AJFMED

Knowledge And Acceptability of Group Antenatal Care Among Antenatal Care Providers in Zaria, Kaduna State, Nigeria

Fatima Shehu — 2024-11-25

ABSTRACT

BACKGROUND: Antenatal care (ANC) is one of the strategies aimed at addressing maternal mortality in developing countries. Despite the importance of ANC, its utilization remains low in our environment. The content of the visits and coverage of essential interventions have also been shown to be of inadequate quality. Group antenatal care (GANC) is a new, innovative and alternative evidence based ANC model that has the potential to improve the quality and utilization of ANC.

OBJECTIVE: The aim of the study was to assess the knowledge and acceptability of GANC among ANC providers in Zaria, Kaduna state, Nigeria.

MATERIALS AND METHODS: The study was a cross-sectional descriptive study that was conducted between January 2021 and March 2021. Respondents were ANC providers from Tertiary, Secondary and Primary health care centres within Sabon Gari Local Government, Zaria. The health care centres were selected using multistage stratified sampling technique and disproportionate sampling allocation was used for sample size allocation for each centre. Ethical approval was obtained from Ethical Clearance Committee of Ahmadu Bello University, Zaria and Kaduna State Ministry of Health. Data was collected using a self-administered pretested questionnaire and analyzed using SPSS version 25

RESULTS: The mean age of respondents was 34.4 years (SD=7.0). Of the total respondents, 76.6% were aware of GANC and the most known type of GANC was Centeringpregnancy. Knowledge of GANC was found to be poor in 31.3% of respondents and only 28.1% had excellent knowledge score. Those with higher knowledge score were more likely to accept GANC (p value <0.001). Antenatal providers from Primary and Secondary health care were found to have more knowledge regarding GANC than those in Tertiary center (p value<0.001). Majority accepted GANC (88.3%) and were willing to participate in its implementation.

CONCLUSION: The knowledge regarding GANC was found to be poor in this study. It was however found to be an acceptable alternative to the traditional antenatal care among Antenatal providers as majority were willing to participate in its implementation.

KEYWORDS: group antenatal care, antenatal providers, knowledge, acceptability.

Anaemia and its Associated Risk Factors among Pregnant Women in The Gambia

Timothy A. O. Oluwasola — 2024-11-25

Background: Anaemia is a global health problem affecting about a third of the world’s population. In pregnancy, it is a public health concern with consequences for mothers and infants, including maternal death and infant mortality. In low-income countries, 25% indirect maternal mortality and 30% neonatal deaths are due to anaemia in pregnancy. This study aimed to determine the prevalence of anaemia among pregnant women in The Gambia and identify common risk or predisposing factors associated with anaemia in pregnancy among them.

Methods: This was a cross-sectional study of 420 consenting pregnant women, who attended two secondary-care level hospital for antenatal care between March and May 2023. They were selected by using a simple random sampling technique. Data were collected using a validated structured questionnaire and participants’ current antenatal cards while SPSS software version 26.0 was used for analyzing data.

Results: The findings of this study shows that 24.8% and 8.1% of the pregnant women were anaemic at booking using 11.0g/dl and 10.0g/dl as cut off respectively with the mean Haemoglobin concentration of 11.76+-1.36g/dl. The study revealed that anaemia during pregnancy is associated with factors such as educational level (p=0.048) and the average income per month (p=0.039). Majority of the women, (166, 92.2%), have taken malaria prophylaxis but only 95 (52.8%) admitted to sleeping under insecticide-treated mosquito nets which shows the low prevalence of Malaria among the participants (5.6%)

Conclusion: The prevalence of anaemia among pregnant women in the Gambia is 21.7% which implies that anaemia is still a public health problem. Therefore it is important for actions like early booking and improvement on health and nutritional education to be taken in order to reduce anaemia among pregnant women.

Determinants of Facility-Based Delivery Among Pregnant Women Attending the Tertiary Hospital in Ondo State, South West, Nigeria.

Bamidele Jimoh Folarin — 2024-11-25

Background: A significant number of pregnant women in developing countries like Nigeria do not have the opportunity of giving birth in health facilities where their delivery can be supervised by skilled birth attendants, which is a major factor contributing to maternal mortality.

Aim: The aim of this study was to assess the determinants of institutional births among pregnant women in Ondo State.

Methods: This study was a cross- sectional study conducted at the University of Medical Sciences Teaching Hospital Complex located in Akure and Ondo town between July and September 2023. A semi-structured questionnaire was used to obtain information by trained research assistants and the data collected were analysed using Statistical Package for Social Science Version 22. Descriptive statistics were computed for all relevant variables and Chi-Square test was used to derive factors responsible for institutional births with the level of significance set at p <0.05.

