Open Access Original Research Article

Pattern and Outcome of Iatrogenic Genitourinary Fistula from Obstetric and Gynaecological Surgeries in a Tertiary Institution, North-Western Nigeria

S. Nasir, A. M. Elladan, M. Hassan, A. A. Panti

Asian Journal of Medicine and Health, Page 1-7
DOI: 10.9734/AJMAH/2018/39244

Introduction:  Genitourinary fistula is commonly caused by prolonged obstructed labour; however, not all genitourinary fistulas are obstetric in origin. Inadvertent injuries to the urinary tract leading to fistulae do occur during obstetric and gynaecological procedures because of the close anatomical relationship between the urinary tract and the genital tract.

Objectives: This study aims to determine the prevalence, aetiology and outcome of iatrogenic genitourinary fistula repair at the National Obstetric Fistula Centre, Katsina (NOFIC).

Methodology: This was a two-year retrospective review of all patients who had surgery for iatrogenic fistula between 1st January 2015 and 31st December 2016 at NOFIC, Katsina. All patient case notes on this procedure during the stated period were retrieved and analysed.

Results: A total of 728 genitourinary fistula surgeries were carried out in the Centre, out of which 117 (16.1%) were repairs for iatrogenic fistulae, giving a prevalence rate of 16.1%. Only 110 case notes were eligible for analysis, giving a retrieval rate of 94%. The mean age of the patients was 30.40 ± 8.39 years, and the modal parity was 1. All presented with a history of continuous urine leakage, and 71 (64.5%) had a history of a previous caesarean section. The procedures that lead to the development of the fistula were conducted at secondary healthcare centres in 84 (87.5%) of the patients. The fistulae were a result of emergency caesarean sections in 73.6% of the cases, yankan gishiri in 9.1%, caesarean hysterectomies for ruptured uterus in 6.4%, elective caesarean sections in 4.5% and gynaecologic hysterectomies in 5.4%. A diagnosis of vesicocervicovaginal fistula (VCVF) was made in 62.7% of the cases, vesicouterine fistula (VUF) in 12.7% and ureteric fistula in various combinations in 10%. The abdominal route was used for the repair in 20.9% of the patients. Intraoperative bleeding was the commonest (21%) complication associated with vaginal repair of VCVF. At discharge, 73.6% were successfully closed and continent, while 19.1% had residual fistula.

Conclusion: The prevalence of 16.1% found in this study was high, and the most common cause of iatrogenic fistula was emergency caesarean sections. The majority of the causal procedures were done at secondary healthcare centres; therefore, this study recommends adequate training, mentoring and ongoing supervision of doctors conducting caesarean sections and other gynaecological procedures in secondary health centres as well as increased community education and involvement in preventing harmful traditional practices like yankan gishiri.

Open Access Original Research Article

Assessment of Exclusive Breastfeeding Practice among Palestinian Mothers in the Gaza Strip: A Mixed Methods Design

Rima Rafiq El Kishawi, Kah Leng Soo, Yehia Awad Abed, Wan Abdul Manan Wan Muda

Asian Journal of Medicine and Health, Page 1-13
DOI: 10.9734/AJMAH/2018/39292

Aims: This study was conducted to assess breastfeeding (BF) among the mothers in the Gaza Strip, particularly to determine the prevalence and the associated factors of Exclusive Breastfeeding (EBF), and to explore mothers’ EBF perceptions and practices.

Study Design: A mixed methods design.

Place and Duration of Study: This study was carried out among mothers in the households between April and October 2012 in three areas in the Gaza Strip, namely, El Remal urban area, Jabalia camp, and Al Qarara rural area.

Methodology: A multi-stage cluster sampling method was used to recruit 357 mothers of children aged 2-5 years in the Gaza Strip. Purposive sampling was used for a qualitative study. Descriptive statistics were applied to quantitative data (p<0.05), and content analysis was used for qualitative data.

Results: Almost all mothers practiced BF (97.8%), whereas the low proportion of mothers (24.4%) practiced EBF for 6 months. Results showed 75.6% of the mothers introduced complementary food to their infants at an early age. Results revealed that the practice of EBF was statistically significant among young age of mothers (CI -3.34,-0.25; p=0. 022), low child’s order (CI -1.19,-0.07; p=0. 028), and mothers with few children (CI -0.99,-0.03; p=0. 037). The qualitative findings showed the primary constraints to EBF to be the perceptions of mothers that breastmilk was not enough for baby's growth, and mothers –in- law influenced the mothers’ EBF practices.

Conclusion: In this study, the prevalence of EBF for six months remains low among the mothers in the Gaza Strip. The associated factors of EBF among the mothers were an age of mother, child's birth order, and the number of children. Health care workers should educate and emphasis mothers, grandmothers, and mothers-in-law on the importance of EBF.

Open Access Original Research Article

Availability and Readiness of Antenatal Care in the Primary Healthcare Setting in Ogoniland

M. Abbey, A. O. U. Okpani

Asian Journal of Medicine and Health, Page 1-12
DOI: 10.9734/AJMAH/2018/39787

Background: Maternities are always encouraged to attend antenatal clinics (ANC) but unfortunately, in sub-Sahara Africa yearly assessment of the preparedness of the clinics to deliver care is not always carried out.

