Predictors of postpartum depression among an obstetric population in South-Western Nigeria.

BACKGROUND: Perinatal maternal depression is the most common mood disturbance associated with pregnancy. It has grave consequences on both maternal health and wellbeing of offsprings, albeit usually neglected in low- and middle-income countries. OBJECTIVE: To evaluate the relationship between antenatal depression(APD) and postpartum depression(PPD) and predictors of postpartum depression among an obstetric population in South-western Nigeria. METHODS: This was a prospective longitudinal cohort study involving272 pregnant women recruited between 34 and 36 weeks of pregnancy and followed up to till 6 weeks after delivery. Edinburgh Postnatal Depression Scale (EPDS) questionnaires were administered to collect data. Data were analysed with SPSS version 23.A p-value < 0.05 was taken as statistically significant. RESULTS: The prevalences of antepartum and postpartum depression were 6.3%, (95% CI 3.4%-9.2%) and 8.8% (95% CI 5.4%-12.1%) respectively. The Spearman correlation coefficient for antepartum EPDS and postpartum EPDS scores was 0.52, p < 0.001.The predictors of postpartum depression were antepartum depression (adjusted OR 10.6, 95% CI 8.33-48.60, p < 0.001), puerperal sepsis (adjusted OR 4.33, 95% CI 3.89-8.69, p = 0.03), domestic violence (adjusted OR 3.40, 95% CI 1.94-15.67, p = 0.01) and age group 25-34 years (adjusted OR 0.11, 95% CI 0.02-0.75, p = 0.02), and household income $1671-$3330 (adjusted OR 0.10, 95% CI 0.02-0.56, p = 0.01). CONCLUSION: There was a positive association between the antenatal EPDS and postnatal EPDS scores. Screening for maternal depression should be considered in prenatal period. Further studies are necessary to explore the novel finding of predictive role of puerperal sepsis in PPD.

Adverse birth outcomes among women exposed to intimate partner violence in pregnancy in Ikere-Ekiti, South-west Nigeria: A prospective cohort study.

OBJECTIVE: Studies on birth outcomes associated with intimate partner violence in pregnancy in Nigeria are scarce. We aimed to evaluate adverse birth outcomes among women exposed to intimate partner violence in pregnancy in a Nigerian population. STUDY DESIGN: We performed a prospective cohort study involving 363 women with singleton pregnancies presenting for antenatal care between March 2019 and September 2019. Intimate partner violence was assessed with a validated self-administered questionnaire- ongoing abuse screen. We compared adverse birth outcomes between women that experienced intimate partner violence in pregnancy and those that did not. Multivariate logistic regression was used to adjust for confounders. RESULTS: Of the 363 pregnant women that completed the study, 56(15.4%) experienced intimate partner violence in pregnancy. Women who experienced intimate partner violence in pregnancy were significantly more likely to experience composite adverse birth outcome (53.6% compared with 20.2%,adjusted OR 4.72, 95% CI: 2.43-9.19, p < 0.001) preterm delivery (26.8% compared with 13.4%,adjusted OR 2.96, 95% CI: 1.34-6.50, p = 0.007), stillbirths(17.9% compared with 3.3%,adjusted OR 9.52, 95% CI: 3.96-22.90, p < 0.001) and neonatal intensive care unit admission (32.1% compared with 19.9%, adjusted OR 1.93, 95% CI: 1.19-10.60, p = 0.03). Mode of delivery and low birth weight did not differ significantly between the two groups. CONCLUSION: Intimate partner violence is associated with increased risk of preterm delivery, stillbirth and neonatal intensive care unit admission. There is a need to evaluate the effect of interventions on these adverse birth outcomes.

Predictors of Maternal Preference for Sex-Selective Pregnancy Termination in a Developing Nation with Restrictive Abortion Laws.

