A Decade Of Hysterectomy In ATertiary Hospital In Urban Niger-delta Region Of Nigeria

Hysterectomy is a very common gynaecological procedure which has a significant place in optimizing the reproductive health outcomes ofwomen. To document the indications the type of hysterectomy commonly performed, the difficulties encountered and complications of the procedure at theCentralHospital,BeninCity. This was a retrospective review of the service delivery records of patients that had hysterectomy in the gynaecological unit between January, 1994 andDecember, 2003. There were 1216 major gynaecological operations during the study period. Of these, 131 (10.8%) hysterectomies were done. Total abdominal hysterectomy accounted for 80.4% of the procedures performed and most were done by consultants (94.4%). The mean age of the patients was 45.7 years with a median of 46years and theywere commonly grandmultiparous (71.0%).The commonest indication for the procedurewas symptomatic uterine fibroid (62.3%) followed by urogenital prolapse (13.1%). The crude morbidity rate was 30.3%and themortality ratewas 1.6%. Hysterectomy in this centre is a fairly safe procedure. There is paucity of skills for vaginal and radical procedures. Training is advocated with a view to reducing the presently high morbidity rate as well as achieving our aimof optimizing the reproductive health outcomes of ourwomen. Keywords: Decade,Hysterectomy,Tertiary Hospital,Urban Nigeria Nigerian Journal of Clinical Practice Vol. 11 (4) 2008: pp. 359-36

Incidence and Determinants of Stillbirth amongst Parturients in Two Hospitals in Southern Nigeria

Background: Fetal death is a major but often overlooked public health issue. Aim: Knowledge of the causes and risk factors will help in designing measures to reduce the burden of fetal death in Nigeria. Materials and Methods: A 5 year descriptive study of all fetal mortality of >28 weeks in Southern Nigeria. Relevant details were extracted from the case notes and the registers in the labor ward, maternity ward, the labor ward theater and the main theater. Statistical Analysis Used: The data was analyzed using Statistical Package for Social Scientist (SPSS PC+) and this consisted of univariate analysis and comparisons of identified relationships. Results: The total number of deliveries from 28 weeks was 25,780 and the number of parturients with fetal mortality after 28 weeks was 157 and therefore the incidence of stillbirth was 0.6% giving a mortality rate of 6.1/1000 total births. However, 148 (85%) case notes of the total fetal deaths were retrieved and formed the study sample. Socio-demographic variables such as extremes of age and parity, unbooked status, unemployment, unmarried, Isoko, Itsekiri and Ijaw ethnic groups and primary level or no formal education were determinants of stillbirth. Others were maternal diabetes mellitus, malaria, hypertension, labor duration >4 h, instrumental or assisted vaginal delivery, gestational age at booking >12 weeks, low birth weight and preterm births. Conclusion: The fetal mortality (stillbirth) rate was low and the determinants were identified. Public health education, female education and socio-economic empowerment are suggested preventive measures.Keywords: Amongst parturients, determinants, fetal mortality, incidence, Southern Nigeria, stillbirt

Prevalence of Malaria and Anaemia among HIV Infected Pregnant women Receiving Co-trimoxazole Prophylaxis in Tanzania: A Cross Sectional Study in Kinondoni Municipality.

HIV-infected pregnant women are particularly more susceptible to the deleterious effects of malaria infection particularly anaemia. In order to prevent opportunistic infections and malaria, a policy of daily co-trimoxazole prophylaxis without the standard Suphadoxine-Pyrimethamine intermittent preventive treatment (SP-IPT) was introduced to all HIV infected pregnant women in the year 2011. However, there is limited information about the effectiveness of this policy. This was a cross sectional study conducted among HIV-infected pregnant women receiving co-trimoxazole prophylaxis in eight public health facilities in Kinondoni Municipality from February to April 2013. Blood was tested for malaria infection and anaemia (haemoglobin <11 g/dl). Data were collected on the adherence to co-trimoxazole prophylaxis and other risk factors for malaria infection and anaemia. Pearson chi-square test, Fischer's exact test and multivariate logistic regression were used in the statistical analysis. This study enrolled 420 HIV infected pregnant women. The prevalence of malaria infection was 4.5%, while that of anaemia was 54%. The proportion of subjects with poor adherence to co-trimoxazole was 50.5%. As compared to HIV infected pregnant women with good adherence to co-trimoxazole prophylaxis, the poor adherents were more likely to have a malaria infection (Adjusted Odds Ratio, AOR = 6.81, 95%CI = 1.35-34.43, P = 0.02) or anaemia (AOR = 1.75, 95%CI = 1.03-2.98, P = 0.039). Other risk factors associated with anaemia were advanced WHO clinical stages, current malaria infection and history of episodes of malaria illness during the index pregnancy. The prevalence of malaria was low; however, a significant proportion of subjects had anaemia. Good adherence to co-trimoxazole prophylaxis was associated with reduction of both malaria infection and anaemia among HIV infected pregnant women

