Correlation of female age with outcome of IVF in a low-resource setting.

OBJECTIVE: To determine the effect of female age on pregnancy outcome after in vitro fertilization/embryo transfer (IVF-ET). METHODS: A prospective study was conducted involving 266 women who had IVF-ET at Nisa Fertility and Genetic Center, Abuja, Nigeria. All eligible consenting women were recruited to the study. The main outcome measure was clinical pregnancy. Data were analyzed using IBM SPSS Statistics version 25. P < 0.05 at 95% confidence intervals was taken as significant. RESULTS: A total of 266 patients were recruited and included in the study; 104 pregnancies were recorded, giving an overall pregnancy rate of 39.1%. The age range of the patient was 26-43 years (mean age 33.9 ± 2.41 years) while the mean number of embryo transfers per patient was 2.2. The clinical pregnancy rate for women aged below 30 years was 69.4% while the pregnancy rate for patients aged 30-34 years, 35-39 years, and 40-43 years was 52.6%, 24.7%, and 9.4%, respectively (P < 0.0001). CONCLUSION: The study found that the success rate of IVF-ET decreases significantly in women aged over 34 years. Women should be counseled about the age-related risk of infertility and referred to a fertility center as early as possible.

Marriage to first pregnancy interval and related factors among women in North Central Nigeria.

Background: The age at which a woman gets married may affect the timing and occurrence of her first pregnancy as well as the total number of children she will have in her lifetime. Factors which affect the marriage to first pregnancy interval include the age at marriage of the woman, her educational level, and cultural and religious beliefs among others. This study seeks to find out the marriage to first pregnancy interval and factors that affect this interval as well as the average number of children of women in North Central Nigeria. Materials and Methods: This was a cross-sectional community survey utilizing structured questionnaires. Information on marriage to first pregnancy interval as well as related factors was obtained from 300 currently or ever-married women in Abuja, North Central Nigeria. Results: The women were aged 13-72 years (mean: 28.67 years); the mean age at first marriage was 21.57 years, and the mean age at first pregnancy was 22.48 years. Marriage to first pregnancy interval was <3 months in 68 (22.6%), 1 year in 86 (28.6%), and ≥2 years in 154 (51.3%). The mean number of children for 45 years and above was 4.5. Overall, women who are artisans were found to be more likely to have a pregnancy soon after marriage. Husband's place of residence, educational qualification of the woman, age at marriage, tribe, and religion did not significantly affect first marriage to first pregnancy interval. Conclusion: Women in this part of Nigeria marry in early adulthood and are likely to want to have their first pregnancy soon after marriage. This has social implications for population dynamics and planning.

Résumé Contexte: L'âge auquel une femme se marie peut affecter le moment et la survenue de sa première grossesse ainsi que le nombre total d'enfants qu'elle aura au cours de sa vie. Les facteurs qui influencent l'intervalle entre le mariage et la première grossesse sont, entre autres, l'âge de la femme au moment du mariage, son niveau d'éducation et ses croyances culturelles et religieuses. Cette étude vise à déterminer l'intervalle entre le mariage et la première grossesse et les facteurs qui affectent cet intervalle ainsi que le nombre moyen d'enfants des femmes du Centre-Nord du Nigeria. Matériaux et méthodes: Il s'agit d'une enquête communautaire transversale utilisant des questionnaires structurés. Des informations sur l'intervalle entre le mariage et la première grossesse ainsi que sur les facteurs associés ont été obtenues auprès de 300 femmes actuellement ou jamais mariées à Abuja, dans le centre-nord du Nigeria. Résultats: Les femmes étaient âgées de 13 à 72 ans (moyenne : 28,67 ans) ; l'âge moyen au premier mariage était de 21,57 ans, et l'âge moyen à la première grossesse était de 22,48 ans. L'intervalle entre le mariage et la première grossesse était de <3 mois chez 68 (22,6%), 1 an chez 86 (28,6%) et ≥2 ans chez 154 (51,3%). Le nombre moyen d'enfants pour les 45 ans et plus était de 4,5. Dans l'ensemble, on a constaté que les femmes artisans étaient plus susceptibles d'avoir une grossesse peu après le mariage. Le lieu de résidence du mari, le niveau d'instruction de la femme, l'âge au mariage, la tribu et la religion n'ont pas affecté de manière significative l'intervalle entre le premier mariage et la première grossesse. Conclusion: Les femmes de cette région du Nigeria se marient au début de l'âge adulte et sont susceptibles de vouloir avoir leur première grossesse peu après le mariage. Ceci a des implications sociales pour la dynamique et la planification de la population. Mots-clés: Âge au mariage, facteurs, intervalle entre le mariage et la première grossesse.

