Mohammed Bukar

Risk factors for obstetric fistulae in north-eastern Nigeria

Summary This prospective comparative study of obstetric fistulae (OF) was aimed at identifying risk factors. A total of 80 obstetric fistulae treated at the gynaecological unit of the FMCG, and 80 inpatients without fistulae recruited randomly as controls formed the basis of this study. Through interview and case record review, information on age, parity and marital status was collected. Other features were educational status, occupation and booking status of the pregnancy that might have led to this condition. The duration of labour, place of birth and mode of delivery, including its outcome were also collected. The data were analysed using the Epi Info. The majority of the patients were Hausa/Fulani 87.5%, Muslims 91.2%, with large vesicovaginal fistulae (average size 5.0 cm) mainly resulting from obstructed labour (93.7%). Major risk factors included early age at first marriage (average 14 years), short stature (average height 146.2 cm) and illiteracy (96.3%). Also low social class and lack of gainful employment were factors. Failure to book for antenatal care (93.7%), and rural place of residence (95%) were also factors associated with acquiring the fistulae. Living far away (>3 km) from a health facility also contributed or predisposed to the development of an obstetric fistula. Social violence and stigma associated with the fistulae included divorce, being ostracised as a social outcast, and lack of assistance from relations in terms of finding and funding treatment. This study supports improved access to basic essential obstetric care, family planning services, and timely referral when and where necessary. Universal education will provide a long-term solution by improving the standard of living and quality of life. Especially important are media- and community-based programmes on the ills of teenage marriage and child pregnancy using cultural and religiously-based values to give sound advice. In a male dominated society, reaching out to men with traditionally palatable messages that will change their attitude and practices to taking responsibility in reproductive health could be a winning strategy.

Anaemia in pregnancy at booking in Gombe, North-eastern Nigeria

Summary Anaemia in pregnancy is an important reproductive health problem associated with increased maternal and perinatal morbidity and mortality. This study was undertaken to determine the prevalence of anaemia in pregnancy at booking in Gombe, North-eastern Nigeria. A cross-sectional study of 461 women attending the antenatal clinic was carried out. Anaemia in pregnancy was defined as a packed cell volume (PCV) of <30%. The capillary technique was used for the estimation of the PCV. The biosocial characteristics (age, parity and social class); and gestational age at booking were obtained and analysed. Of the 461 pregnant women studied, 239 were anaemic, a prevalence of anaemia at booking of 51.8%. The majority of these patients, 67.4%, were mildly anaemic, 30.5% were moderately anaemic while only 2.1% had severe anaemia. Most, 316 (68.5%) of the women booked in the second trimester while only 3.0% booked in the first trimester. There was no relationship between parity and anaemia in pregnancy in this study The majority of the women, 293 (63.5%) were in the lower social class. Because the majority of the anaemic gravidae are in the low social class, provision of haematinics at little or no cost will go a long way towards reducing the high prevalence of anaemia in pregnancy. In the long run, educational and economic empowerment of the women is the key to reducing the overall prevalence of anaemia to the barest minimum.

Hysterosalpingographic findings in infertile women: A seven year review

OBJECTIVES To review the hysterosalpingographic (HSG) findings in women investigated for infertility in a tertiary center in north eastern Nigeria. MATERIALS AND METHODS A retrospective review of HSG films of 272 women investigated for infertility between January 2000 and December 2006 were reviewed. RESULTS One hundred and thirty (47.8%) were investigated for primary infertility, while 142 (52.2%) were investigated for secondary infertility. Most of the women investigated for infertility by HSG had abnormal findings 192(70.6%). The most common pathology revealed among the infertile women was tuboperitoneal factor in 196 (72.1%) followed by uterine synechia in 35(12.9%). Seventeen (6.3%) had bilateral tubal block and 5 (1.8%) had bicornuate uterus. CONCLUSION HSG is helpful in the investigation of infertile women.

