Oluwarotimi Akinola

Risk factors for hepatitis B virus infection among pregnant women in Lagos, Nigeria

Objectives. To determine the risk factors for hepatitis B virus infection among pregnant women in Lagos, Nigeria, and the possible implications for hepatitis B prevention in the country. Design. Prospective case control study. Setting. Lagos Island Maternity Hospital. Methods. Between 1 August 2006 and 31 January 2007, risk factors for hepatitis B infection were determined amongst pregnant women using a structured questionnaire. The women were tested for hepatitis B surface antigen (HBsAg) as part of routine antenatal care. Univariate and multivariate analyses were carried out using logistic regression. Main outcome measures. Risk factors for hepatitis B virus infection among pregnant women. Results. Of the 1,052 women attending the antenatal clinic, 6.08% (n = 64) were positive for HBsAg. A total of 61 HBsAg positive and 183 negative controls were interviewed. The significant risk factors for HBV infection were an early age of sexual debut below 19 years (adjusted OR = 2.79; 95% CI = 1.44–5.40; p = 0.0023); history of multiple sexual partners (adjusted OR = 2.02; 95% CI = 1.02–3.98; p = 0.0427); and past history of sexually transmitted infection (adjusted OR = 2.61; 95% CI = 1.15–5.90; p = 0.0214). Of the HBsAg positive women, 45 (73.77%) had at least one of these risk factors while 91 (49.73%) of the controls had at least one risk factor. Conclusion. Screening pregnant for hepatitis B infection on the basis of risk factors may not be effective. Education on modification of lifestyle and sexual behavior as well as non‐selective screening of pregnant women for HBV infection is recommended.

Efficacy of visual inspection of the cervix using acetic acid in cervical cancer screening: A comparison with cervical cytology

Summary Screening programmes for the early detection of premalignant lesions of the cervix are expensive and technically difficult, especially in resource-challenged settings. There is a need for cheaper and equally effective alternative screening methods. This study compared the efficacy of visual inspection of the cervix using acetic acid (VIA) with the Pap smear method. A total of 186 subjects had a Pap smear followed by visual inspection of the cervix using 3 – 5% acetic acid with biopsies taken from suspicious acetowhite positive lesions. Cases of abnormal cytology were recalled for biopsies. A total of 150 subjects were negative for both tests; 30 (16.2%) were positive for VIA, while six were positive for both VIA and Pap smear. VIA detected one lesion missed by Pap smear on biopsy. The sensitivity of VIA was 100%, while that of Pap smear was 85.7%. The negative predictive value of VIA was 100%, while the positive predictive value was 20%. The sensitivity of VIA equals the reported rates for Pap smear. VIA is proposed as a credible alternative to Pap smear in resource-challenged settings.

Emergency peripartum hysterectomy in a tertiary hospital in Lagos, Nigeria: a five-year review

This was a retrospective descriptive study of all the patients who underwent emergency peripartum hysterectomy from January 1st 2003 to December 31st 2007 at the Lagos State University Teaching Hospital. Of the 15,067 deliveries during the study period, 57 patients had emergency peripartum hysterectomy (3.78/1000 deliveries). 19.3% of these patients were booked for antenatal care in the hospital, while 80.7% were unbooked. The mean age of patients was 32.7 years (SD = 5.5) and the mean parity was 3.08 (SD = 1.9). The major indications for emergency peripartum hysterectomy were ruptured uterus (77.2%), uterine atony (10.5%), abruptio placentae (3.5%) and sepsis (3.5%). Subtotal hysterectomy was performed in 96.5% of the cases. The maternal mortality was 19.3% and the perinatal mortality was 75.4%. The incidence of emergency peripartum hysterectomy in this study is high and the major indication is ruptured uterus. It is associated with high maternal and perinatal morbidity and mortality.

Mammography and mammographic screening: are female patients at a teaching hospital in Lagos, Nigeria, aware of these procedures?

