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To estimate the prevalence of women who were admitted to health facilities with abortion-related complications who reported feeling anxious/stressed during their stay, and to identify sociodemographic, facility, and abortion-related characteristics associated with self-reported experience of anxiety/stress.We used data from four countries in Eastern and Southern Africa (Kenya, Malawi, Mozambique, and Uganda) collected from 2017-2018 as part of the World Health Organization (WHO) Multi-Country Survey on Abortion-related morbidity (MCS-A). Information was extracted from women's medical records and their participation in audio computer-assisted self-interviews (ACASI). Based on a question in the ACASI, "Did you encounter any anxiety or stress during your hospital stay?", the percentage of women who self-reported feeling anxious/stressed during their facility stay was calculated. Generalized estimating equations were used to identify the determinants of anxiety/stress following a hierarchical approach whereby potential determinants were grouped from most distal to most proximal and analyzed accordingly.There were 1254 women with abortion-related complications included in the analysis, of which 56.5% self-reported that they felt anxious/stressed during their facility stay. We found evidence that lower socioeconomic status, lower levels of education, no previous childbirth, no previous abortion, higher gestational age at abortion, and use of unsafe methods of abortion were independent determinants of self-reporting anxiety/stress.Action should be taken to reduce experience of anxiety/stress among women attending facilities for postabortion complications, including reducing the number of women experiencing abortion-related complications by improving access to safe abortion. This issue warrants further study using more comprehensive and validated tools to understand the levels and drivers of anxiety/stress self-reported by women attending facilities with abortion-related complications.

To evaluate the capability of high-volume comprehensive emergency obstetric care (CEmOC) health facilities on the provision of comprehensive postabortion care (PAC) in Sub-Saharan Africa and to determine the frequency of women with severe abortion-related complications in high capability facilities.A cross-sectional analysis conducted across 11 countries in Sub-Saharan Africa, using facility-level information from the World Health Organization (WHO) Multi-Country Survey on Abortion-related morbidity (MCS-A) between 2017 and 2018. PAC signal functions were adapted to assess facilities' capability to deliver comprehensive PAC through infrastructure, standard comprehensive capability, and extended comprehensive capability to provide PAC. The percentage of facilities with each signal function and distribution of facilities by number of signal functions were calculated for the three capability categories. Distribution of severe abortion complications by facility capability score was assessed.Of 210 high-volume CEmOC facilities included, 47.9% (n = 100) had capability to provide all facility infrastructure signal functions, 54.4% (n = 105) for standard comprehensive PAC, reducing to 17.7% (n = 34) for extended comprehensive PAC capability. Overall, there were gaps in extended capabilities including availability of a functioning ICU (available in 37.3% of facilities) and providers 24/7 (65.5% of facilities reported an obstetrician available 24/7 dropping to 41.3% for anesthesiologists). Facilities' PAC capability varied across regions. Overall, 34.6% (n = 614) of women with severe abortion-related complications were treated in facilities with the maximum capability score for extended comprehensive PAC.Although high levels of capability to provide abortion-related care for most signal functions were evident, significant gaps that impact on the management of severe abortion-related complications remain, particularly related to extended facility capabilities including specialized human resources and ICU.

Objective To assess satisfaction with care for abortion-related complications experienced among adolescents compared to older women. Methods A secondary analysis of the WHO Multi-Country Survey on Abortion-related Morbidity and Mortality-a cross-sectional study conducted in health facilities in 11 Sub-Saharan African countries. Women with abortion-related complications who participated in an audio computer-assisted self-interview were included. Two composite measures of overall satisfaction were created based on five questions: (1) study participants who were either satisfied or very satisfied across all five questions; and (2) study participants who reported being very satisfied only across all five questions. Multivariable general estimating equation analyses were conducted to assess whether there was any evidence that age (adolescents 12-19 years and older women 20+) was associated with each composite measure of satisfaction, controlling for key confounders. Results The study sample consisted of 2817 women (15% adolescents). Over 75% of participants reported being satisfied or very satisfied for four out of five questions. Overall, 52.9% of study participants reported being satisfied/very satisfied across all five questions and 22.4% reported being consistently very satisfied. Multivariable analyses showed no evidence of an association between age group and being either satisfied or very satisfied (OR 1.07; 95% CI, 0.82-1.41, P = 0.60), but showed strong evidence that adolescents were 50% more likely to be consistently very satisfied with their overall care than older women (OR 1.49; 95% CI, 1.13-1.96, P = 0.005). Conclusion Both adolescents and older women reported high levels of satisfaction with care when looking at different components of care individually, but the results of the composite measure for satisfaction showed that many study participants reported being less than satisfied with at least one element of their care. Further studies to explore the expectations, needs, and values of women's satisfaction with care for abortion-related complications are needed.

OBJECTIVE: To investigate the level and determinants of nonreceipt of contraception among women admitted to facilities with abortion-related complications in East and Southern Africa. METHODS: Cross-sectional data from Kenya, Malawi, Mozambique, and Uganda collected as part of the World Health Organization (WHO) Multi-Country Survey on Abortion-related morbidity. Medical record review and the audio computer-assisted self-interviewing system were used to collect information on women's demographic and clinical characteristics and their experience of care. The percentage of women who did not receive a contraceptive was estimated and the methods of choice for different types of contraceptives were identified. Potential determinants of nonreceipt of contraception were grouped into three categories: sociodemographic, clinical, and service-related characteristics. Generalized estimating equations were used to identify the determinants of nonreceipt of a contraceptive following a hierarchical approach. RESULTS: A total of 1190 women with abortion-related complications were included in the analysis, of which 33.9% (n = 403) did not receive a contraceptive. We found evidence that urban location of facility, no previous pregnancy, and not receiving contraceptive counselling were risk factors for nonreceipt of a contraceptive. Women from nonurban areas were less likely not to receive a contraceptive than those in urban areas (AOR 0.52; 95% CI, 0.30-0.91). Compared with women who had a previous pregnancy, women who had no previous pregnancy were 60% more likely to not receive a contraceptive (95% CI, 1.14-2.24). Women who did not receive contraceptive counselling were over four times more likely to not receive a contraceptive (AOR 4.01; 95% CI, 2.88-5.59). CONCLUSION: Many women leave postabortion care having not received contraceptive counselling and without a contraceptive method. There is a clear need to ensure all women receive high-quality contraceptive information and counselling at the facility to increase contraceptive acceptance and informed decision-making.

