Attitude of Nigerian obstetrician-gynecologists toward gamete donation.

BACKGROUND: Assisted Reproductive Technology (ART) as a treatment for infertility has come to stay in Nigeria. However, currently there is no national regulation of the practice even though the Association for Fertility and Reproductive Health has recently produced a guideline for practice by its members. Though there is an international trend toward more information giving to donors/clients/child in gamete donation, opinions and attitudes depend on cultural and societal values. AIM: To investigate the attitude of Nigerian obstetrician/gynecologists toward gamete donation. SUBJECTS AND METHODS: This is a cross-sectional descriptive study in which a structured questionnaire was administered to 110 obstetrician-gynecologists following an oral informed consent. Data analysis was done using SPSS v. 20 by descriptive statistics of frequency and percentage, with Pearson Chi-square test for association between demographic variables and responses. RESULTS: The age range of respondents was 31-68 years with a mean of 44.5 +/-8.9 SD. Majority (85.5%) were males and 72 (65.5%) were <50 years of age. Seventy-five (68.2%) and sixty-six (60%) respondents were in support of anonymous and non-anonymous gamete donation, respectively. More than two-thirds of participants rejected giving off-springs donor information either in child or adulthood. Forty respondents (36.4%) rejected that parents be honest with the child about his/her genetic origin, whilst sixty-two (56.4%) and forty-three (38%) gynecologists were of the view that sperm and oocyte donors should not be compensated, respectively. CONCLUSION: There is a greater support for anonymous than non-anonymous gamete donation among Nigerian obstetrician/gynecologists, and they also have a negative attitude to disclosure of donor-information to off-springs from gamete donation. They were more likely to support compensation for oocyte than sperm donors. Legal protection of donors and recipients through a national regulation will provide greater openness among all stakeholders.

Evaluation of content and cost of traditional eye medication in a resource-poor country - Implications for eye care practice and policy.

BACKGROUND: Cataract, glaucoma, and conjunctivitis are common causes of ocular morbidity in Nigeria. A major obstacle in reducing the burden of ocular morbidity in rural areas is access to eye care services. Up to 80% of the population in developing countries use traditional medications for their primary healthcare needs because they are accessible, available, and affordable. The aim of this study is to evaluate the content and cost of commercialized traditional medications used in the treatment of common eye conditions in Nigeria. PATIENTS AND METHODS: All the registered traditional healers (THs) at an International Trade Fair in Enugu who treated eye problems were identified. Data on their location and scope of their practice were collected by the researchers. Proxy patients consulted THs in the trade fair with simulated cataract, glaucoma, and bacterial conjunctivitis, and treatment was sought. Medication for the treatment of the simulated disorders was paid for and procured. The mode of administration and the cost of the drugs were recorded by proxy patients. Each medication was labeled with a code and sent to the laboratories of the National Agency for Drug Administration and Control for analysis. Data were entered into a database on Microsoft Access and transferred to STATA V12.1 (StataCorp) for analysis. RESULTS: Cataract was treated by 87.5% of all the traditional eye healers interviewed. A total of 32 samples were collected and analyzed. These comprised mainly oral (53.1%) and topical traditional medications (43.8%). The pH of the topical samples ranged from 3.5 to 10, while the mean microbiological load per topical solution was 3.3 × 104 cfu/mL ± 0.96. The cost of treatment of cataract ranged from 4 to 70 USD. CONCLUSION: The content of the majority of the samples of traditional eye medications in this study had high extremes of pH and/or had a high microbial content. The practice of THs should be regulated.

Beliefs, perceptions, and views of pregnant women about cesarean section and reproductive decision-making in a specialist health facility in Enugu, Southeast Nigeria.

CONTEXT: Through the process of socialization, women and men are conditioned to behave and play different roles in society. While the African culture "rewards" women who have vaginal birth despite the cost to their health, the burden of reproductive decision-making is placed on the menfolk. However, these seem to be changing. AIMS: Our aim was to assess the beliefs and perceptions of pregnant women about cesarean section (CS), including their views regarding decision-making on the mode of delivery, in Enugu, Southeast Nigeria. SETTINGS AND DESIGN:: A cross-sectional descriptive study. SUBJECTS AND METHODS: A structured questionnaire was administered to 200 pregnant women, following an oral informed consent. STATISTICAL ANALYSIS USED: : Statistical Package for the Social Sciences version 17 with descriptive statistics of frequencies and percentages. RESULTS: All the respondents believe that CS is done for the safety of the mother/baby. Thirteen percent reject the procedure for themselves no matter the circumstance. Joint decision-making was the view of two-thirds of the women. Majority of them will accept CS if their husbands consent. Younger women were of the view that husbands decide on the delivery mode (P = 0.019). CONCLUSIONS: Culture remains an impediment to CS uptake. Most women preferred joint decision-making on the mode of delivery.

