Obstetrics and Gynaecology- Scholarly Publications

Permanent URI for this collection

https://ir.unilag.edu.ng/handle/123456789/3629

Browse

Browsing Obstetrics and Gynaecology- Scholarly Publications by Title

Now showing 1 - 20 of 198
  • Item
    Open Access
    A 3-year review of the pattern of contraceptive use among women attending the family planning clinic of a University Teaching Hospital in Lagos, Nigeria
    (2016) Okunade, KS; Daramola, E; Ajepe, A; Sekumade, A
    Background: Contraceptives are methods or devices used to prevent pregnancy. In Nigeria, the contraceptive prevalence was reported at 15% in 2013. Aims: This study aimed to determine the pattern of contraceptive use and sociodemographic characteristics of the users of family planning services in a teaching hospital in Lagos. Subjects and Methods: This was a descriptive, retrospective study of women who sought contraceptive services at the family planning clinic over a 3-year period. Relevant information was extracted from the case records of these women. Data were analyzed using Epi Info statistical package for Windows. Results: A total of 594 women opted to use a form of contraception in the study, within an age range of 15–52 years and with mean age of 34.3 ± 4.2 years. Fifty-four percent (54%) of the women users belonged to the Yoruba tribe and 89.4% were of the Christian faith. Married women accounted for 97.6% of the users, with the majority (68.9%) having parity of 2–4. Majority (77.6%) of the women had at least a tertiary level of education, with 46.1% of them involved in a form of skilled occupation. Nurses were the commonest source of referrals (42.9%). A larger proportion of the women (46.3%) preferred Jadelle implant while the least used method is Norplant (0.5%). Conclusion: Equipping medical personnel with the information and skills needed to meet the increasing demand for family planning services is necessary to avert the needless increase in the incidence of unwanted pregnancies, unsafe abortion, and their sequelae.
  • Item
    Open Access
    A 4-Year Clinical Review of Elective Hysterectomies at a University Teaching Hospital in Lagos, Nigeria
    (2017) Okunade, KS; Sekumade, A; Daramola, E; Oluwole, AA
    Objective: The aim of this research was to determine the types, indications, and operative outcomes of elective hysterectomies at the Lagos University Teaching Hospital (LUTH), in Lagos, South West, Nigeria. Design: This was a descriptive retrospective study of hysterectomies performed at LUTH from January 1, 2008, to December 3, 2012. Materials and Methods: Case notes of patients undergoing elective hysterectomy were retrieved from the hospital’s records department, and relevant information was extracted. Collation and analysis of data were performed, using the Epi Info statistical software package, version 7.2. Results: Hysterectomies accounted for 9.4% of all gynecologic surgical procedures. The mean age and parity of the studied women was 49.9 – 7.7 years and 3.74 – 1.57, respectively. Total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH/BSO) was the most commonly performed (50.8%), and vaginal hysterectomy (VH) (14.5%) was the least performed. There was a rising trend in the number of TAH/BSOs (7%) and radical hysterectomies (RHs; 25%), with a 40% reduction in the number of VHs performed over the study period. General anesthesia was most commonly preferred anesthetic technique (66.7%), while uterine fibroids were the most common indication for hysterectomy. The mean units of blood transfused were 2.2 – 1.5 units, and the mean days of postoperative admission was 8.0 – 4.9 days. Conclusions: There is an urgent need to fortify postgraduate specialist training as a way to improve the skills of future gynecologists so they can perform procedures such as VH to improve the overall outcome for Nigerian women undergoing hysterectomy.
  • Item
    Open Access
    A double-edged sword-telemedicine for maternal care during COVID-19: findings from a global mixed-methods study of healthcare providers
    (BMJ Glob Health, 2021-02) Galle A.; Semaan A.; Huysmans E.; Audet C.; Asefa A.; Delvaux T.; Afolabi, B.B.; El Ayadi A.M.; Benova L.
