Search

Objective: To evaluate the feasibility and performance of self-collected vaginal swab samples for HPV screening among women in Lagos, Nigeria., Methods: A cross-sectional study was implemented from March to August 2020 among sexually active women. Study participants provided same-day paired vaginal swab samples. Medic-sampling and poster-directed self-sampling methods were used to collect the two samples per participant. A real-time PCR assay detected HPV 16, HPV 18, other-high-risk (OHR) HPV, and the human β-globin gene. The self-collected samples' sensitivity, specificity, and accuracy were determined against the medic-collected samples using the MedCalc Online Diagnostic Calculator., Results: Of the 213 women aged 16 ~ 63-year-old recruited, 187 (88%) participants had concordant results, while 26 (12%) participants had discordant results. Among the 187 concordant results, 35 (19%) were HPV positive, 150 (80%) participants were HPV negative, and two (1%) were invalid. 18 (69%) out of the 26 discordant samples were invalid. The self-collected sample was invalid for 14 (54%) participants. Two (8%) medic-collected samples were invalid. Compared to the medic-collected sample, the self-collected sample was 89.80% (95% CI: 77.77 ~ 96.60%) sensitive and 98.21% (95% CI: 94.87 ~ 99.63%) specific, with an accuracy of 96.31% (95% CI: 92.87 ~ 98.40%). The mean age for HPV positive and negative participants were 39 and 40, respectively, with an ANOVA p-value of 0.3932. The stratification of HPV infection by the age group was not statistically significant (P > 0.05)., Conclusions: With high accuracy of 96%, self-collected sampling is adequate when tested with real-time PCR and may increase the uptake of HPV testing. Though more self-collected samples were invalid than medic-collected samples, most likely due to poor collection, they could be identified for repeat testing. Future implementation can avoid this error with improved guidance and awareness., (© 2022. The Author(s).)

Objective: To investigate the prevalence of life-threatening complications related to pregnancies with abortive outcome and the associated health service events and performance in Nigerian public tertiary hospitals.Design: Secondary analysis of a nationwide cross-sectional study.Setting: Forty-two tertiary hospitals.Population: Women admitted for pregnancy-related complications.Methods: All cases of severe maternal outcomes (SMO: maternal near-miss or death) due to abortive pregnancy complications (defined as spontaneous or induced abortion, and ectopic pregnancy) were prospectively identified over 1 year using uniform identification criteria.Main Outcome Measures: Prevalence of SMO, mortality index (% maternal death/SMO), case fatality rate, time until death after admission, and health service performance.Results: Of 5779 women admitted with abortive pregnancy complications, 444 (7.9%) experienced an SMO: 366 maternal near-misses and 78 maternal deaths. Intra-hospital maternal mortality ratio from complicated abortive pregnancy outcome was 85/100 000 live births. Case fatality rate was worst for abortion-related infections (19.1%). A quarter of maternal deaths occurred on the same day of admission; however, the peak time of occurrence of death was 3-7 days of admission. Women experiencing cardiovascular, renal or coagulation organ dysfunction were less likely to survive. Higher level of maternal education and closer residence to a health facility improved chance of maternal survival.Conclusions: Abortive outcome remains a major contributor to SMO in Nigeria. Although early hospital presentation by women is critical to surviving abortive pregnancy complications, improved, appropriate, and timely management is essential to enhance maternal survival.Tweetable Abstract: 78 maternal deaths and 366 near-misses occurred from abortions and ectopic pregnancies in 42 Nigerian referral hospitals in 1 year. [ABSTRACT FROM AUTHOR]

Objective: To investigate the prevalence of life-threatening complications related to pregnancies with abortive outcome and the associated health service events and performance in Nigerian public tertiary hospitals., Design: Secondary analysis of a nationwide cross-sectional study., Setting: Forty-two tertiary hospitals., Population: Women admitted for pregnancy-related complications., Methods: All cases of severe maternal outcomes (SMO: maternal near-miss or death) due to abortive pregnancy complications (defined as spontaneous or induced abortion, and ectopic pregnancy) were prospectively identified over 1 year using uniform identification criteria., Main Outcome Measures: Prevalence of SMO, mortality index (% maternal death/SMO), case fatality rate, time until death after admission, and health service performance., Results: Of 5779 women admitted with abortive pregnancy complications, 444 (7.9%) experienced an SMO: 366 maternal near-misses and 78 maternal deaths. Intra-hospital maternal mortality ratio from complicated abortive pregnancy outcome was 85/100 000 live births. Case fatality rate was worst for abortion-related infections (19.1%). A quarter of maternal deaths occurred on the same day of admission; however, the peak time of occurrence of death was 3-7 days of admission. Women experiencing cardiovascular, renal or coagulation organ dysfunction were less likely to survive. Higher level of maternal education and closer residence to a health facility improved chance of maternal survival., Conclusions: Abortive outcome remains a major contributor to SMO in Nigeria. Although early hospital presentation by women is critical to surviving abortive pregnancy complications, improved, appropriate, and timely management is essential to enhance maternal survival., Tweetable Abstract: 78 maternal deaths and 366 near-misses occurred from abortions and ectopic pregnancies in 42 Nigerian referral hospitals in 1 year., (© 2019 World Health Organization; licensed by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists.)