INTRODUCTION: The rapid and unexpected increase in the sex ratio at birth in Nigeria between 1996 and 2014 is yet to be fully explained. The contribution of sex-selective abortion has not been explored. METHODS: A cross-sectional survey of pregnant women was employed to address this need. RESULTS: Preference for sex-selective abortion was noted in 8.6% of the respondents. The association between parity ≥ 4 and preference for sex-selective abortion was statistically significant. Women who were child gender-biased were significantly more likely to prefer sex-selective abortion. Experiencing intimate partner violence, and having problems with in-laws for inability to give birth to their desired gender, were predictors of maternal preference for sex-selective abortion. Women who preferred sex-selective abortion, however, felt it was necessary to campaign against gender preference. CONCLUSION: Preference for sex-selective abortion exists in Nigeria, despite our restrictive abortion laws. However, the women's underlying reasons may include gender balancing in the family and an escape from discrimination. Improving contraceptive uptake, restriction of disclosure of fetal sex for non-medical indications, and sanctions against violent partners/oppressive in-laws are advocated. Rapid progress towards achieving a world free of the offensive gender inequalities that force women to opt for sex-selective abortion ab initio is desirable.

Perceptions and Practice of Early Diagnosis of Sickle Cell Disease by Parents and Physicians in a Southwestern State of Nigeria.

BACKGROUND: Early sickle cell disease (SCD) diagnosis has shown promise in combating SCD in many countries. The aim of this study was to assess the practice and perception of early SCD diagnosis among a group of parents and physicians in Nigeria. Patients and Methods. This was a cross-sectional descriptive study conducted to assess the opinions and practice of early diagnosis of SCD among 135 physicians caring for SCD patients and 164 mothers of children with SCD in a southwestern state of Nigeria. RESULTS: Most physicians 132 (97.8%) were aware of prenatal SCD diagnosis, but only 51 (37.8%) would recommend it. Most physicians 129 (95.6%) routinely recommend premarital SCD genetic counseling and testing, and 89 (65.1%) were aware of the national government newborn screening program but lesser proportion 75 (55.6%) were willing to recommend it. Amongst the mothers, 154 (94%) and 158 (96%) had encountered genetic counseling for SCD and were willing to offer newborn screening to their children, respectively. On the contrary, fewer mothers 42 (25%) were aware of prenatal SCD diagnosis, 28 (17%) were willing to partake in it, and 44 (26%) were undecided. There were discrepancies in the willingness by physicians to practice early SCD diagnosis and its uptake by mothers (p < 0.0001). The commonest reason given by both the physicians and mothers for not practicing SCD prenatal diagnosis was the high cost of the procedure. CONCLUSION: The perceptions and practice of early SCD diagnosis was suboptimal in the study locality. Scaling up awareness and universal coverage are required.

Poor prenatal service utilization and pregnancy outcome in a tertiary health facility in Southwest Nigeria.

INTRODUCTION: Poor prenatal service utilization is common in developing countries. However, the predictors and pregnancy outcomes of poor utilizers have not been fully examined in our setting. METHODS: Poor and good prenatal service utilizers were compared with respect to demographic characteristics and pregnancy outcomes in Ado-Ekiti, Nigeria. RESULTS: Poor utilizers were significantly more likely to be single mothers, with unemployed husbands/partners, but less likely to have labour induction compared with good utilizers. Also, the women with fewer than four antenatal visits had significantly more babies with low birth weight (18% versus 9.8%, p = 0.003), and 5-minute Apgar scores less than 7 (17.9% versus 10.1%, p = 0.023). Multivariate regression analysis revealed that having an unemployed husband/partner (adjusted odds ratio (AOR): 2.33; 95% Confidence Interval (C.I.): 1.24 - 4.38; p = 0.009), with low birth weight babies (AOR: 1.66; 95% C.I.: 1.01 - 2.73; p = 0.045), and delivering without induction of labour (AOR: 4.27; 95% C.I.: 2.38 - 7.64; p < 0.001) were independently associated with poor prenatal service utilization. CONCLUSION: Efforts devoted to identifying women who are likely to be non- and poor-utilizers of prenatal care are recommended. Scaling up awareness campaigns on maximizing the benefits of prenatal care, increasing the content quality of antenatal visits to give women a positive pregnancy experience and implementing a National Health Insurance package that strategically targets the most socially underprivileged classes are advocated to promote safe motherhood and the objectives of antenatal care.

Randomised Controlled Trial of Sublingual and Rectal Misoprostol in the Prevention of Primary Postpartum Haemorrhage in a Resource-Limited Community.

