Cervical cancer screening and practice in low resource countries: Nigeria as a case study

Cervical cancer is the most common female genital tract malignancy in Nigeria and majority of the patients present with advanced disease. It is a preventable cancer as there are well‑defined treatable premalignant phases. The objective of the study is to review the burden of cervical cancer, its screening modalities, and practice of screening and treatment in low resource countries with emphasis on Nigeria. This is a review involving internet and literature search. While developed countries have recorded significant reduction in the incidence of cervical cancer owing to organizedscreening programs, treatment of premalignant cervical lesions, and follow‑up of treated cases, developing countries including Nigeria are yet to optimally utilize screening services due to lack of organized population‑based screening programs with only pockets of screening services which are at best opportunistic. This has not reduced the incidence of cancer because only a fraction of the target population is covered. Apart from this, loss to follow‑up is rampant. The level of awareness of cervical cancer and its preventive strategies are low among the population and policymakers in Nigeria. There is no organized screening program, and the few services available are only opportunistic with little or no impact. Development of cervical cancer screening policy and institution of organized screening program targeted at covering ≥80% of population at risk is fundamental. There is also a need for widespread education of the populace on the burden of cervical cancer and the public health importance of the disease using the mass media, counseling at antenatal clinics, and the involvement of men will contribute immensely to reduction in the incidence of cervical cancer. Decentralization of services by incorporation of cervical screening and treatment in primary health care programs will ensure adequate rural‑urban coverage.Keywords: Cervical cancer screening; human papillomavirus, low resource countries; Nigeria; premalignant diseas

Prostaglandin levels and semen quality in male partners of infertile couples in Ile-Ife, Nigeria

The study revealed a high percentage of men with sub-normal semen .Range of PGF2á in the subjects was 0.15-11.05µg/ml with a mean of 2.77± 0.23 µg/ml while that of PGE was 21.8- 652.0 µg/ml with a mean of 248.79± 13.88 µg/ml. Among men with normal semen profile, mean PGF2á and PGE levels are 2.1± 0.32 µg/ml and 325.1± 28.3 µg/ml respectively while that in semen of men with subnormal semen are 3.0± 0.28 µg/ml and 225.1 ± 15.1µg/ml respectively. Despite the wide range of PG values in all the groups, significant differences(P<0.05) were found to exist between the PG values of men in the normal and sub normal semen groups. Significant differences were also found when they were grouped according to sperm count alone. However, differences observed when in the grouping according to other individual semen characteristics are not significant. Conclusion: The wide range of PG values obtained in all the groups make it difficult to make far reaching conclusions as to the relationship between PG levels and semen quality. Further research is desirable in establishing the role of PGs in sperm function

Cross-sectional study of antioxidant status in normotensive and hypertensive pregnancy

Objectives: The study measured the concentrations of antioxidants in women during pregnancy and the Post Partum Period (PPP) with a view to investigating their role in the aetiology of pregnancy induced hypertension (PIH). Study Design: Informed consent was obtained from 105 women who were divided into three groups: 15 age and parity matched normotensive non-pregnant (control group), 45 normotensive and 45 hypertensive pregnant women. The two groups of pregnant women were divided into three groups of 15 each and studied in the second and third trimesters and PPP respectively. Venous blood was obtained from all the participants for measurements of some antioxidants (uric acid, albumin, catalase and vitamin C). Data were analyzed using descriptive and inferential statistical methods. Results: The results show that the mean concentrations of catalase, albumin, vitamin C and uric acid for the control were 3.1 ± 0.18 µ/l, 46.6 ± 6.6 g/l, 0.38 ± 0.01 mg/dl and 0.16 ± 0.03 mmol/l respectively. The mean concentration of all antioxidants except uric acid were significantly lower during pregnancy when compared with controls (t= 2.06; p<0.01). In the normotensive group of pregnant women, vitamin C was the only antioxidant that showed significant higher concentration when the second trimester concentration and third trimester concentration were compared (t=2.06; p<0.05). Uric acid levels were significantly higher (t=2.06; p<0.05) and nd rd catalase and vitamin C levels were significantly lower in the hypertensive group during the 2 and 3 trimesters (t=2.06; p<0.05). There was a tendency for all antioxidant concentrations to return to normal values during the PPPin the normotensive group; however in the hypertensive group, uric acid levels remained significantly higher (t=2.06; p<0.05). Conclusion: In conclusion this study showed that pregnancy generally reduced the concentration of antioxidants but vitamin C levels were higher in late pregnancy of normotensive women. Therefore higher levels of vitamin C may protect against PIH

Trends in vaginal hysterectomy in a Nigerian teaching hospital: A 14-year review

Background: The procedure of vaginal hysterectomy is a fast disappearing art. This study looks at 14 years’ experience of vaginal hysterectomy in Ile‑Ife, Nigeria.Objectives: To determine and compare the rate, indications, and complications of vaginal hysterectomy over a 14-year period at Ile‑Ife, Nigeria.Methods: The medical records of patients managed with vaginal hysterectomies performed from 1st January 2005 to 31st December 2018 were reviewed. The demographics and indications for vaginal hysterectomy were extracted. Data were analyzed using Statistical Package for Service Solutions – IBM version 22. Frequencies and percentages were calculated and associations compared where applicable using Chi‑square with level of significance set at &lt;0.05.Results: Pelvic organ prolapse accounted for 0.8% of gynecological admissions and vaginal hysterectomy accounted for 2.3% of major&nbsp; gynaecological operations. The mean age was 66.1 ± 9.2 years with a mean age of menopause of 15.2 ± 7.1 years. The mean parity was 6.2 ± 1.6. Pelvic organ prolapse was the commonest indication. The mean blood loss at surgery was 314.2 ± 184.8 ml. The modal post‑operative complication was post‑operative anemia, and hypertension was the commonest comorbidity. The mean duration of surgery was 3 ± 0.9 h and the mean duration of admission was 5.4 ± 2.7 days.Conclusion: The rate of vaginal hysterectomy is on the decline. This may be due to case under reporting, limiting of family size, or low uptake of farming occupation in our society. Key words: Comorbidities; complications; incidence; indications; vaginal hysterectomy