Results: A total of 205 pregnant women were recruited into the study. A larger proportion of them; 193(94.1%) attended antenatal clinic (ANC) and 184(89.7%) had their last delivery in health facilities. Determinants of health facility were age: younger women (61.4%) had facility delivery compared to older women (31.5%) (P=0.722). Married women (P=0.261), living in urban area and religion had association but were not statistically significant (P>0.05) while occupation (traders, civil servants and artisans) had significant association (P=0.002) in addition education. The client’s partner’s age, tertiary level of education, family resources, health insurance and monogamous family setting had association but were also not statistically significant( P>0.05). Others were being able to deliver in a friendly environment that allows labour companionship.

Conclusion: Most of the pregnant women had facility delivery which could be due to government’s policy on user fee removal and improved lifestyle. The determinants for this were; having tertiary level of education, living in urban areas, having high family income, health insurance coverage, having antenatal care and being able to deliver in a friendly environment that allows labour companionship. Efforts need to be intensified to encourage women to deliver at health facilities.

Key words: Determinants, Facility delivery, Pregnant women, Ondo State.

Relationship Between Sonographic Foetal Thymus Transverse Diameter and Histological Chorioamnionitis in Patients with Preterm Rupture of Membranes in Ibadan, Nigeria.

AS Olagunju — 2024-11-25

INTRODUCTION:

One of the major challenges faced by the clinicians in the management of preterm rupture of the membranes (PROM) is to correctly identify when a significant chorioamnionitis is evolving to decide the appropriate time for delivery of the fetus. A promising diagnostic tool to serve as a surrogate marker for predicting the occurrence of subclinical chorioamnionitis is the use of sonographic fetal transverse thymus diameter (FTTD). The objective of this study was to determine the relationship between sonographic FTTD and histological chorioamnionitis in patients with PROM.

METHODOLOGY:

This hospital based prospective cohort study was conducted among consenting pregnant women who presented with PROM between gestational ages of 28 to 34 weeks at the University College Hospital, Ibadan, Nigeria over an 8-month period. Sonographic measurement of fetal thymus transverse diameter (FTTD) was performed on all fetuses at admission. After delivery, the placenta was histologically examined to diagnose chorioamnionitis.

Ethical approval was obtained, and Data were analysed using Statistical Package for the Social Sciences (SPSS) version 23 with level of statistical significance set at P<0.05 and CI at 95%.

RESULTS

One hundred and twenty-two women were recruited for this study The mean age was 30.2 ±5.4 years with 82 (77.2%) in the 25-35 years’ age group. Ninety-one (74.6%) of the women presented with PROM at gestational age of 32 to 34 weeks. Seventy-three (59.3%) of the respondents had no constitutional symptoms. Majority (85, 69.7%) had spontaneous vaginal delivery.

Forty-eight (39%) of the fetuses had TTD less than 5^th Centile for their GA on ultrasound scan.

Fifty-seven (46.7%) of the women had placenta histological features of chorioamnionitis and there was a significant association between small thymus and histological chorioamnionitis (P < 0.001) compared with apparently normal thymus. The Sensitivity was increased with the number of thymic ultrasounds done before delivery.

CONCLUSION

Fetal thymus ultrasound scanning seemed to be a promising sensitive predictor for the occurrence of choriomanionitis in women with preterm rupture of membranes.

Do Our Women Prefer Female Obstetricians and Gynecologists? - A Cross-Sectional Survey at A Tertiary Hospital in Southwestern Nigeria

Lawal Oyeneyin — 2024-11-25

Objective: To evaluate the provider gender preferences of obstetricians and gynecologists by female attendees at the University of Medical Sciences Teaching Hospital (UNIMEDTH) in Ondo city, south-western Nigeria.

Methods: This was a cross-sectional study involving 500 consenting attendees at the site’s out-patient unit of the department of obstetrics and gynecology. Selection was by systematic random sampling technique using pre-tested, structured, self-administered questionnaires. Data was analyzed using Statistical Package for Social Sciences (SPSS) Version 26. Descriptive analysis was presented as tables and charts and summarized as means and standard deviation, proportions and percentages. Chi-square analysis was carried out to determine the association between variables, and regression analysis carried out to identify determinants of gender preference. P-value of ≤0.05 was considered as significant statistically.

Results: Of the 498 respondents’ data analyzed (response rate of about 99%), 62% had past pelvic examinations by female specialists and 58%, by males. In addition, 53% of total respondents preferred female specialists, 28% were gender indifferent and remainder preferred males. Furthermore, clinical competence was chosen by 41% of respondents as the most important attribute for a specialist performing pelvic examinations while only 7% selected gender. Finally, when subjected to tests of association, the differences in respondents’ socio-demographic characteristics and provider gender preferences were predominantly statistically insignificant.

Conclusion: Most of this cohort prefer pelvic examinations by female specialists with no dominant associated socio-demographic characteristic. However, a great majority chose attributes of clinical competence, empathy and friendly bedside manner of the provider in preference to the latter’s gender. It is recommended that specialists of both genders be made available to female health seekers to improve accessibility and reproductive health indicators in Nigeria.

