The contribution of privately owned hospitals in the provision of essential obstetric care in Nigeria.

OBJECTIVE: To highlight the private sector contribution in the provision of essential obstetric care in Abia State, Southeastern Nigeria. METHOD: Following two workshops a structured questionnaire was used to seek information on the type of facility, ownership, type of services, number of staff, instruments and medical consumables, deliveries and data on clients attended to in the previous twelve months. On the basis of the response the facilities were classified into not essential obstetric care, basic essential obstetric care and comprehensive essential obstetric care. RESULTS: Of 638 facilities visited only 378 offered antenatal and postnatal services. The 13 government hospitals and 173 primary health centers conducted 5601 deliveries. The 146 private hospitals/clinics and 46 maternity homes conducted 21,128 deliveries. Only 121 offered essential obstetric services: 42 basic with 2488 deliveries and 79 comprehensive with 14,489 deliveries. Of the basic essential obstetric facilities that were private, 84.6% were concentrated in the 6 urban local government areas (LGA) leaving 15.4% in the 11 rural LGA. Similarly 85.6% of the comprehensive essential obstetric facilities that were private are concentrated in the 6 urban LGA leaving 14.4% scattered in the 11 rural LGA CONCLUSION: The private sector, with its greater essential obstetric facilities, is concentrated mainly in the 6 urban LGA. This resulted in 14,970 deliveries as against 2007 deliveries in the government facilities. Although there is an apparent neglect of the other 11 LGA, the deliveries in the private facilities constituted over 79% within the study period. This greater contribution should be noted and considered when planning maternal and infant mortality and morbidity reforms in Nigeria.

Incidence of pelvic organ prolapse in Nigerian women.

OBJECTIVE: To establish the incidence and types of utero-vaginal prolapse. METHODS: Retrospective medical records analyses of women who were subjected to reconstructive pelvic surgery for various types of pelvic relaxation at the Nnamdi Azikiwe University Teaching Hospital, Nnewi and the University Of Nigeria Teaching Hospital, Enugu, Nigeria was carried out. The study was conducted from January 1996 to December 1999 during which there were 7515 surgical admissions. The inclusion criteria were those women who complained of feeling a mass in the vagina with demonAstrable descent of the anterior and/or posterior and/or apical vaginal walls and/or perineal descent. Excluded were patients who had other symptoms other than utero-vaginal prolapse and those whose grades and sites of prolapse were not determinable from the clinical or surgical notes. Also excluded were patients with nerve injury or disease, connective tissue disorders and neuromuscular diseases. The subjects were divided into two groups. Group I consisted of 54 women (age < or = 40 years), and group II included 105 women (age > or = 40 years). The findings between those two groups were compared with reference to sites, types and degree of prolapse. Also, coexistence of pelvic relaxation and underlying medical conditions were evaluated. RESULTS: A total of 159 subjects out of 492 charts studied met the inclusion criteria for the study. In group I, mean age was 32.839 with a standard deviation (SD) of +/- 6.012 years; and in group II the mean age was 56.543 with a SD of 8.094. Hypertrophic (elongated) cervix was determined in 15 (6.3%) subjects in group I for an incidence of 1.58% per year, cystocele (vaginal anterior wall descent) was present in 21 (8.9%) women for an incidence of 2.2% per year; rectocele (posterior vaginal wall descent) was identified in 15 (6.3%) women for an incidence of 1.58% per year; vaginal cough prolapse (apical descent) was present 21 (8.9%) women for an incidence of 2.2% per year. Perineal descent was absent in this group. In group II, there was no hypertrophic cervix; cystocele was present in 39 (16.5%) cases for an incidence of 4.13% per year; rectocele was identified in 27 (11.4%) women, amounting to an incidence of 2.85% per year; vaginal cough prolapse was present in 36 (15.%) women, an incidence of 3.75% per year; perineal descent was present in 63 (25.6%) women, for an incidence of 6.4% per year. CONCLUSION: (1) The incidence of hypertrophic cervix without any other abnormality amounted to 1.58% per year. This medical entity can present as uterine prolapse and was noted only in group I. (2) The annual incidence for hospital admission with a diagnosis of uterine prolapse was 2.1%. (3) The incidence of cystocele, and rectocele was not statistically different in the two groups; but the incidence of perineal descent and uterine prolapse were significantly more in group II than group I. (4) The etiology of hypertrophic cervix is not known, but it is of importance especially in the childbearing age when it may be related to prolonged pregnancy, cervical dystocia, etc.

