Obstetrics indices at Nnamdi Azikiwe University Teaching Hospital, Nnewi,Anambra State, Nigeria

Background: Obstetrics indices vary from population to population. Some are natural occurring indices while other corresponds to the level ofobstetric practice in an area.Objective of the study: This study sought to find the obstetrics indices like mean birth weight, twinning rate, the sex ratio, caesarean section rate,instrumental vaginal delivery rate, maternal mortality rate and fetal death rate.Study design, setting and subjects: This was a retrospective study of all deliveries at Nnamdi Azikiwe University Teaching Hospital, Nnewi fromJanuary 1998 to December 2007, a ten year period. Data was extracted from the labor ward birth register and analyzed.Results: There were five thousand, six hundred and fifty eight (5658) deliveries within the period of the study. The mean birth weight was 3.3kg.The mean weight for female babies was 3.26kg and 3.34kg for the male babies. The twinning rate was 34/1000 deliveries. There was no triplet within the period of the study. The sex ratio was 93 males: 100 females. The caesarean section rate was 9.4% .Instrumental vaginal delivery rate was 3%. The maternal mortality rate was 324/ 100,000 births, while the fetal death rate was 21/1000 births.Conclusion: The obstetric indices were found to be within the range as those in other studies in the region

Contribution of indirect obstetric deaths to maternal mortality at Nnamdi Azikiwe University Teaching Hospital, Nnewi.

Introduction: Maternal death is unacceptably high in this center like in most centers in the developing world.Objective: To determine the maternal mortality ratio and the contribution of the direct and indirect obstetric complications to maternal deaths.Method: A retrospective review of all maternal deaths at Nnamdi Azikiwe University Teaching Hospital Nnewi, between January, 2003 andDecember 2007, a 5 year period. Maternal deaths, were identified from the labour ward, lying-in ward, sick prenatal ward, postnatal ward,gynaecology ward records and the medical records. The total number of births was gotten from the labour ward register.Results: There were 36 maternal deaths within the study period, and maternal mortality ratio of 1282 per 100,000 deliveries. The majority(64%) were due to indirect causes. The most common cause was pulmonary tuberculosis (25%). Anaemia contributed 14% and, viral hepatitis 11%. Cerebral malaria, intestinal obstruction and metastatic breast cancer caused 2.8% of maternal deaths each. The direct obstetrics causes contributed 36%, with preclampsia/eclampsia 19.4%, sepsis (Septic abortion and puerperal Sepsis) 8.4%, haemorrhage 5.6% and uterine rupture 2.8%.Conclusion: Indirect obstetric causes accounted for majority of the maternal deaths recorded within the study period

Knowledge, attitude and practice of family planning among pregnant women at Grace Specialist Hospital

Background: Unwanted pregnancy is a common event in our environment and many of them will end in an unsafe abortion. Unsafe abortion isa significant cause of maternal mortality. Correct use of effective family planning methods will reduce the incidence of unwanted pregnancy andimprove the health of women.Objective: To determine the knowledge, attitude and practice of family planning among ante natal clients.Method: A cross sectional study of 346 consecutive antenatal clients using a self administered structured questionnaire. Analysis was with SPSSfor windows, version 15 and level of significance was set at P = 0.5 ( 95% confidential interval).Results: The mean age in the study was 28.06 + 4.9 and the mean parity was 1.51 + 1.5. 96.3% were married and all of them had at leastprimary education. Ninety-six percent of the respondents (n = 309) were aware of at least one family method. The most common methods knownby the respondents were Condom and Billings’ methods (48.6%). The commonest source of information on family planning was the mediarepresenting 35.1%. Only 47.5% of the respondents had used one form of family planning method. The most commonly used method wasBillings / Calendar (50.3%). Child spacing was the commonest reason for using family planning. Most of those who did not use (30.2%) feltthey had no need for it. Education and religion did not significantly affect the use of a family planning method. However, members of religiousgroups other than Roman Catholic were more likely to use a modern method (

A Review of Gynaecological Hysterectomies in a Private Specialist Hospital in Nigeria

