Spectrum of Uropathogens and its Antibiotic Susceptibility in Pregnant Women with Symptomatic Urinary Tract Infection in a Nigerian Teaching Hospital. Running headline: Urinary Tract Infection in Pregnancy

Background: Urinary tract infections (UTI) are the most common bacterial infections in pregnancy and associated with maternal and perinatal morbidity and mortality.Objectives: To determine the current uropathogens and their antibiotic susceptibility pattern and to compare the pregnancy outcome among clinical UTI and non clinical UTI cohorts.Patients and methods: This was a prospective matched cohort study carried out between 1st January, 2012 and 30th June, 2012 at the department of Obstetrics and Gynaecology of the University of Ilorin Teaching Hospital, Ilorin, Nigeria. The study population was made up of 200 pregnant women with clinical signs and symptoms of urinary tract infections and 200 pregnant women without clinical signs and symptoms ofurinary tract infection as control matched with maternal age group, parity and gestational age.Results: Of 3442 obstetric patients seen 200 had clinically diagnosed UTI in pregnancy giving a rate of 5.8%. Age bracket 21- 30years and multipara had highest frequency of significant bacteriuria. Low social status and third trimester of pregnancy were identified risk factors for UTI in pregnancy. Frequency of maternal anaemia (p=0.02) and hypertension (p=0.03) were significantly higher among subjects than control. The common bacterial uropathogen isolated were Escherichia coli (46.7%), Staphylococcus aureus (17.9%), Proteus spp.(13.3%) and Klebsiella spp. (11.1%). The antibiotics with highest coverage included Co-amoxyclave (81%), Gentamicin (68.8%) and Cefuroxime (54.4%).Conclusion: Maternal anaemia and hypertension were significantly higher among subjects than control. Gram negative isolates were predominantand E. coli was the most common isolated bacteria. Co-amoxyclave had highest coverage against the bacteria. Therefore, co-amoxyclave is  recommended for empirical use for urinary tract infection in pregnancy in this locality.Keywords: Uropathogens, urinary tract infection, pregnancy, antibiotic sensitivity

Giant Unilocular Intra-Abdominal Abscess after Caesarean Section Mimicking Intestinal Obstruction

Intra abdominal abscess (IAA) following Caesarean section (CS) is rarely unilocular. A giant one 1+ 0 diagnosed 5weeks after CS in a 30-year-old woman, para is presented. The clinical presentation mimicked intestinal obstruction. This presentation emphasized the relevance of plain radiograph and ultrasound in the management of IAA, and discussed the unfavourableoutcome of open laparotomy drainage in the patient. We warn that a healthy postoperative period does not exclude the possibility of a developing intra-abdominal abscess and concluded base on the catastrophic outcome of open laparotomy drainage in this case, that percutaneous drainage may be safer and should be the initial option to in giant IAA

Knowledge and Practices of PMTCT among Health Care Providers in Private Hospital in Ilorin, Nigeria

Introduction: In the developed countries where mother to child transmission of the virus is still high preventing MTCT is essential and starts during the antepartum period where diagnosis can be made andantiretrovirals and other prevention strategies can be instituted. A  significant proportion of Maternity care and delivery services are rendered by private hospitals. Adequate knowledge by health care providers ofantiretroviral use and other PMTCT strategies will be required to ensure control of vertical transmission of the virus.Objective: To assess the knowledge and practice of PMTCT among health care providers in private health facilities in Ilorin, Nigeria.Method: This is a review of health care providers in private health facilities Ilorin, Nigeria, between December2011 and November2012. Information on biodata, general knowledge on HIV and PMTCT and practices done to prevent vertical transmission were collected with use of questionnaires and were analyzed using SPSS statistical software version 17.Result: 265 questionnaires were applied but 223 were complete and analyzed. Their age range was 20-62years; mean age was 32.45+7.0SDyrs and Mean working experience was 5.89+5.17SD yrs. Nurses constituted the greater percentage 64.1% of the health care providers. Knowledge that vertical transmission could be prevented was good (95.5%), however 15.2% felt HIV could be transmitted through sharing of spoon or eating together. Only 20% had training in PMTCT and 17% worked in health facilities where ARV was administered to HIV positive pregnant women. A larger number 72% referred the HIV positive women to other centres for antenatal care and delivery. Antiretroviral drugs administered to the mothers were, 42.1% administered single drug ARV therapy, 21.1% gave 2 ARV drugs which is not in any standard protocol while only 5.3%  administered 3 ARV drugs. Prophylactic ARV administration to the babies also revealed deficiencies.Conclusion: Knowledge and practice of PMTCT among health care providers in private sectors was poor. There were no clear cut guidelines for  antiretroviral drug administration for mothers and babies. Training and retraining on PMTCT should be encouraged.Keywords: Knowledge, Practice, health care provider, PMTC

