Menstruation in Rural Igbo Women of South East Nigeria: Attitudes, Beliefs and Practices

Many cultures hold on to different beliefs and retain community-defined restrictions for menstruating women. The Igbo society of southeast Nigeria is rich in culture, myths and superstitions but, surprisingly no documentation exists on menstrual beliefs and practices among the population. This questionnaire-based cross sectional study supplemented with in-depth interviews evaluated the beliefs, myths and traditional practices associated with menstruation within rural Igbo communities. It revealed that the menstrual egress is of great significance in Igbo culture and must be disposed of carefully to avoid exposure to witchcraft and rituals. Some respondents observed self-imposed restrictions on exercises, food items, visits and sex in order to maintain physical and spiritual cleanliness, lessen discomfort and avoid embarrassment. Gynaecologists working in this region should utilize the opportunities of clinical consultations to discuss menstrual health issues with their female patients and educate them on the physiology and significance of menstruation.Keywords: Culture, menstruation, Igbo, myth, hygiene.African Journal of Reproductive Health Vol. 12 (1) 2008: pp. 109-11

Risk factors and perinatal outcome of umbilical cord prolapse in Ebonyi State University Teaching Hospital, Abakaliki, Nigeria

Aim: The goal of this study was to identify risk factors associated with umbilical cord prolapse and to document the perinatal outcome of cases of cord prolapse.Materials and Methods: During the period of the study (from July 1, 2001 and June 30, 2007), forty-six cases of umbilical cord prolapse were identified from the labor ward record and analyzed retrospectively. Associations between cord prolapse and potential risk factors were evaluated by means of the odds ratio.Results: During the period of the study, 46 cases of cord prolapse were encountered out of 10,080 deliveries which was 0.46% of all deliveries. Of the 46 fetuses with umbilical cord prolapse 32.6% had a fetal weight of less than 2.5 kg compared with 15.2% for fetuses in control group (P<0.012). The umbilical cord prolapse occurred in association with breech presentation eleven times (23.9%) and transverse presentation seven times (15.2%). The occurrence of breech presentation among the control cases was 4.3% (P<0.00031), and that of transverse lie was 4.4%  (P<0.02007). Among the women that had cord prolapse, 47.8% had unbooked pregnancies compared with the control group with 14.5% (P<0.0000033). Multiparity accounted for 78.3% in the cord prolapse cases and 68.1% in the controls (P=0.19). The perinatal mortality rate was 413/1000. (41.3%), compared to the perinatal mortality of 58/1000 for the control group.Conclusions: Our findings in this study has confirmed an association between increased risk of umbilical cord prolapse and abnormal fetal presentation, low birth weight and unbooked status. It is therefore suggested that pregnant women should be encouraged to register early in pregnancy for antenatal care and this will enhance the early identification of these risk factors and an appropriate management instituted to reduce perinatal mortality

Trends and Factors Associated With Maternal Mortality in Ebonyi State University Teaching Hospital (EBSUTH), Abakaliki

Background: Maternal health indices are poor in Nigeria. Regular audit of maternal deaths is vital to maternal health care planning and delivery in Nigeria and other developing countries.Objectives: The aim of the study was to audit maternal deaths in EBSUTH and determine the trend and factors associated with such mortality.Method: A retrospective review and analysis of all maternal deaths between January 2004 and December 2007 at Ebonyi State University Teaching Hospital was carried out.Result: There were thirty-five deaths out of the 3471 live births during the study period giving a maternal mortality ratio (MMR) of 1,008 per 100,000 live births. This represents a 41.2% decline from the preceding immediate triennia ratio. The commonest cause of maternal death during the period were obstructed labour/ ruptured uterus which accounted for 40% of the deaths as against sepsis which was responsible for 33% of deaths in the preceding triennia. The un-booked parturients and rural dwellers accounted for 74.3% and 82.9% of the deaths respectively.Conclusion: Preventable maternal deaths remain a feature of obstetric practice in Nigeria. Concerted effort must be focused on the precipitating factors of such deaths if the Millennium Development Goal on maternal health is to be attained.  Key Words: Maternal Death, Morbidity, Pregnancy Complication

A Review of Gynaecological Hysterectomies at the Ebonyi State University Teaching Hospital (EBSUTH), Abakaliki: Indications and Outcome

Context: Hysterectomy is one of the commonly performed major gynaecological operations in the world. There is no baseline information in our hospital regarding this surgery.Objective: To determine the rate, indications and outcome of gynaecological hysterectomy at EBSUTH Abakaliki.Method: Descriptive analysis of retrospective records of all cases of gynaecological hysterectomy over a five year period (January 1, 2005-December 31, 2009).Results: The hysterectomy rate was 10.6% of gynaecological operations. The mean age of patients was th th 47.0±12.00 years (2S.D).  Hysterectomies were commonest in the 4 and 5 decades of life (58.0%) with th highest occurrence in the 5 decade (32.1%). Grandmultipara accounted for 63% of all cases. The major indications for hysterectomy were uterovaginal prolapse (45.7%), uterine fibroids (21.0%) and cervicalcarcinoma (12.3%). Total abdominal hysterectomy(TAH), was the commonest type of hysterectomy (54.3%) while vaginal hysterectomy accounted for 45.7%. Uterine fibroid was the commonest indicationfor TAH (38.6%). Vaginal hysterectomy was employed exclusively uterovaginal prolapse. Wound infection was the commonest complication (41.2%). Majority of the patients were hospitalized for more than 10 days (92.6%).Conclusion: The commonest indication for hysterectomy in this study differs from other reports. Hysterectomy is safe in our centre. There is the need to allow senior residents actively participate in hysterectomy to enable them acquire enough skill.Keywords: Hysterectomy, Indications, Benign, Management, Outcom

