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Preconception care (PCC) is a preventive strategy for maternal and perinatal morbidity and mortality. This study aimed to assess the level of awareness and utilisation of PCC services. A descriptive cross-sectional survey was conducted at a teaching hospital. Interviewer-administered questionnaires were used to extract information. A total of 450 participants responded; 44.2% (190/450) were aware, 31.7% (143/450) had good knowledge, while only 10.3% (46/450) received PCC. Health care providers were the main source of information (77.9%). There was statistically significant correlation between awareness and participants' level of education (p < .001) and residence (p < .001), as well as between utilisation and education (p < .001), and information from doctors (p < .001). There was a low level of awareness and poor utilisation of PCC, underpinning the need to scale up health education, establishment of functional PCC clinics and formulation of evidence-based guidelines to improve uptake and pregnancy outcome. Impact statement What is already known on the subject of the paper? PCC has been known in high-income countries as a prevention-based strategy, which aims at improving obstetric outcomes. However, the level of utilisation in low-income countries like Nigeria is either unknown or far too low. What do this study add? This work has provided local data on PCC; clearly indicating that the awareness and utilisation of PCC services in Abakaliki, Nigeria is very low when compared with other regions of the world, and this was influenced by the socio-demographic factors - particularly education and place of residence (for awareness), and level of education and information from health care providers (for utilisation), thus suggesting that enlightenment and improvement in social infrastructures could improve awareness, access and utilisation of PCC. What are the implications for clinical practice and/or further research? The implications of these findings in low resource settings like ours will include introducing interventions to scaling up health education, universal establishment of functional PCC units and formulation of evidence-based guidelines aimed at improving the uptake of PCC and pregnancy outcome. Further research will also be needed in future to assess the impact of such interventions and how to sustain potential benefits. [ABSTRACT FROM AUTHOR]

The maternal mortality ratio (MMR) of Nigeria remains high. This retrospective study aims to suggest evidence-based strategies towards achieving the sustainable development goal target 3.1 at the Obafemi Awolowo University Teaching Hospital (OAUTHC), Nigeria by providing contemporary data on MMR between October 2012 and September 2015. There were 86 maternal deaths and 5243 live births over the triennium, with annual MMRs of 1744, 1622 and 1512/100,000 live births, respectively. Fifty-six (65.2%) were postpartum deaths, while 44 (51.2%) occurred within 12 hours of admission. Using the WHO ICD-10 system, the causes of mortality were pregnancy-related infections; 26 (30.2%), haemorrhage; 20 (23.3%), hypertension; 13 (15.2%) and pregnancies with abortive outcomes; 11 (12.7%). Financial constraints, misdiagnosis and delayed referrals constituted the predominant contributors. The MMR at OAUTHC, Nigeria in the last triennium of the MDG was 'Extremely High'. Improved aseptic techniques, blood transfusion services, antimicrobial sensitivity evaluation, Universal Health Coverage, training-retraining of skilled birth-attendants and effective referral systems are advocated. IMPACT STATEMENT What is already known on the subject of the paper: Nigeria now contributes the largest proportion (19%) of the burden of maternal mortality worldwide, despite constituting just 2% of the global population. Reversing this adverse trend during the sustainable development goal (SDG) period demands effective strategies, which can only be predicated on reliable data at the hospital, regional and national levels.What This Study Adds: This article provides the contemporary maternal mortality data of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria, during the last triennium of the Millennium Development Goal era. The findings from the study revealed that the average maternal mortality ratio (MMR) of the Hospital over the three years was 1640/100,000 live births, and that pregnancy-related infection is now the leading cause of maternal death, followed by obstetric haemorrhage. What the implications are for clinical practice: Improvement in aseptic techniques, evaluation of antimicrobial sensitivity patterns and efficient blood transfusion services, as well as Universal Health Insurance coverage and Skilled Birth Attendants will improve the maternal health indices of the hospital, and ultimately the country during the SDG execution period. [ABSTRACT FROM AUTHOR]

The major causes of maternal death in Nigeria are avoidable and preventable. Many of these deaths occur in the rural health facilities and hospitals which are severely lacking in skilled birth attendants. Of the many strategies that have been developed to reduce avoidable maternal death significantly, increasing the availability of skilled human resources is crucial. The shortage of obstetric specialists, especially in the rural and peripheral health facilities in rural Nigeria where more than 60% of the population resides, has been a major contributing factor to the low number of skilled birth attendants. The increased availability of skilled human resources ensures that all aspects of obstetrics, such as antenatal care, postnatal care and other life-saving interventions, including emergency surgery, is available for women during labour and in the immediate postpartum period. In this paper, we propose a short obstetric-training programme for generalist medical officers to increase the number of skilled birth attendants in both rural and peripheral health facilities in Nigeria. These general practice/family practitioners (GP/FPs) and hospital medical officers (MO), will have designated career structures within the primary and secondary healthcare systems, while the consultant obstetrician and sub-specialists, trained with long postgraduate programmes will function at the urban 'specialists' and in teaching hospitals. [ABSTRACT FROM AUTHOR]

In recent times, long-acting reversible contraceptives (LARC) use among adolescent girls has received a great deal of attention in developed countries. However, in some developing countries like Nigeria, it has received little attention, despite the fact that unwanted pregnancies and unsafe abortions are high among adolescents. This paper presents the findings of a study conducted among 243 adolescent girls aged 10--19 years in 12 secondary schools in Nnewi, Nigeria. Of these, 81 (34.5%%) were sexually active; 42 (17.9%%) have heard of LARC and 25 (10.6%%) have used LARC. The most common source of information about contraception was from friends (47.6%%), while religious (25.7%%) and cultural (21.4%%) beliefs were the most common reasons for non-use of LARC. The acceptability rate for LARCs was high (95.8%%). The authors argue that reproductive health services should focus on the delivery of adequate and accurate information on user-independent contraceptives to improve use among adolescent girls. [ABSTRACT FROM AUTHOR]

Mother-to-child transmission of HIV accounts for 90% of paediatric HIV. The objective of this paper is to assess the outcome of preventing mother-to-child transmission of the human immunodeficiency virus (HIV), using highly active antiretroviral therapy (HAART). All pregnant women booking for antenatal care at the university of Maiduguri teaching hospital received voluntary counselling and testing for HIV. All HIV-positive mothers were placed on HAART for the prevention of mother-to-child transmission of HIV. All exposed babies received single dose nevirapine within 72 h of birth and zidovudine syrup for 6 weeks. The babies were then tested for viral DNA using the polymerase chain reaction (PCR) at 6 and 12 weeks of age. Among 5,461 mothers screened for HIV during the study period, 695 (12.7%) were confirmed HIV-positive. Out of 446 mother–baby pairs followed up to a minimum period of 6 months postpartum, only five (1.1%) babies were HIV-positive. [ABSTRACT FROM AUTHOR]

