Prevalence, Clinical Pattern and Major Causes of Male Infertility in Nnewi, South East Nigeria: A Five YearReview

BACKGROUND: Infertility is a major cause of marital disharmony in Nigeria because of the high premium placed on child bearing. Unfortunately, the blame is on the woman most times. OBJECTIVES: To determine the prevalence, clinical pattern and major causes of infertility based on the clinical and laboratory findings of both partners. METHODOLOGY: This is a descriptive retrospective study of 268 infertility cases that presented at Nnamdi Azikiwe University Teaching Hospital, Nnewi over a five-year period, between January 1, 2005 and December 31, 2009. RESULTS: Of the 1449 patients that presented at the gynaecology clinic, 268 came because of infertility giving a prevalence of 18.5%. The mean age was 39.1±6.0 years .The majority ( 68% )stopped formal education at the secondary level. Seventy-two percent were employed as unskilled workers. 13% admitted the history of alcohol intake while none took tobacco. The mean duration of infertility was 5 years. The more frequent type of infertility was secondary infertility (59%). The leading cause of male infertility was oligospermia. Male factor infertility alone accounted for 52 (25%)of the cases. CONCLUSION: Contribution of male factor to infertility is high. There is a need for public education on the contribution of male factor to infertility. Keywords: Prevalence, clinical pattern, male infertility, Nigeri

The Pattern and Obstetric Outcome of Hypertensive Disorders of Pregnancy in Nnewi, Nigeria

BACKGROUND:Hypertension is a common medical complication of pregnancy. It is one of the leading causes of maternal and fetal mortality and morbidity worldwide. Early detection, close surveillance and timely delivery are necessary to reduce complications associated with the condition.OBJECTIVES: To determine the pattern, risk factors, maternal and fetal outcomes in women with hypertensive disorders of pregnancy.METHODOLOGY:This was a descriptive retrospective study of the pattern and obstetrics outcome of hypertensive disorders in Nnewi.. The Obstetric variables from 148 women with hypertensive disorders of pregnancy at the Nnamdi Azikiwe University Teaching Hospital Nnewi, from the 1st January 2004 to 31st December 2008 were analyzed. Stastical analysis was done using Epi Info version 3.3.2. The level of statistical significance was set at P<0.05.RESULTS: of the 4021 deliveries in the hospital during the period under review, 148(3.7%) were managed for hypertensive disorders of pregnancy. Only 138 folders were used for analysis. The mean age of the women was 31.3±5.7years. Majority of the women were unbooked (57.2%). Pre-eclampsia was the commonest type of hypertensive disorder of pregnancy (46.4%) with the majority presenting with severe disease. The level of proteinuria was significant in 74.6% of cases of preeclampsia. The mean gestational age at delivery was 35.3±1.5weeks. The mean birth weight was 1.6±0.3kg. Twenty-four intra uterine deaths were recorded giving a stillbirth rate of 17.4%. The perinatal mortality rate was 20.9%.  Diagnosis was made in the ante-partum period in 92.0% of the cases while 55.2% of the women delivered through Caesarean section. Eight maternal deaths were recorded, giving a case fatality rate of 5.8%. CONCLUSION: Hypertensive disorders of pregnancy are associated with high maternal and fetal morbidity and mortality in Nnewi, Nigeria. Antenatal care will help in early diagnosis and timely intervention of the cases. There is need for strengthening of communication and referral systems in the healthcare.KEY WORDS: Hypertensive disorders, pattern, obstetrics outcome.Erratum Note: Mbachu 1, Udigwe GO, Okafor CI, Umeonunihu OS, Ezeama C, Eleje GU on the article “The Pattern and Obstetric Outcome of Hypertensive Disorders of Pregnancy in Nnewi, Nigeria” on Page Nig. J. Med 2013. 117-122. Should read: Mbachu II, Udigwe GO, Okafor CI, Umeonunihu OS, Ezeama C, Eleje GU

The Role of Human Papilloma Virus (HPV) Testing in Cervical Cancer Screening

Background: Cervical cancer is the most studied gynaecologic cancer with a clear natural history. Screening for the premalignant lesions has reduced the mortality from cervical cancer mainly in developed countries. Cancer of the cervix is regarded as a sexually transmitted disease because of its association with human papilloma virus. The backbone of screening has been pap smear. The variability of the sensitivity and specificity of Pap smear has lead to development of other screening tests including HPV testing. Aim: To review the role of human papilloma virus testing in cervical cancer screening. Methodology: A medline and other internet search engines were accessed to retrieve online publications on human papilloma virus and cervical cancer. Textbooks and other hard copies of publications on human papilloma virus and cervical cancer were also accessed and information extracted. Result: HPV testing can be used either alone or as an adjunct screening test for pre-malignant lesions of the cervix. It can also be used in monitoring of treatment. It provides an explorable option in low resource countries with high disease burden and no organized screening programme. Conclusion: Development of strategies that will incooperate HPV testing will reduce the false positive results from pap smear and increase the uptake of cervical cancer screening in developed countries. The extent of the role will also be determined by the existing infrastructure. Key words: Cervical cancer, screening, human papilloma virus, testing

