Asymptomatic Bacteriuria in a University Teaching Hospital in Southern Nigeria: Prevalence, Uropathogens, and Antibiotic Susceptibility

Background: Asymptomatic bacteriuria (ASB) has been documented as the main risk factor for the development of symptomatic urinary tract infection in pregnancy and is associated with maternal and fetal complications. Objective: To determine the ASB prevalence, the causative microorganisms, their drug sensitivity patterns, and the factors associated with its occurrence in pregnant women in the Uyo, Nigeria. Methodology: Three hundred and twenty women were recruited during their first antenatal visit over a period of 13 weeks. A midstream urine specimen was obtained from each patient, cultured, isolates identified and antimicrobial sensitivity done. Data were analyzed using the Statistical Package for the Social Sciences version 20.  Results: The ASB prevalence was 9.1% with the two commonest identified isolates being Escherichia coli (41.4%) and Klebsiella pneumoniae (24.1%). Imipenem(100.0%) and gentamycin (37.9%) were the two most sensitive drugs. The association between respondents’ educational level and the occurrence of ASB was significant statistically. Conclusion: The prevalence of ASB was relatively high among the respondents. This, therefore, emphasizes the need for routine  screening  of our antenatal female population for ASB in all our health facilities

Innovative use of tourniquet in the management of an advanced abdominal pregnancy to achieve an unusually normal postoperative outcome: a case report

Mrs. UVG was an un-booked G3P1+1 petty trader, who presented with an obstetric ultrasound scan report, with an incidental diagnosis of abdominal pregnancy at 32 weeks of gestation with the placenta attached to the fundus of the uterus. Her admission packed cell volume was 24%. She had pre-operative preparation and 2 units of compatible blood were transfused to correct the anemia. Four additional units of compatible blood were made available before she was scheduled for an exploratory laparotomy at 33 weeks of gestation. A grossly normal male infant weighing 2.2 kg was delivered from the peritoneal cavity with Apgar scores of 2 at 1 minute and the same at 5 minutes. The placenta which was attached to the fundus of the uterus was removed manually completely after a tourniquet had been applied distal to the point of separation. Intra-operative blood loss was 1000 ml. The infant died 1 hour after delivery due to respiratory failure. Autopsy report revealed massive intracerebral hemorrhage and pulmonary hypoplasia. The post-operative period was uneventful and the decline in serum assay of β-human chorionic gonadotrophin postpartum was normal. She was discharged home on the 8th post-operative day and seen at the postnatal clinic twice at weekly intervals with normal serum assay of β-human chorionic gonadotrophin. Her 6 weeks postnatal visit was also uneventful

Sources of Contraceptive Commodities for Users in Nigeria

BACKGROUND: Understanding the sources of contraceptive commodities is an important aspect of the delivery of family planning services and is required by planning programme managers for strategic planning purposes. Findings from the 2003 Nigeria Demographic and Health Survey have previously showed that the private sector was the most frequently reported source of contraceptive supply, providing contraception to two and a half times as many women as the public sector. We conducted a community-based study to examine further the sources of contraceptive commodity for users in Nigeria with a view to identifying their preferences for distribution centres. This information would be useful to improve commodity distribution and to build the necessary capacity for satisfactory delivery of contraceptives. METHODS AND FINDINGS: A multi-stage random sampling technique was used. A state was randomly selected to represent each of the four health zones in Nigeria. Two local government areas (LGAs) were then selected representing both urban and rural areas. Ten enumeration areas were subsequently selected from each LGA. Of the 2,001 respondents aged 15–49 years, 1,647 (82.3%) were sexually active, out of which 244 were found to be using contraceptive methods at the time of the study, giving a contraceptive prevalence of 14.8%. The commonest source of information on contraceptives was through friends (34%), followed by the radio (11.5%) and husbands (10.2%). Most respondents procured their contraceptives from chemist/patent medicine shops (19.7%), while only 0.8% obtained them from designated family planning clinics. The younger groups in this study (15–24 years), single people, Catholics, and Muslims, showed a greater preference for chemist/patent medicine shops for their sources of contraceptives. The older groups and married respondents, however, made use of government and private hospitals to obtain their contraceptives. CONCLUSION: Strategies to increase contraceptive use must take into consideration these identified sources of contraceptives with a view to enhancing the quality, quantity, and variety of methods available, and to building capacity for effective service delivery. There is also a need to encourage the establishment of adolescent-friendly clinics where young people can go for counselling and obtain contraceptives of their choice, including emergency contraceptive pills