Over 90% of the children infected with HIV globally were as a result of mother-to-child transmission. With a high prevalence of HIV among women of reproductive age and a high fertility rate in Nigeria, the prevention of mother-to-child transmission of HIV is an important strategy to curb the menace of HIV. This paper examines the value of highly active antiretroviral treatment in the prevention of mother-to-child transmission of HIV. Pregnant women attending the antenatal clinic of the University of Maiduguri Teaching Hospital were offered voluntary counselling and testing for HIV. Seropositive women who fulfilled the criteria for administration of antiretroviral drugs were offered a triple combination of nevirapine, stavudine and lamivudine in pregnancy. Women who did not fulfil the criteria were offered single dose nevirapine in labour. The newborn of all HIV-positive women were offered nevirapine suspension within 72 h of delivery. Overall transmission rate for women who had combination treatment was 9.1% which was lowered to zero level among those that had elective caesarean section and infant formula in addition to the drugs. Those who had single dose nevirapine in labour had a transmission rate of 33.3%. It is recommended that the single dose nevirapine be abandoned in favour of combination treatment. [ABSTRACT FROM AUTHOR]

The incidence of colorectal cancer associated with pregnancy is low. Only 2-6% of all females suffering from colorectal cancer are within the child bearing age (i.e. under 40 years). This paper describes the experience at the Ahmadu Belle University Teaching Hospital, Kaduna, Nigeria, from 1 January 1975 to 31 December 1997. Twenty-five cases of colorectal cancer associated with pregnancy were seen and treated; 15 cases in which colorectal cancer occured de novo in pregnant patients; and 10 cases in which pregnancy(ies) occurred in patients with a previous diagnosis of colorectal cancer. Treatment of the cancer, future pregnancies and their management, and the question of possible prophylactic oophorectomy in selected patients are discussed. [ABSTRACT FROM AUTHOR]

This paper aims to assess the influence of maternal glycaemia and other clinical indices on the birthweight of babies born to Nigerian women resident in Maiduguri. Eighty-four pregnant women (aged, 25.7 0.5 years, mean SE) in the third trimester of pregnancy were recruited for the studies. Blood pressure, weight and height were measured while other social variables were obtained by questionnaire. Fasting and 2-hour blood samples, after 75 g oral glucose load, were collected for plasma glucose measurements. None of the women was a known diabetic while 3.6% were known hypertensives. The mean SE fasting (4.2 0.11 mmol/l) and 2-hour (5.8 0.19 mmol/l) plasma glucose concentrations and the systolic (111 1.20 mmHg) and diastolic (72 0.96 mmHg) blood pressures were normal by WHO criteria. Incidence of macrosomic babies was nil. The birthweight of the babies was not significantly related to either the fasting plasma glucose (r=-0.11, P 0.05) or 2-hour postprandial glucose concentrations (r=-0.09, P 0.05), but was significantly related to the maternal pre-pregnancy bodyweight (r=0.30, P 0.05) and body mass index (BMI) (r=0.31, P 0.05). It is concluded that Nigerian women resident in Maiduguri maintain a normal glucose tolerance during the third trimester of pregnancy. Pre-pregnancy body weight and BMI, and not plasma glycaemia, would seem more important factors associated with the birthweight of babies born in this Nigerian population. [ABSTRACT FROM AUTHOR]

This paper describes the findings in the first 100 women who underwent saline sonohysterosalpingography (SHG) at two privately owned health facilities in Enugu, South East Nigeria. This was a prospective study of the first 100 consecutive women presenting with infertility to the authors at Mbanefo Hospital and Hansa Clinics, both in Enugu, South-East geopolitical zone of Nigeria from 1 May 2005 to 20 January 2006. Saline sonohysterosalpingography was carried out in the standard way in these women. The findings were analysed using simple percentages and means ± SD. The procedure was completed in 98 women, while in two others it was not possible to cannulate the uterine cavity. A total of 61 of the women had normal uterine musculature, 37 had interstitial fibroids and two had sonographic features of adenomyosis. Regarding the endometrial cavity, 93 women had a normal endometrium, four had a submucosal fibroid, one had intrauterine adhesions, while the endometrial cavity could not be assessed in two women who could not be cannulated. No case of submucosal polyp or uterine septa or other congenital uterine anomalies was seen. As assessed sonologically, 77 of the study subjects had bilateral patent tubes, while five had unilateral tubal patency. In one woman, there was uncertainty about tubal patency or blockage; in two women, the tubes could not be assessed because of non-cannulation of the uterine cavity and in 15 women, both tubes were blocked. A total of 74 women had normal ovaries; 15 had polycystic ovaries; five had atrophic ovaries consistent with ovarian failure and six women had ovarian cysts. In 18 women, the findings at sonosalpingography (SSG) were confirmed at laparoscopy in 11 women or laparotomy (two women) or by the fact that the patients became pregnant (five women). In 15 (83.3%) of these 18 women, the findings at SSG and laparotomy/laparoscopy or of the woman becoming pregnant were compatible. SSG is a useful screening test for assessing endometrial, tubal and ovarian factors in infertile Nigerian women, thereby obviating the need for laparoscopy and hysteroscopy in the majority of cases. [ABSTRACT FROM AUTHOR]

Ectopic pregnancies can be very difficult to diagnose at initial admission. This paper reviewed the morbidity and mortality associated with misdiagnosis of ectopic gestation over a 15-year period (1985–99) at Ile-Ife, Nigeria. There were 380 confirmed ectopic pregnancies of 35 857 live births, giving an incidence of 10.5 per 1000 live births. Of the 380 cases, 38 (10%) were misdiagnosed initially at presentation. Mistaken diagnoses include pelvic inflammatory diseases, cholera, acute appendicitis, typhoid enteritis, incomplete septic abortion, uterine fibroid with menorrhagia, malaria, gastroenteritis, peptic ulcer and intestinal obstruction. There were five maternal deaths among the 38 misdiagnosed cases compared to two maternal deaths among the 342 initially correctly diagnosed cases. Significant morbidity included prolonged hospital stay, increased hospital costs and an enterocutaneous fistula. To improve the chances of correct diagnosis at initial admission, accurate menstrual and sexual history should be obtained. Facilities for improved diagnosis such as serum beta HCG and transvaginal ultrasonography should be provided. Colleagues from other specialities should be educated to increase their suspicion of ectopic pregnancy in any woman of childbearing age and perform the appropriate investigations. [ABSTRACT FROM AUTHOR]

The objective of this study is to examine the sexual behaviour of infertile women in Ile-Ife, Nigeria and to elucidate to what extent women seeking treatment for secondary infertility are at risk of sexually transmitted diseases. In a 1-year study period, 236 secondarily infertile women (cases) and 472 pregnant women (controls) were interviewed using detailed open-ended questionnaires. Infertile women were at a significant risk of having multiple sexual partners OR 3·80 (1·97–7·32), reproductive tract infections OR 8·52 (5·08–14·37), early age at first sexual intercourse OR 19·13 (92·45–29·47) and poor condom use OR 4·50 (2·01–9·31) compared to controls (pregnant women). The paper discusses the reasons for the above observations and made recommendations aimed at reducing the infections related infertility in this subregion. [ABSTRACT FROM AUTHOR]

