O. Olayemi

Current causes and management of violence against women in Nigeria

Violence against women is an important health and human rights issue. It carries with it both short- and long-term sequelae for women that can affect both their physical and psychological wellbeing. Every day obstetric providers treat patients who have been assaulted. Timely identification can interrupt the cycle of violence, prevent further injury and initiate the help-seeking process. The objectives of this study were to survey how often Nigerian obstetrician – gynaecologists see these patients in their practice and to describe the demographics and management of their most recent case so as to give an idea of the extent of the problem. This is especially important as abuse is grossly under-reported because the victims are afraid to report it because of male dominance in society and the fear of losing their homes. We used a self-administered questionnaire survey of 138 practising obstetricians and gynaecologists in Nigeria. Questions were asked about the yearly estimation of cases seen and how recently a case was seen. The type of abuse, risk factors and management of their most recent case was also documented. Most (98.6%) obstetricians surveyed had previously managed a case of violence. The mean estimate of abused women seen was 7.0 per year. Details of the last case managed were recollected by 91.3% of respondents. The majority (51.6%) of patients were pregnant. The assailant was the husband in 69.8% of cases and the most common factor for abuse was as a result of women requesting money for the family needs from their husbands. The most common type of abuse was physical (79.4%), with 34.9% of patients sustaining cuts. Treatment and counselling were the forms of management in most cases. The police were informed in 9.5% of cases and one obstetrician had to give evidence in court. Of the pregnant abused women, 73.8% had live births. Better job opportunities and female empowerment can reduce the risk of violence. Obstetricians should screen routinely for battery, provide education about violence, assess the danger, review safety plans and refer women appropriately. We cannot solve the problem alone, but sensitivity and commitment can begin to make a difference.

Ovarian cancer in Ibadan: characteristics and management*

Ovarian cancer has the highest case fatality rate among gynaecological cancers worldwide because of lack of effective screening methods and non-specific early warning symptoms with late presentation. A reinvigorated study is necessary in the developing countries because of a projected increase in its incidence. The decreasing fertility rate and increasing use of ovulation induction drugs are some of the reasons. The Ovarian Cancer Service of the Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Oyo State, Nigeria commenced the first longitudinal study of this malignancy from 1 December 1998 in order to establish a regional management and research centre. It is a questionnaire survey detailing the demography, clinical and staging laparotomy findings and histology of all confirmed cases. Twenty-one staging laparotomy and histologically confirmed ovarian cancer cases were managed from 1 December 1998 to 31 July 2002, about 1.5% of the 1387 gynaecological admissions. It is the third most common of the gynaecological cancers, representing 9.8% of the 214 cases. More than 60% of the patients were 50 years or younger. Only 19% were nulliparous, with 47.6% having had five or more deliveries. Only two patients (9.5%) had used the oral contraceptive pill, for a maximum period of 1 month. Only one patient (4.8%) had a positive family history of cancer. Abdominal swelling was the most common presenting symptom. Eighty-one per cent of the patients presented in Stages III and IV. Epithelial ovarian cancer constituted about 76.2% of the cases. Only 23.8% had adjuvant therapy, consisting of combination chemotherapy using cisplatin-based regimes. The case fatality rate 6 months after surgery was 76%. The ovarian cancer patients in this environment are younger and of higher parity than expected. The risk factors for this disease require further study.

Determinants of pain perception in labour among parturients at the University College Hospital, Ibadan

This cross-sectional study of one thousand parturients aims to evaluate the factors, which are associated with pain perception in labour and to identify women who will benefit most from analgesia in labour. The instrument applied was a structured questionnaire incorporating the Box numerical scale (BNS) for pain assessment. Patients who delivered by elective or emergency caesarean section and women who did not give informed consent were excluded from the study. Spearmans and Pearsons correlational analyses were applied. Pain scores showed significant correlation with age (r =  − 0.087, p < 0.01), parity (r =  − 0.226, p < 0.01), gestational age at delivery (r =  − 0.074, p < 0.05), onset of labour (rho = 0.195, p < 0.01), mode of delivery (rho = 0.160, p < 0.01), booking status (rho =  − 0.070, p < 0.05) and educational status (rho = 0.182, p < 0.01). Certain groups of patients would benefit from obstetric analgesia. These patients include, nulliparous patients, young patients, patients who have had labour induced, those with preterm deliveries and those with an assisted vaginal delivery especially if they are well educated.

