Tropical Journal of Obstetrics and Gynaecology

Impact of Naira Scarcity and Cashless Policy on Health-Seeking Behaviour and Antenatal Care Utilisation Among Pregnant Women in Northcental Nigeria

Matthew FIJABIYI — 2024-11-27

Introduction: Cashless policy is a macroeconomic measure aimed at repositioning the nation for economic growth, through reduction of currency notes in circulation, lowering of the inflation, money laundering and other financial related crimes. Unfortunately the implementation of this policy brought about untoward hardship to the citizens. Among the worst hit by the naira scarcity are the pregnant women, whom by the virtue of their physiological state could not endure the long queues at ATM or the banking hall to access cash. Thus, the artificial naira scarcity created could negatively affect the uptake of antenatal care services among pregnant women and contribute to unwarranted increase in maternal mortality and morbidity.

Objectives: This study sought to determine the effects of naira Scarcity on the difficulties encountered in seeking health among pregnant women attending ANC clinic, determine the effects of socioeconomic indices on the difficulties in seeking health amidst the naira scarcity and to estimate the proportion of pregnant women who had difficulties in accessing health care services consequent to naira scarcity at the Federal Medical Centre, Keffi, Nasarawa State, North- Central Nigeria.

Materials and Methods: This was a cross sectional study conducted among pregnant women attending antenatal care in Federal Medical Centre Keffi, Nasarawa state Nigeria. The study was carried out during the period of naira scarcity between 10th January 2023 and 9th march 2023. During the period, a total of 340 pregnant women were recruited using a convenient sampling method. Consecutive, consenting patients were given questionnaire and information including their sociodemographic, obstetrics, average cumulative family income, modes of transaction before the naira scarcity and during the scarcity, effect of naira scarcity on their willingness to attend ANC, difficulty in transportation and difficulty in accessing care among many others. Data were gotten and analyzed using SPSS 25. Categorical variables were presented as frequencies and percentages.

Results: A total of 340 pregnant women were recruited for this study. Women aged between 30-39 years (60.3%) ranked highest in the study with 246(72.4%) having tertiary level of education A larger number of the women in the study were unemployed 135(39.7%) while majority of the husbands of the women in the study were civil servants accounting for 195(57.4%).Most of the families in the study earned an average monthly income of >100,000 naira per month. The Point of sale (POS) was the most preferred mode of transaction accounting for 34.7% and 44.4% before and during the naira scarcity. The association between level of education and the mode of transaction during the period of the naira scarcity was significant with mobile bank app with a P = 0.0000. About 189(55.5%) women missed between 1-6 antenatal visits due to the naira scarcity but the association between the average monthly family income of respondents and the number of ante natal care missed was not statistically significant with an overall P= 0.479 .

About 266(78.2%) and 310 (91.2%) of the respondents believed that prolonged effect of the naira scarcity could lead to increased maternal mortality and morbidity

Conclusion: The cashless policy of Central Bank of Nigeria was geared towards economic recovery. The artificial naira scarcity created by the policy brought unimaginable hardship on the health seeking behavior of pregnant women such as difficulty in accessing care, missed antenatal appointments, denial of antenatal care services due to lack of cash and failure of electronic payment platforms. All the aforementioned difficulties could ultimately have a negative effect on pregnancy outcome and maternal health.

Pattern of Cervical Cytology in a Tertiary Health Care Centre in Abuja - The Capital City of Nigeria