Severity of intrauterine adhesions and pregnancy success rates after treatment: Comparison of adhesions obtained from open myomectomy versus uterine curettage.

Intrauterine adhesions (IUA) are rare. A retrospective comparative study was conducted between January 1, 2015, and December 31, 2018. Group A comprised 117 women who developed IUAs after open myomectomy, while Group B comprised 113 women who developed IUAs following uterine trauma caused by uterine instrumentation after a termination of pregnancy (TOP) or spontaneous miscarriage. The IUA grade and pregnancy rates and outcomes were compared using the March classification system. All patients underwent hysteroscopic adhesiolysis. The adhesions tended to be more severe (45/117, 38.5%) in Group A than in Group B (29/113, 25.7%); however, this difference was not statistically significant (Chi-Suare 5.047; p = .080). The period of observation was 24 months from the last hysteroscopy. The pregnancy rate in Group A (26, 22.2%) was significantly lower than in Group B (46, 40.7%) (OR: 2.403, 95% CI: 1.352-4.271; p = .003). Open myomectomy was the preceding aetiological factor in a greater proportion of women with IUA in our study. In cases where pregnancy is desired after open myomectomy, especially where the endometrial cavity is breached, postoperative hysteroscopy to exclude IUAs is recommended.

Severity of intrauterine adhesions and pregnancy success rates after treatment: Comparison of adhesions obtained from open myomectomy versus uterine curettage

Intrauterine adhesions (IUA) are rare. A retrospective comparative study was conducted between January 1, 2015, and December 31, 2018. Group A comprised 117 women who developed IUAs after open myomectomy, while Group B comprised 113 women who developed IUAs following uterine trauma caused by uterine instrumentation after a termination of pregnancy (TOP) or spontaneous miscarriage. The IUA grade and pregnancy rates and outcomes were compared using the March classification system. All patients underwent hysteroscopic adhesiolysis. The adhesions tended to be more severe (45/117, 38.5%) in Group A than in Group B (29/113, 25.7%); however, this difference was not statistically significant (Chi-Suare 5.047; p = .080). The period of observation was 24 months from the last hysteroscopy. The pregnancy rate in Group A (26, 22.2%) was significantly lower than in Group B (46, 40.7%) (OR: 2.403, 95% CI: 1.352­4.271; p = .003). Open myomectomy was the preceding aetiological factor in a greater proportion of women with IUA in our study. In cases where pregnancy is desired after open myomectomy, especially where the endometrial cavity is breached, postoperative hysteroscopy to exclude IUAs is recommended.

Retained intra-abdominal surgical clamp complicating emergency laparotomy: incidental finding on hysterosalpingogram for evaluation of tubal infertility.

The finding of intraperitoneal foreign body complicating surgical intervention broadly remains as an issue of safety in the operative room, a source of emotive concern for the patient, and an upsetting but equally embarrassing situation to the surgeon and the team. However, in the media world, it is a source of sumptuous and captivating headline on the newspaper and to the legal profession, an attractive case to prosecute. A middle age teacher presented with secondary infertility. She had emergency laparotomy fifteen years ago for ruptured tubal ectopic pregnancy in a private hospital and postoperative period was uneventful. Amongst other investigations to find out the cause of infertility, she had hysterosalpingography and a radio-opaque clamp was visualized on the films. She was counselled and had laparotomy. A pair of surgical Kocher clamps was retrieved buried in the mesentery.

