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We investigated perceptions of the causes of maternal mortality by women attending referral hospitals in Nigeria. Focus group discussions were conducted with various categories of women. Our results showed that women were aware of the medical causes of mortality, although a few listed divine reasons. Delays in reaching hospitals or after women arrive in hospitals featured prominently as lead causes mentioned by women. Listening to women as end-users is an important approach to identify points of remediation in the provision of maternal health care. This should be taken into cognizance when policymakers or international agencies plan the prevention of maternal deaths in developing countries. [ABSTRACT FROM AUTHOR]

Background. The debate on the benefit of leaving the peritoneum unsutured is ongoing among gynaecologists. There is yet to be a final decision on this surgical step, especially considering the long-term complications of adhesion formation, subfertility and chronic pelvic pain. Objectives. The objective of the study is to determine the attitudes of Nigerian gynaecologists toward the peritoneum during laparotomy for both benign conditions and caesarean sections. Methods. The survey was conducted during the 50th International Conference of Gynaecologists hosted by the Society of Gynaecology and Obstetrics of Nigeria in October 2015. A questionnaire was distributed to attending participants across the board regarding peritoneal closure at laparotomy. A total of 125 respondents completed the survey. Data were entered into SSPA statistical software for analysis. Results. The attitude towards the peritoneum was not associated with the year of experience as a gynaecologist. The reasons for the decision not to close the peritoneum was mostly based on the little evidence there is as regards the benefits. Conclusion. The attitude towards the peritoneum during gynaecological procedures amongst Nigerian specialists appears to be in congruity with international practices where there is no clear-cut preference on the status of the peritoneum. However, the younger specialists gravitate towards non-closure. [ABSTRACT FROM AUTHOR]

Achieving the ambitious maternal mortality reduction aims of the Millennium Development Goals will require more than generating sufficient donor support and carrying out appropriate medical interventions. It also will necessitate convincing governments in developing countries to give the cause political priority. The generation of political priority, however, is a subject that has received minimal research attention. In this article, we assess the state of political priority for maternal mortality reduction in Nigeria, which has more maternal deaths in childbirth than any country except India. We also identify challenges that advocates face in promoting priority. We find that after decades of neglect, a policy window has opened for safe motherhood in Nigeria, giving hope for future maternal mortality reduction. However, priority is as yet in its infancy, as advocates have yet to coalesce into a potent political force pushing the government to action. The case of Nigeria suggests that there is an urgent need for safe motherhood policy communities in countries with high maternal mortality to transform their moral and technical authority into political power, pushing policy-makers to action. We offer a number of suggestions on how they may do so. [ABSTRACT FROM AUTHOR]

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

The seroprevalence of maternal and neonatal hepatitis B surface antigen (HBsAg) was determined prospectively through unlinked anonymous testing of volunteers at delivery at the University of Benin Teaching Hospital, Benin City, Nigeria. Six hundred and forty (320 mother–cord blood pairs) samples were assayed for HBsAg using hepatitis B latex test kit (Biotech Laboratory Ltd, UK). Repeatedly reactive samples were confirmed by the use of ELISA kit (Wellcome Laboratory, UK). None of these women had had a blood transfusion or hepatitis B vaccination in the past, and none was an intravenous drug abuser. The maternal seroprevalence was 2·19%. This means one of every 45 pregnant women was a carrier of the antigen. The neonatal seroprevalence and the vertical transmission rate were 0·96% and 42·86%, respectively. The endemicity of this occasionally fatal disease is thus being propagated. We advocate universal free screening and immunisation of our pregnant women and their infants as part of the antenatal and childhood immunization programmes. Healthcare providers should be vaccinated routinely. [ABSTRACT FROM AUTHOR]