Erectile dysfunction is currently a growing health concern and one of the most prevalent sexual dysfunctions in men worldwide. Diabetes mellitus is considered a risk factor for developing ED. Therefore, this SHIM study was designed to assess the prevalence, severity and determinant of erectile dysfunction in type II diabetes mellitus patients and healthy men. This hospital-based cross-sectional study was conducted on 132 diabetic male patients and 66 healthy men at the Nkenkaasu hospital, Offinso North, Ghana between January-June, 2019. A pre-structured questionnaire and patients’ medical records were used to document relevant information. Erectile function was assessed using Sexual health inventory for men questionnaire. Data were analyzed using SPSS version 22.0. Chi-square test, binary and multivariable logistic regression analysis were used appropriately. The mean age of study participants was 57.94 ± 9.79 years. The overall mean score on the SHIM test was 12.42 ± 8.15 (range: 1–25), mean of 9.59±7.83 for the type II diabetics and 18.08±5.39 for non-diabetic men. The total erectile dysfunction (ED) prevalence was 81.8% (95% CI: 0.757, 0.869). ED was common in diabetics (70.4%) compared with healthy men (29.6%). Severe ED was 93.7% and 6.3% in the diabetic and non-diabetic men respectively. Multivariate logistic regression revealed that diabetic men with poor health-related quality of life had 3.48 times likelihood of having ED compared to their non-diabetic counterparts (AOR= 3.48, 95% CI; 1.284, 9.453). Very high erectile dysfunction was observed in our study participants. This is worrisome owing to the profound negative impact of ED on the quality of life and fertility of men. It is recommended that periodic assessment of erectile function should form part of routine diabetes care, focusing attention on the modifiable risk factors in preventing, delaying progression, or reversing established ED in persons. Doi: 10.28991/SciMedJ-2021-0301-4 Full Text: PDF

Uterine fibroid (UF) is a tumour in some parts of the uterus, which introduces health challenges or death due to failed surgery among women globally. This study was designed to ascertain the involvement of micro-nutrients, inflammation, and antioxidant enzymes in the UF development to gain further insights and provide a strategy for managing the disease. One hundred ninety reproductive-aged women were recruited and classified equally into case and control subjects. The supernatant obtained from excised tissues from the fibroid and the normal samples from the adjacent myometrium were assessed for the selected biochemical parameters with standard methods. The levels of vitamin A and sodium between 26-35 years; vitamins D, E, zinc, and selenium between 46-55 years; and vitamin E at 56 years and above significantly decreased (p

Background Postpartum haemorrhage (PPH) is a leading cause of maternal mortality worldwide. Maternal anaemia greatly increases the risk of PPH, and over a third of all pregnant women are anaemic. Because anaemia reduces the oxygen-carrying capacity of the blood, anaemic women cannot tolerate the same volume of blood loss as healthy women. Yet the same blood loss threshold is used to define PPH in all women. The lack of an established PPH definition in anaemic women means the most appropriate outcome measures for use in clinical trials are open to question. We used data from the WOMAN-2 trial to examine different definitions of PPH in anaemic women and consider their appropriateness as clinical trial outcome measures. Main body The WOMAN-2 trial is assessing tranexamic acid (TXA) for PPH prevention in women with moderate or severe anaemia at baseline. To obtain an accurate, precise estimate of the treatment effect, outcome measures should be highly specific and reasonably sensitive. Some outcome misclassification is inevitable. Low sensitivity reduces precision, but low specificity biases the effect estimate towards the null. Outcomes should also be related to how patients feel, function, or survive. The primary outcome in the WOMAN-2 trial, a ‘clinical diagnosis of PPH’, is defined as estimated blood loss > 500 ml or any blood loss within 24 h sufficient to compromise haemodynamic stability. To explore the utility of several PPH outcome measures, we analysed blinded data from 4521 participants. For each outcome, we assessed its: (1) frequency, (2) specificity for significant bleeding defined as shock index ≥1.0 and (3) association with fatigue (modified fatigue symptom inventory [MFSI]), physical endurance (six-minute walk test) and breathlessness. A clinical diagnosis of PPH was sufficiently frequent (7%), highly specific for clinical signs of early shock (95% specificity for shock index ≥1) and associated with worse maternal functioning after childbirth. Conclusion Outcome measures in clinical trials of interventions for PPH prevention should facilitate valid and precise estimation of the treatment effect and be important to women. A clinical diagnosis of PPH appears to meet these criteria, making it an appropriate primary outcome for the WOMAN-2 trial. Trial registration ClinicalTrials.gov NCT03475342, registered on 23 March 2018; ISRCTN62396133, registered on 7 December 2017; Pan African Clinical Trial Registry PACTR201909735842379, registered on 18 September 2019.

To estimate the prevalence of infection among abortion-related complications in health facilities, describe their management, and identify sociodemographic and clinical factors associated with abortion-related infections.A secondary analysis of the WHO Multi-Country Survey on Abortion-related morbidity (MCS-A) conducted in 210 health facilities of 11 Sub-Saharan African countries between 2017 and 2018. The outcome variable was abortion-related infections, categorized into three mutually exclusive groups of abortion-related complications: infections only, infection with other complications, and other complications without infection. We described the sociodemographic and clinical characteristics and the management of abortion-related infection and identified the factors associated with abortion-related infections using a multinomial logistic model.A total of 9232 women with abortion-related complications were included, with infection occurring among 10.6% of women (n = 974). Infection was involved in 47.4% (n = 153) of severe maternal outcomes with a case fatality rate of 27.4% (n = 42). The most common management approach was antibiotics, uterine evacuation, and uterotonics combined: 43.2% (n = 384) in the group of women with infection only and 48.6% (n = 4235) among those with infection and other complications. In addition, 85.9% (n = 7095) of women without infection also received therapeutic antibiotics. Factors associated with an increased odds of infection only compared with complication without infection were age younger than 20 years compared with those aged over 30 (aOR 1.84; 95% CI,1.24-2.74), not living in a couple (aOR 2.05, 95% CI,1.52-2.76), and gestational age of 13 weeks or more (aOR 1.70, 95% CI,1.27-2.26). The same factors were associated with infection and other complications.Infection is frequent among severe abortion-related complications, and its case fatality rate is high. Further research to assess the relationship between abortion-related infections and outcomes is needed. There is also a need to question the quality of postabortion care and improve adequate use of antibiotics.