Context: In Nigeria, abortion is permitted only to save the life of a woman. Unsafe abortion is common and is a major cause of maternal mortality, yet policymakers have done little to address the problem., Methods: In-depth interviews were conducted in 2008 with 49 Nigerian politicians and officials to assess their awareness of unsafe abortion and its role in maternal mortality, and to determine their perceptions of the policies and actions needed to address these problems., Results: Participants had poor knowledge of Nigeria's abortion law and the number of abortions and abortion-related deaths, though many knew of women who had died or nearly died from unsafe abortion. Policymakers were guided by moral and religious considerations rather than by evidence-based approaches. About one-third of informants felt that abortion should not be legal under any circumstances, one-fifth supported liberalization on medical grounds and a similar proportion believed that abortion should be legal in cases of rape and incest. Strategies recommended by respondents to reduce maternal mortality included facilitating access to contraceptives, providing sexuality education, improving the health care system, empowering women and providing free pregnancy care., Conclusions: Intense public health education and advocacy targeting policymakers is needed to increase political will for reducing abortion-related maternal deaths in Nigeria. Presenting statistics on unsafe abortion together with compelling personal stories will likely resonate with policymakers and contribute to an informed public debate on abortion law reform.

Introduction: Human Papillomavirus (HPV) infection is a risk factor for cervical cancer, the fourth most common cancer among women globally. Its burden is the highest in sub-Saharan Africa, with over 90% mortality. Interventions may fail without evidence-based data on stratified prevalence and risk factors among most at-risk women across Nigeria. Methods: A cross-sectional comparative study, with participants recruited from the Nigerian Institute of Medical Research's Clinics, NGO outreaches, a cancer screening centre and a university teaching hospital. Questionnaires were selfadministered. Trained medics performed sampling at healthcare facilities, and self-sampling was used at outreaches. Results: Nine hundred eighty-five study participants were recruited. About 37% and 27% of the women knew about HPV and its vaccines, respectively, but only 6% confirmed vaccination with HPV vaccines. HPV prevalence was highest among women with unknown marital status (35.9%), single women (33.8%), widowed/divorced/separated women (30.3%), and married/cohabiting women (19.6%). HPV infection was significantly higher among women who take alcohol (odds=1.7 [95% CI: 1.2-2.4]) and women who smoke (odds=2.6 [95% CI: 1.4 - 4.6]. HPV strains detected included HPV16 (1.3%), HPV18 (1.5%), Low Risk (0.2%) and Other High-Risk groups (19.7%). Conclusion: The inverse relationship between prevalence and education suggests interventions improving awareness and prevention would be impactful. Such interventions could also target HIV-positive women, women presenting with sexually-transmitted infections, who smoke and frequently drink alcohol. [ABSTRACT FROM AUTHOR]

Background: Abortion-related complications are one of the five main causes of maternal mortality. However, research about abortion is very limited in fragile and conflict-affected settings. Our study aims to describe the magnitude and severity of abortion-related complications in two referral hospitals supported by Médecins Sans Frontières and located in such settings in northern Nigeria and Central African Republic (CAR). Methods: We used a methodology similar to the World Health Organization (WHO) near-miss approach adapted in the WHO multi-country study on abortion (WHO-MCS-A). We conducted a cross-sectional study in the two hospitals providing comprehensive emergency obstetric care. We used prospective medical records' reviews of women presenting with abortion-related complications between November 2019 and July 2021. We used descriptive analysis and categorized complications into four mutually exclusive categories of increasing severity. Results: We analyzed data from 520 and 548 women respectively in Nigerian and CAR hospitals. Abortion complications represented 4.2% (Nigerian hospital) and 19.9% (CAR hospital) of all pregnancy-related admissions. The severity of abortion complications was high: 103 (19.8%) and 34 (6.2%) women were classified as having severe maternal outcomes (near-miss cases and deaths), 245 (47.1%) and 244 (44.5%) potentially life-threatening, 39 (7.5%) and 93 (17.0%) moderate, and 133 (25.6%) and 177 (32.3%) mild complications, respectively in Nigerian and CAR hospitals. Severe bleeding/hemorrhage was the main type of complication in both settings (71.9% in the Nigerian hospital, 57.8% in the CAR hospital), followed by infection (18.7% in the Nigerian hospital, 27.0% in the CAR hospital). Among the 146 women (Nigerian hospital) and 231 women (CAR hospital) who did not report severe bleeding or hemorrhage before or during admission, anemia was more frequent in the Nigerian hospital (66.7%) compared to the CAR hospital (37.6%). Conclusion: Our data suggests high severity of abortion-related complications in these two referral facilities of fragile and conflict-affected settings. Factors that could contribute to this high severity in these contexts include greater delays in accessing post-abortion care, decreased access to contraceptive and safe abortion care that result in increased unsafe abortions; as well as increased food insecurity leading to iron-deficiencies and chronic anaemia. The results highlight the need for better access to safe abortion care, contraception, and high quality postabortion care to prevent and manage complications of abortion in fragile and conflict-affected settings. [ABSTRACT FROM AUTHOR]

