Gender attitude to the empowerment of women: an independent right to contraceptive acceptance, choice and practice.

Multiple factors influence the acceptance, choice and utilisation of contraceptive. The objective of the study is to identify individual attitude towards the empowerment of women to an independent right to accept, choose and utilise a contraceptive method of their choice without recourse to their male partners. This is a cross sectional study of men and women of different socio-cultural background working or utilising the services of the Federal Medical Centre Gombe, Nigeria. There were 554 respondents. Only 187 (34.4%) respondents thought that all women, irrespective of marital status, should have an independent right to contraceptive acceptance, choice and practice. Significantly more men (85.4%) than women (61.8%) rejected that women should have an independent right to contraceptive acceptance, choice and practice. Majority of both gender favoured male influence in the acceptance and choice of method of contraception. Our study has re-echoed the importance of male involvement in contraception decision-making.

Myomectomy at the Federal Medical Centre Gombe.

BACKGROUND: The need to conserve the uterus, against all odds even when child bearing is complete makes conservative management of uterine fibroids quite appealing in our environment. Our objective is to document the prevalence, demographic characteristics and the outcome of patients who had myomectomy METHODOLOGY: All cases of myomectomy performed at the Federal Medical Centre Gombe between 1st January 2002 and 31st December 2004 were retrospectively reviewed. Only cases of histologically confirmed fibromyomata were included in the study. Fourty three (43) out of the 45 retrieved cases met the criteria for inclusion in the study. The age, parity Marital status, clinical presentation, and outcome were analysed using the EPI-INFO Version 6.0 statistical package. RESULTS: There were 51 cases of myomectomy out of 581 major gynaecological surgeries giving an incidence of myomectomy of 8.8% for the period under study. The majority of the patients, 30 (69.8%) were aged between 30 and 39 years and 40 (93.0%) were of low parity. The commonest indication for myomectomy was infertility 18, (41.9%), followed by menorrhagia 12, (27.9%). The uterine size at presentation was greater than twelve weeks gestation size in 33, (76.7%) of the cases. Wound infection 6, (14%) was the commonest morbidity followed bypyrexia 3, (7%). About 10(23.3%) were single while 33 (76.7%) were married. Forty (93%) of the fibroids were located in the body of the uterus while 3 (7%) were cervical in location. Most 28 (65.1%) of the skin incisions were Pfannenstiel while 15 (34.9%) had midline subumbilical skin incision. Only 7 (16.3%) of the patients had blood transfusion. Of the 18 patients who complained of infertility, 6 (33%) had conceived. CONCLUSION: Two thirds of the patients in this study presented with uterine masses greater than twelve week size, suggesting some delay in presentation. Liberal pelvic examination for women at risk of uterine fibroids may lead to early detection with consequent reduction in morbidity.

Anaemia in pregnancy at booking in Gombe, North-eastern Nigeria.

Anaemia in pregnancy is an important reproductive health problem associated with increased maternal and perinatal morbidity and mortality. This study was undertaken to determine the prevalence of anaemia in pregnancy at booking in Gombe, North-eastern Nigeria. A cross-sectional study of 461 women attending the antenatal clinic was carried out. Anaemia in pregnancy was defined as a packed cell volume (PCV) of <30%. The capillary technique was used for the estimation of the PCV. The biosocial characteristics (age, parity and social class); and gestational age at booking were obtained and analysed. Of the 461 pregnant women studied, 239 were anaemic, a prevalence of anaemia at booking of 51.8%. The majority of these patients, 67.4%, were mildly anaemic, 30.5% were moderately anaemic while only 2.1% had severe anaemia. Most, 316 (68.5%) of the women booked in the second trimester while only 3.0% booked in the first trimester. There was no relationship between parity and anaemia in pregnancy in this study The majority of the women, 293 (63.5%) were in the lower social class. Because the majority of the anaemic gravidae are in the low social class, provision of haematinics at little or no cost will go a long way towards reducing the high prevalence of anaemia in pregnancy. In the long run, educational and economic empowerment of the women is the key to reducing the overall prevalence of anaemia to the barest minimum.

Attitude of Nigerian women to contraceptive use by men.

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.

Risk factors for obstetric fistulae in north-eastern Nigeria.