BACKGROUND/PURPOSE: Misoprostol is beneficial in preventing postpartum haemorrhage (PPH). However, there is no consensus yet as to which route will give the balance of efficacy, safety and patient preference, especially at the recommended dose of 600 mcg. This study compared the efficacy and adverse effects of rectal and sublingual misoprostol for the prevention of PPH. METHODS: In a prospective fashion, consenting eligible parturients were randomised into two groups to receive either 600 mcg of misoprostol rectally or sublingually after vaginal delivery. All study participants were followed up till 24 h postpartum. Primary outcomes were blood loss of 500 ml or greater and at least 10% change in peripartum haematocrit levels. RESULTS: Seven (6.7%) and 16 (15.7%) of the sublingual and rectal routes, respectively, had PPH. However, the odds of having PPH after rectal misoprostol were at least twice the odds after the sublingual route (p = 0.041). Also, the mean blood loss after the first, fourth and 24th hour postpartum were significantly higher after rectal administration. Although significantly more patients had shivering and pyrexia after sublingual misoprostol, it was acceptable to more participants than the rectal route. CONCLUSION: At the recommended dose, sublingually administered misoprostol ('the sweet of life') is associated with a lower incidence of PPH than the rectal route. Despite its higher incidence of shivering and pyrexia, it was accepted by more women than rectally administered misoprostol.ClinicalTrials.gov identifier PACTR201911500348367.

Obstetric Correlates of Maternal Falls in Southern Nigeria.

Falls during pregnancy can be associated with serious obstetric complications. Apart from sparse data highlighting traumatic outcomes, there are no studies identifying the obstetric correlates of maternal falls in Nigeria. A cross-sectional cohort survey of 1,175 women in five public health facilities in Ado-Ekiti was conducted to address this need. Fall rate was 25%; mothers who fell during pregnancy were significantly older, of higher parity, and with unintended/unwanted pregnancies than those who did not fall. Most of the reported falls occurred in the third trimester, with about 10% of the women falling at least thrice during the course of the pregnancy. More than half of the reported falls occurred while engaging in household chores and carrying child/object with compromised visibility of the feet and floor. Uterine contractions/abdominal pain was the commonest; 29 (76.3%), obstetric event attributed to the falls. Antepartum haemorrhage, 4 (10.5%), and ruptured membranes, 2 (5.3%), also occurred after falls, although it was rare and occurred with the same frequency as in the general population. Maternal age ≥ 30 years (odds ratio: 1.36; 95% C.I. 1.03 - 1.80, p = 0.031), multiparity (odds ratio: 1.54; 95% C.I. 1.15 - 2.07, p = 0.004), unintended pregnancy (odds ratio: 1.48; 95% C.I. 1.02 - 2.15, p = 0.037), and delivery age ≤ 40 weeks (odds ratio: 1.71; 95% C.I. 1.07 - 2.75, p = 0.026) were found to be independent risk factors for falls during pregnancy. Fall awareness campaigns and fall-preventing safety tips are advocated in women's clinics. Improving contraceptive uptake will reduce unintended pregnancies and the risk of pregnancy-related fall/injuries.

Clinical suspicion, management and outcome of intrapartum foetal distress in a public hospital with limited advanced foetal surveillance.

OBJECTIVES: To determine the basis for the clinical suspicion of foetal distress, the instituted managements and delivery outcome in a tertiary hospital in sub-Saharan Africa with limited capability for advanced foetal monitoring. METHODS: It is a 3-year retrospective analysis of all the obstetrics cases with intrapartum foetal distress. RESULTS: There were 301 cases reviewed. The birth asphyxia incidence rate was 233/1000 live births and the perinatal death rate was 47/1000 live births. Suspicion of foetal distress was premised on the presence of persistent tachycardia or bradycardia during intermittent auscultation. Main resuscitative measures were left lateral repositioning of patient, fast saline infusion, intranasal oxygen administration and discontinuation of oxytocin infusion, if any. Only 124 (41.2%) of all the cases had delivery achieved within 2 h of diagnosis. Mean decision-delivery interval by caesarean section was 2.93 ± 2.05 h. Socio-demographic factors (p= 0.001) and pregnancy risk category (p = 0.002) influenced incidence of birth asphyxia. CONCLUSION: To reduce subsisting high perinatal morbidity and mortality in sub-Saharan Africa, it is best that at the least referral hospitals should have advanced facilities for foetal monitoring and shortened surgical intervention time.

Antenatal drug consumption: the burden of self-medication in a developing world setting.

