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Eluobaju D, Okonofua F, Weine S, Goba G. Understanding birthing preferences of women in Benin City, Nigeria: a qualitative study. BMJ Open 2023; 13:e054603. [PMID: 37130674 PMCID: PMC10163546 DOI: 10.1136/bmjopen-2021-054603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
OBJECTIVE The aim of this study was to explore women's birthing preferences and the motivational and contextual factors that influence their preferences in Benin City, Nigeria, so as to better understand the low rates of healthcare facility usage during childbirth. SETTING Two primary care centres, a community health centre and a church within Benin City, Nigeria. PARTICIPANTS We conducted one-on-one in-depth interviews with 23 women, and six focus groups (FGDs) with 37 husbands of women who delivered, skilled birth attendants (SBAs), and traditional birth attendants (TBAs) in a semi-rural region of Benin City, Nigeria. RESULTS Three themes emerged in the data: (1) women reported frequently experiencing maltreatment from SBAs in clinic settings and hearing stories of maltreatment dissuaded women from giving birth in clinics, (2) women reported that the decision of where to deliver is impacted by how they sort through a range of social, economic, cultural and environmental factors; (3) women and SBAs offered systemic and individual level solutions for increasing usage of healthcare facilities delivery, which included decreasing costs, increasing the ratio of SBAs to patients and SBAs adopting some practices of TBAs, such as providing psychosocial support to women during the perinatal period. CONCLUSION Women in Benin City, Nigeria indicated that they want a birthing experience that is emotionally supportive, results in a healthy baby and is within their cultural scope. Adopting a woman-centred care approach may encourage more women to transition from prenatal care to childbirth with SBAs. Efforts should be placed on training SBAs as well as investigating how non-harmful cultural practices can be integrated into local healthcare systems.
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Affiliation(s)
- Debra Eluobaju
- Department of Obstetrics and Gynecology, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - F Okonofua
- Women's Health and Action Research Centre, Benin City, Edo State, Nigeria
- Centre of Excellence in Reproductive Health Innovation, University of Benin, Benin City, Nigeria
| | - Stevan Weine
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Gelila Goba
- Department of Obstetrics and Gynecology, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
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Atwoli L, Erhabor GE, Gbakima AA, Haileamlak A, Kayembe Ntumba JM, Kigera J, Laybourn-Langton L, Mash B, Muhia J, Mulaudzi FM, Ofori-Adjei D, Okonofua F, Rashidian A, El-Adawy M, Sidibé S, Snouber A, Tumwine J, Yassien MS, Yonga P, Zakhama L, Zielinski C. COP27 Climate Change Conference: urgent action needed for Africa and the world. Ann Oncol 2023; 34:7-9. [PMID: 36334703 DOI: 10.1016/j.annonc.2022.10.504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 10/25/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | - B Mash
- African Journal of Primary Health Care & Family Medicine
| | - J Muhia
- London School of Medicine and Tropical Hygiene
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- Journal de la Faculté de Médecine d'Oran
| | | | | | - P Yonga
- East African Medical Journal
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Okonofua F. Development of the FAST-M maternal sepsis care bundle: requires proof of validity in low-resource settings. BJOG 2019; 127:424. [PMID: 31778264 DOI: 10.1111/1471-0528.16029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- F Okonofua
- Women's Health and Action Research Centre, College of Medical Sciences, University of Benin, Benin City, Nigeria
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Okonofua F. Maternal near-miss morbidity: is this evidence of maternal health quality in sub-Saharan Africa? BJOG 2019; 126:762. [PMID: 30657625 DOI: 10.1111/1471-0528.15619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- F Okonofua
- Obstetrics and Gynaecology, College of Medical Sciences, Women's Health and Action Research Centre, University of Benin, Benin City, Edo State, Nigeria
