Typhoid perforation in Maiduguri, Nigeria

Background: Typhoid fever is still a serious health burden in our environment. Though it is primarily a medical problem, its complications such as perforation require the attention of the surgeon. The disease spears no age or sex; including pregnant women. Four patients with pregnancy and pregnancy related conditions were managed during this period of review and this actually stimulated this study. Method: This is a retrospective study of all patients managed for typhoid perforation over a five-year period in University of Maiduguri Teaching Hospital. Results: Four hundred and sixty-seven patients were managed for typhoid fever in University of Maiduguri Teaching Hospital during the 5-year study period. Forty-three (9.2%) of these patients had typhoid perforations. There were six (14%) deaths among those patients with perforations. High rate of mortality was noted among those with pregnancy and pregnancy related perforations (50%) and multiple perforations requiring resection and anastomosis (100%). Conclusion: The morbidity and mortality associated with typhoid fever in our environment can only be reduced significantly when the nation and public health officials begin to pursue the principles of primary health care with all seriousness it deserves i.e. emphasis on provision of potable water supply and sanitation. Key Words: Typhoid perforation, pregnancy, public health Annals of African Medicine Vol.3(2) 2004: 69-7

Ectopic pregnancy at the university of maiduguri teaching hospital-a ten-year review

Ectopic pregnancy is a common surgical emergency in gynaecology especially in the tropics where the patients usually present with the ruptured variety with the attendant peritoneal flooding and its clinical consequences. Objectives: To determine the incidence, demographic characteristics, risk factors, clinical features, treatment, and outcomes of patients with ectopic pregnancy in our center. Methods: A descriptive study of ectopic pregnancy seen at the University of Maiduguri Teaching Hospital from January 1995 to December 2004. Results: A total of 136 cases of ectopic pregnancies occurred during this period. With the 15,120 deliveries that occurred during the same period, the overall incidence of ectopic pregnancy was 0.9/1000 deliveries (0.9%). Majority of the patients (69.8%) were between 21 to 30 years of age, 57.4% were para 1 to 4 and 86.0% were married. The duration of amenorrhoea ranged between 2 to 14 weeks with a mean of 6.9 weeks and 58.1% of the patient had a period of amenorrhoea of 5- 8weeks. There were no historical risk factors for ectopic gestation in 30.1% of the patients but abortion, infertility, PID and previous ectopic pregnancy were found to be major risk factors. Lower abdominal pain (92.6%) was the commonest symptom and cervical excitation tenderness (51.5%) the commonest sign. The initial diagnosis was missed in 31.6% of the cases. In 69.8% the implantation site was the ampulla and the ectopic pregnancy was ruptured in 68.9% of the patients. All the patients were managed by laparatomy and the 57.4% of the patients that were transfused, were given homologous blood. There was a statistically significant association between blood transfusion and the initial packed cell volume (PCV) and the amount of haemoperitoneum found at operation. There was no maternal death and of 12 patients (8.1%) that developed complications, 8 (66.7%) had wound infection. Conclusion: As absent of risk factors does not in any way exclude the possibility of ectopic pregnancy as shown in thisreview, keeping high index of suspicion is vital in its diagnosis. Education of the populace especially women on ectopic and training and retraining of health care personnel in the management of this gynaecological emergency will reduce its occurrence and improve its management

Incidence and Correlates of HIV-1 RNA Detection in the Breast Milk of Women Receiving HAART for the Prevention of HIV-1 Transmission

