Complications of unsafe abortion: case reports and the need for curriculum review in Nigeria

Unsafe abortion remains a major reproductive health problem in Nigeria. These are 2 case reports of unsafe abortion, one performed by a patent medicine dealer where a false passage was created in the substance of thecervix to evacuate the uterus using a cannula. A piece of the cannula was left in situ for five years leading to chronic infection and infertility.The second case was performed by amedical practitioner for a second trimester abortion. He deliberately created a false passage in the substance of the cervix to evacuate the uterus leading to severe haemorrhage.We conclude that there is a need to reviewand improve the training ofmedical practitioners in termination of pregnancies to avoid unsafe abortion.Keywords: unsafe abortion, cervical injury

Perforation of the Rectum by a Copper-T Intrauterine Contraceptive Device with Retrieval per Rectum: A Case Report

Intrauterine contraceptive devices are among the most effective forms of contraceptives available. They provide long term reversible protection from pregnancy and are currently the most popular and widely use reversible contraceptive method. Though they are associated with few side effects, perforation of the uterus remains the most serious. We report the case of a grandmultiparous lady whose copper-IUCD perforated her rectum 8 years after its insertion. We advocate the inclusion of rectal examination in theevaluation of patients for missing IUCDs and removal of the devices per rectum if partially embedded rather than resorting to surgery.Key Words: Rectum, Perforation, IUC

Attainment of menstrual hygiene by girls in boarding secondary schools in a state in Sub-Saharan Africa

Background: Menarche is the most dramatic manifestation of puberty in girls; unlike the biometric developmental changes that occur at puberty, menarche requires the personal adjustment and response of an affected girl in order to attain good menstrual hygiene. This study was designed to evaluate how boarding secondary school girls manage their menstruation in school, away from the guidance of their parents.Methods: A cross sectional survey was performed in four public boarding secondary schools in the study area with the aid of structured questionnaires to evaluate how such girls manage their menstruation while in school.Results: The study population was 975 girls whose survey revealed the mean age at menarche of 12.5±1.4 years.  Seven hundred and two (72.0%) respondents had received sexuality education before onset of menarche. Respondents who attained good menstrual hygiene were 775(79.5%). Such respondents were those who had received sexuality education (p<0.001) and those who had access to synthetic sanitary pad (p=0.005). Duration of the menstrual period and the volume of menstrual blood loss did not affect (p=0.219) the ability of respondents to attain good menstrual hygiene. Respondents who received sexuality education had about 605 chances of attaining good menstrual hygiene than those who did not receive such education.Conclusions: A vast majority of the respondents had received sexuality education before onset of menarche and a larger proportion attained good menstrual hygiene. Major factors that positively influenced the girls’ capacity to attained good menstrual hygiene were prior sexuality education and access to synthetic sanitary pad

Seminal Fluid Indices Of Male Partners Of Infertile Couples In Uyo, Nigeria

This retrospective study analyzes the seminal fluid indices of 633 male partners of infertile couples at the University of Uyo Teaching Hospital over a four year period. All the laboratory records on seminal fluid analysis between 1st January 2003 and 31st December 2006 were reviewed. The seminal fluid characteristics of the patients were determined and the abnormalities classified according to the World health organisation guidelines. Five hundred (79.0%) of the men had abnormal seminal fluid parameters. About 56.0% of the subjects were asthenozoospermic, 38.9% were oligozoospermic, 2.8% had teratozoospermia while 7.0% had azoospermia. The significant contribution of the male factor to infertility in our environment is highlighted. The need for the encouragement of male partners of infertile couples to avail themselves for proper infertility evaluation and the advantages of early detection and treatment of sexually transmitted infections in men is stressed. KEY WORDS: Male infertility, seminal fluid indices, Uy