    Introduction: The COVID-19 pandemic has led to a rapid implementation of telemedicine for the provision of maternal and newborn healthcare. The objective of this study was to document the experiences with providing telemedicine for maternal and newborn healthcare during the pandemic among healthcare professionals globally. Methods: The second round of a global online survey of maternal and newborn health professionals was conducted, disseminated in 11 languages. Data were collected between 5 July and 10 September 2020. The questionnaire included questions regarding background, preparedness and response to COVID-19, and experiences with providing telemedicine. Descriptive statistics and qualitative thematic analysis were used to analyse responses, disaggregated by country income level. Results: Responses from 1060 maternal and newborn health professionals were analysed. Telemedicine was used by 58% of health professionals and two-fifths of them reported not receiving guidelines on the provision of telemedicine. Key telemedicine practices included online birth preparedness classes, antenatal and postnatal care by video/phone, a COVID-19 helpline and online psychosocial counselling. Challenges reported lack of infrastructure and technological literacy, limited monitoring, financial and language barriers, lack of non-verbal feedback and bonding, and distrust from patients. Telemedicine was considered as an important alternative to in-person consultations. However, health providers emphasised the lower quality of care and risk of increasing the already existing inequalities in access to healthcare. Conclusions: Telemedicine has been applied globally to address disruptions of care provision during the COVID-19 pandemic. However, some crucial aspects of maternal and newborn healthcare seem difficult to deliver by telemedicine. More research regarding the effectiveness, efficacy and quality of telemedicine for maternal healthcare in different contexts is needed before considering long-term adaptations in provision of care away from face-to-face interactions. Clear guidelines for care provision and approaches to minimising socioeconomic and technological inequalities in access to care are urgently needed.
  • Item
    Open Access
    A giant hydronephrotic pelvic kidney mimicking an ovarian cyst in a 34-week pregnancy
    (International Journal of Medicine and Biomedical Research, 2016-08) Okunade, K.S.; Sekumade A.; Sajo, E.A.; Daramola E.; Okojie O.E.; Ojewola R.W.; Balogun O.; Afolabi, B.B.; Anorlu R.I.
    Background: A giant hydronephrosis is defined as a dilated pelvi-calyceal system with an amount of urine exceeding one Litre in the urinary tract of an adult. It can mimic several other clinical conditions including a huge ovarian cyst. An ectopic pelvic kidney with hydronephrosis in pregnancy is a rare occurrence. Aim: This study documents a case of giant hydronephrosis that was wrongly diagnosed as an ovarian cyst. Findings: A 36-year old primiparous with a giant hydronephrosis which was initially diagnosed as an ovarian cyst. She was planned for a laparotomy with caesarean section and ovarian cystectomy at 34 weeks gestation. She was delivered of a live female neonate. Further exploration was done which revealed a left ectopic kidney. She had a left simple nephrectomy because the kidney appeared totally unhealthy. Conclusion: There is a need to be careful when dealing with cystic lesions of the abdomen. A high index of suspicion is required and further imaging other than ultrasound scan such as computerized tomography or magnetic resonance imaging may be necessary to make accurate diagnosis.
  • Item
    Open Access
    A mixed-methods study of maternal health care utilisation in six referral hospitals in four sub-Saharan African countries before and during the COVID-19 pandemic
    (BMJ Glob Health, 2022-02) Banke-Thomas A.; Semaan A.; Amongin D.; Babah O. A.; Dioubate N.; Kikula A.; Nakubulwa S.; Ogein O.; Adroma M.; Anzo Adiga W.; Diallo A.; Diallo L.; Cellou Diallo M.; Maomou C.; Mtinangi N.; Sy T.; Delvaux T.; Afolabi, B.B.; Delamou A.; Nakimuli A.; Pembe A.B.; Benova L.
    Introduction: In sub-Saharan Africa, referral hospitals are important sources of key maternal health services, especially during a crisis such as the COVID-19 pandemic. This study prospectively assessed the effect of the COVID-19 pandemic on maternal health service utilisation in six large referral hospitals in Guinea, Nigeria, Tanzania and Uganda during the first year of the pandemic. Methods: Mixed-methods design combining three data sources: (1) quantitative data based on routine antenatal, childbirth and postnatal care data collected March 2019-February 2021, (2) qualitative data from recurring rounds of semi-structured interviews conducted July 2020-February 2021 with 22 maternity skilled heath personnel exploring their perceptions of service utilisation and (3) timeline data of COVID-19 epidemiology, global, national and hospital-level events. Qualitative and quantitative data were analysed separately, framed based on the timeline analysis and triangulated when reporting. Results: Three periods including a first wave, slow period and second wave were identified. Maternal health service utilisation was lower during the pandemic compared with the prepandemic year in all but one selected referral hospital. During the pandemic, service utilisation was particularly lower during the waves and higher or stable during the slow period. Fear of being infected in hospitals, lack of transportation, and even when available, high cost of transportation and service closures were key reasons affecting utilisation during the waves. However, community perception that the pandemic was over or insinuation by Government of the same appeared to stabilise use of referral hospitals for childbirth. Conclusion: Utilisation of maternal health services across the continuum of care varied through the different periods and across countries. In crisis situations such as COVID-19, restrictions and service closures need to be implemented with consideration given to alternative options for women to access and use services. Information on measures put in place for safe hospital use should be communicated to women.