Patterns of anti-malarial drug treatment among pregnant women in Uganda

BACKGROUND: Prompt use of an effective anti-malarial drug is essential for controlling malaria and its adverse effects in pregnancy. The World Health Organization recommends an artemisinin-based combination therapy as the first-line treatment of uncomplicated malaria in the second and third trimesters of pregnancy. The study objective was to determine the degree to which presumed episodes of uncomplicated symptomatic malaria in pregnancy were treated with a recommended anti-malarial regimen in a region of Uganda. METHODS: Utilizing a population-based random sample, we interviewed women living in Jinja, Uganda who had been pregnant in the past year. RESULTS: Self-reported malaria during the index pregnancy was reported among 67% (n = 334) of the 500 participants. Among the 637 self-reported episodes of malaria, an anti-malarial drug was used for treatment in 85% of the episodes. Use of a currently recommended treatment in the first trimester was uncommon (5.6%). A contraindicated anti-malarial drug (sulphadoxine-pyrimethamine and/or artemether-lumefantrine) was involved in 70% of first trimester episodes. Recommended anti-malarials were used according to the guidelines in only 30.1% of all second and third trimester episodes. CONCLUSIONS: Self-reported malaria was extremely common in this population and adherence to treatment guidelines for the management of malaria in pregnancy was poor. Use of artemether-lumefantrine combined with non-recommended anti-malarials was common practice. Overuse of anti-malarial drugs, especially ones that are no longer recommended, undermines malaria control efforts by fueling the spread of drug resistance and delaying appropriate treatment of non-malarial febrile illnesses. Improved diagnostic capacity is essential to ultimately improving the management of malaria-like symptoms during pregnancy and appropriate use of currently available anti-malarials

Maternal death and obstetric care audits in Nigeria: A systematic review of barriers and enabling factors in the provision of emergency care.

Acknowledgements We would like to thank Yutaka Osakabe for co-ordinating the retrieval of full text articles. The John D. and Catherine T. MacArthur Foundation supported this study, grant number 12-100074-000-INPPeer reviewedPublisher PD

Unsafe Abortion and miscarriages: Quantification and public health related perspectives in Nigeria

No Abstrac

The story of abortion: Issues, Controversies and a case for the review of the Nigerian National Abortion Laws

Abortion continues to be a major public health issue that evokes social, political, legal, cultural and religious sentiments and debates in all societies. This is particularly so in countries with restrictive abortion laws. It is one of the leading causes of maternal mortality and morbidity. Despite variations in the legal status of abortions in favor of restrictiveness in developing countries compared with developed countries, overall rates are quite higher in the developing countries13. This review article therefore, examines the historical perspectives of induced abortion as well as the issues and controversies associated with induced abortion. Also, a review of the Nigeria national abortion law is made. We believe that this is capable of identifying useful interventions for designing programs that will lead to a reduction in the burden of unsafe abortion in developing countries

Maternal mortality at the Central Hospital, Benin City Nigeria: A ten year review

Maternal mortality remains a major challenge in Nigeria. This retrospective study was conceptualized to document the number and pattern of obstetric deaths at the Central Hospital, Benin City, over a ten year period, to identify common causes of maternal deaths and proffer relevant interventions. The overall maternal mortality ratio (MMR) was 518/100,000. MMR was 30 times higher in unbooked as compared to the booked patients, while 60% of maternal deaths occurred within 24 hours of admission. The leading direct causes of maternal deaths were sepsis, hemorrhage, obstructed labor and preeclampsia/ eclampsia, while the major indirect causes are institutional difficulties and anaemia. Low literacy, high poverty levels, extremes of parity and non-utilization of maternity services wereassociated with maternal mortality. Recommendations are made for public enlightenment campaign and advocacy activities aimed at mobilizing resources for reducing maternal mortality. Also, femaleeducation and poverty alleviation programmes will contribute to the reduction of the burden of maternal mortality (Afr J Reprod Health 2008; 12[3]:17-26)

Soluble Transferrin Receptor - A Marker For Iron Deficiency; A Review

Parameters for measuring iron deficiency have been established for decades and have served clinicians in the management of this nutritional disorder. The bone marrow still remains the gold standard in the final diagnosis of iron deficiency. However, researchers have been able to identify the dominating role of the transferrin transferrin receptor complex in the internalization of iron, subsequent to its transport and utilization. The serum transferrin are shed into the blood and its level has been found to correlate with the level of iron stores and thereby the degree of erythropoietic activity. The aim of this literature review is to explore the physical properties of the serum transferrin receptor and its usefulness in the detection of iron deficiency. Literature on the subject was researched using manual library search, articles in journals, internet search such as pubmed, medscape and as well as conference abstracts. Serum transferrin receptor was found to be a reliable marker in the detection of iron deficiency in early pregnancy and other conditions such as patients with chronic renal failure undergoing haemodialysis. Many of the parameters currently being used as markers for iron deficiency have draw backs especially in anaemia that is complicated with other conditions. It has been shown that the concentration of serum transferrin receptors are unaffected by the acute phase reaction seen in many inflammatory conditions. The serum transferrin receptor concentration has been found to correlate well with bone marrow iron stores and red cell indices. However the serum transferrin receptor has not yet been in clinical use in Nigeria and has been mainly in the realms of experiment despite the obvious advantages it presents over the bone marrow aspiration procedure. The procedure for the determination of the serum transferrin receptor concentration is quite easy to understand, the introduction of its estimation into clinical practice will enhance early diagnosis and management of iron deficiency and other related conditions.Key words: Iron deficiency anaemia, soluble transferrin, serum ferriti