Complete androgen insensitivity syndrome with persistent Mullerian derivatives: a case report.
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Adult↗
Biomedical subjects
F E Okonofua
Publications and source records attributed to F E Okonofua.
Attitudes and practices of private medical providers towards family planning and abortion services in Nigeria.
CONTEXT: The study was designed to investigate the attitudes and practices of private medical practitioners towards abortion, postabortion care and postabortion family planning in Nigeria. METHODS: Three hundred and twenty-three private practitioners who were proprietors of private clinics in three states of the country were interviewed with a structured questionnaire that elicited information on their knowledge and experiences of abortion and postabortion care in the cities. RESULTS: Twenty-four percent of the doctors reported that they routinely terminate unwanted pregnancies when requested to do so by women, while 82% reported that they frequently treat women who experience complications of unsafe abortion. Over 45% reported that they use manual vacuum aspiration (MVA) for the management of abortion in the first trimester, while 25% use dilatation and curettage (D and C). Nearly 28% reported the use of MVA followed by D and C in the first trimester. Fifty-seven percent reported their lack of expertise in managing second-trimester abortions, while those admitting that they manage second-trimester abortions reported nonstandard methods and procedures. In addition, there was evidence of inadequate counseling of women, lack of institutional protocols and poor use of postabortion family planning by the doctors. CONCLUSIONS: These results suggest the need for a program of retraining of private practitioners on the principles and practices of safe abortion, postabortion care and family planning in Nigeria and the integration of these topics into medical training curricula in the country.
Abortion, Induced↗
Knowledge, attitudes and experiences of sex trafficking by young women in Benin City, South-South Nigeria.
Benin City, the headquarters of Edo State, is known to have one of the highest rates of international sex trafficking of young women in Nigeria. This study was designed to determine the knowledge, attitudes and experiences of young women in Benin City, towards international sex trafficking. A random household sample of 1456 women aged 15-25 years was interviewed with a structured questionnaire that elicited information on women's experiences of, and attitudes towards international sex trafficking. The results indicate that 97.4% of the women have heard of international sex trafficking; 70% had female relatives who lived in the receiving countries of Italy, Spain, and the Netherlands; while 44.0% knew of someone who was currently engaged in sex work abroad. Up to 32% of the women reported that they had been approached by someone offering to assist them to travel abroad. Women of poorer socio-economic status (being out-of-school, unemployed, parents uneducated and unemployed) were more likely to report having been offered assistance to travel abroad. Up to 81.5% of the women supported the notion that sex trafficking should be stopped, while 18.5% felt it should be allowed to continue. The perception that sex trafficking leads to wealth creation and economic gains for women was the most common reason proffered by those wanting the practice to continue. By contrast, the fear of adverse health consequences and the need to maintain social and religious morals were the reasons given by those wanting the practice to discontinue. These results suggest that programs that promote the economic well being of women, and social advocacy focusing on harm reduction will be most helpful in reducing the rate of sex trafficking in Benin City.
Adolescent↗
Avulsion of the uterine cervix complicating hysterosalpingography in a hypo-oestrogenic woman.
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Adult↗
Knowledge, attitude and practice of private medical practitioners in Calabar towards post-abortion care.
This study examined the knowledge, attitude and practice of private medical practitioners in Calabar on abortion, post-abortion case and post-abortion family planning. Forty eight private practitioners who were proprietors of private clinics in the city were interviewed using a structured questionnaire. The results showed that 22.9% of the doctors routinely terminate unwanted pregnancies when requested to do so by women, while 83.3% of them treat women who experience complications of unsafe abortion. The major reasons given by some of the doctors for not terminating unwanted pregnancies were religious, moral and ethical considerations rather than respect for the Nigerian abortion law. Only 18.2% of the doctors use standard procedures such as manual vacuum aspiration (MVA) for the management of patients with abortion and abortion complications. A good number of them did not routinely practice integrated post-abortion family planning and STDs management. There is need for a comprehensive programme of retraining of private medical practitioners in Calabar on the principles and practices of safe abortion, post-abortion care and family planning. These aspects of reproductive health need to be integrated into the medical training curricula in Nigeria. It is believed that this approach would help reduce the present high rate of abortion-related morbidity and mortality in Nigeria.
Abortion, Induced↗
Morbidity and mortality from bowel injury secondary to induced abortion.
