Female genital mutilation and obstetric outcome: A cross-sectional comparative study in a tertiary hospital in Abakaliki South East Nigeria

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Study Justification:
– Female genital mutilation (FGM) is a harmful practice that affects the health and well-being of women.
– The study aims to compare the obstetric outcomes of women with FGM to those without FGM.
– Understanding the impact of FGM on obstetric outcomes can help inform policies and interventions to improve maternal health.
Highlights:
– The study included 260 healthy parturients with FGM and 260 cohorts without FGM.
– The mean age of the women was 27.9 years and the mean gestational age was 38.9 weeks.
– Majority of the women belonged to social class 4 and 82.0% had Type 2 FGM.
– Women with FGM had increased odds of perineal tear and episiotomy.
– The mode of delivery and neonatal Apgar scores were not significantly influenced by the presence of FGM.
Recommendations:
– Continued awareness creation to stop FGM.
– Implementation of interventions to prevent perineal trauma and associated complications in women with FGM.
Key Role Players:
– Obstetricians and gynecologists
– Nurses and midwives
– Community health workers
– Policy makers and government officials
– Non-governmental organizations (NGOs) working on women’s health
Cost Items for Planning Recommendations:
– Training and capacity building for healthcare providers on managing obstetric complications related to FGM
– Awareness campaigns and educational materials
– Community outreach programs
– Research and data collection on FGM prevalence and its impact on obstetric outcomes
– Monitoring and evaluation of interventions
– Collaboration with NGOs and other stakeholders
– Policy development and implementation

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study design is a cross-sectional comparative study, which allows for comparison between two groups. The sample size is adequate with 260 participants in each group. The data analysis was done using appropriate statistical methods. However, the study could be improved by providing more details on the selection criteria for participants, the specific outcomes measured, and any potential confounding factors that were controlled for. Additionally, it would be helpful to include information on the reliability and validity of the questionnaire used to collect data. To improve the evidence, future studies could consider using a prospective cohort design to establish a causal relationship between FGM and obstetric outcomes, and include a larger and more diverse sample to enhance generalizability.

Background: Female genital mutilation (FGM) is an assault on womanhood. Objective: To compare the obstetric outcome between parturient with genital mutilation with a cohort that has no genital mutilation. Materials and methods: This cross-sectional prospective study was done in the labour ward of Federal Teaching Hospital Abakaliki between 1st January 2013 and 31st December 2013. The obstetrics outcome of 260 consenting healthy parturients with FGM in the 1st stage of labour was compared with 260 cohorts with no FGM and also in labour. Data were obtained with a structured questionnaire and analysed using IBM SPSS Statistic version 20. Simple percentage odd ratio and Chi-square were used for data analysis at a p-value of 0.05). Conclusion: The study has shown that FGM in labour increases the odds of developing perineal trauma which may be associated with a host of short- and long-term complications. We recommend continued awareness creation to stop FGM.

This cross-sectional comparative study was carried out in Obstetrics and Gynaecology department of Federal Teaching Hospital Abakaliki (FETHA), Ebonyi. Ebonyi state was created in 1996 with 13 local government areas, one urban, one semi-urban, and the rest rural. It has a population of 2.4 million according to 2006 Nigerian national population commission census and it occupies a land mass of 5932 km. About 75% of the population dwells in the rural areas with farming as their major occupation. FETHA is a tertiary institution which is the only referral center in the state. It was the product of a merger in December 2011 between the former Federal Medical Centre Abakaliki and Ebonyi State University Teaching Hospital, Abakaliki. Apart from FETHA, there are private, primary/secondary health facilities and two Catholic mission hospitals (St Patrick hospital, Abakaliki and St Vincent hospital Ndubia) in the study area. They provide maternal and child health services to numerous patients within and outside Ebonyi state. The Department of Obstetrics and Gynaecology of the hospital (FETHA) ran an antenatal clinic that is managed by consultants and resident doctors with trained nurses. The antenatal clients who are booked on Wednesday are distributed to the five (5) teams in the department with 30 consultants. The choice for a place for antenatal and labour care by the women is a personal decision but they are encouraged to access care in a center with a skilled birth attendant like FETHA. The average delivery rate is 150 deliveries per month. The ethical committee of the hospital granted approval for the study.

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Based on the information provided, here are some potential innovations that can be used to improve access to maternal health:

1. Community education and awareness programs: Implementing continued awareness creation programs to educate communities about the dangers of female genital mutilation (FGM) and the importance of seeking skilled birth attendants for maternal care.