Juliet Offor — 2024-11-27

Background: Cervical cancer is a preventable disease. Its incidence and mortality have reduced drastically in countries with well-established cervical cancer screening programmes. Objectives: To determine the pattern of cervical cytology and associated risk factors in women routinely screened at the Federal Medical Centre Abuja. Methodology: This was a cross-sectional study conducted from September 2018 to September 2019. An equal number of 270 women each were recruited from the postnatal, family-planning and gynaecological clinics giving a total of 810 women enrolled in the study. Informed consents were obtained from the participants and data on risk assessment was collected using an interviewer administered structured questionnaire. Afterwards, a cervical sample was taken from each participant’s transformation zone(liquid-based cytology), and results were reported using the Bethesda classification. The data was analysed and presented as tables of frequencies/percentages and central tendencies. The risk factors for cervical dysplasis were determined using multiple logistic regression analysis. Statistical significance was set at p-value < 0.05. Results: Overall, the prevalence of abnormal/dysplastic smears was 3.95% while 96.05% had negative smears for intraepithelial lesion or malignancy(NILM). According to the severity of dysplasia, ASCUS had prevalence of 2.96%, ASC-H 0.37%, LSIL 0.37% and HSIL 0.25%. Group specific prevalence was highest among the postnatal group (6.3%). Age was the only factor associated with increased likelihood of developing dysplasia. Conclusions: . The prevalence of cervical dysplacia is relatively low in Federal Medical Centre Abuja. Instituting routine screening of all sexually active women at every opportunity especially in postnatal clinics be encouraged as this will help in early detection of cervical dysplasia and management, thus reducing the incidence of cervical cancer.

Prevalence And Risk Factors For Antepartum Depression Among Women Attending Antenatal Clinic

Hafsat Abdullahi Maikudi — 2024-11-27

Background: Pregnancy increases the susceptibility of women to mental health disorders, especially depression. Depression is more prevalent in low and middle-income countries and is associated with adverse maternal and perinatal morbidity. However, screening for depression is not routinely offered to pregnant women in this setting.

Aim: To determine the prevalence of antepartum depression; describe the characteristics of the depressed women and identify the risk factors for antepartum depression among women attending the antenatal clinic of the study hospital.

Methodology: A cross-sectional study where 250 women attending antenatal clinics were recruited. An interviewer-administered questionnaire was used to obtain relevant information on socio-demographic and obstetric history. The Edinburgh postnatal depression scale was used to screen for depression and a score of 13 and above was considered positive for depression. Data was analysed using SPSS version 28. P value <0.05 was considered significant.

Results: The prevalence of antepartum depression was 6.4% (16/250). The majority of women with antepartum depression were aged ≤35 years (15/16), of the Islamic faith (14/16); had tertiary education (10/16); had low income (12/16) but had spouses with higher income (12/16) and reported no history of marital conflict (10/16). These women were predominantly parous (15/16); in the third trimester (11/6) and had no bad obstetric history (14/16). Tribe and gestational age were associated with APD (p<0.05). Younger women had doubled odds of having APD (OR 2.3, CI 0.29-17.9). Educational level, income, parity, presence of marital conflict and bad obstetric history were not associated with the risk of having APD.

Conclusion: APD is common and occurs across all educational levels, socio-economic and obstetric statuses. Gestational age was associated with APD. Screening for APD should be integrated among antenatal packages that promote maternal and perinatal health, especially in the third trimester.

Keywords: antepartum depression, prevalence, risk factors, characteristics maternal and perinatal morbidity.

Awareness and Desirability of Companionship in Labour among Pregnant Women attending Antenatal Clinic in Owo, South-West, Nigeria

Saheed Yomi Adebayo — 2024-11-27

Abstract

Background: Labour is a stressful physical and psychological experience in a woman’s life, requiring optimal coping mechanisms. Companionship in labour provides such needed support in this vulnerable moment of women. The presence of a companion of the woman’s choice in labour improves her satisfaction with parturition.

General objective: To determine the awareness and desirability for companionship in labour of pregnant women attending antenatal clinic at a tertiary centre in Owo, South-West Nigeria.

Methods: An institutional based descriptive cross-sectional study of 292 antenatal clinic attendees in Owo. Participants were selected by systematic random sampling and data collected through interviewer-administered questionnaire, assessing their awareness and desirability for companionship in labour. The data was analysed using SPSS IBM version 24.0.

Results: A total number of 292 pregnant women with mean age 31.8years participated in the study. Most of the respondents (57.2%) were aware of companionship in labour, 88.7% had desire for companionship in labour though only 18% had companionship in their previous delivery (ies) or knew someone who had it before. All with companionship in their previous delivery (ies) were satisfied. Husband/partner is the most preferred companion in labour 64.4%. Majority (92%) desire to deliver their baby (ies) in a hospital where there is provision for a companion in labour. Most of those who desired to have their delivery at facilities with provision for companionship in labour (63.7%) would prefer it even at an additional cost of care.