IntroductionComplications due to unsafe abortions are an important cause of morbidity and mortality in many sub-Saharan African countries. We aimed to characterise abortion-related complication severity, describe their management, and to report women’s experience of abortion care in Africa.MethodsA cross-sectional study was implemented in 210 health facilities across 11 sub-Saharan African countries. Data were collected on women’s characteristics, clinical information and women’s experience of abortion care (using the audio computer-assisted self-interviewing (ACASI) system). Severity of abortion complications were organised in five hierarchical mutually exclusive categories based on indicators present at assessment. Descriptive bivariate analysis was performed for women’s characteristics, management of complications and reported experiences of abortion care by severity. Generalised linear estimation models were used to assess the association between women’s characteristics and severity of complications.ResultsThere were 13 657 women who had an abortion-related complication: 323 (2.4%) women were classified with severe maternal outcomes, 957 (7.0%) had potentially life-threatening complications, 7953 (58.2%) had moderate complications and 4424 (32.4%) women had mild complications. Women who were single, multiparous, presenting ≥13 weeks of gestational age and where expulsion of products of conception occurred prior to arrival to facility were more likely to experience severe complications. For management, the commonly used mechanical methods of uterine evacuation were manual vacuum aspiration (76.9%), followed by dilation and curettage (D&C) (20.1%). Most frequently used uterotonics were oxytocin (50∙9%) and misoprostol (22.7%). Via ACASI, 602 (19.5%) women reported having an induced abortion. Of those, misoprostol was the most commonly reported method (54.3%).ConclusionThere is a critical need to increase access to and quality of evidence-based safe abortion, postabortion care and to improve understanding around women’s experiences of abortion care.

Summary Background Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial. Funding UK National Institute for Health Research Health Technology Assessment Programme.

Objectives: To assess the prevalence of unwanted pregnancies and induced abortion among female undergraduates.Methodology: A cross‑sectional survey was conducted among female undergraduates in University of Ibadan, Nigeria. The survey used a structured, self‑administered questionnaire. Data analysis was conducted using Statistical Package for the Social Sciences version 20 with Chi‑square and t‑tests. Statistical significance was set at P < 0.05.Findings: The mean age of the participants was 20.3 (±2.7) years and 80% were single at the time of the study. The prevalence of induced abortion was 51%. The overall prevalence of unwanted pregnancy was 17%, and 92.7% of students who had ever been pregnant had considered the pregnancy unwanted. Only 7.3% reported willingness to be pregnant while engaged and 58.3% were unwilling to keep pregnancy if engagement ends. Unwanted pregnancy was less among those ever married (χ2 = 49.96, P < 0.001), and more of the induced abortions were found in the unmarried group albeit not statistically significant (χ2 = 0.21, P = 0.640). Unwanted pregnancy occurred more during the engaged period than any other time, which was statistically significant (χ2 = 20.24, P < 0.001), although no significant difference in induced abortion was found.Conclusion: The prevalence of unwanted pregnancy and induced abortion is high especially among university undergraduates. As it appears to happen more often while they are engaged, unprotected sex during the engagement period needs to be targeted.Keywords: Engaged or married status; induced abortion; unwanted pregnancy

OBJECTIVE To compare the effectiveness of mefloquine and sulphadoxine-pyrimethamine as intermittent preventive therapy for malaria among pregnant women with HIV. METHODS The present randomized, controlled, prospective, open-label study enrolled women with HIV who had reached at least 16 weeks of pregnancy attending prenatal clinics at secondary and tertiary health facilities in South West Nigeria between January 1 and August 31, 2016. Block randomization was used to assign patients to treatment with mefloquine or sulphadoxine-pyrimethamine for malaria prophylaxis. The primary outcome was malaria parasitemia at delivery. Data were compared with the χ2 and t tests on a per-protocol basis. RESULTS Of 142 women enrolled and randomized equally to each group, 131 (92.3%) completed the study (64 in the mefloquine group and 67 in the sulphadoxine-pyrimethamine group). Blood-sample malaria parasites were isolated from 6 (9%) and 5 (7%) patients in the mefloquine and sulphadoxine-pyrimethamine groups, respectively, at enrolment, and 6 (9%) and 9 (13%) patients in the mefloquine and sulphadoxine-pyrimethamine groups, respectively, at delivery; the differences between the groups was not significant at enrolment (P=0.693) or delivery (P=0.466). CONCLUSION Outcomes following prophylactic use of mefloquine for intermittent preventive therapy for malaria among pregnant women with HIV were comparable to sulphadoxine-pyrimethamine treatment; mefloquine is a feasible alternative therapy. ClinicalTrials.gov: NCT02524444.

Diabetes mellitus, an endocrine disorder, has been implicated in many including hypogonadism in men. Given the fact that diabetes mellitus is becoming a fast-growing epidemic and the morbidity associated with it is more disabling than the disease itself. This study sought to assess the prevalence of low testosterone levels and predictors in type 2 diabetes mellitus patients and non-diabetic men in a district hospital in Ghana. This hospital-based case-control study comprised 150 type 2 diabetics and 150 healthy men. A pre-structured questionnaire and patient case notes were used to document relevant demographic and clinical information. Venous blood sample of about 6 ml was taken to measure FBS, HbA1c, FSH, LH, and testosterone levels. All data were analyzed using STATA version 12 (STATA Corporation, Texas, USA). The overall hypogonadism in the study population was 48% (144/300). The prevalence of hypogonadism in type 2 diabetic subjects was almost three times more than in healthy men (70.7% vs 25.3%). The odds of having hypogonadism was lower in the men with normal weight and overweight with their underweight counterparts (AOR = 0.33, 95% CI; 0.12–0.96, p = 0.042) and (AOR = 0.29, 95% CI; 0.10–0.84, p = 0.023) respectively. Also, the odds of suffering from hypogonadism was lower in non-smokers compared with smokers (AOR: 0.16, 95% CI; 0.05–0.58, p = 0.005). Participants who were engaged in light (AOR: 0.29, 95% CI; 0.14–0.61, p = 0.001), moderate (AOR: 0.26, 95% CI; 0.13–0.54, p

Objective To assess the effectiveness of a 12-hour versus 24-hour intravenous maintenance dose of magnesium sulfate (MgSO4 ) in women with pre-eclampsia, and the maternal and fetal outcomes. Methods This was a randomized controlled trial conducted at the labor ward complex of University College Hospital, Ibadan, Nigeria between May and August 2014. Pregnant women with severe pre-eclampsia were randomized to receive a 12-hour versus 24-hour maintenance dose of MgSO4 . Study outcomes were occurrence of seizures, adverse maternal effects, neonatal survival, and admission to the intensive care unit. Data analysis involved descriptive statistics and bivariate analysis using Statistical Package for Social Science (SPSS) version 20. Results There were 80 patients randomized to the 12-hour (n=40) and 24-hour (n=40) groups. The participants in the two groups had comparable demographic features. There was no significant difference (P>0.999) between the satisfactory maternal outcome following the 12-hour maintenance dose and the standard 24-hour regimen (95.0% vs 97.5%). Similarly, there was no significant difference (P=0.276) in perinatal mortality in the 12-hour versus 24-hour arm (17.5% vs 12.5%, respectively). No case of eclampsia and maternal death was recorded. Conclusion A 12-hour maintenance dose of intravenous MgSO4 in the management of severe pre-eclampsia is effective and safe when compared with the 24-hour maintenance dose.