The study was conducted to evaluate whether routine induction of labour at 41-42 weeks of gestation has an increased risk for operative delivery, maternal or fetal complication compared with spontaneously initiated labour of similar gestation. A case-control study design was used; main outcome measures were caesarean section rate, instrumental delivery and fetal outcome. There was no significant difference in caesarean section rates 36(18·0%) in the induction group, compared with 28(13·8%) in parturient spontaneously initiating labour {P=0·24 odds ratio 95% CI 1·37 (0·78:2·43)}. Instrumental interventions were comparable in the two groups (5·5% and 4·0%). A subgroup analysis of nulliparous women was also not statistically different. Other than higher rates of admission into the neonatal unit in the induction group, fetal outcomes were similar. In conclusion, a routine induction of labour for prolonged pregnancy is safe, having no significant increase in caesarean section or fetal complications. The policy is advocated especially in developing countries, in view of the uncertainty of further prolongation of pregnancy beyond 42 completed weeks. [ABSTRACT FROM AUTHOR]

Development of the FAST-M maternal sepsis care bundle: requires proof of validity in low-resource settings Finally, and most importantly, the lack of validation of the bundle in some low-resource countries to determine its external validity is an important drawback that limits the applicability and use of the bundle. In conclusion, although the development of a maternal sepsis care bundle for use in low-income countries is an important contribution, the bundle should not be regarded as an instrument that is fit for all. [Extracted from the article]

The article offers information on a study by some hospitals in southern Ghana to investigate the incidence of and factors associated with maternal near-miss morbidity. Topics discussed include use of World Health Organization Maternal NearMiss Screening tool to identify maternal near misses; conclusion by researchers that women experiencing fever within 7 days of delivery were six times more likely to experience a near miss compared with women without fever.

The article comments on the observational study which validates the accuracy on the use of D-dimer and chest x-ray in diagnosing pulmonary embolism (PE) in pregnancy and postpartum. Topics include the inaccuracy of the clinical decision rules and D-dimer, the suggestion for further research to identify the most effective and accurate diagnostic procedures and the potential radiation effects of diagnostic imaging.

The author argues that cervical dilatation over time is a poor predictor of severe adverse birth outcomes and calls for higher level evidence for the identification of women at risk of severe adverse outcomes. The author points out that parthography is not an accurate diagnostic tool for severe birth outcomes and that parthographic labor monitoring lack efficacy. The author agrees with the need to conduct more studies to validate parthographic monitoring of labor.

A letter to the editor is presented in response to the article titled "The interdigitating Y-plasty procedure for correction of transverse vaginal septum" written by Nikolaos Arkoulis.

The article focuses on the proper management of neglected shoulder presentation caused by transverse lie delivery. It notes that transverse lie delivery must be done in caesarian section or destructive operation rather than home delivery with untrained birth attendants to avoid internal podalic version and breech extraction. Meanwhile, clinicians are reluctant to perform caesarian when the fetus is dead because they do not want to compromise future fertility or maternal death.

A response by J. Shiffman and F. E. Okonofua to a letter to the editor on their article about the causes of newborn mortality and morbidity and the solutions to adverse obstetric outcomes in Nigeria is presented.

Presents the osteomalacia of the immigrant population at clinical and subclinical levels in Asia. Increase on the demands for vitamin D; Induction of clinical osteomalacia; Occurrence of fractures in pregnant women.

Achieving a successful vaginal birth after a previous caesarean section (VBAC) is an important strategy in reducing the rising rate of caesarean section and its associated morbidities. Records of 188 women attempting trial of vaginal delivery after a previous lower segment caesarean section were reviewed to predict factors favouring successful vaginal delivery. Of the 188 women, 64 had recurrent indications for caesarean section, while 124 had non-recurrent indications. The group with recurrent indications for previous caesarean section had less vaginal delivery and more repeat caesarean sections as compared with the group with non-recurrent indications (21.9% and 78.1% vs 46.8% and 53.2%, respectively, p = 0.01). Cephalopelvic disproportion was more frequent in the group with recurrent indications (65.6% vs 27.4%, p < 0.0001). Significant predictors of successful VBAC in this cohort of women were non-recurrent indications for the previous caesarean section ( p < 0.001, odds ratio (95% CI) 0.32 (0.2–0.6)) and a previous vaginal delivery ( p < 0.0001, odds ratio (95% CI) 3.90 (2.1–7.4)). A previous vaginal delivery and a non-recurrent indication for the previous caesarean section are important predictors of VBAC in this cohort of women. [ABSTRACT FROM AUTHOR]