Conclusion: Companionship in labour is evidently the intense aspiration of parturients. Majority of the participants desired companionship in labour but its utilization is low. Permitting women to have a companion of their choice during labour and delivery can be a cost-effective intervention to improve the quality of maternal care with positive birth experience.

Prevalence and Types of Gender-Based Violence Among Secondary School Students in Southwest, Nigeria.

Adenike Adeoye — 2024-11-27

Background: Gender-based violence (GBV) continues to be a significant public health issue. Although it preventable, its recurrence presents teenagers with a number of negative implications that may extend into the future. Globally, one in every three women has experienced some type of violence. Young people are particularly vulnerable; a total of 73 million males and 150 million females are being considered to be impacted.

Methods: This study was a cross-sectional study that used a multistage sampling technique to recruit 909 in-school students from 6 secondary schools (3 public and 3 private) in Ibadan North LGA, Oyo State, Nigeria between May to July 2023. A pretested semi-structured self-administered questionnaire, with close- and open-ended questions was used for data collection. Data was analyzed using IBM SPSS version 25. Level of significance was p-value≤ 0.05.

Result: The modal age-group was 12-14 years (54.7%). The overall prevalence of GBV was 65.5%, male (66.1%) and female (64.9%) are almost equally affected, with majority occurring among females in private schools (67.4%, p=0.119). Verbal violence was most common form of GBV experienced by adolescents (55.9%) .

Conclusion: GBV occurs among adolescents. Both males and females are affected and the spectrum of types of violence is similar to older individuals; thus, a need to help this group. There is a need for supportive services within secondary schools, early and gender-responsive interventions to promote gender equality, prevent them from being victims of violence and school authorities to actively prevent experience of GBV among students.

Utility of Early Pregnancy HbA1C in detecting Gestational Diabetes Mellitus among High-Risk Women in Nigeria

Nengak Gokir — 2024-11-27

ABSTRACT

Background: Gestational Diabetes Mellitus GDM is a major cause of maternal and perinatal morbidity and mortality. Early detection and treatment will ensure good pregnancy outcomes. There is a paucity of data regarding the use of HbA1c in classifying and managing hyperglycaemia in pregnancy in Nigeria. This study set out to investigate the utility of early pregnancy HbA1c values in detecting hyperglycaemia among Nigerian pregnant women.

Materials and Methods

A total of 125 pregnant women presenting for their booking visits at 20 weeks or less of gestation and having one or more risk factors for GDM were recruited and blood samples were taken for HbA1c and OGTT determination according to the WHO protocol.

Results

The mean (SD) age of the study population was 30.4 (5.8) years. The prevalence of HIP from this study after screening at early gestation (<20 weeks) was 15.2% of which 13.3% was classified as GDM. There was a significant correlation between HBA1c and 0-hour glucose (r=0.412), 1-hour glucose (r=0.394), and 2-hour glucose (r= 0.379), P<0.001. At HbA1c of 5.4% and 5.7%, the sensitivity for detecting HIP was 66.7% and 22.2% respectively and the specificity was 65.9% and 80.5% respectively. At HbA1c of 5.4% and 5.7%, the PPV was 26% and 16.9% respectively while the NPV was 88.2% and 79.7% respectively.

Conclusion: The study shows a very high prevalence of HIP in early pregnancy among women with a high risk for GDM. HbA1c correlated moderately well with glucose levels in early pregnancy. Overall, HbA1c does not have a very robust sensitivity and specificity for diagnosis of HIP when used alone. However, the utility appears to be better when used as a marker to rule out HIP in early pregnancy.

Problems of Grand Multiparity in Labour And Delivery As Seen in Federal Teaching Hospital, Katsina (FTHK). A 5 Year Review.