PURPOSE To determine the level of awareness of mammography and mammographic screening amongst women in Lagos, Nigeria. MATERIALS AND METHODS A structured questionnaire was administered to 555 consecutively recruited women who visited various clinics at the Lagos State University Teaching Hospital, Ikeja, between January 2009 and June 2009. RESULTS The mean age of respondents was 38.16 ± 9 years, and the majority (59.6%) had a tertiary education. A family history of breast cancer was present in 33 (6.0%) women, less than 20% of whom had undergone mammography. Only 20% of all subjects were aware of the recommendation that they should receive routine mammography and mammographic screenings on an annual or biannual basis, depending on their age, and of the side effects associated with the procedure. The mass media was womens main source of information regarding these procedures. The majority (67.6%) of participants confirmed that they performed breast self-examinations, though less than 5% of them had had their breasts examined by mammography. CONCLUSION This study revealed a rather low level of awareness about mammography and mammographic screening, indicating the need to educate women about the risk of breast cancer and the importance of screening as a tool for the early detection and treatment of this condition.

Active management of third stage of labour: a survey of providers’ knowledge in southwest Nigeria

BackgroundThe disparity between current evidence and practice on active management of third stage of labour (AMTSL) demands assessment of providers’ knowledge on the subject.ObjectiveTo assess the level and determinant(s) of accurate knowledge of obstetric providers regarding AMTSL.MethodsQuestionnaire-based survey of 361 labour and delivery professionals in public tertiary obstetric centres in southwest Nigeria.ResultsFemale nurses at different cadres accounted for most of the respondents. Majority (90.6%) of the respondents reported being aware of AMTSL as an obstetric intervention and 49.7% were aware of FIGO/ICM recommendation on AMTSL. Out of 13 potential third stage interventions, 102 respondents (28.3%) correctly and exclusively identified the components of AMTSL as defined by FIGO/ICM. Many procedures reserved for treatment of complicated third stage of labour such as manual placental removal (37.7%), blood transfusion (20.2%), bimanual uterine compression (24.7%) and uterine artery ligation (13.9%) were also selected as AMTSL components. Multivariate logistic regression analysis indicated that being in administrative position (adjusted OR: 2.68; CI 1.19–6.02) and frequent compared to rare or no consultation of books, journal and internet sources for information (adjusted OR: 2.58; CI 1.21–5.52) increased the odds of having accurate knowledge of AMTSL while being a nurse/midwife (adjusted OR: 0.15; CI 0.05–0.39), matron (adjusted OR: 0.25; CI 0.08–0.79) or intern (adjusted OR: 0.07; CI 0.01–0.29) compared to postgraduate resident doctors reduced the odds of having accurate knowledge of AMTSL.ConclusionAMTSL was a familiar but poorly understood intervention among obstetric care providers in this region. Improvement in healthcare quality and practitioners’ adherence to recommended guidelines on AMTSL urgently requires educational interventions that target those who provide routine delivery care and organisation of the health care delivery system in such a way that enables providers to act on acquired knowledge.

Uterine artery ligation for management of uterine fibroids

To determine the efficacy of uterine artery ligation by the vaginal route for the management of symptomatic uterine fibroids. A pilot study had suggested that the procedure was effective.

Caesarean section – an appraisal of some predictive factors in Lagos Nigeria

BackgroundSeveral maternity units in the developing world lack facilities for caesarean section and often have to transfer patients in extremis. This case controlled study aimed to appraise predictive factors for caesarean section.MethodsOne hundred and fifty two consecutive women with singleton pregnancies who had caesarean section were studied. The next parturient with normal delivery served as control. Variables such as age, parity, marital status, booking status, past obstetric history, weight, height, infant birth weight were assessed. Data obtained were analysed using SPSS 16.0 Windows package.ResultsDuring the study period, there were 641 deliveries with 257 of them by caesarean section (40.1%).Logistic regression analysis showed that parity, booking status, maternal height; maternal weight, birth weight, previous caesarean section and ante-partum bleeding were significant predictive factors for caesarean section while maternal age was not.ConclusionsThese predictive factors should be considered in antenatal counseling to facilitate acceptance by at risk women and early referral.

