Female genital mutilation/cutting: Knowledge, practice and experiences of secondary schoolteachers in North Central Nigeria

Background. Despite global efforts at eradicating female genital mutilation/cutting (FGM/C), the act continues to be performed globally. Objective. To determine the experience of schoolteachers about FGM/C and their possible role in contributing to its eradication. Methods. A prospective cross-sectional survey involving secondary schoolteachers from 18 secondary schools in Ilorin, North Central Nigeria, was undertaken during October and November 2014. All consenting participants completed a self-administered questionnaire on FGM/C. Statistical analysis was with SPSS version 20.0 with χ2 and logistic regression; a p-value of <0.05 was considered significant. Results. There were 371 participants (113 males (30.5%) and 258 females (69.5%)). More females than males were aware of FGM/C (205 v. 94; χ2 41.2; p=0.001); 180 women (69.8%) and 81 men (71.7%) wanted awareness and the implications of FGM/C to be taught in schools, while 46 women (17.8%) and 23 men (20.4%) had previously educated students about FGM/C. Also, 109 (42.3%) of the female teachers had been mutilated (mean (standard deviation) age 4.76 (4.86) years), and 49 mutilations (45.0%) had been performed by traditional circumcisers. Of the teachers, 44.0% of men and 24.5% of women had subjected their daughters to FGM/C (p=0.029), mostly for religious reasons. The men initiated the majority of their daughters' mutilations, while the mothers-in-law were the main initiators among the women; 44 (17.0%) women and 23 (20.4%) men held the opinion that females should be circumcised, while the majority considered education and legislation to be the most important interventions to encourage its eradication. Predictors of the likelihood to support discontinuation of FGM/C include awareness of government policy about FGM/C and having a mutilated daughter. Conclusion. Education, reorientation and motivation of teachers will position them as agents for eradicating FGM/C

Role of Risk-Based Approach in the Prevention of Vertical Transmission of Neonatal Sepsis.

AIMS AND OBJECTIVES: Vertical transmission of infections remains a common cause of neonatal morbidity and mortality worldwide. We studied the risk-based approach in preventing the vertical transmission of neonatal sepsis. PATIENTS AND METHODS: A prospective case control study of 154 pregnant women with risk factors for vertical transmission of infections (subjects) and 154 pregnant women without the risk factors (control) at University of Ilorin Teaching Hospital, Ilorin from 1st July to 31st December, 2010. After counseling and consent taking, all participants had active management of labour and all subjects had parenteral intrapartum antibiotic prophylaxis with Ampicillin. There was postnatal evaluation of all babies for signs of neonatal sepsis followed by blood culture and treatment of culture positive babies. The outcome measures were signs and symptoms of neonatal sepsis, neonatal positive blood culture and maternal postpartum morbidity. RESULTS: Neonatal sepsis occurred in 16 babies (subjects=11, control=5); three babies had Early Onset Group B Streptococcal Disease (EOGBSD) (subjects=2, control=1; P=0.501) while 13 had non Group B Streptococcal (GBS) infections (subjects=9, control=4; P=0.113); onset of signs and symptoms was < 24hrs in all cases, incidence of EOGBSD were 12.9/1000 (subjects) and 6.5/1000 (controls). Subjects whose babies had sepsis had multiple risk factors; one dose of antibiotics and antibiotics to delivery interval < 2hours. There was no sepsis in babies of mothers who had adequate antibiotic prophylaxis. There was no maternal or neonatal death but 17.5% of subjects had maternal postpartum morbidities. CONCLUSION: The risk-based approach is a practicable alternative in preventing vertical transmission of neonatal sepsis if antibiotic prophylaxis is adequate before delivery.

Predictors of maternal mortality among critically ill obstetric patients.

