Management of Rectovaginal Fistulas at the National Obstetric Fistula Centre, Abakaliki over a 5-year Period

Objective: To share our experience in the management of rectovaginal fistula. Methods This was a retrospective study conducted at the National Obstetric Fistula Centre, Abakaliki, South-East Nigeria. The case folders of patients that had rectovaginal fistula between January 2012 and December 2016 were reviewed. Data was analyzed using the Statistical Package for Social Sciences, version 21. Results The records of 21 out of 26 patients who had rectovaginal fistula were available for review. The mean age was 31 ± 9 years. Majority (95.24%) were Christians. Twenty (95.24%) of  the cases were low rectovaginal fistula. The risk factors for rectovaginal fistula were mainly episiotomy, perineal tears during labour and prolonged obstructed labour Two (10%) out of the 20 patients that had surgery had minor complications. There was no mortality. The success rate after the first repair was 85% for those that were offered surgery. Conclusion The study suggests a good outcome for the patients reviewed with minimal complications. Keywords: Rectovaginal fistula, episiotomy, perineal tear

Evaluation of Vesicouterine Fistula with Ultrasonography in a Resource-constrained Setting

Objective: To determine the role of ultrasonography in the evaluation of patients with vesicouterine fistula. Methodology: This was a retrospective study conducted at the National Obstetric Fistula Centre, Abakaliki, South-East Nigeria between January 2015 and November 2016. Ethical clearance was obtained from Ethics and Research Committee of the National Obstetric Fistula Centre, Abakaliki, Nigeria. A total of 25 patients had vesicouterine fistula during the study period. The records of 22 patients who had pelvic ultrasonography were reviewed and formed the basis of this study. Results: The mean age of the study population was 30.1±6.2 years. Pelvic ultrasonography revealed a communication between the uterus and the bladder in 19 (86.4%) of patients which is suggestive of vesicouterine fistula. Three patients (13.6%) had normal sonographic assessment. All patients were successfully repaired. Conclusion: Ultrasonography appears to be a useful, cheap, quick and readily available means of evaluating vesicouterine fistula in a resource-constrained setting. It provides an added advantage to clinical diagnosis in the evaluation of vesicouterine fistula. Keywords: Vesicouterine fistula, urogenital fistula, ultrasonography

Relationship between spiritual wellbeing and medication adherence among adults attending the antiretroviral therapy clinic of Bingham University Teaching Hospital, Jos

Introduction: HIV causes AIDS, which is a potentially life-threatening diagnosis, that can trigger deep spiritual questions about the meaning of illness, purpose of life, and relationship with God. When people living with HIV/AIDS take their medications, the virus is exposed to inadequate concentrations of antiretroviral medications. Spirituality assessment is increasingly becoming an important assessment for people with illnesses like HIV/AIDS, especially for evaluating the ART usage and for finding solutions to identified barriers influencing adherence to ARVs. Aim: The aim of the study was to determine the relationship between spiritual wellbeing and medication adherence of adults attending the ART Clinic of Bingham University Teaching Hospital, Jos. Methodology: The study was a cross-sectional analytic study carried out in the ART Clinic of Bingham University Teaching Hospital, Jos. A systematic random sampling method was used to select 372 consenting adults attending the ART clinic, who fulfilled the selection criteria. A semi-structured interviewer administered questionnaire was used to collect data, which was analyzed with the SPSS, version 22. Results: Majority of the study participants were between 18 and 49 years old. The prevalence of medication adherence in this study was 34.1%. More than half of the study participants had a high spiritual wellbeing score. Most of the clients were diagnosed with HIV for 1 - 10 years and had been on ART for about the same period. There was a significant relationship between spiritual wellbeing, educational status (p = 0.000) and high medication adherence of the study participants (p = 0.000). Conclusion: Non-adherence to antiretroviral drugs was common at Bingham University Teaching Hospital, Jos. The findings of this study illustrate the necessity for Researchers, Clinicians and Policy makers to understand the perspectives and relevance attributed to spirituality/religiosity by HIV/AIDS clients. Family Physicians should use every encounter with HIV/AIDS patient to screen for their medication adherence and spiritual wellbeing

Relationship between spiritual wellbeing and medication adherence among adults attending the antiretroviral therapy clinic of Bingham University Teaching Hospital, Jos

Introduction: HIV causes AIDS, which is a potentially life-threatening diagnosis, that can trigger deep spiritual questions about the meaning of illness, purpose of life, and relationship with God. When people living with HIV/AIDS take their medications, the virus is exposed to inadequate concentrations of antiretroviral medications. Spirituality assessment is increasingly becoming an important assessment for people with illnesses like HIV/AIDS, especially for evaluating the ART usage and for finding solutions to identified barriers influencing adherence to ARVs.Aim: The aim of the study was to determine the relationship between spiritual wellbeing and medication adherence of adults attending the ART Clinic of Bingham University Teaching Hospital, Jos.Methodology: The study was a cross-sectional analytic study carried out in the ART Clinic of Bingham University Teaching Hospital, Jos. A systematic random sampling method was used to select 372 consenting adults attending the ART clinic, who fulfilled the selection criteria. A semi-structured interviewer administered questionnaire was used to collect data, which was analyzed with the SPSS, version 22.Results: Majority of the study participants were between 18 and 49 years old. The prevalence of medication adherence in this study was 34.1%. More than half of the study participants had a high spiritual wellbeing score. Most of the clients were diagnosed with HIV for 1 - 10 years and had been on ART for about the same period. There was a significant relationship between spiritual wellbeing, educational status (p = 0.000) and high medication adherence of the study participants (p = 0.000).Conclusion: Non-adherence to antiretroviral drugs was common at Bingham University Teaching Hospital, Jos. The findings of this study illustrate the necessity for Researchers, Clinicians and Policy makers to understand the perspectives and relevance attributed to spirituality/religiosity by HIV/AIDS clients. Family Physicians should use every encounter with HIV/AIDS patient to screen for their medication adherence and spiritual wellbeing. Keywords: Spiritual wellbeing, Medication adherence, Antiretroviral therapy, Adults, Bingham University Teaching Hospital, Jo