Burden and characteristics of domestic violence among males in a sub Saharan African setting.

BACKGROUND: Domestic violence has been a subject of interest worldwide. However, most studies document men as the culprits with little attention given to male victims. This study sought to find out the prevalence and characteristics of domestic violence experienced by men in a sub Saharan African setting. METHOD: This was a cross sectional study using questionnaires administered to 410 men aged 20 - >60 years. RESULTS: Two hundred and twenty-seven (55.4%) of the men have ever experienced domestic violence, and 82.4% of them were verbally and emotionally abused. In 49.8% cases the culprit was their wife/wives, while in others a girlfriend 33 (14.5%) or a mother-in law (11.5%) was responsible. In 90 (39.6%) men, their own parents were also verbally abused by the culprit. Thirty (13.2%) of the 227 men who had experienced abuse were physically abused. Victims usually report the abuse to a third party, mostly to family members. Men aged above 40 years and those educated below tertiary level were more likely to experience domestic violence (p = 0.0001 and 0.014). CONCLUSION: Men are also victims of domestic violence in this setting, but the violence is mostly verbal and psychological in nature. There is need to provide support services for male victims of domestic violence and also encourage them to report their experience of domestic violence in order to obtain help and assistance.

Operative vaginal deliveries in Zaria, Nigeria.

BACKGROUND: Operative vaginal deliveries are frequent features of obstetrics practice in tertiary levels of care even in developing countries. It is essential to review these practices in order to assess their benefits or otherwise to safe motherhood in resource limited settings. STUDY DESIGN: Labor records on operative vaginal delivery cases and matched controls who had spontaneous vaginal deliveries between January 1997 and December 2001 at the Ahmadu Bello University Teaching Hospital, Zaria, Nigeria, were analyzed with respect to mode of delivery, indication for operative vaginal delivery, anesthesia use, fetal 5-min Apgar score, birth weight, fetal, and maternal complications. RESULTS: Of 7,327 deliveries at the center in the study period, 262 (3.6%) were by operative vaginal deliveries. Forceps delivery was most frequently performed (55.7%), while vacuum delivery was found to be in increased use (38.2%). Embryotomy procedures were performed selectively (6.1%). Operative vaginal deliveries were more commonly employed on primigravida (78.6%) compared to multiparas and the most common indication was delayed second stage of labor. Forcep- and vacuum-assisted deliveries were both associated with maternal and newborn complications. There was no significant difference in the use of anesthesia between forceps and vacuum deliveries. CONCLUSION: Operative vaginal delivery rates in this center are comparable to other centers as are the possible complications. Making these procedures safer will improve safe motherhood in settings where there are performed.

The cervical smear pattern in patients with chronic pelvic inflammatory disease.

BACKGROUND: Cancer of the cervix is the commonest malignancy of the genital tract in Nigeria. In an atmosphere of opportunistic screening due to lack of a national screening programme, studies are needed to determine patients at risk of premalignant lesions of the cervix. GOAL: To determine cervical smear pattern in patients with chronic pelvic inflammatory disease and investigate the potential of chronic pelvic inflammatory disease as a risk factor to cervical dysplasia. STUDY DESIGN: Case-control study. SETTING: Department of Obstetrics and Gynaecology, Ahmadu Bello University Teaching Hospital Zaria, Nigeria. SUBJECTS: Three hundred and sixty-nine premenopausal women attending the gynaecologic and family planning clinics of Ahmadu Bello University Teaching Hospital Zaria, Nigeria from January to December 2000. RESULTS: Of the 369 women that had cervical cytology by Pap smear, 163 (44%) had chronic pelvic inflammatory disease (cases) while 206 (56%) were non chronic PID patients (control). There was no statistical significance in the mean age between the two groups. The mean age at first coitus and marriage of all the women were 17.92.7 years and 18.5 3.4 years respectively. There were 52 dysplastic smears encountered, giving a prevalence rate of 140/1,000 or 14% for Cervical Intraepithelial Neoplasia. There were higher cases of dysplasia in the chronic PID group than in the control and this differences was statistically significant (p<0.05). Other risk factors to dysplasia identified include high parity (>4) and age of first coitus less than 20 years. Only 10% of all the women screened were aware of both cervical cancer and Pap smear. CONCLUSION: Women with chronic pelvic inflammatory disease are probably at higher risk of developing cervical dysplasia than women without chronic pelvic inflammatory disease. Cervical cancer screening programmes should be intensified in chronic pelvic inflammatory disease patients. However, further studies are needed in our setting to verify the association between pelvic inflammatory disease and cervical dysplasia.

Obstetric outcome in pregnant women subjected to domestic violence.

OBJECTIVE: To determine the prevalence of domestic violence and its relationship to adverse obstetric outcomes amongst pregnant women who deliver at a tertiary level hospital in Zaria, Nigeria. METHOD: A cross-sectional study involving 310 women who delivered at the labour ward. Questionnaires were administered to parturient women. Details of their socio-demographic characteristics and obstetric outcome were compiled and the relationship to experiences of domestic violence studied. RESULTS: The prevalence of domestic violence was 28.4%. There was positive relationship between domestic violence during pregnancy, non-supervision of pregnancy and poor attendances to antenatal clinic (p<0.05). There was however, no statistically significant relationship between domestic violence, and complications of labour and neonatal outcome (p>0.05). CONCLUSION: The prevalence of domestic violence in pregnancy is high in this environment. Poor attendances to the antenatal clinic is a significant association.

Risk scoring for domestic violence in pregnancy.