AIM: Evaluation of the predictors of maternal mortality among critically ill obstetric patients managed at the intensive care unit (ICU). METHODS: A case control study to evaluate the predictors of maternal mortality among critically ill obstetric patients managed at the intensive care unit (ICU) of the University of Ilorin Teaching Hospital, Ilorin, Nigeria from 1st January 2010 to 30th June 2013. Participants were critically ill obstetric patients who were admitted and managed at the ICU during the study period. Subjects were those who died while controls were age and parity matched survivors. Statistical analysis was with SPSS-20 to determine chi square, Cox-regression and odds ratio; p value < 0.05 was significant. RESULTS: The mean age of subjects and controls were 28.92 ± 5.09 versus 29.44 ± 5.74 (p = 0.736), the level of education was higher among controls (p = 0.048) while more subjects were of low social class (p = 0.321), did not have antenatal care (p = 0.131) and had partners with lower level of education (p = 0.156) compared to controls. The two leading indications for admission among subjects and controls were massive postpartum haemorrhage and severe preeclampsia or eclampsia. The mean duration of admission was higher among controls (3.32 ± 2.46 versus 3.00 ± 2.58; p = 0.656) while the mean cost of ICU care was higher among the subjects (p = 0.472). The statistical significant predictors of maternal deaths were the patient's level of education, Glasgow Coma Scale (GCS) score, oxygen saturation, multiple organ failure at ICU admission and the need for mechanical ventilation or inotrophic drugs after admission. CONCLUSION: The clinical state at ICU admission of the critically ill obstetric patients is the major outcome determinant. Therefore, early recognition of the need for ICU care, adequate pre-ICU admission supportive care and prompt transfer will improve the outcome.

Coagulation profile in severe pre-eclampsia and eclampsia in Ilorin, Nigeria: implications for anaesthetic management in operative obstetrics.

BACKGROUND: Severe preeclampsia and eclampsia are associated with coagulopathy which may be a contraindication to central neural axial blockade for caesarean section. Many investigations of bleeding tendencies are not done in our environment because of logistic reasons and emergency presentations of these patients.The study was designed to determine the coagulation profile of severe preeclamptic and eclamptic women in labour and possibly arrive at affordable and readily available investigation(s) that can be used in excluding bleeding tendencies in these patients. STUDY DESIGN: In a prospective study, 50 severely preeclamptic/eclamptic patients in labour and, 50 parturients with normal pregnancies, and, in labour were recruited. Full blood count including platelet count, prothrombin time (PT) using the International Normalized Ratio (INR) and partial thromboplastin time with kaolin (PTTK) were done in all the patients. RESULTS: Mean platelet count was significantly lower in study patients than in controls, 158.1 × 10(9)/l versus 216.9 × 10(9)/l, p = 0.0001. Mean INR and PTTK were within the reference values for the reagents used but mean INR was significantly greater in cases than in controls, 1.06 ± 0.01 versus 0.92 ± 0.01 (p = 0.001) while PTTK was also significantly longer in cases than in controls, 38.4 ± 0.21 versus 34.3 ± 0.44 seconds (p = 0.002). CONCLUSION: As platelet count can be readily obtained and it is affordable in our environment, it can be used in assessing bleeding tendencies in these patients for their effective management.

Effectiveness of a structured checklist of risk factors in identifying pregnant women at risk of gestational diabetes mellitus: a cross-sectional study.

BACKGROUND: Gestational diabetes mellitus (GDM) is associated with increased risk of mortality and morbidity for pregnant women and newborns. Identifying pregnant women with risk factors for GDM based on the clinical suspicion is a popular approach. However, the effectiveness of the use of a structured checklist of risk factors is yet to be evaluated. This study assessed the effectiveness of a structured checklist of risk factors in identifying pregnant women at risk of GDM at the University College Hospital, Ibadan. MATERIALS AND METHODS: It was a comparative cross-sectional study implemented in two phases. The first phase (Group A) of the study was a prospective study that involved 530 pregnant women who presented at the booking clinic. A structured checklist containing risk factors was used to identify women at the risk of GDM. The second phase (Group B) was a retrospective study of 530 pregnant women managed 2 years previously who were selected by systematic random technique. RESULTS: The mean age, gestational age at booking, gestational age at delivery and birth weight were 30.2 ± 5.2 years, 21 ± 10.8 weeks, 38.7 ± 2.7 weeks and 3.1 ± 0.7 kg respectively. The prevalence of GDM in Group A and B were 4.9% and 1.6% respectively ( P < 0.05). There was about three fold increase in identification of women at risk of GDM by use of a checklist. CONCLUSION: Identification of women at risk of GDM was approximately 3-4 fold higher with the use of checklist of risk factors. Exhaustive clinical identification with a checklist of risk factors for GDM should be encouraged.

Grandmultiparity: evaluating obstetric and neonatal outcomes after eliminating confounders.