The incidence and correlates of breast milk HIV-1 RNA detection were determined in intensively sampled women receiving highly active antiretroviral therapy (HAART) for the prevention of mother-to-child HIV-1 transmission.Women initiated HAART at 34 weeks of pregnancy. Breast milk was collected every 2-5 days during 1 month postpartum for measurements of cell-associated HIV DNA and cell-free HIV RNA. Plasma and breast milk were also collected at 2 weeks, 1, 3 and 6 months for concurrent HIV-1 RNA and DNA measurements. Regression was used to identify cofactors for breast milk HIV-1 RNA detection.Of 259 breast milk specimens from 25 women receiving HAART, 34 had detectable HIV-1 RNA (13%, incidence 1.4 episodes/100 person-days 95% CI = 0.97-1.9). Fourteen of 25 (56%) women had detectable breast milk HIV-1 RNA [mean 2.5 log(10) copies/ml (range 2.0-3.9)] at least once. HIV-1 DNA was consistently detected in breast milk cells despite HAART, and increased slowly over time, at a rate of approximately 1 copy/10(6) cells per day (p = 0.02). Baseline CD4, plasma viral load, HAART duration, and frequency of breast problems were similar in women with and without detectable breast milk HIV-1 RNA. Women with detectable breast milk HIV-1 RNA were more likely to be primiparous than women without (36% vs 0%, p = 0.05). Plasma HIV-1 RNA detection (OR = 9.0, 95%CI = 1.8-44) and plasma HIV-1 RNA levels (OR = 12, 95% CI = 2.5-56) were strongly associated with concurrent detection of breast milk HIV-1 RNA. However, no association was found between breast milk HIV-1 DNA level and concurrent breast milk HIV-1 RNA detection (OR = 0.96, 95%CI = 0.54-1.7).The majority of women on HAART had episodic detection of breast milk HIV-1 RNA. Breast milk HIV-1 RNA detection was associated with systemic viral burden rather than breast milk HIV-1 DNA

Postpartum maternal morbidity requiring hospital admission in Lusaka, Zambia – a descriptive study

BACKGROUND: Information on the extent of postpartum maternal morbidity in developing countries is extremely limited. In many settings, data from hospital-based studies is hard to interpret because of the small proportion of women that have access to medical care. However, in those areas with good uptake of health care, the measurement of the type and incidence of complications severe enough to require hospitalisation may provide useful baseline information on the acute and severe morbidity that women experience in the early weeks following childbirth. An analysis of health services data from Lusaka, Zambia, is presented. METHODS: Six-month retrospective review of hospital registers and 4-week cross-sectional study with prospective identification of postpartum admissions. RESULTS: Both parts of the study identified puerperal sepsis and malaria as, respectively, the leading direct and indirect causes of postpartum morbidity requiring hospital admission. Puerperal sepsis accounted for 34.8% of 365 postpartum admissions in the 6-month period. Malaria and pneumonia together accounted for one-fifth of all postpartum admissions (14.5% & 6% respectively). At least 1.7% of the postpartum population in Lusaka will require hospital-level care for a maternal morbidity. CONCLUSIONS: In developing country urban settings with high public health care usage, meticulous review of hospital registers can provide baseline information on the burden of moderate-to-severe postpartum morbidity

Factors associated with lack of postnatal care among Palestinian women: A cross-sectional study of three clinics in the West Bank

Dhaher E, Mikolajczyk RT, Maxwell AE, Krämer A. Factors associated with lack of postnatal care among Palestinian women: a cross-sectional study of three clinics in the West Bank. BMC Pregnancy and Childbirth. 2008;8(1): 26.Background: Only about one-third of women in Palestine (West Bank and Gaza) obtain postpartum care. Therefore, the goal of this study was to assess factors associated with lack of postnatal care, women's reasons for not obtaining postnatal care, and their attitudes towards its importance. Methods: In early 2006, a cross-sectional survey was conducted at three clinics run by the Ministry of Health providing Mother and Child Health Care in West Bank, Palestine. A total of 264 postpartum women attending the clinics were interviewed face-to-face, using a structured questionnaire. Results: Although the majority of women considered postnatal care necessary (66.1%), only 36.6% of women obtained postnatal care. The most frequent reason for not obtaining postnatal care was that women did not feel sick and therefore did not need postnatal care (85%), followed by not having been told by their doctor to come back for postnatal care (15.5%). Based on a multivariable analysis, use of postnatal care was higher among women who had experienced problems during their delivery, had a cesarean section, or had an instrumental vaginal delivery than among women who had a spontaneous vaginal delivery. Use of postnatal care was also higher among women who delivered in a private hospital as compared to those who delivered in a public hospital. In addition, we found regional differences. Conclusion: The higher use of postnatal care among high-risk women is appropriate, but some clinically dangerous conditions can also occur in low-risk women. Future efforts should therefore focus on providing postnatal care to a larger number of low-risk women

