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Abdus-Salam RA, Adeniyi AA, Bello FA. Antenatal Clinic Waiting Time, Patient Satisfaction, and Preference for Staggered Appointment-A Cross-Sectional Study. J Patient Exp 2021; 8:23743735211060802. [PMID: 34869846 PMCID: PMC8640308 DOI: 10.1177/23743735211060802] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Time spent in the antenatal clinic (ANC) is a major disincentive for pregnant women and constitutes a barrier to the utilization of ANC. Long waiting time and poor patient satisfaction may contribute to poor utilization. This study assessed waiting time, patients' satisfaction, and preference for staggered ANC appointments. A cross-sectional study was conducted; information obtained includes sociodemographic and obstetric characteristics, and time spent at ANC service points. Data were analyzed using International Business Machines (IBM) Statistical Products and Service Solutions (SPSS) software version 23. Descriptive statistics and chi-square test were conducted. Level of significance: P < .05. One hundred and twenty-two participants were interviewed. Mean age was 30.52 (±4.65) years, they were mostly multi-gravid, married, and with tertiary education. Mean time spent in ANC and waiting time were 191 min and 143 min, respectively. Waiting time was longest at doctor's consultation (59 min), laboratory services (38 min), and the cash pay-point (18 min). About 68.9% were satisfied with services and highest at doctors' consultation. Satisfaction was associated with waiting time of <45 min. Dissatisfaction was high at the cash pay-point (28.7%), followed by the laboratory (16.4%). About 56.5% preferred staggered appointments. Time spent in ANC should be reduced and staggered appointments may be a useful strategy to reduce waiting time and patient load.
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Affiliation(s)
- R A Abdus-Salam
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria
| | - A A Adeniyi
- Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Nigeria
| | - F A Bello
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria
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Unwaha EA, Bello FA, Bello OO, Oladokun A. Intravenous magnesium sulfate in the management of severe pre-eclampsia: A randomized study of 12-hour versus 24-hour maintenance dose. Int J Gynaecol Obstet 2020; 149:37-42. [PMID: 31833059 DOI: 10.1002/ijgo.13082] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 09/10/2019] [Accepted: 12/10/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess the effectiveness of a 12-hour versus 24-hour intravenous maintenance dose of magnesium sulfate (MgSO4 ) in women with pre-eclampsia, and the maternal and fetal outcomes. METHODS This was a randomized controlled trial conducted at the labor ward complex of University College Hospital, Ibadan, Nigeria between May and August 2014. Pregnant women with severe pre-eclampsia were randomized to receive a 12-hour versus 24-hour maintenance dose of MgSO4 . Study outcomes were occurrence of seizures, adverse maternal effects, neonatal survival, and admission to the intensive care unit. Data analysis involved descriptive statistics and bivariate analysis using Statistical Package for Social Science (SPSS) version 20. RESULTS There were 80 patients randomized to the 12-hour (n=40) and 24-hour (n=40) groups. The participants in the two groups had comparable demographic features. There was no significant difference (P>0.999) between the satisfactory maternal outcome following the 12-hour maintenance dose and the standard 24-hour regimen (95.0% vs 97.5%). Similarly, there was no significant difference (P=0.276) in perinatal mortality in the 12-hour versus 24-hour arm (17.5% vs 12.5%, respectively). No case of eclampsia and maternal death was recorded. CONCLUSION A 12-hour maintenance dose of intravenous MgSO4 in the management of severe pre-eclampsia is effective and safe when compared with the 24-hour maintenance dose.
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Affiliation(s)
- Emmanuel A Unwaha
- Department of Obstetrics & Gynecology, University of Ibadan/University College Hospital, Ibadan, Oyo State, Nigeria
| | - Folasade A Bello
- Department of Obstetrics & Gynecology, University of Ibadan/University College Hospital, Ibadan, Oyo State, Nigeria
| | - Oluwasomidoyin O Bello
- Department of Obstetrics & Gynecology, University of Ibadan/University College Hospital, Ibadan, Oyo State, Nigeria
| | - Adesina Oladokun
- Department of Obstetrics & Gynecology, University of Ibadan/University College Hospital, Ibadan, Oyo State, Nigeria
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Irinyenikan TA, Loto OM, Oluborode B, Awowole I, Bello FA, Fabamwo AO, Guest P, Ganatra B, Fawole B. A prospective study of severity of complications associated with use of misoprostol and other abortion methods in South West Nigeria. Int J Gynaecol Obstet 2019; 146:302-307. [PMID: 31152593 DOI: 10.1002/ijgo.12877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 02/15/2019] [Accepted: 05/30/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To assess the severity of complications following misoprostol used to induce abortion compared with other methods among women admitted for postabortion complications. METHODS A cross-sectional study of women who presented with complications of induced abortion at nine secondary and tertiary hospitals in South West Nigeria between April 1, 2013 and May 31, 2014. Face-to-face interviews were conducted and information on the current admission was extracted from patient records. Associations between abortion method used and severity of abortion complications were evaluated using χ2 and Fisher exact tests. RESULTS Of 522 women included in the study, 177 reported an induced abortion: 41 women (23.2%) had used misoprostol at the first attempt to induce abortion, whereas 79 (44.6%) women had undergone surgical abortion. Occurrence of fever (P=0.06), bleeding (P=0.3), and lower abdominal pain (P=0.32) was not significantly different between the misoprostol and surgical abortion/other methods groups. Severe complications were rare with misoprostol, but more common among women in the surgical abortion/other methods group. Maternal mortality occurred only among women in the surgical abortion/other methods group. CONCLUSION Use of misoprostol for induced abortion was associated with fewer complications and no maternal mortality compared with surgical abortion/other methods.