In developing nations, anaemia is one of the most prevalent medical conditions. It has long been known that parasite infection during pregnancy is one of the main causes of anaemia and an elevated risk of maternal mortality. To ascertain the prevalence and risk factors related to parasite infections and anaemia among pregnant women receiving prenatal care in some selected public health facilities in Kaduna State, Nigeria, an eleven-month cross-sectional study of 180 consenting pregnant women was conducted from February to December 2017. A standardized questionnaire was used to interview the sampled pregnant women. Stool and blood samples of each consented pregnant woman were collected. Formal-ether sedimentation technique, thin and thick blood smears and haematocrit packed cell volume capillary methods were used to screen intestinal helminth parasites, plasmodium species and Packed Cell Volume (PCV) respectively. The result obtained showed parasitic infections prevalence of 102(56.7%) among the study population. Prevalence of Plasmodium species, hookworm, Ascaris lumbricoides and those with co-infection all occurred at 47.2%, 16.7%, 17.8% and 25.0% respectively. Age, educational level, trimester and parity were all significant predictors of Plasmodium species prevalence (p<0.005). Similarly, parity and educational level were significantly (p<0.005) associated with the prevalence of intestinal parasites and co-infection. Anaemia was present in 40.0% of the examined pregnant women. Trimester and educational level were highly significant (p<0.001) predictors of anaemia among the sampled pregnant women. Plasmodium species were the most common parasitic species associated with anaemia as 43.1% of Plasmodium species-infected pregnant women had anaemia compared to those with intestinal helminth infection (30.6%) and co-infection (13.3%). However, statistical analysis revealed a significant association (p<0.05) between the prevalence of anaemia and intestinal helminth infection. Therefore, measures such as improved sanitation and health education are needed to lessen the prevalence of parasitic infections and parasite-related anaemia in the study area. [ABSTRACT FROM AUTHOR]

Introduction: Existing studies have acknowledged the underutilization of skilled maternal healthcare services among women in rural Nigeria. Consequently, women in rural areas face a disproportionate risk of poor health outcomes including maternal morbidity and mortality. Addressing the challenge of non-use of skilled maternal healthcare in rural areas necessitates the involvement of multi-stakeholders across different sectors who have vital roles to play in improving maternal health. This study explores the factors contributing to the non-use of maternal healthcare services in rural areas of Edo, Nigeria from the perspectives of community elders and policymakers. Methods: In this qualitative study, data were collected through 10 community conversations (group discussions) with community elders each consisting of 12 to 21 participants, and six key informant interviews with policymakers in rural areas of Edo State, Nigeria. Participants were purposefully selected. Conversations and interviews occurred in English, Pidgin English and the local language; lasted for an average of 9 minutes; were audio-recorded and transcribed to English. Data were manually coded, and data analysis followed the analytical strategies for qualitative description including an iterative process of inductive and deductive approaches. Results: Policymakers and community elders attributed the non-use of maternal health services to poor quality of care. Notions of poor quality of care included shortages in skilled healthcare workers, apathy and abusive behaviours from healthcare providers, lack of life-saving equipment, and lack of safe skilled pregnancy care. Non-use was also attributed to women's complex utilization patterns which involved a combination of different types of healthcare services, including traditional care. Participants also identified affordability and accessibility factors as deterrents to women's use of skilled maternal healthcare. Conclusion: The emerging findings on pregnant women's combined use of different types of care highlight the need to improve the quality, availability, accessibility, and affordability of skilled maternal care for rural women in Nigeria. [ABSTRACT FROM AUTHOR]

