M. A. Okunlola

Clients’ Perceptions of the Quality of Antenatal Care

OBJECTIVES To assess perceptions of pregnant women about quality of antenatal care. METHODS Descriptive cross-sectional study in a developing country setting. Three-hundred-ninety-five previously booked pregnant women randomly selected from private and public health facilities at the 3 levels of care were interviewed using a 52-stem interviewer-administered, semistructured questionnaire. The questionnaire sought information about bio data, health information and services, interpersonal communications, amenities and constellation of services. RESULTS Mean gestational age at booking was 18.5 +/- 6.3 weeks. Only 25.8% of respondents booked in the first trimester. Mean number of antenatal visits was 4.0 +/- 2.4. Mean time spent during clinic visits was 3.9 +/- 1.4 hours. Waiting time was rated as appropriate by most women (67.1%). Women with high education and in upper socioeconomic class tended to rate the waiting time as too long. Counseling for HIV was the predominant health education subject. More than half (53.9%) of respondents did not receive information about cervical cancer. About 10% of patients did not receive information about danger signs during pregnancy, breast self-examination, family planning and prevention of sexually transmitted infections. Clinic amenities and constellation of services were rated highly. Most women (96.5%) were satisfied with the care received, would use the same facility in future pregnancies and would recommend it to friends. CONCLUSIONS The majority of pregnant women were satisfied with the care they received. However, frequent antenatal visits and long waiting times are the norm of our antenatal service. Measures for improving elements of quality of antenatal care are imperative.

Effect of sublingual misoprostol versus intravenous oxytocin on reducing blood loss at cesarean section in Nigeria: A randomized controlled trial

Aims:  The aim of this study was to compare the effectiveness and safety of sublingual misoprostol with i.v. oxytocin infusion administered after delivery in reducing blood loss at cesarean section in Nigeria.

A double-blind, randomized, placebo-controlled trial of misoprostol and routine uterotonics for the prevention of postpartum hemorrhage

To assess the effects of 400‐μg sublingual misoprostol plus routine uterotonics on postpartum hemorrhage.

Perceptions and attitudes of Nigerian women about the menopause

The attitudes of women to the menopause are strongly influenced by social, cultural and economic settings in which they live and may also reflect the differences in modes of treatment for or perception of its symptoms. The object of this study was to determine the perception and attitude of post-menopausal Nigerian women to the menopause. We interviewed 676 women who had experienced at least 24 months of amenorrhoea using a structured questionnaire. Menopause was considered a normal physiological manifestation of the ageing process by 95.56% of the respondents while 2.66% believed it was a disease condition. The majority of the women had a positive attitude to the menopause and indicated that it did not affect their relationships with their spouses or children. For most of the women (71.13%), sexual life ended with menopause. None of the women was on hormone replacement therapy but among those sexually active, reduced libido/frequency and vaginal dryness were reported by 24.59%. The most commonly reported advantage of menopause was freedom from cyclical bleeding. We conclude that although Nigerian post-menopausal women have a positive disposition towards menopause, they may have a significant reproductive health burden which has been tolerated for so long. It is important to determine the influence of sociocultural belief on sexuality after menopause and also evaluate the benefits of hormone replacement therapy in our environment.The attitudes of women to the menopause are strongly influenced by social, cultural and economic settings in which they live and may also reflect the differences in modes of treatment for or perception of its symptoms. The object of this study was to determine the perception and attitude of post-meno pausal Nigerian women to the menopause. We interviewed 676 women who had experienced at least 24 months of amenorrhoea using a structured questionnaire. Menopause was considered a normal physiological manifestation of the ageing process by 95.56% of the respondents while 2.66% believed it was a disease condition. The majority of the women had a positive attitude to the menopause and indicated that it did not affect their relationships with their spouses or children. For most of the women (71.13%), sexual life ended with menopause. None of the women was on hormone replacement therapy but among those sexually active, reduced libido/frequency and vaginal dryness were reported by 24.59%. The most commonly reported advantage of menopause was freedom from cyclical bleeding. We conclude that although Nigerian post-menopausal women have a positive disposition towards menopause, they may have a significant reproductive health burden which has been tolerated for so long. It is important to determine the influence of sociocultural belief on sexuality after menopause and also evaluate the benefits of hormone replacement therapy in our environment.

Discontinuation pattern among IUCD users at the family planning clinic, University College Hospital, Ibadan

Summary Despite the high popularity of the intrauterine contraceptive device (IUCD) among family planning clients at University College Hospital, Ibadan, some users discontinued its use for a variety of reasons. This study was to determine the discontinuation rate among IUCD users at UCH, Ibadan. It was a 5-year retrospective analytical study. The records of patients using an IUCD seen at the Family Planning Clinic between 1 January, 1998 and 31 December, 2003 were analysed. A total of 867 clients were seen during the study period; 258(29.8%) clients discontinued within 5 years with the highest rate at 1 year 10.1% and least after 5 years 2.8%. The most common reason for discontinuation was the desire for pregnancy (57.0%). Other reasons included: side-effects (28.3%), husbands views (7.0%) and the menopause (8.0%). The reason for discontinuation varied significantly with the age of the clients (92.5% of clients that discontinued were less than 35 years), educational status, husband coercion, number of living children and religion. The discontinuation rate for the IUCD is high inspite of the high initial acceptability of the method in Nigeria. In a country experiencing a very rapid population growth where the prevalence of contraceptive use hardly attains double figures, it is imperative that policy makers double their efforts at ensuring an appreciable continuation rate of contraceptive use in general and IUCD in particular, among Nigerian women.