  • Item
    Open Access
    A preprogram appraisal of factors influencing research productivity among faculty at college of medicine, University of Lagos
    (Ann Afr Med, 2022-06) Ogunsola F. T.; Odukoya O.O.; Banigbe B.; Caleb-Adepoju S.O.; Folarin O.; Afolabi, B.B.; Okubadejo N.U.; Adeyemo W.L.; Akanmu A.S.; Osuntoki A.; Okonkwo P.; Murphy R.; Kanki P.
    Background: A defining feature of any university is its dedication to scholarly activities, leading to the generation of knowledge and ideas Research productivity is a measure of achievement of a scholar. The number of research publications in peer-reviewed journals is an important criterion for assessing productivity and prestige in the academia. Aims and objectives: This cross-sectional descriptive study assessed the level of research productivity (RP) among junior faculty at the College of Medicine, University of Lagos, and investigated factors affecting their research output prior to the implementation of a 5-year training grant funded by the National Institutes of Health. Methods: Seventy junior faculty members attended a pre-program training, and the self-reported number of peer-reviewed publications (PRPs) was used as an indicator. Intrinsic and extrinsic factors influencing RP among the attendees were assessed and ranked. Results: The majority (42/70, 60%) of the respondents had <10 PRPs. The median (interquartile range) number of PRPs was 7 (3-18). A desire for the development of their personal skills, contribution to society, and personal research interests topped the list of intrinsic factors influencing RP. Work flexibility, research autonomy, and scholarly pursuits were the bottom three. A desire for promotion, respect from peers, and increased social standing were the top three extrinsic factors, while monetary incentives, employment opportunities, and the need to attend conferences were the lowest three. The top barriers to RP were lack of resources and lack of mentoring. Perceived older age, lack of time, and motivation were the lowest three barriers. Older age and professional cadre were associated with increased RP (P < 0.05). Conclusion: Among the participants, research output appears to be motivated primarily by a desire for personal development,promotion, and respect from peers. Lack of access to resources was the main barrier to increased RP. These factors may need to be considered when developing programs designed to promote RP.
  • Item
    Open Access
    A Review Of Eclampsia At The Lagos University Teaching Hospital (LUTH), Lagos, Nigeria: Have We Improved?.
    (IOSR Journal of Dental and Medical Sciences (IOSR-JDMS), 2014) Babah O.A.; Oluwole A.A.; Afolabi, B.B.; Odum C.U.
    A total of 12,234 patients were treated in the Lagos University Teaching Hospital (LUTH) for various obstetric conditions between January 1, 1996 and December 31, 2005. Of these, 165 (1.35%) were eclamptics. 148 (89.7%) of these were pre-delivery eclamptics and 17 (10.3%) were post-delivery eclamptics. Unbooked eclamptics remained a dominant group comprising 149 (90.3%) of all eclamptics. Mean maternal age was 26.59±0.44 years. Most of these patients were of low parity; primiparae constituting 76.8% and multiparae 23.2%. Mean gestational amenorrhoea at onset of eclampsia being 34.64±0.44 weeks. There were 22 maternal deaths due to eclampsia and its complications with a maternal mortality rate of 133.3 per 1000 eclamptics. The commonest causes of maternal deaths were septicaemia (13.64%), acute renal failure (9.09%) and respiratory failure (9.09%). There were 54 perinatal deaths, with a perinatal mortality rate of 346.2 per 1000. A comparison of the data obtained from this recent decade (1996 - 2005) to those of the previous three decades (1967 – 1976, 1977 – 1986 and 1986 – 1995) showed that there had been a progressive decline in the number of eclamptics managed in LUTH in the last three decades (572 eclamptics in 1977 – 1986, 299 eclamptics in 1986 – 1995, and 165 in 1996 – 2005). This study also showed a rise in the mean caesarean section rate for pre-delivery eclamptics and all eclamptics (55.41% and 49.70% respectively) compared to findings in the previous decades. There was a significant increase in the maternal mortality and perinatal mortality rates in recent decade. There was a decline in post mortem rate (40.9% in recent decade compared with 60% in previous decades).
