Emergency peripartum hysterectomy in a low resource setting: a 5-year analysis.

BACKGROUND: Emergency peripartum hysterectomy (EPH) is an important life saving surgical procedure often necessitated by life threatening obstetric haemorrhage. The indications for peripartum hysterectomy differs between develop and developing countries and may reflect the level of obstetric practice in a region. PATIENTS AND METHODS: This was a 5-year retrospective study. The medical records of patients who had emergency peripartum hysterectomy at the University of Port Harcourt Teaching Hospital were reviewed and relevant data were retrieved and analyzed. RESULTS: Sixty two cases of peripartum hysterectomy were performed giving a prevalence rate of 0.38% out of 16,113 total deliveries. Being unbooked was significantly associated with peripartum hysterectomy (x2 = 85.29, p = 0.0000). Peripartum hysterectomy was performed for 20.3% of nulliparous women. Subtotal hysterectomy accounted for 55.9% while total hysterectomy was performed for 44.1% of cases. The commonest indication for peripartum hysterectomy was uterine rupture (57.6%). There was no case of ureteric injury Unbooked mothers were 28 times more likely to die than booked mothers. Unbooked status was significantly associated with maternal mortality (p = 0.00008) and perinatal mortality (p = 0.00000). CONCLUSION: Emergency peripartum hysterectomy still remains indispensible in obstetric practice in low resource setting. Labour and delivery when well supervised will reduce the need for emergency peripartum hysterectomy. Training of specialist in the skill of internal iliac artery ligation is recommended.

Tumours of the Vulva in Port Harcourt; Nigeria. A 13-Year Clinico Pathological Study

The aim is to ascertain the pattern and frequency of vulval tumours as seen at the University of Port Harcourt Teaching Hospital. Forty (40) vulval tumours were used for the study. Twenty nine (72.5) were benign and eleven (27.5) were malignant. Patients of age 50 years and above were most affected 24(60). The most common clinical presentation was elevated and ulcerated plaques9 (22.5). Condyloma accummatum was the most common benign tumour while squamous cell carcinoma was the most common malignant tumour. It is concluded that vulval tumours are rare in this environment and that the malignant variants present at advanced stage of the disease in later ages. They constitute a remarkable morbidity and mortality especially in the obese and chronically ill menopausal women

Sero-Prevalence of Hepatitis C Antibodies in Pregnant Women in Port Harcourt; Nigeria

Background: Hepatitis C virus (HCV) infection is now a pandemic; with most of those infected thought to be in developing countries; including sub-Saharan Africa. HCV has emerged as the most important cause of chronic liver disease worldwide and an important cause of acute hepatitis and jaundice in pregnancy; with its attendant serious complications. Aim: To provide some preliminary data on HCV epidemiology in pregnant women in Port Harcourt; Nigeria. Methods: Serial recruitment of 600 patients attending the ante-natal clinic of the University of Port Harcourt Teaching Hospital; Port Harcourt; Nigeria was carried out. HCV testing was done using a rapid ELISA kit. The results are reported as percentages of the total study population. Differences between the groups were compared using the chi-squared test and p0.05 was regarded as statistically significant. Results: Of the 600 subjects; 26 (4.3) tested positive to anti-HCV. Previous histories of blood transfusion; dental manipulations; tattooing and circumcision did not appear to be important modes of transmission of HCV in this locality. Conclusion: HCV infection is fairly common among pregnant women in Port Harcourt; Nigeria. It is sug- gested that in addition to improved compliance with universal safety precautions; ante-natal patients and healthcare staff should be routinely screened for their HCV status in order to reduce vertical transmission of HCV and transmission between patients and health staff

Pathology of vaginal cancers in Port Harcourt, Nigeria. A 14-year study.

