Jacob Olumuyiwa Awoleke

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.

Resumption of intercourse after childbirth in southwest Nigeria

Abstract Objective To determine the history of resumption of intercourse after childbirth and associated contraceptive practices among women in the southwest region of Nigeria. Methods A cohort of 181 women with live births was followed up for 6 months after delivery. Enquiry about the time of first intercourse after childbirth, associated dyspareunia, use of contraception, etc was made during the postnatal clinic visits and/or by telephone contact. Results Fifty (27.6%) had coitus within six weeks of childbirth, it increased to 115 (63.3%) at three months and 127 (70.2%) by six months post-delivery. Prevalence of dyspareunia was 36.2%. Eighty three (65.4%) of sexually active women practiced contraception which was predominantly use of male condom and withdrawal method. Co-habitation with husband (adjusted OR: 6.30; 95% CI: 2.56–17.01; p = 0.001) and mode of delivery (adjusted OR: 2.45; 95% CI: 1.30–4.73; p = 0.006) were strong predictors of commencement of sexual intercourse within six months postpartum. Significantly fewer women who had Caesarean section resumed coitus within six months when compared with those who had vaginal deliveries (59.2% versus 78.4%). Perineal injury did not predict resumption of coitus or experience of dyspareunia. Conclusion In contrast to the norm, more women in southwest Nigeria are resuming coitus soon after childbirth. It is imperative to scale up counselling on postpartum sexuality and contraception within the maternal health services in this region. Chinese Abstract 摘要 目的：了解尼日利亚西南地区女性产后性生活的恢复情况及相关的避孕措施。 方法：对181名活产的女性产后6个月进行随访研究。在产后门诊复查和/或通过电话联系询问女性分娩后第一次性交的时间，相关的性交疼痛，使用的避孕方法等问题。 结果：50名（27.6%）女性产后六周内就有性生活，至产后3个月和产后6个月有性生活的女性分别增至115名（63.3%）及127名（70.2%）。性交疼痛的发生率为36.2%。83名（65.4%）性活跃的女性采用避孕措施，主要为避孕套或体外射精。与丈夫同居（校正OR：6.30; 95% CI: 2.56-17.01; p=0.001）和分娩方式（校正OR：2.45; 95% CI: 1.30-4.73; p= 0.006）是产后6个月内开始性生活的强的预测因素。剖宫产分娩的女性产后6个月内恢复性生活的比例少于经阴道分娩的女性（59.2% vs 78.4%）。会阴损伤并不影响性生活的恢复，也不增加性交疼痛的感受。 结论：与普通妇女比，尼日利亚西南部较多的女性在分娩后不久就恢复性交。在母婴保健服务中扩大对这个地区女性产后性生活和避孕知识的咨询指导势在必行

Role of reminder by text message in enhancing postnatal clinic attendance

Missing a postnatal clinic appointment affects completion of maternal care and contributes to maternal morbidity and mortality. It is unfortunate that postnatal clinic attendance has been consistently poor in Sub-Saharan Africa [1,2]. Various reasons have been adduced for this absenteeism; notably, forgetting the date, time, and possibly the location of the appointment [3]. To date, no study has considered the influence of a reminder system on postnatal clinic attendance. With mobile phone ownership increasing rapidly in the region [4], there is potential for using short message service (SMS) technology as reminders to improve postnatal clinic attendance. The aim of the present study was to test the hypothesis that SMS reminders would reduce non-attendance rates at postnatal clinics in Ado-Ekiti, Nigeria. The studywas conducted at Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria, from February 1 to July 31, 2013. The study protocol was approved by the hospital’s ethics committee and informed consent was obtained from each participant. The primary outcome of interest was failure-to-attend (FTA) rate. The intervention group (SMS group) comprised patients who delivered during the study period, who were scheduled to attend a postnatal clinic, andwhohad provided amobile telephone number in their hospital record. A historic control groupwas chosen, which comprised all patients who had delivered in the hospital within the preceding 6 months of the study (August 1, 2012, to January 31, 2013) andhad been given an appointment to attend a postnatal clinic. Automated SMS reminders were sent twice to participants in the intervention group, at 2 weeks and then at 5 days before their scheduled clinic appointment. The textmessage read: “Good day. This is to remind you to attend your postnatal clinic on bdateN btimeN. Thank you.” It was a one-way message sent during the day and a delivery report was obtained for each SMS sent. Record of actual clinic attendance by patients in the two groups was obtained from the outpatient scheduling system. Two-sample proportion tests were performed using Stata 11 (StataCorp LP, College Station, TX, USA) to compare FTA rate between the SMS group and the historic control group. Relative risks of non-attendance were presented with 95% confidence intervals; level of significance was set at P b 0.05. Of the 1153 women in the intervention group that delivered during the study period, 1126 (97.7%) women successfully received SMS reminders and analyses were based on those women. Among the intervention reminder group, FTA rate was 21.3% (240/ 1126) (Table 1). The historic control group consisted of 971 patients and had an FTA rate of 42.8% (416/971). Absolute reduction in FTA rate in those who received an SMS reminder was 21.5%. This represents 243 patientswhowould otherwise have been lost to postnatal followup. Patientswho received an SMS reminderwere 50% less likely to fail to attend their postnatal appointment (relative risk of FTA 0.50; 95% CI, 0.32 − 0.77; P = 0.002). The cost of sending an automated SMSwas 1.50Naira (US

