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Biomedical subjects

H E Onah

Publications and source records attributed to H E Onah.

13 recordsLinked to original sources
PubMed2003

Effect of prolongation of pregnancy on perinatal mortality.

OBJECTIVES: (1) To determine the distribution of singleton and twin births according to gestational age in a Nigerian obstetric population; and (2) to compare their perinatal outcomes according to gestational age. METHODS: A 10-year retrospective comparative study of twin and singleton births at a tertiary care center in Enugu, Nigeria. The variables analyzed were: the proportion of deliveries occurring at each gestational age, the gestational age-specific rates for stillbirths, cesarean section, babies with 1-min Apgar scores less than 4 and those whose birthweights were below the 10th percentile for gestational age. The trends in these rates were determined by finding the best fitting polynomial regression curve for each variable. Tests of statistical significance for trends in proportions were carried out by means of the chi(2)-test at the 95% confidence level. RESULTS: Of the 496 twin births, 3.6% compared with 17.3% of the 496 singleton births went beyond 40 weeks' gestation while 1.2% of the twin and 4.4% of the singleton deliveries occurred at 42 weeks' gestation or beyond. For twins as well as singletons, there was a consistent and significant decline in the stillbirth rate and the proportion of babies with 1-min Apgar scores less than 4 up to 42 weeks (P=0.0000). Among the twins, the proportion of babies with birthweights below the 10th percentile (i.e. those with impaired growth) significantly rose from 28 weeks and above (P=0.0000) while among the singletons, a declining trend with gestational age was observed (P=0.0003). However, among the twins with impaired growth, the stillbirth rate neither differed between the first and second twins at each gestational age nor did it increase with gestational age in both the first and second twins. While the cesarean section rate for singletons remained almost stable at approximately 13%, there was a significant rise in the cesarean section rate with gestational age among the twin births. CONCLUSIONS: There were 1.2% of twin deliveries compared with 4.4% of singleton deliveries which occurred at 42 weeks' gestation or beyond. In the Nigerian population studied, the perinatal outcomes in twins did not differ from those of singletons up to 42 weeks' gestation suggesting that the 42-week cut-off for prolonged pregnancy applies equally well to twins as to singletons.

Birth Weight↗
PubMed2002

Formal education does not improve the acceptance of cesarean section among pregnant Nigerian women.

OBJECTIVES: To investigate the relationship between formal education, personal beliefs and the acceptance of cesarean section among pregnant Nigerians. METHODS: A questionnaire survey was made of antenatal mothers seen over a 5-month period at a tertiary hospital in Enugu, Nigeria. RESULTS: A total of 1148 subjects were interviewed. Although as a single variable, formal education was significantly related to a more favorable attitude to cesarean section among the respondents, it ceased to be related when their beliefs about the operation were corrected for. CONCLUSIONS: Pregnant Nigerians' beliefs about cesarean section are more important than formal education in determining whether or not they accept it, hence the need to correct such false beliefs during antenatal classes.

Adolescent↗
PubMed2002

Nigerian male sexual activity during pregnancy.

OBJECTIVES: To determine the prevalence of extra-marital sexual affairs as well as other aspects of male sexual behavior during pregnancy in Nigeria. METHODS: A questionnaire survey of the husbands of consecutive women who delivered in three tertiary care centers in south-eastern Nigeria within an 8-week period. The data were analyzed by means of simple percentages and descriptive and inferential statistics, using t-tests, chi-square tests and regression equations at the 95% confidence level. RESULTS: 279 (88.3%) of the 316 eligible husbands responded to the questionnaire. A total of 78 (28.0%) of the respondents engaged in extra-marital sexual relationships during pregnancy. Of the respondents, 36.6% and 32.3% experienced a decrease in achievement of erection and orgasm, respectively. While libido decreased in 41.9%, coital frequency declined in 72.4% of the respondents. On univariate analysis, respondent's age > or = 40 years, duration of marriage > or = 5 years, having an extra-marital sexual partner and beliefs that coitus during pregnancy should be less frequent or can cause miscarriage were significant predictors of reduced coital frequency while a belief that coitus enhances fetal well-being was a significant predictor of increased coital frequency during pregnancy (P<0.05 for each variable). On multivariate logistic regression, three factors were statistically significant predictors of reduced coital frequency - age > or = 40 years (OR=2.3; 95% C.I., 1.9-2.3) and beliefs that coitus during pregnancy can cause miscarriage (OR=1.9; 95% C.I., 1.5-2.3) and should be less frequent (OR=1.9; 95% C.I., 1.8-2.5). CONCLUSIONS: Personal beliefs significantly affect sexual relationships between Nigerian husbands and their pregnant wives, making approximately one-third of husbands engage in extra-marital relationships as a way to satisfy their unmet sexual need during pregnancy. There is a need to educate husbands and their pregnant wives on sexual matters during pregnancy.