AIMS AND OBJECTIVES: The objective was to evaluate obstetric and neonatal outcomes in booked grandmultiparas (para e"5) and compare with outcome in age and social status matched booked multiparas (para 2-4) after eliminating confounders. PATIENTS AND METHODS: A cohort study with grandmultiparas (subjects) and age and social status matched multiparas as controls. All participants were counseled and an informed consent obtained at the antenatal clinic. Maternal demography and history were taken; they were subsequently monitored during pregnancy, labour and immediate puerperium. The main outcome measures were obstetric and neonatal outcomes among subjects and controls. RESULTS: The incidence of grandmultiparity was 4.1%. During antenatal period, grandmultiparas had statistically significantly higher occurrence of late antenatal booking (P=0.0202), anaemia (P=0.0024) and past history of poor perinatal outcome (P=0.0124). Grandmultiparas had statistically significant occurrence of preterm delivery (P=0.0389) and higher but not statistically significant mean duration of labour (P=0.3532), intrapartum complications (P=0.2014) and postpartum haemorrhage (P=0.2126). Neonates of grandmultiparas had statistically significant low first minute Apgar scores (P=0.0011) with higher but not statistically significant occurrence of low birth weight (P=0.1613) and neonatal intensive care admission (P=0.7202). The perinatal mortality rates were 136 and 75 per 1 000 deliveries for grandmultiparas and multiparas. There were no maternal deaths during the study period. CONCLUSION: After controlling for age and social class, booked grandmultiparas had poorer obstetric and neonatal outcome compared to booked multiparas but these were majorly statistically insignificant due to effect of modern antenatal care.

Posterior reversible encephalopathy syndrome in a adult female.

Posterior reversible encephalopathy syndrome is a clinico-neuroradiologic diagnosis, with rapidly evolving neurologic condition, characterized by headache, confusion, altered mental status, seizures, cortical blindness, lethargy, stupor, and occasionally, focal neurological signs accompanied by a typical computed tomography or magnetic resonance imaging pattern. With early recognition and treatment, complete resolution of symptoms occurs. Typical imaging findings characteristically involve the white matter bilaterally in the parieto-occipital regions. Atypical imaging finding of contrast enhancement of lesion can occur, but is less common. A 20-year-old primiparous lady presented with posterior reversible encephalopathy syndrome. To the best of our knowledge, this is the first documented case in Nigeria. This case-report highlights the importance of recognizing the salient imaging features in this lethal but reversible entity with prompt management.

UMBILICAL CORD PARAMETERS IN ILORIN: CORRELATES AND FOETAL OUTCOME.

BACKGROUND: The anthropometric parameters of the umbilical cord have clinical significance. Current parameters of the cord, its correlates and related foetal outcome are lacking in our parturients. OBJECTIVES: To describe the anthropometric parameters and abnormalities of the umbilical cord; and determine their maternal correlates and foetal outcome. DESIGN: A cross sectional analytical study. SETTING: The Obstetric and Gynaecology Department of the Universityof Ilorin Teaching Hospital, between September 2012 and June 2013. SUBJECTS: Healthy pregnant women with singleton pregnancies. RESULTS: Four hundred and twenty-eight (428) singleton deliveries were studied. The respective mean values of the cord length and width were 526.87 ± 115.5mm and 19.56 ± 11.12mm.Short cord (< 40cm) occurred in 7.2% while long cord (> 69cm) was found in 9.3% of the parturient. The incidences of single umbilical artery, cord round the body and knots were 7%, 8.4% and 14.5% respectively. Nuchal cord was the most common (91.4%). Only gestational age had significant statistical relationship with cord length abnormalities (P = 0.0093). The cord length was an important correlate of cord helices, knots and vessels (P < 0.05).Parity had correlations with the number of vessels (R = 0.099, P = 0.042). The cord coiling index was statistically related to the presence of congenital abnormalities (P = 0.011). Other perinatal events were not related to umbilical cord parameters. Perinatal asphyxia was the most common indication for NICU admission (3.5%) but there was no significant statistical difference between NICU admission and cord parameters. CONCLUSION: The umbilical cord parameters in apparently healthy parturients in Ilorin were comparable with others elsewhere. The cord length and helix are important correlates of gestational age and congenital abnormalities. Parity may be related to abnormal umbilical vessels. Cord length, coils, coil index and umbilical vessels should be examined post-natally.