BACKGROUND: Primary malignancies of the vagina are rare as most are metastatic lesions. This study documents a 14-year experience in a tertiary institution in South Southern, Nigeria. DESIGN AND SETTING: A retrospective study of clinical presentations including anatomic sites and histopathologic diagnosis of cancers of the vagina in the University of Port Harcourt Teaching Hospital METHODOLOGY: The tissues received for histologic diagnosis were fixed in 10% formal saline, processed and embedded in paraffin wax. Microtome sections of the tissue (3 -5 microns) were taken and mounted on glass slides and stained with hematoxylin and eosin (H & E) stains. Cases in which both the slide and blocks could not be traced were excluded from the study. RESULTS: A total of 2389 malignancies were diagnosed during the period under review of which 344 were gynaecological. Fifteen cases of vaginal cancers satisfied the criteria for the study, constituting 0.63% and 4.36% of the total and gynaecological malignancies respectively. Five cases (33.33%) occurred in children below the age of 20 years, while 10 cases (66.67%) were in adults. The peak incidence was in the group 0 9 and 60-69 years. Irregular vaginal bleeding was the commonest clinical presentation and the upper posterior vaginal wall was the commonest anatomic site. The most frequent histological type was the non-keratinizing squamous cell carcinoma while FIGO stage 111 (46.67%) cancer was the commonest stage at presentation. CONCLUSION: Vaginal cancers are rare in this environment but they contribute to high morbidity and mortality among women of all ages as the disease is diagnosed at an advanced stage.

Human Bite and Human Immune Defiency Cirus (HIV) Transmission

Background: The concentration of human immune deficiency virus (HIV) in the saliva of a carrier is low. As a result; human bite is not considered the traditional route of HIV infection transmission.Aim: To report a case of HIV sero-positivity following a human bite. Setting: University of Port Harcourt Teaching Hospital; Port Harcourt.Case report: A 30-year-old HIV sero-negative woman who became sero-positive following a bite by a known HIV infected commercial sex worker is presented. Both were engaged in a physical fight over a disagreement.Conclusion: This case highlights the possibility of HIV infection through human bite

An assessment of high risk sexual behaviour and HIV transmission among migrant oil workers in the Niger Delta area of Nigeria.

BACKGROUND: A cross--sectional behavioural survey undertaken amongst migrant oil-workers of an oil exploration outfit operating in the Niger-Delta of Nigeria with the aim of assessing the interplay of migrancy, high-risk sexual behaviour and HIV transmission. METHOD: A total of 300 randomly selected migrant oil workers were assessed using structured questionnaires to evaluate key high - risk sexual behavioral parameters such as multiplicity of sexual partners, bisexuality (closet homosexuality), high grade sexual behaviour and lesbianism. Sampling period was two months with a control cohort of 200. RESULT: The prevalence of high risk sexual behaviour (HRSB) amongst the migrant oil workers was found to be 7.7% while low-risk sexual behaviour (LRSB) was 92.3%. There was no record of HRSB in the control group. We did not also encounter any lesbian sexual orientation in this study. The distribution of HRSB amongst the migrant oil workers showed that the commonest variety was bisexuality (closet homosexuality) with 10(43.5%) followed by high-risk sexual behaviour 7(30.4%), while the least common was multiplicity of sexual partners with 6 (26.1%). Furthermore, majority of these individuals 19 (82.6%) were above the age of 35 years. The index of condom-use and acceptance was high. Here 14 (60.9%) found condom-use convenient while 13 (56.5%) regularly used the condom. CONCLUSION: This study confirms the existence of HRSB among migrant oil workers in the Niger delta. It is therefore advisable to focus interventionist and prevention programmes on this group which appear to be pivotal in the transmission and spread of HIV/AIDS in this environment.

Sero-prevalence of HIV antibodies in pregnant women in Port Harcourt, Nigeria.

BACKGROUND: The aim of the study was to determine the Sero-Prevalence of HIV antibodies in pregnant women attending the antenatal clinic at the University of Port Harcourt Teaching Hospital, Port Harcourt. METHOD: Serial recruitment of 600 women who attended the antenatal clinic. HIV screening was done by rapid ELISA technique. Positive samples were re-tested with a second rapid ELISA kit, with only samples sero-positive with both kits being taken as trulysero-positive. RESULTS: The sero-positivity rate was 7.3%, sixty-nine point seven percent (69.7%) of all sero-positive cases were primiparae, with 84% in advanced stages of pregnancy (2nd and 31rd trimesters). History of blood transfusion, dental manipulations, tattooing and circumcision did not contribute significantly to increased HIV sero-positivity. CONCLUSION: There is high HIV sero-positivity rate among pregnant women attending antenatal clinic in Port Harcourt. The implications of this finding in relation to vertical transmission, transmission of nosocomial infection and increased occupational exposure of laboratory and hospital staff to HIV infection is discussed. Compulsory routine screening of all pregnant women attending antenatal clinics in Sub-Saharan Africa is advocated.

