Decisional Conflict amongst Women Undergoing Caesarean Section in Health Facilities in Ibadan, Nigeria.

BACKGROUND: Despite the global trend of increasing caesarean section rates, aversion to this procedure is common among Nigerian women. This gives rise to conflict during counselling and consent taking for the procedure. OBJECTIVE: This study was done to assess decisional conflict in women undergoing caesarean section. METHODS: This was a prospective cross-sectional study among four hundred and seven booked women undergoing elective caesarean section at secondary and tertiary health facilities in Ibadan, Nigeria. A multi-stage sampling method was used in the selection of participants and informed consent was obtained. The survey instrument was an interviewer-administered questionnaire during the counselling session before the surgery. The decisional conflict scale (DCS), low literacy version was used to quantify decisional conflict. Data was entered into SPSS version 21. The statistical level of significance was set at less than 5%. RESULTS: Most (73.5%) participants booked late for antenatal care and had a tertiary level of education (67.6%). A majority, 316 (77.6%) were not accompanied to antenatal visits. The husband (58.7%) was the sole decision maker with respect to health issues. Eighty-six participants (21.1%) experienced significant decisional conflict. The mean decisional conflict score in those who experienced decisional conflict was 41.1 ± 14.6. Recruitment site (p<0.001), educational level (p=<0.001), and family fecundity (p=0.009) were predictive of having decisional conflict. CONCLUSION: One in five women undergoing caesarean section experience significant decisional conflict, so we recommend the application of the decisional conflict scale to improve counselling of patients having difficulties in giving informed consent.

CONTEXTE: Malgré la tendance mondiale à l'augmentation des taux de césarienne, l'aversion pour cette procédure est courante chez les femmes nigérianes. Cela donne lieu à des conflits lors du conseil et de l'obtention du consentement à l'intervention. OBJECTIF: Cette étude a été réalisée pour évaluer les conflits décisionnels chez les femmes qui subissent une césarienne. MÉTHODES: Il s'agit d'une étude transversale prospective portant sur quatre cent sept femmes inscrites pour une césarienne élective dans des établissements de santé secondaires et tertiaires d'Ibadan, au Nigeria. Une méthode d'échantillonnage à plusieurs niveaux a été utilisée pour sélectionner les participantes et le consentement éclairé a été obtenu. L'instrument d'enquête était un questionnaire administré par un enquêteur lors de la séance de conseil avant l'intervention chirurgicale. L'échelle de conflit décisionnel (DCS), version faible niveau d'alphabétisation, a été utilisée pour quantifier le conflit décisionnel. Les données ont été saisies dans SPSS version 21. Le niveau de signification statistique a été fixé à moins de 5 %. RÉSULTATS: La plupart (73,5 %) des participantes ont pris des rendez-vous tardifs pour des soins prénatals et avaient un niveau d'éducation tertiaire (67,6 %). La majorité, 316 (77,6%), n'étaient pas accompagnées lors des visites prénatales. Le mari (58,7%) était le seul à prendre des décisions en matière de santé. Quatre-vingt-six participantes (21,1 %) ont connu un conflit décisionnel important. Le score moyen de conflit décisionnel chez celles qui en ont fait l'expérience était de 41,1 ± 14,6. Le lieu de recrutement (p= 0,000), le niveau d'éducation (p=0,000) et la fécondité de la famille (p=0,009) étaient des facteurs prédictifs de conflit décisionnel. CONCLUSION: Une femme sur cinq subissant une césarienne est confrontée à un conflit décisionnel important. Nous recommandons donc l'application de l'échelle de conflit décisionnel pour améliorer le conseil aux patientes ayant des difficultés à donner leur consentement éclairé. Mots-clés: Conflit décisionnel, césarienne, établissement de santé, consentement éclairé, confessionnel.

KNOWLEDGE OF EMERGENCY CONTRACEPTION AND PREDICTORS OF ITS USE AMONG FEMALE UNDERGRADUATES IN TWO NIGERIAN UNIVERSITIES.

Background: Unintended pregnancies contribute to the high burden of unsafe abortion, maternal deaths and morbidities among undergraduates. Objective: To assess the determinants of good knowledge and evaluate the trends in the practice of Emergency Contraception (EC) among female undergraduates. Methods: This was a cross sectional study involving four hundred and twenty female undergraduates from two universities in Ibadan, Nigeria. Participants were recruited from their hostels and classrooms. Data collection was done using self-administered questionnaires and good knowledge was defined as three correct answers to five questions testing knowledge. The questionnaires also addressed their practices of EC. The data was stored on the computer, cleaned and analyzed using the Statistical Package for the Social Sciences (SPSS) version 22. Statistical significance was set at p <0.05. Results: Two hundred and fourteen (51.0%) participants were aware of EC and the common sources were friends (43.4%), media (42.9%) and pharmacies (42.0%). One hundred and sixty-four participants (39.1%) had good knowledge of EC. Participants in the age group 20-24 years, second year of study, those who were aware of EC and had ever used EC were associated with good knowledge. Less than half (48%) of the sexually active participants used EC in the past six months and Levonogestrel (51%) was the commonest EC used. Menstrual irregularity and abdominal pain were the major side effects of EC. Conclusion: The practice of EC is poor and with poor knowledge demonstrated among female undergraduates. There is therefore the need to improve information and access to EC in the university community.

