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

A 20-year Review Of Twin Births At Mater Misericordiae Hospital, Afikpo, South Eastern Nigeria

Objectives: To provide information on twin deliveries among Igbos in a rural/semi-urban community of South-Eastern Nigeria, and compare the twinning rate with data from the other two major tribes. Methods: An analysis of the records of deliveries conducted over a 20-year period in a rural/semi-urban community of South-Eastern Nigeria. Results: The twinning rate of the community was 1:24, and increased with increasing maternal age, and generally with birth rank. Twin births were associated with a MMR of 895/100,000, and PMR of 213/1000 maternities, figures 3.4 and 1.7 times those of the total maternal and perinatal mortalities respectively. Ninty percent of the twin mothers delivered vaginally, 2% with the aid of symphysiotomy. Caesarean section rate was 10.6%. Conclusion: The twinning rate within Nigeria may probably be dictated by location rather than ethnicity. The maternal and perinatal mortalities associated with twin pregnancies in this study appear higher than for singleton births. Keywords: Twin Births, Rural Community, Eastern Nigeria. Nigerian Journal of Clinical Practice Vol. 11 (3) 2008: pp. 231-23

Reflections on maternal mortality in Nigeria - The fifth Okoronkwo Kesandu Ogan Memorial Oration

No Abstracts. Tropical Journal of Obstetrics and Gynaecology Vol.20(1) 2003: pp.76-8

Age at Menarche and the Menstrual Pattern of Igbo Women of South-east Nigeria

This study determines the age at menarche and menstrual pattern of an Igbo population in 12 randomly selected rural communities of Ebonyi State. Information on recalled ages at menarche, menstrual flow duration and cycle length was collected using a semi structured questionnaire over three months. 1209 women of reproductive age were interviewed. The mean age at menarche was 15.0 years and this declined over the years. The mean menstrual flow duration and cycle lengths were 3.3 days and 29.7 days respectively. Only 10.2% had a menstrual cycle length of 28 days. Account should be taken of the average length of 29-30 days in the rural Igbo population when calculating the expected date of delivery and in the family planning clinics.Keywords: menarche, menstruation, pattern, Igbo, Cycle, recall.African Journal of Reproductive Health Vol. 12 (1) 2008: pp. 90-9

Uterine Fibroids In A Tertiary Health Centre South East Nigeria

Background: Uterine fibroids are common benign tumours of the female reproductive tract. This study evaluated the clinical presentations and the treatment of fibroids at Ebonyi State University Teaching Hospital over the 5- year period (2001-2005). Methods: A retrospective analysis of all cases of uterine fibroids admitted into the gynaecological ward of the Ebonyi State University Teaching Hospital (EBSUTH) over the five-year period (2001 2005). Results: Uterine fibroids accounted for 13.6% of all gynaecological admissions during the period. It was found predominantly during the third and fourth decades of life in nulliparas and women of the higher socio economic class. Primary infertility (22.9%), lower abdominal mass (21. 6%), menstrual abnormalities(15.9%), lower abdominal pain (15.9%) and anaemia (11.8%) were the common clinical presentations while abdominal myomectomy was the commonest modality of treatment employed (90%). Conclusion: Uterine fibroid is common among gynaecological admissions in Igbo women of Southeastern Nigeria. Infertility is a common presentation necessitating abdominal myomectomy in majority of the cases. Keywords: Fibroids, Igbo, Infertility, Myomectomy, wound breakdown, menorrhagia.Nigerian Journal of Medicine Vol. 17 (4) 2008: pp. 447-45

Maternal and perinatal outcomes of delivery after a previous Cesarean section in Enugu, Southeast Nigeria: a prospective observational study

George O Ugwu,1 Chukwuemeka A Iyoke,1 Hyacinth E Onah,1 Vincent E Egwuatu,2 Frank O Ezugwu2 1Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu, Nigeria; 2Department of Obstetrics and Gynaecology, Enugu State University Teaching Hospital (ESUTH), Parklane, Enugu, Nigeria Background: Obstetricians in developing countries appear generally reluctant to conduct vaginal delivery in women with a previous Cesarean because of lack of adequate facilities for optimal fetomaternal monitoring. Objective: To describe delivery outcomes among women with one previous Cesarean section at a tertiary hospital in Southeast Nigeria. Methods: This was a prospective observational study to determine maternal and perinatal outcomes of attempted vaginal birth after Cesarean sections (VBAC) following one previous Cesarean section. Analysis was done with SPSS statistical software version 17.0 for Windows using descriptive and inferential statistics at 95% level of confidence. Results: Two thousand six hundred and ten women delivered in the center during the study period, of whom 395 had one previous Cesarean section. A total of 370 women with one previous Cesarean section had nonrecurrent indications, of whom 355 consenting pregnant women with one previous Cesarean section were studied. A majority of the women (320/355, 90.1%) preferred to have vaginal delivery despite the one previous Cesarean section. However, only approximately 54% (190/355) were found suitable for trial of VBAC, out of whom 50% (95/190 had successful VBAC. Ninety-five women (50.0%) had failed attempt at VBAC and were delivered by emergency Cesarean section while 35 women (9.8%) had emergency Cesarean section for other obstetric indications (apart from failed VBAC). There was no case of uterine rupture or neonatal and maternal deaths recorded in any group. Apgar scores of less than 7 in the first minute were significantly more frequent amongst women who had vaginal delivery when compared to those who had elective repeat Cesarean section (P=0.03). Conclusion: Most women who had one previous Cesarean delivery chose to undergo trial of VBAC, although only about half were considered suitable for VBAC. The maternal and fetal outcomes of trial of VBAC in selected women with one previous Cesarean delivery for nonrecurrent indications were good. Obstetricians in this area should do more to allow VBAC in women with one previous Cesarean section for nonrecurrent indications. Keywords: previous Cesarean section, vaginal birth, pregnancy, VBA