Extramarital Relations↗
PubMed2002

The knowledge, attitude and practice of child adoption among infertile Nigerian women.

To determine the knowledge, attitude and practice of child adoption among infertile Nigerian women we undertook a questionnaire survey of 279 consecutive infertile women seen in three tertiary care centres in South Eastern Nigeria within a 9-month period. The data were analysed by means of simple percentages and descriptive and inferential statistics, using t-tests, chi-square tests and regression equations at the 95% confidence level. Two hundred and sixty-four questionnaires were analysed. Although 228 (86.4%) of the respondents were aware of child adoption, only 72 (27.3%) knew its correct meaning. Fifty-seven (21.6%) women knew how to adopt a baby while the rest did not; 183 (69.3%) respondents expressed their unwillingness to adopt a baby while the remaining 81 (30.7%) were willing. Twelve (14.8%) of these 81 respondents (or 4.5% of all respondents) had either adopted or made an effort to adopt a child at the time of the study. The major reasons given by the 183 respondents unwilling to adopt a child were: adoption not a solution to their infertility (84 respondents); adoption psychologically unacceptable (78 respondents); fear of unknown parental background (75 respondents) and abnormal behaviour in the child (75 respondents). Univariate analysis showed six factors significantly associated with a favourable attitude to child adoption: a correct knowledge of the meaning of adoption (P=0.00007), duration of infertility >5 years (P=0.0002), previous orthodox specialist treatment (P=0.0002), tubal infertility (P=0.002), no living child (P=0.02) and maternal age >35 years (P=0.03). In a multiple logistic regression involving these six factors, with attitude to adoption as the dependent variable, two factors were associated significantly with a favourable attitude to adoption: correct knowledge of the meaning of adoption (OR=1.9, P=0.04) and previous orthodox specialist treatment (OR=2.9, P=0.05). Although the majority of infertile Nigerian women have heard of child adoption, only a minority knew its real meaning, its legality and the process it entails. Approximately one-third of them were disposed favourably to adoption as a treatment option for their infertility. The Nigerian experience was compared and contrasted with the experiences of other countries. Factors associated with a favourable attitude to adoption were presented and discussed. In the presence of such factors, especially when the probability of cure of infertility is small, child adoption as a treatment option should be offered early so that willing couples can initiate the processes.

Adoption↗
PubMed2002

Conservative management of early-onset pre-eclampsia and fetomaternal outcome in Nigerians.

The aim of this study was to determine the effect of conservative management of pre-eclampsia with onset in the second trimester on fetomaternal outcome. This was a prospective study of 749 consecutive cases of pre-eclampsia seen over a 5-year period in a tertiary care centre in Enugu, Eastern Nigeria. One hundred and seventy-five (23.4%) of the 749 cases started at less than 30 weeks' gestational age. These early-onset cases formed the study group, while the remaining 574 with onset at 30 weeks' gestation or later (the late-onset cases) served as controls. The two groups were compared for some fetomaternal outcome variables at the 95% confidence level. Ninety-one (52%) of the early-onset group had pure pre-eclampsia while the remaining 84 were thought to have pre-eclampsia superimposed on chronic hypertension. The mean gain in gestational age in the early-onset group was 8.8 +/- 1.5 (range: 0-19) weeks. Compared to the late-onset group, the early-onset group had a twofold increase in maternal mortality ratio and a significantly increased incidence of renal failure and HELLP syndrome. The perinatal mortality rate increased fourfold in the early-onset compared to the late-onset group due principally to prematurity and intrauterine growth restriction. The perinatal mortality rate was, however, comparable to results from similar Caucasian studies. It was concluded that there has been an increased incidence of early-onset pre-eclampsia in Nigerian women. Although conservative management of such cases may improve fetal results, it is associated with increased maternal mortality and morbidity because of institutional delays and non-availability of magnesium sulphate at the time of the study. Minimising institutional delays, providing magnesium sulphate and improving neonatal services will enhance maternal and fetal results in early-onset pre-eclampsia in Nigeria and are recommended.

