Determinants of Choice of Place of Delivery among Women Attending Two Referral Hospitals in Kano North-West Nigeria.

BACKGROUND: Women are often unable to choose for themselves when, where, and from whom to seek care. This study was undertaken to determine factors that influence a woman's choice of place of delivery among women attending immunization clinics in two referral hospitals in Kano, Nigeria. MATERIALS AND METHODS: A hospital-based cross-sectional descriptive study conducted among 314 women who delivered in Kano, Nigeria. Stratified random sampling was done. Pretested, interviewer-administered questionnaires were used to obtain responses about sociodemographic characteristics, choice of place of delivery, and factors that influenced their choice of place of delivery. Ethical approval was obtained from an ethical committee. Women who gave birth within the past 12 months and gave informed consent were recruited. The data were analyzed using SPSS statistical software version 22. RESULTS: About 218 (69.4%) women had their previous delivery in the health facility, whereas 96 (30.6%) had theirs outside the health facilities. The level of satisfaction in health facility care was also high. For those who had their deliveries outside the health facility, 37 (38.5%) of the deliveries were monitored by a nurse/midwife. The respondents level of education (P ≤ 0.001), spouse level of education (P < 0.001), spouse occupation (P ≤ 0.015), human influence (P = 0.025), and total cost of each visit (P = 0.010) were associated with the choice of place of delivery; however, at multivariate logistic regression, only human influence and respondents level of education were determinants of the choice of place of delivery. CONCLUSION: Most of the respondents had their previous deliveries in the health facilities and had a high level of satisfaction with the health facilities where they delivered compared to other studies. Utilization of the health facilities for childbirth may increase if there is involvement of relations, especially husbands and mothers and if the clients' level of education is improved.

Perforated gangrenous ileo-colic intussusception in a 9 month old Nigerian infant presenting at a private hospital: A case report.

INTRODUCTION: Intussusception is the process of invagination of a bowel segment into the adjoining intestinal lumen which may cause bowel obstruction and gangrene. It commonly occurs in infants at a mean age of 9-months with male preponderance. The condition has excellent prognosis if diagnosis is made early and appropriate treatment commenced and mortality rate from intussusception in children can be less than 1%. However, if diagnosis or treatments are delayed it can be fatal in a few days. PRESENTATION OF CASE: We present a case of Ileo-colic perforated ileum due to delayed diagnosis. It was initially misdiagnosed as gastroenteritis at another hospital. The infant was resuscitated with intravenous fluid and had laparotomy. A signed consent was obtained before the surgery and media consent was signed for publication. A gangrenous terminal ileum was resected and ileo-colic anastomosis was done. Post-operative course was uncomplicated and the patient was discharged after 5days. DISCUSSION: The index case presented late with complication of gangrene and perforation because it was first managed as a case of gastroenteritis. Gastroenteritis is among the various differential diagnosis of intussusception. Complications have been reported to increase numbers of surgical treatment and sometimes mortality, but rarely occur with good diagnostic acumen. CONCLUSION: We conclude that high clinical suspicion, interaction with senior surgeons and regular use of ultrasound in infants with gastrointestinal symptoms will aid diagnosis. Although surgery was performed in the index case, non-surgical reduction is a very efficient treatment modality in uncomplicated cases.

Awareness, acceptability and barriers to the utilization of modern methods of family planning among women attending antenatal clinic in Bayero University, Kano

