed in primigravidae (79.4%) than multigravidae (X2 = 3017, P < 0.001), fetal macrosomia in 86.9% of the cases (X2 = 669.7, P < 0.001) and assisted vaginal delivery seen in 75% of the cases (X2 = 172.4, P < 0.001). Episiotomy was also associated with more postpartum blood loss when compared with parturients without episiotomy and was statistically significant (t = 95.82, P < 0.001). Conclusion: Episiotomy rate is high in Aminu Kano Teaching Hospital. Midwives and doctors conducting deliveries should be educated on the indications for episiotomy and early repair to reduce associated postpartum blood loss.

Induction to delivery interval using transcervical Foley catheter plus oxytocin and vaginal misoprostol: A comparative study at Aminu Kano Teaching Hospital, Kano, Nigeria

Background: Induction of labor (IOL) is an artificial initiation of labor before its spontaneous onset for the purpose of delivery of the fetoplacental unit. Many factors are associated with its success in postdatism. Objective: To compare the induction delivery intervals using transcervical Foley catheter plus oxytocin and vaginal misoprostol, and to identify the factors associated with successful induction among postdate singleton multiparae. Materials and Methods: The study was a prospective randomized controlled trial of singleton multiparous pregnant women. They were randomized into two groups, one group for intravaginal misoprostol and the other group for transcervical Foley catheter insertion as a method of cervical ripening and IOL. The data were analyzed using SPSS version 17 computer software (SPSS Inc., IL, Chicago, USA). Comparisons of categorical variables were done using Chi-squared test, with P < 0.05 considered as significant. Students t-test was used for continuous variables. Results: The incidence of postdatism was found to be 136 (13.1%). The mean induction delivery time interval was shorter in the misoprostol group 70 (5.54 ± 1.8 h) than in the Foley catheter oxytocin infusion group 66 (6.65 ± 1.7 h) (P = 0.035). There was, however, no statistically significant difference in the maternal and neonatal outcomes when these two agents were used for cervical ripening and IOL. Higher parity and higher Bishops score were the factors found to be associated with high success rate of IOL (P < 0.001). Conclusion: Vaginal misoprostol resulted in shorter induction delivery time interval as compared to transcervical Foley catheter. High parity and high Bishops scores were the factors found to be associated with the success of IOL.

Awareness of fertility period among women attending immunization clinic at Aminu Kano Teaching Hospital, Northern Nigeria

Background: There is a global concern about poor awareness of fertility. Knowledge of fertility period even among fertile women will reduce the burden of infertility. The objective of this study was to determine the awareness of fertility period among fertile women at Aminu Kano Teaching Hospital (AKTH). Patients and Methods: It was a descriptive study among 220 consenting women at AKTH over a period of 3 months, following approval by the hospital management. Structured pretested questionnaires were administered. Data were analyzed with a computer using Statistical Package for Social Sciences (SPSS) version 17 computer software. Results: Two hundred and twenty women were recruited. The mean age ± standard deviation (SD) were 28.47 ± 5.91. One hundred and eighty-four (83.64%) of the respondents knew the duration of their menstrual interval, while 36 (16.36%) were unaware. Menstrual intervals of 30 days was the model (24.50%) followed by 28 days (20.50%). One hundred and seventy-one (77.70%) respondents were aware that pregnancy is related to menstrual cycle, while 49 (22.30%) were not aware. Also, 129 (58.60%) knew their last menstrual periods, while the remaining 91 (41.40%) did not. One hundred and seventeen (53.20%) respondents knew what fertility period meant, while 103 (46.80%) were ignorant of it. Only 85 (38.60%) of the respondents were aware of their fertility periods, while 135 (61.40%) were not. Similarly, only 13 (5.90%) knew any method to determine fertility periods, while 207 (94.10%) did not. Conclusion: The study revealed good knowledge of fertility awareness among fertile women, but awareness of fertility period was lacking.