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Background: Out-patient clinics are very important in medical students’ education. Aim: This study was undertaken to determine the attitudes of patients to the participation of medical students in their consultation in the gynaecology clinic at the University of Nigeria teaching hospital, Ituku-Ozalla Enugu (UNTH), Southeast Nigeria. Methods: This was a descriptive cross sectional survey. Self-administered questionnaires were given to participants recruited using a non-probability convenience sampling technique. One hundred and ninety five patients participated in the study. Results: Most of the patients, 147(75.4%) were willing to allow medical students to participate in their consultation. Seven (3.6%) patients refused the participation of medical students in any form. Of the 141(72.3%) patients who had previous consultation with medical students present, only 59(41.8%) gave informed consent. Consent was not sought from 63(44.7%) of these patents (P=0.046). In the absence of a doctor, 58.2% and 46.4% of the patients did not accept giving history to male and female students respectively (P=0.021). Sixty nine (35.6%) and 146(75.3%) agreed to examination by male and female students respectively (P=0.031). Age (P=0.029) and marital status (P=0.017) were identified as independently significantly associated with the acceptance of medical students’ participation during clinic visits. Conclusion: In UNTH Nigeria, many patients are willing to allow medical students’ participation in their assessment in the gynaecology clinic although there is a preference for female students. There is need to respect patients autonomy by seeking consent in order to maximize their contribution to medical students’ education. There is also the need to create patient awareness on the role of a teaching health facility.
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Background: Asymptomatic Bacteriuria (ASB) in pregnancy is associated with potential urinary and obstetric complications. The diagnosis and management of ASB in expectant mothers is in keeping with safe motherhood initiative. Aim: To determine the prevalence and pattern of ASB among HIV-positive and HIV-negative pregnant women in Enugu State, South Eastern Nigeria. Methods: This was a comparative analytical study among HIV-positive and HIV-negative pregnant women at the University of Nigeria Teaching Hospital, Enugu State. ‘Clean catch’ urine samples of these women collected and analysed. Statistical analysis was performed using the Chi-square and student’s t tests as appropriate. A P-value of less than 0.05 was considered statistically significant. Results: Among the two hundred and forty HIV-positive women, (23.3%) had significant ASB while (10.4%) of an equal number of HIV-negative women had significant ASB. The difference was statistically significant (p=0.013). A higher proportion of HIV-positive women, (22.5%) with CD4 cell count of ≤ 500/mm3 had significant ASB (p=0.015). Escherichia coli was the commonest isolate in both groups of women. The isolates were generally sensitive to amoxicillin-clavullanic acid, nitrofurantoin and cefuroxime in the two groups. The sensitivity to sulfametoxazle-trimethoprim was low; HIV positive (21.5%), HIV negative (16.0%). Among those treated, none had overt UTI in pregnancy. Conclusion: Screening, treatment and follow up for ASB in pregnancy are necessary especially in HIV positive women with CD4 cell count less than 500/mm3. This should be included during counselling in all antenatal protocols.
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Background: Pelvimetry is a poor predictor of obstetric outcome. The predictive value of clinical pelvimetry remains limited except in extreme pelvic contracture or an excessively large fetus. Objective: To determine the attitudes of primigravidae to routine clinical pelvimetry. Subjects and Methods: This was a cross-sectional study of primigravidae at the University of Nigeria Teaching Hospital (UNTH), Enugu between January 1st and December 31st, 2009. Selfadministered, structured, and pre-tested questionnaires were distributed to the consenting selected women by trained medical interns. Data was analyzed using SPSS version 16. P< 0.05 was considered statistically significant. Results: A total of 195 primigravidae were selected at random for this study. One hundred and thirty eight primigravidae (138/195, 70.77%) were aware of clinical pelvimetry while 29.23% (57/195) were not aware of clinical pelvimetry. One hundred and twenty five primigravidae (90.58%, 125/138) desired clinical pelvimetry to continue while thirteen (9.42%, 13/138) did not desire clinical pelvimetry to continue. There was statistically significant difference between those who were aware and unaware of pelvimetry in their desire for pelvimetry [X2=18.903, p=0.0001, OR 5.2, 95% confidence interval=2.20 to 12.44]. Conclusion: There is profound awareness and the desire to continue clinical pelvimetry among primigravidae at the UNTH, Enugu, Nigeria, where majority of the women showed strong preference for it.