Despite growing public resistance to the practice of female genital cutting (FGC), documentation of its prevalence, social correlates or trends in practice are extremely limited, and most available data are based on self-reporting. In three antenatal and three family planning clinics in South-west Nigeria we studied the prevalence, social determinants, and validity of self-reporting for FGC among 1709 women. Women were interviewed on social and demographic history, and whether or not they had undergone FGC. Interviews were followed by clinical examination to affirm the occurrence and extent of circumcision. In total, 45.9% had undergone some form of cutting. Based on WHO classifications by type, 32.6% had Type I cuts, 11.5% Type II, and 1.9% Type III or IV. Self-reported FGC status was valid in 79% of women; 14% were unsure of their status, and 7% reported their status incorrectly. Women are more likely to be unsure of their status if they were not cut, or come from social groups with a lower prevalence of cutting. Ethnicity was the most significant social predictor of FGC, followed by age, religious affiliation and education. Prevalence of FGC was highest among the Bini and Urhobo, among those with the least education, and particularly high among adherents to Pentecostal churches; this was independent of related social factors. There is evidence of a steady and steep secular decline in the prevalence of FGC in this region over the past 25 years, with age-specific prevalence rates of 75.4% among women aged 45-49 years, 48.6% among 30-34-year olds, and 14.5% among girls aged 15-19. Despite wide disparities in FGC prevalence across ethnic, religious and educational groups, the secular decline is evident among all social subgroups. [ABSTRACT FROM AUTHOR]

This study was designed to examine sexual behaviour and contraceptive use among in-school adolescents in Benin City, Nigeria. A random sample of 431 females and 440 males aged 14-21 years from secondary schools in Benin City, Nigeria, were interviewed using a structured pretested questionnaire. The results show that 23% of the females and 40% of males had initiated sexual intercourse. Among those who had done so, the median age at first sexual debut was 16·8 years for girls and 15·4 years for boys. Only 22·2% of females and 23·9% of males used contraception at first sexual intercourse. Use of contraception among sexually active adolescents at last sexual debut declined to 18·6% for females and 22·2% for males. Forty-two per cent of sexually active adolescents engaged in high-risk sexual behaviour. In conclusion, the low prevalence of effective contraceptive use and time-related decline in usage indicate a need for greater emphasis on sex education aimed at adolescents in Nigeria. [ABSTRACT FROM AUTHOR]

A semi-quantitative screening for asymptomatic bacteriuria was carried out in the first trimester of 500 consecutive pregnant women in Benin City. The purpose was to provide baseline data and rational therapy for asymptomatic bacteriuria in pregnant women. Of the 500 women screened, 433 clinical specimens showed significant bacteriuria, representing an incidence of 86·6%. Of this number, 38 (7·4%) were of mixed bacterial colonies while 395 (91%) were of single bacterial colonies. Staphylococus aureus (29·8%), Escherichia coli (29·1%) and Klebsiella pneuononiae (21·5%) were the most frequently isolated pathogens. The high incidence of asymptomatic bacteriuria in pregnancy correlated significantly (P < 0·05) with the observed high proportion of pyuria. On average, sensitivity of the pathogens was ciprofloxacin 99·7%; ceftazidime 81·6%; co-trimoxazole 79·4%; augmentin 71·4%; nalidixic acid 61·7%; nitrofurantoin 61·%; gentamycin 56·9% and ampicillin 25·4%. S. aureus was most sensitive, while Proteus mirabilis was least sensitive among the pathogens. Rational therapy of asymptomatic bacteriuria in pregnant women may prevent associated risks such as pyelonephritis and pre-eclampsia. [ABSTRACT FROM AUTHOR]