Background: Contraceptive prevalence rate (CPR) is generally very low in Nigeria, but particularly lowest in northern Nigeria. Barriers to access and utilization have been variously studied, but there is need to consider specific contexts. Objective: The aim of this study is to determine the level of awareness, acceptability, and barriers to the utilization of modern methods of family planning in Bayero University, Kano, North-west, Nigeria. Methodology: This was a cross-sectional study conducted at the antenatal section of BUK staff clinic, among 152 pregnant women between May and October 2013. Ethical approval and informed consent were obtained. Descriptive statistics was used to report categorical variables. Results: Awareness of modern methods of contraception was high (86.18%) and the majority (86.19%) knew at least one method of family planning. The commonest methods known by the respondents were: Oral contraceptive pills (39.47%), injectables (22.37%) and condom (14.47%). Out of the152 respondents, 77(50.66%) accepted the use of modern methods of family planning and 39(25.65%) out of these number had ever used at least one method, while 38(25.00%) did not. Fear of side effects (42.11%), desire for more children (15.79%), and lack of awareness (13.82%), religious prohibition (10.53%) and opposition by male partners (7.89%) constituted the major barriers to the utilization of modern methods of family planning. Conclusion: The level of awareness was found to be high but acceptability and utilization were low, this is due to the existing barriers to utilization of modern methods of family planning. Effort should be made to allay the fear of side effects and to educate women on the implication of frequent childbirth

Simultaneous pregnancy in each uterine cavity of a double uterus in a young Nigerian multipara who presented with a retained second twin following an unsupervised preterm labor at home; Case report.

INTRODUCTION: Simultaneous pregnancy in each uterine cavity of a double uterus is unusual but is a recognized risk factor for preterm labour and other poor obstetrics outcomes. The work has been reported in line with the SCARE criteria. PRESENTATION OF CASE: We report an unusual case of simultaneous pregnancy in each uterine cavity of a double uterus in a young African grand multipara who presented with a retained second twin following a preterm labour at home. DISCUSSION: A double or didelphys uterus as reported in the literatures is still uncommon even in Africa. While infections are very important and always considered causes of preterm labour a high index of suspicion will help give a diagnosis of a uterine anomaly and this will lead to more precise clinical examinations and studies in cases of recurrent miscarriages and preterm birth where other causes such as infection and cervical incompetence has been ruled out. CONCLUSION: Double uterus is an important cause of recurrent preterm labourv and miscarriages as seen in the index case. Thorough pelvic examination should be conducted for women of reproductive age groups when they present for gynecological consultation to rule out the rare occurrence of double uterus and other uterine abnormalities. Health education should be intensified through different media on the reality of double uterus and its attendant complications as a means to boost ante natal care booking and attendance for early diagnosis and appropriate management of this congenital anomaly.

An assessment of serum prolactin levels among infertile women with galactorrhea attending a gynecological clinic North-West Nigeria.

BACKGROUND: Galactorrhea is a common manifestation of hyperprolactinemia but may not always be present in women with hyperprolactinemia. This study was, therefore, undertaken to assess the serum prolactin levels of infertile women presenting with galactorrhea and to determine the prevalence of hyperprolactinemia among them. MATERIALS AND METHODS: This was a retrospective study of serum prolactin levels of 63 female partners of infertile couples attending the gynecological clinic of Federal Medical Centre, Birnin Kudu, Jigawa State, Nigeria, who were found to have galactorrhea from January 1, 2012, to December 31, 2013. Ethical clearance was obtained. Solid phase enzyme-linked immunosorbent assay was used to measure serum prolactin. Sociodemographic characteristics were determined. The data obtained were analyzed using SPSS version 17.0 statistical software. Absolute numbers and simple percentages were used to describe categorical variables. Similarly, quantitative variables were described using measures of central tendency (mean, median) and measures of dispersion (range, standard deviation) as appropriate. RESULTS: The average age of the women was 27.9 ± 5.6 years. In half of the cases (50%), galactorrhea was associated with menstrual disturbances, mainly amenorrhea (23.3%). Although most (63.3%) of the clients had normal serum prolactin level despite being galactorrheic, averagely there was a marked elevation in serum prolactin of as high as 40.3 ± 52.3 ng/mL. CONCLUSION: We conclude, therefore, that the prevalence of hyperprolactinemia in this study was low when compared with other studies and that galactorrhea does not always indicate raised serum prolactin levels.

Low Serum Vitamin C Status Among Pregnant Women Attending Antenatal Care at General Hospital Dawakin Kudu, Northwest Nigeria.