Eight patients managed for bowel injury following induced abortion were studied for the pattern of morbidity and mortality. The patients were aged 18-39 years. Three of them were married, five were single. Two of the cases were detected at the time of termination of pregnancy. The interval from termination of pregnancy to presentation in hospital was two days to two weeks in the other six patients. Injury was in the ileum in three, jejunum in two and the sigmoid colon in three. Twenty surgical interventions were performed for primary treatment and management of complications. Major complications were abdominal wound dehiscence (5), faecal fistula (2) and postoperative diarrhoea (1). The duration of hospitalisation at the first admission ranged from seven to 163 days. The excessive morbidity is attributed to delay in presentation; most patients been seen after 72 hours. Primary repair of colonic injury is discouraged. No death was recorded. Literature is reviewed on the condition in West Africa and suggestion made on means of reducing morbidity from induced abortion.
Abortion, Induced↗
Female circumcision and obstetric complications.
OBJECTIVES: To examine whether complications at delivery are associated with female circumcision. METHOD: One thousand eight hundred and fifty-one women seeking family planning or antenatal care in three south-west Nigerian hospitals were interviewed and had a medical exam. The prevalence of complications at delivery for uncircumcised women and circumcised women with type 1 (partial or total removal of the clitoris) or type 2 (partial or total removal of the clitoris and part or all of the labia minora) were determined. Associations between self-reported complications at delivery and clinic-reported type of circumcision were analyzed using bivariate and multivariate logistic regression. RESULT: Forty-five percent were circumcised; 71% had type 1 and 24% had type 2. Circumcised women had significantly higher risks of tearing and stillbirths when all pregnancies were analyzed. CONCLUSION: Circumcised women experienced more obstetric complications, while there was no significant difference between women with type 1 and type 2.
Adolescent↗
Congenital absence of the uterus.
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Adult↗
Female genital cutting in southern urban and peri-urban Nigeria: self-reported validity, social determinants and secular decline.
Despite growing public resistance to the practice of female genital cutting (FGC), documentation of its prevalence, social correlates or trends in practice are extremely limited, and most available data are based on self-reporting. In three antenatal and three family planning clinics in South-west Nigeria we studied the prevalence, social determinants, and validity of self-reporting for FGC among 1709 women. Women were interviewed on social and demographic history, and whether or not they had undergone FGC. Interviews were followed by clinical examination to affirm the occurrence and extent of circumcision. In total, 45.9% had undergone some form of cutting. Based on WHO classifications by type, 32.6% had Type I cuts, 11.5% Type II, and 1.9% Type III or IV. Self-reported FGC status was valid in 79% of women; 14% were unsure of their status, and 7% reported their status incorrectly. Women are more likely to be unsure of their status if they were not cut, or come from social groups with a lower prevalence of cutting. Ethnicity was the most significant social predictor of FGC, followed by age, religious affiliation and education. Prevalence of FGC was highest among the Bini and Urhobo, among those with the least education, and particularly high among adherents to Pentecostal churches; this was independent of related social factors. There is evidence of a steady and steep secular decline in the prevalence of FGC in this region over the past 25 years, with age-specific prevalence rates of 75.4% among women aged 45-49 years, 48.6% among 30-34-year olds, and 14.5% among girls aged 15-19. Despite wide disparities in FGC prevalence across ethnic, religious and educational groups, the secular decline is evident among all social subgroups.
Adolescent↗
Outcome of prolonged pregnancy revisited in a Nigerian tertiary centre.
The study was conducted to evaluate whether routine induction of labour at 41-42 weeks of gestation has an increased risk for operative delivery, maternal or fetal complication compared with spontaneously initiated labour of similar gestation. A case-control study design was used; main outcome measures were caesarean section rate, instrumental delivery and fetal outcome. There was no significant difference in caesarean section rates 36(18.0%) in the induction group, compared with 28(13.8%) in parturient spontaneously initiating labour [P=0.24 odds ratio 95% CI 1.37 (0.78:2.43)]. Instrumental interventions were comparable in the two groups (5.5% and 4.0%). A subgroup analysis of nulliparous women was also not statistically different. Other than higher rates of admission into the neonatal unit in the induction group, fetal outcomes were similar. In conclusion, a routine induction of labour for prolonged pregnancy is safe, having no significant increase in caesarean section or fetal complications. The policy is advocated especially in developing countries, in view of the uncertainty of further prolongation of pregnancy beyond 42 completed weeks.
Journal Article↗
Sexual behaviour and contraceptive use among secondary school adolescents in Benin City, Nigeria.