Evaluation of blood reservation and use for caesarean sections in a tertiary maternity unit in south western Nigeria

BackgroundHaemorrhage from obstetric causes is the most common cause of maternal mortality in the developing world. Prevention of mortality from haemorrhage will necessarily involve prompt blood transfusions among other life saving measures. There are however limited stocks of fresh or stored blood in many health care facilities in Sub Saharan Africa. Caesarean section has been identified as a common indication for blood transfusion in obstetrics practice and its performance is often delayed by non availability of blood in our centre. An evaluation of blood reservation and use at caesarean sections in a tertiary maternity unit in Lagos, south western Nigeria should therefore assist in formulating the most rational blood transfusion policies.MethodsCase records of 327 patients who had elective and emergency caesarian sections at the Lagos State University Teaching Hospital between 1st October and 31st December 2007 were reviewed. Data pertaining to age, parity, booking status, type and indication for Caesarean section, pre- and post-operative packed cell volume, blood loss at surgery, units of blood reserved in the blood bank, unit(s) of blood transfused and duration of hospital stay was extracted and the data analysed.ResultsThere were 1056 deliveries out of which 327 (31%) were by Caesarean section. During the study period, a total of 654 units of blood were reserved in the blood bank and subsequently made available in theatre. Out of this number, only 89 (13.6%) were transfused to 41 patients. Amongst those transfused, twenty-six (54%) were booked and 31 (75.6%) had primary caesarian section. About 81% of those transfused had emergency caesarean section. The most common indication for surgery among those transfused were placenta praevia (9 patients with 21 units of blood) and cephalo-pelvic disproportion (8 patients with 13 units).ConclusionEven though a large number of units of blood was reserved and made available in the theatre at the time of operation, majority of the patients operated did not need blood transfusion. Provision of a mini- blood bank within the obstetric unit and careful patient categorization will ensure timely availability of blood for surgery without necessarily tying down stock in the central blood bank.

Uterine artery ligation for the treatment of fibroids

Objective. To determine the efficacy of bilateral uterine artery ligation in the treatment of symptomatic uterine fibroids. Design. A descriptive study. Setting. Tertiary care gynecological clinic, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria. Sample. Fifty women who had trans‐vaginal bilateral uterine artery ligation for the treatment of uterine fibroids between January 2003 and January 2006. Methods. Pre‐operative baseline ultrasonic measurements of uterine and dominant fibroid volumes were carried out and repeated at two, six, and 12 weeks, then three monthly for a period of three years. Severity of menstrual blood loss, changes in pain symptoms and patients’ satisfaction were also assessed. Main outcome measures. Changes in uterine and fibroid volumes, hemoglobin values, menstrual pain ratings, and patients’ satisfaction ratings. Results. The mean fibroid volume, mean uterine volume, and mean menstrual pain rating showed statistically significant reductions at six, 12, and 36 months. The mean hemoglobin level and patients’ satisfaction rating showed a statistically significant increase after six, 12, and 36 months. Conclusion. Trans‐vaginal bilateral uterine artery ligation is a safe and effective method for the treatment of symptomatic uterine fibroids especially in areas where access to high level medical technology is restricted.

Malaria prevention and treatment in pregnancy: Survey of current practice among private medical practitioners in Lagos, Nigeria

We studied the practice of malaria prevention and treatment in pregnancy of 394 private medical practitioners in Lagos State, Nigeria using a self-administered pre-tested structured questionnaire. Only 39 (9.9%) respondents had correct knowledge of the World Health Organization (WHO) strategies. Malaria prophylaxis in pregnancy was offered by 336 (85.3%), but only 98 (24.9%) had correct knowledge of recommended chemoprophylaxis. Of these, 68 (17.3%) had correct knowledge of first trimester treatment, while only 41 (10.4%) had knowledge of second and third trimester treatment. Only 64 (16.2%) of respondents routinely recommended use of insecticide-treated bed nets. The most common anti-malarial drug prescribed for chemoprophylaxis was pyrimethamine (43.7%); chloroquine was the most common anti-malarial prescribed for both first trimester treatment (81.5%) and second and third trimester treatment (55.3%). The study showed that private medical practitioners have poor knowledge of malaria prophylaxis and treatment in pregnancy, and the practice of most do not conform to recommended guidelines.