Awareness and Practice of Emergency Contraception Among Students of University of Port Harcourt, South-South Nigeria.

The awareness and utilization of contraceptives especially emergency contraceptives (EC) among youths and others in the reproductive age group is an important step in preventing unwanted pregnancies and unsafe abortions. The aim of this study was to assess the knowledge, attitude and practice of emergency contraception among undergraduate university students.Methods : A self administered questionnaire was distributed to 240 randomly selected undergraduate students of the University of Port Harcourt, Port Harcourt, South- South Nigeria, in July 2006. Information sought included their sociodemographic characteristics, awareness, perception and use of emergency contraception.Results: Two hundred and forty questionnaires were distributed, while 225 were appropriately filled and retrieved giving a response rate of 93.8% The age of the respondents ranged between 16 to 40 years, with a mean age of 23.2 years. Up to 86.3% of the respondents were sexually active. One hundred and thirty (57.7%) had knowledge of EC, while only 30 (13.3%) had ever used EC. Of the respondents who were aware of EC the most common sources of information on EC were friends in 54(41.2%) and hospital personnel/clinics in 51 (39.2%).Conclusion: The awareness and use of emergency contraception among students of University of Port Harcourt, South- South Nigeria, is unacceptably low. There is therefore an urgent need to improve the student's knowledge and use of EC through education and enlightenment of this vulnerable group in our environment.Key words: Emergency contraception, awareness and practice, university students, Nigeria

Contraceptive practice among HIV positive women attending anti-retroviral clinic at the university of port Harcourt teaching hospital, port Harcourt, southern Nigeria

Background: As the global efforts to curb the human immuno deficiency virus (HIV) pandemic continues, one key intervention is the promotion of effective family planning options for HIV positive women in the reproductive age group.Objectives: To evaluate the level of awareness and utilisation of contraceptives among HIV positive women attending anti-retroviral (ARV) clinic in Port Harcourt, South- South Nigeria and also determine the pattern of contraceptive use before and after sero-conversion.Design: Descriptive cross-sectional Hospital based studySetting: Anti-retroviral (ARV) clinic, University of Port Harcourt Teaching Hospital, (UPTH), Port Harcourt, Nigeria.Subjects: One hundred and seventy HIV positive women in the reproductive age on highly active anti-retroviral therapy (HAART)Results: The mean age of the respondents was 34.34 ± 0.66 years with a range of22-55years and parity range of 0-6 with a median parity of 2. Although majority (76%) of respondents were aware of contraceptives, only 49 (28.82%) were using contraception before diagnosis of HIV infection, but the uptake increased to almost 100% after knowledge of sero-conversion, with majority using male condom. Up to 55 (32.4%) respondents were sero-concodant with sexual partners, 46 (27.1%) sero-discodant while 69(40.6%) were not aware of their partners sero-status.Conclusion: There is extremely high knowledge and uptake of family planning after diagnosis of sero-conversion among HIV positive women attending the ARV clinic in Port Harcourt with the male condom as the most preferred method. This may have contributed to the reportedly overall slowly declining HIV prevalence

Pattern of Microbial Flora in Septic Incomplete Abortion in Port Harcourt, Nigeria.

Background: Septic abortion occurs when there is colonization of the upper genital tract by micro organisms following termination of pregnancy usually before the age of viability. This can result from ascending infections from the lower genital tract or direct inoculation of micro organisms from contaminated and poorly sterilized instruments at the evacuation of the uterus in incomplete abortion or during unsafe abortion. Septic abortion is accompanied by significant morbidity, cost and maternal death in Nigeria. Knowledge of the microbial flora causing septic abortion is important in the prevention and treatment of this condition. The aim of this study is to identify the common micro organisms present in the endocervix and posterior vaginal fornix in patients with septic abortions.Methods: This is a prospective study of the micro organisms present in the endocervix and posterior vaginal fornix in 150 women with septic abortion as identified in bacterial cultures between 1st January 2006 and 31st gt; December 2008 at the Obstetrics and Gynaecology units of University of Port Harcourt Teaching Hospital and Braithwaite Memorial Specialist  Hospital Port Harcourt.Results: There were polymicrobial colonization of the upper genital tract and vagina in most cases. The commonest organisms cultured are Escherichia Coli (49.2%) and Staphylococcus Aureus(37.1%). The least commonly identified organisms were Bacteriodes(3.8%) and Clostridium species(2.3%).Conclusion: Escherichia Coli is the commonest organism cultured in septic abortion in this environment. The infections are usually polymicrobial. They are mainly enteric organisms found in genitourinary infections.Key words: Septic Abortions; Infection Pattern; Nigeria