Male involvement in maternal health promotion is paramount to safe motherhood. This study evaluates the perception and participation of male partners in maternity care (MC). A cross-sectional study involving 372 participants was conducted through qualitative (interviews and focus group discussion) and quantitative research methods which assessed knowledge, attitude and perception, between 1 December 2017 and 21 January 2018. The data were analysed with IBM SPSS version 25.0 using descriptive and inferential statistics. The mean age of the participants was 35.9 ± 11.5 years. Four-fifths (80.4%) had a positive attitude towards MC but only 27.2% was actively involved, due to socio-cultural reasons. Knowledge regarding MC was associated with age (p = .023), employment (p = .039) and education (p = .002) - higher among younger-aged professionals with a higher education. Male partners had a positive attitude towards MC but were poorly involved, due to socio-cultural factors. Community health workers and stakeholders should step up community health education with engagement of men to promote their involvement.Impact statementWhat is already known on this subject? The role of men in maternity care (MC) is well defined and found to improve health outcomes in high income countries. However, their level of participation in a low income country, such as Nigeria, is far below expectation.What do the results of this study add? The result of this work has provided scarce community-based local data on male partners' involvement in MC. This study showed that majority of males demonstrated a positive attitude but were poorly involved, due to socio-cultural reasons. It also shown that those with a younger age, professionals and those with a higher education were more knowledgeable about MC. This suggests the need for health workers and key players to step up community health education and engagement of men to promote active involvement in women's health matters.What are the implications of these findings for clinical practice and/or further research? Stakeholders in low resource-settings like Nigeria could introduce interventions to scaling up health education, create the enabling hospital environment to accommodate male partners, actively engage, support and motivate them to be involved in MC. Further research will be required to assess the impact of such interventions and how to sustain potential benefits. [ABSTRACT FROM AUTHOR]

Neonatal mortality remains a major health concern in sub-Saharan Africa. We conducted a cross-sectional, population-based, retrospective analysis of 31,828 births between 2009 and 2013 to explore the relationship between socio-demographic variables and post-caesarean neonatal mortality in Nigeria. We calculated the caesarean section (CS) rates, the odds of having a CS and post-CS neonatal mortality within variable subgroups. The national average CS rate was 2.1%. The CS rate increased with the increasing wealth index, educational attainment, maternal age, higher among urban residents and among those from the Southern part of Nigeria. The odds of experiencing post-CS neonatal mortality was significantly higher in the Northern regions (OR 2.51-3.17) among rural residents (OR 2.63), economically poorer groups (OR 3.68), with no formal education (OR 3.01) and older maternal age groups (OR 1.76-2.0). Efforts to increase the rate and quality of peripartum services delivered to pregnant women are needed among both advantaged and disadvantaged groups.Impact statementWhat is already known on this subject? In sub-Saharan Africa, a caesarean section is a lifesaving procedure for both the women and their unborn babies. The neonatal mortalities that occur following the procedure need to be explored and quantified.What do the results of this study add? Socioeconomic differentials exist in the access to a caesarean section. However, these differentials have a limited influence on neonatal mortality post-caesarean section in Nigeria.What are the implications of these findings for clinical practice and/or further research? While socio-demographic variables influence access to health care services, timeliness and quality of care are factors to be considered in ensuring societies get the benefits of caesarean section as a lifesaving procedure. [ABSTRACT FROM AUTHOR]

Opposition by male partners is one of the barriers to contraceptive use in sub-Saharan Africa. The study aimed at determining the extent of male partner involvement in female contraceptive (FP) choices in Enugu, south-east Nigeria. Questionnaires were administered to 243 consecutive women attendee of family planning clinic, University of Nigeria Teaching Hospital (UNTH), Enugu from January to June, 2012. A total of 137 women made contraceptive decisions jointly with their partners, which gave a male involvement rate of 56.4%. Only respondents’ higher age (≥ 35 years) had significant association with male partner involvement in FP choices (odds ratio (OR) = 2.1; 95% confidence interval: 1.22, 3.51;p= 0.008). Covert contraceptive use rate was 4.9% (12/243). A majority of women attending the FP clinic of UNTH, Enugu involved their partners when making contraceptive choices. Male-partner-targeted family planning programme has the potential to increase uptake of contraception in our environment. [ABSTRACT FROM PUBLISHER]

Substandard newborn care has been identified as a major contributor to the estimated annual 4 million neonatal deaths and 1 million fresh stillbirths. Low-income countries, including Nigeria account for more than 95% of all cases. A cross-sectional comparative study utilising non-participant observation methods was used to study perinatal care at two maternity centres in Lagos, Nigeria. Data on 63 mother-baby pairs were included in the study. Two stillbirths and two early neonatal deaths occurred during the study period, equally divided between the two hospitals. The partograph, a crucial tool for monitoring progress of labour, was in use in 77.4% vs 50% of cases at the two centres. The only interventions utilised for the prevention of hypothermia were drying and covering newborns with towels. Hygiene routines were poor and caring procedures did not demonstrate adequate knowledge related to a newborn's health. An enabling environment and supportive supervision is urgently required. [ABSTRACT FROM AUTHOR]

Studies assessing the various modes of treatment for abortion and its associated complications remain relevant in the generation of data that will aid policy formulation for abortion management. This descriptive cross-sectional study was undertaken to determine the common methods of, together with the complications associated with, abortion treatment among healthcare practitioners in south-eastern Nigeria. There were 230 males and 207 females, with a mean age of 38.23 ++ 10.4 years. General practitioners accounted for 214 (49.0%) respondents; nurses, 161 (36.8%); specialist doctors, 56 (12.8%); resident doctors, 5 (1.1%); and community health officers, 1 (0.02%). As high as 388 (88.8%) of the respondents had treated abortion. Manual vacuum aspiration (MVA), and sharp curettage were the commonest methods of treatment accounting for 36.0% and 34.1%, respectively, while medication treatment was employed by 15.0% of the respondents. Only 41.0% of the respondents had been formally trained on the use of MVA. Some 285 (65.2%) of the respondents recorded complications during abortion treatment and these included incomplete evacuation, 30.2%; haemorrhage, 26.0%; and infection, 22.2%. A significantly higher number of complications occurred following sharp metal curretage compared to MVA, and includes incomplete evacuation, 54 (62.5%) vs 33 (38.0%) ( p < 0.05); and haemorrhage, 32 (43.2%) vs 15 (20.5%) ( p < 0.05). Syncope, 2 (100%) and uterine perforation, 23 (100%) occurred solely from sharp metal curettage. Building capacity of health professionals on the use of MVA, and ensuring the universal access to the equipment will enable safer abortion treatment and reduce maternal morbidity and mortality from abortion-related complications. [ABSTRACT FROM AUTHOR]