Sonographic determination of normal spleen size in an adult African population

OBJECTIVE The purpose of this study was to determine the normal range of spleen size in an adult African population, and compare the findings to published data to determine any correlation with ethnicity. MATERIALS AND METHODS Three hundred and seventy-four African adults without conditions that can affect the spleen or splenic abnormalities were evaluated with ultrasonography. Spleen length, width and thickness were measured and spleen volume calculated. Spleen size was correlated with age, gender, height, weight, and body mass index. RESULTS The mean spleen volume was 120 cm(3). Spleen volume correlated with spleen width (r=0.85), thickness (r=0.83) and length (r=0.80). Men had a larger mean spleen volume than women. No correlation was found between spleen volume and age, weight, height, or body mass index. CONCLUSION Mean spleen volume in African adults is smaller than data from Western sources, and cannot be explained by difference in body habitus.

Hydatidiform mole as seen in a university teaching hospital: A 10-year review

Summary Hydatidiform mole (HM), is a known cause of early pregnancy wastage and has the risk of malignant potential. This is a retrospective study of 71 patients who were managed for hydatidiform mole at the University of Maiduguri Teaching Hospital, (UMTH) Maiduguri over a 10-year period, from January 1996 to December 2005, inclusive. The objective of the study was to determine the incidence, risk factors, clinical presentations and histological types of HM. Case records of 71 histologically confirmed HM were studied. Their sociodemographic characteristics, clinical presentations and histology reports were obtained and analysed. The institutional incidence of molar pregnancy was 3.8/1,000 deliveries. Histological findings showed partial mole in 51 (71.8%) cases and complete mole in 20 (28.2%) cases. The peak age-specific incidence rate was 17.5 years. The leading presenting clinical feature was abnormal vaginal bleeding seen in 100%. No case of invasive mole was found. Maternal complications included severe haemorrhage requiring blood transfusion (30.0%) and infections (15.5%). There was no maternal death. In conclusion, the incidence of partial hydatidiform mole was found to be higher than that of complete variety in our environment and the identified risk factors were young age, low parity and previous history of HM.

Awareness and perception of human papilloma virus vaccine among healthcare professionals in Nigeria

Abstract Human papilloma virus (HPV) is a necessary cause of cervical cancer and cervical cancer is largely a vaccine-preventable disease. The aim of the study was to document the knowledge of healthcare professionals of the HPV vaccine and its acceptability. It was a cross-sectional study in three of the six geo-political zones of Nigeria, carried out between June 2010 and January 2011. The 602 adult Nigerian respondents were made up of 147 (24.4%) males and 455 (75.6%) females aged 20–57 years, with a mean of 34.3 ± 7.9 years; most were under 40 years (70.1%) and married (n = 394; 65.5%). In total, 548 (91%) were aware of HPV; 83.4% knew HPV as an STI; 78.2% knew HPV can cause cervical cancer but only 265 (44.0%) were aware of the HPV vaccine. Among the healthcare professionals studied, nurses were the least aware of the existence of the HPV vaccine (χ2 = 1.54, p = 0.001). A total of 489 (81.0%) would approve HPV vaccine for their teenage daughters. The men were more likely to accept the vaccination of their daughters than the women (χ2 = 14.76, p = 0.002). The unmarried were more favourably disposed to vaccination of teenagers than the married (χ2 = 27.37, p = 0.001). Safety concerns were the commonest reasons expressed by the 7% who were reluctant to accept the vaccination of their teenage daughters. In conclusion, healthcare providers are the custodians of health in a community, yet have low knowledge of a vaccine that can prevent the commonest cancer in women in sub-Saharan Africa.

Prevalence of bacterial vaginosis in pregnant women in Maiduguri, North‑Eastern Nigeria

OBJECTIVE This study determined the prevalence and socio-demographic characteristics of bacterial vaginosis (BV) among pregnant women with abnormal vaginal discharge. STUDY DESIGN Descriptive cross-sectional study. SETTING University of Maiduguri Teaching Hospital. MATERIALS AND METHODS Vaginal swab samples and data on epidemiological risk factors were collected from 400 consecutive pregnant women with complaints of abnormal vaginal discharge. The data was analyzed using the SPSS 16.0 statistical software. Association between variables was compared by using the Chi-square (χ2 ) and Fishers exact tests while P < 0.05 was considered significant at 95.0% confidence level. RESULT The prevalence of BV among pregnant women with abnormal vaginal discharge was 17.3%. Age 20-24 years, multigravidity, lack of western education and unemployment were associated with increased prevalence of BV. Yellowish, watery vaginal discharge (P = 0.001) was associated with BV. Dysuria, dyspareunia and lower abdominal tenderness were associated with BV (P = 0.001). Fifty three (77%) of patients had BV during the second trimester compared to 6 (9%) who had it in the 1 st trimester of pregnancy (P = 0.012). CONCLUSION The high prevalence of BV in this study may necessitate adequate screening of pregnant women with abnormal vaginal discharge in order to give appropriate treatment and avoid complications associated with it.