This study was designed to examine sexual behaviour and contraceptive use among in-school adolescents in Benin City, Nigeria. A random sample of 431 females and 440 males aged 14-21 years from secondary schools in Benin City, Nigeria, were interviewed using a structured pretested questionnaire. The results show that 23% of the females and 40% of males had initiated sexual intercourse. Among those who had done so, the median age at first sexual debut was 16.8 years for girls and 15.4 years for boys. Only 22.2% of females and 23.9% of males used contraception at first sexual intercourse. Use of contraception among sexually active adolescents at last sexual debut declined to 18.6% for females and 22.2% for males. Forty-two per cent of sexually active adolescents engaged in high-risk sexual behaviour. In conclusion, the low prevalence of effective contraceptive use and time-related decline in usage indicate a need for greater emphasis on sex education aimed at adolescents in Nigeria.
Journal Article↗
Maternal and neonatal seroprevalence of hepatitis B surface antigen (HBsAg) in Benin City, Nigeria.
The seroprevalence of maternal and neonatal hepatitis B surface antigen (HBsAg) was determined prospectively through unlinked anonymous testing of volunteers at delivery at the University of Benin Teaching Hospital, Benin City, Nigeria. Six hundred and forty (320 mother-cord blood pairs) samples were assayed for HBsAg using hepatitis B latex test kit (Biotech Laboratory Ltd, UK). Repeatedly reactive samples were confirmed by the use of ELISA kit (Wellcome Laboratory, UK). None of these women had had a blood transfusion or hepatitis B vaccination in the past, and none was an intravenous drug abuser. The maternal seroprevalence was 2.19%. This means one of every 45 pregnant women was a carrier of the antigen. The neonatal seroprevalence and the vertical transmission rate were 0.96% and 42.86%, respectively. The endemicity of this occasionally fatal disease is thus being propagated. We advocate universal free screening and immunisation of our pregnant women and their infants as part of the antenatal and childhood immunization programmes. Healthcare providers should be vaccinated routinely.
Journal Article↗
Haplotypes and linkage disequilibrium at the phenylalanine hydroxylase locus, PAH, in a global representation of populations.
Because defects in the phenylalanine hydroxylase gene (PAH) cause phenylketonuria (PKU), PAH was studied for normal polymorphisms and linkage disequilibrium soon after the gene was cloned. Studies in the 1980s concentrated on European populations in which PKU was common and showed that haplotype-frequency variation exists between some regions of the world. In European populations, linkage disequilibrium generally was found not to exist between RFLPs at opposite ends of the gene but was found to exist among the RFLPs clustered at each end. We have now undertaken the first global survey of normal variation and disequilibrium across the PAH gene. Four well-mapped single-nucleotide polymorphisms (SNPs) spanning approximately 75 kb, two near each end of the gene, were selected to allow linkage disequilibrium across most of the gene to be examined. These SNPs were studied as PCR-RFLP markers in samples of, on average, 50 individuals for each of 29 populations, including, for the first time, multiple populations from Africa and from the Americas. All four sites are polymorphic in all 29 populations. Although all but 5 of the 16 possible haplotypes reach frequencies >5% somewhere in the world, no haplotype was seen in all populations. Overall linkage disequilibrium is highly significant in all populations, but disequilibrium between the opposite ends is significant only in Native American populations and in one African population. This study demonstrates that the physical extent of linkage disequilibrium can differ substantially among populations from different regions of the world, because of both ancient genetic drift in the ancestor common to a large regional group of modern populations and recent genetic drift affecting individual populations.
Africa↗
Episiotomy in Nigeria.
OBJECTIVE: To review the incidence and complications associated with episiotomy and perineal tears at the University of Benin Teaching Hospital, Benin City, Nigeria. METHOD: A retrospective review of all vaginal births conducted in the hospital between January 1997 and December 1998 was undertaken. Vaginal births (1345) were reviewed. RESULT: The prevalence of episiotomy in the hospital during the period was 46.6%. Over 90% of primigravid parturients had episiotomy. The incidence of episiotomy decreased with increasing parity, while the incidence of spontaneous vaginal tears increased with parity. As compared with perineal tears, episiotomy was associated with a statistically significant increased risk of wound breakdowns requiring secondary resuturing. When controlled for parity, breech births, forceps and vacuum delivery were more likely to lead to episiotomy, compared to spontaneous vertex delivery occurring at term. CONCLUSION: A policy of systematic reduction in the incidence of episiotomy can be pursued in this hospital. Greater attention needs to be paid to selection of women to undergo episiotomy, the prevention of spontaneous perineal tears and the care of episiotomy wounds in this institution.
Episiotomy↗
Maternal and neonatal seroprevalence of human immunodeficiency virus antibodies in Benin City, Nigeria.
