Gender attitude to the empowerment of women: an independent right to contraceptive acceptance, choice and practice.

Multiple factors influence the acceptance, choice and utilisation of contraceptive. The objective of the study is to identify individual attitude towards the empowerment of women to an independent right to accept, choose and utilise a contraceptive method of their choice without recourse to their male partners. This is a cross sectional study of men and women of different socio-cultural background working or utilising the services of the Federal Medical Centre Gombe, Nigeria. There were 554 respondents. Only 187 (34.4%) respondents thought that all women, irrespective of marital status, should have an independent right to contraceptive acceptance, choice and practice. Significantly more men (85.4%) than women (61.8%) rejected that women should have an independent right to contraceptive acceptance, choice and practice. Majority of both gender favoured male influence in the acceptance and choice of method of contraception. Our study has re-echoed the importance of male involvement in contraception decision-making.

Prevalence of utero-tubal infertility.

SUMMARY: Tubal factor infertility is the commonest cause of infertility seen in gynaecological clinics in Nigeria. This, to a large extent, is a preventable cause of infertility. The objective of the study was to determine the prevalence of utero-tubal factors in the causation of infertility. This is a prospective descriptive study of infertile women seen at the gynaecological clinic of the Federal Medical Centre Gombe from June 1999 to May 2002. A total of 229 infertile women were studied. The prevalence of primary and secondary infertility was 37.1% and 62.9%, respectively. Tubal factor was the cause in 67.2% and cervical factors contributed to 19.2%. The women were aged 17-44, with a mean of 28.6 +/- 5 years. There were four (1.7%) teenagers and eight (3.5%) women were aged 40 years or above. The majority, 55% (126), were in their third decade, with those aged 20-34 years constituting 86% (197) of patients. The high prevalence of tubal factor infertility in our environment is unacceptable. Primary prevention of reproductive tract infections and syndromic management of STD will go a long way in reducing the high prevalence of tubal factor infertility.

Caesarean delivery at the Federal Medical Centre Gombe: a 3-year experience.

BACKGROUND: Caesarean delivery carries a higher morbidity and mortality than vaginal delivery. This first audit of caesarean delivery in our centre will be compared with previous studies around the world. Our objective is to document the indications and outcome of caesarean delivery. METHOD: This was a retrospective study of patients who had caesarean delivery in Federal Medical Centre Gombe, from January 2001 to December 2003. The biosocial characteristics, indication for surgery, booking status, number and type of caesarean deliveries, type of uterine incision, complications, and cadre of surgeon and duration of hospital stay were obtained for each patient. RESULTS: 264 caesarean deliveries were performed, 250 cases made the criteria for inclusion. There were 2,172 total deliveries during the study period giving a caesarean delivery rate of 12.2%. The majority, 181 (72.4%) of the patients had emergency caesarean delivery while 69 (27.6%) had elective caesarean delivery. The commonest indication for caesarean delivery was cephalopelvic disproportion (20.8%), followed by preeclampsia/eclampsia (18.8%) and ante partum haemorrhage (14.4%). Others were fetal distress (8.8%), and previous caesarean delivery (7.2%). Majority of the patients, 104 (41.6%) were booked with the Federal Medical Centre Gombe, 88 (35.2%) booked elsewhere and 58 (23.2%) were unbooked. Twenty one (8.4%) had complications of which wound infection 11 (5.2%) was the commonest morbidity encountered. There were two maternal deaths and twenty one perinatal deaths giving a maternal and perinatal mortality rates of 800/100,000 and 82/1000 respectively. CONCLUSION: The indications for caesarean delivery in our study are comparable to findings from other parts of the world. The high emergency caesarean delivery rate among those booked elsewhere is a cause for concern. Health education could reduce the number of emergency caesarean deliveries. Consequently this might reduce the high infectious morbidity associated with the procedure in this study.

Risk factors for obstetric fistulae in north-eastern Nigeria.

This prospective comparative study of obstetric fistulae (OF) was aimed at identifying risk factors. A total of 80 obstetric fistulae treated at the gynaecological unit of the FMCG, and 80 inpatients without fistulae recruited randomly as controls formed the basis of this study. Through interview and case record review, information on age, parity and marital status was collected. Other features were educational status, occupation and booking status of the pregnancy that might have led to this condition. The duration of labour, place of birth and mode of delivery, including its outcome were also collected. The data were analysed using the Epi Info. The majority of the patients were Hausa/Fulani 87.5%, Muslims 91.2%, with large vesicovaginal fistulae (average size 5.0 cm) mainly resulting from obstructed labour (93.7%). Major risk factors included early age at first marriage (average 14 years), short stature (average height 146.2 cm) and illiteracy (96.3%). Also low social class and lack of gainful employment were factors. Failure to book for antenatal care (93.7%), and rural place of residence (95%) were also factors associated with acquiring the fistulae. Living far away (>3 km) from a health facility also contributed or predisposed to the development of an obstetric fistula. Social violence and stigma associated with the fistulae included divorce, being ostracised as a social outcast, and lack of assistance from relations in terms of finding and funding treatment. This study supports improved access to basic essential obstetric care, family planning services, and timely referral when and where necessary. Universal education will provide a long-term solution by improving the standard of living and quality of life. Especially important are media- and community-based programmes on the ills of teenage marriage and child pregnancy using cultural and religiously-based values to give sound advice. In a male dominated society, reaching out to men with traditionally palatable messages that will change their attitude and practices to taking responsibility in reproductive health could be a winning strategy.

