Idris Usman Takai

Awareness and utilization of Papanicoloau smear among health care workers in Maiduguri, Nigeria

Context: Cervical cancer is the leading cause of cancer related deaths among women in developing countries. Lack of awareness and comprehensive cervical cancer screening programmes offered in most developing countries are partly responsible for the high burden of disease. In developed countries, routine use of Papanicoloau smear, in part, has led to a decline in cervical cancer incidence and mortality. Objective: To determine the level of awareness, utilisation and factors associated with awareness of Pap smear test as a tool for cervical cancer screening among health care workers (HCW) in Maiduguri north-eastern part of Nigeria. Subjects and Methods: This was a cross-sectional questionnaire based study conducted among 150 health care workers in Maiduguri, between January and March 2010. Simple descriptive statistics was employed in the analysis of data. Results: A total of 150 participants were recruited for the study. The majority (141) of respondents were aware of Papanicolaou smear and 23.3% of the female respondents had done the test previously. Majority (90.8%) of the men were willing to pay for their spouses to do the screening; some of them (20.0%) were indifferent if their spouses perform the cervical screening without their consent. The major reason given for carrying out the test was for prevention of the disease. The major source of information was the hospital (84.7%). Majority of the women were willing to do the test if offered the opportunity either free (70.6%) or with payment (29.4%). A number of socio-demographic variables played crucial roles in awareness and utilisation of Pap smear. These included higher level of educational status ( P = 0.000) of the respondents, increased maternal age ( P = 0.001) and high parity ( P = 0.003). Conclusion: There is poor utilisation of Pap smear among HCW despite high level of awareness and availability of screening services. A number of socio-demographic variables play crucial roles in awareness of Pap smear. The reasons for the low utilisation among health care workers, who are the custodians of health care need to be investigated to improve their utilisation of Pap smear.

A prospective study of maternal risk factors for low birth weight babies in Maiduguri, North-Eastern Nigeria

Background/Aim: Low birth weight (LBW) is associated with a higher risk of mortality and long term consequences for the survivors. This study determines the incidence and risk factors for LBW babies in Maiduguri. Context/Setting: This study was done in the Departments of Obstetrics and Gynaecology of the University of Maiduguri Teaching Hospital and the State Specialist Hospital, Maiduguri. Materials and Methods: This was a prospective study involving 854 pregnant women and their babies between 2 nd February 2009 and 29 th July 2009. Socio-demographic, obstetric, medical factors, obstetrics interventions and foetal birth weights were obtained and recorded. Association between variables were examined using students t-test and Chi-squared test and multivariate logistic regression analysis a P < 0.05 was considered significant. Results: The incidence of LBW was 16.9%. The risk factors for LBW were non-use of haematinics index pregnancy (OR = 13.04; 95% CI = 12-36; P value 0.000); previous history of stillbirth (OR = 8.11; 95% CI = 6-19; P value 0.000); hypertensive disorders of pregnancy (OR = 6.12; 95% CI = 5-14; P value 0.000); ante-partum haemorrhage (OR = 5.85; 95% CI = 4-9; P value 0.000); less than 4 ANC visitsn (OR = 4.94; 95% CI = 3-12; P value 0.000); previous history of premature delivery (OR = 4.39; 95% CI = 4-11; P value 0.000); previous history of LBW (OR = 3.65; 95% CI = 2-21; P value 0.000) and non-use of intermittent preventive therapy in the index pregnancy (OR = 3.24; 95% CI = 1-16; P value 0.001); and teenage mother (OR = 2.75; 95% CI = 2-27; P value 0.006). Conclusion: This study showed high incidence of LBW. Obstetric factors (problems and intervention of the current pregnancy) and previous obstetric performances played crucial role in the occurrence of LBW in our study. Qualitative antenatal care should be made available and provided to pregnant women at all levels of care.