Pregnant women managed by us after suture repairs for rupture of the pregnant uterus between 2006 and 2009 in Enugu, South-east Nigeria were reviewed. Five pregnancies were managed during the study period. Four had normal pregnancies. Three booked early in pregnancy and had repeat caesarean deliveries at 36 weeks'' gestation. One booked at another private hospital but had emergency caesarean section at 38 weeks'' gestation. The fourth woman had repeat rupture at 28 weeks'' gestation, suture repair and bilateral tubal ligation. Four healthy babies were discharged home. There was no maternal death. The outcomes of pregnancies after rupture of the pregnant uterus are good. Suture repairs should be the method of choice whenever preservation of future fertility is necessary. The woman and her family must be counselled on the associated risks and the need for hospital delivery by elective caesarean section in the subsequent pregnancies before discharge. [ABSTRACT FROM AUTHOR]

This study aims to determine the impact of free maternal care on the utilisation of the available delivery services and to evaluate the obstetric outcome. All deliveries at ESUTH, Parklane within the 4 months of free maternal care from 1 September to 31 December 2008 were studied and compared with deliveries that took place 4 months before and after the free services. The results were analysed using Epi-info statistical software version 3:2:2. There was an 88%% rise in the number of deliveries with the introduction of free maternal services and a 30%% drop within 4 months of its termination. The maternal mortality ratio (MMR) dropped slightly, but morbidity increased significantly, as well as stillbirth rate (77/1,000 births), especially intrapartum stillbirth. Cost barrier limits women''s access to healthcare in developing countries and must be addressed if we aim to achieve Millennium Development Goals (MDGs) 4 and 5. [ABSTRACT FROM AUTHOR]

Violence against women is embedded in most cultures with pregnancy associated with higher rates. This study assessed the pattern of violence in pregnancy in two maternity centres in Ibadan, Nigeria. This was a cross-sectional study of antenatal clinic attendees, between 1 and 31 March, 2007 at the University College Hospital (UCH) and the Adeoyo Maternity (AMH). By systematic random sampling, 404 women were interviewed. Analysis was done by means, χχ2-test (at 5%% level of significance) and logistic regression. At UCH and AMH, 156 (38.7%%) and 248 (61.3%%) were studied, respectively. The prevalence of abuse was 17.1%% (69 women). The perpetrator was most often an intimate partner (48, 66.1%%). The commonest act of violence was a threat of abuse (23, 33.3%%). The most frequent reason for the abuse was demand for money. Women in polygamous unions ( p == 0.035), attending Adeoyo hospital ( p == 0.00) or with secondary school or less education ( p == 0.004) had higher levels of abuse. Regression analysis revealed women attending AMH were 3.6 times more likely to be abused (95%% CI for OR == 1.69--7.81). Violence is not uncommon in this population. Education and employment may reduce these acts. [ABSTRACT FROM AUTHOR]

Cervical cancer is of public health importance in developing countries. High risk sexual behaviour is a risk factor. This cross-sectional study aimed at establishing the cervical cytology profile of infertile women in Abakaliki, Nigeria. It involved 200 infertility patients and 200 general gynaecological patients. They were interviewed with a structured questionnaire and screened for pre-malignant cervical changes. A total of 28 infertility patients (14.9%%) and 34 general gynaecological patients (17.7%%) had epithelial cell abnormalities. A total of 21 infertility patients had cytology positive for pre-malignant changes, comprising: seven with atypical squamous cells of undetermined significance (ASCUS) (3.7%%); eight with a low-grade squamous intraepithelial lesion (LSIL) (4.3%%); and six with a high-grade intraepithelial lesion (HSIL) (3.2%%). There were 25 general gynaecological patients who had cytology positive for pre-malignant changes, comprising: eight ASCUS (4.2%%); seven LSIL (3.5%%); and ten HSIL (5.2%%). The distribution did not attain statistical significance. Infertility did not increase the risk of development of cervical pre-malignant changes. [ABSTRACT FROM AUTHOR]

Cancer of the cervix is the most common cancer and the leading cause of cancer mortality among women in sub-Saharan Africa. Although a vaccine against human papilloma virus (HPV) is now available, its acceptance among vulnerable women in developing countries islargely unexplored. We studied cervical cancer awareness and HPV vaccine acceptance among 375 female university students in northern Nigeria. A total of 133 participants knew of HPV (35.5%), 202 (53.9%) had heard of cervical carcinoma and 277 (74.0%) were willing to accept HPV vaccination. After adjusting for potential confounders, age (adjusted odds ratio (AOR) = 2.3, 95% confidence interval (CI), 1.47-6.53); medical education (AOR = 3.4, 95% CI, 1.74-6.93); HPV knowledge (AOR = 1.8, 95% CI, 1.38-5.41) and awareness of cervical cancer (AOR = 2.3, 95% CI, 1.52-5.06) were significant predictors of readiness to accept HPV vaccine. Public health education and appropriate communication strategies should be implemented in advance of large scale vaccine introduction to increase awareness and prevent misconceptions about the HPV vaccine. [ABSTRACT FROM AUTHOR]

The study was done to determine obstetricians' attitude to and factors predicting obstetricians' acceptance of caesarean delivery on maternal request in Nigeria. Nigerian obstetricians were asked to respond to case scenarios depicting caesarean delivery on maternal request without medical indications and the reasons for their responses. The case scenarios were designed from previously published reasons for caesarean delivery on maternal request from Nigeria. Multiple logistic regressions analysis was done to determine factors predicting obstetricians' acceptance of caesarean delivery on maternal request out of respect for maternal autonomy. The majority (53.1%) of the respondents would accept caesarean delivery on maternal request out of respect for maternal autonomy. Caesarean requests backed up by social mitigating circumstances of previous childlessness and previous negative labour experience received significantly higher acceptances than requests with no back-up mitigating circumstances ( p < 0.0001). A good proportion (48.8%) of Nigerian obstetricians had performed at least one caesarean on maternal request. Obstetricians' bio-professional characteristics do not influence their attitude to request caesarean delivery on maternal request. Some obstetricians expressed fear of legal consequences from caesarean delivery on maternal request. [ABSTRACT FROM AUTHOR]