Background Malaria and human immunodeficiency virus (HIV) infections in pregnancy are important and major contributing factors to maternal morbidity and mortality in sub-Saharan Africa. Prevention of malaria in HIV-positive pregnant woman will reduce the burden of malaria–HIV comorbidity. The objective of this study was to compare effects and safety of azithromycin (AZ) with sulphadoxine–pyrimethamine (SP) for intermittent preventive therapy for malaria in HIV-positive pregnant women. Methods We performed a randomized, controlled, open-label pregnancy trial of 140 HIV-positive pregnant patients attending antenatal clinics at the University College Hospital and Adeoyo Maternity Teaching Hospital, Ibadan, Nigeria. Participants were enrolled from a gestational age of 16 weeks and randomized to receive AZ or SP. The primary outcome was peripheral parasitaemia at delivery. Secondary outcomes were drug tolerability, foetal outcome and birthweight. The χ2 test (or Fisher’s exact test, as appropriate) and Student’s t test were used in the per-protocol analysis. The level of statistical significance was p Results A total of 123 participants (87.9%) completed the study: 60 participants received AZ and 63 received SP. The incidence of malaria parasitaemia at delivery in the AZ group was 6 (10.0%), compared with 7 (11.1%) in the SP group (relative risk 0.89 [95% confidence interval 0.28 to 2.82], p=0.84). Placental parasitization was demonstrated in 1 (1.6%) participant in the SP group compared with 3 (5.0%) in the AZ group (p=0.36). Conclusions The findings suggest that AZ is comparable to SP in malaria prevention and safety in HIV-positive pregnant women.

ObjectiveThe study aimed to assess the use of misoprostol and complications associated with abortions in referral hospitals in Nigeria, a country with restrictive abortion laws.MethodsA cross-sectional study at nine referral hospitals in South-west Nigeria. Nine years' data were retrieved from medical records, including 699 induced abortions. Independent variable was the method of abortion; dependent variables were complications, need for treatment and mortality. Statistical significance was tested with Chi-square, Fishers' exact and chi-square for trend tests (pResultsThere were 699 induced abortions amongst 2,463 abortions found in records. Nearly 70% were surgical abortions, but misoprostol use significantly increased over the study period in a linear trend (Χ2 trend: 30.96, P ConclusionMisoprostol abortion has significantly increased over time, and was associated with less morbidity and need for further treatment, in this study. It appears to be the safer option.

Objectives To assess the severity of complications following misoprostol used to induce abortion compared with other methods among women admitted for postabortion complications. Methods A cross-sectional study of women who presented with complications of induced abortion at nine secondary and tertiary hospitals in South West Nigeria between April 1, 2013 and May 31, 2014. Face-to-face interviews were conducted and information on the current admission was extracted from patient records. Associations between abortion method used and severity of abortion complications were evaluated using χ2 and Fisher exact tests. Results Of 522 women included in the study, 177 reported an induced abortion: 41 women (23.2%) had used misoprostol at the first attempt to induce abortion, whereas 79 (44.6%) women had undergone surgical abortion. Occurrence of fever (P=0.06), bleeding (P=0.3), and lower abdominal pain (P=0.32) was not significantly different between the misoprostol and surgical abortion/other methods groups. Severe complications were rare with misoprostol, but more common among women in the surgical abortion/other methods group. Maternal mortality occurred only among women in the surgical abortion/other methods group. Conclusion Use of misoprostol for induced abortion was associated with fewer complications and no maternal mortality compared with surgical abortion/other methods.

Objective To determine the decision-to-delivery interval (DDI) for emergency cesarean deliveries (CDs) at a tertiary center in Nigeria, to evaluate causes of delay, and to assess the effects of delays on perinatal outcomes. Methods Between September and November 2010, a prospective, observational study was undertaken at University College Hospital, Ibadan. Events that occurred after a decision to perform an emergency CD were recorded. Associations between outcomes and the DDI were analyzed. Results Among 235 emergency CDs included, 5 (2.1%) occurred within 30 minutes and 86 (36.6%) within 75 minutes. The mean DDI was 119.2 ± 95.0 minutes. Among CDs with a DDI of more than 75 minutes, logistic factors were the reason for delay in 65 (43.6 %) cases. No significant associations were recorded between DDI and the 5-minute Apgar score, admission to the special-care baby unit, or perinatal mortality (P > 0.05 for all). In multivariate analysis, neonates delivered after 75 minutes were significantly less likely to die during the perinatal period than were those delivered within this period (odds ratio 0.13, 95% confidence interval 0.03–0.66; P = 0.01). Conclusion Institutional delays in CDs need to be addressed. However, the DDI could be less important for perinatal outcome than are some other factors, such as the severity of the indication.

Oluwasomidoyin Olukemi Bello,1 Timothy AO Oluwasola,1,2 Folasade Adenike Bello1,2 1Department of Obstetrics and Gynecology, University College Hospital, 2Department of Obstetrics and Gynecology, University of Ibadan, Ibadan, Oyo State, Nigeria Purpose: To determine the knowledge, awareness, and factors associated with the practice of dual contraception among female undergraduates in Ibadan, Nigeria.Materials and methods: This is a cross-sectional study using a semi-structured ­self-administered questionnaire to assess the knowledge and practice of dual contraception among female undergraduates in the University of Ibadan and The Polytechnic, Ibadan. A total of 1,200 undergraduate students were interviewed, and data obtained were analyzed with SPSS Version 18.0.Results: The mean age of the respondents was 22.57±3.43years. Among the respondents, 900 (84.6%) were unmarried, 871 (77.9%) have been sexually exposed, 793 (70.9%) had heard of dual contraception, and 659 (58.9%) had knowledge of dual contraception. Majority (66.8%) of the participants used effective contraception, of whom 423 (56.3%) used condom, while others used other short- or long-term reversible contraception. More than two-thirds (79.2%) of the sexually exposed respondents were aware of dual contraception, but only 465 (41.6%) had practiced it. The main sources of information about dual contraception were from friends and radio (45.3% and 36.1%, respectively). Those who had multiple sexual partners and early coitarche were more likely to use dual contraception (P