Three decades of acquired gynaetresia in Ibadan: clinical presentation and management

A retrospective analysis of acquired gynaetresia (Vaginal Stenosis) managed at the University College Hospital Ibadan, Nigeria between 1967 and 1996 was conducted in terms of clinical presentation and management. The prevalence rate was 7/1000. The peak age incidence was 20-30 years. Chemical vaginitis resulting from insertion of caustic vaginal pessaries for various reasons was the major cause of acquired gynaetresia. Dyspareunia/apyreunia and vaginal stenosis/occlusion were the most common symptoms and clinical findings respectively.The various surgical treatment of acquired gynaetresia included one stage vaginoplasty, McIndole-Reads two stage vaginplasty, separation of labial agglutination, Williamss operation, and simple dilatation of the vagina. Successful correction was recorded in 68% of the patients while 28% had residual partial stenosis, 4% had complete stenosis and 6% were lost to follow-up. It was concluded that acquired gynaetresia is preventable. Efforts should be made by authorities to address this issue and create designated centres in the country for the management of these cases and training of junior gynaecologists.A retrospective analysis of acquired gynaetresia (Vaginal Stenosis) managed at the University College Hospital Ibadan, Nigeria between 1967 and 1996 was conducted in terms of clinical presentation and management. The prevalence rate was 7/1000. The peak age incidence was 20-30 years. Chemical vaginitis resulting from insertion of caustic vaginal pessaries for various reasons was the major cause of acquired gynaetresia. Dyspareunia/apyreunia and vaginal stenosis/occlusion were the most common symptoms and clinical findings respectively. The various surgical treatment of acquired gynaetresia included one stage vaginoplasty, McIndole-Reads two stage vaginplasty, separation of labial agglutination, Williamss operation, and simple dilatation of the vagina. Successful correction was recorded in 68% of the patients while 28% had residual partial stenosis, 4% had complete stenosis and 6% were lost to follow-up. It was concluded that acquired gynaetresia is preventable. Efforts should be made by authorities to address this issue and create designated centres in the country for the management of these cases and training of junior gynaecologists.

Knowledge, attitude and concerns about voluntary surgical conception among healthcare workers in Ibadan, Nigeria

Summary A multicentre study was conducted among healthcare workers in three major hospitals in Ibadan, south-west Nigeria. Structured questionnaires were self-administered to different cadres of healthcare workers in these hospitals with the objective of evaluating their knowledge, attitude and concerns about voluntary surgical contraception. The study revealed that though they had a generally good knowledge of voluntary surgical contraception, their attitude and concerns about the procedure was not encouraging and were largely biased. Such beliefs among healthcare workers tend to negatively influence the uptake of the procedure in the general population, further depleting the low contraceptive use in Nigeria, which has only recently attained a percentage in double figures. Strategies and means to improve on this are discussed to encourage better uptake and acceptability of the procedure among the general population.

Assessment of tubal factor contribution to female infertility in a low resource setting (southwest Nigeria): Hysterosalpingography vs laparoscopy

Female factor contribution to infertility in Africa is commonly due to tubal disease. The incidence of bilateral tubal occlusion among infertile African patients is about three times higher than in the developed countries. This is largely due to a high prevalence of pelvic inflammatory disease in Africa. Tubal patency can be investigated using hysterosalpingography laparoscopy and dye test and more recently hysterosalpingo-contrast sonography. However laparoscopy is largely thought to be the gold standard for tubal assessment. Hysterosalpingography or hysteroscopy has a complimentary role to laparoscopy in excluding endometrial pathology in the evaluation of infertile patients. (excerpt)

Endometriosis and associated symptoms among Nigerian women

To determine the prevalence of endometriosis and identify associated symptoms among Nigerian women.

Community health insurance as a catalyst for uptake of family planning and reproductive health services: the Obio Cottage Hospital experience.

Abstract Health service delivery in the Niger Delta region of Nigeria has suffered many setbacks. Community participation may help break the barriers limiting access to health services, especially those associated with family planning and reproductive health services. This is a two-year review of family planning and reproductive health services records offered by the Obio Cottage Hospital from the onset of the Community Insurance Scheme (2010–12). Since the inception of the Community Insurance Scheme, there has been an increase in the uptake of family planning methods of more than 50%; 1,274 women in 2011 vs 3,140 in 2012. An increase in number of women seeking reproductive health services was also observed. The Community Health Insurance Scheme (CHIS) at the Obio Cottage Hospital provides evidence for expansion, as seen in the improvement in patronage for family planning and reproductive health services.