Abidemi Abe — 2024-11-27

Objectives: To determine the prevalence of grand multiparity amongst the parturient in FTHK, to identify their socio-demographic characteristics, to identify the complications they had during labour, to determine their mode of delivery and the maternal and perinatal outcomes after delivery.

Methods: This is a retrospective study conducted over a five-year period between January 1^st 2016 to December 31^st 2020.

Results: The prevalence of grand multiparity was 17.4%. The GMP women were found not to be significantly older than the MP women (X²=12.000, p=0.384).

Breech presentation was the commonest complication seen in the GMP women. The odds of having at least 1 complication were 4 times higher in grand multiparous women compared with multiparous women (OR 3.92, 95%CI=3.07-5.00), 5.3%(44) of GMP women had assisted breech delivery while 0.6%(13) of MP women had this procedure. The odds of having an unfavorable birth outcome were 5 times higher in the GMP women compared with the MP women (OR 5.28, 95%CI=3.88-7.18). The rates of maternal death were also significantly higher among the grand multiparous women compared with the multiparous women.

CONCLUSION: Our study found a high rate of grand multiparity in our environment. Its obvious grand multiparity is still a source of great concern to the Obstetrician. GMP is associated with increased maternal and perinatal morbidity and mortality. To achieve a reduction of this preventable hazard in our environment there must be an increase in the levels of literacy in the community and also provision of family planning services.

A Five-Year Review of Caesarean Sections at the Central Hospital Agbor, Delta State, South South Nigeria.

Ngozi Roy Maduka — 2024-11-27

Background: Caesarean section (CS) is the most commonly performed Obstetric surgery. The rate has been observed to vary from centre to centre.

Aim: The aim of the study was to reviewed the CS done at the Central hospital Agbor (CHA) to document the rate, type (emergency or elective) and indications.

Subjects and methods: This was a retrospective study involving the reviewed of Two thousand six hundred and seven (2,607) cases of CS (1229 emergency, 1378 elective) managed at the CHA, Delta state from 1st January, 2019 to 31st December, 2023. Data collected were analysed using statistical package for social sciences (SPSS) computer software version 25.0 for windows. Results: The total delivery within the period was 5951 with 2607 delivered through CS giving a CS rate of 43.8%. Elective CS was done for 1378 (52.9%) while Emergency CS was done for 1229 (47.1%). The commonest indications were Repeat CS (17.0%), 2 Previous CS (13.7), Fetal distress (9.4%) and Breech (8.0%). The average age of parturient was 30.38 ± 5.34 years while the minimum and maximum ages were 16 and 50 years respectively. The modal age was 30 years. Among the patients that had CS, 37 (1.42%) were teenagers. Conclusion: The CS rate at CHA is high, with repeat CS being the most prevalent indication. Efforts should be directed towards optimizing the CS rate while maintaining the utmost priority on maternal safety and fetal well-being, leveraging evidence-based practices to minimize unnecessary CS procedures.

Key words: Five-year review, Caesarean section, south-south Nigeria

Frozen Embryo Transfers in Sub-Saharan Africa: A Five-Year Retrospective Study at Nordica Fertility Centre, Lagos, Nigeria

Victor Ajayi — 2024-11-27

Background: Frozen Embryo Transfers (FET) have gained popularity in recent years as an alternative or complementary option to fresh embryo transfers in In Vitro Fertilization (IVF) cycles. FETs offer several benefits, such as lower cost versus repeat cycles, reduced stress, and better endometrial receptivity. FETs are also indicated in cases where fresh transfers have been shown to give subpar results, such as in polycystic ovary syndrome (PCOS) and endometriosis patients. However, the evidence on the comparative success rates of FETs and fresh transfers is inconclusive, and the practice of FETs is not widespread in Sub-Saharan Africa.

Objectives: To describe the socio-demographic characteristics, indications, trends and outcomes of FET cycles performed at Nordica Fertility Centre, Lagos, Nigeria, between 2018 and 2022.