The objective of this study is to document the anaesthetic preference of pregnant women in two tertiary institutions in North-eastern Nigeria. This was a cross-sectional study of pregnant women seen at the antenatal clinics of the university of Maiduguri teaching hospital and Federal Medical Centre, Yola, from August to October 2009. A total of 254 women were interviewed. They were aged 18-43 with a mean of 28.56 ± 5.602 years. The parity ranged from 1-9 with a mean of 2.71 ± 1.956. Most (178, 70.1%) respondents preferred general anaesthesia and the commonest reason for the preference was various forms of fear 128 (71.9 %). The commonest reason for preference for regional anaesthesia was to watch the procedure live 50 (65.8%). Age (χ2 = 52.364, p = 0.000), education (χ2 = 8.780, p = 0.032), occupation (χ2 = 18.555, p = 0.002) and religion (χ2 = 4.936, p = 0.026) were significantly associated with preference for general anaesthesia. Only age ( p = 0.000, OR 8.17, CI = 0.000-1.00) retained significance after multivariate analysis. Considering the fact that the global trend is towards regional anaesthesia due to lower morbidity and mortality, the high preference for general anaesthesia in our survey is worrisome. Health education during antenatal clinics should highlight the superiority of regional over general anaesthesia for caesarean delivery. [ABSTRACT FROM AUTHOR]

The aim of maternal calcium homeostasis is to provide adequate calcium flux across the placenta during pregnancy and into breast milk during lactation, to ensure normal fetal and neonatal skeletal mineralisation. The objective of this study was to document the characteristics and outcome of patients who had postpartum hypocalcaemia. Cases of symptomatic postpartum hypocalcaemia managed over a 10-year period (1 January 1998 to 31 December 2007) at the University of Maiduguri Teaching Hospital, were retrospectively reviewed. A total of 34 cases were identified. The sociodemographic characteristics, corrected calcium level, duration of treatment, mode of delivery and the packed cell volume (PCV) were analysed using the EPI-INFO Version 3.4.3 statistical package. The mean age and parity were 24.29 ± 5.88 and 3.39 ± 2.32, respectively. All the patients presented with carpopedal spasm with or without associated symptoms. There was a direct relationship ( R2 linear = 0.292, p = 0.001) between PCV and serum calcium. Multiparous women were significantly more affected than primiparae (χ2 = 15.08; p = 0.0005). Half of the patients presented within 1 week of onset of symptoms. In conclusion, the association between anaemia and postpartum hypocalcaemia needs further study to determine the cause and effect relationship. [ABSTRACT FROM AUTHOR]

Achieving a successful vaginal birth after a previous caesarean section (VBAC) is an important strategy in reducing the rising rate of caesarean section and its associated morbidities. Records of 188 women attempting trial of vaginal delivery after a previous lower segment caesarean section were reviewed to predict factors favouring successful vaginal delivery. Of the 188 women, 64 had recurrent indications for caesarean section, while 124 had non-recurrent indications. The group with recurrent indications for previous caesarean section had less vaginal delivery and more repeat caesarean sections as compared with the group with non-recurrent indications (21.9% and 78.1% vs 46.8% and 53.2%, respectively, p = 0.01). Cephalopelvic disproportion was more frequent in the group with recurrent indications (65.6% vs 27.4%, p < 0.0001). Significant predictors of successful VBAC in this cohort of women were non-recurrent indications for the previous caesarean section ( p < 0.001, odds ratio (95% CI) 0.32 (0.2–0.6)) and a previous vaginal delivery ( p < 0.0001, odds ratio (95% CI) 3.90 (2.1–7.4)). A previous vaginal delivery and a non-recurrent indication for the previous caesarean section are important predictors of VBAC in this cohort of women. [ABSTRACT FROM AUTHOR]

A retrospective study was conducted at a Nigerian tertiary hospital to assess the quality of emergency care provided to women managed for a ruptured uterus over an 11-year period. There were 76 cases of ruptured uterus and 4,770 deliveries (1.6%) during the period. Ten women died from a ruptured uterus, giving a case fatality rate of 13.2%. The mean admission–assessment interval by a senior clinician was 48.4 min. The mean decision–laparotomy interval was 6.9 h. Deviations from management protocol were noted in 66 women (86.8%) and underlying reasons were classified as patient-orientated (59.2%), medical personnel (13.2%) and administrative (22.4%) problems. Among women who died, there were more administrative problems, intraoperative and total blood losses were significantly more and preoperative haematocrit was significantly less compared with survivors. The poor quality of care for ruptured uterus in this centre is attributable to patients' financial limitations, which is compounded by administrative problems, particularly those regarding inefficient blood transfusion services. This study demonstrates the urgent need for implementation of a national health insurance scheme at this centre and reiterates the feasibility of employing detailed enquiry of peripartal circumstances to identify specific problems underlying major causes of maternal morbidity and mortality. [ABSTRACT FROM AUTHOR]

Some pregnant women do book concurrently with multiple antenatal care providers. Structured questionnaires were administered to women attending antenatal clinics in 12 facilities in Enugu, Nigeria. A total of 535 women responded: 372 (69.5%) were booked into more than one facility and 163 (30.5%) were booked into a single facility; 280 (52.3%) booked into the two Teaching Hospitals and 91 (12.5%) booked with a traditional birth attendant. Reasons for multiple bookings included selecting a facility with affordable prices (43.9%); selecting a facility promising vaginal delivery (35.3%); avoiding HIV testing (17.9%); avoiding caesarean section (10.8%); avoiding being regarded as unbooked (10.1%) and booking into a facility where they were not known. Possible disadvantages were confusion in deciding where to deliver (53.1%); default on expert advice (27.5%); mismanagement (18.7%); delays, complications and death (12.5%). Multiple bookings were common in this study. Disadvantages of this practice, including risk of death, were identified by the women. [ABSTRACT FROM AUTHOR]

The objective of this study is to determine the oral health habits, awareness, oral health education and treatment needs among pregnant women who attend the antenatal clinics at the University of Calabar Teaching Hospital, Calabar, Nigeria. A total of 252 women at different stages of pregnancy responded to an interviewer-administered structured questionnaire. Of those, 238 (94.4%) of the respondents used toothbrush and toothpaste for oral cleaning, while 12 (4.8%) used a combination of toothbrush/toothpaste and local chewing sticks. Two (0.8%) adhered to the use of chewing sticks only. A total of 34 (13.5%) respondents were aware of and used dental services while pregnant; 18 (52.9%) of those who presented with dental complaints during pregnancy had bleeding gums. Based on the level of awareness of the need to attend a dental clinic during pregnancy (26.2%) and the percentage of respondents willing to have a dental examination during pregnancy (83.3%), it is recommended that oral health education be incorporated into the antenatal counselling of pregnant women in Nigeria. [ABSTRACT FROM AUTHOR]

A prospective survey of symphysiofundal height (SFH) was undertaken in 202 Nigerian pregnant women in Uromi, Edo State, Nigeria, with the objective of constructing an SFH growth chart for the pregnant population in the community. A customised gravidogram and a growth velocity curve were also constructed and compared with those derived in other regions of the world. The average SFH growth rate between 20 and 40 weeks was 0.8 cm/week. The gradient of the curve was not constant and the SFH growth rate changed with the progression of pregnancy. While the average SFH growth rate between 20 and 36 weeks was 0.9 cm/week, from 36 to 40 weeks there was a marked deceleration to 0.3 cm/week. The average deviation from the mean SFH was 1.96 cm. It is recommended that regional customised gravidograms be derived for different pregnant populations which should be reviewed periodically. With this, routine SFH assessments can help in early detection of fetal growth rate anomalies based on an understanding of the peculiarities of fetal growth patterns in each community. [ABSTRACT FROM AUTHOR]