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Affiliation(s)
| | - Olabisi M Loto
- Department of Obstetrics and Gynecology, Obafemi Awolowo University Teaching Hospital Complex, Ilesha, Nigeria
| | - Babawale Oluborode
- Department of Obstetrics and Gynecology, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Ibraheem Awowole
- Department of Obstetrics and Gynecology, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Folasade A Bello
- Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Adetokunbo O Fabamwo
- Department of Obstetrics and Gynecology, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Philip Guest
- Institute for Population and Social Research, Salaya, Bangkok, Thailand
| | - Bela Ganatra
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), WHO, Geneva, Switzerland
| | - Bukola Fawole
- Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Oyeniran AA, Bello FA, Oluborode B, Awowole I, Loto OM, Irinyenikan TA, Fabamwo AO, Olutayo L, Ganatra B, Guest P, Fawole B. Narratives of women presenting with abortion complications in Southwestern Nigeria: A qualitative study. PLoS One 2019; 14:e0217616. [PMID: 31141550 PMCID: PMC6541294 DOI: 10.1371/journal.pone.0217616] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 05/15/2019] [Indexed: 11/29/2022] Open
Abstract
Unsafe abortion continues to impact negatively on women’s health in countries with restrictive abortion laws. It remains one of the leading causes of maternal mortality and morbidity. Paradoxically, modern contraceptive prevalence remains low and the unmet need for contraception continues to mirror unwanted pregnancy rates in many countries within sub-Saharan Africa. This qualitative study assessed women’s knowledge; their expectation and experiences of the methods employed for abortion; and their health care-seeking decisions following a complicated abortion. Women who presented with abortion complications were purposively sampled from seven health facilities in south-west Nigeria. In-depth interviews were conducted by social scientists with the aid of a semi-structured interview guide. Coding schemes were developed and content analysis was performed with WEFTQDA software. Thirty-one women were interviewed. Misoprostol was used by 16 women; 15 women used other methods. About one-fifth of respondents were aged ≤ 20 years; almost one-third were students. Common reasons for terminating a pregnancy were: “too young/still in school/training”; “has enough number of children”; “last baby too young” and “still breastfeeding”. Women had little knowledge about methods used. Friends, nurses or pharmacists were the commonest sources of information. Awareness about use of misoprostol for abortion among women was high. Women used misoprostol to initiate an abortion and were often disappointed if misoprostol did not complete the abortion process. Given its clandestine manner, women were financially exploited by the abortion providers and only presented to hospitals for post-abortion care as a last resort. Women’s narratives of their abortion experience highlight the difficulties and risks women encounter to safeguard and protect their sexual and reproductive health. To reduce unsafe abortion therefore, urgent and synergized efforts are required to promote prompt access to family planning and post-abortion care services.
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Affiliation(s)
- Agnes A. Oyeniran
- Department of Health Promotion and Education, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Folasade A. Bello
- Department of Obstetrics & Gynaecology, College of Medicine, University of Ibadan, Ibadan, Nigeria
- * E-mail:
| | - Babawale Oluborode
- Department of Obstetrics & Gynaecology, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Ibraheem Awowole
- Department of Obstetrics & Gynaecology, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Olabisi M. Loto
- Department of Obstetrics & Gynaecology, Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | - Adetokunbo O. Fabamwo
- Department of Obstetrics & Gynaecology, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Lanre Olutayo
- Department of Sociology, Faculty of The Social Sciences, University of Ibadan, Ibadan, Nigeria
| | - Bela Ganatra
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Philip Guest
- Institute for Population and Social Research, Salaya, Bangkok, Thailand
| | - Bukola Fawole
- Department of Obstetrics & Gynaecology, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Ayede AI, Bello FA, Kehinde AO. A community-based surveillance of gastrointestinal helminthiasis among pregnant women in Ibadan, South West Nigeria. Niger J Clin Pract 2018; 21:1368-1373. [PMID: 30297573 DOI: 10.4103/njcp.njcp_196_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background : Intestinal helminthiasis is a major public health problem in Africa. Helminthic infection in pregnant women causes loss of appetite, poor nutrient absorption, gastrointestinal impairment, iron deficiency, and iron deficiency anemia resulting in low birth weights and preterm births. The main aim of this study is to assess the prevalence of helminthic infections in pregnant women in rural and peri-urban communities of Ibadan. Materials and Methods : A cross-sectional descriptive study was carried out at the antenatal clinics of 12 selected primary health centers and mission homes in Ibadan, Nigeria. Open- and closed-answer questionnaires were administered to 604 consenting pregnant women, who provided fresh stool samples for microscopy. Helminthic quantification was carried out by the Kato-Katz technique. Proportions were compared using Chi-squared with IBM® SPSS® Statistics 21 for analysis. Statistical significance was set at P < 0.05. Results : Eighty-nine stool samples (14.7%) were positive for helminthiasis. Most had roundworms (13.6%); 13 (2.2%) had hookworms. The mean arithmetic eggs per gram of feces were 2,124 and 248, respectively. No participant had a heavy intensity infection; nearly all were of low intensity. Participants (P = 0.005) and their husbands (P = 0.005) who had higher education were less likely to have helminthiasis. Conclusion These communities are classified as Category III, having a low prevalence and low intensity infection. Therefore, prophylactic anti-helminthic treatment in pregnancy is not recommended. The inverse relationship with education may be a function of better living conditions. Better hygiene should be advocated.
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Affiliation(s)
- A I Ayede
- Department of Paediatrics, Obstetrics and Gynaecology and Medical Microbiology, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | - F A Bello
- Department of Paediatrics, Obstetrics and Gynaecology and Medical Microbiology, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | - A O Kehinde
- Department of Paediatrics, Obstetrics and Gynaecology and Medical Microbiology, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
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Erim DO, Offiong HE, Kim C, Bello FA, Moulton J, Wheeler SB, Thirumurthy H. The spillover effect of midwife attrition from the Nigerian midwives service scheme. BMC Health Serv Res 2018; 18:295. [PMID: 29685178 PMCID: PMC5914034 DOI: 10.1186/s12913-018-3106-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 04/10/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The Nigerian Midwives Service Scheme (MSS) increased use of antenatal services at rural public sector clinics. However, it is unclear if women who would not have otherwise sought care, or those who would have sought care in rural private sector clinics caused this change. Additionally, it is also unclear if the reported midwife attrition was associated with a spillover of the scheme's effect on urban areas. We sought to answer these two questions using data from two nationally representative surveys. METHODS We used an interrupted time series model to assess trends in the use of obstetric (i.e. antenatal and delivery) services among rural and urban respondents in the 2008 and 2013 Nigerian demographic and health surveys. RESULTS We found that the MSS led to a 5-percentage point increase in the use of antenatal services at rural public sector clinics, corroborating findings from a previous study. This change was driven by women who would not have sought care otherwise. We also found that there was a 4-percentage point increase in the use of delivery services at urban public sector clinics, and a concurrent 4-percentage point decrease in urban home deliveries. These changes are most likely explained by midwives' attrition and exemplify a spillover of the scheme's effect. CONCLUSION Midwife attrition from the Nigerian MSS was associated with a spillover of the scheme's effect on the use of delivery services, on urban areas.