Antenatal drug consumption: the burden of self-medication in a developing world setting

0.00938). The total cost for 2252 SMS reminders (1126 × 2) during the 6 months of the study was 3387 Naira (US

Awareness and practice of emergency contraception at a private university in Nigeria

21.12). Extrapolation of annual cost of SMS reminderswould be US

Clinical suspicion, management and outcome of intrapartum foetal distress in a public hospital with limited advanced foetal surveillance

42.24. In this setting, postnatal care is provided free of charge. The present study demonstrated that patients who had received SMS reminders were more likely to attend their postnatal clinic appointment (21.3% v 42.8%; P = 0.002). The outcome supports the hypothesis that SMS reminders will reduce rates of non-attendance at postnatal clinics in this setting. Mobile phone penetration in the West Africa sub-region has been unprecedented and there are now 188 million subscribers. Nigeria has the largest share of 95 million mobile phone users [5]. Virtually all homes except core rural areas have a means of mobile reach. Exploring the benefits of mobile technology in reducing maternal morbidity and mortality in Sub-Saharan Africa is a worthwhile project. The economic cost analysis of SMS reminders is negligible (US

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

42.24 per annum in the present study), the text is automated, and staff training is not required. It can be presumed that, since postnatal care is provided free of charge in this setting, forgetfulness of the date and time of the appointment is more likely to account for clinic absenteeism. The present study has some limitations. Firstly, the use of an historic control group raises the question that the observed difference in FTA rate may be due to seasonal variation. However, return for postnatal care in this environment has been notoriously low formany years, making this assumption of little value. Secondly, despite ascertaining that the texts had been successfully delivered, it was not possible to know whether they had been received by the correct recipients. Two-way

Baird-Pattinson Aetiological Classification and Phases of Delay Contributing to Stillbirths in a Nigerian Tertiary Hospital

This institutional-based cross-sectional study examines the burden of self-medication during pregnancy in a middle-income country setting and the impact on fetal wellbeing. Using a blend of open-ended and indication-oriented questionnaires, 346 pregnant women at term were interviewed about their pregnancy complaints and drug intake. Inferential statistical data analysis was employed with level of significance (α) set at 0.05. Excluding routine supplements and vaccinations, 251 (72.5%) women used medicines, of whom 79 (31.5%) had self-medicated. Consuming drugs without prescription was associated with increased US Food & Drug Administration (FDA) risk category (χ2 = 8.375; P = 0.015). There is therefore a need to scale up efforts towards educating women about the dangers of self-medication, while also introducing effective restrictive policies on over-the-counter drug sales.

Sociodemographic factors associated with anaemia in pregnancy at booking for antenatal care.

BackgroundThe pursuit of formal education now causes many people in developing countries to marry later in life, thereby leading to increased premarital sex and unintended pregnancies. Efforts have been made to characterize awareness and use of emergency contraception (EC) among undergraduate students in public universities in Nigeria; however, it is not known if students in private tertiary institutions adopt different practices or if having an affluent family background plays a role. This pilot study therefore aimed to assess the awareness and use of EC among students at a private Nigerian university toward assisting education planners in developing strategies in improving students’ reproductive well-being.ResultsOut of 94 female students, 42 (44.7%) had sexual experience, but only 32 (34.0%) were currently sexually active. Six students (6.4%) had had unwanted pregnancies, of which all but one were terminated. Fifty-seven respondents (60.6%) were aware of EC, though only 10 (10.6%) ever practiced it. The greatest source of EC information was from health workers and peers; the lowest source was family or relatives. Most respondents desired orientation and availability of EC on campus. EC awareness among the students was predicted by upper social class background (adjusted odds ratio [OR], 2.73; 95% confidence interval [CI], 1.06–7.45) and upbringing in the Federal Capital Territory (adjusted OR, 4.45; 95% CI, 1.56–14.22).ConclusionsThough awareness of EC was higher among the private university students in this study than at most public universities, there was no difference in EC usage. A high pregnancy termination rate was observed; dilatation and curettage were mainly adopted. In Nigeria, youth-friendly reproductive health information and access should not be limited to government-owned tertiary institutions but also extended to private ones.

Ruptured tubal pregnancy: predictors of delays in seeking and obtaining care in a Nigerian population

Abstract Objectives: To determine the basis for the clinical suspicion of foetal distress, the instituted managements and delivery outcome in a tertiary hospital in sub-Saharan Africa with limited capability for advanced foetal monitoring. Methods: It is a 3-year retrospective analysis of all the obstetrics cases with intrapartum foetal distress. Results: There were 301 cases reviewed. The birth asphyxia incidence rate was 233/1000 live births and the perinatal death rate was 47/1000 live births. Suspicion of foetal distress was premised on the presence of persistent tachycardia or bradycardia during intermittent auscultation. Main resuscitative measures were left lateral repositioning of patient, fast saline infusion, intranasal oxygen administration and discontinuation of oxytocin infusion, if any. Only 124 (41.2%) of all the cases had delivery achieved within 2 h of diagnosis. Mean decision-delivery interval by caesarean section was 2.93 ± 2.05 h. Socio-demographic factors (p= 0.001) and pregnancy risk category (p = 0.002) influenced incidence of birth asphyxia. Conclusion: To reduce subsisting high perinatal morbidity and mortality in sub-Saharan Africa, it is best that at the least referral hospitals should have advanced facilities for foetal monitoring and shortened surgical intervention time.