BACKGROUND: Vitamin C levels are low in pregnancy. The purpose of this study was to determine serum Vitamins C levels among pregnant women attending antenatal care at a General Hospital in Dawakin Kudu, Kano, and this can help further research to determine the place of Vitamin C supplementation in pregnancy. METHODS: This was a prospective study of 400 pregnant women who presented for antenatal care in General Hospital Dawakin Kudu, Kano, Nigeria. Research structured questionnaire was administered to 400 respondents. Determination of serum Vitamin C was done using appropriate biochemical methods. RESULTS: Vitamin C deficiency was found in 79.5% of the participants. The values for Vitamin C were 0.20 ± 0.18 mg/dl during the first trimester, 0.50 ± 0.99 mg/dl in the second trimester, and 0.35 ± 0.36 mg/dl in the third trimester and P = 0.001. CONCLUSIONS: There is a significant reduction in the serum Vitamins C concentration throughout the period of pregnancy with the highest levels in the second trimester. Therefore, Vitamin C supplementation is suggested during pregnancy, especially for those whose fruit and vegetable consumption is inadequate.

Vitamins A and E Deficiencies among Pregnant Women Attending Antenatal Care at General Hospital Dawakin Kudu, North-West Nigeria.

BACKGROUND: Vitamins A and E deficiency is prevalent in developing countries, and plasma levels are low in pregnancy. This study was undertaken to determine the serum Vitamins A and E status among pregnant women attending antenatal care at a General Hospital in Dawakin Kudu, Kano and to provide the necessary information needed to suggest the supplementation of Vitamins A and E during pregnancy. METHODS: The study was done in General Hospital Dawakin Kudu Local Government Area. Dawakin Kudu, a rural community in Kano State is about 12 km from Kano metropolis which is the most populous city in Nigeria and commercial nerve center of Northern Nigeria. Most of the women are housewives, however, some engage in subsistent farming and petty trading. This was a prospective study of 200 pregnant women at various maternal ages, gestational ages, and parities. Informed consent was obtained from the participants. Research structured questionnaire was administered to 200 respondents which showed age and parity distributions. Determination of Serum Vitamins A and E was done using methods of Bessey, et al. and Tsen. Ethical approval for the research was obtained from General Hospital, Dawakin Kudu, Kano. STATISTICAL ANALYSIS USED: Data obtained were analyzed using SPSS version 17 statistical software (SPSS Inc., IL, Chicago, USA). Descriptive statistics was done. Mean serum Vitamins A and E concentration between trimesters were compared using two-way ANOVA and P < 0.05 was considered statistically significant. RESULTS: Majority of the women were aged 20-39 years with mean of 23.67 ± 6.11. Most were in the 1-4 parity range. Mean birth weight was 2.42 ± 0.74 kg. Above 65% were deficient while 34.5% had normal levels of Vitamin A and 51% were deficient of serum Vitamin E. Serum Vitamins A and E levels showed a marked reduction from first through third trimester. The differences were statistically significant (P < 0.05). CONCLUSIONS: There is a significant reduction in the serum Vitamins A and E concentration throughout the period of pregnancy with the highest levels in the first trimester. Therefore, further studies should evaluate the value of Vitamins A and E supplementation during pregnancy especially for those whose fruit and vegetable consumption is inadequate.

Poor semen parameters among infertile couples presenting at a gynaecological clinic of Federal Medical Centre Birnin Kudu North-west Nigeria.