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Affiliation(s)
- Daniel O. Erim
- Department of Health Policy and Management, the University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | | | - Christine Kim
- Department of Health Policy and Management, the University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Folasade A. Bello
- Department of Obstetrics and Gynecology, University of Ibadan, Ibadan, Nigeria
| | - Jeremy Moulton
- Department of Public Policy, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Stephanie B. Wheeler
- Department of Health Policy and Management, the University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Harsha Thirumurthy
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, USA
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Akinajo OR, Bello FA, Bello OO, Olayemi OO. Screening for bacterial vaginosis before intrauterine device insertion at a family planning clinic in south-west Nigeria. Niger Postgrad Med J 2017; 24:75-80. [PMID: 28762360 DOI: 10.4103/npmj.npmj_8_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM This study determined the prevalence of bacterial vaginosis (BV) among clients before insertion of intrauterine device (IUD) and compared the incidence of complications between participants who were positive and negative for BV. PATIENTS AND METHODS This was an observational cohort study that was performed between May 2014 and September 2014. A total of 360 women were recruited and followed up for 1 month. High vaginal swabs were obtained from each participant pre-insertion of the IUD and 1 month post-insertion. BV was diagnosed using Nugent's scoring. Data were collected, collated and analysed using frequency distributions and Chi-square test as appropriate. The level of statistical significance was P< 0.05. RESULTS The prevalence of BV was 33.3%. The complication rate was 23.9% in which 30.5% complication rate was seen among participants positive for BV and 22.5% among participants negative for BV (P = 0.192). This was done with respect to four primary clinical outcomes. The incidence of BV one month after IUD insertion was 11.5%. CONCLUSION The prevalence of BV was within the range reported in other populations. The complication rate appeared high; however, the differences in proportion between women positive and negative for BV were not statistically significant.
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Affiliation(s)
- Opeyemi Rebecca Akinajo
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Folasade A Bello
- Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Oyo State, Nigeria
| | - Oluwasomidoyin O Bello
- Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Oyo State, Nigeria
| | - Oladapo O Olayemi
- Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Oyo State, Nigeria
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Salami SA, Oluwatosin OO, Oso AO, Fafiolu AO, Sogunle OM, Jegede AV, Bello FA, Pirgozliev V. Bioavailability of Cu, Zn and Mn from Mineral Chelates or Blends of Inorganic Salts in Growing Turkeys Fed with Supplemental Riboflavin and/or Pyridoxine. Biol Trace Elem Res 2016; 173:168-76. [PMID: 26781955 DOI: 10.1007/s12011-016-0618-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 01/05/2016] [Indexed: 11/28/2022]
Abstract
An 84-day feeding trial was conducted in growing turkeys to measure the bioavailability of Cu, Zn and Mn from a commercial mineral chelate and corresponding inorganic salts in composite feeds containing supplemental riboflavin (B2) and/or pyridoxine (B6). A total of 320, 28-day-old British United Turkeys (BUT) were assigned to eight dietary treatments in a 2 × 4 factorial arrangement comprising two trace mineral sources: chelated trace mineral blend (CTMB) and its corresponding inorganic trace minerals blend (ITMB) fed solely or with supplements of vitamin B2 (8 ppm) or B6 (7 ppm) or 8 ppm B2 + 7 ppm B6. Each treatment was replicated four times with 10 turkeys each. It was observed that turkeys fed with diets supplemented solely with ITMB elicited higher (P < 0.05) Zn excretion than their counterparts fed with diets containing ITMB with supplements of vitamins B2 and/or B6. Manganese retention was lower (P < 0.05) in turkeys fed with diets supplemented solely with ITMB than those fed with diets containing vitamins B2 and/or B6 additives. Combination of CTMB or ITMB with B6 improved (P < 0.05) the concentration of Mn in the liver and Cu in the bone. It was concluded that the minerals in CTMB were more available to the animals than ITMB. Furthermore, vitamins B2 and/or B6 supplementation improved the bioavailability of the inorganic Cu, Zn and Mn in growing turkeys and tended to reduce the concentration of these trace elements in birds' excreta.
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Affiliation(s)
- S A Salami
- College of Animal Science and Livestock Production, Federal University of Agriculture, P.M.B. 2240, Abeokuta, Ogun State, Nigeria.