Survival of ovarian cancer patients in Ibadan: clinical and pathological factors.

This retrospective cross-sectional study evaluated the applicability of the universal grading system in a selected patient population and compared the results with the FIGO staging. A total of 49 patients who met the inclusion criteria, were studied. The slides were independently examined by two pathologists, using Silverberg's parameters. The prognostic value of their findings was analysed using Kaplan-Meier graphs. Papillary subtype and abnormal nuclear features were the most frequent histological pattern and a younger age was associated with improved survival. The longest surviving patient (250 weeks) had the lowest mitotic activity, predominantly glandular architecture and little or no nuclear pleomorphism, the reverse is the case for the shortest-term survivor (120 weeks). The universal grading system is useful and comparable with the FIGO staging. The two systems are complementary.

Trends in the use of female sterilisation through minilaparotomy for contraception at a teaching hospital in north central Nigeria.

BACKGROUND: Female sterilisation is the most widely used method of contraception worldwide. However, only a small proportion of contraceptors are reported to rely on female sterilisation in Nigeria. Continuous reviews of trends in its use are necessary to develop policies that will improve uptake in the country. OBJECTIVE: To determine the volume and trends in the use of female sterilisation through minilaparotomy as a method of contraception in a Nigerian university teaching hospital. METHODS: The records of women who had sterilisation through minilaparotomy over a ten year period were reviewed for socialdemographic characteristics, reasons for undergoing sterilisation, timing of the procedure, surgical method used and complications recorded. This is too sketchy RESULTS: Female sterilisation through minilaparotomy accounted for 95 (0.8%) of the 12,035 total contraceptive use during the period. The rate decreased from 1.5% of total contraceptive use in 1995 to 0.22% in 2003. Eighty two (86.4%) of the female sterilisation acceptors were aged 35 years and above, 46 (48.4%) had no or only primary education and 42 (44.2%) were petty traders. Sixty six (69.5%) of the women were grandmultiparae and 70 (73.7%) had more children than they desired. Seventy three (76.8%) had used other contraceptive methods before sterilisation. The average cost of female sterilisation through minilaparotomy in our hospital was USD25 and this was significantly more than the cost of other contraceptives, and more than hospital charges for normal vaginal delivery. CONCLUSION: The proportion of contraceptive acceptors who rely on female sterilisation is low in our environment and has steadily declined over the years. The higher cost of the procedure as compared to other contraceptives appears to be the main barrier. Reduction or outright elimination of cost will probably act as incentive for women to choose female sterilisation as a method of contraception.

Predictors of maternal mortality in institutional deliveries in Nigeria.

BACKGROUND: Maternal mortality in poor countries reflects the under-development in these societies. Global recognition of the burden of maternal mortality and the urgency for a reversal of the trend underpin the Millenium Development Goals (MDGs). OBJECTIVE: To determine risk factors for maternal mortality in institutional births in Nigeria. METHOD: Twenty one health facilities in three states were selected using stratified multi-stage cluster sampling strategy. Information on all delivered mothers and their newborn infants within a three-month period was culled from medical records. RESULTS: A total of 9 208 deliveries were recorded. About one-fifth (20.5%) of women had no antenatal care while 79.5% had at least one antenatal visit during pregnancy. Four-fifths (80.5%) of all deliveries were normal deliveries. Elective and emergency caesarean section rates were 3.1% and 11.5% respectively. There were 79 maternal deaths and 8 526 live births, giving a maternal mortality ratio of 927 maternal deaths per 100 000 live births. No antenatal care, parity, level of education, and mode of delivery were significantly associated with maternal mortality. Low maternal education, high parity, emergency caesarean delivery, and high risk patients risk independently predicted maternal mortality. CONCLUSION: Meeting goal five of the MDGs remains a major challenge in Nigeria. Multi-sectoral approaches and focused political will are needed to revert the high maternal mortality.

Asymptomatic bacteriuria among an obstetric population in Ibadan.