The prevalence of human immunodeficiency virus antibodies in mothers and their neonates was determined through unlinked anonymous HIV testing at delivery. Two hundred and forty-six apparently healthy volunteer anonymous parturients at the University of Benin Teaching Hospital, Nigeria, and their neonates were recruited for the study. Blood samples were collected from the mothers and cord blood from their neonates at delivery. The blood samples were coded and assayed for HIV antibodies using ImmunoComb HIV 1 and 2 bispot test and ImmunoComb II HIV-1 and 2 CombFirm, both from PBS Orgenics, France. The results for maternal and neonatal blood sample pairs were matched. The maternal seroprevalence for HIV antibodies was 2.4% (6/246) while only two infants had HIV antibodies. The mother-to-child transmission of HIV antibodies was 33.3%. The study highlights the increasing HIV infection among pregnant women in this hospital. The risk of vertical transmission is therefore high. Universal antenatal HIV testing with an opt-out system is suggested. The need for our maternity centres and special care baby units to establish management protocols and anti-retroviral therapy for HIV infected women and their neonates is recommended.
Journal Article↗
Assessment of health services for treatment of sexually transmitted infections among Nigerian adolescents.
BACKGROUND: The available evidence indicates that Nigerian adolescents use various health practitioners for the treatment of sexually transmitted diseases (STDs). However, the quality of the STD treatment used by adolescents has not been investigated previously. GOAL OF THIS STUDY: To investigate the quality of services provided by health practitioners for the treatment and prevention of STDs among adolescents in Benin City, Nigeria. STUDY DESIGN: In-depth interviews were conducted with 48 formal and informal sector health practitioners who were identified by key informants as being the main providers of STD treatment in the city. Their facilities were visited to evaluate the quality of services they provide for STD treatment. RESULTS: Health providers in the informal sector showed inadequate knowledge of the appropriate treatment methods for STDs. Although providers in the formal sector had better knowledge, they lacked appropriate management guidelines and were poorly oriented to the problems of STDs in adolescents. There was consensus among the health providers that adolescents most frequently use informal treatment for STDs. Nevertheless, among all providers, there was evidence of inadequate counseling of adolescents, a poor attitude toward the promotion of condom use, and inadequate use of referral opportunities. CONCLUSIONS: Comprehensive public health measures are needed to address these problems in Nigeria. These include the provision of reproductive health education for adolescents, the retraining of health providers, and the consolidation of services for the prevention and treatment of STDs.
Adolescent↗
Assessing the prevalence and determinants of unwanted pregnancy and induced abortion in Nigeria.
This study was conducted to determine the prevalence and sociodemographic determinants of unwanted pregnancy and induced abortion in the Jos and Ife local government areas of Nigeria. A total of 1,516 randomly selected women aged 15-45 responded to a pretested structured questionnaire designed to elicit information concerning previous unwanted pregnancies and induced abortions in a value-free manner. Nearly 20 percent of the women reported having had an unwanted pregnancy. Of these, 58 percent reported that they had successfully terminated the pregnancies; 32 percent continued the pregnancies; and nearly 9 percent stated that they had attempted termination but failed. Overall, the prevalence of self-reports of induced abortion was 11 percent. The results reveal that information can be obtained on abortion in areas with restrictive abortion policies if an indirect interviewing approach is used.
Abortion, Induced↗
Risk factors for primary postpartum haemorrhage. A case control study.
The objective of the study was to determine which background factors predispose women to primary postpartum haemorrhage (PPH) at the Obafemi Awolowo University Hospital. The study consisted of 101 women who developed PPH after a normal vaginal delivery and 107 women with normal unassisted vaginal delivery without PPH Both cases and controls were investigated for sociodemographic risk factors, medical and obstetric histories, antenatal events and labour and delivery outcomes. Data were abstracted from the medical and delivery records and risks were estimated by multivariate logistic regression. The results of the univariate analysis revealed a number of potential risk factors for PPH but after adjustment by logistic regression three factors remained significant. These were prolonged second and third stages of labour and non-use of oxytocics after vaginal delivery. Previously hypothesised risk factors for PPH such as grand multiparity, primigravidity and previous episodes of PPH were not significantly associated with PPH. We conclude that primary PPH in this population is mostly associated with prolonged second and third stages of labour and non use of oxytocics. Efforts to reduce the incidence of PPH should not only be directed at proper management of labour but also training and retraining of primary health care workers and alternative health care providers in the early referral of patients with prolonged labour.
Adult↗