2. Mobile health clinics: Establishing mobile health clinics that can reach rural areas with limited access to healthcare facilities. These clinics can provide antenatal care, skilled birth attendance, and postnatal care to pregnant women in remote areas.

3. Telemedicine services: Introducing telemedicine services to provide remote consultations and support for pregnant women in areas where healthcare facilities are scarce. This can help improve access to medical advice and guidance during pregnancy and childbirth.

4. Strengthening referral systems: Enhancing the referral systems between primary healthcare facilities and tertiary hospitals like Federal Teaching Hospital Abakaliki (FETHA). This can ensure that pregnant women with complications are promptly referred to higher-level facilities for specialized care.

5. Training and capacity building: Providing training and capacity building programs for healthcare professionals, including doctors, nurses, and midwives, to improve their skills in managing obstetric complications related to FGM.

6. Collaboration with community leaders and traditional birth attendants: Engaging community leaders and traditional birth attendants in promoting safe maternal health practices and discouraging harmful practices like FGM. This can help increase community acceptance and support for accessing skilled birth attendance.

7. Mobile applications for maternal health: Developing mobile applications that provide information, guidance, and reminders for pregnant women regarding antenatal care, nutrition, and childbirth preparation. These apps can be easily accessible and user-friendly, even in low-resource settings.

It is important to note that these recommendations are based on the information provided and may need to be tailored to the specific context and needs of the community in Abakaliki, Nigeria.
AI Innovations Description
Based on the information provided, the recommendation to improve access to maternal health would be to continue raising awareness to stop female genital mutilation (FGM). This practice has been shown to increase the odds of developing perineal trauma during labor, which can lead to short- and long-term complications. By educating communities about the harmful effects of FGM and promoting alternatives to this practice, such as skilled birth attendance at healthcare facilities like the Federal Teaching Hospital Abakaliki, access to safe and quality maternal healthcare can be improved. Additionally, efforts can be made to ensure that antenatal and labor care services are readily available and accessible to women in the study area, including through the provision of skilled healthcare professionals and adequate facilities.
AI Innovations Methodology
Based on the provided information, here are some potential recommendations to improve access to maternal health:

1. Increase awareness and education: Implement comprehensive awareness campaigns to educate communities about the dangers and consequences of female genital mutilation (FGM). This can be done through community outreach programs, workshops, and media campaigns.

2. Strengthen healthcare infrastructure: Invest in improving healthcare facilities, particularly in rural areas, to ensure access to quality maternal healthcare services. This includes equipping healthcare centers with necessary medical equipment, supplies, and trained healthcare professionals.

3. Enhance antenatal care services: Focus on providing comprehensive antenatal care services that include regular check-ups, health education, and counseling for pregnant women. This can help identify and address any potential complications early on.

4. Promote skilled birth attendance: Encourage women to seek care from skilled birth attendants, such as doctors or midwives, who can provide safe and effective delivery assistance. This can be done through community awareness campaigns and by ensuring the availability of skilled birth attendants in healthcare facilities.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define the target population: Identify the specific population group that will be affected by the recommendations, such as women in rural areas or communities practicing FGM.

2. Collect baseline data: Gather data on the current state of maternal health access, including factors such as FGM prevalence, healthcare infrastructure, antenatal care utilization, and skilled birth attendance rates.

3. Develop a simulation model: Create a simulation model that incorporates the identified recommendations and their potential impact on improving access to maternal health. This model should consider factors such as changes in FGM prevalence, increased awareness and education, improved healthcare infrastructure, and increased utilization of antenatal care and skilled birth attendance.

4. Input data and run simulations: Input the baseline data into the simulation model and run multiple simulations to assess the potential impact of the recommendations. This can help estimate changes in maternal health outcomes, such as reduction in perineal trauma, improved birth outcomes, and increased access to quality maternal healthcare services.

5. Analyze results: Analyze the simulation results to evaluate the effectiveness of the recommendations in improving access to maternal health. This can involve comparing the simulated outcomes with the baseline data and identifying any significant improvements or areas that may require further intervention.

6. Refine and iterate: Use the simulation results to refine the recommendations and the simulation model itself. Iterate the process by incorporating new data and running additional simulations to further assess the potential impact and optimize the recommendations.

By following this methodology, policymakers and healthcare professionals can gain insights into the potential impact of specific recommendations on improving access to maternal health and make informed decisions to implement effective interventions.

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