Anal incontinence among Igbo (Nigerian) women.

Anal incontinence in patients who present to the gynaecology clinic for symptoms other than pelvic organ prolapse dysfunction is fairly common. A structured pre-tested 41-item pelvic organ prolapse questionnaire was administered by doctors to 3963 gynaecological patients, recruited from three states of south-eastern Nigeria, who were in the clinic for reasons other than pelvic organ prolapse dysfunction. This report considers only anal incontinence. We found a prevalence of 6.96% for anal incontinence. Of these, 2.67% were incontinent for liquid stool, 2.17% for solid stool and 2.12% for flatus. There appears to be a higher frequency of flatus incontinence in the reproductive years: 36.6% of primiparas aged <30 years had faecal incontinence. Flatus incontinence was present in 28 (43.7%) of 198 para 4 and below, and in 36 (56.3%) of 78 para 5 and above. There was thus a significant association between flatus incontinence and parity (chi2=32.4; p<0.001). Spontaneous vaginal delivery had a significant effect on anal incontinence (p=0.04). Physicians should, be able to detect this embarrassing condition and be alert to factors that may avert or ameliorate it.

Sources of sexual information and its relevance to sexual behaviour in Nigeria.

A study was carried out to identify the various sources of sexual information by adolescents in Nigeria and their influence on the sexual behaviours of the subjects, using: a) coitus prior to marriage b) expectation with first coitus c) freeness to discuss with spouse or anybody as parameters. The study was carried between 1997 and 1998 using subjects randomly selected from three Nigerian communities, viz: Enugu, Benin and Nnewi. Coitus before marriage was significantly higher in those who got their first ever information from peers than those who got it from other sources (P < 0.01). Fulfillment of expectation with first coitus was also significantly higher among those who were taught by parents, peers and teachers than those who sought their information on their own from books, magazines and films (p < 0.05). However, in considering their ability to discuss with anybody, this was found to be significantly higher in those who sought information on their own than those who got their first information by personal contact with parents, peers and teachers (p < 0.05). The latter was found to be more inhibited from discussing sexuality with their spouse or anybody than those who got their information from books/magazines and films. Sex education of adolescents should, therefore, be provided in a cultural, community-based setting of which the guardian programme should be only one component. It may be counter-productive in Nigeria if the adolescents continue to learn about sexuality on their own from books, magazines and films.

Communication and sexuality in a Nigerian community.

The traditional lack of interest in discussing sexuality creates a problem in doctor-patient communication, and this can affect patient management adversely. The dearth, ease or comfort in discussing sex was examined by a self-administered questionnaire to respondents, mainly medical students, nurses and paramedics, 20-70 years of age, who were not seeking treatment for sexual problems. The respondents were mainly of Igbo extraction from Eastern Nigeria. Factors considered include age, sex, religion, marital status, and education. The results show that 71.9% of all the respondents indicated that they would like to be able to discuss freely whereas 28.1% never really bothered; 40.9% of all the respondents could discuss sex with anybody whereas 59.1% could not; 75% in the married group discussed sex freely with their spouses or friends and 25% were unable to do so. Education showed a very significant influence on the ability to discuss sex freely. It is suggested that a systematic approach to education, especially sexual health education, may be a major way to combat the prevailing cultural inhibition.

Cloacal dysgenesis.

Cloacal dysgenesis is a rare anomaly. Fifty cases have been reported in the literature. This condition differs from the usual imperforate anus. The diagnosis, evaluation, and therapeutic management require an understanding of the embryogenesis of the cloaca. The presence at birth of a single interlabial orifice or an abnormality sited anus is a surgical emergency. Early salvage of the kidneys and relieving intestinal obstruction are emphasized. There is a high incidence of multiple system congenital abnormalities.