BACKGROUND: Asymptomatic bacteriuria in pregnancy is the major risk factor for symptomatic urinary tract infection during pregnancy. Screening and identification of bacteriuria during pregnancy have been recommended. OBJECTIVE: To determine the prevalence and pattern of asymptomatic bacteriuria associated with pregnancy. METHODS: The study was a descriptive, cross sectional survey of pattern of asymptomatic bacteriuria among consecutive patients presenting for the first antenatal visit at a University College Hospital, during a period of two months. Relevant information obtained from all the patients recruited for the study included age, parity, educational level, gestational age and occupation of participant. Haemoglobin electrophoresis patterns were also retrieved and recorded. Main outcome measures were prevalence of asymptomatic bacteriuria, bacterial isolates and their antibiotic sensitivities. RESULTS: There were 205 eligible participants with a mean age of 30.6 ± 4.3 years and a mean gestational age at booking of 20.9 ±7.0 weeks. The prevalence of asymptomatic bacteriuria was 22(10.7%). The isolated pathogens were predominantly coliforms (Klebsiella and E. coli) accounting for 45.5% and Staphylococcus saprophyticus (27.3%). Only gentamycin, nitrofurantoin and ofloxacin demonstrated high efficacy against these uropathogens with antibiotic sensitivity rates of 72.7%-81.8%. CONCLUSION: Prevalence of asymptomatic bacteriuria in this centre is relatively high. This underscores the need for routine screening of pregnant women for bacteriuria.

Pregnancy outcome of the obese in Ilorin.

BACKGROUND: Obesity is a nutritional disorder that is fast becoming a public health issue in the developing world. It is associated with increased incidence of maternal complications and adverse perinatal outcome. METHODS AND RESULTS: This is a case-control study of obesity in pregnancy carried out in the maternity wing of University of Ilorin Teaching Hospital, Nigeria. The subjects and controls were 156 obese and 80 non-obese women booked at this hospital for antenatal care. The controls were matched for age and parity. Obesity occurred more commonly among the well educated (P = 0.00) and those in social classes I and II (P = 0.00). The occurrence of other medical conditions was not significantly different. The obese women also had more caesarean sections (P = 0.00), more assisted vaginal deliveries (P = 0.00) and fewer spontaneous vaginal deliveries (P = 0.00) than the non-obese parturients. The mean birth weight of infants of the obese mothers was 4.06 ± 0.13 kg (mean±SD) while the mean for the controls was 3.36 ± 0.49 kg. The difference was statistically significant (P = 0.000). Also, the obese parturients had more macrosomic babies (defined as birth weight >4.2 kg) than the non-obese (P = 0.00). The risks of perinatal asphyxia, birth trauma, neonatal admission and low birth weight were not increased among obese women in this study. CONCLUSION: This study suggests that in our community, obesity occurs more commonly among women of high socioeconomic status and is a risk factor for maternal and fetal complications.

Asymptomatic bacteriuria in pregnancy: evaluation of reagent strips in comparison to microbiological culture.

Screening for asymptomatic bacteriuria during pregnancy, the major risk factor for symptomatic urinary tract infection during pregnancy have been recommended. This cross sectional study was conducted to determine prevalence of asymptomatic bacteriuria in Ibadan and evaluate the diagnostic accuracy and relative cost effectiveness of dipstick tests for nitrite and leucocyte esterase in comparison to laboratory culture. Two hundred and five patients, presenting for their first antenatal visit at the University College Hospital, Ibadan, participated in the study. Urine samples obtained from the participants were subjected to two tests; reagent dipstick test for nitrite and leucocyte esterase and routine laboratory culture, which is the gold standard for diagnosis. Main outcome measures were sensitivity, specificity, positive and negative predictive values of the reagent dipstick tests as well as likelihood ratios. The prevalence of asymptomatic bacteriuria in pregnancy with routine laboratory culture and using combined leucocyte esterase and nitrite strip tests were 10.7% and 11.7% respectively. Compared with laboratory culture, combined strip tests had sensitivity, specificity and negative predictive values of 50%, 92.9% and 93.9% respectively, indicating a statistically significant lower level of accuracy (P < 0.05). The corresponding likelihood ratios for positive and negative strip tests (LR+ and LR-) were 7 and 0.5 respectively. The study concludes that combined Leucocyte esterase-nitrite dipstick test is not sufficiently sensitive and specific to be used for routine screening of bacteriuria in pregnancy in place of laboratory culture, though may be more cost effective in low resource settings.

Predictors of asymptomatic bacteriuria among obstetric population in Ibadan.