| | - O O Oluwatosin
- College of Animal Science and Livestock Production, Federal University of Agriculture, P.M.B. 2240, Abeokuta, Ogun State, Nigeria
- World Bank Center of Excellence in Agricultural Development and Sustainable Environment, Federal University of Agriculture, Abeokuta, Nigeria. , P.M.B. 2240, Abeokuta, Ogun State, Nigeria
| | - A O Oso
- College of Animal Science and Livestock Production, Federal University of Agriculture, P.M.B. 2240, Abeokuta, Ogun State, Nigeria
- World Bank Center of Excellence in Agricultural Development and Sustainable Environment, Federal University of Agriculture, Abeokuta, Nigeria. , P.M.B. 2240, Abeokuta, Ogun State, Nigeria
| | - A O Fafiolu
- College of Animal Science and Livestock Production, Federal University of Agriculture, P.M.B. 2240, Abeokuta, Ogun State, Nigeria
- World Bank Center of Excellence in Agricultural Development and Sustainable Environment, Federal University of Agriculture, Abeokuta, Nigeria. , P.M.B. 2240, Abeokuta, Ogun State, Nigeria
| | - O M Sogunle
- College of Animal Science and Livestock Production, Federal University of Agriculture, P.M.B. 2240, Abeokuta, Ogun State, Nigeria
- World Bank Center of Excellence in Agricultural Development and Sustainable Environment, Federal University of Agriculture, Abeokuta, Nigeria. , P.M.B. 2240, Abeokuta, Ogun State, Nigeria
| | - A V Jegede
- College of Animal Science and Livestock Production, Federal University of Agriculture, P.M.B. 2240, Abeokuta, Ogun State, Nigeria
- World Bank Center of Excellence in Agricultural Development and Sustainable Environment, Federal University of Agriculture, Abeokuta, Nigeria. , P.M.B. 2240, Abeokuta, Ogun State, Nigeria
| | - F A Bello
- College of Animal Science and Livestock Production, Federal University of Agriculture, P.M.B. 2240, Abeokuta, Ogun State, Nigeria
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Bello FA, Odeku AO. POLYCYSTIC OVARIES: A COMMON FEATURE IN TRANSVAGINAL SCANS OF GYNAECOLOGICAL PATIENTS. Ann Ib Postgrad Med 2015; 13:108-9. [PMID: 27162523 PMCID: PMC4853876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- F A Bello
- Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - A O Odeku
- Adeola Odeku Ultrasound Centre, Kongi, New Bodija, Ibadan, Nigeria
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Bello FA, Adesina OA, Morhason-Bello IO, Adekunle AO. MATERNAL MORTALITY AUDIT IN A TERTIARY HEALTH INSTITUTION IN NIGERIA: LESSONS FROM DIRECT CAUSES AND ITS DRIVERS. Niger J Med 2015; 24:300-306. [PMID: 27487605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
INTRODUCTION Nigeria has the second highest number of maternal deaths in the world.The study aimed at determining the causes of and non-obstetric contributors to maternal mortality at a tertiary referral hospital. MATERIALS AND METHODS It was a prospective audit of all consecutive maternal deaths in the hospital over a three-year period. Immediately after the death, information wvas retrieved via a data collection form. Data were analysed with SPSS-20. RESULTS Seventy deaths were examined over the study period. Maternal mortality ratio was 1,265/100,000 live births. The annual ratio decreased steadily over the study period. Most of the deaths were of multiparous women who had not received any antenatal care, and were mostly postpartum,within 24 hours of delivery. Most of them were critically ill on admission to the hospital. Major causes of death were haemorrhage (36%), sepsis (17%) and hypertensive disorders (16%).Delays were identified in 34.3% of cases; most (70.1%) were Phase III delays. DISCUSSION Direct causes of maternal mortality are consistent with those found in literature. Steps which the centre has been taken to counter direct and non-obstetric causes are discussed. Possible strategies to improve health financing and referral system are proffered.
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Bello FA, Odeku AO. Transvaginal sonography is feasible and universally acceptable to women in Ibadan, Nigeria: experience from the 1st year of a novel service. Ann Afr Med 2015; 14:52-6. [PMID: 25567696 DOI: 10.4103/1596-3519.148740] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Transvaginal sonography (TVS) is the standard route for gynecological and early pregnancy assessment scanning, due to the higher resolution that allowed for a better view of the pelvis. It had not been available in the study area prior to this, and it was anticipated that clients would find it intrusive and unacceptable, and thus decline it. The study was aimed at accessing the acceptability of TVS in women. METHOD A cross-sectional study of all clients who presented for gynecological and early pregnancy assessment scans at a private ultrasound diagnostic center in Nigeria during its 1st year of service. All suitable clients were counseled for TVS. This was carried out for them, while nonconsenters had transabdominal sonography. A questionnaire was administered to the consenting participants. Virgins and women currently experiencing heavy vaginal bleeding were excluded. Data were entered into SPSS-16 and analyzed with frequency tables. RESULTS Five hundred and seventy-seven women of varied demographic characteristics were included into the study. Only one (i.e., 1/577; 0.2%) declined TVS. The procedure was abandoned in one (i.e., 1/576; 0.2%) due to severe discomfort. All 575 that completed the examination stated they would accept TVS again in the future, if indicated. CONCLUSIONS TVS was universally accepted by a diverse population of women in South-Western Nigeria. It is recommended that ultrasound scan providers in this location should acquire skills for it, if necessary, and that TVS be offered routinely for gynecological evaluation according to international standards.
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Affiliation(s)
- Folasade A Bello
- Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Bello FA, Tsele TA, Oluwasola TO. Decision-to-delivery intervals and perinatal outcomes following emergency cesarean delivery in a Nigerian tertiary hospital. Int J Gynaecol Obstet 2015; 130:279-83. [PMID: 26058530 DOI: 10.1016/j.ijgo.2015.03.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 02/25/2015] [Accepted: 05/07/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the decision-to-delivery interval (DDI) for emergency cesarean deliveries (CDs) at a tertiary center in Nigeria, to evaluate causes of delay, and to assess the effects of delays on perinatal outcomes. METHODS Between September and November 2010, a prospective, observational study was undertaken at University College Hospital, Ibadan. Events that occurred after a decision to perform an emergency CD were recorded. Associations between outcomes and the DDI were analyzed. RESULTS Among 235 emergency CDs included, 5 (2.1%) occurred within 30 minutes and 86 (36.6%) within 75 minutes. The mean DDI was 119.2±95.0 minutes. Among CDs with a DDI of more than 75 minutes, logistic factors were the reason for delay in 65 (43.6 %) cases. No significant associations were recorded between DDI and the 5-minute Apgar score, admission to the special-care baby unit, or perinatal mortality (P>0.05 for all). In multivariate analysis, neonates delivered after 75 minutes were significantly less likely to die during the perinatal period than were those delivered within this period (odds ratio 0.13, 95% confidence interval 0.03-0.66; P=0.01). CONCLUSION Institutional delays in CDs need to be addressed. However, the DDI could be less important for perinatal outcome than are some other factors, such as the severity of the indication.