Background: Prolonged retention of fetal bones is often overlooked as a possible cause of infertility due to their rarity. The condition is more likely to occur in countries with restrictive abortion laws, where pregnancy termination for social reasons often occurs in midtrimester and clandestine situations. This article presents cases of retained fetal bones in 4 Nigerian women. Cases: Transvaginal ultrasonography (TVUS) was performed for women undergoing evaluation for infertility at the Obafemi Awolowo University Teaching Hospitals Complex, in Ile-Ife, Nigeria, between July 2019 and October 2020. The patients' TVUS results were compared with their hysterosalpingography (HSG) results. Results: Four cases of prolonged retention of fetal bones were diagnosed among 141 women who underwent TVUS. Each of the 4 women had a history of midtrimester surgical termination of pregnancy. The fetal bones were not recognized on HSG. After TVUS results showed that fetal bones were present, hysteroscopic retrieval of multiple white, hard, and gritty masses was undertaken in all of these women. The masses were all histologically confirmed to be fetal bones, Two patients without any comorbidity conceived spontaneously with live births, while the other 2 diagnosis of prolonged women proceeded to in vitro fertilization due to bilateral tubal blockages. Conclusions: TVUS aids the diagnosis of prolonged retention of fetal bones, even when they are initially missed on HSG, and hysteroscopic retrieval leads to rapid return of fertility. (J GYNECOL SURG 38:107) [ABSTRACT FROM AUTHOR]

Pregnancy termination where it is illegally performed has serious implications for women's current and future well-being. In this study, I investigated the association between contextual factors and pregnancy termination among 13,724 young women based on data from the 2018 Nigeria Demographic and Health Survey (NDHS). Three mixed-effect logistic regression models were estimated. Results reveal that 8.68% had ever terminated a pregnancy. Southern women (AOR = 0.68, p < 0.05; 95% CI: 0.48–0.96) and those who resided in communities with a high wealth level (AOR = 0.63, p < 0.05; 95% CI: 0.43–0.90), high education level (AOR = 0.43, p < 0.01; 95% CI: 0.33–0.56), and high media exposure (AOR = 0.74, p < 0.05; 95% CI: 0.61–0.89) had lower odds of pregnancy termination than those who resided in communities with high unmet need for family planning (AOR = 2.19, p < 0.01; 95% CI: 1.76–2.73). Public health policy would benefit from a better understanding of how context enhances demand for pregnancy termination. [ABSTRACT FROM AUTHOR]

Background: Underutilization of formal maternal care services and accredited health attendants is a major contributor to the high maternal mortality rates in rural communities in Nigeria. Perceptions of a poor quality of care and inaccessible services in health facilities strongly influence the low use of formal maternal care services. There is therefore a need to understand local perceptions about maternal health services utilization and maternal death. This study thereby aims to explore perceptions and beliefs about the underutilization of formal care and causes of maternal death, as well as to identify potential solutions to improve use and reduce maternal mortality in rural Nigeria. Methods: Data were collected through 9 community conversations, which were conducted with 158 community elders in 9 rural communities in Edo State, Nigeria. Data from transcripts were analyzed through inductive thematic analysis using NVivo 12 software. Results: Perceived reasons for the underutilization of formal maternal care included poor qualities of care, physical inaccessibility, financial inaccessibility, and lack of community knowledge. Perceived reasons for maternal death were related to medical causes, maternal healthcare services deficiencies, uptake of native maternal care, and poor community awareness and negligence. Elders identified increased access to adequate maternal care, health promotion and education, community support, and supernatural assistance from a deity as solutions for increasing use of formal maternal care and reducing maternal mortality rates. Conclusion: Study results revealed that multifaceted approaches that consider community contexts, challenges, and needs are required to develop acceptable, effective and long-lasting positive changes. Interventions aiming to increase use of formal care services and curb maternal mortality rates must target improvements to the technical and interpersonal qualities of care, ease of access, community awareness and knowledge, and allow community members to actively engage in implementation phases. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To determine the proportion of all clinically confirmed pregnancies that end as induced abortion in a cohort of pregnant women in Nigeria.Methods: A total of 490 women who attended prenatal clinics at the University of Benin Teaching Hospital were interviewed with the preceding birth technique (PBT) on the outcomes of their previous pregnancies, including abortions.Results: Of the 490 women, 384 women (78.4%) reported previous abortions. A total of 1883 previous pregnancies were reported by the women, of which 914 ended in abortion, 545 in live births, and 421 in stillbirths, with 3 unclassified. The total abortion ratio was 914/1842 (49.6%), when 41 women who reported no previous pregnancies were excluded. Of the 914 abortions, 751 (82.25) were induced abortions, 146 (16.0%) were spontaneous abortions, 9 (0.98%) were missed abortions, and 8 were unclassified. Results of logistic regression analysis showed that women aged 25-29 years were 4 times more likely to report induced abortion compared with older women.Conclusion: Induced abortion was found to be highly prevalent in this region of Nigeria, according to self-reports of women who were asked questions on abortion in the context of medical care. [ABSTRACT FROM AUTHOR]