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Okonofua F. The DiPEP (diagnosis of pulmonary embolism in pregnancy) study and the limited accuracy of clinical decision rules and D-dimer: what next? BJOG 2018; 126:393. [PMID: 29873174 DOI: 10.1111/1471-0528.15309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- F Okonofua
- Obstetrics and Gynaecology, College of Medical Sciences, Women's Health and Action Research Centre, University of Benin, Benin City, Nigeria
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de Kok B, Imamura M, Kanguru L, Owolabi O, Okonofua F, Hussein J. Achieving accountability through maternal death reviews in Nigeria: a process analysis. Health Policy Plan 2018; 32:1083-1091. [PMID: 28666342 DOI: 10.1093/heapol/czx012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2017] [Indexed: 11/12/2022] Open
Abstract
Maternal death reviews (MDRs) are part of the drive to increase accountability for maternal deaths and reduce their occurrence by identifying barriers to effective, quality care. However, conducting MDRs well is difficult; staff commitment and establishing a blame free environment are key challenges. By examining the communication strategies used in MDRs this study sought to understand how MDR members implement policy imperatives (e.g. 'no blame, no name') and manage the inevitable sensitivities of discussing a client's death in a multidisciplinary team. We observed and recorded four MDRs in Nigerian teaching hospitals and used conversation and discourse analysis to identify patterns in verbal and non-verbal interactions. MDRs were conducted in a structured way and had multidisciplinary representation. We grouped discursive strategies observed into three overlapping clusters: 'doing' no-name no-blame; fostering participation; and managing personal accountability. Within these clusters, explicit reminders, gentle enquiries and instilling a sense of togetherness were used in doing no-name, no-blame. Strategies such as questioning and invoking protocol were only partially successful in fostering participation. Regarding managing accountability, forms of communication which limit personal responsibility ('pass the buck') and resist passing the buck were observed. Detailed, lengthy eye witness accounts of dramatic events appeared to reduce staff's personal accountability. We conclude that interactional processes affect the meaningfulness of MDRs. In-depth, critical analysis depends on resisting 'passing the buck' by practitioners and chairs especially, who are also key to fostering participation and extracting value from multidisciplinary representation. Our innovative methods provide detailed insights into MDRs as an interactional process, which can inform design of training aimed at enhancing MDR members' skills. However, given the multitude of systemic challenges we should also adjust our expectations of MDRs and the individual practitioners tasked to perform them in the name of enhancing accountability for maternal death reduction.
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Affiliation(s)
- Bregje de Kok
- Department of Anthropology, University of Amsterdam and Institute for Global Health and Development, Queen Margaret University, Musselburgh, UK
| | - M Imamura
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - L Kanguru
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh
| | - O Owolabi
- Women's Health and Action Research Centre, Benin City, Nigeria
| | - F Okonofua
- University of Medical Sciences, Ondo and Women's Health and Action Research Centre, Benin City, Nigeria
| | - J Hussein
- Honorary Senior Clinical Research Fellow, University of Aberdeen, Aberdeen, UK
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Affiliation(s)
- F Okonofua
- Obstetrics and Gynaecology, College of Medical Sciences, Women's Health and Action Research Centre, University of Benin, Benin City, Edo State, Nigeria
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Okonofua F. Y-plasty vaginoplasty needs proof of superior effectiveness. BJOG 2016; 124:336. [PMID: 28012270 DOI: 10.1111/1471-0528.14439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- F Okonofua
- University of Medical Sciences, Ondo City, Ondo State, Nigeria