A review of the prevalence and pattern of presentation of gynaecological cancers in a tertiary hospital in Nnewi, South-East Nigeria

Background: Although the battle against infections and communicable diseases is still ongoing, malignancies are increasingly becoming a health burden especially in gynaecological practice due to the late presentation of cancer patients. When these patients present with advanced forms of disease, medical personnel are often handicapped as they can only offer palliative treatment.Aim / Objective: To conduct a preliminary review (pilot study) of gynaecological cancers in our centre preparatory to the establishment of a Gynaecological Oncology unit.Method: This is a retrospective review of gynaecological cancers in our centre over a three-year period using information from patients’ folders, and theatre and admission registers.Results: Out of a total of 1849 new gynaecological patients, 57(3.1%) were malignancies, representing 10.8% of all gynaecological admissions. Cervical cancer (61.4%) remains the most common cancer, while cancers of the fallopian tube and vulva (1.8%) are the least common. About 80% of the patients either had only primary or no formal education. The mean onset-to-presentation interval for symptoms ranged from 130days for cervical cancer to 336days for endometrial cancer.Conclusion: Cervical cancer, though largely preventable, remains the most common gynaecological cancer in our environment with a strong linkage to illiteracy.Keywords: Cancers, gynaecological, Nnewi, patter

The pattern of gynaecological outpatient diagnosis in a tertiary health institution in southeast Nigeria

Background: Pattern of clinical presentations and diagnosis varies worldwide. Determining the pattern of clinical cases seen in low resourceareas is necessary to ensure an efficient distribution of the available human and material resources, and planning.Objective: To determine the pattern of gynaecological cases seen at the Nnamdi Azikiwe University Teaching Hospital Nnewi, Nigeria.Study design/settingA retrospective study of all the cases seen in the gynaecological outpatient clinic of Nnamdi Azikiwe University Teaching Hospital, Nnewi overa 5-year period.Materials and methods: The case files of all the gynaecological patients seen within the study period were analyzed for biosocial data and theclinical diagnosis. Data analysis was done with epi info version 2006.Result: 1108 cases were seen during the study period but only 1066 folders were available for analysis. Majority (53.0%) of the patients wereaged 20-29 years, and most of them were nulliparous (47.7%). 77.8 % of the patients had acquired secondary education and above, while mostof them (36.6%) were civil servants. 59.3 percent of the patients were married. Infertility was the commonest case seen (36.6%) followed by uterine fibroids (17.3%), gynaecological cancers (13.2%) and gynaecological infections (10.2%). Only 0.6 %( n=6) of the patients presented on account of contraceptive needs. Of the gynaecological cancers, carcinoma of the cervix was the commonest gynaecological malignancy (53.2%), followed by cancer of the ovary (22.7%) and cancer of the endometrium (13.5%)Conclusion: Infertility, uterine fibroids and gynaecological cancers were the commonest gynaecological cases seen among the patients. There isthe need to build capacity towards an effective and up to date management of these case

Prevalence and pattern of stillbirths in a tertiary institution in South-East Nigeria

Background: Death of a foetus in-utero is devastating both to the parents and the attending obstetrician. Knowledge of the relative importance of the different causes will help in the prevention or reduction of its occurrence.Aim: This study evaluated the prevalence and pattern of stillbirths at the Nnamdi Azikiwe University Teaching Hospital Nnewi, Anambra State, South-East Nigeria.Methodology: This was a retrospective study of 297 stillbirths at the Nnamdi Azikiwe University Teaching Hospital, Nnewi from 1st January, 2007 to 31st December, 2011.Results: The stillbirth rate was 56.9/1000 deliveries. Majority of the cases 238 (80.1%) were unbooked. One hundred and twenty-nine (43.4%) were nulliparous. There were 180 (60.6%) male stillbirths while 117 (39.4%) were females. The major causes were abruptio placentae 40 (13.5%), prolonged pregnancy 38 (12.8%), uterine rupture 37 (12.5%) and pre-eclampsia 31 (10.4%). Seventy (23.6%) cases were unexplained.Conclusion: The stillbirth rate is high in our centre. There is need for quality, accessible and affordable antenatal care and delivery services to reduce the rate of stillbirth. Establishment of a subspecialty of prenatal diagnosis and foetal medicine will help in reducing the rate of stillbirths in our environment.Keywords: Foetal death, nulliparous, obstetric care, risk factors, unbooke