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Affiliation(s)
- Folasade A Bello
- Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan, Nigeria; Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Nigeria.
| | - Taiwo A Tsele
- Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Nigeria
| | - Timothy O Oluwasola
- Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan, Nigeria; Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Nigeria
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Bello FA, Adesina OA, Morhason-Bello IO, Adekunle AO. Maternal mortality audit in a tertiary health institution in Nigeria: Lessons from direct causes and its drivers. Niger J Med 2015. [DOI: 10.4103/1115-2613.278943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
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Fawole AO, Ezeasor C, Bello FA, Roberts A, Awoyinka BS, Tongo O, Adeleye JO, Ipadeola A. Effectiveness of a structured checklist of risk factors in identifying pregnant women at risk of gestational diabetes mellitus: a cross-sectional study. Niger J Clin Pract 2014; 17:495-501. [PMID: 24909476 DOI: 10.4103/1119-3077.134051] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is associated with increased risk of mortality and morbidity for pregnant women and newborns. Identifying pregnant women with risk factors for GDM based on the clinical suspicion is a popular approach. However, the effectiveness of the use of a structured checklist of risk factors is yet to be evaluated. This study assessed the effectiveness of a structured checklist of risk factors in identifying pregnant women at risk of GDM at the University College Hospital, Ibadan. MATERIALS AND METHODS It was a comparative cross-sectional study implemented in two phases. The first phase (Group A) of the study was a prospective study that involved 530 pregnant women who presented at the booking clinic. A structured checklist containing risk factors was used to identify women at the risk of GDM. The second phase (Group B) was a retrospective study of 530 pregnant women managed 2 years previously who were selected by systematic random technique. RESULTS The mean age, gestational age at booking, gestational age at delivery and birth weight were 30.2 ± 5.2 years, 21 ± 10.8 weeks, 38.7 ± 2.7 weeks and 3.1 ± 0.7 kg respectively. The prevalence of GDM in Group A and B were 4.9% and 1.6% respectively ( P < 0.05). There was about three fold increase in identification of women at risk of GDM by use of a checklist. CONCLUSION Identification of women at risk of GDM was approximately 3-4 fold higher with the use of checklist of risk factors. Exhaustive clinical identification with a checklist of risk factors for GDM should be encouraged.
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Affiliation(s)
- A O Fawole
- Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Oyo State, Nigeria
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Morhason-Bello IO, Adedokun BO, Mumuni TO, Bello FA, Abdus-Salam RA, Lawal OO, Okunlola MA, Ojengbede OA. Knowledge and use of emergency contraception by medical doctors on internship in a tertiary healthcare facility in Nigeria. Niger J Clin Pract 2014; 17:431-5. [PMID: 24909465 DOI: 10.4103/1119-3077.134028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
CONTEXT Emergency contraception (EC) is widely used to prevent unwanted pregnancy and it is largely adopted in many countries as over the counter drug to improve access. AIMS To determine and compare the correct knowledge, attitude and current use of EC among newly graduated medical doctors (MDs). SETTINGS AND DESIGN A cross-sectional study conducted among 255 newly graduated MDs at the University College Hospital, Ibadan, Nigeria. MATERIALS AND METHODS A pretested self-administered questionnaire was used to obtain data from consenting participants. STATISTICAL ANALYSIS USED Descriptive, bivariate, and multivariable analyses were performed, and statistical significance was set at 0.05. Statistical Package for Social Science version 15.0 (Chicago, IL, USA) software was used. RESULTS The mean age of the respondents was 27.2 years (standard deviation = 2.1). The commonest indication for emergency contraceptive use mentioned was rape-96.5%. About 70% support EC in Nigeria, while about a quarter (26.9%) routinely counsel women about ECP use. About 21% of respondents currently use EC. Logistic regression analysis revealed significant results for gender [odds ratio (OR) =3.64; 95% confidence interval (CI) OR = 1.31-10.01), religion (OR = 0.26; 95% CI OR = 0.11-0.630) and marital status (OR = 0.19; 95% CI = 0.07-0.56). CONCLUSION The correct knowledge and professional disposition toward EC as a form of contraception is low. We recommend that in-service training should focus more on EC to improve the quality of their knowledge and attitude towards it.
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Affiliation(s)
- I O Morhason-Bello
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, University of Ibadan/University College Hospital, Ibadan, Oyo State, Nigeria
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Abstract
Objectives: To determine the frequency of retained placenta at
the University College Hospital Ibadan (UCH). and to describe
the socio-demographic characteristics of the patients and examine
the risk factors predisposing to retained placenta. Methods: This is a descriptive study covering a period of 5 years
from January 1st 2002 to December 31st 2006. During the study
period, 4980 deliveries took place at the University College
Hospital, Ibadan and 106 cases of retained placenta were managed
making the incidence 2.13 per cent of all births. Results: During the five year period, there were 106 patients with
retained placenta; of these, 90 (84.9%) case notes were available
for analysis. The mean age was 29.37 ± 4.99 years. First and second
Para accounted for 52 per cent of the patients. Majority of the
patient were unbooked for antenatal care in UCH with booked
patients accounting for 27.8 per cent of the cases. The mean
gestational age at delivery was 34.29 ± 6.02. Three patients
presented to the hospital in shock of which 2 died on account of
severe haemorrhagic shock. Fifty-eight patients (64.8%) presented
with anaemia (packed cell volume less than 30 per cent) and 35
patients (38.8%) had blood transfusion ranging between 1-4 pints.
1 patient required hysterectomy on account of morbidly adherent
placenta. Eleven patients (12.2%) had placenta retention in the
past, 28 patients (31%) had a previous dilatation and curettage, 14
patients (15.5%) had previous caesarean sections and 47 patients
(41.3%) had no known predisposing factors Conclusion: Retained placenta still remains a potentially life
threatening condition in the tropics due to the associated
haemorrhage, and other complications related to its removal. The
incidence and severity may be decreased by health education,
women empowerment and the provision of facilities for essential
obstetric services by high skilled health care providers in ensuring
a properly conducted delivery with active management of the third
stage of labour.