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Onubi O, Marais D, Aucott L, Okonofua F, Poobalan A. Maternal obesity in Africa: Is it time to pay more attention? Ann Glob Health 2015. [DOI: 10.1016/j.aogh.2015.02.730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Agholor K, Omo-Aghoja L, Okonofua F. Association of anti-Chlamydia antibodies with ectopic pregnancy in Benin city, Nigeria: a case-control study. Afr Health Sci 2013; 13:430-40. [PMID: 24235946 DOI: 10.4314/ahs.v13i2.33] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Ectopic pregnancy remains a major public health problem especially in many developing countries where it is a significant contributor to pregnancy related morbidity and mortality. OBJECTIVE To determine the association between prior Chlamydia trachomatis infection and the risk of ectopic pregnancy. METHODS A case-control study from two tertiary health care facilities in Benin City, Nigeria. Ninety eight women with ectopic pregnancy (cases) and another 98 women with uncomplicated intrauterine pregnancy (controls) matched for age, were interviewed using a semi-structured questionnaire and evaluated for serological evidence of prior Chlamydia trachomatis infection. RESULTS The antibody titres in cases (48%) were significantly higher than in controls (16.3%) (p<0.001). However, the association between Chlamydia antibodies and ectopic pregnancy was attenuated when the effects of indicators of previous pelvic infections, socio-demographic characteristics, contraceptive and sexual history were controlled for. Primary level of education (OR = 6.32; CI, 2.31 - 17.3), three or more lifetime sexual partners (OR = 5.71; CI, 2.39 - 13.65) and prior history of vaginal discharge (OR = 5.00; CI, 2.03 - 12.3) were more likely to be associated with ectopic pregnancy than with the presence of antibodies to Chlamydia trachomatis (OR = 2.82; 95% CI, 1.33 - 5.95). The Population Attributable Risk was 30.9%. CONCLUSION Chlamydial infections play only a limited role in the pathogenesis of ectopic pregnancy.
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Affiliation(s)
- K Agholor
- Women's Health and Action Research Centre, Benin city
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Ogu R, Okonofua F, Akuse J, Ujah I, Galadanci H, Fabamwo A. O510 ASSESSMENT OF SUBLINGUAL MISOPROSTOL AS FIRST LINE TREATMENT FOR PRIMARY POSTPARTUM HEMORRHAGE: RESULTS OF A MULTICENTER TRIAL. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)60940-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Nzeribe E, Ogu R, Omo-Aghoja L, Agholor K, Okpokunu E, Okonofua F, Aigbogun O, Hussein J. O506 ASSESSMENT OF INFECTION CONTROL PRACTICES IN DELIVERY CARE UNITS IN SOUTHERN NIGERIA. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)60936-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ogu R, Okonofua F, Akuse J, Ujah I, Fabamwo A, Galadanci H, Archibong E, Chama C, Onah H. O509 OUTCOME OF AN INTERVENTION TO IMPROVE CASE MANAGEMENT OF ECLAMPSIA IN NIGERIA'S TEACHING HOSPITALS. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)60939-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Olagbuji B, Ezeanochie M, Okonofua F. Predictors of successful vaginal delivery after previous caesarean section in a Nigerian tertiary hospital. J OBSTET GYNAECOL 2011; 30:582-5. [PMID: 20701507 DOI: 10.3109/01443615.2010.486085] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Achieving a successful vaginal birth after a previous caesarean section (VBAC) is an important strategy in reducing the rising rate of caesarean section and its associated morbidities. Records of 188 women attempting trial of vaginal delivery after a previous lower segment caesarean section were reviewed to predict factors favouring successful vaginal delivery. Of the 188 women, 64 had recurrent indications for caesarean section, while 124 had non-recurrent indications. The group with recurrent indications for previous caesarean section had less vaginal delivery and more repeat caesarean sections as compared with the group with non-recurrent indications (21.9% and 78.1% vs 46.8% and 53.2%, respectively, p = 0.01). Cephalopelvic disproportion was more frequent in the group with recurrent indications (65.6% vs 27.4%, p < 0.0001). Significant predictors of successful VBAC in this cohort of women were non-recurrent indications for the previous caesarean section (p < 0.001, odds ratio (95% CI) 0.32 (0.2-0.6)) and a previous vaginal delivery (p < 0.0001, odds ratio (95% CI) 3.90 (2.1-7.4)). A previous vaginal delivery and a non-recurrent indication for the previous caesarean section are important predictors of VBAC in this cohort of women.