This study was conducted to determine the prevalence and sociodemographic determinants of unwanted pregnancy and induced abortion in the Jos and Ife local government areas of Nigeria. A total of 1,516 randomly selected women aged 15-45 responded to a pretested structured questionnaire designed to elicit information concerning previous unwanted pregnancies and induced abortions in a value-free manner. Nearly 20 percent of the women reported having had an unwanted pregnancy. Of these, 58 percent reported that they had successfully terminated the pregnancies; 32 percent continued the pregnancies; and nearly 9 percent stated that they had attempted termination but failed. Overall, the prevalence of self-reports of induced abortion was 11 percent. The results reveal that information can be obtained on abortion in areas with restrictive abortion policies if an indirect interviewing approach is used. [ABSTRACT FROM AUTHOR]

The prevalence of human immunodeficiency virus antibodies in mothers and their neonates was determined through unlinked anonymous HIV testing at delivery. Two hundred and forty-six apparently healthy volunteer anonymous parturients at the University of Benin Teaching Hospital, Nigeria, and their neonates were recruited for the study. Blood samples were collected from the mothers and cord blood from their neonates at delivery. The blood samples were coded and assayed for HIV antibodies using ImmunoComb HIV 1 and 2 bispot test and ImmunoComb II HIV-1 and 2 CombFirm, both from PBS Orgenics, France. The results for maternal and neonatal blood sample pairs were matched. The maternal seroprevalence for HIV antibodies was 2.4% (6/246) while only two infants had HIV antibodies. The mother-to-child transmission of HIV antibodies was 33.3%. The study highlights the increasing HIV infection among pregnant women in this hospital. The risk of vertical transmission is therefore high. Universal antenatal HIV testing with an opt-out system is suggested. The need for our maternity centres and special care baby units to establish management protocols and anti-retroviral therapy for HIV infected women and their neonates is recommended. [ABSTRACT FROM AUTHOR]

Objective To estimate the maternal mortality ratio, identify the contribution of type - delays and assess the status of emergency obstetric services in a Nigerian Teaching Hospital. Methods Service delivery records of all maternities over 2 years were analyzed. Emergency care facilities in the hospital were physically verified and 10 senior medical/midwifery staff were interviewed in-depth. Results The maternal mortality ratio was 2,356/100,000 deliveries. The leading causes of death were HIV/AIDS (20-2%), eclampsia (12-4%), puerperal sepsis (11-9%),unsafe abortion (9-5%), and postpartum hemorrhage (4-8%). Associated causes of death were Type - delay (61-9%), type I delay (28-6%), type - delay (0%) and 9-5% of the women had no delay. Type - delay was due largely to delayed referral. Other causes were lack of blood, oxygen, and necessary equipment in the hospital. Although the hospital had relevant emergency obstetric care facilities, there is inadequate midwifery staff, blood, oxygen supplies and intensive care facilities. Conclusion Tertiary health institutions engaged in maternity care in Nigeria should step up their emergency obstetric services and reach out to other care providers to build greater understanding of issues relating to safe motherhood. [ABSTRACT FROM AUTHOR]

A recent study found, in a large sample of Ashkenazi Jews, a highly significant association between schizophrenia and a particular haplotype of three polymorphic sites in the catechol-O-methyl transferase, COMT, gene: an IVS 1 SNP (dbSNP rs737865), the exon 4 functional SNP (Val158Met, dbSNP rs165688), and a downstream SNP (dbSNP rs165599). Subsequently, this haplotype was shown to be associated with lower levels of COMT cDNA derived from normal cortical brain tissue, most likely due to cis-acting element(s). As a first step toward evaluating whether this haplotype may be relevant to schizophrenia in populations other than Ashkenazi Jews, we have studied this haplotype in 38 populations representing all major regions of the world. Adding to our previous data on four polymorphic sites in the COMT gene, including the Val158Met polymorphism, we have typed the IVS 1 rs737865 and 3' rs615599 sites and also included a novel IVS 1 indel polymorphism, yielding seven-site haplotype frequencies for normal individuals in the 38 globally distributed populations, including a sample of Ashkenazi Jews. We report that the schizophrenia-associated haplotype is significantly heterogeneous in populations worldwide. The three-site, schizophrenia-associated haplotype frequencies range from 0% in South America to 37.1% in Southwest Asia, despite the fact that schizophrenia occurs at roughly equal frequency around the world. Assuming that the published associations found between the exon 4 Val158Met SNP and schizophrenia are due to linkage disequilibrium, these new haplotype data support the hypothesis of a relevant cis variant linked to the rs737865 site, possibly just upstream in the P2 promoter driving transcription of the predominant form of COMT in the brain. The previously described HindIII restriction site polymorphism, located within the P2 promoter, varies within all populations and may provide essential information in future studies of schizophrenia.Molecular Psychiatry (2004) 9, 859-870. doi:10.1038/sj.mp.4001496 Published online 6 April 2004 [ABSTRACT FROM AUTHOR]