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Background: The female condom remains the only female-initiated means of preventing both pregnancy and sexually transmitted infections, including HIV. Unfortunately uptake in the West and in some developing countries has been low thus precluding the realization of the dual benefits of this device. Aim: The aim of the study was to determine the prevalence of the use of the female condom and factors associated with its use among female students in a tertiary institution of learning in Enugu, Nigeria. Methods: This was a questionnaire based non comparative study. Sampling was by multi-stage technique. Data was collected using a semi-structured self administered questionnaire. Data was analyzed using SSPS statistical software version 17.0 for windows [Chicago IL, USA]. Bivariate analysis was done to determine the association of socio-demographic variables with awareness and use of female condoms using Pearson Chi-square test. P-value <0.05 was considered significant. Results: A total of 313 female undergraduates were studied. Their mean age was 23.9 years ± 4.1 SD. About 76.7% had knowledge of female condoms. Fifty (15.9%) used the female condom since admission to tertiary institution principally to prevent unwanted pregnancy and sexually transmitted infections. Among those that used the female condom the potential dropout rate was 58%, mainly because it was costly and not readily available. The feature of female initiation and control of the device was the principal reason or intention to continue to use the female condom. The sociodemographic characteristics that were significantly associated with the use of the female condom included marital status (χ2=7.79, p=0.01), religion (χ2-5.67, p-0.02), course of study (χ2=14.26, p=0.00) and previous sexual exposure prior to university admission (χ2=3.48, p=0.00). Conclusion: There was a low use rate for the female condom despite a high level of awareness and this could be due to non-availability and cost. It is recommended that donor agencies, governmental and non-governmental organizations pool their efforts together to make female condoms more available and affordable.
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Background: Amniotic fluid embolism (AFE) is a rare obstetric emergency with unclear aetiology, pathophysiology, diagnosis and management. The true incidence is unclear and diagnosed largely by exclusion. It can neither be predicted nor prevented and its management is fraught with controversy. Objective: To provide clinicians with current knowledge regarding the epidemiology, pathophysiology and management of AFE. Methods: This was a descriptive review of AFE. We searched several databases (Medline, Google scholar and Pubmed) with keywords, amniotic fluid, amniotic fluid embolism, amniotic fluid embolus and sudden postpartum collapse from inception to June 2014. Results: Data regarding the presence of risk factors for AFE are inconsistent, complex and contradictory. No risk factor has been identified that would justify modification of standard obstetric practice to reduce the risk of AFE. Further understanding of this syndrome has been hampered by lack of universally accepted diagnostic criteria. Diagnosis of AFE is clinical, largely by exclusion, and maternal treatment is primarily supportive and not causative. Mortality is still high despite improved modalities for diagnosing AFE, and better intensive care support facilities. Conclusion: AFE is a rare and dreadful obstetric emergency with a high morbidity and mortality rate. Our understanding of its aetiology and pathophysiology is incomplete and the criteria used to make its diagnosis are controversial. Inspite of advances in the care of critically ill patients, no management interventions have been found to improve survival or long-term outcome of patients with AFE.
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Background: Preventing transmission of HIV from mother to child after birth is one of the greatest challenges in HIV prevention. Aim: To evaluate the infant feeding practices among HIV-positive mothers and the factors that influenced their decisions at the University of Nigeria Teaching Hospital, Enugu, Nigeria. Methods: This was a questionnaire based cross-sectional study carried out at the paediatric HIV follow-up clinic between 1st January and 31st March 2014. Analysis was carried out using SSPS version 10.0 (Chicago IL, USA). P values less than 0.05 were considered significant. Results: Fifty four HIV-Positive mothers were evaluated. The mean (standard deviation) for age of the respondents was 29.7 (4.2) years. Thirty two respondents (59.3%) practiced replacement feeding, 14(29.9%) practiced mixed feeding while 8(14.8%) practiced exclusive breast feeding. Of the mothers that practiced mixed feeding, 10(71.4%) did not receive counseling on infant feeding practices. Replacement feeding was adopted by 27 (84.4%) of respondents for fear of transmission of HIV to their children. Disclosure of status and counseling were independently significantly associated with the adoption of recommended infant feeding methods (EBF and RF) P<0.05. Conclusion: Exposure to counseling on infant feeding methods was low. Current guidelines on infant feeding methods should be disseminated through structured counseling sessions at Maternity care centres for HIV-positive mothers.
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Background: Infertility is a phenomenon which influences all lifestyle aspects of a couple and has cultural, social, legal and especially psychological consequences. Depression is a common consequence of infertility and its impact can be devastating to the infertile persons and to their partners. Aim: To determine the prevalence of depression and its indicators among infertile women in Awka, Southeast Nigeria. Methods: This was a cross-sectional survey on consecutive attendees at the Fertility Clinic of Anambra State University Teaching Hospital, Awka, southeast, Nigeria, over a three month period. Data on socio-demographic variables were extracted using a pretested semi-structured questionnaire. Depression was assessed using the Beck’s Depression Inventory (BDI). Statistical Package for Social Sciences SPSS 10 (SPSS Inc, Chicago IL) was used for analysis. A value of P<0.05 was considered significant. Results: Of the 96(100%) respondents, 37(38.5%) had depressive disorder while 59(61.5%) were normal (P=0.001). Thirty (21.3%) respondents had primary infertility while 66(68.7%) had secondary infertility. Of those with primary infertility 22(77.3%) had depression compared to 15(22.7%) with secondary infertility (P=0.001). Depression was also significantly associated with duration of infertility (P=0.001), verbal abuse (P=0.001), willingness to adopt (p=0.009) and increasing maternal age (p=0.001). The associations between husband being supportive (P=0.140), social status (P=0.652), family setting (P=0.106), place of residence (P=0.134), employment (0.652), educational level (P=0.444) and depression were not statistically significant. Conclusion: The prevalence of depression among infertile women in Awka is significant. This should be taken into account in the treatment of infertile women in view of the adverse effects of depression in the aetiology and outcome of management of the infertile women.