Breast self-examination practices in Nigerian women attending a tertiary outpatient clinic.

BACKGROUND: The morbidity and mortality caused by breast cancer can be decreased by early detection with breast self-examination (BSE). The objective of this study was to determine the prevalence and the factors determining the practice of BSE. MATERIALS AND METHODS: The study was conducted on 140 women aged above 18 years who presented consecutively in a General Outpatient's clinic in a tertiary hospital in Nigeria. This was the baseline study from an intervention study which looked at the effect of demonstration of BSE on improving Clinical Breast Examination (CBE) among two groups of respondents. Structured questionnaires were validated and administered by an interviewer and the data were analyzed using Statistical Package for Social Sciences (SPSS) version 12. RESULTS: The overall self-reported prevalence of BSE practice was 62.1% among the respondents. Older women (16, 76.2%), married women (63, 65.6%) and women with tertiary education (51, 68.9%) had the highest prevalence of BSE practice. Prevalence rate was highest for civil servant (25, 78.1%), P = 0.04. The practice of BSE was higher among women with a previous history of breast disease (15, 68.2%) and in respondents with a family history of breast disease (7, 63.6%), Only 11 (12.6%) performed BSE as per guidelines, which was once in a month. CONCLUSION: The prevalence of BSE was found to be high, especially in those with tertiary education and in those with a past personal or family history of breast disease. In resource-constrained countries, BSE is a screening tool that can be employed to help reduce the breast cancer burden because routine mammography screening is not yet feasible. Women need to be informed about the when and how to perform BSE.

Primary ovarian pregnancy mimicking abdominal pregnancy.

The objectives of this study were to emphasise that ectopic pregnancy (EP) can occasionally occur in rare sites such as the ovary, and to show that it may be difficult making the diagnosis clinically and radiologically. It also highlighted the benefit of early surgical intervention in reducing mortality and morbidity from this condition. The case was a 31-year-old nulliparous woman who presented with amenorrhoea of 20 weeks and a 2-month history of lower abdominal pain. Radiological studies suggested abdominal pregnancy coexisting with uterine fibroids for which she had an exploratory laparotomy, which revealed a primary right ovarian pregnancy necessitating the performance of right ovariectomy. Locating the sites of EP may still pose a diagnostic challenge. Despite the benefits and reliability of ultrasound scanning, there will still be situations where the definitive diagnosis can only be confirmed at surgery.

Cervical ectopic pregnancy managed with methotrexate and tranexamic acid: A case report.

BACKGROUND: Cervical pregnancy is a rare life-threatening form of ectopic pregnancy and when it occurs, it is challenging to decide the management options. Surgical intervention has been documented to be complicated by intractable haemorrhage and most often necessitating hysterectomy. We hereby report a case of cervical pregnancy managed conservatively with medical agents prior to surgical intervention. CASE PRESENTATION AND MANAGEMENT: A 29 year old primiparous woman with gestational diabetes mellitus who presented at 10 weeks gestation with 5 days history of brownish vaginal discharge and 2 days history of painless vaginal bleeding. On pelvic examination the cervix was disproportionately larger than the uterus with a closed internal os. Transvaginal and abdominal ultrasound scanning confirmed a live cervical pregnancy. She had intramuscular methotrexate and tranexamic acid followed by suction evacuation combined with balloon tamponade. Examination at 6 weeks post procedure revealed a normal cervix. CONCLUSION: Cervical pregnancy still occurs in this environment despite its rarity. Surgical intervention usually results in hysterectomy and adopting medical management as a first line treatment option offers the benefit of uterine preservation.

Acceptability of counselling and testing for HIV infection in women in labour at the University College Hospital, Ibadan, Nigeria.

BACKGROUND: Many patients are referred to labour ward as emergencies, and therefore do not benefit from the antenatal HIV counselling and testing and treatment offered to registered patients. OBJECTIVE: To assess the acceptability and suitability of offering HIV counselling and testing to women of unknown HIV status presenting in labour. METHODS: A cross-sectional study comprising counselling and obtaining consent for HIV testing among 104 unregistered patients who presented in labour over a 3-month period. Rapid and enzyme-linked immunosorbent assay screening was performed for 90 consenting respondents. Reactive results were confirmed by Western blot. Appropriate therapy was instituted. RESULTS: Acceptance rate for HIV testing was 86.5%, prevalence of HIV was 6.7%. Women of lower educational status were more likely to accept testing in labour (OR: 0.3; 95% CI: 0.1-0.7; p=0.01); age, parity, occupation and knowledge of HIV had no influence. Most women (66.3%) had satisfactory knowledge of HIV. No one admitted to feeling coerced to test in fear of being denied care. Most refusals for screening were to avoid needle pricks (28.6%). Compared to ELISA screening test, specificity of the rapid test was 100%, sensitivity 85.7%, positive predictive value 100% and negative predictive value 98.8%. Attitude to testing was maintained on post-partum re-evaluation. CONCLUSION: The prevalence of HIV amongst unregistered parturients showed the importance of offering point-of-care HIV testing and intervention, especially in an environment where antenatal clinic attendance is poor. Rapid testing appeared to be acceptable and feasible in labour to prevent the mother-to-child transmission of HIV.