Background: Hysterectomy, the removal of the uterus, is practised worldwide. It is a major surgery, which may lead to significant morbidity or even mortality, hence, there must be a justifiable indication before the procedure is undertaken. Symptomatic fibroids and utero-vaginal prolapse are common indications in this environment.Objective: To audit the 30 consecutive gynaecological hysterectomies done in our centre from January 2003 to July 2009, with a view to determining the demographic factors, indications, types of hysterectomies done, and morbidity/mortality associated with the procedures.Methodology: This is a retrospective descriptive study. Data concerning these 30 patients were retrieved from the theatre records and their case notes. The analysis was done using simple tables and percentages.Results: Hysterectomies accounted for 30(28.0%) of 107 major gynaecological operations done during the period under review. Of the 30 hysterectomies 11(36.7%) were vaginal hysterectomies, while total and subtotal abdominal hysterectomies accounted for 13(43.3%) and 6(20%), respectively. Bilateral salpingo-oophorectomy was done in 4(13.3%) patients. The most common indication was uterine fibroids 16(53.3%) followed by utero-vaginal prolapse 8(26.7%). The most common age range of the patients was 40-49year group 16(53.3%), mean age was 45.5±6.7. The most common parity group was para 5-8(53.3%). On the average, the vaginal hysterectomy patients needed less diclofenac injections for pain relief. One bladder injury was encountered. There was no mortality.Conclusion: The indications for, and surgical outcome following gynaecological hysterectomy in a private specialist hospital, is comparable to that from public hospitals. The private hospitals should be considered in manpower development to help improve gynaecological practice

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

Design of a continuous concrete filled steel tubular column in fire

Concrete filled steel tubular (CFST) columns used in multi-storey buildings are generally designed as continuous members. The fire behaviour is predicted based on the results of experimental standard fire testing of CFST members where the same temperature is applied to the column over the full column height. Over the past 36 years, 238 experimental tests have been reported in the literature on CFST columns; different types of concrete infill have been considered: plain, steel fibre and bar reinforced concrete. In these tests, the columns were loaded axially under either concentric or eccentric load, and subjected to the standard ISO 834 fire or its equivalent in a furnace. This paper has focused on the in-depth analysis of behaviour of a continuous CFST columns in fire and provided a simple design procedure to calculate the axial capacity of the CFST columns at elevated temperature. The examples given in the later section gives a step by step design procedure for practicing engineers to calculate the axial capacity of both concentrically and eccentrically loaded CFST columns in fire

Numerical analysis of plain and steel fiber reinforced concrete filled steel tubular slender column

Concrete filled steel tube columns (CFST) have many potentials which include; high seismic resistance, high load bearing capacity, and fire resistance without external protection. Some major projects worldwide has adopted the use of this type of column member extensively, for columns in both the gravity systems and the seismic resisting systems. Experimental tests performed on concrete filled steel tube columns at ambient temperature indicates that, the use of steel fibre reinforced concrete infill affects the crack width propagation of the concrete. This paper presents an advanced 3D numerical model which predicts the behaviour of a CFST column filled with steel fibre reinforced concrete, taking into account the increased tensile strength of the concrete which affects the column ductility. For columns subjected to compression loading only, it is recommended to use a high strength concrete, and also increase the thickness of the steel tube rather than using a steel tube with a higher yield strength. For slender square columns loaded under large eccentricity, it is recommended to use an e/D (eccentricity/depth) ratio value less than 0.5 for design purposes, to avoid the premature fracture of the loaded end of the column having smaller steel tube thickness

Behaviour of continuous concrete filled steel tubular columns loaded concentrically in fire

Design recommendations for concrete filled steel tubular (CFST) columns in fire are based on the results of experimental standard fire testing of CFST members where the same temperature is applied to the column over the full column height. However, this is not representative of a CFST column in a typical building, which is continuous between floors and which, in fire, is subjected to severe fire conditions on one floor at a time while the floors above and below remain cooler. In the experimental tests described in this paper, the columns are of 3.2 m height with the fire applied only to the central 2 m. Significant differences are observed between these tests and those previously conducted due to the partial length heating. In total, ten tests are conducted; the tests cover three different types of infill: plain concrete; bar reinforced concrete; and steel fibre reinforced concrete. End restraint conditions of fixed-fixed (F-F) and pinned-fixed (P-F) are considered; the axial load levels are between 0.33 to 0.38 of the squash load. The longitudinal elongation of the steel tube was less than 3 mm. Using the experimentally measured structural fire resistance (R), the axial capacity in fire was calculated in accordance with the codes of practice and are Compared with the experimentally tested structural fire resistance, showing that in some instances current design practice can be un-conservative

Simple design procedure for concrete filled steel tubular columns in fire

Over the past 36 years, 238 experimental tests have been reported in the literature on concrete filled steel tubular (CFST) columns; different types of concrete infill have been considered: plain, steel fibre and bar reinforced concrete. In these tests, the columns were loaded axially under either concentric or eccentric load, and subjected to the standard ISO 834 fire or its equivalent in a furnace. In this paper, the experimental tests reported in the literature have been used to propose simple design equations to determine the axial capacity of CFST columns. The proposed equations are compared with that presented in DR AS/NZS 2327 and Albero et al.; it is shown that the proposed equations are more accurate. The proposed design procedure has been used for the Auckland International Airport Phase 4 Pier B Extension Project’s structural fire design, brief details of which are presented