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Affiliation(s)
- B Olagbuji
- Department of Obstetrics and Gynecology, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
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Okonofua F, Ogu R, Menakaya U, Iribhogbe P, Bergstrom S. O698 Etiology and outcome of treatment in 190 infertile Nigerian couples. Int J Gynaecol Obstet 2009. [DOI: 10.1016/s0020-7292(09)61071-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Menakaya U, Otoide V, Omo Aghoja L, Omo Agboja L, Odunsi K, Okonofua F. Experience with misoprostol in the management of missed abortion in the second trimester. J OBSTET GYNAECOL 2009; 25:583-5. [PMID: 16234145 DOI: 10.1080/01443610500239354] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The aim of this study was to determine the effectiveness and safety of misoprostol (cytotec, Searle) used during labour in women with missed abortion in the second trimester of pregnancy. Labour was induced in 42 women with missed abortion at the Women's Health and Action Research Centre, Benin City, Nigeria with intermittent vaginal administration of 100 microg tablets of misoprostol every 6 h. All women achieved successful vaginal delivery with five women requiring post-delivery uterine evacuation. The gestational ages of the women at the time of induction ranged between 13-24 weeks with a median of 17 weeks. The median dose of misoprostol resulting in successful delivery was 1,100 microgand ranged between 300 microg to 3,100 microg. Side-effects were minimal with five patients experiencing shivering, two women experiencing fever, while three vomited during the period of the induction. These results confirm the efficacy and safety of misoprostol for induction of labour in second trimester missed abortion in Nigerian women. We conclude that misoprostol is effective in the management of missed abortion in the second trimester in Nigeria.
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Affiliation(s)
- U Menakaya
- Women's Health and Action Research Centre, 4 Alofoje Street, Off Uwasota Street, Ugbowo, Benin City, Nigeria.
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Palmatier MA, Pakstis AJ, Speed W, Paschou P, Goldman D, Odunsi A, Okonofua F, Kajuna S, Karoma N, Kungulilo S, Grigorenko E, Zhukova OV, Bonne-Tamir B, Lu RB, Parnas J, Kidd JR, DeMille MMC, Kidd KK. COMT haplotypes suggest P2 promoter region relevance for schizophrenia. Mol Psychiatry 2004; 9:859-70. [PMID: 15098000 DOI: 10.1038/sj.mp.4001496] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A recent study found, in a large sample of Ashkenazi Jews, a highly significant association between schizophrenia and a particular haplotype of three polymorphic sites in the catechol-O-methyl transferase, COMT, gene: an IVS 1 SNP (dbSNP rs737865), the exon 4 functional SNP (Val158Met, dbSNP rs165688), and a downstream SNP (dbSNP rs165599). Subsequently, this haplotype was shown to be associated with lower levels of COMT cDNA derived from normal cortical brain tissue, most likely due to cis-acting element(s). As a first step toward evaluating whether this haplotype may be relevant to schizophrenia in populations other than Ashkenazi Jews, we have studied this haplotype in 38 populations representing all major regions of the world. Adding to our previous data on four polymorphic sites in the COMT gene, including the Val158Met polymorphism, we have typed the IVS 1 rs737865 and 3' rs615599 sites and also included a novel IVS 1 indel polymorphism, yielding seven-site haplotype frequencies for normal individuals in the 38 globally distributed populations, including a sample of Ashkenazi Jews. We report that the schizophrenia-associated haplotype is significantly heterogeneous in populations worldwide. The three-site, schizophrenia-associated haplotype frequencies range from 0% in South America to 37.1% in Southwest Asia, despite the fact that schizophrenia occurs at roughly equal frequency around the world. Assuming that the published associations found between the exon 4 Val158Met SNP and schizophrenia are due to linkage disequilibrium, these new haplotype data support the hypothesis of a relevant cis variant linked to the rs737865 site, possibly just upstream in the P2 promoter driving transcription of the predominant form of COMT in the brain. The previously described HindIII restriction site polymorphism, located within the P2 promoter, varies within all populations and may provide essential information in future studies of schizophrenia.