The objective of this study was to determine the knowledge, attitude and practice of private medical practitioners in Enugu, South-eastern Nigeria, on abortion and post-abortion care. It was a cross-sectional study of private medical practitioners in the study area using self-administered structured questionnaires. The results showed that 32.3% of the doctors terminate unwanted pregnancies when requested to do so. The majority of them (51.6%) use D&C in combination with manual vacuum aspiration for the termination of pregnancies in the first trimester. A total of 61 (63.5%) respondents offered various types of post-abortal care (PAC) services, while 42 (43.8%) of them screened women with abortion complications for sexually transmitted infections. For the doctors who do not terminate unwanted pregnancies, their main reasons were religious and moral considerations rather than obedience to the Nigerian abortion laws. We conclude that the majority of private medical practitioners in Enugu, South-eastern Nigeria, do not terminate unwanted pregnancies because of their religious beliefs. [ABSTRACT FROM AUTHOR]

Summary: This study evaluated malaria care-seeking behaviour, as well as the prevalence of parasitaemia and anaemia among pregnant women attending antenatal clinics of two tertiary healthcare facilities in Edo State, Nigeria. Malaria was highly prevalent in the study group (20% by microscopy and estimated 25% by PCR), but parasitaemia and incidence decreased with increasing number of pregnancies. Although the level of education of the study participants was relatively high, antimalarial control measures during pregnancy were found to be poorly utilised by the women and malaria care-seeking was often delayed. A minority of the interviewed pregnant women said they had received sulphadoxine/pyrimethamine-based intermittent preventive therapy (IPT) during current pregnancy. Moreover, the use of inferior antimalaria treatment (e.g. chloroquine) was frequent. The majority of the pregnant women, mainly primigravidae, were anaemic. Efforts to improve antimalaria healthcare must be intensified, targeting pregnant women, particularly the primigravidae and secundigravidae and the healthcare providers. [ABSTRACT FROM AUTHOR]

Summary: Most of the adverse effects of malaria in pregnancy on the fetus are usually as a consequence of placental malaria (PM). This study was conducted with the objective of determining the prevalence, risk factors and pregnancy outcome of PM. A cross-sectional study of 437 pregnant women who delivered at the UMTH, Maiduguri was conducted between 24 July 2007 and 12 January 2008. Placental histology was done for the malaria parasite. Maternal packed cell volume was done and thick blood films were studied for the malaria parasite in maternal peripheral blood and the cord blood/heel prick of their babies. The prevalence of PM was 33.9% (148/437). It is associated with non-usage of intermittent preventive treatment of malaria in pregnancy (IPT) and maternal HIV infection. PM in turn predisposes to low birth weight and cord parasitaemia. Only 2.8% of the women were sleeping under insecticide-treated nets (ITNs). The high prevalence of PM calls for renewed efforts for preventive measures, particularly the routine use of IPT and ITN during the antenatal period. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Summary: This questionnaire survey explored the sexual practices and problems of 184 HIV-positive individuals in two tertiary health institutions in south-east Nigeria over a 6 month period. It showed that many (56.5%) HIV-positive individuals continue to be sexually active and almost half (47.6%) of them do not know the sero-status of their partners. About 60% (n = 62) of sexually active respondents use condoms with 27.9% using them consistently, 31.7% inconsistently, while 40.4% engage in unprotected intercourse. Condom use was more among the male than the female respondents (p < 0.05) and the married or divorced couples than the unmarried (p > 0.05). Diagnosis of HIV resulted in increased abstinence (37.3%) due to loss of interest in sex and/or loss of partner. Almost half (49%) of the respondents had sexually related problems in the form of lack of sexual desire (82.4%), erectile dysfunction (25.5%) and ejaculatory problems (5.9%). These problems are more in the first 6 months of HIV diagnosis and are probably psychological. There is a need for continued discussion on safe sexual practices with HIV-positive individuals during the course of routine clinical consultation. [ABSTRACT FROM AUTHOR]

Summary: Inadequate vitamin B12 status in a pregnant woman increases the risk for adverse maternal and fetal outcomes. The use of serum vitamin B12 concentration alone to assess vitamin B12 status in pregnant women is unreliable because of the decrease in serum vitamin B12 levels in normal pregnancy. The combination of serum vitamin B12 and methylmalonic acid (MMA) concentrations may provide a better estimate of vitamin B12 status. We obtained blood samples from 98 pregnant women in the third trimester at an antenatal clinic in Jos, Nigeria. All subjects were taking iron and folate supplements. Twelve of the subjects had a serum vitamin B12 concentration <148 pmol/l and 18 subjects had a serum MMA level >271 nmol/l. Using a combination of low serum vitamin B12 and elevated MMA concentrations, eight subjects were classified as having subclinical vitamin B12 deficiency. Because of the potential harmful consequences of vitamin B12 deficiency in pregnant women, it would be advisable to add vitamin B12 supplements to the existing regimen of folate and iron supplements currently provided to pregnant women in Nigeria. [ABSTRACT FROM AUTHOR]

The objective was to determine the awareness and practice of preconception care in a developing country. This is a cross-sectional study of women receiving antenatal care at the University of Nigeria Teaching Hospital and Enugu state university teaching hospital (ESUT) between October 2005 and March 2006. Sampling was systematic where every consenting second of two pregnant women receiving antenatal care at the hospital was mobilised for the study. Data analysis was by descriptive and inferential statistics using statistical package for social sciences (SPSS) software version 11 (SPSS Inc. 2001). A total of 1,500 questionnaires were distributed while 1,331 were completed and returned giving a response rate of 88.7%. The mean age was 30.0 + 5.0 years. Of these, 573 (43.1%) women had heard of preconception care. The respondent's awareness of preconception care and their ability to define the subject correctly increase significantly with their educational status and parity. However, there was a difference between knowledge and behaviour. The practice of preconception care was not affected significantly by the parity of the patients. The majority believed that preconception care might improve the health of mother and child. The practice of preconception care is almost non-existent in developing countries. It is important that all stake holders in maternal and child health be involved in vigorous, targeted and sustained female education to improve knowledge and utilisation of preconception care by women of reproductive age groups in developing countries. Health institutions in these underserved populations should develop, and maintain functional dedicated and multidisciplinary clinics for preconception care to decrease perinatal and maternal mortality. Preconception clinics are more important in developing countries such as Nigeria compared with the western world because they would help correct inadequate education and identify a high level of existing illness relevant to pregnancy - much higher than in the western world. [ABSTRACT FROM AUTHOR]

