Effects of an educational intervention on Nigerian midwives' intention to provide planned home birth care.

BACKGROUND: The majority of women in Sokoto, Nigeria prefer homebirths, but midwives are reluctant to provide care in the home setting. As such, many women continue to give birth at home alone or assisted by untrained attendants, which is associated with an increased risk for maternal and neonatal morbidity and mortality. METHODS: A randomized controlled trial was conducted among 226 midwives from 10 health care facilities. The intervention group received an educational program on home birth. A validated questionnaire that evaluated knowledge, attitudes, norms, perceived control, and intention to provide planned home birth care was given at baseline, immediately after the intervention, and at three-months follow-up. Data were analyzed using linear mixed-effect model statistics. RESULTS: Following the intervention, the intervention group demonstrated higher knowledge and more positive attitudes, norms, perceived control, and intention to provide planned home birth care compared with the control group (P < 0.05). No significant changes in the scores of the control group were observed during the study duration (P > 0.05). DISCUSSION: Educating midwives on planned home birth increases their willingness to provide planned home birth care. Health system administrators, policymakers, and researchers may use similar interventions to promote skilled home birth attendance by midwives. Increasing the number of midwives who are willing to attend planned home births provides women at low risk for medical complications with safer options for labor, delivery, and postpartum care.

Assessment of health-related quality of life of vesicovaginal fistula patients attending a repair center in Northwest Nigeria.

Introduction: Vesicovaginal fistula (VVF) has devastating effects on a woman's hygiene, self-esteem, interpersonal relationships, and environment disrupting all elements of her health. Despite VVF being a persistent condition, very few researches have been conducted in Nigeria to determine the quality of life (QoL) of these patients. This study was carried out with the aim of assessing the QoL of VVF patients receiving care in a repair center in Sokoto, Northwest Nigeria. Materials and Methods: This was cross-sectional study conducted at a VVF repair center in Sokoto. Study population comprised of patients who had undergone VVF repair at the health facility. The total number of study participants present at the facility was 81, and all were recruited into the study. The study assessed socio-demographics and QoL of the respondents. Data obtained were entered into IBM software package and subsequently analyzed. Level of significance was set at 5%. Results: The environmental domain had the highest mean score of 51.7 ± 11.8 while psychological domain had the least score of 41.3 ± 14.3. The mean overall QoL and general health were 49.5 ± 10.2. There was a moderate positive correlation between physical domain score and Age, (r = 0.258, P < 0.005). There was also a positive correlation between psychological domain score and Husband's educational status (rpb = 0.241, P < 0.05). Social relationship domain score positively correlated with being married (rpb = 0.414, P < 0.01). Conclusion: Older study participants had higher mean scores for physical and psychological domains, while younger study participants had higher overall QoL and general health scores compared with older study participants. Future research should compare the pre and postoperative QoL of women who undergo repair of obstetric fistula.

RésuméIntroduction: La stula vésico-vaginale (VVF) a des effets dévastateurs sur l'hygiène, l'estime de soi, les relations interpersonnelles et l'environnement d'une femme, perturbant tous les éléments de sa santé. Bien que la FVV soit une maladie persistante, très peu de recherches ont été menées au Nigéria pour déterminer la qualité de vie (QoL) de ces patients. Cette étude a été réalisée dans le but d'évaluer la qualité de vie des patients VVF recevant des soins dans un centre de réparation à Sokoto, au nord-ouest du Nigeria. Matériaux et méthodes: Il s'agissait d'une étude transversale menée dans un centre de réparation VVF à Sokoto. Population de l'étude composée de patients ayant subi une réparation VVF dans l'établissement de santé. Le nombre total de participants à l'étude présents dans l'établissement était de 81, et tous ont été recrutés dans l'étude. L'étude a évalué les caractéristiques sociodémographiques et la qualité de vie des répondants. Les données obtenues ont été saisies dans le progiciel IBM et ensuite analysées. Le niveau de signification a été fixé à 5%. Résultats: Le domaine environnemental avait le score moyen le plus élevé de 51,7 ± 11,8 tandis que le domaine psychologique avait le score le moins élevé de 41,3 ± 14,3. La qualité de vie globale moyenne et l'état de santé général étaient de 49,5 ± 10,2. Il y avait une corrélation positive modérée entre le score du domaine physique et l'âge (r = 0,258, p <0,005). Il y avait également une corrélation positive entre le score du domaine psychologique et le niveau de scolarité du mari (rpb = 0,241, p <0,05). Le score du domaine des relations sociales est positivement corrélé au mariage (rpb = 0,414, p <0,01). Conclusion: Les participants plus âgés à l'étude avaient des scores moyens plus élevés pour les domaines physique et psychologique, tandis que les participants plus jeunes à l'étude avaient des scores globaux de qualité de vie et de santé générale plus élevés que les participants plus âgés. Les recherches futures devraient comparer la qualité de vie pré et postopératoire des femmes qui subissent une réparation de la fistule obstétricale.