  • Item
    Open Access
    A study of urinary prostacyclin products and some haematological parameters in pregnant women with sickle cell anaemia
    (Journal of Clinical Sciences, 2013) Akanmu A.S.; Afolabi, B.B.; Taiwo-Osunubi P. A.; Abudu O.O.
    ABSTRACT Objective: Normal gestation is associated with an increased plasma volume (PV) and vasodilation which plasma prostacyclin (PGI2) may account for. This study measured PGI2 levels in pregnant haemoglobin (Hb) SS patients as they have been reported to lack PV expansion. Methods: Urinary prostacyclin (UP) concentration and full blood count parameters were determined in pregnant Hb AA and Hb SS women, with non-pregnant controls. Results: Thirty-three Hb AA (19 non-pregnant and 14 pregnant) and 25 Hb SS (18 non-pregnant and 7 pregnant) were studied. UP did not rise in pregnant Hb SS women compared to non-pregnant (Geometric mean (GM) 614 ± 2.4 vs 248 ± 3.8, p=0.063), despite a very significant rise in Hb AA pregnancy (GM 1406 ± 2.1 vs 260 ± 2.9 pg/ml, p<0.0001). Conclusion: There is a lack of significant rise in plasma prostacyclin levels during pregnancy in Hb SS women, which could account for their reported lack of plasma volume expansion.
  • Item
    Open Access
    Absorbable suture materials for primary repair of episiotomy and second degree tears : RHL commentary . The WHO Reproductive Health Library; Geneva: World Health Organization.
    (WHO Reproductive Health Library, 2011) ADEGBOLA, O
    Repair of perineal trauma with synthetic absorbable sutures is associated with less short-term pain, reduction in the use of analgesia, less wound breakdown and reduced need for perineal re-suturing compared with catgut. However, the use of standard synthetic sutures was associated with greater frequency of removal of unabsorbed sutures compared with catgut. There was no significant difference between standard synthetic sutures and rapidly absorbed synthetic sutures, although with the latter fewer women required removal of unabsorbed suture up to 3 months post delivery, there was less analgesic use and more gaping wound edges.
  • Item
    Open Access
    The Acceptance Rate of Intrauterine Contraceptive Device (IUCD) Amongst Family Planning Clinic Users in Lagos University Teaching Hospital
    (Lagos University Medical Society, 2008-10) Ogedengbe, O.K; Adegbola, O.
    BACKGROUND: Intrauterine Contraceptive Device is an effective reversible long-term contraceptive method that is popular and widely used in this environment. OBJECTIVES: To determine the characteristics of women using this mode of contraception, their main reasons for acceptance, complications arising from usage and the discontinuation rate as well as reasons for discontinuing the method. METHODS: A review of case records of all the new contraceptive acceptors attending the Department of Obstetrics and Gynaecology Family Planning Clinic of the Lagos University Teaching Hospital (LUTH) from 1st January 1990 to 31st December 1994 was examined and the clients that accepted the intrauterine contraceptive device, (IUCD) during this period were identified. The records of those that opted for IUCD were thoroughly reviewed to identify the follow up events through the subsequent ten years visits to determine outcome of the contraceptive usage. RESULTS: Amongst the 2754 new contraceptive acceptors during the study period, 1602 (58.17%) clients accepted the Intrauterine Contraceptive Device (IUCD). Of these IUCD acceptors, the mean age was 31.3 +/- 5.5 years, mean parity was 3.9 +/- 2 and mean number of children alive was 3.6 +/- 1.8. Seven hundred and forty nine (46.8%) of them had previously used contraceptives and 1175 (73.3%) of them still wanted more children, thus child spacing was the main reasons for accepting this method. By 12 months, the discontinuation rate was 13.9% with the cumulative discontinuation rate of 47% as at forty-eighth month. The commonest reason for discontinuation was planning to get pregnant in 426 (26.6%) of the clients. Menstrual disorders accounted for 108 (6.7%). The mean duration of IUCD was 25.4 +/- 18.8 months with an accidental pregnancy rate of 0.3%. CONCLUSION: Intrauterine Contraceptive Device is widely accepted amongst women in the study group. Devices that reduce menstrual loss and also have long duration of action like Levonorgestrel intrauterine system (LNG-IUS) qualifies to be considered.