Gender-based violence, though deeply entrenched in some cultures and religions, has remained a neglected area in health research in South-east Nigeria. This study assessed the prevalence, pattern and background factors precipitating domestic violence in a population of prenatal clinic attendees. This was a cross-sectional questionnaire-based study. Booked antenatal women were recruited into the study after informed consent. Trained research assistants administered the questionnaires in the local dialects of the women. Analysis was by the Epi Info Statistical Software package version 3.2.2 of 2005. A total of 500 women were involved in the study that spanned 3 months. Of these, 68 were exposed to gender-based violence. Verbal abuse/insult was the commonest form of male engendered violence. Others were sexual abuse, financial deprivation, threats and physical harm. Financial and domestic issues were the major sources of disagreements. Some 17.6% sustained physical injury, while all admitted to some degree of psychological trauma. Routine assessment in a non-judgemental way of antenatal population for gender-based violence is advocated. This will determine the true prevalence and pattern of domestic violence, and form a rational basis for the formulation of interventional strategies. [ABSTRACT FROM AUTHOR]

All cases of obstructed labour seen and managed at the University of Nigeria Teaching Hospital, Enugu, Nigeria, between January 1999 and December 2004 were identified from the Accident and Emergency department records, labour ward and obstetric theatre records. There were 4,521 deliveries during the study period and 120 (2.7%) of these were complicated by obstructed labour. Of the 120 women, 68 (56.7%) were nullipara. A total of 41 women (34.2%) were booked, 70 (58.3%) unbooked, and 9 (7.5%) booked elsewhere. Most women were in occupational social class V. The cause of obstruction was cephalopelvic disproportion in 68 women (56.6%). The most common intervention was a lower segment caesarean section. Perinatal mortality was 30%. There were four maternal deaths (3.3%). Obstructed labour remains a major public health problem in Nigeria contributing significantly to perinatal mortality and maternal morbidity and mortality. [ABSTRACT FROM AUTHOR]

This study was aimed at finding the attitude of Nigerian women to contraceptive use by their male partners. A total of 417 women received the questionnaire; 71% of these were sexually active and 34.8% were not aware of any male contraceptive method. Only 1.7% reported regular use of condoms by their spouses, however this was significantly higher if the women were better educated. Most of the women had a positive attitude to contraceptive use by their spouses, as 54% (225/417) of them showed preference to male dependant contraceptives in their relationship. However, only 32.3% (135/417) of the women had ever-requested their spouse to use a condom and in just 18.5% (25/135) was such a request regularly complied with. Significantly more Muslim women prefer their partners to use a contraceptive rather than themselves (p = 0.001), but the condom usage by their spouses is significantly lower than their Christian counterparts (p = 0.000). There is a need to offer counselling on male contraceptives to both genders so that they can make an informed choice, especially with the dual protection offered by the use of condoms. [ABSTRACT FROM AUTHOR]

Twin pregnancy is associated with an increased risk of pre-term deliveries, perinatal morbidity, mortality and maternal complications, especially in developing countries. A descriptive study of all women who had twin pregnancies in a rural mission tertiary hospital over a 7-year period was undertaken. There were a total of 3,351 deliveries and 99 cases of twin deliveries during the study period giving an incidence of 29.5/1,000 or one in 33.8 deliveries. Some 60% of the twins were delivered by caesarean section, while 36.4% had vaginal delivery. A total of 4% had vacuum delivery and a combination of vacuum and caesarean delivery. Twinning rate increased with increasing age and parity. The majority of the patients were unbooked (65.7%). The study could not detect any differences in the birth weights of twin 1 compared to twin 2. There were more females (52%) than males (48%). Low birth weight babies constituted 57.1% of twins. There were 26 perinatal deaths giving rise to a perinatal mortality rate of 131/1,000 and there was no difference in the perinatal mortality rate in the unbooked (131/1,000) and the booked (132/1,000). ). Booking status had no significant effect on perinatal mortality of twins and singletons, p value = 0.65. Singletons had significantly more caesarean section and vaginal delivery than twins, p value < 0.0001. Prematurity was the chief cause of perinatal death (65.4%). The most common mode of presentation was cephalic/cephalic (58.6%), followed by cephalic/breech (29.2%), breech/cephalic (7.1%) and breech/breech (5.1%). There was no maternal death. [ABSTRACT FROM AUTHOR]

This study evaluated the rate and factors influencing male uptake of infertility investigations. Infertility constituted 11.2% of all new gynaecological consultations in the centre during the study period. A total of 61 (70.1%) males consented to seminal fluid studies without much hesitation, 12.4% after much persuasion, while the remainder (17.5%) refused. Obliging doctor's recommendation was the primary motivation for those who willingly had seminal fluid studies while the claim to be healthy and not being responsible for infertility were the commonest barriers for reluctance or refusal to be investigated. Fears of exposure of semen so obtained to witchcraft and rituals were also contributory. Gynaecologists working in rural South-east Nigeria should through systematic public enlightenment dispel misconceptions of necessary medical intervention. [ABSTRACT FROM AUTHOR]

The benefits of elective caesarean section (ELCS) for the prevention of mother-to-child transmission (PMTCT) of HIV are now well known. However, the benefits of such a procedure must be weighed against the risks involved. This study examines the risks of ELCS for PMTCT at the University of Maiduguri Teaching Hospital, Maiduguri, Nigeria, from January-December 2006 inclusive. A total of 52 HIV-positive mothers who opted for ELCS for PMTCT were prospectively followed-up for any intra- and postoperative complication. A total of 52 cases of ELCS of HIV-negative mothers during the same period of study were used as controls. The HIV-positive mothers were found to be younger and of lower parity than the uninfected women. Unlike the uninfected mothers, they did not have co-morbid conditions, such as diabetes mellitus and severe pregnancy induced hypertension. There was no significant difference in intra- and postoperative morbidities between the two groups of mothers. The fetal outcome in terms of Apgar scores and birth weight was significantly better among the HIV-infected women. It is recommended that HIV-infected mothers in this environment should be offered the option of ELCS for the purpose of prevention of HIV from mother to child. [ABSTRACT FROM AUTHOR]

We set out to assess menopausal symptoms and the adaptability to them in a Nigerian population. This was a cross-sectional survey using a self-administered questionnaire and supplemented with focus group discussion carried out on a rural postmenopausal population in South-east Nigeria. Data were analysed using the epi Info version 3.3.2. Data from 186 were analysed. The mean age of women at the time of interview was 49.6±6.3 years. Mean and median ages at menopause were 45.47±5.5 years and 47 years, respectively. The major symptoms at menopause were: hot flushes 36 (58.1%), sweating 25 (40.3%), urinary frequency 24 (38.7%), vaginal dryness, discomfort or discharge 22 (35.5%), lack of concentration 17 (27.4%) and irritability 15 (24.2%). Widowhood and the empty nest syndrome but not educational attainment imparted negatively on the ability of the women to cope with the menopausal symptoms. Menopausal symptoms are a health concern to the Christian population in South-east Nigeria. Doctors working in this environment should utilise the opportunity of clinical consultation to raise and discuss these symptoms with postmenopausal women. [ABSTRACT FROM AUTHOR]