Heterotopic pregnancy in a natural conception cycle. A case report.

We report a case of combined intrauterine and tubal pregnancy in a 32 year old para. The patient presented at the Gynaecological emergency unit, with lower abdominal pain, and vaginal bleeding. A pelvic scan confirmed an intrauterine pregnancy. While being managed as a case of threatened abortion, her condition deteriorated and the likelihood of an ectopic pregnancy was entertained. A repeat scan revealed significant peritoneal collection. suggestive of haemoperitoneum, and laparotomy confirmed heterotopic pregnancy. She had a right salpingectomy without complications. The patient had a supervised antenatal care and safe delivery of the intrauterine pregnancy.

The analysis of eclamptic morbidity and mortality in the Specialist Hospital Gombe, Nigeria.

A retrospective review of 302 cases of eclampsia treated at the Specialist Hospital Gombe (SHG), between January 1st 1997 and December 31st 1999 is presented. Intrapartum eclampsia was the commonest presentation, occurring in 166 (55.0%) patients. Headache, blurred vision, and epigastric pain preceded the first episode of seizure in 272 (90.0%) of the cases. The diastolic blood pressure of 110 mmHg or more was recorded in 102 (33.8%) of the study group. Eclampsia was more common among teenage mothers 202 (66.9%), and primigravidae 222 (73.5%). Spontaneous vaginal delivery occurred in 159 (52.6%) of the patients. Caesarean section was performed in 122 (40.4%) of the cases. Pyrexia was the commonest morbidity. There were 35 maternal deaths giving a case fatality rate of 11.6%. There were 111 (36.8%) perinatal deaths during the study period. Expanded sections in mass media education of the general populace and counselling young women on care during pregnancies are suggested. The provision and use of life-saving treatment is paramount, at the same time efforts towards eliminating the conditions that created the unbooked emergencies are crucial.

Obstructed labour: a public health problem in Gombe, Gombe State, Nigeria.

This study reviewed retrospectively the cases of obstructed labour as seen at the specialist Gombe Hospital (SHG), Gombe State, over a period of 5 years. The incidence of obstructed labour was 4.0%. There was a progressive decline in the time trend over the study period. About 80.3% of the patients were unbooked emergencies and 99.5% of them had been in labour elsewhere before presenting at the hospital. The leading cause of obstructed labour was cephalopelvic disproportion (83.0%). Caesarean section (72.2%) was the most common method of delivery. Puerperal sepsis was the most frequent morbidity. However, the longest duration of hospital stay was as a result of a bedsore. The maternal mortality for cases of obstructed labour was 7605/100,000 and the perinatal mortality was 628/1000 births. The study aims to reinstate public interest in this health problem and offers suggestions on how to curb this human tragedy.

Study of the immunopotentiator effects of dialyzable leukocyte extracts obtained out of leukocytes previously used for interferon production.

The existence of immunopotentiator factors able to induce blastogenesis, chemotaxis and able of inhibiting migration of leukocytes was investigated in alcohol precipitates of different batches of dialyzed leukocyte extracts (DLE). These were prepared either out of fresh leukocytes from a large pool of buffy coats obtained from all blood collected from healthy donors with irrelevant antigen sensitiveness (DLE-NS) or from similar leukocytes which were incubated during 19 h for interferon production (DLE-NS-I). Alternatively, the same factors were investigated on a batch of DLE obtained from a donor exquisitely sensitive to Candida antigen (C-DLE-CS). It was observed that all the three batches contained equal amounts of either specific or nonspecific immunological enhancing factors. The similarity of the intensity of specific factors between the so-called nonspecific batches (DLE-NS and DLE-NS-I) and the specific batch (C-DLE-CS) was interpreted to be the result of the random selection of the donors for the preparation of the nonspecific batches, which consequently contain randomized relevant specificities. It is postulated, therefore, that batches of DLE which represent a large waste of leukocytes used for interferon production can be a useful tool for double-blind DLE therapy purposes.