Assessment of the effect of psychosocial support during childbirth in Ibadan, south-west Nigeria: A randomised controlled trial

Objective: To assess the effect of psychosocial support on labour outcomes.

ATTITUDE AND PREFERENCES OF NIGERIAN ANTENATAL WOMEN TO SOCIAL SUPPORT DURING LABOUR

SummaryThis was a hospital-based cross-sectional study of 224 randomly selected antenatal women receiving care at the University College Hospital, Ibadan, Nigeria. The study aimed to seek the attitude and preferences of respondents about social support during childbirth and also identify variables that may influence their decisions. Seventy-five per cent of respondents desired companionship in labour. Approximately 86% preferred their husband as companion while 7% and 5% wanted their mother and siblings as support person respectively. Reasons for their desire for social support were emotional (80.2%), spiritual (17.9%), errands (8.6%) and physical activity (6.8%). Socio-demographic variables found to be statistically significant on logistic regression analysis for the desire of a companion in labour were nulliparity (OR 3.57, 95% CI 1.49-8.52), professionals (OR 3.11, 95% CI 1.22-7.94) and women of other ethnic groups besides Yoruba (OR 2.90, 95% CI 1.02-8.26), which is the predominant ethnic group in the study area. Only those with post-secondary education were found to want their husbands as doula (OR 2.96, 95% CI 1.08-8.11). More than half of the respondents wanted information about labour prior to their experience. It is important that Nigerian women are allowed the benefit of social support during childbirth, particularly as there is a lack of one-to-one nursing care and other critical services, including epidural analgesia in labour, at many of the health care facilities in Nigeria. Men could play a pivotal role in the process of introducing support in labour so as to improve the outcome for both the mother and her newborn.

Pattern of chloroquine-induced pruritus in antenatal patients at the University College Hospital, Ibadan

The importance of Malaria, especially in pregnancy, cannot be over-emphasised. A major determinant of compliance with treatment in this environment is the pruritus chloroquine induces when ingested. This cross-sectional study of 200 antenatal patients was aimed at obtaining the pattern of the pruritus in antenatal patients. The prevalence of chloroquine-induced pruritus was 64.5%; 76.3% of the patients experienced the itching within 24 hours of ingestion of the drug and 60% of the patients still use the drug in spite of the itching for various reasons. Among the indices of severity, the frequency of itching with chloroquine use was the only factor that correlated with continuation of use (P < 0.01).

