Solomon Avidime

Reproductive health in Nigeria.

BACKGROUND Adolescents have special reproductive health needs, but these peculiar needs are often unmet in many cultures and countries. METHODS A cross-sectional study involving adolescents in three secondary schools in a northern Nigerian setting. Demographic characteristics as well as reproductive health issues (adolescent sex, abortion, sexual experience) among the students were surveyed. RESULTS Of the 1070 students that fully participated in the survey, 539 (50.4%) were girls and 531 (49.6%) boys. They were aged 10 - 27 years (median 16 Years). Five hundred forty three (50.7%) were Christians and 499 (46.6%) Muslims. Nine hundred and four (84.5%) of the students knew about abortion. On their view about reasons why adolescents indulge in premarital sex, 574 (53.6%) felt it was to please boyfriend/girlfriend, 391 (36.5%) to experiment with sex, 312 (29.6%) to test fertility and 239 (22.3%) felt it was to stop painful menstruation. One hundred thirty five (12.6%) have had sex and 15 - 19 years age group were more likely to be sexually active. Twelve (1.1%) of the girls had been pregnant once - four times before and all had an abortion. Children of civil servants were significantly more likely to be sexually active compared to other groups of children (p <0.05). All the respondents knew one or more complication of abortion to include inability to get pregnant in future 682 (63.7%), abdominal pain 589 (55%) and painful menstruation 427 (39.9%). CONCLUSION Adolescents are unique in every way including issues of reproductive health. The age at sexual debut in this setting is early. There is a need to include reproductive health education in the curriculum of secondary schools. This should help the adolescents to obtain the correct information from the right source.

Objective structured clinical examination vs traditional clinical examination: An evaluation of students' perception and preference in a Nigerian medical school

Background: Method of testing clinical competence of medical students in this setting has been controversial. This report evaluates the perceptions and preferences of 5th and 6th year medical students about traditional clinical examination (TCE) and objective structured clinical examination (OSCE). Materials and Methods: A cross-sectional study using a structured questionnaire, administered to 156 students, who had been previously exposed to TCE and OSCE. Results: There were 110 (70.5%) males and 46 (29.5%) females, with median age group of 26–30 years. One hundred and thirty-one respondents (84%) felt TCE is more difficult and 20 (12.8%) felt OSCE was more difficult. One hundred and forty-two (91%) felt OSCE was easier to pass, 8 (5.1%) felt TCE was easier to pass and 6 (3.8%) were undecided. Majority of the 5th and 6th year students (95.5% and 100%, respectively) preferred OSCE for assessment. In relation to validity and reliability of OSCE, 124 (79.5%) of all the students felt it provides a true measure of essential clinical skills, 130 (83.3%) felt its scores are standardised, 143 (91.7%) felt it is a practical and useful experience and 135 (86.5%) felt students’ personality, ethnicity and gender will not affect OSCE scores. Overall, there were no significant differences in preference and perceptions between 5th and 6th year students and between males and females. Conclusion: Students preferred OSCE as method of assessing clinical competence and considered it a more valid and reliable method of examination.

Prevalence of Trichomonas vaginalis and HIV co‑infection among asymptomatic pregnant women in Zaria, northern Nigeria

Background: Trichomonas vaginalis infection is the most common curable, sexually transmitted infection worldwide. Serious adverse reproductive health outcomes including pregnancy complications, pelvic inflammatory disease, and an increased risk of human immunodeficiency virus (HIV) acquisition have been linked to T. vaginalis infection. Objective: To determine the prevalence of T. vaginalis in asymptomatic pregnant women and their HIV status in Ahmadu Bello University Teaching Hospital, Zaria, northern Nigeria. Materials and Methods: This was a prospective cross‑sectional descriptive study conducted using a proforma to obtain demographic and reproductive health information from consenting pregnant women attending the antenatal clinic. Vaginal swab and blood samples were taken and analyzed for T. vaginalis and HIV, respectively. Data were analyzed using Statistical Package for Social Science (SPSS) V17, with the level of significance set at 5% . Results: The overall prevalence of T. vaginalis was 19.2%. There was an inverse relationship between the level of education and acquisition of T. vaginalis infection in pregnancy; women having no formal education had a higher prevalence of the T. vaginalis infection (7.5%) as against those who had tertiary education (1.7%). The 26–30 years age group had the highest prevalence of both HIV infection (5.0%) and T. vaginalis infection (5.8%), strongly suggesting the possibility of co‑infection between the two agents. There was a statistically significant association between T. vaginalis infection and HIV infection with a P value of 0.0003. The relative risk (RR) of acquiring HIV in the presence of T. vaginalis infection was 4 (RR: 4.193; Confidence Interval: 1.756–10.01). Conclusion: Improvement of the socioeconomic status and education of women, especially sexual health; will reduce the prevalence of T. vaginalis and HIV co‑infection.

