Reliability of a clinical method in estimating foetal weight and predicting route of delivery in term parturient monitored at a voluntary agency hospital in Southwest Nigeria

BACKGROUND

The antepartum estimation of foetal weight is a major determinant of the route of delivery and this has become vital in modern day obstetrics. The limitations to the use of obstetric ultrasonography, considered as the gold standard in estimating foetal weight, make clinical estimation methods attractive alternatives, especially in resource- constrained settings where many un-booked women may report for delivery.

AIM

To determine the reliability of intrapartum clinical foetal weight estimation in predicting the actual birth weight (ABW) and route of delivery among term parturient.

SETTING

The study was conducted at the Sacred Heart Hospital, Lantoro, a voluntary mission agency hospital in Southwest Nigeria.

METHODS

This cross-sectional study was conducted among 291 term parturient recruited by systematic random sampling between June and September 2017. The clinical estimation of foetal weight was carried out using Johnson's formula.

RESULTS

The accuracy of Johnson's formula to predict the ABW was 59.5%; while for the mode of delivery, it was 130 (75.1%) for spontaneous vaginal delivery (SVD) and 43 (24.9%) for caesarean section (CS). The sensitivity of the accuracy of Johnson's formula to predict the mode of delivery was 75.1%, with a specificity of 35.6%, a positive predictive value (PPV) of 63.1%, and a negative predictive value (NPV) of 49.4%.

CONCLUSION

The intrapartum clinical foetal weight estimation at term determined by Johnson's formula was reliably predictive of ABW and SVD, but it was unreliable in predicting the need for a CS.

Attitudes and perceptions of final year medical students on sexual history taking from patients in Ogun state, Southwestern Nigeria

Background: An important aspect of sexual health is the ability to take a sexual history. Previous studies have shown that most medical students believed that sexual history taking is an important skill for future practice. Still, a majority reported inadequate, inconsistent or no training in this area.Objectives: To assess the attitudes of final year medical students on sexual history taking and perceptions of the training they received in medical schoolDesign: A cross-sectional study using an online surveyParticipants: Consented and conveniently sampled 100 final year medical students.Results: The overall response rate was 74.6%, and the mean age of the respondents was 24.1±2.9 years. The majority (97%) of the students believed it is important for doctors to know how to take a sexual history. Still, only 31% admitted to finding it easy, with 57% of the students admitted to being comfortable taking a sexual history from adult patients. While 70% had exposure on simulated patients, just 54% have observed doctors taking sexual history during clinical rotations, mostly in Obstetrics and Gynaecology (97%) and Urology (60%) postings.Conclusions: Many final year medical students are interested in and appreciated the importance of sexual history taking, but they are not well grounded in many aspects of the topic. Despite the importance of sexual health, many students did not have enough exposure and training on the topic while still in medical schools. There is thus a need for a review of the curriculum of undergraduate medical education in Nigeria.

Detection of mental disorders with the Patient Health Questionnaire in primary care settings in Nigeria

Mental disorders lead to difficulties in social, occupational and marital relations. Failure to detect mental disorder denies patients potentially effective treatment. This study aimed to assess the prevalence and nature of mental disorders at the primary care settings and the recognition of these disorders by the attending physicians. Over a period of eight weeks, consecutive and consenting patients who attended three randomly selected primary health care facilities in Sagamu Local Government Area of Ogun state were recruited and administered a questionnaire that included a socio-demographic section and Patient Health Questionnaire (PHQ). A total of 412 subjects took part in the study. Subject age ranged from 18–90 years with a mean age of 52.50±21.08 years. One hundred and seventy-six (42.7%) of the subjects were males. A total of 120 (29.1%) of the subjects had depressive disorder, 100 (24.3%) had anxiety disorder, 196 (47.6%) somatoform disorder and 104 (25.2%) met the criteria for an alcohol related problem. The PHC physicians were only able to diagnose disorders relating to mental health in 52 (12.6%) of the subjects. Health and work situations accounted for more than three-quarters of the causes of stress experienced by the subjects. We conclude that there is a high prevalence of mental disorders among patients seen in primary care settings and that a significant proportion of them are not recognized by the primary care physicians. Stress relating to health, work and financial problems is common among primary health care attendees. Physicians in primary health care should be alert to the possibility and the impact of undetected psychiatric morbidity.

Patients' satisfaction with emergency care and priorities for change in a university teaching hospital in Nigeria

Little work has been done on patients' satisfaction with hospital care in Nigeria. This prospective study was done to identify factors affecting patients' satisfaction with emergency care in a teaching hospital in Nigeria. This study was carried out among adult patients who had received care at the Accident and Emergency unit of the hospital. We used the priority index (calculated by combining the mean score on all items and correlated weight) to identify areas of emergency services in need of urgent improvement. There were 250 respondents; 147 males and 103 females. Six (6.4%) patients declined to answer the questionnaire. Time to surgical intervention was the item with the highest priority for change. This was followed by three indicators of caregiver conduct: showing genuine concern by health workers, attitude of nurses, and courtesy by health workers. Females rated all indices of satisfaction lower than males. Surgical and gynecological patients were also less satisfied with their care than their medical and trauma counterparts. The results from this study provided necessary data to guide changes needed to improve patient satisfaction in the A&E. Our findings suggest that improving speed of access to surgery and enhancing interpersonal skills of healthcare givers are areas that need to be prioritized.

Patients' perception of quality of emergency care in a Nigerian teaching hospital: The influence of patient-provider interactions

BACKGROUND

Attention is rarely given to patients' opinions regarding the quality of care they received, which is an important feedback to healthcare providers, planners and policy makers.