Contributions of uterine fibroids to infertility at Ile‑Ife, South‑Western Nigeria

Background: Uterine fibroid is the most common tumor of the female genital tract. The benign tumors often grow into large sizes and assume unsightly shapes with concomitant symptoms and signs. Being a predominantly reproductive age disease, concurrent infertility and symptomatic uterine fibroids pose management challenges. Individualization of the patient is thus essential to the success of the reproductive outcome.Objectives: This study determined the prevalence, trend, management modalities, pregnancy outcome, and exposition of factors affecting pregnancy outcome among patients presenting with uterine fibroids and infertility at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC).Materials and Methods: This is a retrospective study of case records of 106 women managed for uterine fibroids and infertility over a 5‑year period (January 1, 2012, to December 31, 2016) at the OAUTHC. The outcome measure is the pregnancy rate among those who had a myomectomy.Results: About a quarter of women with infertility had symptomatic uterine fibroids and this represents about 35%–40% of the overall number of women presenting as uterine fibroid within the study. About 84.9% had uterine size &gt;12 weeks at presentation. Two‑third of the patients had open myomectomy alone with 43.9% achieving conception thereafter. Conception rate for myomectomy with tuboplasty was 31.3% whereas myomectomy with subsequent in vitro fertilization (IVF) was 50%. Pregnancy rate decreased with increasing size of the uterus before myomectomy.Conclusion: Symptomatic fibroid was significantly prevalent among women with infertility. Myomectomy improves fertility potential and success rate of IVF. Uterine fibroid has both direct and indirect effect on infertility and pregnancy rate in this group of the patient can be improved through routine screening for uterine fibroids and early removal of the fibroids before they grow into giants size.Keywords: Infertility; myomectomy; pregnancy outcome; uterine fibroid

Antibiotic Sensitivity Patterns of Microbial Isolates from the Urine of Pregnant Women with Urinary Tract Infections

Context: Urinary tract infections are the most common bacterial infections during pregnancy. Though the causative organisms have remained essentially the same over time, they have become increasingly resistant to the usual antibiotics. Objective: To determine the current microbial isolates and their pattern of antibiotic sensitivity in pregnant women with urinary tract infection. Patients and Methods:This was a descriptive study done in the Obstetric Unit of the Obafemi Awolowo Unversity Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria. Midstream urine specimens of all pregnant women with features of urinary tract infection were collected and subjected to microscopy, culture and sensitivity before commencement of antibiotic therapy. Results: The incidence of urinary tract infection in pregnancy was 6.2%. The commonest organisms isolated were Escherichia coli (42.2%), Staphylococcus aureus (21.9%), Klebsiella spp (12.8%), unspecified coliform organisms (11.7%) and Streptococcus faecalis (4.2%). Nitrofurantoin (83.7%), gentamicin (61.2%) and pefloxacin (54.2%) were the only antibiotics to which at least 50% of the organisms isolated were sensitive. Conclusion: Gram-negative organisms remain the leading group of organisms infecting the urinary tract of pregnant women at Ile-Ife, Nigeria and they are generally sensitive to nitrofurantoin, gentamicin and pefloxacin. Key Words: Urinary Tract Infection, Pregnancy, Antibiotic Sensitivity [Trop J Obstet Gynaecol, 2003, 20: 113-115

Preterm vaginal birth in the background of an unrepaired vesicovaginal fistula: A case report

Obstetric fistula accounts for most genital tract fistulae seen in the developing countries and poses significant psychosocial stress on the woman. It is a cause of marital disharmony, stigmatization, and infertility. Thus, women with unrepaired vesicovaginal fistula (VVF) rarely present with coexisting pregnancy. We present a rare case of a 29-year-old unbooked G3P2 (1A) with unrepaired VVF who presented with an advanced second stage of labor of a preterm fetus at 32 weeks of gestation. She was referred from a primary health center in labor. She had ruptured her fetal membranes about 3 days before presentation. She had been experiencing continuous involuntary leakage of urine about 2 weeks after vaginal delivery of a macerated male stillbirth following prolonged labor at a traditional birth home about 13 months earlier. She had not sought any specialized care for her condition due to financial challenges. She had regular unprotected coitus despite urinary soiling; her menstrual cycle was regular and she achieved conception. At presentation, she was in intermittent painful distress with bearing down efforts and had ammoniacal fetor. Fundal height was 34 cm and a singleton fetus was palpated in longitudinal lie and cephalic presentation with a normal fetal heart rate. The fetal head was visible at the introitus without parting the labia, and amnii liquor was foul smelling with ammoniacal dermatitis of the vulva and upper thigh. She delivered a live male baby with poor APGAR scores and birth weight of 1.96 kg. A 4 cm × 4 cm mid-vaginal defect was noticed on the anterior vaginal wall accommodating an inflated balloon of urethral catheter. She subsequently had VVF repair and rehabilitation. Financial challenge is an impediment to adequate care of VVF. This report establishes the possibility of regular coitus leading to conception and a live birth despite ongoing urinary soilage. Enhancement of social support services is advocated