Rectovaginal fistula following sexual intercourse.

Female genital fistula is an important feature of the developing countries gynecology. Most of the rectovaginal fistulae encountered in the tropics are due to obstetrics causes and genital malignancies. In developed countries, radiation injury and Crohn’s disease are also common etiological factors. Theindex case is reported to highlight the rare situation, where a 24-year old married nullipara sustained low rectovaginal fistula following normal coitus. She was later divorced by her husband

Analysis of 137 obstetric fistula cases seen at three fistula centres in northwest Nigeria

Objectives: To determine the contributory factors to development of obstetric fistula and to determine the knowledge and practice of modern contraception among fistula patients.Design: Descriptive hospital cross-sectional study.Setting: Three fistula centres in north west Nigeria.Subjects: All obstetric fistula patients that met the inclusion criteria.Results: Of 137 cases of obstetric fistula patients that satisfied the inclusion criteria, 88% had only Vesico-vaginal fistula, while 10% and 2% had recto-vaginal fistula, and combined vesico vaginal fistula and recto-vaginal fistula respectively. All the patients had early marriage (before age 20 years) with median ages at first marriage of 15 years and at presentation in hospital of 16 years. Majority (93.4%) of the patients developed fistula during the first delivery. Approximately two-third of the patients had no form of education. Only 42.3% of the patients received antenatal care and 86% delivered at home. Only 28% of the patients was aware of modern contraception and 2% had used modern contraceptive before developing fistula. All the patients expressed willingness to use modern contraception after fistula repair.Conclusion: This study shows that child marriage, low education, unskilled birth attendance and low contraceptive uptake are common among the obstetric fistula patients in north west Nigeria. Public advocacy and formulation of laws and policies to protect girls from early marriage, girl child education to secondary school level be encouraged, public education on the importance of and utilisation of maternity and modern family planning services

Pharmacological Exposure of Pregnant Mothers in Ilorin, Nigeria

Context: Use of drug during pregnancy is a universal event. However, in developing countries, drug use is poorly controlled as most of the drugs could be obtained without prescription. This constitutes potential hazard both for the mother and the fetus.Objective: To determine the pattern of drug use (including alcohol and smoking) prescription and non prescription of drug by pregnant mothers in Ilorin, Kwara State, Nigeria.Study Design: A cross sectional study of pregnant mothers attending antenatal clinic of the University of Ilorin Teaching Hospital, Ilorin.Result: Four hundred 400 pregnant women participated in the study, 335 adequately completed questionnaire for data analysis. Majority of the respondents 273 (81.5%) had taken one or more drugs, 62 (18.5%) had not used any. Average number of drugs used was 2.7. Routine haematinics (folic acid and Ferrous Sulphate) are the common drug taken by 241 (81.5%) of the respondents. Anti malarial drugs were taken by 47 (14%) while herbal drug was taken by 41 (12.2%). Five (1.5%) of the respondents admitted to taking alcohol and only one woman (0.3%) admitted to smoking cigarette. One (0.3%) each of the respondents was on anti depressant and anticonvulsant drugs. Occupation was significantly related to herbal use. Parity was also significantly related to alcohol consumption and the use of unprescribed drugs.Conclusion: Drug use is common during pregnancy. Haematinics were the commonest drug used. Herbs are used to some extent and antimalarials are underutilized. Alcohol is minimally used and smoking during pregnancy is virtually non- existent. There is need to caution our pregnant mothers on the use of herbs as there is no full understanding of their pharmacokinetics