Objective structured clinical examination vs traditional clinical examination: An evaluation of students' perception and preference in a Nigerian medical school.

BACKGROUND: Method of testing clinical competence of medical students in this setting has been controversial. This report evaluates the perceptions and preferences of 5(th) and 6(th) year medical students about traditional clinical examination (TCE) and objective structured clinical examination (OSCE). MATERIALS AND METHODS: A cross-sectional study using a structured questionnaire, administered to 156 students, who had been previously exposed to TCE and OSCE. RESULTS: There were 110 (70.5%) males and 46 (29.5%) females, with median age group of 26-30 years. One hundred and thirty-one respondents (84%) felt TCE is more difficult and 20 (12.8%) felt OSCE was more difficult. One hundred and forty-two (91%) felt OSCE was easier to pass, 8 (5.1%) felt TCE was easier to pass and 6 (3.8%) were undecided. Majority of the 5(th) and 6(th) year students (95.5% and 100%, respectively) preferred OSCE for assessment. In relation to validity and reliability of OSCE, 124 (79.5%) of all the students felt it provides a true measure of essential clinical skills, 130 (83.3%) felt its scores are standardised, 143 (91.7%) felt it is a practical and useful experience and 135 (86.5%) felt students' personality, ethnicity and gender will not affect OSCE scores. Overall, there were no significant differences in preference and perceptions between 5(th) and 6(th) year students and between males and females. CONCLUSION: Students preferred OSCE as method of assessing clinical competence and considered it a more valid and reliable method of examination.

Knowledge and attitude towards child adoption among women in Zaria, northern Nigeria.

BACKGROUND: The success of marriages has largely been premeditated on child bearing in most African society and oftentimes women are at the receiving end of childlessness with possible psychological and physical torture. OBJECTIVE: To assess the knowledge and attitude of women of reproductive age towards child adoption in Zaria, Northern Nigeria. METHODOLOGY: A cross-sectional descriptive study, structured closed and open ended questionnaires was administered to 200 consenting consecutive women aged 15-49years to obtain information on socio-demographic characteristics, reproductive profile, knowledge and attitude towards child adoption. Data was analysed using SPSS V17 with p value set at 0.05. RESULTS: The majority 89.4% of respondents have heard and are aware of child adoption and 77% agreed it is a good practice. The most prevalent source of information is the Mass media in 35.0% of respondents. The female gender is preferred by majority 64.2% of respondent if they will adopt. There is a strong association between numbers of living children and willingness to consider child adoption with P value < 0.05. CONCLUSION: There is a high level of knowledge and acceptability of child adoption practices in our environment. Child adoption institutions should therefore be supported to meet the need of the infertile couples.

Application of queuing theory to patient satisfaction at a tertiary hospital in Nigeria.

BACKGROUND: Queuing theory is the mathematical approach to the analysis of waiting lines in any setting where arrival rate of subjects is faster than the system can handle. It is applicable to healthcare settings where the systems have excess capacity to accommodate random variations. MATERIALS AND METHODS: A cross-sectional descriptive survey was done. Questionnaires were administered to patients who attended the general outpatient department. Observations were also made on the queuing model and the service discipline at the clinic. Questions were meant to obtain demographic characteristics and the time spent on the queue by patients before being seen by a doctor, time spent with the doctor, their views about the time spent on the queue and useful suggestions on how to reduce the time spent on the queue. A total of 210 patients were surveyed. RESULTS: Majority of the patients (164, 78.1%) spent 2 h or less on the queue before being seen by a doctor and less than 1 h to see the doctor. Majority of the patients (144, 68.5%) were satisfied with the time they spent on the queue before being seen by a doctor. Useful suggestions proffered by the patients to decrease the time spent on the queue before seeing a doctor at the clinic included: that more doctors be employed (46, 21.9%), that doctors should come to work on time (25, 11.9%), that first-come-first served be observed strictly (32, 15.2%) and others suggested that the records staff should desist from collecting bribes from patients in order to place their cards before others. The queuing method employed at the clinic is the multiple single channel type and the service discipline is priority service. The patients who spent less time on the queue (<1 h) before seeing the doctor were more satisfied than those who spent more time (P < 0.05). CONCLUSION: The study has revealed that majority of the patients were satisfied with the practice at the general outpatient department. However, there is a need to employ measures to respond to the suggestions given by the patients who are the beneficiaries of the hospital services.