This institutional-based cross-sectional study examines the burden of self-medication during pregnancy in a middle-income country setting and the impact on fetal wellbeing. Using a blend of open-ended and indication-oriented questionnaires, 346 pregnant women at term were interviewed about their pregnancy complaints and drug intake. Inferential statistical data analysis was employed with level of significance (α) set at 0.05. Excluding routine supplements and vaccinations, 251 (72.5%) women used medicines, of whom 79 (31.5%) had self-medicated. Consuming drugs without prescription was associated with increased US Food & Drug Administration (FDA) risk category (χ2 = 8.375; P = 0.015). There is therefore a need to scale up efforts towards educating women about the dangers of self-medication, while also introducing effective restrictive policies on over-the-counter drug sales.

Baird-Pattinson Aetiological Classification and Phases of Delay Contributing to Stillbirths in a Nigerian Tertiary Hospital.

PURPOSE: This study aims to identify triggers of stillbirth in the study setting and to make suggestions to reduce the prevalence. METHOD: A three-year retrospective case-control study of stillbirths at Ekiti State University Teaching Hospital. RESULTS: The stillbirth rate was 33 per 1000 births. Based on Baird-Pattinson classification of the primary obstetric causes of stillbirth, adverse intrapartum events, hypertensive diseases, and unexplained intrapartum fetal deaths were topmost causes of stillbirths. In comparison with the controls, other identified predictors of SB were grand multiparity (p = 0.016), delays in seeking medical care and/or in receiving treatment (p = 0.001), wrong initial diagnosis (p = 0.001), inadequate intrapartum monitoring (p = 0.001), and inappropriate clinical management (p = 0.001). CONCLUSION: Stillbirth rate remains high in our setting. Elimination of obstacles to accessing care, effective management of hypertensive disorders in pregnancy, updated health facilities, improved dedication to duty, and retraining of health workers will reduce the prevalence.

Awareness and practice of emergency contraception at a private university in Nigeria.

BACKGROUND: The pursuit of formal education now causes many people in developing countries to marry later in life, thereby leading to increased premarital sex and unintended pregnancies. Efforts have been made to characterize awareness and use of emergency contraception (EC) among undergraduate students in public universities in Nigeria; however, it is not known if students in private tertiary institutions adopt different practices or if having an affluent family background plays a role. This pilot study therefore aimed to assess the awareness and use of EC among students at a private Nigerian university toward assisting education planners in developing strategies in improving students' reproductive well-being. RESULTS: Out of 94 female students, 42 (44.7%) had sexual experience, but only 32 (34.0%) were currently sexually active. Six students (6.4%) had had unwanted pregnancies, of which all but one were terminated. Fifty-seven respondents (60.6%) were aware of EC, though only 10 (10.6%) ever practiced it. The greatest source of EC information was from health workers and peers; the lowest source was family or relatives. Most respondents desired orientation and availability of EC on campus. EC awareness among the students was predicted by upper social class background (adjusted odds ratio [OR], 2.73; 95% confidence interval [CI], 1.06-7.45) and upbringing in the Federal Capital Territory (adjusted OR, 4.45; 95% CI, 1.56-14.22). CONCLUSIONS: Though awareness of EC was higher among the private university students in this study than at most public universities, there was no difference in EC usage. A high pregnancy termination rate was observed; dilatation and curettage were mainly adopted. In Nigeria, youth-friendly reproductive health information and access should not be limited to government-owned tertiary institutions but also extended to private ones.

Screw driver: an unusual cause of cervical spinal cord injury.

Non-missile penetrating spinal injuries are rare. Screw driver injury, more especially to the cervical spine, represents an even rarer subset. To our knowledge, this is the first reported case from West Africa of cervical spinal cord injury from a screw driver. A middle-aged man was stabbed from the back with a screw driver. He presented with right-sided C4 Brown-Sequard syndrome with the impaling object in situ. Cervical spine x-rays showed the screw driver to have gone into the spine between the spinous processes of C4 and C5, traversing the spinal canal and lodged in the anterior part of the C4/5 intervertebral disc space. C4 and C5 laminectomies were performed and the screw driver removed under vision. The object was found to have traversed the right side of the cervical spinal cord. The dural tear was repaired. He had some neurologic improvement initially, but later declined. He died from severe pulmonary complications 2 weeks postinjury. Screw driver represents an unusual cause of non-missile penetrating cervical spinal injury. Its neurological effects and complications of the cord injury lead to significant morbidity and mortality.