Grandmultiparitytrends and complications: a study in two hospital settings

Pregnancy after the fifth delivery is viewed with anxiety, especially by obstetricians in developing countries working with inadequate facilities. High parity is still common with serious consequences to the fetus, the mother, the family and society. In the last 40 years, non-governmental, national and international efforts have been made to reduce fertility rates. We therefore intended to determine the trend in the grandmultiparity rates from 1 January 1987 to 31 December 1994 in the South Western part of Nigeria. The obstetric performance of these grandmultiparae in two different settings were to be compared. This was a retrospective, case-note analysis of all the grandmultiparae delivered at the University College Hospital (UCH) (Group A) and the Oluyoro Catholic Hospital (OCH) (Group B), both in Ibadan city. The former is a tertiary health care centre while the latter is a secondary centre. The socio-clinico-demographic characteristics of these patients were collated and analysis and comparison performed using EPI-INFO software. In Group A, 828 grandmultiparae were seen among 9215 deliveries, a rate of 8.99% (10.90% in 1987 to 3.36% in 1994). In Group B, there were 1940 cases among 22 587 deliveries, i.e. 8.59% (12.75% to 6.07%), respectively. The modal age group was 31-35 years, and women above 35 years formed one-third of cases. The parity group 5-7 was the most frequent in both groups (91.6% vs. 94.9%). Only two mothers (both in group B) had parity above 10. Booked patients formed a larger percentage in Group B than in Group A (85.8% vs. 69.7%, respectively). In Group B 85.9% had spontaneous vertex delivery as opposed to 66.3% in Group A. Caesarean section was the mode of delivery in 9.0% and 24.2% in Groups B and A, respectively. Equal percentages had breech delivery. The modal birth weight was 2.51-3.00 kg in both groups. Macrosomic babies formed 3.7% in Group A and 2.4% in Group B, while low birth weight babies formed 17.7% and 11.7% in Groups A and B, respectively. The crude perinatal death ratio was 123/1000 in Group A and 68/1000 in Group B. Antepartum haemorrhage, anaemia and premature rupture of membranes in Group A and anaemia, hypertension and antepartum haemorrhage in Group B were the most common pregnancy complications noted. In labour, abnormal lie/presentation, prolonged labour and premature labour in Group A and abnormal lie/presentation, antepartum haemorrhage and birth asphyxia in Group B formed the majority of the complications. The most common puerperal complications were primary postpartum haemorrhage, wound/genital sepsis in Group A and anaemia and primary postpartum haemorrhage in Group B, respectively. Maternal death ratio was 10.85/100 000 total deliveries in Group A and 35.42/100 000 in Group B. High parity is still common in developing countries, although the incidence is declining, with rates of 3.4% and 6.1% of total deliveries in Groups A and B, respectively. More patients are delivered per abdomen at UCH compared to OCH. The perinatal mortality rate is higher at UCH than OCH but the maternal mortality rates follow the reverse. Recommendations are made concerning the reduction in high parity rates and its associated complications.Pregnancy after the fifth delivery is viewed with anxiety, especially by obstetricians in developing countries working with inadequate facilities. High parity is still common with serious consequences to the fetus, the mother, the family and society. In the last 40 years, non-governmental, national and international efforts have been made to reduce fertility rates. We therefore intended to determine the trend in the grandmultiparity rates from 1 January 1987 to 31 December 1994 in the South Western part of Nigeria. The obstetric performance of these grandmultiparae in two different settings were to be compared. This was a retrospective, case-note analysis of all the grandmultiparae delivered at the University College Hospital (UCH) (Group A) and the Oluyoro Catholic Hospital (OCH) (Group B), both in Ibadan city. The former is a tertiary health care centre while the latter is a secondary centre. The socio-clinico-demographic characteristics of these patients were collated and analysis and comparison performed using EPI-INFO software. In Group A, 828 grandmultiparae were seen among 9215 deliveries, a rate of 8·99% (10·90% in 1987 to 3·36% in 1994). In Group B, there were 1940 cases among 22 587 deliveries, i.e. 8·59% (12·75% to 6·07%), respectively. The modal age group was 31-35 years, and women above 35 years formed one-third of cases. The parity group 5-7 was the most frequent in both groups (91·6% vs. 94·9%). Only two mothers (both in group B) had parity above 10. Booked patients formed a larger percentage in Group B than in Group A (85·8% vs. 69·7%, respectively). In Group B 85·9% had spontaneous vertex delivery as opposed to 66·3% in Group A. Caesarean section was the mode of delivery in 9·0% and 24·2% in Groups B and A, respectively. Equal percentages had breech delivery. The modal birth weight was 2·51-3·00 kg in both groups. Macrosomic babies formed 3·7% in Group A and 2·4% in Group B, while low birth weight babies formed 17·7% and 11·7% in Groups A and B, respectively. The crude perinatal death ratio was 123/1000 in Group A and 68/1000 in Group B. Antepartum haemorrhage, anaemia and premature rupture of membranes in Group A and anaemia, hypertension and antepartum haemorrhage in Group B were the most common pregnancy complications noted. In labour, abnormal lie/presentation, prolonged labour and premature labour in Group A and abnormal lie/presentation, antepartum haemorrhage and birth asphyxia in Group B formed the majority of the complications. The most common puerperal complications were primary postpartum haemorrhage, wound/genital sepsis in Group A and anaemia and primary postpartum haemorrhage in Group B, respectively. Maternal death ratio was 10·85/100 000 total deliveries in Group A and 35·42/100 000 in Group B. High parity is still common in developing countries, although the incidence is declining, with rates of 3·4% and 6·1% of total deliveries in Groups A and B, respectively. More patients are delivered per abdomen at UCH compared to OCH. The perinatal mortality rate is higher at UCH than OCH but the maternal mortality rates follow the reverse. Recommendations are made concerning the reduction in high parity rates and its associated complications.

