Hysterectomy in Adolescents, in Port Harcourt, Nigeria.

Background: Hysterectomy in adolescents is a very difficult decision to take as the consequence is always a loss of future reproductive potential. However, it may be necessary sometimes as a salvage measure.Methods: A retrospective descriptive analysis of 28 cases of adolescent hysterectomies managed at the University of Port-Harcourt (UPTH) over a 17-year period was carried out. Variables analysed included socio-demographic factors, indications for and type of hysterectomy performed, decision level, duration of surgery and complications encountered.Results: Majority (78%) of the hysterectomies were in adolescents aged 16 years and above. Sixty percent of them had a secondary education, 78% were unmarried and nine had a previous successful pregnancy. About half the cases resided in rural areas, while half resided in urban settlements. Seventy-one percent of the hysterectomies were abortionrelated. Decisions for the hysterectomies were taken mainly by consultants and occasionally, in dire emergencies, by senior residents to prevent death from bleeding. Mortality was 21%.Conclusion: The results suggest the need for a greater emphasis on sexuality education and expansion of sexual and reproductive health services to adolescents especially those who are sexually active. Life planning and livelihood skills training are needed to enable young people acquire valuebased skills, which are essential for making safe and informed choices. With such high level of mortality from septic abortion even with intervention, the need for Youth Friendly Centres/services cannot be over emphasized

Awareness and practice of emergency contraception at a private university in Nigeria.

BACKGROUND: The pursuit of formal education now causes many people in developing countries to marry later in life, thereby leading to increased premarital sex and unintended pregnancies. Efforts have been made to characterize awareness and use of emergency contraception (EC) among undergraduate students in public universities in Nigeria; however, it is not known if students in private tertiary institutions adopt different practices or if having an affluent family background plays a role. This pilot study therefore aimed to assess the awareness and use of EC among students at a private Nigerian university toward assisting education planners in developing strategies in improving students' reproductive well-being. RESULTS: Out of 94 female students, 42 (44.7%) had sexual experience, but only 32 (34.0%) were currently sexually active. Six students (6.4%) had had unwanted pregnancies, of which all but one were terminated. Fifty-seven respondents (60.6%) were aware of EC, though only 10 (10.6%) ever practiced it. The greatest source of EC information was from health workers and peers; the lowest source was family or relatives. Most respondents desired orientation and availability of EC on campus. EC awareness among the students was predicted by upper social class background (adjusted odds ratio [OR], 2.73; 95% confidence interval [CI], 1.06-7.45) and upbringing in the Federal Capital Territory (adjusted OR, 4.45; 95% CI, 1.56-14.22). CONCLUSIONS: Though awareness of EC was higher among the private university students in this study than at most public universities, there was no difference in EC usage. A high pregnancy termination rate was observed; dilatation and curettage were mainly adopted. In Nigeria, youth-friendly reproductive health information and access should not be limited to government-owned tertiary institutions but also extended to private ones

An assessment of high risk sexual behaviour and HIV transmission among migrant oil workers in the Niger Delta area of Nigeria

No Abstract. Nigrian Journal of Clinical Practice Vol.9 (1) 2006: pp.48-5

Homosexuality amongst migrant oil workers in the Niger Delta region of Nigeria

Aims: To determine the prevalence of homosexuality among migrant oil workers in Niger Delta. Methods: A prospective questionnaire – based study was conducted among migrant oil workers in the Niger Delta region of Nigeria. The design was to determine the prevalence of homosexuality in the workers in oil workers. The questionnaire was administered to 314 subjects. Results: Out of 314 subjects, only 5.14% of the subjects practice homosexuality. There was no case of Lesbianism. There was a 70.6% used of condom in those who were homosexual, while 29.4% did not use condom. All the subjects who practice homosexuality are below the age of 45years. The synagestic behaviour profile thus reported points to a problem trigger that may fuel an already high sero-prevalence of HIV and STI in the region. Conclusion: The emergencies of homosexuality in oil workers may worsen the existing problems of HIV and other STI in the community of Niger Delta region. Highland Medical Research Journal Vol. 4(1) 2006: 53-5

Sociodemographic Characteristics Of Young Adults Screened For HIV In A Tertiary Health Centre In South-South Nigeria

Background: Human immune deficiency virus (HIV) infection is endemic globally, more so in developing countries like Nigeria and is an important cause of mortality and morbidity. Objective: This study was undertaken to document the sero-prevalence of HIV infection among young adults (10 – 24 years). Method: HIV screening was performed on all (n = 673) young adults referred to the retrovirology unit of the Haematology Department of the University of Port Harcourt Teaching Hospital between January 2003 to December 2003 comprising of 205 males and 432 females were screened for HIV using a double ELISA confirmatory of Immunocomb and Genscreen HIV 1 & 2 kits. Result: A total of 637 young adults were screened for HIV. Two hundred and seventy-two (42.7%) were found positive to HIV. The highest infection burden occurred among the 20-24 years group 242 (50%) and lowest among the 10-14years group 4(12.1%). Infection rate was significantly higher among females 217 (50.2%), and in less educated adolescent with no formal education 56 (80%). History of alcoholism 262 (99.2%), drug use 146(60.6), number of sexual partners and age at first sexual debut were independent risk factors in adolescents for infection with HIV (P < 0.05). Conclusion: This study confirmed a high prevalence of HIV among adolescents and describes the groups more at risk as seen in other parts of Nigeria. This calls for urgent health education of the young adult population with emphasis on a combination of behavioural and social changes to curb the spread of HIV. Key Words: Socio demographic, HIV infection, young adults, Nigeria Highland Medical Research Journal Vol. 3 (1) 2005: 24-3

Antiretroviral drug compliance and implications in a resource - poor setting

No Abstract. Nigerian Medical Practitioner Vol. 49(3) 2006: 42-4

Urethral Injury Following Genital Mutilation in Pregnancy: A Rate Cause of Postpartum Haemorrhage

OBJECTIVE: To reveal the danger in genital mutilation in pregnancy METHOD:The authors present the case of a 20-year old primigravida who was subjected to this ritual in the third trimester, sustained focal injuries to the urethra which initially healed, but during delivery 4 weeks later, and resulted in significant primary postpartum haemorrhage. RESULTS: Her pregnancy was unsupervised; she received 2 doses of tetanus toxoid 4 weeks apart in a local health center. The pregnancy was uneventful until she was subjected to the genital cutting 4 weeks earlier by an appointed lady in the community whom she recognized as a health assistant who gave her the tetanus toxoid injection. The aim was to enable her achieve “a safe vaginal delivery and be accepted as a woman in her Community”. The procedure involved slicing of the upper part of her urethral region along with the clitoris with a “sharp object”, a local herb was applied and there was no significant bleeding as her thighs were strapped together for about 2 hours when the ritual singing was completed Her cervix could barely admit two fingers; there was neither evidence of laceration nor active haemorrhage from the uterus. A diagnosis of primary post partum haemorrhage due to genital injuries secondary to female genital mutilation in pregnancy in imminent shock was made. Immediate resuscitation included rapid infusion of 1 liter of normal saline; she received two units of compatible whole blood at a pre transfusion packedcell volume of 18%. CONCLUSION: There is the need to establish National Policies and Programmes that will be effectively backed with legal instruments to abolish female genital mutilation. Health care providers and policy makers in the mean time should be aware and well trained in the management of FGM complications to decrease the risks of mortality and serious morbidity. The obvious danger of this barbaric ritual in pregnancy labour and pueperium is highlighted for increased sanctions and advocacy at all level of healthcare. Nig Jnl Orthopaedics & Trauma Vol.2(2) 2003: 130-13