Clinical audit of knowledge and practice of epidural labour analgesia amongst obstetricians in south-west Nigeria.

Epidural analgesia (EA) is the most ideal method for pain relief during labour. We sought to highlight the current knowledge and practice of the obstetricians regarding epidural labour analgesia (ELA). An audit was conducted amongst obstetricians in two teaching hospitals in the south west of Nigeria. Most of our respondents received lectures about ELA but about half of them rated the lectures as inadequate. Though 37.8% and 53.3% of respondents are of the opinion that there is interference with labour and increased incidence of instrumentation following epidural analgesia in labour respectively, however 84.4% agreed that the technique is not associated with adverse neonatal or maternal outcome and 97.8% will prefer their patients having epidural labour analgesia. We are of the opinion that education regarding ELA, both during and after obstetric speciality training, be improved, and well-established interpersonal relationship between obstetricians and anaesthetists will be needed to achieve this.

Health risks of obesity.

Obesity is becoming of interest as a non-communicable disease. There is however a dearth of information on obesity in this environment, as literature in developing countries is limited. Review of health risks of obesity is useful in order to increase the pool of available information in Nigeria and to draw attention to obesity and its attendant health risks.

Psychiatric morbidity in a pregnant population in Nigeria.

Psychiatric morbidity among 240 pregnant women attending an antenatal unit was assessed by a two-stage screening procedure, using the General Health Questionnaire (GHQ-30) and Present State Examination Schedule (PSE). The prevalence of psychiatric morbidity was found to be significantly associated with younger age (< 24 years), being primigravid, married for less than 1 year, having an unsupportive husband, and a previous history of induced abortion. It is suggested that more attention needs to be paid to the mental health of pregnant women in developing countries (where pregnancy rates and the risks associated with pregnancy/delivery are much higher than in the developed countries) at the primary, secondary, and tertiary levels of health care.

Psychiatric morbidity in a gynaecology clinic in Nigeria.

Psychological disorders among 233 women attending a gynaecology out-patient clinic was assessed by a two-stage screening procedure, using the GHQ-30 and the PSE. The prevalence of psychiatric disorders was found to be 35.2%. Psychiatric morbidity was significantly associated with a history of induced abortion, previous marriages, having no children, complaints of menstrual abnormalities, chronic pelvic pain and having unsupportive husbands. It is suggested that more attention needs to be paid to the psychological health of patients with gynaecological disorders (in line with the biopsychosocial model of health care). This will ensure an overall improvement in the quality of care.

PIP: Many studies in developed countries show a high frequency of psychological distress among women attending gynecology clinics. The aim of this study is to assess the prevalence of psychiatric morbidity among 239 women attending a gynecology clinic at Ilorin Maternity Hospital in Nigeria. The aim also was to test the validity of using the 30-item version of the General Health Questionnaire (GHQ-30) as a screening tool. Clinical diagnoses were recorded according to the International Classification of Diseases-Ninth Edition (ICD-9). Psychiatric morbidity was determined according to the method of Deshpande. Literate respondents used a self-administered GHQ-30 and illiterate respondents were interviewed with the GHQ-30. The psychiatric interview was conducted by a research psychiatrist. Patients were grouped into 1) patients with symptoms diagnoses according to ICD-9, 2) cases with subdiagnostic syndromes, and 3) patients without significant psychiatric symptoms. A basic demographic profile of patients is given. Obstetrics and gynecologic data reveal that 31.3% were nulliparous, 44.5% had between 1 and 4 children, and 24.5% had 5-8 children. 64.4% reported regular menses, 21.9% reported scanty menstrual flow, and 64.4% had a normal flow. 17/6% reported a history of induced abortion, and 43.4% reported previous spontaneous abortion. 23.6% had primary infertility and 28.3% had secondary infertility; infertility was the most common complaint. A score of 5 or higher on the GHQ-30 indicated a psychiatric case. 35/2% were found to suffer from definite psychiatric morbidity. An additional 6.4% had severe psychiatric symptoms. Of the psychiatric diagnoses, 34.1% were for neurotic depression, 24.4% for anxiety, 25.7% for adjustment reaction, 12.2% manic depressive psychosis (depressed type), 2.4% phobic state, and 1.2% schizophrenia. Psychiatric morbidity was found to be unrelated to age, marital status, religion, education, occupational group, or duration of marriage. Symptoms such as irregular menses, pelvic pain, ad having no children were factors significantly associated with psychiatric morbidity; this pattern is supported in the developed country literature. Policy should be directed to a preventive and biopsychosocial model of health care.