  • Item
    Open Access
    Accreditation of undergraduate medical training programs: practices in nine developing countries as compared with the United States
    (Educ Health (Abingdon), 2006-07) Cueto, J Jr.; Burch, V.C.; Adnan, N.A; Afolabi, B.B.; Ismail, Z.; Jafri, W.; Olapade-Olaopa, E.O.; Otieno-Nyunya, B.; Supe, A.; Togoo, A.; Vargas, A.L.; Wasserman, E.; Morahan, P.S.; Burdick, W.; Gary, N.
    Context and objectives: Undergraduate medical training program accreditation is practiced in many countries, but information from developing countries is sparse. We compared medical training program accreditation systems in nine developing countries, and compared these with accreditation practices in the United States of America (USA). Methods: Medical program accreditation practices in nine developing countries were systematically analyzed using all available published documents. Findings were compared to USA accreditation practices. Findings: Accreditation systems with explicitly defined criteria, standards and procedures exist in all nine countries studied: Argentina, India, Kenya, Malaysia, Mongolia, Nigeria, Pakistan, Philippines and South Africa. Introduction of accreditation processes is relatively recent, starting in 1957 in India to 2001 in Malaysia. Accrediting agencies were set up in these countries predominantly by their respective governments as a result of legislation and acts of Parliament, involving Ministries of Education and Health. As in the USA, accreditation: (1) serves as a quality assurance mechanism promoting professional and public confidence in the quality of medical education, (2) assists medical schools in attaining desired standards, and (3) ensures that graduates' performance complies with national norms. All nine countries follow similar accreditation procedures. Where mandatory accreditation is practiced, non-compliant institutions may be placed on probation, student enrollment suspended or accreditation withdrawn. Conclusion: Accreditation systems in several developing countries are similar to those in the developed world. Data suggest the trend towards instituting quality assurance mechanisms in medical education is spreading to some developing countries, although generalization to other areas of the world is difficult to ascertain.
  • Item
    Open Access
    Accuracy of urine dipsticks, 2-h and 12-h urine collections for protein measurement as compared with the 24-h collection
    (2008) Abebe, J; Eigbefoh, J; Isabu, P; Okogbenin, S; Eifediyi, R; Okusanya, B
    Summary The presence of protein in hypertensive disorders of pregnancy is a sign of a worsening condition and thus requires early intervention to prevent adverse consequences. Accurate assessment of proteinuria in patients with pre-eclampsia will ensure prompt and timely intervention to reduce or prevent the maternal and perinatal morbidity and mortality associated with preeclampsia. This study compared the reliability and validity of the more rapid diagnostic tests, such as the dipstick, 2-h and 12- h protein estimations with the 24-h protein. The result of the dipstick, 2-h and 12-h urine were also compared with the 24-h urine results using confidence interval (CI) for proportions with a value of p50.05 considered significant (CI 95%). When compared with the gold standard, there was a high degree of correlation between the 2-h (p 0.244, CI 95%) and 12-h (p50.0255, CI 95%) with the 24-h sample in the quantification of proteinuria in women with pre-eclampsia. The most sensitive and specific test was the 12-h protein estimation, (89%) and (93%), respectively. The least sensitive and specific test was the dipstick test; (81%) and (47%), respectively. The 12-h protein estimation test had the highest positive predictive value (84%). The 12-h protein test also had the lowest false positive rate (12%) and false negative rates (11%), respectively. The most accurate test was the 12-h protein estimation (88%). The dipstick tests were however much cheaper and the results were faster. It is recommended that routine rapid quantisation of proteinuria in patients with pre-eclampsia be done using either the 2-h or 12-h urine sample.
  • Item
    Open Access
    Actions and Adaptations Implemented for Maternal, Newborn and Child Health Service Provision During the Early Phase of the COVID-19 Pandemic in Lagos, Nigeria: Qualitative Study of Health Facility Leaders.
