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Ajah LO, Ajah MI, Ezegwui HU, Nwankwo TO, Iyoke CA, Nwigboji WN. Preoperative versus postoperative misoprostol use for prevention of blood loss during caesarean section in pregnant women at term: a multi-centre randomised controlled trial. J Int Med Res 2023; 51:3000605231213242. [PMID: 37994048 PMCID: PMC10666823 DOI: 10.1177/03000605231213242] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 10/20/2023] [Indexed: 11/24/2023] Open
Abstract
OBJECTIVE Caesarean section is associated with higher blood loss than vaginal delivery. This study was performed to compare the safety and efficacy of preoperative versus postoperative rectal and sublingual misoprostol use for prevention of blood loss in women undergoing elective caesarean delivery. METHODS Eligible patients in Southeast Nigeria were randomly classified into those that received 600 µg of preoperative rectal, postoperative rectal, preoperative sublingual, and postoperative sublingual misoprostol. All patients received 10 units of intravenous oxytocin immediately after delivery. Data were analysed with SPSS Version 23. RESULTS Preoperative sublingual misoprostol use caused the highest postoperative packed cell volume, least change in the packed cell volume, and lowest intraoperative blood loss. Preoperative sublingual and rectal misoprostol use was associated with better haematological indices and maternal outcomes than postoperative use by these routes. However, preoperative sublingual and rectal use caused more maternal side effects than postoperative use by these routes. CONCLUSION Preoperative sublingual misoprostol was associated with the most favourable haematological indices. Although preoperative sublingual and rectal misoprostol use caused more maternal side effects, these routes were associated with better haematological indices and maternal outcomes than postoperative sublingual and rectal misoprostol use.
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Affiliation(s)
- Leonard Ogbonna Ajah
- Institute of Maternal and Child Health, Ituku-Ozalla Campus, University of Nigeria, Enugu, Nigeria
- Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, University of Nigeria, Enugu, Nigeria
| | - Monique Iheoma Ajah
- Institute of Maternal and Child Health, Ituku-Ozalla Campus, University of Nigeria, Enugu, Nigeria
| | - Hyginus Uzo Ezegwui
- Institute of Maternal and Child Health, Ituku-Ozalla Campus, University of Nigeria, Enugu, Nigeria
- Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, University of Nigeria, Enugu, Nigeria
| | - Theophilus Ogochukwu Nwankwo
- Institute of Maternal and Child Health, Ituku-Ozalla Campus, University of Nigeria, Enugu, Nigeria
- Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, University of Nigeria, Enugu, Nigeria
| | - Chukwuemeka Anthony Iyoke
- Institute of Maternal and Child Health, Ituku-Ozalla Campus, University of Nigeria, Enugu, Nigeria
- Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, University of Nigeria, Enugu, Nigeria
| | - Wilson Ndukwe Nwigboji
- Department of Obstetrics and Gynaecology, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
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Ajah LO, Ifezuoke DT, Ajah MI, Nwankwo TO, Ezeome IV, Umeh UA, Agu PU. Complementary and Alternative Medicine Use among Gynaecological Cancer Patients in Enugu, South-East Nigeria. Glob J Health Sci 2021. [DOI: 10.5539/gjhs.v13n9p16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION: The high cost and associated adverse effects of conventional therapy make the patients seek complementary and alternative medicine. Complementary and alternative medicine use may contribute to the delay the patients have before seeking orthodox care.
OBJECTIVES: To determine the prevalence, pattern, factors responsible for complementary and alternative medicine use and if complementary and alternative medicine use causes delay in seeking orthodox care among gynaecological cancer patients in Enugu.
MATERIAL & METHODS: A pretested, semi-structured interviewer-administered questionnaire -based cross-sectional survey of 396 eligible gynaecological cancer patients recruited from both University of Nigeria Teaching Hospital, Enugu and Enugu State University of Science and Technology Teaching Hospital, Enugu between January, 2018 and June, 2020. The data was analyzed using the statistical package for social sciences version 23 (IBM SPSS, Chicago, IL).
RESULTS: The mean age of the respondents was 57.3 years and it ranged from 41 to 77 years. Cervical cancer (76%) was the most common type of gynaecological cancer. A total of 283(71.5%) of the respondents used complementary and alternative medicine. Herbs (65%) were the most common type of complementary and alternative medicine used. Majority (56.9%) of complementary and alternative medicine users rarely used it. A total of 178(62.8%) complementary and alternative medicine users presumed that it would cure them while 105 (37.1%) presumed that it would relieve the symptoms of their cancer. However, 197 (69.6%) complementary and alternative medicine users stated that there was no actual benefit from its use. The low educational status has a statistically significant influence on complementary and alternative medicine use among the respondents(P-value=<0.0001). Complementary and alternative medicine use had a significant influence on delay to seek orthodox care among the study participants (P-value=<0.0001). Majority (84.5%) of the doctors, caring for the patients, were not aware of the patients’ use of complementary and alternative medicine.