Context: Symptomatic uterine fibroids are frequently encountered in gynecological practice in black populations. An evaluation of the surgical management is in order to audit practice, highlight complications, and facilitate care. Aims: This study aimed to evaluate morbidity following abdominal myomectomy and hysterectomy for symptomatic uterine fibroids. Settings and Design: A cross-sectional study retrospectively reviewing cases of symptomatic uterine fibroids that were managed surgically at a tertiary hospital in south-west Nigeria. Methods and Material: Surgeries performed over a five-year period were retrieved from the gynecological theatre of the hospital. The case notes were retrieved and information on socio-demographic, perioperative and postoperative characteristics was obtained. Statistical analysis used: Chi-square tests and Student's-t tests were performed to evaluate categorical and continuous variables, respectively. Significant P was set at < 0.05. Results: Of 214 eligible cases, 79 (36.9%) had hysterectomy and 135 (63.1%) had myomectomy. No other surgical treatment methods were employed. Age was the only significant socio-demographic feature; younger women were more likely to have myomectomy (P < 0.001). Mean blood loss and transfusion rates were comparable between the two groups. Complications included hemorrhage in 36.0%, wound infection in 4.7%, and postoperative fever in 1.9%. There were no conversions of myomectomy to hysterectomy and no mortalities. There was no significant difference in the prevalence of complications in either surgery group. Conclusions: Apart from hemorrhage, morbidities were few in this series. Gynecologists should ensure adequate preparations to control blood loss before and during fibroid surgery.

This study aimed to compare patients’ satisfaction and outcome of caesarean section wound closure by skin staples and subcuticular suture at discharge and 6 weeks of postoperation. It was a randomized controlled trial of pregnant women scheduled for caesarean section at the University College Hospital, Ibadan, Nigeria, allocating them to wound closure by skin staples or subcuticular suture. Pain was assessed using the box numeric pain scale. Scar assessments were by patient, research nurse, and independent observers using the visual analogue scale, modified patient observer scar assessment scale, and patient satisfaction scale. Operation time (minutes) was significantly shorter in the staple group, 40.26 (±16.53) compared to 47.55 (±14.55) in the suture group (P=0.025). Skin closure time (seconds) was significantly less in the staple group, 118.62 (±69.68) versus 388.70 (±170.40) in the suture group (P≤0.001). There was no difference in pain experienced, wound assessment by the participants, and patients’ satisfaction. Participants in the staple group scored higher on both scar assessment scales by the nurse (P=0.044). Cost comparison analysis showed that staple use costs significantly more than suture use (P<0.001). The perceived benefit of subcuticular suture over skin staples was not observed and participants were satisfied with both wound closure techniques.

The knowledge of pregnant women about Hepatitis B virus infection at three different levels of healthcare and their access to screening and vaccination was evaluated by a questionnaire-based cross-sectional study. There were 643 respondents with a mean age of 30.2 ± 5.2 years and mean gestational age of 26.1 ± 8.4 weeks. The distribution of respondents was 55 (8.6%, primary), 204 (31.7%, secondary) and 383 (59.6%, tertiary) women. The majority of respondents were traders (36%) or civil servants/professionals (28.6%). Overall, 76% of all women had inadequate knowledge about hepatitis B infection; 19.5% had been screened, while 9.7% had been vaccinated. There was an increased likelihood of adequate knowledge, previous screening and vaccination among health workers (p = 0.00). Other positive predictors of knowledge and vaccination were tertiary education (p = 0.04) and tertiary care (p = 0.00). There is inadequate knowledge among pregnant women in Ibadan about Hepatitis B infection, with significant differences at the various levels of care, particularly in non-tertiary settings where screening and vaccination is also sub-optimal. Information dissemination, universal screening and vaccination services for pregnant women in Nigeria require urgent consideration.

The levels of awareness, knowledge and the perceptions of women about cervical ripening and induction of labour were assessed in a cross-sectional questionnaire-based interview of 265 antenatal attendees of the University College Hospital, Ibadan, Nigeria from 1 March to 30 April 2009. Questions included evaluated sociodemographic data, obstetric history, awareness of both procedures and knowledge of specific methods. Data analysis was done using SPSS v.14.0 for Windows; frequency tables were utilised to determine proportions and significant variables from χ(2) analysis were entered into a logistic regression model. The majority of respondents were between 26 and 34 years; 56.4% were nulliparous. Awareness of cervical ripening and induction of labour was found in 71% of respondents. Knowledge of misoprostol and Foley's catheter however, was present in 25% and 13% of all women, respectively. Both procedures were perceived to prevent caesarean section or reduce burden of health workers in 16% of respondents. No significant predictor of knowledge was found but history of previous induction was a predictor of awareness (p 0.05). Improved counselling is required to further increase knowledge of methods for induction and correct wrong perceptions, particularly in women at risk of labour induction.

Objective To assess perception and level of proper utilization of emergency contraception (EC) among female undergraduates. Methods Cross-sectional questionnaire study was performed on 383 female undergraduates in Nigeria in June 2006. Data analysis was with χ-square test and logistic regressions (P Results One hundred and five (48.2%) had been sexually exposed. Only 32 (30.5%) used regular contraception. Seventy-three (24.3%) female undergraduates were aware of EC. Only 29 (7.6%) had used EC before. Most would not use emergency contraceptive drugs in future due to lack of awareness (64.8%), and fear for future fertility and of drugs being injurious to health. Use of EC was associated with awareness of correct interval for use (OR=9.1; 95%CI: 2.1-39.9). Conclusion There is poor knowledge about EC and poor use, while significant need remains. Most knowledge was acquired from peers and inaccurate. Peer educators are important and professionals' knowledge needs improvement.

Hepatitis B infection remains a significant source of morbidity among women and infants at different levels of care particularly in developing countries.To determine the prevalence of hepatitis B infection among pregnant women in tertiary and non-tertiary health facilities.Women receiving antenatal care in a tertiary centre and 2 non-tertiary centres in Ibadan. Nigeria were consecutively screened for Hepatitis B surface antigen by the ELISA method following written informed consent. The results were entered with socio-demographic and obstetric data into a proforma and significant associations determined by chi-square test and logistic regression (p0.05).A total of 658 women were recruited; 389 were from the tertiary hospital while 259 were from nontertiary health facilities. The mean age of the whole population was 30.17 +/- 5.24 years while the median gestational age was 27 weeks. Majority of the participants (64.5%) were between 26 and 35 years. The total prevalence of Hepatitis B infection was 16.3%. Prevalence of hepatitis B infection was 30.9% in the non-tertiary health facilities and 6.4% in the tertiary health facility (p = 0.000).The only significant positive predictor variable for hepatitis B infection was being in a non-tertiary health facility (OR: 0.086 CI: 0.037-0.199, p = 0.004).The burden ofAntenatal hepatitis B infection in Ibadan may be significantly greater in nontertiary health facilities. Health policy, particularly in these centres, should be directed towards education, screening and vaccination programmes.