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Background: The quest for ideal treatment and understanding of fibroid biology has resulted in further studies in pharmacological, radiological and surgical options with the goals of being safe, less invasive, cost-effective and enhancing reproductive potentials. However, surgery remains the mainstay of present effective management for large symptomatic fibroids. Aim: The aim is to review the treatment options available for women with uterine fibroids. Methods: Publications on the management of uterine fibroids were accessed using medline, google scholar and pubmed databases. Relevant materials on treatment of uterine fibroids, selected references from internet services, journals, textbooks and lecture notes on management of uterine fibroids were also accessed and critically reviewed. Results: The mainstay of management for large symptomatic fibroids is surgical (myomectomy or hysterectomy). Minimally invasive procedures are becoming more commonly performed via both laparoscopic or hysteroscopic approaches, minimizing recovery time, postoperative pain and morbidity. Uterine artery embolization (UAE) carries a risk of pelvic infection with limited evidence regarding the risks for future pregnancies. Levonorgestrel-releasing intrauterine system (LNG-IUS) is effective as a treatment for heavy menstrual bleeding. However, it is not recommended if the uterine cavity is markedly enlarged or distorted by fibroids. Gonadotrophin releasing hormone analogue (GnRHa) is the most widely used medical option. It can reduce the size of fibroids by about 30-35%, but only used for short-term course or preoperative mode of management since the resulting hypoestrogenic state can cause osteoporosis in long-term course. Furthermore, it can restore haemoglobin levels and apparently reduce blood loss at operation but notorious for rebound growth of fibroids upon cessation of therapy with major adverse effects. Newly introduced treatment options are poorly understood, still unclear with lots of theoretical advantages not fully backed with long-term effects. Little is known about their risks, cost and adverse effects. Conclusion: Fibroids are commonly found in women of reproductive age. Most women do not require treatment because fibroids are benign and most times asymptomatic. For symptomatic fibroids, many treatment options exist and should be considered before the decision to perform hysterectomy which precludes future fertility.
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Background: Sexually transmitted infections (STIs) constitute major public health concern and enigma. A comprehensive knowledge of the modes of transmission is necessary to evolve an effective preventive strategy. Aim: The aim of the study is to assess the vulnerability; knowledge and prevention of STIs among female traders of reproductive age in Enugu; Southeast Nigeria. Subjects and Methods: This was a cross-sectional descriptive study carried out on female traders aged 15-49 years at Ogbete Main Market; Enugu; Southeast Nigeria. Data was analyzed using Epi-Info 2000 version 3.3.1 Centers for Disease Control and Prevention Atlanta USA) was used to analyze the data and results were presented in tabular form. Results: A total of 200 female traders of reproductive age participated in the study. The mean (standard deviation) age was 26 (7.4) years. 16 (32/200) were adolescents. Knowledge of specific STIs was highest for human immunodeficiency virus/acquired immune deficiency syndrome 90 (130/200). Parents were poor sources of information as only 28.5 (57/200) respondents heard about STIs from their parents compared with 46 (151/200); non-use of condoms 62 (124/200) and early debut 58 (116/200). Majority 67.5 135/200) were aware that STIs could be treated by a visit to the doctor while 21.5 (43/200) preferred traditional/herbal healers. Conclusion: The inclusion of health education in schools' curricula to ensure that adolescents are adequately aware of STIs; their modes of transmission; prevention and treatment before embarking on any vocation out-of-school is advocated
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Health Education , Knowledge , Nigeria , Sexually Transmitted Diseases , Vulnerable Populations , WomenABSTRACT
Background: Female genital mutilation is known to exist especially in many third world countries including Nigeria with many women being victims of this harmful practice and its complications. The practice is rife in Southeast Nigeria and efforts have been made to discourage it. Objective: To determine women's views on aspects of female genital mutilation and the prevalence among the study population. Method: Women attending the antenatal clinics of two university teaching hospitals in Southeast Nigeria were interviewed by means of structured pre-tested interviewer- administered questionnaires. The data obtained were analysed using SPSS version 10.0 and the results expressed in descriptive statistics as percentages. Results: The prevalence of FGM was 42.1. However; only 14.3of the respondents circumcised their own daughters or showed willingness to circumcise their daughters indicating considerable reduction in uptake of the practice. A larger proportion (63.7) would support legislation against FGM. Conclusion: There is a high opinion against the practice of FGM in Southeast Nigeria; with the majority of the women showing support for legislation