    (Ann Glob Health, 2022) Balogun M.; Banke-Thomas A.; Gwacham-Anisiobi U.; Yesufu V.; Ubani O,; Afolabi, B.B.
    Background: The early phase of the COVID-19 pandemic led to significant disruptions in provision of maternal, newborn, and child health (MNCH) services, especially in low- and middle-income countries (LMICs) with fragile health systems, such as Nigeria. Measures taken to 'flatten the curve' such as lockdowns, curfews, travel restrictions, and suspension of public services inadvertently led to significant disruptions in provision of essential health services. In these countries, health facility leaders are directly responsible for driving changes needed for service delivery. Objective: To explore perspectives of health facility leaders in Lagos, Nigeria, on solutions and adaptations implemented to support MNCH service provision during the early phase of the COVID-19 pandemic. Methods: Key informant interviews were remotely conducted with purposively sampled 33 health facility leaders across primary, secondary, and tertiary public health facilities in Lagos between July and November 2020. Following verbatim transcription of recordings, data familiarization, and coding, thematic analysis was used to synthesize data. Results: Health facility leaders scaled down or discontinued outpatient MNCH services and elective surgeries. However, deliveries, newborn, immunization, and emergency services continued. Service provision was reorganized with long and staggered patient appointments, collapsing of wards and modification of health worker duty rosters. Some secondary and tertiary facilities leveraged technology like WhatsApp, webinars, and telemedicine to support service provision. Continuous capacity-building for health workers through training, motivation, psychological support, and atypical sourcing of PPE was instituted to be able to safely maintain service delivery. Conclusion: Health facility leaders led the frontline of the COVID-19 response. While they took to implementing global and national guidelines within their facilities, they also pushed innovative facility-driven adaptations to address the indirect effects of COVID-19. Insights gathered provide lessons to foster resilient LMIC health systems for MNCH service provision in a post-COVID-19 world.
  • Item
    Open Access
    Active management of third stage of labour: evidence versus practice
    (Informa Healthcare, 2009) Oladapo, O.T; Akinola, O.I; Fawole, A.O; Adeyemi, A.S; ADEGBOLA, O; Loto, O.M; Fabanwo, A.O; Alao, M.O; Sotunsa, J.O
    Objective. To determine the correct use of active management of third stage of labor (AMTSL) (using the full complement of existing standard definitions) and compare the outcomes of third stage of labor in women who received AMTSL (according to these definitions) with those who did not. Design. Observational, cross-sectional survey. Setting. Seven tertiary centers in southwest Nigeria. Population. Women undergoing non-instrumental vaginal deliveries. Methods. Prospective direct observations of childbirth procedures. AMTSL was defined according to Cochrane review, ICM/FIGO (International Confederation of Midwives/International Federation of Gynecology and Obstetrics), and WHO (World Health Organization) recommendations. Main outcome measures. Use of AMTSL and its components and outcome of third stage of labor. Results. There was a high rate of compliance with most of the individual components of AMTSL. The use of AMTSL varied widely with the definition applied and tended to decrease with increasing strictness of the criteria (Cochrane review: 88.9%; ICM/FIGO: 42%; WHO: 1.8%). The frequencies of adverse labor outcomes were generally low (postpartum hemorrhage (PPH): 4.9%; severe PPH: 0.8%; retained placenta: 1.9%; uterine inversion: 0.0%). Frequencies of PPH, postpartum anemia, and mean blood loss among women who received AMTSL according to the Cochrane review definition were significantly lower than for those who did not (p < 0.05). There was no significant difference between any of the outcomes for women who received AMTSL according to the ICM/FIGO definition and those who did not. Conclusions. The survey reveals substantial definition-dependent variation in the providers’ adherence to recommended AMTSL practices. The clinical implications of the current practice in this population suggest the need for randomized comparison of various AMTSL packages to determine their comparative effectiveness in the prevention of PPH.