COVID-19 Vaccine Uptake Among Pregnant Women Attending Antenatal Clinic in A Tertiary Health Institution In South-Western, Nigeria – Decisions And Lessons Learnt

Rukiyat Adeola Abdus-Salam — 2024-11-25

Background: COVID-19 infection is a pandemic of global public health importance. COVID-19 vaccination was rapidly adopted and shown to be an important strategy to control the spread of the disease. However, pregnant women were reluctant to receive the vaccines for various reasons. This study assessed the prevalence of COVID-19 vaccination among pregnant women and the willingness of the unvaccinated women to receive the vaccine during or after pregnancy.

Methods: This was a descriptive cross-sectional study conducted using pretested interviewer-administered questionnaires among antenatal clinic attendees from 1^st October to 31^st December 2022. Information obtained includes socio-demographic data, COVID-19 vaccination history, acceptance among the unvaccinated, and COVID-19 prevention measures. Data was analyzed using Statistical Product and Service Solutions version 25.0 software (IBM Inc. New York, United States). Level of significance was p<0.05.

Results: Mean age of the participants was 31.55 years (SD ±5.522). About 48.5% of participants were vaccinated against COVID-19 before the index pregnancy. Participants’ occupation (p= 0.001), and parity (p=0.024) were associated with pre-pregnancy vaccination. There was a significant association between the level of education and willingness to receive the COVID-19 vaccine (p=0.015). About 14.4% and 21.0% of the unvaccinated participants were willing to be vaccinated during- and after pregnancy respectively. The reason for remaining unvaccinated in pregnancy was predominantly due to vaccine unavailability (1.1%).

Conclusion: This study revealed that the vaccine uptake and willingness to accept the vaccine during- and after pregnancy was poor. Health education, intensified vaccination campaigns and increased availability to the pregnant population will improve vaccine uptake and coverage.

Transverse Fundal Incision Due to Huge Lower Segment Fibroid at Caesarean Section: A Case Report

Joshua Ifebude — 2024-11-25

We present the case of a 29-year-old primigravida at a gestational age of 37 weeks, who had a transverse fundal uterine incision done due to a huge anterior wall leiomyoma and transverse lie. The rarity of this type of uterine incision and the size of the uterine myoma prompted this case report. She had a safe delivery of the foetus through the transverse fundal incision with a birth weight of 1.8kg, estimated blood loss of 600mls and APGAR score of 7 at 1 minute and 9 at 5 minutes. The patient had an uneventful post-operative period and was discharged home with her baby on the fourth postoperative day. In conclusion, the use of transverse fundal uterine incision is rare but may be a life-saving procedure in patients with multiple huge uterine fibroids in order to reduce the morbidity associated with caesarean myomectomy.

Fetal Bradyarrhythmia and Abnormal Doppler Velocimetry in A Preterm Fetus: Management in A Resource-Constrained Setting: Case Report

Rabi'at Aliyu Muhammad — 2024-11-25

Background: Benign cardiac rhythm abnormalities of short duration have been noted in 2 % of second to third-trimester fetuses. However, their association with abnormal doppler velocimetry is rare. Fetal bradycardia is an ominous sign whose occurrence at preterm gestation adds dilemma to the management of such cases due to additional risks associated with prematurity if the fetus is delivered prematurely, especially in a resource-constrained setting. Case presentation: The fetus of a 29-year-old primipara was found to have an irregular fetal heart rate of 90 beats per minute at 29 weeks of gestation on routine antenatal evaluation. An ultrasound scan confirmed the bradycardia with ectopic beats and an appropriate for gestational age fetus with no cardiac/other structural abnormality or features of hydrops. Doppler velocimetry revealed intermittent absent flow in the umbilical artery and ductus venosus with a reversal of flow in the middle cerebral artery. Following maternal evaluation, she was diagnosed to have gestational diabetes mellitus and had a negative antinuclear antibody test. She had a course of dexamethasone for fetal lung maturation and was commenced on insulin and dietary modification. The fetal heart rate normalised 48 hours after the administration of dexamethasone. A multidisciplinary care approach was instituted with a weekly biophysical profile and fetal doppler studies. The fetal heart irregularity persisted till 36 weeks’ gestation and the abnormal doppler parameters completely normalised by 35 weeks gestation. She was delivered at term of a normal infant with a good APGAR score that weighed 3.2kg. The umbilical cord was noted to be marginally inserted into the placenta but with a normal number of vessels. The neonate had normal electrocardiographic and echocardiographic findings and an uneventful neonatal period. Conclusion: Bradyarrhythmia in the preterm fetus even when associated with abnormal doppler velocimetry may resolve spontaneously and not indicate an urgent need for delivery. However, intensive fetal surveillance is warranted to balance the risk of prematurity against perinatal loss.