Delayed Interval Delivery following Early Loss of the Leading Twin.

This was a case of a nulliparous woman with reduced chance of conception following unilateral salpingectomy and years of infertility. She eventually conceived following ovulation induction resulting in twin pregnancy. She had miscarriage that led to loss of one of the twins at 17 weeks of gestational age. The pregnancy was however continued for 116 days following meticulous management with eventual delivery of a live female baby with good outcome.

Contents and readability of currently used surgical/procedure informed consent forms in Nigerian tertiary health institutions.

BACKGROUND: Surgical informed consent forms should have evidence that their use will enhance a shared decision-making which is the fundamental objective of informed consent in clinical practice. In the absence of any guideline in Nigeria on the content and language of informed consent forms, we sort to examine the surgical and procedure consent forms used by Federal tertiary health institutions in Nigeria, to know whether they fulfill the basic elements of informed consent. MATERIALS AND METHODS: The surgical and procedure informed consent forms of 33 tertiary health institutions in Nigeria were assessed for their readability and contents. Adequacy of their content was evaluated based on provision for 28 content items identified as necessary information to be provided in a good consent form. The potential of the forms to be comprehended were assessed with Flesch readability formula. RESULTS: The contents of majority of the forms were scant. None of the forms made provision for documentation of the patient's permission for blood transfusion, tissue disposal, awareness of the risks of not undergoing the prescribed treatment, and the risk of anesthesia. Risk disclosures were only mentioned in specific terms in 11.4% of the forms. Less than 10% of the forms made provisions for an interpreter, signature of anesthetists, alternative to the procedure to be mentioned, and answering of the patient's questions. The Flesch reading ease scores of the forms ranged from 34.1 (Difficult) to 67.5 (Standard), with a mean score of 55.2 (Fairly difficult level). Field evaluation of the forms show that they shall be partly understood by 13- to 15-year-old patients with basic education but are best understood by literate adult patients. CONCLUSION: The content of majority of the informed consent forms used in Nigerian tertiary health institutions are poor and their readability scores are not better than those used in developed parts of the world. Health Institutions in Nigeria should revise their informed consent forms to improve their contents and do a usability trial on the sample forms before deployment in order to ensure that they are comprehensible for their patient population.

Induction of labor on request in a resource-poor setting.

OBJECTIVE: To determine the prevalence of and reasons for induction of labor on maternal request in a setting where aversion to induction of labor is the norm. METHOD: Women undergoing induction of labor on maternal request at three maternity centers in Enugu, Nigeria were interviewed by means of pre-tested self-administered questionnaires. The outcomes of labor in these women were also compared with those of a control group consisting of women who had induction of labor for medical reasons. RESULTS: The prevalence of induction of labor on maternal request was 7.4%. Maternal convenience was the commonest reason for request induction. The outcomes of labor were similar between the subjects and their controls. CONCLUSION: Nigerian women are beginning to request induction of labor without medical indications and have comparable outcomes with those who have medical indications. There is need for appropriate regulatory guidelines.

Cesarean section on request in a developing country.

OBJECTIVE: To assess the prevalence of cesarean sections (CSs) and women's reasons for requesting the procedure in a developing country. METHOD: Pregnant women scheduled for elective CS were interviewed to determine whether the procedure was requested by them or suggested by a physician. The women who personally requested a CS filled out questionnaires before surgery and at the postnatal visit 6 weeks later, and their answers were analyzed. RESULTS: The prevalence of CS on request was 4.4%. Previous infertility and advanced maternal age at first pregnancy were the most common reasons for requesting a CS, but most women said they would prefer a vaginal delivery in subsequent pregnancies. CONCLUSION: The women who requested a CS in this study did so for reasons different from those put forth by women in developed countries. The view that a CS is the surest way toward a live birth was the critical factor underlying their choice.