Missed Diagnosis of Twin Pregnancy and Mis-Diagnosed Fetal Hydrocephalous

We present a 41 year old booked grandmultipara with twin gestation erroneously diagnosed as singleton pregnancy with fetal hydrocephalous and scheduled for elective caesarean delivery at term but subsequently went into spontaneous labour at 35weeks of gestation and had vaginal delivery of two live male babies while awaiting emergency caesarean section. The babies had good Apgar scores with no clinical hydrocephalous. The 1st twin had spina bifida cystica. Multiple clinical and ultrasound diagnostic errors leading to wrong clinical decision taking and unnecessary intervention can occur even in experienced hands. Correct diagnosis following sequential and meticulous forward clinical reasoning serves the clinician and patients interest better

Post Operative Miscarriage Following Ruptured Appendix in Pregnancy

Acute appendicitis in pregnancy though rare, is the most common non- obstetric complication warranting emergency laparotomy. Gestational physiological changes make difficult the diagnosis and delay in diagnosis  and surgery results in increased complications. We present a-24 year old primiparous lady at 16 weeks of gestation who was referred from a private hospital to the accident and emergency unit of the University of Port Harcourt Teaching Hospital with 6 days history of abdominal pain, fever and vomiting at an ultrasound gestational age of 16 weeks and managed as case of ruptured appendix in pregnancy. She had laparotomy and appendicectomy. Intraoperative findings were purulent peritoneal exudates, ruptured appendix with flakes of necrotic tissues and fecolith. She subsequently had post operative miscarriage 48hours after the surgery which was completed by manual vacuum aspiration. She did remarkably well and was discharged on the 7th post operative day. Delay in diagnosis of appendicitis in pregnancy and surgery correlates to a more advanced disease with an increased risk of appendiceal rupture, which may contribute to increased risk of further complications. Prompt surgical intervention should be performed when acute appendicitis is suspected during pregnancy.Key words: Ruptured appendix, appendicectomy, pregnancy, miscarriage

Knowledge, attitude and practice of cervical cancer screening – Papanicolaou test (Pap smear) among female health care providers in Port Harcourt

Background: Cervical cancer is the second most common malignancy affecting women globally and the commonest female genital cancer in Nigeria. It can be prevented through regular cytologic screening by Pap smear. The general public sees health care providers as models, therefore, their attitudes and actions would predictably influence societal health behaviour.Aim: To assess the knowledge, attitude and practices of female health workers in Port Harcourt, towards cervical cancer screening.Methods: A questionnaire-based survey of 133 female health care providers at the Braithwaite Memorial Specialist Hospital and the University of Port Harcourt Teaching Hospital, Port Harcourt, which evaluated the socio-demographic characteristics of respondents, knowledge of cervical cancer, attitude and utilization of cervical cancer screening service was carried out. The data were entered into SPSS version 11.0 which was used for analysis and results are presented as Frequency tables, percentages and means. The level of significance was set at p-value <0.05.Results: Up to 123 (92.2%) respondents had knowledge of Pap smear as a screening tool for cervical cancer, and 96 (72.2%) respondents recognized early sexual debut as a risk factor. Nine-three (70%) respondents would be willing to have Pap smear.  Only 17(12.8%) had done a Pap smear previously.Conclusion: The high knowledge of cervical cancer screening and their positive attitudes towards it did not translate to service utilization by female health professionals in Port Harcourt.There is therefore need to improve uptake of Pap smear by health professionals in order to improve their effectiveness in encouraging the public to utilize this service. Keywords: Cervical cancer, Pap smear, Female health workers, Knowledge, Attitude, Practic