This is a retrospective case-control study of 62 HIV-positive women and 100 HIV-negative controls who delivered in the University of Nigeria Teaching Hospital, Enugu, from 2 August, 2002 to 31 March, 2004. The HIV-positive women were relatively younger and of lower mean parity than the HIV-negative controls. They were also significantly more likely to have positive syphilis serology, higher mean duration of labour, perineal tear, puerperal sepsis and higher mean duration of hospital stay, higher prevalence of low birth weight, birth asphyxia and more admissions to the Newborn Special Care Unit than the controls (p < 0.05). However, there was no significant difference in the two groups in the prevalence of hepatitis B surface antigenaemia, recurrent vulvovaginitis, abortions, stillbirths, congenital anomalies, pre-term delivery, mean interval between rupture of membranes and delivery and mode of delivery (p > 0.05). All (100%) the HIV-negative and 96.8% of the seropositive women had voluntary counselling and testing (VCT). There was no maternal death in either group. Untreated maternal HIV infection is associated with adverse pregnancy outcomes in the form of increased maternal and fetal morbidities. Hence for optimal outcomes, prevention of mother-to-child transmission (PMTCT) programmes must incorporate combination drug treatment for the mother as early in pregnancy as possible. [ABSTRACT FROM AUTHOR]

A cross-sectional survey was carried out at two tertiary health institutions in south-east Nigeria from 1 January 2005 to 31 March 2005 to determine the factors associated with domestic violence (DV). The study group comprised of 600 consecutive men seen at the General Outpatient department of the two hospitals during the study period. More than two-thirds (70%) of respondents reported abuse in their family, with 92% (n = 385) of the victims being female partners and the remaining 8% (n = 35) male. DV was significantly associated with lower social class, alcohol consumption, increasing age disparity between couples and spouse unemployment (p < 0.05). The male victims of DV are associated with financial disparity in favour of the female, influential in-laws, educated women and couples within the same age group. The most common form of abuse was shouting at partner (93%), slapping or pushing (77%) and punching or kicking (46%). A total of 348 (83%) respondents reported physical abuse. Only one-fifth (21%) of the abuse occurred during pregnancy and financial constraints was the major reason. There was gross under-reporting (8.1%) of DV because of cultural factors, embarrassment and the repercussions that follow such reports. [ABSTRACT FROM AUTHOR]

A prospective study on the maternal deaths in public and private health facilities in Ogun State was undertaken for a period of 9 months (November 2003 – July 2004). While data were collected from all of the primary, the secondary and tertiary health facilities, it could only be collected from 123 (18.6%) of the private health facilities in the state. Of the 20,831 live births during the period, 37 maternal deaths occurred giving a maternal mortality ratio of 177.6 deaths per 100,000 live births. Some 84% of maternal deaths were not registered for delivery in the health facilities they delivered. The maternal mortality ratio is comparable with previously reported data for South-West Nigeria. A total of 81% of the deaths were due to three main causes: haemorrhage, eclampsia and infection. The maternal mortality ratio was almost three-fold greater in women above the age of 35 years. There is therefore a need to enhance activities to reduce maternal mortality. Private health facilities registration must be tied to sending data to authorised government departments. There is also a need to capture childbirth and attendant complications and death occurring outside orthodox health facilities. [ABSTRACT FROM AUTHOR]

In order to assess the current level of maternal mortality in health institutions with comprehensive emergency obstetric care in Enugu State, South Eastern Nigeria, a retrospective analysis of maternal deaths for the years 1999–2003 was carried out to establish the maternal mortality ratios in the eligible health institutions. Each maternal death was studied in detail to establish the socio-demographic characteristics of the women who died; their referral sources, type of delay (if any), medical causes of death and their preventability. In-depth interviews of the service providers were carried out to throw more light on the maternal mortality situation in the state. Five out of seven eligible health institutions were studied. Within the 5-year period (1999 – 2003), there were 141 maternal deaths and 18,257 live births giving a maternal mortality ratio of 772 maternal deaths per 100,000. The folders of 89 out of the 141 women who died were retrieved. Of these 89 maternal deaths, 51.7% of them were unemployed, 52.4% were referred from private hospitals; type 3 delay was the commonest type of delay encountered in the care of the women. Referral delay was the main cause of delay accounting for 46.4% of all cases of type 3 delay. The leading causes of maternal deaths among the women were obstetric haemorrhage (19.1%), sepsis (18.0%), prolonged obstructed labour/ruptured uterus (16.9%) and pre-eclampsia/eclampsia (16.9%). The in-depth interviews corroborated the high maternal mortality ratio recorded and the type 3 delays in tackling obstetric emergencies. It also showed some discrepancies between reality and the health providers' perception of the magnitude of maternal mortality situation in the state. It was concluded that in health institutions in Enugu State with comprehensive emergency obstetric care facilities, the maternal mortality ratio remains high due to type 3 delays. Most of the referrals come from private hospitals, hence the need to retrain the private practitioners in emergency obstetric care. [ABSTRACT FROM AUTHOR]

AbstractIn almost all societies in the world there is an increase in sexual activity among young persons (10?–?24 years). There is a need for contraceptive use among them to prevent high risk unintended pregnancies.This study was carried out to determine the contraceptive prevalence among young women in Nigeria. The study population was 832 young women between the ages of 15 and 24 years.Only 11.1% of the respondents had ever used contraceptives although 63.2% of them had had sexual intercourse. Contraceptive usage was significantly higher (p?

The adolescent maternal mortality ratio is high in Jos, north-central Nigeria. The main causes of maternal deaths among the adolescents were unsafe abortion, eclampsia and sepsis. The Hausa/Fulani ethnic group constituted the largest ethnic group of adolescent maternal deaths in our study. The risk factors for adolescent maternal mortality found in our study were illiteracy, non-utilisation of antenatal services and Hausa/Fulani ethnic group. [ABSTRACT FROM AUTHOR]

We sought to determine the magnitude and spatio-temporal pattern of maternal morbidity in Kano State, Nigeria. Analysis was on deliveries within the period 1990 - 1999. We counted 59 772 maternal complications among 171 621 deliveries, yielding an overall maternal morbidity ratio of 34.8%. We observed yearly variations and increment in the number of complications among mothers ( p  = 0.04). A total of 4154 maternal deaths were registered within the period. The level of maternal deaths correlated significantly with burden of morbidity ( r  = 0.44; p  = 0.0008). Case fatality rate was 6.9% with temporal fluctuations, and wide variations among the various health institutions. Our study revealed an extremely high morbidity ratio, which indicates that a high proportion of pregnant mothers are in need of essential obstetric care in this population. [ABSTRACT FROM AUTHOR]