Emergency peripartum hysterectomy in a tertiary hospital in southern Nigeria

Introduction: Emergency peripartum hysterectomy, a maker of severe maternal morbidity and near miss mortality is an inevitable surgical intervention to save a woman’s life when uncontrollable obstetric haemorrhage complicates delivery. This study was conducted in order to determine the incidence, types, indications and maternal complications of emergency peripartum hysterectomy at the University of Uyo Teaching Hospital, Uyo, Nigeria. Methods: The case records of all women who underwent emergency peripartum hysterectomy between 1st January 2004 and 31st December 2011 were studied. Results: There were 12,298 deliveries during the study period and 28 emergency peripartum hysterectomies were performed resulting in a rate of 0.2% or 1 in 439 deliveries. The modal age group of the patients was 26-30 years (35.7%), majority were of low parity (64.4%), while 17.9% attained tertiary level education. Half of the patients (50.0%) were  unbooked while 14.3% were antenatal clinic defaulters. Extensive uterine rupture (67.8%) was the most common indication for emergency hysterectomy distantly followed by uterine atony with uncontrollable haemorrhage (17.9%). Subtotal abdominal hysterectomy was performed in 92.8% of the cases. The case fatality rate was 14.3% while the perinatal mortality rate was 64.3%. Conclusion: Emergency peripartum hysterectomy is not uncommonly performed in our centre and extensive uterine rupture from prolonged obstructed labour is the most common indication. In addition, it is associated with significant maternal and perinatal mortality. There is need to enlighten women in our communities on the benefits of ANC and hospital delivery as well as the dangers of delivering without skilled attendance. Government should consider enacting legislation to discourage people or organisations who operate unlicensed maternity homes in our environment.Key words: Emergency peripartum hysterectomy, extensive uterine rupture, uncontrollable haemorrhage, Uy

Association between hookworm infection and anaemia among antenatal attendees in a university teaching hospital in southern Nigeria

Background: Hookworm infection is among the major causes of anaemia in poor communities. Its importance in causing maternal anaemia however is poorly understood, and this has hampered effective lobbying for the inclusion of anti-helmintic treatment in maternal health packages.Methodology: A cross sectional analytical study was conducted to assess the association between hookworm infection and anaemia among pregnant women obtaining antenatal Care at the University of Uyo Teaching Hospital, Uyo. Nigeria. Two hundred and fourteen pregnant women were recruited over a six week period. Pre-coded and structured questionnaires were administered to each eligible pregnant woman, Blood samples were obtained for determination of packed cell volume and serum iron/total iron binding capacity respectively. Stool samples were collected from each pregnant woman for microscopy. Data obtained was analyzed with Epinfo-version 3.5.2 December 2010 software. Result: Twenty four of 211 women had hookworm infection resulting in a prevalence of 11.4% (95% CI= 7.4%-16.5%). Sixty two (29,8%) of 208 women had iron deficiency anaemia, Fourteen (22,6%) of the 62 women with iron deficiency anaemia had hookworm infection while 9 (6.3%) of 143 women without iron deficiency anaemia had hookworm infection (x2=11.5, p= 0.000689). There was no statistically significant association between hookworm infection and all the socio-demographic variables analyzed except between hookworm infection and place of residence (x2= 22.3 and p=0.0000351 ),Conclusion : Hookworm infection is associated with anaemia in pregnant women in Uyo. This therefore reinforces the WHO recommendation to include routine de-worming into our antenatal care package as a strategy to reduce or prcvent maternal anaemia.Keywords. Hookworm infection. anaemia, pregnancy. Uy

Empowering members of a rural southern community in Nigeria to plan to take action to prevent maternal mortality: a participatory action research project