Knowledge of hepatitis B virus infection, access to screening and vaccination among pregnant women in Ibadan, Nigeria

The knowledge of pregnant women about Hepatitis B virus infection at three different levels of healthcare and their access to screening and vaccination was evaluated by a questionnaire-based cross-sectional study. There were 643 respondents with a mean age of 30.2 ± 5.2 years and mean gestational age of 26.1 ± 8.4 weeks. The distribution of respondents was 55 (8.6%, primary), 204 (31.7%, secondary) and 383 (59.6%, tertiary) women. The majority of respondents were traders (36%) or civil servants/professionals (28.6%). Overall, 76% of all women had inadequate knowledge about hepatitis B infection; 19.5% had been screened, while 9.7% had been vaccinated. There was an increased likelihood of adequate knowledge, previous screening and vaccination among health workers (p = 0.00). Other positive predictors of knowledge and vaccination were tertiary education (p = 0.04) and tertiary care (p = 0.00). There is inadequate knowledge among pregnant women in Ibadan about Hepatitis B infection, with significant differences at the various levels of care, particularly in non-tertiary settings where screening and vaccination is also sub-optimal. Information dissemination, universal screening and vaccination services for pregnant women in Nigeria require urgent consideration.

The influence of westernisation on pain perception in labour among parturients at the university college hospital Ibadan

Summary Pain perception as perceived by the parturient is determined by physical and psychological factors. The interplay of these factors is important to the healthcare professional who will be managing these women in labour. We therefore set out to assess the influence of educational attainment as a proxy for westernisation on pain perception by parturients. This was a cross-sectional study conducted among 765 parturients using a questionnaire with the Box Numerical Scale to assess pain score within 48 h of delivery. We studied women in labour at the University College Hospital Ibadan Nigeria from August 2003 to July 2004. A total of 1,000 consecutive parturients were enrolled into the study but 765 were included in the analysis after excluding women requiring caesarean section. Multiple linear regression with robust estimation of the Standard Error of the Mean (SEM) was utilised. The main outcome studied was the pain score obtained within 48 h of delivery using the Box Numerical Scale (BNS). The pain scores were highest among ethnic groups other than the predominant ethnic group (Yoruba) 9.13 (95% CI 8.13 – 9.33), it was lowest among those with no formal education. Multivariate analysis revealed educational attainment as a significant predictor of BNS. An interaction between age and educational attainment; only women between the ages of 25 – 30 had lower mean pain scores when educated compared with those without formal education −3.56 (95% CI −4.28, −2.87). In conclusion, findings in this study support the hypothesis that westernisation through education tends to increase perception of pain by parturients in this environment.

Vulval carcinoma in pregnancy

Vulval carcinoma has a relatively low incidence worldwide compared to other genital tract tumours. In Nigeria between 1960 and 1966 it constituted 5.85 per cent of the total gynaecological cancers recorded at the Ibadan Registry (Babarinsa et al. 1999). Corresponding reports from Enugu Eastern Nigeria (Megafu 1977) 2.66 per cent Vulval cancer has a consistently low incidence across Africa (Megafu 1977; Doh et al. 1988; Rogo and Orero 1988; Bassett et al. 1992). It is extremely rare to have the condition in pregnancy as most sufferers are either at the end of their reproductive lives or beyond it. This case report represents an unusual occurrence. It also had the unique feature of having the vulvar cancer develop from within a histologically confirmed condylomatous lesion. It also occurred at a much earlier age than is usually reported (Babarinsa et al. 1999). (excerpt)