Antibiotic sensitivity pattern of uropathogens from pregnant women with urinary tract infection in Abakaliki, Nigeria

RC Onoh,1 OUJ Umeora,1 VE Egwuatu,2 PO Ezeonu,1 TJP Onoh31Department of Obstetrics and Gynecology, Federal Teaching Hospital Abakaliki, Ebonyi State, Nigeria; 2Department of Obstetrics and Gynecology, Enugu State University Teaching Hospital, Enugu State, Nigeria; 3Department of Pathology, Federal Teaching Hospital Abakaliki, Ebonyi State, NigeriaBackground: Urinary tract infection (UTI) is a common bacterial infection during pregnancy and a significant cause of perinatal and maternal morbidity and mortality. The causative bacteria have remained virtually the same although with variations in individual prevalence. There has been an increasing resistance by these bacteria to the commonly available antibiotics.Objectives: To determine the prevalence of UTI, the common causative bacteria, and their antibiotic sensitivity pattern among pregnant women with UTI.Methodology: This is a descriptive study that was carried out at the Obstetrics Department of two tertiary institutions in Abakaliki, Ebonyi State, Nigeria (Federal Medical Center and Ebonyi State University Teaching Hospital) over a period of 12 months. Midstream urine specimens from selected pregnant women with clinical features of UTI were collected for microscopy, culture, and sensitivity. The results were analyzed with the 2008 Epi Info™ software.Results: A total of 542 pregnant women presented with symptoms of UTI and were recruited for the study over the study period. Of the 542 pregnant women, 252 (46.5%) had significant bacteriuria with positive urine culture and varying antibiotic sensitivity pattern. The prevalence of symptomatic UTI was 3%. Escherichia coli was the most common bacteria isolated with a percentage of 50.8%. Other isolated micro organisms included Stapylococcus aereus (52 cultures, 20.6%), Proteus mirabilis (24 cultures, 9.5%), S. saprophyticus (18 cultures, 7.1%), Streptococcus spp. (14 cultures, 5.6%), Citrobacter spp. (5 cultures, 2.0%), Klebsiella spp. (4 cultures, 1.6%), Enterobacter spp. (4 cultures, 1.6%), and Pseudomonas spp. (3 cultures, 1.2%). Levofloxacin had the highest overall antibiotic sensitivity of 92.5%. Others with overall antibiotic sensitivity pattern greater than 50% included cefpodoxime (87.3%), ofloxacin (77.4%), ciprofloxacin (66.7%), ceftriaxone (66.7%), and gentamicin (50.8%).Conclusion: E. coli was the most common etiological agent of UTI in pregnancy with Enterococcus (Staphylococcus) gaining prominence. Cephalosporin and quinolones were shown to be very effective against the organisms causing UTI in these pregnant women.Keywords: antibiotic sensitivity pattern, pregnancy, urinary tract infection, uropathogen

Fetal Umbilical Cord Length and Associated Intrapatum Complications In A Tertiary Institution, Southeast Nigeria.

Context: Extremes of umbilical cords have been associated with antepartum and intrapartum complications. Few studies which have investigated both risk factors and outcomes associated with these conditions contain conflicting reports. Aims and Objectives: This study aims at documenting the length of the umbilical cord in babies born in Ebonyi State University Teaching Hospital (EBSUTH), as well as any association between umbilical cord length and fetal sex, number of fetuses, presenting part, cord accidents and certain intrapartum complications. Methodology: Prospective study of umbilical cords length of deliveries conducted in the department of Obstetrics and Gynaecology of EBSUTH, Abakaliki, from 1st October, 2008 over a six months period was done. Analyses were done using EPI info. Results: A total of 588 consecutive deliveries met the inclusion criteria. The mean cord length was 57.87 +12.6 cm and ranged between 22cm and 124cm.The mean cord length for male babies were significantly more than the females (58.16cm vs 57.59 cm). Significant difference also existed in cord lengths for multiple deliveries and singletons. The mean umbilical cord length associated with loops was significantly higher than that of the study population 63.58cm vs 57.28cm. Shoulder dystocia, hand prolapse in a transverse lying fetus, abruptio placentae and prolonged second stage of labour had shorter cords while fetal distress, cord prolapse and mecunium stained liquor had longer cords when compared with the mean umbilical cord length of the study population. Conclusion: Umbilical cord length was positively associated with number of fetuses and sex of the babies, but not with FETAL presentations. Extremes of cord length could predispose to certain intrapartum complications.Keywords: Umbilical cord, Length, intrapartum complication