A Reappraisal of Indications for Abdominal Delivery at a Referral Health Institution in South East Nigeria

Background: There is a globalworry about the increase in the rate of caesarean section despite attempts to reduce the rising trend especially in developing countries where the figures are competing seriously with those for developed counties.Objective: The study assesses the current caesarean section rate in the hospital, compare it with past figures and appraise the indications for the Caesarean sections.Materials and Method: Case records of all cases of caesarean section managed in the hospital over a three-year period (1st of January 2006 to 31st of December 2008) were analyzed.Results: A total of 4005 deliveries were undertaken during the study period (1st of January 2006 to 31st of December 2008.Out of which 736 were caesarean section giving an incidence of Caesarean section tobe 18.4%. The commonest indication is previous Caesarean section, accounting for 19.6%. This is followed by obstructed labour (11.7%) and presumed foetal distress (7.9%).Conclusion: There is a rising trend in caesarean section rate. There is need for more comprehensive audit, taking into consideration the opinion of the consultants and patients if the rate should be curbed. There is also need to improve facilities to pick true foetal distress before embarking onCaesarean section.Key words: Caesarean Section, Indications, Fetal Distress, Obstructed Labour, Nigeria,Running Header: Indications for Abdominal Deliver

The hidden cost of 'Free Maternity Care' in a low-resource setting in south-eastern Nigeria

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Assessing clients'satisfaction at a free antenatal care clinic in a limited-resource population

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After the Repair, What Next? Reproductive Health Expectations of Vesico-Vaginal Fistula(VVF) Patients in Southeast Nigeria

Background: Reproduction occurs under conditions that threaten the life and well-being of women resulting in a very high level of maternal mortality and morbidity. Prominent among these morbidities is obstetric fistula which when occurs threatens the reproductive health of the . womanAim and Objective: To examine the reproductive health expectations of women who had successful Obstetric VVF repair in South East Nigeria.Methods: A qualitative study based on an in-depth interview was conducted of six successfully repaired post vvf repair women at the South East Fistula Centre.Results: Six women who had successful repair of their fistulae participated in the in depth interview. Their mean age was 28.7+ 6.4 years (2SD). Majority belonged to low social economic class. Their VVF resulted from prolonged obstructed labour and they were well aware of this. All participants had established mentrual function during the period of the condition. Five desired future pregnancy would gladly access prenatal care in their next pregnancy in a modern health facility and would also accept Caesarean delivery. None will attempt vaginal birth

Profiling Gestational Trophoblastic Disease in a Tertiary Hospital in South-East Nigeria

Background: Gestational trophoblastic disease (GTD) comprises a spectrum of interrelated tumours including complete and partial hydatidiform mole, placental site trophoblastic tumours and choriocarcinoma.Objective: To evaluate the clinical presentation, management and treatment outcomes of gestational trophoblastic diseases in a tertiary health institution.Methodology: This was a descriptive study of all cases of gestational trophoblastic diseases managed at Ebonyi State University Teaching Hospital, Abakaliki over a five-year period.Results: The incidence of GTD was 3.58 per 1000 deliveries. The age range was 19-55 years and the mean age was 33.4±7.4 years. The mean gravidity was 6 and women who are gravida 5 and above accountedfor 63.3% of those that presented with GTD. Gestational trophoblastic disease was commonly found in women with blood group O (60%) and 46.7% of cases of gestational trophoblastic disease occured in agegroup 30-39 while 23.3% of gestational trophoblastic diseases occured in women 40 years and above. The commonest clinical presentation was recurrent vaginal bleeding 96.7%. Suction curettage (66.7%) was the commonest form of treatment offered to those with GTD in EBSUTH. Total Abdominal hysterectomy and chemotherapy was performed only in 10% of the patients. The commonest complication was haemorrhage (40%). Maternal death attributable to GTD was 10%. About 60% of the patients did not turn up for follow up.Conclusion: Early presentation and proper treatment of this condition is emphasized. There is need for adequate follow-up of these patients.Key Words: Molar Pregnancy, Trophoblastic, Mortality, Chemotherap

Bilateral tubal ligation in a rural hospital in the Niger Delta, Nigeria

Background and Objective: To document bilateral tubal ligation (BTL) rate  and highlight the need to improve on the rates.Materials and Methods: A retrospective review of BTLs done in a five-year period from January 2000 to December 2004 constituted the study group.Results: There were a total of 103 BTLs, 58 were Caesarean BTLs, six were cases of BTL with repair of uterine rupture and 39 had BTL from mini-laparotomy. There were 937 Caesarean sections and 2,356 deliveries during the study period. BTL therefore constituted 0.044% of the total deliveries. The majority (51.7%) were above 35 years of age and grandmultiparity constituted 60.4% of BTL cases. The majority was in the low social Class 4 and 5 (41.3%). Grandmultiparity was the most common indication (60.4%). Previous Caesarean sections were more in the highest social class with a mean of 2.9 ± 1.21 while ruptured uterus had the lowest. Unbooked cases of BTL constituted 62.1% of BTL.Conclusions: Bilateral tubal ligation rate was low in this study with grandmultiparity being the commonest indication, the majority of patients were elderly parturient and largely unbooked. Social class was highest among those with previous Caesarean section