To determine the prevalence of endometriosis and identify associated symptoms among Nigerian women.A cross-sectional study was conducted at a center in Ibadan, Nigeria, between October 2008 and December 2010. All women aged 18-45 years scheduled for their first diagnostic laparoscopy for gynecologic indications were enrolled. Participants completed a previously validated self-administered questionnaire. Endometriosis was diagnosed on the basis of visual evidence.Among 239 women analyzed, 115 (48.1%) had endometriotic lesions. Endometriosis was more common among women reporting dysmenorrhea and pelvic pain than among those not reporting these symptoms (20/28 [71.4%] vs 95/211 [45.0%]; P=0.009). Women who reported dysmenorrhea were significantly more likely to have endometriosis than were those without dysmenorrhea (90/171 [52.6%] vs 25/68 [36.8%]; P=0.027). The risk of endometriosis was not significantly increased in women with one pain symptom (odds ratio [OR]1.69; 95% confidence interval [CI] 0.67-4.27), but was significantly increased in women with two (OR 2.70; 95% CI 1.13-6.52) or three (OR 4.87; 95% CI 1.88-12.82) pain symptoms (χ(2)trend=15.5; P0.001). In a multivariate logistic regression model, only pain other than dysmenorrhea or dyspareunia independently predicted endometriosis (P=0.017).Endometriosis is fairly common among Nigerian women. Efforts to increase the awareness of endometriosis among the public, researchers, and clinicians are needed.

Infertility affects 20% of couples in Nigeria. Assisted reproductive techniques (ART) offered in Nigeria include in-vitro fertilization (IVF), gamete donation and surrogacy. This cross-sectional questionnaire study aimed at assessing the acceptability of ART to women seeking infertility treatment at the University College Hospital, Ibadan, Nigeria. Of the 307 respondents, 58.3% were aware of IVF and 59.3% would accept it as treatment; 35.2% would accept donor eggs and 24.7% would accept donor sperms-a smaller proportion anticipated acceptability by their husbands. Thirty five percent were aware of surrogacy, 37.8% would accept it as treatment; most preferring a stranger as a surrogate. Most felt surrogates should not be paid. Acceptance of ART was associated with older age, longer duration of infertility, previous failed treatment and women without other children. As chances of successful pregnancy are improved in younger individuals, counselling towards overcome barriers to accepting gamete donation and surrogacy should be instituted early.

Context: Emergency contraception (EC) is widely used to prevent unwanted pregnancy and it is largely adopted in many countries as over the counter drug to improve access.Aims: To determine and compare the correct knowledge, attitude and current use of EC among newly graduated medical doctors (MDs).Settings and Design: A cross.sectional study conducted among 255 newly graduated MDs at the University College Hospital, Ibadan, Nigeria.Materials and Methods: A pretested self.administered questionnaire was used to obtain data from consenting participants.Statistical Analysis Used: Descriptive, bivariate, and multivariable analyses were performed, and statistical significance was set at 0.05. Statistical Package for Social Science version 15.0 (Chicago, IL, USA) software was used.Results: The mean age of the respondents was 27.2 years (standard deviation = 2.1). The commonest indication for emergency contraceptive use mentioned was rape.96.5%. About 70% support EC in Nigeria, while about a quarter (26.9%) routinely counsel women about ECP use. About 21% of respondents currently use EC. Logistic regression analysis revealed significant results for gender [odds ratio (OR) =3.64; 95% confidence interval (CI) OR = 1.31.10.01), religion (OR = 0.26; 95% CI OR = 0.11.0.630) and marital status (OR = 0.19; 95% CI = 0.07.0.56). Conclusion: The correct knowledge and professional disposition toward EC as a form of contraception is low. We recommend that in.service training should focus more on EC to improve the quality of their knowledge and attitude towards it.Key words: Emergency contraception, knowledge, Medical Doctor, Nigeria

Background: Gestational diabetes mellitus (GDM) is associated with increased risk of mortality and morbidity for pregnant women and newborns. Identifying pregnant women with risk factors for GDM based on the clinical suspicion is a popular approach. However, the effectiveness of the use of a structured checklist of risk factors is yet to be evaluated. This study assessed the effectiveness of a structured checklist of risk factors in identifying pregnant women at risk of GDM at the University College Hospital, Ibadan.Materials and Methods: It was a comparative cross.sectional study implemented in two phases. The first phase (Group A) of the study was a prospective study that involved 530 pregnant women who presented at the booking clinic. A structured checklist containing risk factors was used to identify women at the risk of GDM. The second phase (Group B) was a retrospective study of 530 pregnant women managed 2 years previously who were selected by systematic random technique.Results: The mean age, gestational age at booking, gestational age at delivery and birth weight were 30.2 } 5.2 years, 21 } 10.8 weeks, 38.7 } 2.7 weeks and 3.1 } 0.7 kg respectively. The prevalence of GDM in Group A and B were 4.9% and 1.6% respectively (P < 0.05). There was about three fold increase in identification of women at risk of GDM by use of a checklist.Conclusion: Identification of women at risk of GDM was approximately 3.4 fold higher with the use of checklist of risk factors. Exhaustive clinical identification with a checklist of risk factors for GDM should be encouraged.Key words: Checklist, gestational diabetes, risk factors, screening

Context: Dysmenorrhea is common and can be severe, hampering women’s quality of life.Aims: This study aimed to assess the prevalence and factors associated with dysmenorrhea in a population of young females and to explore the impact on routine activity and proven relief measures experienced by this group.Settings and Design: This is a cross‑sectional, observational study among female medical and nursing students at a tertiary health care facility in South‑Western Nigeria.Subjects and Methods: It was a questionnaire study carried out among 360 female students. Explanatory variables were age, parity, use of combined oral contraception, and first‑degree family history of dysmenorrhea. The main outcome variable was the presence of dysmenorrhea.Statistical Analysis Used: Data were analyzed by Chi‑square test and logistic regression (P < 0.05).Results: All respondents had attained menarche at 12.4 ± 1.2 years; 299 (83.1%) reported dysmenorrhea. Primary dysmenorrhea constituted 63.6%; secondary was 19.4%. Younger respondents (teenagers) and married females were significantly less likely to suffer dysmenorrhea, while nonusers of oral contraceptives were more likely to. Period pain precluded usual activity in 48.8% of sufferers; 39.5% had missed classes on account of it; however, only 10% had sought medical care. The most effective treatment used was piroxicam (an antiprostaglandin drug). On multivariate analysis, increasing age (Odds ratio-10.6 [95% Confidence Interval: 3.4-34.0]) was significantly associated with dysmenorrhea.Conclusions: Dysmenorrhea is a highly prevalent problem among this population. Women should be encouraged to seek medical care to limit the debility that arises from dysmenorrhea. Some women may benefit from investigations and definitive treatment.Key words: Dysmenorrhea; medical students; Nigeria; nursing students.