Knowledge and attitude towards child adoption among women in Zaria, northern Nigeria

Background: The success of marriages has largely been premeditated on child bearing in most African society and oftentimes women are at the receiving end of childlessness with possible psychological and physical torture. Objective: To assess the knowledge and attitude of women of reproductive age towards child adoption in Zaria, Northern Nigeria. Methodology: A cross-sectional descriptive study, structured closed and open ended questionnaires was administered to 200 consenting consecutive women aged 15–49years to obtain information on socio-demographic characteristics, reproductive profile, knowledge and attitude towards child adoption. Data was analysed using SPSS V17 with p value set at 0.05. Results: The majority 89.4% of respondents have heard and are aware of child adoption and 77% agreed it is a good practice. The most prevalent source of information is the Mass media in 35.0% of respondents. The female gender is preferred by majority 64.2% of respondent if they will adopt. There is a strong association between numbers of living children and willingness to consider child adoption with P value < 0.05. Conclusion: There is a high level of knowledge and acceptability of child adoption practices in our environment. Child adoption institutions should therefore be supported to meet the need of the infertile couples.

Age at menarche and prevalence of menstrual abnormalities among adolescents in Zaria, northern Nigeria

Background: Nigerian adolescents constitute about 20% of the total population. Problems associated with menstruation affect 75% of adolescent females in both the developing and the developed world. Objectives: The objective of this study is to establish the age at menarche and menstrual abnormalities among adolescents in secondary schools in Zaria. Materials and Methods: A descriptive cross sectional study in which a self-administered pretested, semi-structured questionnaire in english was administered to 535 female secondary school students in Zaria, northern Nigeria. The students were selected from five schools that were chosen by simple random sampling from a list of schools in Zaria metropolis. Information obtained included age at menarche and menstruation related issues. Results: Of the 535 female secondary school students interviewed, 448 (83.7%) were in senior secondary school. The mean age of the respondents was 15.35 ± 1.48 years. The average age at menarche was 12.53 ± 1.33 years. Most respondents, 369 (69.0%) experienced regular menses. The average duration of menstruation was 5.45 ± 1.81 days in 354 (66.2%) of the respondents. Three hundred and forty-four (64.3%) of the respondents had dysmenorrhea, and it was severe in 229 (66.6%) of them. Only, 137 (25.6%) experienced premenstrual symptoms, the most common symptom being breast tenderness in 62 respondents (45.2%). Conclusion: The age at menarche and the menstrual pattern amongst adolescents in Zaria, northern Nigeria is similar to findings from other parts of Nigeria as well as from other parts of the world. Further studies are however needed to explore the full range of menstrual abnormalities that can occur in the adolescent age group.

Pattern of cervical dysplasia among women of reproductive age in Zaria Northern Nigeria.

Background : Cervical cancer is a preventable and the most common female genital tract cancer despite the availability of screening services for precancerous lesions of the cervix. This study aims to determine the prevalence of cervical dysplasia in women of reproductive age in Zaria. Methodology: A prospective study of 131 women of child bearing age attending the family planning and Gynaecology clinics in Ahmadu Bello University Teaching Hospital, Zaria - Nigeria were recruited for the study after obtaining their consent. Cervical samples were collected and subjected to pap staining and cytological examination by a pathologist and classified using the Bethesda System. The data were processed using Statistical Package for the Social Sciences (SPSS) version 17. Bivariate analysis was done and the level of significance was set at a P Results: Cervical dysplasia prevalence of 7.0% was found out of which High Grade Squamous Intraepithelial Lesion (HSIL) was 2.3% (n = 3), Low Grade Squamous Intraepithelial Lesion (LSIL) was 3.1% (n = 4) and Atypical Squamous Cells of Undetermined Significance (ASC-US) was 1.6% (n = 2). There were 13% (n = 17) inflammatory features. Normal cytological features for Pap smear testing was present in 77.1% (n = 101). Conclusion: These findings underscore the importance of routine screening and early treatment of cervical dysplasia in order to reduce morbidity and mortality associated with cervical cancer.