CONCLUSION: Complementary and alternative medicine use among gynaecological cancer patients is high in Enugu. It also delays their presentation for orthodox care. Female education and public sensitization on the effect of complementary and alternative medicine use is necessary to curb this trend.
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Enebe JT, Ajah LO, Enebe NO, Onwudiwe EN, Chikezie IN, Ajah MI, Onwujekwe OE. Analysis of cost burden of obstetric care among human immune-deficiency virus (HIV) positive women in Enugu metropolis, South-East Nigeria. J OBSTET GYNAECOL 2020; 41:581-587. [PMID: 32811222 DOI: 10.1080/01443615.2020.1787963] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The cost of obstetric care could hinder the capacity of human immune-deficiency virus (HIV) positive women to receive adequate care during pregnancy and delivery. This study was aimed at determining the relationship between antenatal/delivery care cost and delivery place choice among HIV positive women in Enugu metropolis. This was a cross-sectional study of 232 post-partum HIV-positive women who came for 6-weeks post-natal visit. Data were analysed using SPSS version 20. The ethical clearance number obtained at UNTH on 18/11/2015 was NHREC/05/01/2008BFWA00002458-1RB00002323. The average obstetric care cost among the respondents was N55,405.67 (US$346.28). The delivery cost (p-value-0.043) had positive relationship with delivery place choice. The women's proportion delivered by skilled birth attendants (SBA) was 93.1%. In conclusion, obstetric care cost among HIV positive women in Enugu was high. The high obstetric care cost influenced the delivery place of one-third of them. The choice of ill-equipped health facilities may result in higher risk of HIV transmission.IMPACT STATEMENTWhat is already known on this subject? The high HIV/AIDs burden in Nigeria could be attributed to poverty, ignorance, corruption and poor implementation of policies targeted at halting the spread of the infection. The cost of obstetric care could hinder the capacity of HIV positive women to receive adequate care during pregnancy and delivery.What do the results of this study add? The cost of antenatal care (p-value = .02) and delivery (p-value = .001) had a significant positive relationship with the choice of place of delivery by the respondents. The proportion of the women delivered by SBA was 93.1%. Approximately 31.9% of the women delivered at the health facilities different from where they had antenatal care.What are the implications of these findings for clinical practice and/or further research? This implies that the obstetric care cost among HIV positive women in Enugu metropolis was catastrophic. Though 93.1% of the respondents were delivered by SBA, the high cost of obstetric care influenced the delivery of one-third of them at centres different from where they had antenatal care. This may lead to women delivering in poorly equipped health facilities, which, in turn, may result in a higher risk of mother-to-child HIV transmission.
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Affiliation(s)
- J T Enebe
- Department of Obstetrics & Gynaeoclogy, College of Medicine/Teaching Hospital, Enugu State University of Science and Technology, Enugu, Nigeria
| | - L O Ajah
- Faculty of Medical Sciences, Department of Obstetrics and Gynaecology, University of Nigeria, Enugu, Nigeria
| | - N O Enebe
- Department of Community Medicine, University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria
| | - E N Onwudiwe
- Nisa Prime Fertility Centre, Port Harcourt, Nigeria
| | - I N Chikezie
- Health Policy Research Group, University of Nigeria, Nsukka, Nigeria
| | - M I Ajah
- Faculty of Medical Sciences, Institute of Maternal and Childhealth, University of Nigeria, Nsukka, Nigeria
| | - O E Onwujekwe
- Department of Health Administration and Management, University of Nigeria, Nsukka, Nigeria
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Onu FA, Ajah LO, Ezeonu PO, Umeora OUJ, Ibekwe PC, Ajah MI. Profile and microbiological isolates of asymptomatic bacteriuria among pregnant women in Abakaliki, Nigeria. Infect Drug Resist 2015; 8:231-5. [PMID: 26244027 PMCID: PMC4521676 DOI: 10.2147/idr.s87052] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Detecting and treating asymptomatic bacteriuria (ASB) prevents urinary tract infection and its consequences. The cost-effectiveness of routine screening for ASB in pregnancy is controversial. In populations with high prevalence, however, it is worthwhile and justifiable. Aim To determine the profile, prevalence, microbiological isolates, and risk factors of ASB among booking antenatal clinic attendees in Abakaliki, Nigeria. Materials and methods This was a cross-sectional study involving booking antenatal clinic attendees at the Federal Teaching Hospital, Abakaliki, who met the inclusion criteria. This study occurred between January and December, 2012. The midstream urine samples of these women were subjected to microscopy, culture, and sensitivity. Results A total of 300 randomly selected booking antenatal clinic attendees participated in the study; 74 of them had ASB, giving a prevalence of 24.7%. With the exception of rural residence, sociodemographic and obstetric characteristics did not influence the risk of ASB among the participants in this study. Staphylococcus aureus was the commonest organism isolated. The majority of the organisms were sensitive to ofloxacin and ceftriaxone. Conclusion There is a high prevalence of ASB among pregnant women in Abakaliki. With the exception of rural dwelling, sociodemographic and obstetric characteristics did not significantly influence the risk of ASB among these pregnant women. Therefore, routine ASB screening of pregnant women is recommended in our environment.