Background: Many patients are referred to labour ward as emergencies, and therefore do not benefit from the antenatal HIV counselling and testing and treatment offered to registered patients.Objective: To assess the acceptability and suitability of offering HIV counselling and testing to women of unknown HIV status presenting in labour.Methods: A cross-sectional study comprising counselling and obtaining consent for HIV testing among 104 unregistered patients who presented in labour over a 3-month period. Rapid and enzyme-linked immunosorbent assay screening was performed for 90 consenting respondents. Reactive results were confirmed by Western blot. Appropriate therapy wasinstituted.Results: Acceptance rate for HIV testing was 86.5%, prevalence of HIV was 6.7%. Women of lower educational status were more likely to accept testing in labour (OR: 0.3; 95% CI: 0.1-0.7; p=0.01); age, parity, occupation and knowledge of HIV had no influence. Most women (66.3%) had satisfactory knowledge of HIV. No one admitted to feeling coerced to test in fear of being denied care. Most refusals for screening were to avoid needle pricks (28.6%). Compared to ELISA screening test, specificity of the rapid test was 100%, sensitivity 85.7%, positive predictive value 100%and negative predictive value 98.8%. Attitude to testing was maintained on post-partum re-evaluation.Conclusion: The prevalence of HIV amongst unregistered parturients showed the importance of offering point-of-care HIV testing and intervention, especially in an environment where antenatal clinic attendance is poor. Rapid testing appeared to be acceptable and feasible in labour to prevent the mother-to-child transmission of HIV.

This was a cross-sectional study carried out on 372 clients receiving antenatal care at a rural, suburban and urban centres, in order to assess the acceptance of caesarean delivery amongst them and the factors influencing their attitude. Caesarean section was acceptable to 65.7%. Many respondents will refuse the surgery, because they do not think abdominal delivery is natural or necessary. However, if indicated by their health caregiver to be necessary to save life, 78.3% would comply. Others would leave for a religious healing home, another hospital, a traditional birth attendant or be delivered at home. The cultural reasons why some women decline include feeling that caesarean delivery is due to “spiritual attacks”, retribution for maternal infidelity and failure of a woman to fulfil her reproductive function. Respondents were more likely to accept the surgery if they had heard of it before or had a previous caesarean delivery. They were less likely to accept it if they were Christians or attended the rural health centre. Age, parity and educational level had no influence. Only 4% of the respondents would request a caesarean section for non-medical reasons. Health education needs to be carried out in the community, as well as during antenatal classes, to address the cultural beliefs. Means of involving religious bodies in enlightenment campaigns to improve women's attitude should be explored.

Objectives: To determine the frequency of retained placenta at the University College Hospital Ibadan (UCH). and to describe the socio-demographic characteristics of the patients and examine the risk factors predisposing to retained placenta. Methods: This is a descriptive study covering a period of 5 years from January 1st 2002 to December 31st 2006. During the study period, 4980 deliveries took place at the University College Hospital, Ibadan and 106 cases of retained placenta were managed making the incidence 2.13 per cent of all births. Results: During the five year period, there were 106 patients with retained placenta; of these, 90 (84.9%) case notes were available for analysis. The mean age was 29.37 ± 4.99 years. First and second Para accounted for 52 per cent of the patients. Majority of the patient were unbooked for antenatal care in UCH with booked patients accounting for 27.8 per cent of the cases. The mean gestational age at delivery was 34.29 ± 6.02. Three patients presented to the hospital in shock of which 2 died on account of severe haemorrhagic shock. Fifty-eight patients (64.8%) presented with anaemia (packed cell volume less than 30 per cent) and 35 patients (38.8%) had blood transfusion ranging between 1-4 pints. 1 patient required hysterectomy on account of morbidly adherent placenta. Eleven patients (12.2%) had placenta retention in the past, 28 patients (31%) had a previous dilatation and curettage, 14 patients (15.5%) had previous caesarean sections and 47 patients (41.3%) had no known predisposing factors Conclusion: Retained placenta still remains a potentially life threatening condition in the tropics due to the associated haemorrhage, and other complications related to its removal. The incidence and severity may be decreased by health education, women empowerment and the provision of facilities for essential obstetric services by high skilled health care providers in ensuring a properly conducted delivery with active management of the third stage of labour.

A study of 375 antenatal attendees to assess women's views and experience in sexual matters during pregnancy and following childbirth. Explanatory variables included the perception women had of sex during pregnancy and after childbirth. Outcome variables were frequency and satisfaction of sexual activity. The commonest reasons for having coitus in pregnancy were marital harmony and facilitation of delivery. Libido rose throughout pregnancy but orgasms were less often experienced. The man-on-top position became less practised. Vaginal intercourse remained the commonest type. Masturbation and anal intercourse increased, while oral sex declined throughout. Marriage (OR 9.0, 95% CI 1.0–79.5) and current cohabitation (OR 13.6, 95% CI 1.6–113.4) were predictors of sex in pregnancy. Dyspareunia and partners' extramarital affairs were deterrent. Vaginal delivery and episiotomy were not significant predictors of postnatal sex. The respondents and their partners seem able to adapt to pregnancy changes and enhance their marital bonds. Anticipatory guidance and informed counselling may encourage this.