Complete, infected, chronic, nonpuerperal uterine inversion: A case report

Most gynecologists may not encounter a case of nonpuerperal uterine inversion in their practice. We present the case report of a 35-year-old grand multipara who presented with 2 years history of a protrusion per vaginum that was complicated by profuse vaginal bleeding and hemorrhagic shock. A diagnosis of complete infected nonpuerperal uterine inversion was made. The patient was resuscitated with intravenous fluids, blood transfusion, and antibiotic therapy. She had vaginal hysterectomy. Nonpuerperal uterine inversion can pose a diagnostic dilemma to the unwary physician and its management can be challenging.

Prevalence of obesity and outcome of weight loss on reproduction: A study among women attending infertility clinic in Zaria, Northern Nigeria

Objective: Obesity is rising in the developing countries because of changing life style, and this has its burden on fertility and its management. This study determined the prevalence of obesity and clinical correlation of obesity with menstrual abnormalities, as well as the rate of spontaneous conception among obese infertile women on nonsurgical weight loss therapy. Methodology: A cross-sectional longitudinal study was done among women that presented with infertility to the gynecology clinic. The main outcomes measured were percentage of infertile women that are obese, menstrual pattern of these women, and spontaneous conception among obese infertile women following weight loss therapy. Results: Of the 205 patients, 68 (33.2%) were found to be obese; there was a significant association between obesity and abnormal menstrual pattern (P = 0.0002). Oligomenorrhea and hypomenorrhea were also found to be significantly associated with obesity (P = 0.009 and P = 0.022, respectively). Following average of 12-month follow up, spontaneous conception among obese infertile women while on weight loss therapy was 21.1%. Conclusion: The prevalence of obesity was high with a significant association between obesity and menstrual abnormalities. Weight loss among obese infertile women led to improvement in spontaneous conception.

A quantitative survey on potential barriers to the use of modern contraception among married women of high parity attending an antenatal clinic in Kaduna, Northern Nigeria

Background: Nigeria has high maternal mortality ratios, and women of high parity are at higher risk of obstetric complications. Understanding barriers to the uptake of contraception is thus important. Methodology: A cross-sectional quantitative survey was done at the antenatal and postnatal clinics of Barau Dikko Teaching Hospital between September and December 2015. Questionnaires were administered to 400 married consenting women of high parity (five or more deliveries). The questionnaire extracted general and demographic information, history of contraception, and possible barriers to contraceptive uptake. Data were analyzed using Statistical Package for Social Sciences (SPSS) software version 22. Descriptive analysis was done using frequencies, percentages, and cross-tabulation. Chi-square test was used as a test of association where relevant, and P< 0.05 was considered statistically significant. Results: About 353 questionnaires were retrieved; respondents were mainly aged between 30 and 39 years, educated up to secondary level, Hausa and Muslims, and homemakers or traders. Women had a mean parity of 7 deliveries and highest, 15. There was high level of awareness of contraception, adequate spousal communication, and approval but a perception of high risk and side effects with contraceptive use. Conclusion: Fear of side effects was a major barrier to contraceptive use. However, a window of opportunity exists because they would be willing to use contraception in future. Hence, specific and individualized contraceptive counseling and patient selection is needed, as well as further education of women.

Cervical adenoma malignum: Diagnostic dilemma of a rare form of cervical cancer

Adenoma malignum of the cervix is a rare variant of Adenocarcinoma of the uterine cervix. Its overall incidence rate is low. We report a case of a 51-year-old married multipara who presented with a 4-year history of recurrent, heavy, prolonged menstrual flow, postcoital bleeding, and passage of mucoid vaginal discharge. Pelvic examination revealed a bulky, firm, endophytic cervical mass with ulcerative areas. Ultrasonography showed features of multiple uterine fibroids. Cervical smear cytology and histology of cervical punch biopsy did not show evidence of malignancy. The patient subsequently had a total abdominal hysterectomy and bilateral salpingo-oophorectomy for a purportedly benign pathology of the cervix. Diagnosis of cervical adenoma malignum was made from the surgical specimen postoperatively.