BACKGROUND: Asymptomatic bacteriuria in pregnancy is the major risk factor for symptomatic urinary tract infection during pregnancy. Screening and identification of bacteriuria during pregnancy have been recommended. The general objective of the study was to determine the pattern as well as possible predictors of asymptomatic bacteriuria at the University College Hospital, Ibadan. METHODS: The study was a descriptive, cross sectional, exploratory survey of the pattern of asymptomatic bacteriuria among all consecutive patients presenting for the first antenatal visit at the University College Hospital, Ibadan during the study period. RESULTS: The prevalence of asymptomatic bacteriuria was 10.7%. Although no statistically significant association was found, the prevalence was higher among women aged between 26 - 35 years (11.5%) and those with only secondary education (14.6%). Other demographic parameters characterized by high rates of bacteriuria were Christian women (12.7% compared to 4.3% among Muslims) and genotypes AS and AC (16.4% and 16.7% respectively). Low parity (para 1-2), 2nd and 3rd trimesters of pregnancy were the identified possible obstetric predictors of bacteriuria in pregnancy. Staphylococcus species constitute the predominant isolates in 3rd trimester and among Muslim pregnant women. CONCLUSION: Since no statistically significant predictors for bacteriuria in pregnancy were found, routine screening of all our pregnant women for this condition in 2nd trimester is recommended.

Utilization of the partograph in primary health care facilities in southwestern Nigeria.

OBJECTIVE: To assess knowledge about the partograph and its utilization among maternity care providers in primary health care in southwestern Nigeria. METHOD: Two hundred and seventy-five maternity care providers comprising of 64 CHEWS (23.3%), 74 Auxiliary midwives (26.9%), 123 Nurses/midwives (44.7%) and 14 medical doctors (5.1%) were interviewed in primary health centres and private hospitals in three states in southwestern Nigeria using a multi-stage sampling strategy. Knowledge about the partograph and assessment of labour were assessed with an interviewer-administered questionnaire. RESULTS: About a quarter of respondents, 75 (27.3%) had received prior training on the partograph. Only 25 (9.1%) reported that the partograpgh was available in their labour wards. Knowledge about the partograph was poor; only 18 (16.0%) of all respondents correctly mentioned at least one component part of the partograph, 21 (7.6%) correctly explained function of the alert line and 30 (10.9%) correctly explained function of the action line. Prior training significantly influenced knowledge about the partograph (gamma2 = 49.2; p < 0.05). Knowledge about assessment of labour was also poor: less than 50% of all respondents knew the normal duration of labour and just about 50% understood assessment for progress of labour. CONCLUSION: The partograpgh is not utilized for labour management in Nigeria. Knowledge about partograph and assessment during labour is grossly deficient. Findings suggest poor quality intrapartum care. Effective interventions to improve labour supervision skills and partograph utilization are urgently required.

Gynaecological morbidities among adolescents in Ibadan.

A descriptive retrospective study, was conducted on adolescent girls (10 to 19 years) at the University College Hospital (UCH), Ibadan to determine the common gynaecological conditions among these group of girls that attended gynaecological clinic of UCH between January 2000 and December 2007. Demographic characteristics including age, sex, occupation, religion, marital status and level of education were extracted from patients' medical records and recorded on a pre-designed data sheet. Presenting complaints and the definitive diagnosis were also recorded. A total of 243 adolescents presented within the study period. The commonest gynaecological complaint was abnormal vaginal discharge (44.4%) while the least was breast lump (1.7%). The commonest gynaecological diagnosis was reproductive tract infection (62.6%), out of which sexually transmitted infections constituted 40%. Infertility (1%) was the least diagnosed condition. Other gynaecological conditions included pregnancy related complications (6.6%), sexual abuse (3.3%), menstrual abnormalities (4.5%) and dysfunctional uterine bleeding (1.7%). Gynaecological complaints were commoner among the older (15 to 19 years) than the younger (10 to 14 years) adolescents (p < 0.01). It was concluded from this study that adolescents experience various forms of gynaecological morbidities, especially reproductive tract infections. We recommend sexual education and counselling for adolescents to help withstand peer pressure in initiating sexual activity. Pregnancy prevention programmes to encourage contraceptive use are imperative.

Prevalence of violence against pregnant women in Ibadan, Nigeria.