Psychometric Properties of a Theory of Planned Behavior Questionnaire for Assessing the Midwives' Intention to Provide Planned Home Birth Services in Nigeria.

We developed and psychometrically tested a Theory of Planned Behavior (TPB) questionnaire which focused on assessing the midwives' intention to provide planned home birth (PHB) services. This is a quantitative, cross-sectional survey, conducted among 226 midwives working in ten participating health facilities. The reliability and validity of the theoretical constructs were assessed. The Cronbach's alpha values were >0.8 for all scales, suggesting satisfactory internal consistency. Confirmatory factor analysis revealed sufficient convergent validity (the average variance extracted was >0.5 for each construct) and discriminant validity. The study gathered an evidence of the usefulness of TPB in the specific context of PHB.

Awareness and perception of preconception care among women in Usmanu Danfodiyo University Teaching Hospital Sokoto, North-Western Nigeria.

BACKGROUND: Preconception care is an interventions aim to identify and modify biomedical, behavioral and social risks to pregnancy through prevention and management, emphasizing factors that must be acted upon before conception or in early pregnancy to have maximal impact. OBJECTIVE: The aim of the study is to assess awareness and perception of preconception care among women. METHOD: A cross-sectional study conducted at UDUTH Sokoto, Nigeria, from 5 February to 1 March, 2018. A total of 131 women were recruited by simple random sampling technique via the ante-natal care clinic, using semi-structured interviewer questionnaires. Data were analyzed using SPSS version 24 and the results were presented in tables and charts. A P value of <0.05 was considered statistically significant. RESULTS: There ages ranged between 16 years to 46 years and 32.8% (43/131) were within 26-30 years with a mean of 28.10 ± 6.064. Only 20.61% of them were aware of preconception care. There was significant association between awareness and the patient's tribe as well as employment status at P value 0.004 and 0.017 respectively. Among those who were unaware, 88.46% will accept if offered while, about 45.75% of those who declined believed it was not necessary. CONCLUSION: There was poor awareness but good perception and acceptability of preconception care. Therefore, there is a need to create awareness and incorporate it into routine maternal healthcare services to achieve better feto-maternal outcome.

Successful pregnancy following acquired gynatresia.

Acquired gynatresia is a common gynecological condition in developing countries where puerperal complications and unskilled interventions prevail. A 23-year-old primipara who had spontaneous vaginal delivery complicated by gynatresia had vaginoplasty that failed due to erectile dysfunction in the spouse. She subsequently developed secondary amenorrhea and was relieved with dilatation and evacuation. She was planned for definitive surgery, however,she incidentally conceived with q pin-hole vagina. She was delivered of a live fetus at term via an elective cesarean section. This case is peculiar as spontaneous conception occurred with a pinhole opening. There is a need to adequately evaluate cases before definitive management to maximize success.

Résumé Acquis Gynatrésie est une condition gynécologique commune dans les pays en développement où les complications puerpérale et les interventions non qualifiées Prévaloir. Un primipares de 23 ans qui avait la livraison vaginale spontanée compliquée par Gynatrésie avait vaginoplastie qui a échoué en raison de l'érection dysfonctionnement chez le conjoint. Elle a par la suite développé une aménorrhée secondaire et a été soulagée par la dilatation et l'évacuation. Elle a été travaillé pour défi nitive chirurgie quand elle accidentellement conçu avec une cavité vaginale sténopé et a été livré d'un fœtus vivant à terme à travers césarienne élective. Ce cas est particulier que la conception spontanée a eu lieu avec une ouverture sténopé. Il est nécessaire de Evaluer les cas avant la gestion défi nitive pour maximiser le succès.

Predictors of midwives' intention to provide planned home birth services to low-risk women: A theory of planned behaviour approach.