Background: The available evidence indicates that Nigerian adolescents use various health practitioners for the treatment of sexually transmitted diseases (STDs). However, the quality of the STD treatment used by adolescents has not been investigated previously.Goal Of This Study: To investigate the quality of services provided by health practitioners for the treatment and prevention of STDs among adolescents in Benin City, Nigeria.Study Design: In-depth interviews were conducted with 48 formal and informal sector health practitioners who were identified by key informants as being the main providers of STD treatment in the city. Their facilities were visited to evaluate the quality of services they provide for STD treatment.Results: Health providers in the informal sector showed inadequate knowledge of the appropriate treatment methods for STDs. Although providers in the formal sector had better knowledge, they lacked appropriate management guidelines and were poorly oriented to the problems of STDs in adolescents. There was consensus among the health providers that adolescents most frequently use informal treatment for STDs. Nevertheless, among all providers, there was evidence of inadequate counseling of adolescents, a poor attitude toward the promotion of condom use, and inadequate use of referral opportunities.Conclusions: Comprehensive public health measures are needed to address these problems in Nigeria. These include the provision of reproductive health education for adolescents, the retraining of health providers, and the consolidation of services for the prevention and treatment of STDs. [ABSTRACT FROM AUTHOR]

About 80% of HIV-positive pregnant women in our unit have a seronegative spouse. The prevalence, pattern and determinants of spousal disclosure of HIV serostatus was evaluated among 166 HIV-positive pregnant women receiving antiretroviral treatment. Although 146 women (88%) disclosed their HIV serostatus, 20 women (12%) did not disclose their status to their spouse. Non-disclosure was significantly associated with nulliparous ( p == 0.024) and unmarried women ( p == 0.026). Fear, regarding spread of the information (57.8%), stigmatisation (53%) and deterioration in the relationship with the spouse (47%) were the three commonest reasons for non-disclosure. Disclosure of HIV-positive status remains a sensitive issue among infected pregnant women. Strategies to reduce the stigma associated with HIV infection, appropriate management of the information following disclosure of seropositive status by HIV-infected persons are necessary to encourage disclosure to sexual partners and ultimately prevent new HIV infections. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine the effectiveness and safety of misoprostol (cytotec, Searle) used during labour in women with missed abortion in the second trimester of pregnancy. Labour was induced in 42 women with missed abortion at the Women's Health and Action Research Centre, Benin City, Nigeria with intermittent vaginal administration of 100 μg tablets of misoprostol every 6 h. All women achieved successful vaginal delivery with five women requiring post-delivery uterine evacuation. The gestational ages of the women at the time of induction ranged between 13–24 weeks with a median of 17 weeks. The median dose of misoprostol resulting in successful delivery was 1,100 μg and ranged between 300 μg to 3,100 μg. Side-effects were minimal with five patients experiencing shivering, two women experiencing fever, while three vomited during the period of the induction. These results confirm the efficacy and safety of misoprostol for induction of labour in second trimester missed abortion in Nigerian women. We conclude that misoprostol is effective in the management of missed abortion in the second trimester in Nigeria. [ABSTRACT FROM AUTHOR]

Presents a case report involving complete androgen insensitivity syndrome with persistent Mullerian derivatives. Mutations in the androgen receptor gene; Determination of the biological intersex conditions; Factor the mutations causing amino acid substitutions.