Aims and objectives. To facilitate the empowerment of members of a rural community to plan to take action to prevent maternal mortality. Background. Globally, about 300,000 maternal deaths occur yearly. Sub-Saharan Africa and Southern Asia regions account for almost all the deaths. Within those regions, India and Nigeria account for over a third of the global maternal deaths. Problem of maternal mortality in Nigeria is multifaceted. About 80% of maternal deaths are avoidable, given strategies which include skilled attendants, emergency obstetric care and community mobilization. In Part One of this article presented here, a strategy of community empowerment to plan to take action to prevent maternal mortality is discussed. Part Two examines evaluation of the actions planned in Part One. Design. Participatory action research was utilized. Methods. Volunteers were recruited as co-researchers into the study through purposive and snowball sampling. Following orientation workshop, participatory data collection was undertaken qualitatively with consequent thematic analysis which formed basis of the plan of action. Results. Community members attributed maternal morbidities and deaths to superstitious causes, delayed referrals by traditional birth attendants, poor transportation and poor resourcing of health facilities. Following critical reflection, actions were planned to empower the people to prevent maternal deaths through: community education and 2 advocacy meetings with stakeholders to improve health and transportation infrastructures; training of existing traditional birth attendants in the interim and initiating their collaboration with skilled birth attendants. Conclusion. The community is a resource which if mobilized through the process of participatory action research, can be empowered to plan to take action in collaboration with skilled birth attendants to prevent maternal mortality. Relevance to clinical practice. InterventioAims and objectives. To facilitate the empowerment of members of a rural community to plan to take action to prevent maternal mortality. Background. Globally, about 300,000 maternal deaths occur yearly. Sub-Saharan Africa and Southern Asia regions account for almost all the deaths. Within those regions, India and Nigeria account for over a third of the global maternal deaths. Problem of maternal mortality in Nigeria is multifaceted. About 80% of maternal deaths are avoidable, given strategies which include skilled attendants, emergency obstetric care and community mobilization. In Part One of this article presented here, a strategy of community empowerment to plan to take action to prevent maternal mortality is discussed. Part Two examines evaluation of the actions planned in Part One. Design. Participatory action research was utilized. Methods. Volunteers were recruited as co-researchers into the study through purposive and snowball sampling. Following orientation workshop, participatory data collection was undertaken qualitatively with consequent thematic analysis which formed basis of the plan of action. Results. Community members attributed maternal morbidities and deaths to superstitious causes, delayed referrals by traditional birth attendants, poor transportation and poor resourcing of health facilities. Following critical reflection, actions were planned to empower the people to prevent maternal deaths through: community education and 2 advocacy meetings with stakeholders to improve health and transportation infrastructures; training of existing traditional birth attendants in the interim and initiating their collaboration with skilled birth attendants. Conclusion. The community is a resource which if mobilized through the process of participatory action research, can be empowered to plan to take action in collaboration with skilled birth attendants to prevent maternal mortality. Relevance to clinical practice. InterventioAims and objectives. To facilitate the empowerment of members of a rural community to plan to take action to prevent maternal mortality. Background. Globally, about 300,000 maternal deaths occur yearly. Sub-Saharan Africa and Southern Asia regions account for almost all the deaths. Within those regions, India and Nigeria account for over a third of the global maternal deaths. Problem of maternal mortality in Nigeria is multifaceted. About 80% of maternal deaths are avoidable, given strategies which include skilled attendants, emergency obstetric care and community mobilization. In Part One of this article presented here, a strategy of community empowerment to plan to take action to prevent maternal mortality is discussed. Part Two examines evaluation of the actions planned in Part One. Design. Participatory action research was utilized. Methods. Volunteers were recruited as co-researchers into the study through purposive and snowball sampling. Following orientation workshop, participatory data collection was undertaken qualitatively with consequent thematic analysis which formed basis of the plan of action. Results. Community members attributed maternal morbidities and deaths to superstitious causes, delayed referrals by traditional birth attendants, poor transportation and poor resourcing of health facilities. Following critical reflection, actions were planned to empower the people to prevent maternal deaths through: community education and 2 advocacy meetings with stakeholders to improve health and transportation infrastructures; training of existing traditional birth attendants in the interim and initiating their collaboration with skilled birth attendants. Conclusion. The community is a resource which if mobilized through the process of participatory action research, can be empowered to plan to take action in collaboration with skilled birth attendants to prevent maternal mortality. Relevance to clinical practice. InterventioInterventions to prevent maternal deaths should include community empowerment to have better understanding of their circumstances as well as their collaboration with health professionals

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Prevalence Of HIV Infection Among Antenatal Attendees At Uyo Teaching Hospital, Akwa Ibom State, South-South Nigeria

This retrospective study was conducted at the maternity unit of the University of Uyo Teaching Hospital Uyo. The aim was to determine the prevalence of HIV infection among pregnant women receiving antenatal care in the center. The voluntary counselling and testing register, the partner notification and antenatal clinic registers of all patients that booked for antenatal care between 1st July 2005 and 31st December 2007 were reviewed. There were 5,635 new antenatal clients during the study period out of which 464 were confirmed HIV positive resulting in a prevalence of 8.2%. Most of the patients were between 21-30 years (70.0%). About 59.4% of the patients were multiparous while 49.4% booked for antenatal care in the third trimester of pregnancy. HIV was diagnosed in the antenatal clinic in 408 (87.9%) of the patients and 182 (39.2%) received antiretroviral drugs during pregnancy. Only 38.8% of the patients accepted to notify their partners. One hundred and eighty eight patients delivered in the hospital. One hundred and twenty (63.8%) had spontaneous vaginal delivery, 63 (33.5%) were delivered by caesarean section, 3 (1.7%) had assisted vaginal breech delivery and 2 (1.1%) had ventouse delivery. The high prevalence of HIV infection among women pregnant women who have antenatal care in our hospital is highlighted. The intensification of strategies aimed at primary prevention of HIV infection in the community, encouraging all pregnant women to avail themselves of orthodox antenatal care, and the need to emphasize the advantages of self disclosure of serostatus to partners during counselling sessions in the antenatal clinic are advocated. KEY WORDS: HIV Positive women, antenatal attendees, Uy