This prospective comparative study of obstetric fistulae (OF) was aimed at identifying risk factors. A total of 80 obstetric fistulae treated at the gynaecological unit of the FMCG, and 80 inpatients without fistulae recruited randomly as controls formed the basis of this study. Through interview and case record review, information on age, parity and marital status was collected. Other features were educational status, occupation and booking status of the pregnancy that might have led to this condition. The duration of labour, place of birth and mode of delivery, including its outcome were also collected. The data were analysed using the Epi Info. The majority of the patients were Hausa/Fulani 87.5%, Muslims 91.2%, with large vesicovaginal fistulae (average size 5.0 cm) mainly resulting from obstructed labour (93.7%). Major risk factors included early age at first marriage (average 14 years), short stature (average height 146.2 cm) and illiteracy (96.3%). Also low social class and lack of gainful employment were factors. Failure to book for antenatal care (93.7%), and rural place of residence (95%) were also factors associated with acquiring the fistulae. Living far away (>3 km) from a health facility also contributed or predisposed to the development of an obstetric fistula. Social violence and stigma associated with the fistulae included divorce, being ostracised as a social outcast, and lack of assistance from relations in terms of finding and funding treatment. This study supports improved access to basic essential obstetric care, family planning services, and timely referral when and where necessary. Universal education will provide a long-term solution by improving the standard of living and quality of life. Especially important are media- and community-based programmes on the ills of teenage marriage and child pregnancy using cultural and religiously-based values to give sound advice. In a male dominated society, reaching out to men with traditionally palatable messages that will change their attitude and practices to taking responsibility in reproductive health could be a winning strategy.

Heterotopic pregnancy in a natural conception cycle. A case report.

We report a case of combined intrauterine and tubal pregnancy in a 32 year old para. The patient presented at the Gynaecological emergency unit, with lower abdominal pain, and vaginal bleeding. A pelvic scan confirmed an intrauterine pregnancy. While being managed as a case of threatened abortion, her condition deteriorated and the likelihood of an ectopic pregnancy was entertained. A repeat scan revealed significant peritoneal collection. suggestive of haemoperitoneum, and laparotomy confirmed heterotopic pregnancy. She had a right salpingectomy without complications. The patient had a supervised antenatal care and safe delivery of the intrauterine pregnancy.

The analysis of eclamptic morbidity and mortality in the Specialist Hospital Gombe, Nigeria.

A retrospective review of 302 cases of eclampsia treated at the Specialist Hospital Gombe (SHG), between January 1st 1997 and December 31st 1999 is presented. Intrapartum eclampsia was the commonest presentation, occurring in 166 (55.0%) patients. Headache, blurred vision, and epigastric pain preceded the first episode of seizure in 272 (90.0%) of the cases. The diastolic blood pressure of 110 mmHg or more was recorded in 102 (33.8%) of the study group. Eclampsia was more common among teenage mothers 202 (66.9%), and primigravidae 222 (73.5%). Spontaneous vaginal delivery occurred in 159 (52.6%) of the patients. Caesarean section was performed in 122 (40.4%) of the cases. Pyrexia was the commonest morbidity. There were 35 maternal deaths giving a case fatality rate of 11.6%. There were 111 (36.8%) perinatal deaths during the study period. Expanded sections in mass media education of the general populace and counselling young women on care during pregnancies are suggested. The provision and use of life-saving treatment is paramount, at the same time efforts towards eliminating the conditions that created the unbooked emergencies are crucial.

Obstructed labour: a public health problem in Gombe, Gombe State, Nigeria.

This study reviewed retrospectively the cases of obstructed labour as seen at the specialist Gombe Hospital (SHG), Gombe State, over a period of 5 years. The incidence of obstructed labour was 4.0%. There was a progressive decline in the time trend over the study period. About 80.3% of the patients were unbooked emergencies and 99.5% of them had been in labour elsewhere before presenting at the hospital. The leading cause of obstructed labour was cephalopelvic disproportion (83.0%). Caesarean section (72.2%) was the most common method of delivery. Puerperal sepsis was the most frequent morbidity. However, the longest duration of hospital stay was as a result of a bedsore. The maternal mortality for cases of obstructed labour was 7605/100,000 and the perinatal mortality was 628/1000 births. The study aims to reinstate public interest in this health problem and offers suggestions on how to curb this human tragedy.