BACKGROUND: Most studies and work on domestic violence against women are aimed at helping victims, Studies aimed at detecting those at risk of domestic violence are few. Risk identification has important implications for early detection and prevention. METHODS: A risk scoring tool was developed and tested on 466 antenatal clinic attendees at 3 levels of health care in Zaria, Nigeria. RESULTS: The prevalence of domestic violence was 11.8%. The sensitivity of the tool was 96.6% and specificity 11.8%. The positive predictive value and accuracy were 13.7% and 22.5% respectively. CONCLUSIONS: The tool has a high sensitivity and could be a good screening tool for identifying those at risk for domestic violence in pregnancy.

Sociodemographic and clinicopathologic characterization of cervical cancers in northern Nigeria.

OBJECTIVE: To evaluate the sociodemographic and clinicopathological characteristics of patients with cervical cancer seen in a tertiary referral center in northern Nigeria. MATERIALS AND METHODS: Between January 2002 and December 2004, 70 consecutive patients with histologically confirmed cervical cancer, with a median age of 48 years (range, 30-75 years), were interviewed on the basis of a structured pro forma. RESULTS: Of these patents, 39 (56%) had had no formal education, and 36 (51%) were unemployed housewives. Sixty (86%) had become sexually active before 17 years of age; 44 (63%) were in polygamous families, and 25 (36%) patients were in at least a second marriage. There was an average of 6.8 live births per patient. Vaginal bleeding was seen in all patients, and 55 (79%) had vaginal discharges; 50 (71%) had a bulky cervical mass, and 46 (66%) presented with at least Stage IIIA disease. Squamous cell carcinoma was the commonest histology. The three HIV-seropositive patients were young and had advanced disease. CONCLUSION: Sociodemographic factors, such as low socioeconomic level, early age at first sexual intercourse and multiple sexual partners, place women at high risk of developing cervical cancer in northern Nigeria. Late presentation with advanced disease predominates.

A case control study of active genital Chlamydia trachomatis infection among patients with tubal infertility in northern Nigeria.

A case-controlled study of the prevalence of genital Chlamydia trachomatis infection in 120 patients with tubal infertility (study group) and 120 clients of the family planning clinic (control group) attending the Ahmadu Bello University Teaching Hospital, Zaria in northern Nigeria is reported. The prevalence was 38.3%, 95% confidence interval (CI) (29.6-47.6%) in the study group and 13.3%, 95% CI (7.8-20.7%) in the control group. There was a fourfold risk of having genital Chlamydial infection among the cases compared to the controls (odds ratio [OR] = 4.04, 95% CI (2.04 < OR < 8.09). Tubal infertility was found to be significantly associated with genital C. trachomatis infection (P < 0.001). Out of the 58 cases of primary infertility, 22(37.9%) tested positive for genital C. trachomatis compared with 24 of the 62 (38.7%) that had secondary infertility. The infection was not found to be significantly associated with a particular type of infertility (primary or secondary), number of sexual partners or previous sexually transmitted disease (P < 0.05). There is need for provision of facilities to enable screening for genital C. trachomatis infection in view of its high prevalence in the study population.

Attitudes and practices of private medical providers towards family planning and abortion services in Nigeria.

CONTEXT: The study was designed to investigate the attitudes and practices of private medical practitioners towards abortion, postabortion care and postabortion family planning in Nigeria. METHODS: Three hundred and twenty-three private practitioners who were proprietors of private clinics in three states of the country were interviewed with a structured questionnaire that elicited information on their knowledge and experiences of abortion and postabortion care in the cities. RESULTS: Twenty-four percent of the doctors reported that they routinely terminate unwanted pregnancies when requested to do so by women, while 82% reported that they frequently treat women who experience complications of unsafe abortion. Over 45% reported that they use manual vacuum aspiration (MVA) for the management of abortion in the first trimester, while 25% use dilatation and curettage (D and C). Nearly 28% reported the use of MVA followed by D and C in the first trimester. Fifty-seven percent reported their lack of expertise in managing second-trimester abortions, while those admitting that they manage second-trimester abortions reported nonstandard methods and procedures. In addition, there was evidence of inadequate counseling of women, lack of institutional protocols and poor use of postabortion family planning by the doctors. CONCLUSIONS: These results suggest the need for a program of retraining of private practitioners on the principles and practices of safe abortion, postabortion care and family planning in Nigeria and the integration of these topics into medical training curricula in the country.

Puerperal complications of episiotomies at Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.

OBJECTIVES: To establish the epidemiological variables associated with episiotomies and their puerperal complications at Ahmadu Bello University Teaching Hospital Zaria, in order to institute appropriate management including preventive measures. DESIGN: A prospective cohort study. SETTING: Ahmadu cello University Teaching Hospital, Zaria, Nigeria. METHODS: A cohort of all consecutive patients that underwent vaginal deliveries during a 12-week period were followed up for six weeks in order to determine the distribution and determinants of episiotomy and its complications. RESULTS: The episiotomy rate was 35.6% of all vaginal deliveries. Episiotomies were significantly associated with primigravidity being performed in 88.5% of all primigravidae. The mean delivery-repair interval was 60.5 minutes. The most common puerperal complication of episiotomies was perineal pain that lasted an average of 5.5 days. Other complications included asymmetry (32.9%), infection (23.7%), partial dehiscence (14.5%), skin tags (7.9%), haemorrhage (5.3%) and extension of the incision (1.3%). The complications were not significantly associated with any potential risk factor. CONCLUSION: In view of the very high episiotomy rate among primigravidae, it is recommended that the episiotomy rate among primigravidae be reduced by re-acquainting accoucheurs with the indications for episiotomy. Attention needs to be given to adequate pain relief for all women who have had an episiotomy and the delivery-repair interval in this unit should be reduced by provision of materials for episiotomy repair in the delivery suite.