Attitudes to female genital mutilation/cutting among male adolescents in Ilorin, Nigeria

Background. The central role of males in female reproductive health issues in patriarchal societies makes them an important group in the eradication of female genital mutilation/cutting (FGM/C).Objectives. To determine knowledge about and attitudes to FGM/C among male adolescents, and their preparedness to protect their future daughters from it.Methods. A cross-sectional survey among male adolescent students in Ilorin, Nigeria. Participants completed a self-administered questionnaire after consent had been obtained from them or their parents. Statistical analysis was with SPSS version 20.0 (IBM, USA). A p-value of <0.05 was taken as significant.Results. Of 1 536 male adolescents (mean age 15.09 (standard deviation 1.84) years, range 14 - 19), 1 184 (77.1%) were aware of FGM/C, 514 (33.5%) supported female circumcision, 362 (23.6%) would circumcise their future  daughters, 420 (27.3%) were of the opinion that FGM/C had benefits, mostly as a necessity for womanhood (109, 7.1%), and 627 (40.8%) perceived it as  wickedness against females; 546 (35.5%) were aware of efforts to eradicate FGM/C, and 42.2% recommended education as the most important intervention to achieve this.Conclusion. Education and involvement in advocacy may transform male adolescents into agents for eradication of FGM/C

A population-based cross-sectional study of age-specific risk factors for high risk human papillomavirus prevalence in rural Nigeria

<p>Abstract</p> <p>Background</p> <p>Cervical cancer, caused by persistent infection with carcinogenic human papillomavirus (HR-HPV), is particularly prevalent in Sub-Saharan Africa and is associated with a high mortality rate. Some studies in West Africa, including our own, have found unusually high HR-HPV across all ages with a slight peak in older women. This increased prevalence at older ages may complicate screen-and-treat programs, which are implemented in regions where HPV prevalence declines with age and typically target women between 30-49 years. A better understanding of the determinants of high HR-HPV prevalence at older ages is needed. The goal of this study is to explore risk factors for HR-HPV prevalence by age among women in our population-based study in Irun, a rural town in southwestern Nigeria.</p> <p>Methods</p> <p>1,420 women were administered a clinic-based questionnaire regarding sexual and reproductive behavior, marital status (including co-wives), and malaria exposure. Logistic regression compared questionnaire responses and PCR positivity for a set of 13 carcinogenic HR-HPV types. Results were stratified by age (15-29, 30-45, 46-55, and 56+ years).</p> <p>Results</p> <p>Birth control use and age at first pregnancy were associated with HR-HPV (<it>p-value </it>= 0.03 and 0.05, respectively). Early age at sexual debut and multiple sex partners were risks for HR-HPV, but did not reach significance (<it>p-value </it>= 0.1 and 0.07, respectively). Neither self-reported malaria nor presence of co-wives in the household was associated with HR-HPV (<it>p-value </it>= 0.85 and 0.24, respectively). In age sub-categories, early age at sexual debut was a significant risk factor for HR-HPV among women 35-45 years (<it>p-value = 0.02</it>). Early age at first pregnancy remained a significant risk factor for women aged 56+ years (<it>p-value </it>= 0.04). Greater than 2 sex partners and use of birth control were associated (though not significantly) with HR-HPV in women aged 30-45 (<it>p-value </it>= 0.08, respectively).</p> <p>Conclusions</p> <p>In this high-risk region with elevated HR-HPV prevalence at older ages, we confirmed previously described, behavioral determinants of HR-HPV. There was no association with self-reported malaria or co-wives, which we had hypothesized might correlate with HR-HPV at older ages.</p