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Affiliation(s)
- M A Palmatier
- Department of Genetics, Yale University School of Medicine, New Haven, CT 06520-8005, USA
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Okonofua F. Gendered socialisation: a neglected issue in adolescent sexual and reproductive health in Africa. Afr J Reprod Health 2001; 5:7-10. [PMID: 12471924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
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Affiliation(s)
- F Okonofua
- Department of Obstetrics and Gynecology, College of Medical Sciences, University of Benin, Benin City, Nigeria.
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Abstract
A semi-quantitative screening for asymptomatic bacteriuria was carried out in the first trimester of 500 consecutive pregnant women in Benin City. The purpose was to provide baseline data and rational therapy for asymptomatic bacteriuria in pregnant women. Of the 500 women screened, 433 clinical specimens showed significant bacteriuria, representing an incidence of 86.6%. Of this number, 38 (7.4%) were of mixed bacterial colonies while 395 (91%) were of single bacterial colonies. Staphylococcus aureus (29.8%), Escherichia coli (29.1%) and Klebsiella pneumoniae (21.5%) were the most frequently isolated pathogens. The high incidence of asymptomatic bacteriuria in pregnancy correlated significantly (P < 0.05) with the observed high proportion of pyuria. On average, sensitivity of the pathogens was ciprofloxacin 99.7%; ceftazidime 81.6%; co-trimoxazole 79.4%; augmentin 71.4%; nalidixic acid 61.7%; nitrofurantoin 61.%; gentamycin 56.9% and ampicillin 25.4%. S. aureus was most sensitive, while Proteus mirabilis was least sensitive among the pathogens. Rational therapy of asymptomatic bacteriuria in pregnant women may prevent associated risks such as pyelonephritis and pre-eclampsia.
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Affiliation(s)
- J Akerele
- Department of Pharmaceutical Microbiology, University of Benin, Benin City, Nigeria.
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Okonofua F. Adolescent reproductive health in Africa: future challenges. Afr J Reprod Health 2000; 4:7-12. [PMID: 11000704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Okonofua F. Economic development and reproductive health in Africa. Afr J Reprod Health 1997; 1:6-9. [PMID: 10214409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Snow R, Okonofua F. Launching the African Journal of Reproductive Health. Afr J Reprod Health 1997; 1:3-4. [PMID: 10214396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Okonofua F. Preventing unsafe abortion in Nigeria. Afr J Reprod Health 1997; 1:25-36. [PMID: 10214400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
This paper reviews pertinent literature and identifies research needs relating to unsafe abortion in Nigeria. The paper is organised into three sections. In the first part of the article, a conceptual framework for developing a research agenda to prevent unsafe abortion among Nigerian women is articulated. This section argues for a systematic research agenda that would allow a fuller understanding of the determinants of all segments of the induced abortion cycle. In the second section of the article, we offer a detailed description of the available research data as well as gaps in knowledge on unsafe abortion in Nigeria. In the final part of the paper, recommendations are made on priority areas of research that are capable of stemming the high rate of morbidity and mortality from unsafe abortion among Nigerian women. In particular, the paper recommends high quality, multidisciplinary formative and intervention research to foster an understanding of the determinants of abortion among Nigerian women. Such research should be geared toward providing accurate information to policy makers in a logical manner so as to enable them to generate appropriate policies for preventing unsafe abortion.