Prevalence of utero-tubal infertility

Summary Tubal factor infertility is the commonest cause of infertility seen in gynaecological clinics in Nigeria. This, to a large extent, is a preventable cause of infertility. The objective of the study was to determine the prevalence of utero-tubal factors in the causation of infertility. This is a prospective descriptive study of infertile women seen at the gynaecological clinic of the Federal Medical Centre Gombe from June 1999 to May 2002. A total of 229 infertile women were studied. The prevalence of primary and secondary infertility was 37.1% and 62.9%, respectively. Tubal factor was the cause in 67.2% and cervical factors contributed to 19.2%. The women were aged 17–44, with a mean of 28.6 ± 5 years. There were four (1.7%) teenagers and eight (3.5%) women were aged 40 years or above. The majority, 55% (126), were in their third decade, with those aged 20–34 years constituting 86% (197) of patients. The high prevalence of tubal factor infertility in our environment is unacceptable. Primary prevention of reproductive tract infections and syndromic management of STD will go a long way in reducing the high prevalence of tubal factor infertility.

Gender attitude to the empowerment of women: An independent right to contraceptive acceptance, choice and practice

Multiple factors influence the acceptance, choice and utilisation of contraceptive. The objective of the study is to identify individual attitude towards the empowerment of women to an independent right to accept, choose and utilise a contraceptive method of their choice without recourse to their male partners. This is a cross sectional study of men and women of different socio-cultural background working or utilising the services of the Federal Medical Centre Gombe, Nigeria. There were 554 respondents. Only 187 (34.4%) respondents thought that all women, irrespective of marital status, should have an independent right to contraceptive acceptance, choice and practice. Significantly more men (85.4%) than women (61.8%) rejected that women should have an independent right to contraceptive acceptance, choice and practice. Majority of both gender favoured male influence in the acceptance and choice of method of contraception. Our study has re-echoed the importance of male involvement in contraception decision-making.

Home births and postnatal practices in Madagali, North-Eastern Nigeria

BACKGROUND Home births are common in resource poor countries and postnatal practices vary from one community to the other. OBJECTIVE To determine the proportion of home births, reasons for home delivery, and evaluate postnatal practices in Madagali, north-eastern Nigeria. MATERIALS AND METHODS This was a cross-sectional descriptive study of 400 women of reproductive age, who had put to birth in the past 1 year. The study was carried out over a period of 8 weeks from April to June 2010. The multistage method of sampling was used to select respondents. In the first stage, four of the five health districts were chosen randomly, namely, Gulak, Madagali, Sukur, and Duhu. The questionnaires were evenly distributed among the four health districts. In the second stage, from each district, two villages were chosen by simple random sample. In the third stage, two wards were selected in each village by simple random sampling. RESULT Of the 400 respondents interviewed, 289 (72.2%) were aged between 20 and 39 years, and most, 374 (93.5%) were married. Only 14 (3.5%) had tertiary education. Most respondents, 224 (56.0%) were farmers and grandmultiparae, 187 (46.7%). A total of 196 (49.0%) women delivered at home, whereas 204 (51.0%) delivered at the hospital. Of the 196 respondents who delivered at home, the bedroom 142 (72.4%), was the preferred place of birth. The most common reason for home birth was short duration of labor in 71 (36.3%) cases. Delivery was conducted by untrained persons in 50, (25.4%), whereas 99 (50.8%) and 31 (15.5%) deliveries were supervised by Traditional Birth Attendants (TBAs) and Midwives/Nurses, respectively. Postpartum, the majority, 235 (58.7%) respondents used sanitary pads to stanch lochia, whereas 140 (35%) used rags. CONCLUSION A significant number of births take place in the home and supervised by unskilled persons. Against the backdrop of poor education and low socio-economic status of respondents, perineal hygiene can be adjudged satisfactory. There is the need to increase on the number of hospital birth and also trained TBA who conduct most of home deliveries.