OBJECTIVE: Planned home birth may increase women's access to skilled midwives in all settings. Using theory to understand and predict midwives' intention regarding planned home birth services is rare. Therefore, using the theory of planned behaviour, we determined the factors associated with midwives' intention to provide planned home birth services to low-risk women. DESIGN: This cross-sectional study adopted a quantitative approach and a survey. Stratified random sampling was used to recruit 226 midwives in Sokoto, Nigeria. Data-including descriptive statistic and multiple linear regression analyses-were analysed using SPSS 23 and significant was set at 0.05. SETTING: Ten public health facilities in Sokoto, northwestern Nigeria. PARTICIPANTS: Among all 460 midwives (women aged 20-60 years), working in the maternity wards of health facilities in Sokoto, a sample of 226 midwives was calculated using a power of 0.80 and a 95% confidence interval. FINDINGS: The multiple linear regression analyses confirmed that the major factors associated with midwives' intention to provide planned home birth services were midwives' attitude towards planned home birth (p < .001) and midwives' previous experience with planned home birth practice (p = .008). CONCLUSIONS AND IMPLICATIONS: The theory of planned behaviour is a useful framework for identifying factors that affect midwives' intention to provide planned home birth services. While future research may employ a qualitative approach to explore other factors, planned home birth education campaigns should target information that enhances positive attitude and encourages midwives to provide planned home birth services.

Prevalence and pattern of sexual assault in Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria.

INTRODUCTION: Sexual violence is an important public health problem of growing concern all over the world. This study was conducted to determine the prevalence and pattern of sexual assault managed in Usmanu Danfodiyo University Teaching Hospital Sokoto, Nigeria. METHODS: It was a retrospective study that looked into cases of sexual assault admitted into the hospital between January 2010 and December 2014. Information on patients' biodata, and relevant details on the cases were extracted from the patients' case files and analyzed. RESULTS: Out of the 5317 gynecological admissions during the period under study, 45 (0.84%) were cases of sexual assault. Of these, only 34 case files were available for data extraction. The patients' ages ranged from 2 to 37 years (mean = 12.6 + 8.3). About two thirds (61.8%) of those affected were young children (aged 12 years and below). In majority of cases (70.6%) the assault was penetrative, and in most of the cases (91.2%) only a single assailant was involved. In close to two thirds of cases, the assailant was either an acquaintance (38.2%) or a family member (20.6%). Although law enforcement agents were informed in majority (58.8%) of cases, arrests were made in less than half (41.2%). CONCLUSION: Although the prevalence of sexual assault in this study appears to be low, a major cause for concern is the fact that those affected were predominantly young children. Parents should be more vigilant in monitoring their children's movement, and stringent laws should be enacted and enforced to curb this heinous act.

Kidd blood group phenotypes among pregnant women in Sokoto, North Western Nigeria.

OBJECTIVE: To investigate the prevalence of Kidd antigens among pregnant women in Sokoto, North Western Nigeria. METHODS: One hundred and sixty two pregnant women aged 18-45 years [mean age (27.19±4.72) years] attending antenatal clinic in Usmanu Danfodiyo University Teaching Hospital, Sokoto, were screened for the presence of Kidd blood group antigens using the conventional tube method and anti-Jka and Jkb reagents (Lorne Laboratories, UK). RESULTS: Out of the 162 pregnant women tested, 82 (50.6%) were Hausa, 26 (16%) were Igbo, 23 (14.2%) were Fulani and 20 (12.3%) were Yoruba while the minority ethnic groups were 11 (6.8%). The distribution of Kidd antigen was compared based on the ethnic groups of subjects. Jka antigen was the highest among the Yoruba ethnic group (10.0%) followed by the Hausa ethnic group (7.31%). The prevalence of Jkb was highest among Hausa subjects (10.97%) followed by the Yoruba ethnic group (10.0%). Subjects were categorized based on parity. Majority of the subjects were multigravidae, 122 (75.3%) compared to primigravidae 40 (24.7%). Subjects were stratified based on trimester. A significant number of women were in the second trimester, 111 (68.5%) compared to the third trimester 38 (23.5%) and the first 13 (8.0%). The distribution of Kidd antigens among subjects studied indicated a prevalence of Jka, Jkb and Jk(a+b+) with 8 (4.9%), 13 (8.0%) and 0 (0.0%), respectively. A significant number of subject tested were negative for Kidd antigens. Of the 162 pregnant women tested, 154 (95.1%), 149 (75.3%) and 141 (87.04%) tested were negative for Jka, Jkb, and Jk(a-b-), respectively. CONCLUSIONS: This study indicates that blood group antigens can be distributed differently within different nationalities. Kidd phenotypes observed among pregnant women in this study was similar to previous reports among blacks but at variance with report among Caucasians and Asians. We recommend that detailed routine phenotyping for all clinically significant red cell antigen including Kidd antigen being carried out routinely among all pregnant women in Nigeria. There is also the need to routinely screen all pregnant women for alloantibodies to facilitate the selection of antigen negative units for those with clinically significant alloantibodies who require a red cell transfusion. This can potentially optimise the obstetric management of haemolytic disease of foetus and newborn and prevent haemolytic transfusion reaction among pregnant women.