Adult↗
PubMed2002

Cervico-vaginal fistula from induced abortions causing subsequent spontaneous midtrimester abortions in Nigerians: case report.

A report of three cases of cervico-vaginal fistula (CVF) from induced abortions causing subsequent spontaneous mid-trimester abortions and a literature review is presented. Restrictive abortion laws, low contraceptive usage and increased sexual activity consequent upon adverse socio-economic conditions have led to an increase in the prevalence of illegal abortions in Nigeria over the previous two decades. CVF appears to be an emerging complication of such abortions. Cervical cerclage is preferred to trachelorrhaphy in the management of such cases. However, where vaginally performed cerclage does not succeed, the abdominal route should be used as a last resort. After a previous induced abortion, clinicians managing the subsequent pregnancy need to search carefully for cervico-vaginal fistula, which may compromise that particular pregnancy. Appropriate contraceptive use and safe abortions using modern methods in cases of contraceptive failure will prevent such horrendous complications of induced abortions in Nigeria and other developing countries.

Abortion, Induced↗
PubMed2002

Correlation between intrapartum fundal height and birth weight.

In a prospective cross-sectional study, the correlation between symphysiofundal height (SFH) and birth weight was evaluated in 2646 consecutive parturients at the University of Nigeria Teaching Hospital, Enugu, over a 19-month period. The standard deviations of the observed birth weight were least when the SFH measured 33-39 cm, which corresponded to the birth weight range 2500-3999 g. The overall standard deviation was 275 g. A second order polynomial fitted the data best, giving the equation y +/- 258.1-62.9x -3.8x2, where y represents the observed birth weight in grams and x the SFH in centimetres. The R2 statistic for the model was 0.82. This and other assessment showed a good model fit. The birth weight centiles for the various SFH measurements were derived and their usefulness discussed. It was concluded that the SFH-derived birth weight centiles are useful alternatives to ultrasonography especially in the birth weight range 2500-3999 g.

Adolescent↗
PubMed2001

Maternal mortality at the University of Nigeria Teaching Hospital, Enugu, before and after Kenya.

A comparative retrospective analysis of maternal deaths at the University of Nigeria Teaching Hospital, Enugu, Nigeria, was carried out for two ten-year periods--1976-1985 and 1991-2000--in order to evaluate the effect of Safe Motherhood Initiative on maternal mortality in the hospital. Variables for the two periods were compared by means of the t-test at 95% confidence level. Maternal mortality ratio was significantly higher in Period II than in Period I (1406 versus 270 per 100,000, p = 0.00). The leading causes of maternal death were uterine rupture for Period I and septicaemia for Period II. Although from the first to the second ten-year period there was a significant decrease in the number of midwives, physicians and nurse anaesthetists, there was more than a proportionate decrease in the number of deliveries. There was also increase in the incidence of anaemia due to diminished standards of living and in the mean decision-intervention interval (1.5 +/- 0.5 versus 5.8 +/- 1.2 hours; p = 0.000) as a result of worker dissatisfaction and changes in hospital policies. We conclude that since the launching of the Safe Motherhood Initiative, MMR at the University of Nigeria Teaching Hospital, Enugu, Nigeria, has increased five-fold as a result of institutional delays and a deterioration in the living standards of Nigerians, both consequences of a depressed economy. To halt this trend, we recommend that the living standard of all Nigerians should be improved. Furthermore, healthcare personnel should be motivated through enhanced salaries and provision of working materials including efficient mobile telephone services.

Cause of Death↗
PubMed2000

Declining fetal growth standards in Enugu, Nigeria.

OBJECTIVE: To compare the birth-weights of babies born before and after the introduction of the Structural Adjustment Program in Nigeria. METHODS: A retrospective analysis of the birth-weights of all singleton live births at the University of Nigeria Teaching Hospital Enugu, Eastern Nigeria, in 1984 and 1998. RESULTS: The babies were on average 183 g lighter in 1998 than in 1984. The mean birth-weight for each gestational age, parity and fetal sex was significantly lower in 1998 than in 1984. The incidences of low birth-weight, intrauterine growth retardation and preterm delivery were significantly higher in 1998 than in 1984. The above findings were associated with a significant reduction in the mean gestational age, parity and utilization of the hospital's maternity services, probably consequences of an adverse socio-economic environment. CONCLUSION: Reversing the declining growth standards of Nigerian fetuses would entail improving the socio-economic status of Nigerian women as well as the quality of maternity care.

Birth Weight↗