  • Item
    Open Access
    Active management of third stage of labour; a survey of providers’ knowledge in southwest Nigeria
    (Springer-Verlag, 2009) Oladapo, O.T; Fawole, A.O; Loto, O.M; ADEGBOLA, O; Akinola, O.I; Alao, M.O; Adeyemi, A.S
    Background The disparity between current evidence and practice on active management of third stage of labour (AMTSL) demands assessment of providers’ knowledge on the subject. Objective To assess the level and determinant(s) of accurate knowledge of obstetric providers regarding AMTSL. Methods Questionnaire-based survey of 361 labour and delivery professionals in public tertiary obstetric centres in southwest Nigeria. Results Female nurses at diVerent cadres accounted for most of the respondents. Majority (90.6%) of the respondents reported being aware of AMTSL as an obstetric intervention and 49.7% were aware of FIGO/ICM recommendation on AMTSL. Out of 13 potential third stage interventions, 102 respondents (28.3%) correctly and exclusively identiWed the components of AMTSL as deWned by FIGO/ICM. Many procedures reserved for treatment of complicated third stage of labour such as manual placental removal (37.7%), blood transfusion (20.2%), bimanual uterine compression (24.7%) and uterine artery ligation (13.9%) were also selected as AMTSL components. Multivariate logistic regression analysis indicated that being in administrative position (adjusted OR: 2.68; CI 1.19–6.02) and frequent compared to rare or no consultation of books, journal and internet sources for information (adjusted OR: 2.58; CI 1.21–5.52) increased the odds of having accurate knowledge of AMTSL while being a nurse/midwife (adjusted OR: 0.15; CI 0.05–0.39), matron (adjusted OR: 0.25; CI 0.08–0.79) or intern (adjusted OR: 0.07; CI 0.01–0.29) compared to postgraduate resident doctors reduced the odds of having accurate knowledge of AMTSL. Conclusion AMTSL was a familiar but poorly understood intervention among obstetric care providers in this region. Improvement in healthcare quality and practitioners’ adherence to recommended guidelines on AMTSL urgently requires educational interventions that target those who provide routine delivery care and organisation of the health care delivery system in such a way that enables providers to act on acquired knowledge
  • Item
    Open Access
    Adenosine deaminase activity in subjects with normal pregnancy, pregnancy induced hypertension and pre-eclampsia
    (West Afr J Med, 2009-05) Oladipo, O.O.; Afolabi, B.B.; Okorodudu, A.O.
    Both pregnancy and adenosine deaminase (ADA) are associated with depressed cellular mediated immunity. There is little information on ADA activity in pregnant Africans. To determine the serum levels of adenosine deaminase (ADA) in normal pregnancy and pregnancy complicated by hypertension in Nigerian women. One hundred and twenty-five pregnant women comprising 35 normal non-pregnant women, 35 normal pregnant women, 35 pregnant women with pregnancy induced hypertension and 20 patients with pre-eclampsia were recruited for the study. Serum adenosine deaminase enzyme (ADA) activity was measured by the Giusti and Galanti spectrophotometric method in all study subjects. The mean serum ADA level in the non-pregnant women was higher than that in the normal pregnant women (23.21 +/- 6.3 v 14.69 +/- 3.2, p<0.001). Amongst the pregnant women, mean serum ADA in the hypertensive and pre-eclamptic women was significantly higher than that in the normal pregnant group (p<0.001). These findings indicate a probable decrease in cellular immunity in normal pregnancy and an enhanced cell mediated immunity in pre-eclampsia.
  • Item
    Open Access
    Africa can solve its own health problems. Africa needs less globalisation and more real assistance
    (BMJ, 2002) Afolabi, B.B.
    The article by Holmes and the accompanying commentaries essentially aim to explore the evidence for the efficacy and effectiveness of the psychotherapies and how this should be applied in everyday clini≠cal practice.1It is ironic that the arguments against cognitive therapy include numerous instances of idiosyncratic use of research evidence.Firstly, for example, in his commentary Bolsover selects three studies to support hisview that the evidence base for cognitive therapy is weak. We would challenge him to apply his arguments to the seven systematic reviews of cognitive therapy in the Cochrane Database and the Database of Abstracts of Reviews of Effectiveness.2Holmes and also Bolsover cite a single paper to suggest that cognitive therapy isless effective in the real world of clinical practice than in university based clinicaltrials. This caricature may have applied tosome trials conducted 30 years ago but isirrelevant now. To give just two examples,recent trials of cognitive therapy for chronic depression specifically recruited individualswho were depressed despite adequate trialsof pharmacotherapy and psychotherapy.3Also, the Cochrane review of cognitivetherapy for schizophrenia includes exam≠ples of “real world” interventions.