AIM

To assess how patients who survived life-threatening/emergency conditions percieved the quality of care they received.

METHOD

This prospective study was carried out among adult patients who had received emergency care at the Accident & Emergency (A & E) unit of Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu, between March and December 2004 using a semi-structured questionnaire.

RESULTS

There were 1129 respondents, 81 males and 48 females. Their mean age was 35.3 years. 62% were treated for surgical, and 37.2% for medical emergencies. The mean duration of stay at A & E was 2.4 days. Although 91% of the respondents regarded available equipments as very adequate, 38.8% perceived the overall quality of care as sub-optimal. Many of the patients were displeased with their interactions with care providers. They longed for urgent improvement in waiting time, speed of issuing drugs, imterpersonal relationship with health workers and attending to emotional distress of emergency victims. They also wished to have free treatment during emergencies

CONCLUSION

Majority of the patients who received care in A & E of this tertiary hospital perceived the quality of care received as satisfactory. However, a substantial proportion regarded the quality of care as sub-optimal. Although most thought equipments were adequate, many of them expressed displeasure with their interactions with care providers. To improve patient's satisfaction with emergency care, greater emphasis needs to be placed on enhancing the interpersonal relationships between health workers and patients than is currently done.

Changing patterns of emergency obstetric care at a Nigerian University hospital

OBJECTIVE

To analyze the changing patterns of critical obstetric care over two consecutive 3-year periods and identify the factors responsible for the trend through combined audits of near miss and maternal mortality at a Nigerian University hospital.

METHODS

Retrospective audit and comparison of "near misses" and maternal deaths recorded in 1999-2001 and 2002-2004 at a tertiary care center in southwest Nigeria. The definition of near miss morbidity was based on validated disease-specific criteria. For each near miss and maternal death, the local audit committee compared the actual management with local treatment protocols and explored avoidable factors. Case fatality rate was calculated for "critically ill obstetric patients" (CIOP-CFR) for both periods. The cause-specific case fatality rate (CFR) was used to assess the trend in standards of care for life-threatening obstetric conditions. Data were compared using the chi(2) or Fisher's exact test. P<0.05 was considered statistically significant.

RESULTS

There were 175 near misses and 27 maternal deaths in 1999-2001 and 211 near misses and 44 maternal deaths in 2002-2004. The CIOP-CFRs for the two periods showed a declining (but non-significant) trend in the standard of emergency obstetric care for life-threatening conditions (13.4% to 17.3%, P=0.250). The CIOP-CFR for postpartum hemorrhage significantly increased from 3.1% to 21.1% in the 2nd period (P=0.033), reflecting a decline in the standard of care. Lack of blood for transfusion became a more significant administrative problem in the 2nd period occurring in 17.8% of all critically ill patients managed in 2002-2004. There was a notable though statistically insignificant increase in the non-adherence to treatment protocol among cases of maternal death in 2002-2004 compared with 1999-2001.

CONCLUSIONS

The standard of critical obstetric care in this center is suboptimal with no evident improvement over the 6-year period. This audit supports the feasibility of including near miss reviews in maternal death audits to provide insights into the trend in the quality of emergency services for severe maternal complications while highlighting factors associated with deficiency or improvement in care for specific maternal conditions.

Biosocial characteristics and mode of delivery at term of women monitored in a voluntary agency hospital

BACKGROUND

Many deliveries and maternal deaths occur in peripheral facilities and are usually attended to by General Practitioners (GPs). Maternal features that could help the GP predict whether a pregnancy will end in normal delivery or whether skilled assistance will be required to deliver the woman at term would be useful guides for early referrals or interventions.

METHODS

This was a prospective study of 400 mothers with singleton pregnancies monitored at the Sacred Heart Hospital, Lantoro, Abeokuta, from February to July 1999. Records of maternal age, height, parity, occupation, educational level, weight-gain during pregnancy, the regularity of antenatal visits and delivery were analyzed.

RESULTS

Mothers shorter than 1.55m, those who recorded large weight-gains during pregnancy, and those who booked late were more likely to experience difficult deliveries at term. Highly educated mothers and those in the upper socio-economic class were also more likely to have difficult delivery and require skilled assistance before birth at term.

CONCLUSION

Some maternal biological and social characteristics can be used ante-natally by GPs to predict the type of delivery a woman will undergo at term. GPs should routinely look for such features in pregnant mothers.

Ability of Nigerian hypertensive patients to perceive changes in their blood pressure

The objective of this study was to examine the ability of hypertensive patients to predict correctly when their blood pressure (BP) was elevated, and the symptoms they felt when such changes occurred. We also sought to determine whether literacy levels or the number of years that a patient had been diagnosed as hypertensive had a correlation with whether a patient was a predictor and whether he was an accurate predictor. One hundred and seventy-seven patients were studies, of which 101 (57.1%) claimed they could tell when their BP was elevated. Only 45 (44.5%) of the predictors were right in their prediction. Although being literate and longer time of being hypertensive was found to be likely to make a patient a predictor, neither of these variables was likely to make a predictor accurate. Predictors were also likely to be younger than non-predictors. The symptoms the patients were likely to complain about as denoting a rise in BP included headache (20.4%), weakness/tiredness (20.4%) and palpitation (18.5%). The study has shown that the majority of predictors were not accurate and so hypertensive patients should be counseled not to depend on how they feel but to visit physicians regularly for BP checks.