Aims: To assess the availability and readiness of antenatal care in the Primary Health Centres (PHCs) in Ogoniland, identify shortcomings and recommend measures to improve care

Methodology: This was an observational descriptive cross-sectional study that was carried out in Ogoniland, Rivers State, Nigeria between from June 2016 to August 2017. The availability and readiness of antenatal care in the 33 PHCs in Ogoniland were assessed with the aid of 5 WHO domains namely antenatal care services, staff and guidelines, diagnostics, medicine and commodities and equipment. A stepwise multistage cluster sampling and analysis of the WHO tracer items for the 5 domains was carried out.

Results: There were 30 functioning Primary Health Centres in Ogoniland. The average percentage of fulfilled tracer items for the 5 domains - antenatal care services, combined 3 domains namely staff and guidelines, diagnostics, medicine and commodities and the fifth (equipment) were 100%, 28.06% and 56.94%respectively. The corresponding figures for the combined 3 domains in Khana, Gokana, Tai and Eleme Local Government areas of Ogoniland were 30.30%, 34.09%, 26.39% and 25% respectively in contrast to the WHO benchmark and Nigerian minimum standard of 100%.

Conclusion: The overall substandard indices of the tracer items for the availability and readiness of antenatal care in the PHCs in Ogoni Kingdom underscore the urgent need for improvement of care in the region through funding by the State and Federal Government and public-private partnerships.

Open Access Original Research Article

Incidence of Oligohydramnios – Amniotic Fluid Index (AFI) Versus Single Deepest Pocket (SDP)

Ezem B. Uche, Okeudo Chijioke, Ojiyi E. Chukwuemeka, Onoh C. Robinson, Uwakwe K. Anderson

Asian Journal of Medicine and Health, Page 1-8
DOI: 10.9734/AJMAH/2018/28069

Aim: The aim of the study is to determine the incidence of oligohydramnios using ultrsonographic assessment of the amniotic fluid and compare the incidence between AFI and SDP.

Study Design: A prospective cross sectional study.

Place and Duration of Study: Obstetrics and Gynecology department of St Elizabeth Specialist Hospital, Owerri, Imo State from January 31 to December 31, 2015.

Methodology: This is a prospective study involving 400 healthy women carrying uncomplicated singleton pregnancies referred to St Elizabeth Specialist, Owerri for ultrasound scanning in pregnancy from Jan 31 to Dec 31, 2015. The age of the women, gestational age based on last menstrual cycle and the parity were all taken.

With the women in the semi-Fowler position and using Moore and Cayle technique the AFI and SDP were obtained.

Data analysis is done with IBM SPSS statistics version 21.

Results: Of the 400 pregnant women scanned, their age ranged from16 years to 42 years with a mean of 27.97years. Their gestational age from LMP ranged from 14 weeks to 41weeks with a mean of 29.25 weeks. Seventeen of the women had an AFI <5 (oligoydramnios), which is an incidence of 4.3%, while only five had SDP <2cm, an incidence of 1.3%. The incidence of oligohydramnios was significantly (P=0.001) higher in the third trimester with all the seventeen with AFI <5 and all the 5 with SDP <2cm occurring in the third trimester.

Conclusion: The AFI compared with the SDP excessively characterizes patients as having oligohydramnios.

Open Access Original Research Article

Impact of the Diet Profile and Alcohol Consumption on Cardiometabolic Risks in Dschang Health District-Cameroon

M. B. S. Dandji, F. N. Zambou, F. C. N. Nana, D. S. B. Dangang, D. Lemogoum, F. M. Tchouanguep

Asian Journal of Medicine and Health, Page 1-14
DOI: 10.9734/AJMAH/2018/39781

Aims: The study was conducted between March 2015 and June 2017 to determine the prevalence of cardiometabolic risks in adult men from Dschang Health District in Cameroon.

Methodology: After obtaining the ethical clearance, a simplified questionnaire was used for 254 volunteer participants aged from 30 to 60 years, selected in 10 areas of Dschang Health District. Some clinical parameters and fasting blood glucose were measured. The collected data were submitted to EPI-InfoTM version 7.1.5.0. Software. The results were expressed as frequency and mean ±SD at the 5% significance level.

Results: In Dschang Health District There are 38.98% obese, 39.76%, and 28.74% hypertensive patients with systolic hypertension and diastolic hypertension respectively. 87.07% and 40.19% of alcoholism respectively in rural and urban areas. Diabetes has a prevalence of 17.72%, and 74.02% of cases of hypertriglyceridemia are observed. We can conclude that the prevalence of cardiometabolic risk factors is high and is above the national average. This is a consequence of the high consumption of alcohol and salt beyond the World Health Organization standard (>5g/day), abundant use of unrefined palm oil for cooking but especially a low fruit and vegetable consumption (>400g/day) despite availability in the study area.

Conclusions: This study of two groups of subjects living in two different environments showed that educational level, occupation and even marital status influenced diet profile, alcohol consumption and the occurrence of cardiometabolic diseases in the Dschang Health District. Good eating habits and a healthy lifestyle prevent cardiometabolic disorders. Salt, alcohol and unrefined palm oil are to be consumed in moderation and on the other hand, consuming fruits and vegetables at all ages keep the heart and arteries healthy.