Pattern of Presentation of Cervical Cancer at Nnamdi Az ikiwe University Teaching Hospital, Nnewi

Background: Cervical cancer is the second commonest cancer among women worldwide. It remains the commonest cancer cause of death among women in developing countries. Objectives: This is to assess the pattern of presentation of cervical cancer in Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi and to make relevant recommendation concerning screening. Methods: This is a retrospective review of the case records of st patients managed for cancer of the cervix between January 1 st 1999 and December 31 , 2008. Results: Thirty seven patients were included in the study. The mean age of the patients was 59.7 + 13.3 years while the mean parity was 6.4 + 3.2. Only 23.1% of the women had at least a secondary education while 46.2% had no formal education. The commonest presenting symptom was post menopausal vaginal bleeding (67.6%) followed by irregular vaginal bleeding (59.5%), watery vaginal discharge (35.1%) and post coital bleeding (16.2%). Weight loss was present in 29.7% while 10.8% had evidence of distant metastasis. The mean duration of symptom was 4.5 + 3.6 months, and the commonest cause of delayed presentation was inability to appreciate the problem (77.8%). Only 7.1% had stage 1 disease while 46.4% had stage 3b. Complication was present in 75.7% of patients. Squamous cell carcinoma accounted for 84.2% of the cancers. Treatment was mainly palliative for these women. Conclusion: Late presentation is common in our environment. Women empowerment and increased provision of cervical cancer screening are expected to reduce the burden of this disease. In resource-deprived settings, expanded training on visual inspection techniques cannot be overemphasized. Key words: Cervical cancer, presentation, vaginal bleeding. Afrimedic Journal 2010; 1(1): 20-2

Third Degree Perineal Tear Following Sexual assault in a minor: a case report and review of literature

Background: Child sexual assault presents a major challenge to the society that is supposed to be protective. This has both short and long-term health implications for the child. Objectives: This is to highlight the presence of child sexual assault in our society, its associated complications and to proffer ways of preventing its occurrence in our society. Methods: A case report of third degree perineal tear following sexual assault in a minor that presented with vaginal bleeding. Results: The third degree perineal tear was repaired after resuscitation. There was no incontinence of flatus and faeces post repair. Conclusion: Child sexual abuse is present in our society and may be associated with severe injury. Prompt management of injuries is very important in preventing long term effects. Keywords: Perineal tear, sexual assault, minor. Afrimedic Journal 2010; 1(1): 37-3

Pregnancy Outcome in HIV Seropositive Women Booked at a Tertiary Healthcare Institution in South Eastern Nigeria

Background: The Human Immunodeficiency Virus (HIV) pandemic remains a major public health issue in developing countries with the prevention of mother to child transmission (PMTCT) being a key challenge. Various reports have been published on the effect of HIV on pregnancy with conflicting results. Objective: This was to determine the effect of HIV infection on pregnancy outcome among women booked for antenatal care at Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi to provide a baseline for further studies. Methods: This is a retrospective study of cases of HIV in pregnancy managed between 1st January, 2006 and 31st December 2007, at NAUTH, Nnewi. Results: Out of a total of 2,960 pregnant women booked for ante-natal care within the study period and a seroprevalence rate of 10.5% was noted. Two hundred and fifty patients were included in the study. The majority, 170 (68%) of the patients were between 21-29 years and the majority also, 148 (59.2%) were of low parity (0-2). Only 181 (72.4%) of the patients had an entry CD4 count of = 500/ml. All the patients were on Highly Active Antiretroviral Therapy (HAART) during the pregnancy. Maternal complications were encountered in 176 (70.4%) cases, anaemia being the commonest, 100 (40.0%). The commonest foetal complications were stillbirth, 26 (10.4%) and low birth weight 54 (21.6%). Sixty three (25.2%) of the women had puerperal complications. There was no maternal or perinatal death. Conclusion: The HIV sero-prevalence rate among pregnant women booked for antenatal care at NAUTH, Nnewi was high, but the effect of HIV on pregnancy was very minimal. Key words: pregnancy outcome, HIV sero-positive, booked women Afrimedic Journal 2010; 1(2): 28-3