Current Practice of Forceps and Vacuum Deliveries by Nigerian Obstetricians

Obstetricians should be competent and confident in the use of both the forceps and vacuum extractor to assist vaginal delivery. Objective : To asses the current practice of forceps and vacuum deliveries by Nigerian Obstetricians. Methodology: A self administered questionnaire survey of 57 Obstetricians that attended the 6th International Congress of the Society of Gynaecology and Obstetrics of Nigeria (SOGON) held in Abuja in November 2002. Results: Most (94.7%) of the Obstetricians surveyed performed these deliveries. The vacuum extractor was used by slightly more Obstetricians (81.5% compared to 79.6% using the forceps). The mean number of forceps and vacuum deliveries performed annually were 17.44 + 16.84 and 9.30 + 10.16 respectively. Most of the respondents believed that these instruments have a place in modern Obstetric practice with more favouring the vacuum to the forceps (89.4 % compared to 77.2%). The most common severe maternal complication experienced by them from both instruments was perineal and lower genital lacerations, while scalp injuries and cephalohaematoma were the most common severe fetal complications from forceps and vacuum deliveries respectively. Maternal and fetal mortality occurred only with the forceps. Conclusion: Assistance with the birth process may be desirable and can be life saving and should always be available. Operative vaginal deliveries are an art that can safely and quickly deliver the fetus in skilled hands. Obstetricians should be trained in their use. Key Words: Forceps, Vacuum, Operative, Vaginal, Delivery, Obstetricians. [Trop J Obstet Gynaecol, 2004;21:40-43

Induced Abortion in Nigeria: Findings from Focus Group Discussion

Abortion is carried out daily in Nigeria despite the restrictive abortion law. This study was carried out to obtain information on societal attitude to the issues of family planning, unwanted pregnancy, abortion, adoption of children and laws relating to them. Focus group discussions were held in south-western Nigeria among 11 sub-groups. Participants felt that there was high prevalence of unwanted pregnancy and abortion particularly among youths. They had high level awareness of contraceptives and ascribed its low use to negative side effects, high cost and provider bias. Christians favoured planning of pregnancies while the Muslims did not. Majority of the respondents had negative perception of induced abortion. Some of them supported abortion if the education of the young girl would be disrupted, if paternity of pregnancy is in dispute, or if it would save the family from shame. Participants supported the enactment of laws that would make adoption of unwanted children easier. (Afr J Reprod Health 2005; 9[1]: 133-141

Characteristics of Abortion Care Seekers in South- Western Nigeria

This prospective hospital-based study was carried out to understand the characteristics of abortion care seekers in south-western Nigeria. Information was obtained from a total of 1876 women seeking abortion at hospitals using a questionnaire. The results show that majority (60%) were between the ages of 15 and 24 years, of which adolescents between the ages of 15 and 19 years constituted 23.7%. Most (63.2%) of the respondents were unmarried, but married women also constituted a significant proportion (30.2%) of the abortion care seekers. Students were the single highest group, while the predominant economic activity was trading (26.7%). Respondents terminated their pregnancies mainly because they were students or because they did not desire to have children. Most (35.5%) of the women were introduced to providers by friends. Average contraceptive prevalence among the abortion care seekers was 27.4%. It is obvious from the results that young persons, especially in-school adolescents, should be targeted for comprehensive sexuality education especially in view of the current HIV/AIDS pandemic. (Afr J Reprod Health 2004; 8[3]: 81-91

Community-Based Survey of Unwanted Pregnancy in Southwestern Nigeria

Unwanted pregnancy, and consequently unsafe abortion, remains major reproductive health problems in Nigeria that needs to be tackled. Unfortunately, there is a dearth of information on this problem at the community level. This study therefore examined the prevalence of unwanted pregnancy in the community as well as associated factors including the views, perceptions and attitudes of community members towards unwanted pregnancy and the pattern of help-seeking behaviour on unwanted pregnancy. Information was obtained from 3,743 women in urban and rural communities in two Nigerian states of Lagos and Edo. At some point in life, 26.6% of the respondents had had unwanted Pregnancy while abortion prevalence was 21.7%. Short birth intervals (21.1%), high cost of raising children (20.1%), interruption of education (20.1%) and being unmarried (17.3%) were the most common reasons for not wanting pregnancies. Most of the respondents (91.3%) were aware of some form of contraception but ever-use rate was only 36.6% while current use rate was 23.4%. Both abortion and contraceptive use were significantly associated with increasing levels of education. Unwanted pregnancy constitutes a problem even at the community level and more research is needed to understand the persistent disparity between contraceptive knowledge and usage, as increased usage will reduce unwanted pregnancy and induced abortion. (Afr J Reprod Health 2004; 8[3]:103-115