Methodology: This was a retrospective study of all FET cycles performed at Nordica Fertility Centre, Lagos, Nigeria, from January 2018 to December 2022. Data on patient age, parity, infertility diagnosis, number of frozen embryos transferred, implantation rate, clinical pregnancy rate, live birth rate and complications were collected and analyzed using descriptive statistics and Chi-square tests were employed to assess the associations between categorical variables.

Results: A total of 444 FET cycles were performed during the study period with 290 (65.3%) being from own eggs and 154 (34.7%) from recipients. The patients' overall mean age was 39.2±5.8 years with mean age of 33.4±4.7 and 45.0±6.9 for own eggs and recipients respectively. Fifty-two (17.9%) patients transferred 1 embryo, 166 (57.2%) patients transferred 2 embryos and 72 (24.8%) transferred 3 embryos while 10 (6.5%) patients transferred 1 embryo, 101 (65.6%) patients transferred 2 embryos and 43 (27.9%) transferred 3 embryos from own eggs and recipients, respectively for the FET procedure. The findings show that there is a significant (p=0.02) difference in the proportion of patients that transferred 1, 2 or 3 embryos when own eggs and recipients are compared. Ninety-four (32.4%) FET cycles resulted in viable pregnancies (Positive) and 196 (67.6) FET cycles were unsuccessful (Negative) from own eggs. Forty-four (28.6%) FET cycles resulted in viable pregnancies (Positive) and 110 (71.4) FET cycles were unsuccessful (Negative) from recipients. The result shows that there is no significant difference in the proportions of Own eggs and recipients that had positive or negative outcome (p=0.41). The FET cycles using Own Eggs had a slightly higher success rate of approximately 32.41% compared to FET cycles using Donor eggs which had a success rate of approximately 28.57%. This study observed a notable increase in the number of FETs performed annually, reaching its peak in 2022. This trend aligns with global patterns reported by the Society for Assisted Reproductive Technology (SART), reflecting a growing acceptance and utilization of FET over time.

Conclusion: FET is a safe and effective option for IVF patients in Sub-Saharan Africa, with comparable success rates to fresh transfers and lower risk of complications. FET is especially indicated for patients with PCOS, endometriosis, and recurrent implantation failure.

Preterm Delivery in a Nullipara with Urinary Tract Infection and Undiagnosed Uterine Anomaly (Uterine Didelphys): A Case Report

Kenneth Toby Maduako — 2024-11-27

Uterine didelphys is a rare congenital abnormality which results from complete failure of fusion of the Mullerian duct during embryological phase of life. In pregnancy, uterine didelphys is commonly associated with adverse foetal outcome. We report a 25 year old nullipara with previous history of miscarriages who presented at 33 weeks gestation with complaints of preterm contraction with associated urinary symptoms. She was managed for urinary tract infection in pregnancy and symptoms resolved. Obstetric scan showed normal findings with no abnormality of the uterus or adjacent structures. She subsequently had Caesarean section for nullipara breech in labour with delivery of a live baby and an incidental intra-operative finding of uterine didelphys. Mother and baby were discharged home healthy on the 4^th post-operative day and postpartum period was unremarkable. The rare incidence of this finding and the good perinatal outcome are the peculiarity of this report.

The Hepatic Metastasis From Recurrent Ovarian Granulosa Cell Tumour: A Rare Entity

Shaliq Navas — 2024-11-27

Granulosa cell tumour (GCT) is a rare sex cord-stromal tumour of the ovary with considerable propensity for late recurrences. However, liver metastasis is extremely rare, with an incidence of 5-6%. We present a case report of remote recurrence of GCT with liver metastasis in a patient with a past surgical history for right ovarian GCT many years back. GCT primarily has a low malignant potential, but it has a high tendency to recur with metastasis, usually within the pelvis. Inhibin B and AMH are the most accurate tumour markers for the detection of recurrent GCT. Ultrasound of the abdomen revealed a complex solid cystic mass in the retroperitoneum and multiple hepatic lesions, the biopsy from which revealed metastatic GCT. Henceforth, the radiologists and gynaecologists need to be aware of delayed and remote recurrence of ovarian GCT with distant metastasis for prompt and appropriate management.