  • Item
    Open Access
    Antepartum or intrapartum deinfibulation for childbirth in women with type III female genital mutilation: A systematic review and meta-analysis
    (2017) Esu, E; Udo, A; Okusanya, BO; Agamse, D; Meremikwu, MM
    Background: There remains no consensus on the best timing of deinfibulation in women with type III female genital mutilation (FGM). Objectives: To conduct a systematic review of the effects of antepartum or intrapartum deinfibulation on childbirth outcomes in women with type III FGM. Search strategy: The following major databases were searched: Cochrane Central Register for Controlled Trials (CENTRAL), MEDLINE, Scopus, Web of Science, and ClinicalTrials.gov, from inception until August 2015 without any language restrictions. Selection criteria: Studies of pregnant women or girls with type III FGM who were deinfibulated antepartum or intrapartum were included. Data collection and analysis: Two team members independently screened and collected data. Quality of evidence was assessed using GRADE. Summary odds ratios and proportions were calculated when possible. Results: There is no evidence of a significant difference between antepartum and intrapartum deinfibulation for obstetric outcomes such as duration of labor, perineal lacerations, episiotomies, postpartum hemorrhage, and cesarean deliveries. Outcomes in women living with type III FGM and those who have undergone deinfibulation were not statistically different; however, trends show a benefit for deinfibulation. All studies were underpowered to detect statistical differences. Conclusion: Larger studies are required to have full confidence in these findings. PROSPERO registration: CRD42015024464
  • Item
    Open Access
    The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications
    (Br J Anaesth, 2018-12-01) Kluyts, H.L.; le Manach, Y.; Munlemvo, D.M.; Madzimbamuto, F.; Basenero, A.; Coulibaly, Y.; Rakotoarison, S.; Gobin, V.; Samateh, A.L.; Chaibou, M.S.; Omigbodun, A.O.; Amanor-Boadu, S.D.; Tumukunde, J.; Madiba, T.E.; Pearse, R.M.; Biccard, D.M.; Afolabi, B.B.; ASOS investigators
    BACKGROUND: The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications. METHODS: ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery. RESULTS: The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784. CONCLUSIONS: This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance. CLINICAL TRIAL REGISTRATION: NCT03044899.
  • Item
    Open Access
    An assessment of geographical access and factors influencing travel time to emergency obstetric care in the urban state of Lagos, Nigeria
    (Health Policy Plan, 2021-10) Banke-Thomas, A.; Wong, k.L.M.; Collins, L.; Olaniran, A.; Balogun, M.; Wright, O.; Babajide, O.; Ajayi, B.; Afolabi, B.B.; Abayomi, A.; Benova, L.
    Previous efforts to estimate the travel time to comprehensive emergency obstetric care (CEmOC) in low- and middle-income countries (LMICs) have either been based on spatial models or self-reported travel time, both with known inaccuracies. The study objectives were to estimate more realistic travel times for pregnant women in emergency situations using Google Maps, determine system-level factors that influence travel time and use these estimates to assess CEmOC geographical accessibility and coverage in Lagos state, Nigeria. Data on demographics, obstetric history and travel to CEmOC facilities of pregnant women with an obstetric emergency, who presented between 1st November 2018 and 31st December 2019 at a public CEmOC facility were collected from hospital records. Estimated travel times were individually extracted from Google Maps for the period of the day of travel. Bivariate and multivariate analyses were used to test associations between travel and health system-related factors with reaching the facility >60 minutes. Mean travel times were compared and geographical coverage mapped to identify 'hotspots' of predominantly >60 minutes travel to facilities. For the 4005 pregnant women with traceable journeys, travel time ranges were 2-240 minutes (without referral) and 7-320 minutes (with referral). Total travel time was within the 60 and 120 minute benchmark for 80 and 96% of women, respectively. The period of the day of travel and having been referred were significantly associated with travelling >60 minutes. Many pregnant women living in the central cities and remote towns typically travelled to CEmOC facilities around them. We identified four hotspots from which pregnant women travelled >60 minutes to facilities. Mean travel time and distance to reach tertiary referral hospitals were significantly higher than the secondary facilities. Our findings suggest that actions taken to address gaps need to be contextualized. Our approach provides a useful guide for stakeholders seeking to comprehensively explore geographical inequities in CEmOC access within urban/peri-urban LMIC settings.