Prevalence of sexual dysfunction among females in a university community in Enugu, Nigeria

BACKGROUND

Female sexual dysfunction is a common, condition that significantly reduces the quality-of-life of the affected persons. Unfortunately, because of the veil of secrecy that shrouds discussions on human sexuality, there has been limited research on this topic in some sociocultural settings.

AIM

The aim was to determine the prevalence and some sociodemographic factors associated with sexual dysfunction in females in a university community at the University of Nigeria, Enugu Campus, Enugu State, Nigeria.

SUBJECTS AND METHODS

This is a cross-sectional study involving 500 females recruited randomly in a tertiary institution in Nigeria. A self-administered structured pretested questionnaire on sexual activity was administered (the Female Sexual Function Index [FSFI]). Statistical analysis was performed using SPSS software package (Version 17.0, Chicago, IL, USA). Multiple logistic regression was used to determine the relationship between the sociodemographic factors, and the total FSFI scores dichotomized as normal and reduced sexual function. In addition, multiple linear regression was used to determine the relationship between the six different domains scores and the continuous values of the total score. For all, calculations, P < 0.05 was considered as statistically significant at 95% confidence interval (CI).

RESULTS

The prevalence of female sexual dysfunction (FSFI score ≤ 26.50) was 53.3%. The highest prevalence occurred in the 41-50 years age group (73.3%; 66/90), married and living together 56.4% (123/218) and had postsecondary education (56.1%; 137/244). Only age significantly predicted female sexual function (P = 0.007; 95% CI; 0.691-0.943). Marital status, religion, ethnic group, and educational qualification had no significant effect (P < 0.05). The total FSFI significantly increase as desire increases (P = 0.002; 95% CI = 0.817-3.573).

CONCLUSION

Female sexual dysfunction is common in the university environment, with the highest prevalence occurring in 41-50 years age group.

Knowledge, attitude and practice of private medical practitioners towards abortion and post abortion care in Enugu, South-eastern Nigeria

The objective of this study was to determine the knowledge, attitude and practice of private medical practitioners in Enugu, South-eastern Nigeria, on abortion and post-abortion care. It was a cross-sectional study of private medical practitioners in the study area using self-administered structured questionnaires. The results showed that 32.3% of the doctors terminate unwanted pregnancies when requested to do so. The majority of them (51.6%) use D&C in combination with manual vacuum aspiration for the termination of pregnancies in the first trimester. A total of 61 (63.5%) respondents offered various types of post-abortal care (PAC) services, while 42 (43.8%) of them screened women with abortion complications for sexually transmitted infections. For the doctors who do not terminate unwanted pregnancies, their main reasons were religious and moral considerations rather than obedience to the Nigerian abortion laws. We conclude that the majority of private medical practitioners in Enugu, South-eastern Nigeria, do not terminate unwanted pregnancies because of their religious beliefs.

Pain perception among parturients in Enugu, South-eastern Nigeria

In order to evaluate pain perception among parturients in Enugu, South-east Nigeria, a cross-sectional questionnaire study of parturients who delivered vaginally in four health institutions in Enugu from 2 December 2005 to 21 January 2006 was administered. Data analysis was by means of percentages, means +/- SD, correlation coefficients, t-tests, chi2-tests, one-way ANOVA and other inferential statistics using the statistical package SPSS for MS Windows at the 95% confidence level. A total of 250 questionnaires were distributed, out of which 181 were correctly filled and returned for a response rate of 72.4%. On a scale of 0 to 10, with 0 representing no pain and 10 representing maximal pain, the mean intensity of pain recorded by the respondents was 7.7 +/- 2.8. A total of 40 (22.1%) parturients received some pain relieving drug during their labour while 141 (77.9%) did not. Of the 40 women who received intra-partum analgesia, three women received pethidine, 17 (42.5%) received pentazocine, while 20 (50%) did not know the analgesic they received. Of the 141 respondents who did not receive intra-partum analgesia, 79 (56.0%) would have liked to have receive analgesia, while 62 (44.0%) would not. Of the 92 women who had their backs rubbed by companions during labour, 67 (72.8%) reported that this practice was helpful in relieving their labour pains, while 25 (27.2%) did not find it helpful. Of the 141 women who had a companion, 103 (73.0%) reported that this was helpful in relieving labour pains, while 38 (27.0%) reported no benefit. Antenatal care, place of residence, ethnicity, religion, marital status, occupational level, receiving intra-partum analgesia, type of analgesia received, having a companion during labour or receiving lectures on labour pains during the antenatal period had no significant impact on pain perception by the respondents (p > 0.05 for each of these variables). There was no significant correlation between pain scores and the respondents' ages and gestational age at delivery (p > 0.05). However, there was a significant positive correlation between the parturients' pain scores and their educational levels (r = 0.18, p = 0.018) and a significant negative correlation between pain scores and parity (r = -0.23, p = 0.009), with primigravidae having the highest perceived mean pain score compared with multiparas and grandmultiparas (7.5 +/- 2.3 vs 6.6 +/- 2.5 vs 6.3 +/- 2.1, p = 0.048). Additionally, those parturients who had their backs rubbed by a companion had a significantly higher mean perceived pain score than their counterparts whose backs were not rubbed (8.4 +/- 2.4 vs 6.8 +/- 2.9, p = 0.000). Parturients whose labours were either induced or augmented had a significantly higher perceived mean pain score than those who had spontaneous labour (8.9 +/- 2.5 vs 7.1 +/- 2.8, p = 0.001). It was concluded that parturients in Enugu, Eastern Nigeria, perceive labour as a very painful process with only a minority of them receiving any form of intra-partum analgesia. There is thus a large unmet need for pain relief among the parturients. Obstetric analgesia as is currently practiced in developed countries is long overdue in Nigeria.