The burden, distribution and risk factors for cervical oncogenic human papilloma virus infection in HIV positive Nigerian women

Background: The expected reduction in cervical cancer incidence as a result of increased access to antiretroviral therapy is yet to be seen. In this study we investigated the effect of HIV infection and treatment on high-risk (hr) human papilloma virus (HPV) prevalence and distribution. Methods: Cervical cells from 515 (220 HIV positive and 295 HIV negative) women, recruited during community cervical cancer screening programme in states of Ogun and Lagos and at the cervical cancer screen clinic, Nigerian Institute of Medical Research Lagos were evaluated for the presence of 13 hr HPV genotypes by polymerase chain reaction based assay. Results: The prevalence of high-risk HPV was 19.6% in the studied population. HPV 16 (3.9%), 35 (3.5%), 58 (3.3%) and 31 (3.3%) were the most common hr HPV infections detected. We observed that the prevalence of hr HPV was higher in HIV positives (24.5%) than 15.9% in HIV negative women (OR = 1.7; 95% CI: 1.1-2.7). A multivariate logistic regression analysis showed a lower hr HPV prevalence in HIV positive women on antiretroviral drugs (OR = 0.4; 95% CI: 0.3-0.5) and with CD4 count of 500 and above (OR = 0.7; 95% CI: 0.5-0.8). A higher prevalence of hr HPV was also noted in HIV positive women with CD4 count <200 cells/mm3 (OR = 2.4; 95% CI: 1.7-5.9). Conclusion: HPV 16, 35, 58 and 31 genotypes were the most common hr HPV infection in our study group, which could be regarded as high risk general population sample; with higher prevalence of HPV 16 and 35 in HIV positive women than in HIV negative women. The use of antiretroviral drugs was found to be associated with a lower prevalence of hr HPV infection, compared to those not on treatment. This study raises important issues that should be further investigated to enable the development of robust cervical cancer prevention and control strategies for women in our setting

The surgical treatment of symptomatic uterine fibroids at the university of maiduguri teaching hospital, Maiduguri, Nigeria.

Uterine fibroid is commonly seen in our practice and myomectomy and hysterectomy are regular procedures on every gynaecological surgery list in our centre. The only treatment offered for symptomatic uterine fibroids in our environment so far is surgery. Objective: To compare the outcome of abdominal myomectomy and abdominal hysterectomy in the surgical management of uterine leiomyomas. Method: This is a retrospective descriptive study of the outcome of myomectomy and hysterectomy for uterine fibroids at the university of Maiduguri teaching hospital. Hospital records of women with histologically confirmed uterine fibroid who had either abdominal myomectomy or abdominal hysterectomy between January 1, 2003 and December 31, 2007 were reviewed. Results: A total of 221 myomectomies and 110 hysterectomies for uterine fibroids over the study period were reviewed. There was no significant difference in the blood transfusion rates (RR 0.8, 95% CI 0.43- 1.5), postoperative wound infection (RR 2.1 CI 0.6-7.4), wound dehiscence (RR 1.3 95% CI 0.2-6.5), intra operative haemorrhage (RR 0.6 95% CI 0.2-2.0), postoperative pyrexia (RR 1.3 95% CI 0.7- 2.7) and mean duration of hospital stay (myomectomy 8.3 days, hysterectomy 8.2 days P value 0.869) between the hysterectomy and myomectomy groups. Myomectomy was however associated with less mean estimated intraoperative blood loss (myomectomy 364.3ml, hysterectomy 423.6ml; P value 0.004) and decreased risk of intraoperative visceral injury(RR 3.1 95% CI 2.6- 3.6). Conclusion: Myomectomy was associated with a decreased intraoperative blood loss and decreased risk of visceral injury compared with hysterectomy. It can therefore be considered a safe alternative to hysterectomy for symptomatic uterine fibroids. It also has the added advantage of preserving a woman's reproductive function