Knowledge, Attitude and Practice of Private Medical Practitioners in Calabar towards Post-Abortion Care

This study examined the knowledge, attitude and practice of private medical practitioners in Calabar on abortion, post-abortion care and post-abortion family planning. Forty eight private practitioners who were proprietors of private clinics in the city were interviewed using a structured questionnaire. The results showed that 22.9% of the doctors routinely terminate unwanted pregnancies when requested to do so by women, while 83.3% of them treat women who experience complications of unsafe abortion. The major reasons given by some of the doctors for not terminating unwanted pregnancies were religious, moral and ethical considerations rather than respect for the Nigerian abortion law. Only 18.2% of the doctors use standard procedures such as manual vacuum aspiration (MVA) for the management of patients with abortion and abortion complications. A good number of them did not routinely practice integrated post-abortion family planning and STDs management. There is need for a comprehensive programme of retraining of private medical practitioners in Calabar on the principles and practices of safe abortion, post-abortion care and family planning. These aspects of reproductive health need to be integrated into the medical training curricula in Nigeria. It is believed that this approach would help reduce the present high rate of abortion-related morbidity and mortality in Nigeria. (Afr J Reprod Health 2003; 7 [3]: 55–64) RÉSUMÉ Connaissance, attitude et pratique des praticiens médicaux privés à Calabar envers les soins post-avortements. Cette etude a examiné la connaissance, l'attitude et la pratique des praticiens médicaux privés à Calabar à l'égard de l'avortement, des soins de post-avortement et de la planifiction familiale du post-avortement. Nous avons interviewé 48 praticiens privés, propriétaires des cliniques privées dans la ville, à l'aide d'un questionnaire structuré. Les résultats ont montré que 22,9% des médecins interrompent systématiquement des grossesses non-désirées quand les femmes le demandent alors que 83,3% d'eux soignent les femmes qui ont des complications des avortements dangereux. Les raisons principales données par certains médecins pour lesquelles ils interrompent les grossesses non-desirées étaient plutôt plus pour des considerations religieuses et morales que pour le respect pour la loi nigériane sur l'avortement. Seuls 18,2% emploient des procedures normales telle l'aspiration pneumatique manuelle (APM) pour le traitement des patients qui ont des problèmes de l'avortement et des complications de l'avortement. Bon nombre d'eux ne pratiquent pas systématiquement la planification familiale du post-avortement intégré et du traitement des MSTs. Il faut un programme compréhensif du stage de recyclage des praticiens privés à Calabar sur les principes et les pratiques de l'avortement sans risque, les soins post-avortement et la planification familiale. Ces aspects de la santé reproductive doivent être intégrés dans le programme de la formation médicale au Nigéria. Nous espérons que cette approche aidera à réduire le présent taux élevé de la morbidité et de la mortalité lié à l'avortement au Nigéria. (Rev Afr Santé Reprod 2003; 7[3]: 55–64) KEY WORDS: Private medical practitioners, abortion, family planning, sexually transmitted infection

Diminished neutrophil extracellular trap (NET) formation is a novel innate immune deficiency induced by acute ethanol exposure in polymicrobial sepsis, which can be rescued by CXCL1

<div><p>Polymicrobial sepsis is the result of an exaggerated host immune response to bacterial pathogens. Animal models and human studies demonstrate that alcohol intoxication is a key risk factor for sepsis-induced mortality. Multiple chemokines, such as CXCL1, CXCL2 and CXCL5 are critical for neutrophil recruitment and proper function of neutrophils. However, it is not quite clear the mechanisms by which acute alcohol suppresses immune responses and whether alcohol-induced immunosuppression can be rescued by chemokines. Thus, we assessed whether acute ethanol challenge via gavage diminishes antibacterial host defense in a sepsis model using cecal ligation and puncture (CLP) and whether this immunosuppression can be rescued by exogenous CXCL1. We found acute alcohol intoxication augments mortality and enhances bacterial growth in mice following CLP. Ethanol exposure impairs critical antibacterial functions of mouse and human neutrophils including reactive oxygen species production, neutrophil extracellular trap (NET) formation, and NET-mediated killing in response to both Gram-negative (<i>E</i>. <i>coli</i>) and Gram-positive (<i>Staphylococcus aureus)</i> pathogens. As compared with WT (C57Bl/6) mice, CXCL1 knockout mice display early mortality following acute alcohol exposure followed by CLP. Recombinant CXCL1 (rCXCL1) in acute alcohol challenged CLP mice increases survival, enhances bacterial clearance, improves neutrophil recruitment, and enhances NET formation (NETosis). Recombinant CXCL1 (rCXCL1) administration also augments bacterial killing by alcohol-treated and <i>E</i>. <i>coli-</i> and <i>S</i>. <i>aureus</i>-infected neutrophils. Taken together, our data unveils novel mechanisms underlying acute alcohol-induced dysregulation of the immune responses in polymicrobial sepsis, and CXCL1 is a critical mediator to rescue alcohol-induced immune dysregulation in polymicrobial sepsis.</p></div