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Affiliation(s)
- G O Obajimi
- Department of Obstetrics and Gynaecology, University of Ibadan, Nigeria
| | - A O Roberts
- Department of Obstetrics and Gynaecology, University of Ibadan, Nigeria
| | - C O Aimakhu
- Department of Obstetrics and Gynaecology, University of Ibadan, Nigeria
| | - F A Bello
- Department of Obstetrics and Gynaecology, University of Ibadan, Nigeria
| | - O Olayemi
- Department of Obstetrics and Gynaecology, University of Ibadan, Nigeria
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Adeyemi AB, Enabor OO, Ugwu IA, Abraham OA, Bello FA, Olayemi O. Prevalence of antenatal hepatitis B infection in tertiary and non-tertiary health facilities in Ibadan, Nigeria. Niger J Med 2014; 23:248-253. [PMID: 25185383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Hepatitis B infection remains a significant source of morbidity among women and infants at different levels of care particularly in developing countries. AIM To determine the prevalence of hepatitis B infection among pregnant women in tertiary and non-tertiary health facilities. MATERIALS & METHODS Women receiving antenatal care in a tertiary centre and 2 non-tertiary centres in Ibadan. Nigeria were consecutively screened for Hepatitis B surface antigen by the ELISA method following written informed consent. The results were entered with socio-demographic and obstetric data into a proforma and significant associations determined by chi-square test and logistic regression (p < 0.05). RESULTS A total of 658 women were recruited; 389 were from the tertiary hospital while 259 were from nontertiary health facilities. The mean age of the whole population was 30.17 +/- 5.24 years while the median gestational age was 27 weeks. Majority of the participants (64.5%) were between 26 and 35 years. The total prevalence of Hepatitis B infection was 16.3%. Prevalence of hepatitis B infection was 30.9% in the non-tertiary health facilities and 6.4% in the tertiary health facility (p = 0.000).The only significant positive predictor variable for hepatitis B infection was being in a non-tertiary health facility (OR: 0.086 CI: 0.037-0.199, p = 0.004). CONCLUSION The burden ofAntenatal hepatitis B infection in Ibadan may be significantly greater in nontertiary health facilities. Health policy, particularly in these centres, should be directed towards education, screening and vaccination programmes.
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Bello FA, Akinajo OR, Olayemi O. In-vitro fertilization, gamete donation and surrogacy: perceptions of women attending an infertility clinic in Ibadan, Nigeria. Afr J Reprod Health 2014; 18:127-133. [PMID: 25022149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Infertility affects 20% of couples in Nigeria. Assisted reproductive techniques (ART) offered in Nigeria include in-vitro fertilization (IVF), gamete donation and surrogacy. This cross-sectional questionnaire study aimed at assessing the acceptability of ART to women seeking infertility treatment at the University College Hospital, Ibadan, Nigeria. Of the 307 respondents, 58.3% were aware of IVF and 59.3% would accept it as treatment; 35.2% would accept donor eggs and 24.7% would accept donor sperms-a smaller proportion anticipated acceptability by their husbands. Thirty five percent were aware of surrogacy, 37.8% would accept it as treatment; most preferring a stranger as a surrogate. Most felt surrogates should not be paid. Acceptance of ART was associated with older age, longer duration of infertility, previous failed treatment and women without other children. As chances of successful pregnancy are improved in younger individuals, counselling towards overcome barriers to accepting gamete donation and surrogacy should be instituted early.
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Adeyemi AB, Enabor OO, Ugwu IA, Bello FA, Olayemi OO. Knowledge of hepatitis B virus infection, access to screening and vaccination among pregnant women in Ibadan, Nigeria. J OBSTET GYNAECOL 2014; 33:155-9. [PMID: 23445138 DOI: 10.3109/01443615.2012.711389] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The knowledge of pregnant women about Hepatitis B virus infection at three different levels of healthcare and their access to screening and vaccination was evaluated by a questionnaire-based cross-sectional study. There were 643 respondents with a mean age of 30.2 ± 5.2 years and mean gestational age of 26.1 ± 8.4 weeks. The distribution of respondents was 55 (8.6%, primary), 204 (31.7%, secondary) and 383 (59.6%, tertiary) women. The majority of respondents were traders (36%) or civil servants/professionals (28.6%). Overall, 76% of all women had inadequate knowledge about hepatitis B infection; 19.5% had been screened, while 9.7% had been vaccinated. There was an increased likelihood of adequate knowledge, previous screening and vaccination among health workers (p = 0.00). Other positive predictors of knowledge and vaccination were tertiary education (p = 0.04) and tertiary care (p = 0.00). There is inadequate knowledge among pregnant women in Ibadan about Hepatitis B infection, with significant differences at the various levels of care, particularly in non-tertiary settings where screening and vaccination is also sub-optimal. Information dissemination, universal screening and vaccination services for pregnant women in Nigeria require urgent consideration.
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Affiliation(s)
- A B Adeyemi
- Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Nigeria
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20
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Ajayi AB, Oladokun A, Bello FA, Morhason-Bello IO, Ogundepo MO. Viral infections among couples for assisted reproduction in a fertility clinic in Nigeria. Niger J Clin Pract 2013; 16:352-5. [PMID: 23771460 DOI: 10.4103/1119-3077.113461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
CONTEXT The risk of laboratory cross-contamination may limit the availability of assisted conception for couples infected with chronic viruses. However, assisted conception is the standard of care for people living with human immunodeficiency virus (HIV) to minimize risk of transmission or reinfection. AIMS To assess the burden of viral infection among couples that present for assisted reproductive technology (ART) with a view to evaluating implications for their care. SETTINGS AND DESIGN A cross-sectional descriptive study carried out among 138 couples at a private fertility clinic in Nigeria. MATERIALS AND METHODS Screening for HIV, hepatitis B virus (HBV) and hepatitis C virus were carried out among these clients. The males' seminal parameters were analyzed according to World Health Organization (WHO) criteria. STATISTICAL ANALYSIS USED Statistical Package for Social Sciences was employed. Analysis was by Chi-square test; statistical significance was set at 0.05. RESULTS Viral infections were found in 10/138 women (7.2%) and 15/138 (10.9%) men. The most prevalent infection was HBV. Twenty-one couples were sero-discordant. Two couples had concordant HIV and HBV infections, respectively. There was no significant association between sperm quality and chronic hepatitis infection. CONCLUSION Nearly a fifth of the couples had at least one partner infected with a chronic virus - a proportion significant enough to demand attention. Apart from separate laboratory and storage facilities, basic principles to minimize transmission are recommended: HBV vaccination in sero-discordant partners of HBV carriers (and immunoprophylaxis for the baby) and antiretroviral therapy for HIV-positive partners to reduce the viral load before fertility treatment is commenced.