Malaria chemoprophylaxis during pregnancy: a survey of current practice amongst general practitioners in Port Harcourt, Nigeria

Background: Malaria is a common health problem especially among the pregnant women in endemic countries such as Nigeria. Sulphadoxine/pyrimethamine (SP) has been recommended by the World Health Organisation (WHO) for malaria chemoprophylaxis in pregnancy and has been incorporated into our national malaria control programme. General medical practitioners provide prenatal care for significant proportion of our women in pregnancy.Aim: To examine the current knowledge and practice of malaria chemoprophylaxis during pregnancy among general medical practitioners in Port Harcourt, southern Nigeria.Methods: It was a questionnaire based study of 90 general medical practitioners in Port Harcourt, southern Nigeria which sought for their socio-demographic characteristics and knowledge and practice of malaria chemoprophylaxis during pregnancy. The data were entered into a personal computer and analysed using SPSS for windows version 10.0 and presented as frequency tables and percentages.Results: Of the 90 questionnaires, 59 duly completed forms were retrieved, giving a response rate of 65.60%. The age range of the respondents was 21-60 years with 31-40 years as the most common range. Only 33(55.93%) respondents knew the current malaria chemoprophylactic agent in pregnancy as recommended by WHO. Almost all (98.30%) respondents administered malaria chemoprophylaxis routinely to their antenatal women but only 44.06% administered correctly SP as recommended.Conclusion: The knowledge and practice of the WHO recommended malaria chemoprophylaxis in pregnancy among general medical practitioners is below average. Training and re-training of these primary care physicians on the use of sulphadoxine-pyrimethamine will tremendously improve their knowledge and practice of this WHO recommended chemoprophylactic agent in pregnancy which will in turn reduce malaria - related perinatal and maternal complications.Keywords: Malaria, Chemoprophylaxis, Pregnancy, WHO, General Practitioner

Perineal Trauma in Port Harcourt, Souh-South Nigeria

Background: Morbidities associated with vaginal deliveries are many but under reported. Where data exist, women had been shown to suffer myriad of problems following vaginal birth. These include immediate trauma to the perineum from episiotomy and perineal laceration at vaginal deliveries. These women may also have other problems such as pelvic pain, uterine descent and incontinence to urine, stool or flatus as well as sexual, social and psychological dysfunction on the long term. The objective of the study was to determine the prevalence and predisposing factors of perineal trauma amongst women delivering at the University of Port Harcourt Teaching Hospital. Methods: A retrospective study of vaginal births between 1st January 2005 and 31st December 2007 at the University of Port Harcourt Teaching Hospital was done. The delivery register at the labour ward was used to identify the parturient with injury to the perineum following a vaginal birth. Data was retrieved from their case notes, entered into an excel spreadsheet and analyzed with SPSS version 17 for Microsoft windows. Results: A total of 2429 (53.8%) out of 5422 parturient had trauma to their perineum at delivery. Episiotomies were in 1811 (40.1%) parturient and perineal tears occurred in 697 (13.7%) parturient. While the prevalence of episiotomy decreased with parity, the incidence of perineal tears was found to increase with parity. Assisted vaginal deliveries and high parity were risk factors for episiotomy and perineal tear respectively. Conclusion: The perineal trauma prevalence rate of 53.8% in Port Harcourt is unacceptably highly. Nulliparity, vaginal breech and instrumental vaginal deliveries are the major risk factors for perineal trauma. Keywords: Perineal Trauma, Perineal Tear, Episiotomy, Vaginal delivery, Port Harcour