BACKGROUND: Male partners contribute significantly to infertile couple problem. The present study was undertaken to review the seminal fluid analysis (SFA) of couples presenting with inability to conceive at the gynecological clinic of Federal Medical Centre, Birnin Kudu, Jigawa State using World Health Organization 2010 criteria, identify the correlation between poor semen quality and age and to identify culture and sensitivity patterns of isolates. MATERIALS AND METHODS: This was a retrospective study. The sample size was 63 Ethical clearance was obtained. Patients' case records and laboratory registers were retrieved. The volume, viscosity, pH, sperm count, motility, and the morphology of the seminal fluid were determined. Semen m/c/s was done. Data were analyzed by using SPSS version 16 (SPSS Inc., Chicago, Il, USA). Descriptive statistics was used. Association between age and semen parameters were determined using Pearson's coefficient of correlations and Chi-square test and P < 0.05 was considered statistically significant. MAIN OUTCOME MEASURES: The proportion of infertile male with abnormal semen parameters. RESULTS: Of the 308 couple presenting for infertility evaluation, only 63 male partners presented for SFA. This is 20.5% of the couples. After analysis, 52.38% were normospermic while 26.98% and 20.64% were azoospermic and oligospermic, respectively. Asthenospermia was the commonest motility/morphology abnormality occurring in 60.3%. The mean volume, sperm count, motility, morphology, and pH were 2.8 ± 1.8, 40.1 ± 52.3, 28.2 ± 27.7, 46.1 ± 35.6, and 8.3 ± 0.67, respectively. The volume, motility, morphology, and pH showed weak correlations with age. CONCLUSION: Male partners are significant contributors to the infertile couple problems in this study; therefore awareness is needed in order to engage more males in evaluation and treatment of infertility.

Maternal anthropometric characteristics as determinants of birth weight in north-west Nigeria: prospective study.

OBJECTIVE: This study was undertaken to determine the sensitivity and specificity of anthropometric measurements in predicting birth weight. METHODS: This was a prospective study. Interviewer-administered questionnaires were used. Two hundred were used. The weight, height and BMI of the women were measured. Unclothed newborns were weighed immediately after delivery. The data obtained were analyzed using SPSS version 16.0 statistical software. The accuracy of maternal weight, height and body mass index in predicting birth weight was compared using chi-squared test and p < 0.05 was considered statistically significant. RESULT: The mean maternal age was 28.2 ± 5.7 years. The mean parity was 3 ± 2. The mean gestational age at delivery was 38.5 ± 2 years. The mean actual birth weight was 3.27 ± 0.53 kg. The mean maternal weight was 72.03 ± 11 kg. Maternal weight showed a strong positive correlation with birth weight (r = 0.48) and this was statistically significant (p < 0.001). The mean maternal height was 1.64 ± 0.55 m. The mean maternal BMI was 27.9 ± 4.33. Maternal weight, height and BMI had sensitivities of 50%, 40% and 50% and specificities of 48%, 57.9% and 67.3%, respectively. CONCLUSION: Maternal weight, height and BMI are not good predictors of birth weight and cannot be recommended for use as screening test in poor resource setting where ultrasound available.

Estimation of fetal weight before delivery in low-resource setting of North-west Nigeria: can we rely on our clinical skills?

OBJECTIVE: To compare the accuracy of sonographic versus clinical methods of fetal weight estimation in a low-resource setting. METHODS: This was a prospective study. Ethical clearance and informed consent were obtained. Two hundred (200) women admitted for delivery were assessed. Questionnaires and data collection forms were used to obtain socio-demographic and other clinical information. The actual weight was determined at birth. Estimated fetal weight (EFW) was compared with the actual weight (BW). The data obtained were analyzed using SPSS version 16.0 statistical software. The accuracy of clinical and sonographic fetal weight estimation was compared using Students' t-test, Chi-square test and Pearsons' coefficient of correlation and p < 0.05 was considered statistically significant. RESULTS: The mean of absolute percentage error was smaller for ultrasonic (9.8 ± 7.2) than clinical (10.5 ± 7.5) estimation, but the difference was not statistically significant (p = 0.083). In the 2.5-3.99 kg group there was no statistically significant difference between the mean absolute percentage errors for the two methods (p = 0.096). In the <2.5 kg group, clinical method overestimated birth-weight while in ≥4.0 kg, the sonographic method underestimated the birth weight. For birth weight 2.5-3.99 kg, sensitivity, specificity, positive predictive value and negative predictive value were 96.9, 76.9, 98.1, 66.7% and 96.8, 75, 96.8, 75% for sonographic and clinical estimates, respectively. The predictive powers of sonographic and clinical methods were better for low birth weight and macrosomic fetuses, respectively. CONCLUSION: Clinical method of fetal weight estimation can only be recommended for use as screening tool for normal weight and macrosomic fetuses.