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Affiliation(s)
- A B Ajayi
- Department of Obstetrics and Gynaecology, University of Ibadan, Ibadan, Nigeria
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Enabor OO, Olayemi OO, Bello FA, Adedokun BO. Cervical ripening and induction of labour-awareness, knowledge and perception of antenatal attendees in Ibadan, Nigeria. J OBSTET GYNAECOL 2012; 32:652-6. [PMID: 22943711 DOI: 10.3109/01443615.2012.657271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The levels of awareness, knowledge and the perceptions of women about cervical ripening and induction of labour were assessed in a cross-sectional questionnaire-based interview of 265 antenatal attendees of the University College Hospital, Ibadan, Nigeria from 1 March to 30 April 2009. Questions included evaluated sociodemographic data, obstetric history, awareness of both procedures and knowledge of specific methods. Data analysis was done using SPSS v.14.0 for Windows; frequency tables were utilised to determine proportions and significant variables from χ(2) analysis were entered into a logistic regression model. The majority of respondents were between 26 and 34 years; 56.4% were nulliparous. Awareness of cervical ripening and induction of labour was found in 71% of respondents. Knowledge of misoprostol and Foley's catheter however, was present in 25% and 13% of all women, respectively. Both procedures were perceived to prevent caesarean section or reduce burden of health workers in 16% of respondents. No significant predictor of knowledge was found but history of previous induction was a predictor of awareness (p < 0.05). Improved counselling is required to further increase knowledge of methods for induction and correct wrong perceptions, particularly in women at risk of labour induction.
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Affiliation(s)
- O O Enabor
- Department of Obstetrics and Gynaecology, University College Hospital, Nigeria.
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22
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Nsonwu-Anyanwu AC, Charles-Davies MA, Oni AA, Taiwo VO, Bello FA. Chlamydial infection, plasma peroxidation and obesity in tubal infertility. Ann Ib Postgrad Med 2011; 9:83-8. [PMID: 25161489 PMCID: PMC4111027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Genital tract infections and obesity are both sources of oxidative stress. Alterations in immune and antioxidant parameters may arise from this or from an indeterminate autoimmune mechanism. OBJECTIVE This study aimed to investigate the association of Chlamydial infection, obesity and oxidative response with tubal infertility in Nigerian women. METHODS It was a case-control study of 40 women with tubal infertility and 32 fertile women, respectively, recruited from the Infertility and Family Planning Clinics respectively, of the University College Hospital, Ibadan, Nigeria. Anthropometric indices were measured in each subject and endocervical swabs were taken to screen for current genital tract infection. Antioxidant, hormonal and immunologic analysis were performed on serum. RESULTS None of the subjects had current genital tract infections. Chlamydia trachomatis IgG positivity was significantly higher in infertile than in fertile subjects [OR 4.33; 95%CI (0.078-0.681)]. No significant variations were observed in the anthropometric indices, antioxidant parameters and hormones between infertile and the fertile women. Body mass index correlated positively with oxidative stress in infertile subjects. Waist and hip circumferences correlated negatively with oestradiol in women with tubal infertility. CONCLUSION Chlamydial infection is associated with tubal factor infertility, however, obesity seems to increase oxidative stress and reduce fertility potential in women with tubal factor infertility.
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Affiliation(s)
| | | | - A A Oni
- Department of Medical Microbiology & Parasitology, University College Hospital, Ibadan
| | - V O Taiwo
- Department of Veterinary Pathology, University College Hospital, Ibadan
| | - F A Bello
- Department of Obstetrics and Gynaecology, University of Ibadan, Nigeria
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Abstract
Background: Self-medication is widely practiced in the study area, as many drugs are available over-the-counter, in addition to the use of local herbal preparations. Also, apprehension about the dangers of drug use in pregnancy appears to affect the compliance of prescribed medication. This study assess the drug use profile of an antenatal population. Materials and Methods: This was a questionnaire-based descriptive study of 410 antenatal clients attending primary, secondary and tertiary centers in Ibadan, Nigeria. The variables analysed were demographic data of respondents and level of health care received. Outcome measures were use of prescribed drugs, self-medication or herbal preparations. Chi-tests and logistic regression were used for statistical analysis. Results: All patients on prescribed medication for medical conditions claimed to be compliant with their drugs. Exactly 19.2% admitted to self-medication, mostly hematinics and pain-relieving pills (acetaminophen). No one admitted to alcohol or tobacco use, but 46.3%, especially attendees of the rural center (OR 5.79; 95% CI 2.56-13.10), ingested herbal concoctions while pregnant. Married women (OR 0.2; 95% CI 0.05-0.75) or those whose spouses had higher education (OR 0.43; 95% CI 0.21-0.89) were less likely to practice self-medication, while hypertensive women were more likely to practice it (OR 22.54; 95% CI 3.81-133.49). Conclusions: Social support has a role in safe drug use practices. This should be used to advantage by encouraging partners’ attendance at antenatal sessions. Patients need counseling on the dangers of procuring their usual prescription drugs without consultation. Use of herbal concoctions needs to be explored in the community.
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Affiliation(s)
- Folasade A Bello
- Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Bello FA, Olayemi O, Odukogbe AA. An audit of vaginal hysterectomies at the University College Hospital, Ibadan. Niger J Med 2011; 20:426-431. [PMID: 22288316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND Cost reduction, less postoperative morbidity and absence of abdominal scars are advantages of vaginal hysterectomy. The study aimed to examine the rate, indications, and complications of vaginal hysterectomies performed at University College Hospital Ibadan to derive lessons for the immediate future. METHODS An analysis of the records of all vaginal hysterectomies performed from 1995-2004. Information on the patients' epidemiological characteristics, indications and details of surgery performed, length of duration of surgery and postoperative course was retrieved. Data was analyzed with Stata-11 software. RESULTS Vaginal: abdominal hysterectomy ratio was 1:9, the former constituting 2.3% of major gynaecological operations done. The mean age of patients was 56.6 +/- 12.9 years and most were grandmultiparous. Twenty-two cases (81.8%) were due to genital prolapse. No uteri were larger than 12 weeks' size. Most (78.1%) were performed by consultants. Complication rate was 63.0%; the most frequent was intra-operative haemorrhage. Mean hospital stay was 7.4 +/- 3.5 days. Post-operation anaemia was associated with longer hospital stay (p = 0.02). CONCLUSION With increasing detection rate of CIN, lesser parities and the availability of the operating laparoscope at our centre, there is need to widen case selection beyond genital prolapse (in view of known benefits of vaginal hysterectomy) for renewed skill acquisition to reduce the high complication rates and for better training of resident doctors.