Antepartum hemorrhage: A retrospective analysis from a northern nigerian teaching hospital

Background: Antepartum hemorrhage (APH) contributes significantly to maternal and perinatal morbidity and mortality globally, particularly in the developing world like ours. Prevention, early detection, and prompt management cannot be overemphasized to significantly reduce the morbidity and mortality associated with this condition. Objectives: The study is aimed at determining the prevalence, etiology, sociodemographic characteristics, and the fetomaternal outcome of pregnancies complicated by APH in Aminu Kano Teaching Hospital, Kano. Materials and Methods: A 5 years retrospective study of all pregnancies complicated by APH at Aminu Kano Teaching Hospital, Kano, Nigeria, between January 1, 2009, and December 31, 2013, was conducted. Results: A total of 224 cases of APH were recorded out of the 18,273 cases admitted for delivery during the study period, giving an institutional prevalence rate of 1.2%. Two hundred and eighteen folders were retrieved and analyzed giving a retrieval rate of 97.3%. The mean gestational age at presentation was 35.3 ± 2 weeks and the most common causes were abruptio placenta and placenta previa constituting 68.3% and 30.0%, respectively. Sociodemographic characteristics associated with the occurrence of APH included age, booking status, parity, and socioeconomic status. The peak prevalence of APH was observed in the 35–39 year age group accounting for 33.0%. There were 123 live births and 92 stillbirths. The cesarean section rate was 53.5%. Major complications were intrauterine fetal deaths in 42.8%, postpartum hemorrhage in 24.2% of cases, and anemia necessitating blood transfusion in 61.5%. There were three maternal deaths all due to abruptio placentae during the study period giving a case specific fatality rate of 2%. Conclusion: The prevalence of APH in our setting is high. The major causes were abruptio placenta and placenta previa. The major fetal complication was intrauterine fetal death, and the major maternal complications were postpartum hemorrhage and anemia with consequent high blood transfusion rate. Early detection, provision of antenatal care, and emergency obstetric care services can reduce the negative effects of APH.

First trimester body mass index and pregnancy outcomes: A 3-year retrospective study from a low-resource setting

Background: Extremes of body mass index (BMI) are associated with adverse pregnancy outcomes. This study was conducted to determine the prevalence of obesity and underweight among women in their first trimester and evaluate the impact of first trimester BMI on pregnancy outcome. Patients and Methods: Pregnant women who booked in the first trimester of pregnancy in Aminu Kano Teaching Hospital, and met the inclusion criteria, were studied retrospectively for a 3-year period from January 2012 to December 2014. Their booking BMIs were calculated and categorized using WHO classes. Pearsons Chi square test was used for all categories. Results: A total of 649 pregnant women booked in the first trimester during the study period, out of which 502 were eligible for the study. Of this, 99 women were obese and 57 were underweight giving the prevalence of obesity and underweight in first trimester of pregnancy as 15.3% and 8.8% respectively. Maternal outcomes mostly associated with obesity and overweight were hypertensive disorders in pregnancy (42.0%), gestational diabetes mellitus (41.3%), increased abdominal and instrumental delivery (38.6%), as well as third and fourth degree perineal tears (71.4%). Neonatal outcomes were low birth weight and fetal macrosomia (57.8%), preterm delivery and prolonged pregnancy (46.0%). The underweight group had a favorable outcome in majority of the outcomes assessed. Conclusion: Obesity in pregnancy is relatively common in our environment and is associated with adverse fetomaternal outcome when compared to the underweight subjects. There is a need for preconception care and further research to identify and possibly mitigate the risk factors of obesity.

An assessment of serum prolactin levels among infertile women with galactorrhea attending a gynecological clinic North-West Nigeria.

Background: Galactorrhea is a common manifestation of hyperprolactinemia but may not always be present in women with hyperprolactinemia. This study was, therefore, undertaken to assess the serum prolactin levels of infertile women presenting with galactorrhea and to determine the prevalence of hyperprolactinemia among them. Materials and Methods: This was a retrospective study of serum prolactin levels of 63 female partners of infertile couples attending the gynecological clinic of Federal Medical Centre, Birnin Kudu, Jigawa State, Nigeria, who were found to have galactorrhea from January 1, 2012, to December 31, 2013. Ethical clearance was obtained. Solid phase enzyme-linked immunosorbent assay was used to measure serum prolactin. Sociodemographic characteristics were determined. The data obtained were analyzed using SPSS version 17.0 statistical software. Absolute numbers and simple percentages were used to describe categorical variables. Similarly, quantitative variables were described using measures of central tendency (mean, median) and measures of dispersion (range, standard deviation) as appropriate. Results: The average age of the women was 27.9 ± 5.6 years. In half of the cases (50%), galactorrhea was associated with menstrual disturbances, mainly amenorrhea (23.3%). Although most (63.3%) of the clients had normal serum prolactin level despite being galactorrheic, averagely there was a marked elevation in serum prolactin of as high as 40.3 ± 52.3 ng/mL. Conclusion: We conclude, therefore, that the prevalence of hyperprolactinemia in this study was low when compared with other studies and that galactorrhea does not always indicate raised serum prolactin levels.