Women are at risk of violence at all stages of their life, including during pregnancy. Using a interviewer-administered questionnaire, 306 pregnant women were interviewed in two public secondary health facilities in Ibadan to compare prevalence and risk factors of VAW before and during pregnancy. Prevalence ofVAW a year before current pregnancy was 41.5% compared to 17.7% during pregnancy. Perpetrators before pregnancy were mostly relatives (22%), while during pregnancy, partners (64%). Major reasons for violence were "not obeying instructions" (33.3%) and "misbehaving" (26%). Education (OR 0.49; 95% CI 0.29-0.83) and polygamous union (OR 9.56; 95% CI 3.71-24.63) and consumption of alcohol (OR 7.19; 95% CI 0.04-0.53) were statistically significant a year before pregnancy. Mothers occupation (OR 0.19; 95% CI 1.05-4.49); type of union (OR14.13; 95% CI 6.13-32.59), alcohol consumption by partner (OR 6.06; 95% CI 0.05-0.54); and not wanting pregnancy (OR 3.53; 95% CI 1.20-9.30) were statistically significant in the index pregnancy. Hemorrhage (7.4% vs. 4.8%), abortion (1.9% vs. 1.2%), intrauterine death (3.7% vs. 1.2%) and premature labour (9.3% vs. 3.2%) were more often found in women who experienced VAW than those who did not, the latter was statistically significant (P < 0.05). Violence avoidance strategies included 'playing along' (51.3%) and 'praying' (21%). Pregnancy was protective against VAW. Empowerment of women through education and employment is crucial. Counselling on planning of families is also necessary. Screening for violence in pregnancy and close monitoring of the abused to ensure good obstetric outcome is recommended.

Predictors of Asymptomatic Bacteriuria among Obstetric Population in Ibadan

Asymptomatic bacteriuria in pregnancy is the major risk factor for symptomatic urinary tract infection during pregnancy. Screening and identification of bacteriuria during pregnancy have been recommended.The general objective of the study was to determine the pattern as well as possible predictors of asymptomatic bacteriuria at the University College Hospital; Ibadan. The study was a descriptive; cross sectional; exploratory survey of the pattern of asymptomatic bacteriuria among all consecutive patients presenting for the first antenatal visit at the University College Hospital; Ibadan during the study period. The prevalence of asymptomatic bacteriuria was 10.7. Although no statistically significant association was found; the prevalence was higher among women aged between 26 - 35 years (11.5) and those with only secondary education (14.6). Other demographic parameters characterized by high rates of bacteriuria were Christian women (12.7compared to 4.3among Muslims) and genotypes AS andAC (16.4and 16.7respectively). Low parity (para 1-2); 2 and 3 trimesters of pregnancy were the identified possible obstetric predictors of bacteriuria in pregnancy. Staphylococcus species constitute the predominant isolates in 3 trimester and among Muslim pregnant women. Since no statistically significant predictors for bacteriuria in pregnancy were found; routine screening of all our pregnant women for this condition in 2 trimester is recommended

Menstrual characteristics of secondary school girls in Ibadan, Nigeria.

BACKGROUND: Disturbances of menstrual function are the commonest complaints among adolescents. Disorders of menstruation may have implications for future reproductive health. OBJECTIVE: To assess menstrual patterns among school girls in Ibadan, south-western Nigeria. METHODS: This was cross-sectional descriptive study in which 1,213 apparently healthy school girls were selected by multistage sampling technique in fifteen secondary schools from the five local governments within the metropolis. Information about details of menstrual experience was obtained with a self-administered questionnaire. RESULTS: The girls were aged between 9 and 23 years. Majority of respondents 768 (633%) experienced normal cycle length, 391 (32.2%) had short cycles; and 55 (4.5%) had cycle length greater than 35 days. Prevalence of normal cycles increased with increasing age; abnormalities of cycle length tended to decrease with increasing age (p < 0.01). The majority, 1,152 (95%), had normal menstrual loss. The majority 882 (72.7%) experienced dysmenorrhoea; severe dysmenorrhoea was reported by 154 (12.7%). Cycle length was not associated with presence of dysmenorrhoea (p > 0.05); 695 (57.3%) had symptoms of pre-menstrual syndrome. CONCLUSION: Prevalence of menstrual abnormalities among adolescent schoolgirls is high. More attention should be paid to identify and treat these menstrual morbidities.