Pregnancy outcome in HIV-positive women in Enugu, Nigeria

This is a retrospective case-control study of 62 HIV-positive women and 100 HIV-negative controls who delivered in the University of Nigeria Teaching Hospital, Enugu, from 2 August, 2002 to 31 March, 2004. The HIV-positive women were relatively younger and of lower mean parity than the HIV-negative controls. They were also significantly more likely to have positive syphilis serology, higher mean duration of labour, perineal tear, puerperal sepsis and higher mean duration of hospital stay, higher prevalence of low birth weight, birth asphyxia and more admissions to the Newborn Special Care Unit than the controls (p < 0.05). However, there was no significant difference in the two groups in the prevalence of hepatitis B surface antigenaemia, recurrent vulvovaginitis, abortions, stillbirths, congenital anomalies, pre-term delivery, mean interval between rupture of membranes and delivery and mode of delivery (p > 0.05). All (100%) the HIV-negative and 96.8% of the seropositive women had voluntary counselling and testing (VCT). There was no maternal death in either group. Untreated maternal HIV infection is associated with adverse pregnancy outcomes in the form of increased maternal and fetal morbidities. Hence for optimal outcomes, prevention of mother-to-child transmission (PMTCT) programmes must incorporate combination drug treatment for the mother as early in pregnancy as possible.

An evaluation of the shock index in predicting ruptured ectopic pregnancy

In order to evaluate the shock index in predicting a ruptured ectopic pregnancy in a Nigerian obstetric population, a prospective observational study of consecutive pregnant women presenting to the emergency room of the University of Nigeria Teaching Hospital, Enugu with complaints of abdominal pain and/or vaginal bleeding in the first trimester of pregnancy over a 23-month period (1 February 2003 to 31 December 2004) was carried out. A total of 152 subjects were studied. Of these, 15 (9.9%) of the women had ruptured ectopic pregnancy while the rest had other causes of bleeding in early pregnancy. The mean shock index for ruptured ectopic pregnancy was significantly different from that for threatened abortion (p < 0.001), incomplete abortion (p = 0.022) and inevitable abortion (p < 0.001) but not from that for unruptured ectopic pregnancy and septic abortion (p > 0.05 for both categories). The areas under the relative operating characteristic (ROC) curves for shock index and heart rate were statistically significant (p < 0.001 for both variables) but those under the curves for systolic blood pressure, diastolic blood pressure and mean arterial blood pressure were not statistically significant (p > 0.05 for the three variables). From the curves, the cut-offs that combined highest sensitivity with lowest false positivity (1-specificity) were 0.935 for the shock index and 99 bpm for heart rate. On univariate logistic regression, the odds ratio (OR) for predicting ruptured ectopic pregnancy was 52.9 (95% CI = 10.9 - 257.3, p < 0.001) for shock index > or =0.935 and 26.4 (95% CI = 6.8 - 102.8, p < 0.001) for heart rate > or =99/min. On multivariate logistic regression using both shock index > or =0.935 and heart rate > or =99/min, only shock index > or =0.935 was statistically significant with an OR of 4.5 (95% CI = 1.8 - 11.6, p = 0.002). We conclude that when faced with the possibility of ruptured ectopic pregnancy, shock index has a high predictive value in the Nigerian population studied and is a useful addition to the currently available diagnostic armamentarium in ruptured ectopic pregnancy.