Cancellations of elective surgical procedures performed at a Teaching Hospital in North-West Nigeria

Background: Cancellation of cases on the scheduled day of surgery leads to inefficient utilization of operating theater space, waste of valuable workforce, and scarce resources for patients and hospitals. Objectives: The objective of this study is to determine the prevalence and reasons for cancellations of elective surgical procedures done at Aminu Kano Teaching Hospital, Kano. Materials and Methods: A retrospective cross-sectional descriptive study was undertaken by reviewing the list of all patients whose names appeared on the routine elective surgical operation lists in the Surgical Departments of the hospital, from January to September 2012. The list of those whose surgeries were cancelled was compiled. A sample of 200 cases (determined using appropriate formula, n = z 2 pq/d 2 ) were selected by stratified sampling technique with proportionate allocation. The demographic data, diagnosis, specialty of surgery, proposed surgery, and reasons for cancellation were extracted and analyzed. Results: A total of 2355 cases were booked for elective surgeries during the study. Out the 200 sample selected for the study, 97 were cancelled for various reasons giving a cancellation rate of 48.5%. Overall, Obstetrics and Gynecology accounted for the highest number of cases booked 27.5% (55 out of 200) and cancelled 27.8% (27 out of 97); and had the highest cancellation rate of 49.1% (27 out of 55). The most common reason for the cancellation was a patient factor (60.8%) arising from patient absconding from surgery for personal reasons not communicated to the surgeons, and lack of funds to pay for surgery. Conclusion: The prevalence of cancellation of elective cases on the scheduled day of surgery is still high in our hospital. Most of the causes of the cancellations are due to patient-related factors which are preventable and avoidable. Avoidance of unnecessary cancellations of cases is an important way of ensuring efficient utilization of scarce resources. Adequate counseling before, during, and after elective surgical procedures in our setting is highly recommended.

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.

An Audit of Gynaecological Procedures Performed at Aminu Kano Teaching Hospital, Kano

Background: Audit of all gynecological procedures as one of the commonest operations performed in medical practice is not routinely done in developing countries, including Nigeria. Aim: The study was aimed at determining the rate of all gynecological procedures performed; the common gynecological procedures and their indications, and the cadre of surgeons that performed different gynecological procedures within the period under review. Materials and Methods: A 1-year retrospective chart analysis of all gynecological procedures performed at Aminu Kano Teaching Hospital (AKTH) between 01/10/2012 and 30/09/2013 was conducted. Patients with complete relevant information in the registers were included in the audit and those with incomplete data were excluded. Data was further cleaned and analyzed using Microsoft Excel for Mac 2011, for frequencies and percentages. Results were presented by simple statistical tables. Results: A total of 6,604 patients were gynecological attendees, out of which 646 patients had gynecological procedures performed, giving an institutional gynecological procedure rate of 9.8% (646/6,604), within the period under review. Emergency gynecological procedures accounted for 5.9% (38/646), while the elective cases accounted 4.0% (26/646). Majority of the gynecological procedures was among the 20-40 years age group. About 20 different types of gynecological procedures were done and manual vacuum aspiration (MVA), for incomplete miscarriage accounted for 58.8% (380/646), while excision of transverse vaginal septum was the least at 0.3% (2/646) of all the gynecological procedures. Interns, registrars, senior registrars, and consultants were involved in performing the different gynecological procedures. Between 69 and 100% (446/646-646/646) of some of the major gynecological procedures were carried out by consultants, 14-27% (90/646-174/646) by senior residents (SRs), while the junior residents and interns performed only MVAs among the gynecological procedures at 53.1% (343/646) and 7.3% (47/646), respectively. Conclusion: The common gynecological procedure performed in AKTH is MVA by all cadres of surgeons, and consultants performed the highest number of all the gynecological procedures except MVA. A more regular audit of services rendered by the department is advocated. This may help to identify the gaps in training and services.