Congenital vaginal obstruction in neonates and infants: recognition and management.

BACKGROUND: Congenital vaginal obstruction commonly presents after puberty and presentation in infancy is uncommon. Due to lack of awareness, diagnosis may be missed in infants, sometimes with disastrous consequences. METHOD: A retrospective review of 9 neonates and infants treated for congenital vaginal obstruction in 16 years. RESULTS: The patients were aged 2 days to 4 months (median 28 days) at presentation. The main presenting feature was a lower abdominal mass, producing intestinal and urinary obstruction in 7 patients. In 2 patients, other conditions were suspected and diagnosis made only intraoperatively and in one patient, diagnosis was incidental during treatment for another condition. The cause of vaginal obstruction were low transverse vaginal septum 6, imperforate hymen 2, high transverse vaginal septum one. Associated anomalies were present in 5 patients (persistent cloaca 3, Hirschsprung disease 1, polydactyly 1). Low vaginal septum was treated by incision and drainage of hydrometrocolpos, imperforate hymen by hymenotomy and drainage of hydrometrocolpos and high vaginal septum by excision. There was recurrence of hydrometrocolpos in one patient who had low vaginal septum, requiring repeat surgery. One patient, in whom diagnosis was missed, died from overwhelming infection. Short term follow-up was good. CONCLUSION: Congenital vaginal obstruction is an uncommon presentation in this setting. Missing the diagnosis can lead to disastrous consequences. A high index of suspicion is required for prompt recognition and treatment.

Computer knowledge amongst clinical year medical students in a resource poor setting.

OBJECTIVE: To study the computer knowledge and desires of clinical year medical students at one of the oldest and largest medical schools in Nigeria. DESIGN: A survey using validated structured questionnaires. SETTING: Medical school of Ahmadu Bello University, Zaria, Nigeria. SUBJECTS: Two hundred and thirty seven clinical year (4th, 5th and 6th years) medical students. OUTCOME MEASURES: Computer knowledge, mode of acquiring computer knowledge, regular access to computer, desire for inclusion of computer training in curriculum. RESULTS: One hundred twenty (50.6%) students had knowledge of computer technology and it use. Of these, 108 (90%) had no regular access to a computer and none owned a computer; only 32 (26.7%) were sufficiently familiar with computer tools to perform advanced tasks, but 72 (60%) were comfortable with word processing. Seventy two of the 120 students acquired their computer knowledge through self-learning efforts while 45 (37.5%) attended short periods of formal training. Overall, 45.7% of males and 64.5% of females had computer knowledge. The main reason for lack of computer knowledge was lack of time and lack of access to a computer. Eighty percent of all students would like computer education to be included in medical school curriculum. CONCLUSION: Knowledge and use of computers amongst clinical year medical students in this setting is low. It is important that computer education be taught to the students to enhance their ability to use electronic information and communicate more effectively using computer resources.

Providing safe surgery for neonates in sub-Saharan Africa.

Advances in neonatal intensive care, total parenteral nutrition and improvements in technology have led to a greatly improved outcome of neonatal surgery in developed countries. In many parts of sub-Saharan Africa, however, neonatal surgery continues to pose wide-ranging challenges. Delivery outside hospital, delayed referral, poor transportation, and lack of appropriate personnel and facilities continue to contribute to increased morbidity and mortality in neonates, particularly under emergency situations. Antenatal supervision and hospital delivery needs to be encouraged in our communities. Adequate attention needs to be paid to providing appropriate facilities for neonatal transport and support and training of appropriate staff for neonatal surgery. Neonates with surgical problems should be adequately resuscitated before referral where necessary but surgery should not be unduly delayed. Major neonatal surgery should as much as possible be performed by those trained to operate on neonates. Appropriate research and international collaboration is necessary to improve neonatal surgical care in the environment.