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Affiliation(s)
- Fidelis Agwu Onu
- Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Ebonyi State University, Abakaliki, Nigeria
| | - Leonard Ogbonna Ajah
- Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Ebonyi State University, Abakaliki, Nigeria
| | - Paul Olisaemeka Ezeonu
- Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Ebonyi State University, Abakaliki, Nigeria
| | | | - Perpetus Chudi Ibekwe
- Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Ebonyi State University, Abakaliki, Nigeria
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Ajah LO, Onubogu ES, Anozie OB, Lawani LO, Iyoke CA, Onwe EO, Ajah MI. Adolescent reproductive health challenges among schoolgirls in southeast Nigeria: role of knowledge of menstrual pattern and contraceptive adherence. Patient Prefer Adherence 2015; 9:1219-24. [PMID: 26346663 PMCID: PMC4556251 DOI: 10.2147/ppa.s89258] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Reproductive health services in the form of adolescent health and contraceptive services are fundamental in the prevention of a high incidence of teenage pregnancy. The purpose of this study was to determine the age at menarche, menstrual pattern, and awareness of and use of modern contraception among secondary school girls in Abakaliki, Nigeria. SUBJECTS AND MATERIALS This was a cross-sectional study in which self-administered questionnaires were completed by 482 adolescent girls at two girls' secondary schools between August and September 2012. RESULTS The mean age at menarche was 13.13±1.37 years. The mean menstrual cycle length was 27.8±3.14 days, and the mean duration of menstrual flow was 4.8±1.14 days. Thirty-seven (7.7%) respondents were ignorant of their cycle length, while 29 (6.0%) had irregular cycles. Premenstrual syndrome and dysmenorrhea were major menstrual issues, which resulted in 69 (14.3%) and 59 (12.2%) of respondents resorting to self-medication and absenteeism from school, respectively. Mothers were the main source of their daughters' adolescent education, while friends and mass media were the main source of contraceptive information. Though there was a high level (75.7%) of awareness of contraceptive information among the girls, usage (8.9%) was poor. Only eight (18.6%) of the 43 respondents who had ever used modern contraception were adherent to modern contraceptives. Students who were more than 15 years old, attained menarche at 13 years or less, and whose families were of low socioeconomic classes were more likely to be sexually active. CONCLUSION The declining age at menarche, menstrual challenges, and poor reproductive health status of adolescent girls in this study have made menstrual issues and contraceptive adherence critical aspects of adolescent health care, especially when appropriate sources of reproductive health information were not fully harnessed. Therefore, there is an urgent need to establish adolescent-friendly clinics and include sexuality education in the curriculum of schools in this environment.
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Affiliation(s)
- Leonard Ogbonna Ajah
- Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Abakaliki, Nigeria
| | - Ebele Samuel Onubogu
- Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Abakaliki, Nigeria
| | | | - Lucky Osaheni Lawani
- Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Abakaliki, Nigeria
| | - Chukwuemeka Anthony Iyoke
- Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Nigeria
| | | | - Monique Iheoma Ajah
- Well Women Centre, Federal Teaching Hospital, Abakaliki, Nigeria
- Correspondence: Leonard Ogbonna Ajah, Department of Obstetrics and Gynaecology, Federal Teaching Hospital, PMB 102, Abakaliki, Ebonyi 480001, Nigeria, Tel +234 803 392 0789, Email
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