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Abstract
Eleven Nigerian children with clinically and radiologically proven rickets were assessed biochemically. The children had low or low normal concentrations of total and corrected calcium, and elevated plasma alkaline phosphatase (ALP) activity, but normal plasma phosphate concentrations. Their serum 25-hydroxyvitamin D (25-OHD) and 1,25-dihydroxyvitamin D (1,25-(OH)2D) concentrations were not significantly different from those in controls, but the ratio of 1,25-(OH)2D to 25-OHD was significantly greater than that in controls. Parathyroid hormone (PTH) concentrations were greater in rachitic children, and there was a significant correlation between 1,25-(OH)2D and PTH concentrations. Osteocalcin concentrations in rachitic children were not significantly different from those in controls, but they were markedly elevated in the three patients with the highest 1,25-(OH)2D and PTH concentrations. One child, from whom a sample of bone (from a corrective osteotomy) was available for histological examination, showed markedly thickened osteoid seams, characteristic of rickets. All the rachitic children had a calcium intake of less than 150 mg daily. Treatment of these rachitic children with calcium gluconate (1 g/d) led to clinical, radiological, and biochemical healing of rickets. We conclude that rickets in Nigerian children is not due to vitamin D deficiency, but to a lack of calcium. This observation has implications regarding the pathogenesis, treatment, and prevention of rickets/osteomalacia in Nigeria and possibly other African and tropical countries.
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Affiliation(s)
- F Okonofua
- Department of Obstetrics and Gynaecology, University of Ile-Ife, Nigeria
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Hussain SY, O'Brien PM, De Souza V, Okonofua F, Dandona P. Reduced atrial natriuretic peptide concentrations in premenstrual syndrome. Br J Obstet Gynaecol 1990; 97:397-401. [PMID: 2142604 DOI: 10.1111/j.1471-0528.1990.tb01825.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Atrial natriuretic peptide (ANP) concentrations were determined by radioimmunoassay technique in 23 women, 11 women with premenstrual syndrome (PMS) and 12 comparable asymptomatic women. The asymptomatic women showed no change in ANP concentration during the menstrual cycle. In the PMS group ANP levels showed a significant fall in the midluteal phase compared to levels in the follicular phase. Throughout the cycle ANP concentrations were lower in the PMS group than in the comparison group. This difference was statistically significant in the early, mid and late luteal phases of the cycle. The lower ANP concentration in the PMS group in the luteal phases may indicate either a lower plasma volume or a decrease in the total body sodium content or both. These findings are contrary to those expected.
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Affiliation(s)
- S Y Hussain
- Academic Department of Obstetrics and Gynaecology, Royal Free Hospital School of Medicine, Hampstead, London
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Abdalla HI, Ah-Moye M, Brinsden P, Howe DL, Okonofua F, Craft I. The effect of the dose of human chorionic gonadotropin and the type of gonadotropin stimulation on oocyte recovery rates in an in vitro fertilization program. Fertil Steril 1987; 48:958-63. [PMID: 3119376 DOI: 10.1016/s0015-0282(16)59591-0] [Citation(s) in RCA: 90] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The effect of the dose of human chorionic gonadotropin (hCG) on oocyte retrieval in an in vitro fertilization (IVF) program was studied. Following ovulation induction using clomiphene citrate and either pure follicle-stimulating hormone (FSH) or human menopausal gonadotropin (hMG), hCG was administered at a dose of 2000 IU (n = 88), 5000 IU (n = 110), and 10,000 IU (n = 104). There was a significantly lower successful oocyte recovery in patients who received 2000 IU of hCG (77.3%) compared with patients who received either 5000 IU of hCG (95.5%) or 10,000 IU of hCG (98.1%; P less than 0.001). There was no significant difference between 5000 or 10,000 IU of hCG. In patients who received 2000 IU of hCG, successful oocyte recovery was significantly lower when pure FSH was used (60%) compared with those who received hMG (84.1%; P less than 0.03). Patients have different thresholds for follicular response to hCG and the recommended minimum dose of hCG should be at least 5000 IU.