SummaryThis was a cross-sectional study carried out on 462 pregnant women attending antenatal care in Ibadan, Nigeria. The study's aims were to assess the level of participation of Nigerian men in pregnancy and birth, the attitude of the women and likely targets for improved care delivery. Three hundred and forty-nine women (75.5%) were aware that husbands could participate in childbirth. Most women did not think it was their husbands' place to attend antenatal clinic (48.3%) or counselling sessions (56.7%). Nearly all husbands (97.4%) encouraged their wives to attend antenatal clinic – paying antenatal service bills (96.5%), paying for transport to the clinic (94.6%) and reminding them of their clinic visits (83.3%). Three hundred and thirty-five husbands (72.5%) accompanied their wives to the hospital for their last delivery, while 63.9% were present at last delivery. More-educated women were less likely to be accompanied to the antenatal clinic, while more-educated men were likely to accompany their wives. Yoruba husbands were less likely to accompany their wives, but Yoruba wives with non-Yoruba husbands were 12 times more likely to be accompanied. Women in the rural centre were less likely to receive help with household chores from their husbands during pregnancy, while educated women were more likely to benefit from this. Monogamous unions and increasing level of husbands' education were associated with spousal presence at delivery. It appears that male participation is satisfactory in some aspects, but increased attendance at antenatal services and delivery would be desirable.

Context: Induction of labour is a useful obstetric intervention, yet it is underutilized in Africa. Recommendations for practice may reduce its unmet need.Objective: This study aims to determine labour induction success rates and identify predictors of outcome.Study Design, Setting and Patients: This was a retrospective, descriptive, cross‑sectional study of 104 women who had induction of labour at the University College Hospital, Nigeria.Main Outcome Measures: Primary outcomes were vaginal delivery within 24 hours and caesarean delivery. Analyses were done by Chi‑square tests, t‑tests and logistic regression.Results: Labour induction rate was 12.7%; most were performed on account of post‑dated pregnancies and pre‑labour rupture of membranes. Forty‑six, (44.2%) had vaginal delivery within 24 hours whereas induction failed (i.e. caesarean delivery) in 38 (36.5%). The mean duration of the process was 12.0 ± 6.6 hours with misoprostol, 8 hours less than with oxytocin (P < 0.01). Misoprostol was significantly more likely to result in delivery within 24 hours in comparison to extra‑amniotic transcervical catheter for ripening (P = 0.02, OR = 5.1, 95% CI = 1.2–21.1), and to oxytocin for induction (P = 0.03, OR = 6.5, 95% CI = 1.2–36.3), respectively. Adverse effects were infrequent and comparable with either method.Conclusion: Success rate needs to be improved upon. Higher parity, later gestation and misoprostol ripening or induction are associated with successful outcomes. It is recommended that clients’ experience may be improved by commencing misoprostol cervical ripening the night before induction and administering the medication orally rather than vaginally.Keywords: Induction of labour; intervention; outcome; predictor of success

In Nigeria, breast-feeding has been shown to be very closely related to infant survival. Prolonged and adequate breast-feeding is critical to most infants' nutritional health and growth. This study aims to determine the influence of family support on the duration of exclusive and total breast-feeding of infants of antenatal patients. This cross-sectional study was conducted between 1 September and 30 December 2005. The tool was a structured questionnaire. The main outcome variables were the duration of breast-feeding; both total and exclusive explanatory variables were mainly related to support obtained during breast-feeding from husband and older female relations. Husbands support significantly increased the total duration of breast-feeding by a mean of 1.69 months (95% CI 0.88, 2.51), however, exclusive breast-feeding was not significantly affected by the husband's support (OR 0.94; 95% CI 0.63, 1.39). Female support had a significant influence on both the total duration of breast-feeding which is increased by a mean of 1.08 months (95% CI 0.14, 2.02), and the adequate conduct of exclusive breast-feeding (OR 1.83; 95% CI 1.17, 2.86). The cultural practice of having additional female support in the postpartum period has been shown by this study to be beneficial. Therefore, this cultural practice should be encouraged and catalogued as a beneficial cultural practice. This practice is also cheap and sustainable.

Background: Transvaginal sonography (TVS) is the standard route for gynecological and early pregnancy assessment scanning, due to the higher resolution that allowed for a better view of the pelvis. It had not been available in the study area prior to this, and it was anticipated that clients would find it intrusive and unacceptable, and thus decline it. The study was aimed at accessing the acceptability of TVS in women. Method: A cross-sectional study of all clients who presented for gynecological and early pregnancy assessment scans at a private ultrasound diagnostic center in Nigeria during its 1st year of service. All suitable clients were counseled for TVS. This was carried out for them, while nonconsenters had transabdominal sonography. A questionnaire was administered to the consenting participants. Virgins and women currently experiencing heavy vaginal bleeding were excluded. Data were entered into SPSS-16 and analyzed with frequency tables. Results: Five hundred and seventy-seven women of varied demographic characteristics were included into the study. Only one (i.e., 1/577; 0.2%) declined TVS. The procedure was abandoned in one (i.e., 1/576; 0.2%) due to severe discomfort. All 575 that completed the examination stated they would accept TVS again in the future, if indicated. Conclusions: TVS was universally accepted by a diverse population of women in South-Western Nigeria. It is recommended that ultrasound scan providers in this location should acquire skills for it, if necessary, and that TVS be offered routinely for gynecological evaluation according to international standards.

Context: The risk of laboratory cross‑contamination may limit the availability of assisted conception for couples infected with chronic viruses. However, assisted conception is the standard of care for people living with human immunodeficiency virus (HIV) to minimize risk of transmission or reinfection. Aims : To assess the burden of viral infection among couples that present for assisted reproductive technology (ART) with a view to evaluating implications for their care. Settings and Design: A cross‑sectional descriptive study carried out among 138 couples at a private fertility clinic in Nigeria. Materials and Methods: Screening for HIV, hepatitis B virus (HBV) and hepatitis C virus were carried out among these clients. The males’ seminal parameters were analyzed according to World Health Organization (WHO) criteria. Statistical analysis Used: Statistical Package for Social Sciences was employed. Analysis was by Chi‑square test; statistical significance was set at 0.05. Results: Viral infections were found in 10/138 women (7.2%) and 15/138 (10.9%) men. The most prevalent infection was HBV. Twenty‑one couples were sero‑discordant. Two couples had concordant HIV and HBV infections, respectively. There was no significant association between sperm quality and chronic hepatitis infection. Conclusion: Nearly a fifth of the couples had at least one partner infected with a chronic virus – a proportion significant enough to demand attention. Apart from separate laboratory and storage facilities, basic principles to minimize transmission are recommended: HBV vaccination in sero‑discordant partners of HBV carriers (and immunoprophylaxis for the baby) and antiretroviral therapy for HIV‑positive partners to reduce the viral load before fertility treatment is commenced. Key words : Assisted reproduction, hepatitis B virus, hepatitis C virus, human immunodeficiency virus