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Affiliation(s)
- F A Bello
- Department of Obstetrics and Gynaccology, University of Ibadan, Ibadan, Nigeria.
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Bello FA, Ogunbode OO, Adesina OA, Olayemi O, Awonuga OM, Adewole IF. Acceptability of counselling and testing for HIV infection in women in labour at the University College Hospital, Ibadan, Nigeria. Afr Health Sci 2011; 11:30-35. [PMID: 21572854 PMCID: PMC3092324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
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.
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Affiliation(s)
- F A Bello
- Department of Obstetrics & Gynaecology, University of Ibadan, Ibadan, Nigeria.
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Bello FA, Enabor OO, Adewole IF. Human papilloma virus vaccination for control of cervical cancer: a challenge for developing countries. Afr J Reprod Health 2011; 15:25-30. [PMID: 21987934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Primary HPV prevention may be the key to reducing incidence and burden of cervical cancer particularly in resource-poor countries. Vaccination programmes are already established in several developed regions, but several grey areas stand in the path of similar success in developing countries. This review sought to identify challenges of HPV vaccination in developing countries and discuss vaccine use, pitfalls and controversies; areas requiring collaborative efforts were identified. A Pub Med search was done; key words included Human papilloma virus, HPV vaccine and sub-Saharan Africa. Other resources included locally-published articles and additional internet resources. The potential benefit of mass HPV vaccination appears enormous. However, the challenges of competing health demands, poverty, ignorance, religion, culture, weak health system, establishment of an effective intersectoral collaboration and underfunding must be overcome to make maximal vaccine uptake a reality. Education and effective communication is crucial in achieving successful immunization programmes.
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Affiliation(s)
- F A Bello
- Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Nigeria.
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Oladokun A, Morhason-Bello IO, Bello FA, Adewole IF. The learning curve of radical hysterectomy for early cervical carcinoma. Afr J Med Med Sci 2010; 39:329-332. [PMID: 21736000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Cervical cancer remains a public health concern in developing countries that lack the wherewithal to cope with the associated challenges. Screening for premalignant cervical lesions and offering definitive care for early disease is the key to preventing the scourge. We conducted an audit of the radical hysterectomies performed on account of early cervical carcinoma at our centre between September 2006 and August 2008, following capacity-building by Operation Stop Cervical Cancer. Ten women aged 35 to 60 years were managed. All had type III radical hysterectomy. Three patients had adjuvant teletherapy (one was stage IIb, diagnosed intra-operatively). There was a linear reduction in the surgical blood loss and duration of surgery. Average blood loss was 1500 mls; four had blood transfusions. One case was complicated with rectovaginal fistula (the woman with stage IIb disease) and another had bilateral lymphoedema and left lower limb sensory neuropathy. There was no tumour recurrence on follow-up. Definitive surgery for early cervical cancer is feasible in developing countries despite limited resources. Audit of surgical care of cervical cancer will assist in strengthening the scarce skill. Determination of suitable cases during preoperative evaluation is crucial to the success of the surgery.
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Affiliation(s)
- A Oladokun
- Department of Obstetrics & Gynaecology, College of Medicine, University College Hospital, Ibadan, Nigeria.
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28
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Olayemi O, Aimakhu CO, Bello FA, Motayo VO, Ogunleye AA, Odunukan OW, Ojengbede OA. The influence of social support on the duration of breast-feeding among antenatal patients in Ibadan. J OBSTET GYNAECOL 2008; 27:802-5. [PMID: 18097898 DOI: 10.1080/01443610701666876] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In Nigeria, breast-feeding has been shown to be very closely related to infant survival. Prolonged and adequate breast-feeding is critical to most infants' nutritional health and growth. This study aims to determine the influence of family support on the duration of exclusive and total breast-feeding of infants of antenatal patients. This cross-sectional study was conducted between 1 September and 30 December 2005. The tool was a structured questionnaire. The main outcome variables were the duration of breast-feeding; both total and exclusive explanatory variables were mainly related to support obtained during breast-feeding from husband and older female relations. Husbands support significantly increased the total duration of breast-feeding by a mean of 1.69 months (95% CI 0.88, 2.51), however, exclusive breast-feeding was not significantly affected by the husband's support (OR 0.94; 95% CI 0.63, 1.39). Female support had a significant influence on both the total duration of breast-feeding which is increased by a mean of 1.08 months (95% CI 0.14, 2.02), and the adequate conduct of exclusive breast-feeding (OR 1.83; 95% CI 1.17, 2.86). The cultural practice of having additional female support in the postpartum period has been shown by this study to be beneficial. Therefore, this cultural practice should be encouraged and catalogued as a beneficial cultural practice. This practice is also cheap and sustainable.
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Affiliation(s)
- O Olayemi
- Department of Obstetrics and Gynecology, University College Hospital Ibadan, Ibadan, Nigeria.
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Abstract
A unique case of 17 alpha-hydroxylase deficiency with steroid-responsive primary hyperaldosteronism is reported. Initially the patient was misdiagnosed as testicular feminization for 16 years and was thought to have typical primary hyperaldosteronism for 5 years. However, careful detailed endocrine studies showed markedly elevated progesterone, deoxycorticosterone, and 18-hydroxycorticosterone values with low levels of 17-hydroxyprogesterone, 11-deoxycortisol, testosterone, and DHEA-Sulfate. In contrast to the suppressed aldosterone levels that are found in 17 alpha-hydroxylase deficiency, this patient's aldosterone levels were inappropriately elevated before and after ACTH stimulation. Use of glucocorticoid replacement resolved the patient's symptoms and completely corrected the hypokalemia and hypertension. In summary, recognition of 17 alpha-hydroxylase deficiency with steroid-responsive primary hyperaldosteronism is important because hypertension, hypokalemia, and symptoms respond to steroid replacement.
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Affiliation(s)
- D A Cottrell
- Department of Internal Medicine, Ohio State University College of Medicine, Columbus
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