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Affiliation(s)
- H I Abdalla
- In Vitro Fertilization Department, Humana Hospital Wellington, London, United Kingdom
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Okonofua F, Menon RK, Houlder S, Thomas M, Robinson D, O'Brien S, Dandona P. Calcium, vitamin D and parathyroid hormone relationships in pregnant Caucasian and Asian women and their neonates. Ann Clin Biochem 1987; 24 ( Pt 1):22-8. [PMID: 3827181 DOI: 10.1177/000456328702400103] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Plasma calcium, serum 25 hydroxyvitamin D [25(OH)D], 1,25 dihydroxyvitamin D[1,25(OH)2D] and parathyroid hormone (PTH) have been measured in pregnant and newborn Caucasians and Asians. Calcium and 25(OH)D concentrations were lower in Caucasian than in Asian women at all four stages (three trimesters and during labour) of pregnancy. PTH concentrations were greater in Asian than in Caucasian women during the three trimesters, but not at labour, and increased in both groups through pregnancy, without a concomitant change in plasma calcium concentrations. There was a significant inverse correlation between calcium and PTH, as well as 25(OH)D and PTH, concentrations. These data demonstrate the presence of progressive 'hyperparathyroidism' during pregnancy in Caucasian and Asian women. The higher PTH concentrations in Asian women may reflect the necessity of maintaining adequate plasma calcium concentrations through PTH-induced osteolysis in the face of vitamin D deficiency. Relative hyperparathyroidism in Asians may contribute to net loss of calcium from the skeleton and osteopenia in Asian women. Calcium, 25(OH)D and 1,25(OH)2D concentrations were lower, and those of PTH higher, in Asian newborns compared with Caucasian newborns. Serum 1,25(OH)2D concentrations in the Asian newborn, though lower than respective maternal levels, were comparable with normal adult levels, indicating that 1,25(OH)2D biosynthesis is stimulated in the Asian newborn to compensate for the low serum 25(OH)D concentrations.
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Okonofua F, Menon RK, Houlder S, Thomas M, Robinson D, O'Brien S, Dandona P. Parathyroid hormone and neonatal calcium homeostasis: evidence for secondary hyperparathyroidism in the Asian neonate. Metabolism 1986; 35:803-6. [PMID: 3747837 DOI: 10.1016/0026-0495(86)90219-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Calcium, 25-hydroxyvitamin D (25 OHD), and parathyroid hormone (PTH) concentrations were measured in 11 Asian and ten Caucasian pregnant women at parturition and in their respective newborns following a full term normal delivery. Maternal calcium and 25 OHD concentrations were significantly lower while PTH concentrations were significantly greater in Asians than those in Caucasians. There was a significant inverse relationship between calcium and PTH and the relationship between 25 OHD and PTH concentrations. Neonatal calcium and 25 OHD concentrations were also significantly lower and PTH concentrations significantly higher in Asians than those in Caucasians. There was a highly significant inverse correlation between neonatal calcium and PTH concentrations. Three of the 11 Asian babies had supranormal concentrations of PTH in their cord blood. We conclude that PTH participates in neonatal calcium homeostasis and Asian newborns have frequent secondary hyperparathyroidism.
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Abstract
In view of the high incidence of rickets in infants of women practising purdah (the use of veils) in northern Nigeria we conducted a study on plasma calcium, phosphate, and serum 25-hydroxyvitamin D (25 OHD) concentrations in pregnant Nigerian women and in cord blood obtained from the newborns. Plasma calcium, phosphate, and serum 25 OHD concentrations were lower in practising women and their newborns than those not practising purdah and their infants, respectively. The concentrations of 25 OHD in all Nigerian women were greater than those observed in caucasian women in the United Kingdom. These data emphasise the role of exposure to sunshine in regulating serum 25 OHD concentrations and the adverse effect of deliberate exclusion of sunshine and are consistent with previous data indicating hypovitaminosis D in purdah clad women and their newborns in Saudi Arabia. These data do not, however, provide an explanation for the pathogenesis of the high incidence of neonatal rickets and tetany in infants born of purdah clad women as these women have 25 OHD concentrations greater than those in caucasian women in the United Kingdom.
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Dandona P, Okonofua F, Clements RV. Osteomalacia presenting as pathological fractures during pregnancy in Asian women of high socioeconomic class. Br Med J (Clin Res Ed) 1985; 290:837-8. [PMID: 3919812 PMCID: PMC1418581 DOI: 10.1136/bmj.290.6471.837] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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