Rate, pattern and barriers of HIV serostatus disclosure in a resource-limited setting in the Niger delta of Nigeria.

The disclosure of HIV serostatus is a difficult emotional task creating opportunity for both support and rejection. In this study, we evaluated the rate, patterns and barriers to HIV serostatus disclosure. A pre-tested interviewer-administered questionnaire from 187 HIV infected people residing in a resource-limited setting in the Niger Delta of Nigeria was analysed. Of the 187 HIV seropositive patients studied, 144 (77.0%) had disclosed their HIV-serostatus while 43 (23.0%) had not. Results showed that the patients had disclosed their HIV-serostatus to: parents (22.3%), siblings (9.7%), pastors (27.8%), friends (6.3%), family members (10.4%) and sexual partners (23.6%) (P = 0.004). Females were more likely (59.7%) to disclose their HIV serostatus compared with males (40.3%) (P = 0.003). Mothers were twice as likely (65.6%) to be confided in compared with fathers. Barriers to HIV serostatus disclosure included fear of stigmatization, victimization, fear of confidants spreading the news of their serostatus and fear of accusation of infidelity and abandonment (P = 0.002). Married respondents were more likely to disclose their status. Better-educated respondents with tertiary education were more likely to disclose their HIV-serostatus. Expectation of economic, spiritual, emotional and social support was the major reason for disclosure. The ratio of disclosure to non-disclosure among patients with non-formal education was (2.6:1.0), primary education (2.3:1.0), secondary education (3.3:1.0) and tertiary education (10.0:1.0). Disclosure of HIV serostatus can foster economic social and economic support. There is need for the re-intensification of interventional measure that combines provider, patients and community education particularly in the aspect of anti-stigma campaign, partner notification and skill building to facilitate appropriate HIV serostatus disclosure.

Sero-prevalence of HIV antibodies in pregnant women in Port Harcourt, Nigeria

BACKGROUND: The aim of the study was to determine the Sero-Prevalence of HIV antibodies in pregnant women attending the antenatal clinic at the University of Port Harcourt Teaching Hospital, Port Harcourt.METHOD:Serial recruitment of 600 women who attended the antenatal clinic. HIV screening was done by rapid ELISA technique. Positive samples were re-tested with a second rapid ELISA kit, with only samples sero-positive with both kits being taken as trulysero-positive.RESULTS:The sero-positivity rate was 7.3%, sixty-nine point seven percent (69.7%) of all sero-positive cases were primiparae, with 84% in advanced stages of pregnancy (2nd and 31rd trimesters). History of blood transfusion, dental manipulations, tattooing and circumcision did not contribute significantly to increased HIV sero-positivity.CONCLUSION:There is high HIV sero-positivity rate among pregnant women attending antenatal clinic in Port Harcourt. The implications of this finding in relation to vertical transmission, transmission of nosocomial infection and increased occupational exposure of laboratory and hospital staff to HIV infection is discussed. Compulsory routine screening of all pregnant women attending antenatal clinics in Sub-Saharan Africa is advocated

Succenturiate placenta: a rare variant in Rivers State Nigeria (a report of one case).

BACKGROUND: The objective of this paper is to highlight the complications associated with succenturiate placenta in pregnant women. METHODS: A case report of succenturiate placenta. Thorough examination of the placenta grossly and histologically as well as autopsy of the fetus following standard procedure to confirm the gestational age and to ascertain the cause of death was undertaken by the authors. RESULT: The succenturiate lobe was attached to the major placenta by fibrous tissue which was transversed by blood vessels. The visceral surface showed haemorrhagic necrosis and thrombosis and these led to placental insufficiency resulting in fetal death. CONCLUSION: This rare placental abnormality showed that abnormal placental can be responsible for intrauterine fetal death. This can be detected through the use of ultrasonography.

Urethral prolapse: a retrospective analysis of hospitalized cases in Port Harcourt.

BACKGROUND: Urethral prolapse is a disease of the prepubertal girls and postmenopausal women. It is rare and seen in most cases as a circular protrusion of the distal urethra through the external meatus. METHOD: A retrospective study of cases managed in University of Port Harcourt Teaching Hospital (UPTH) between January 1989 and December 2000 were analysed. RESULTS: Nineteen (0.4%) excisions of urethral mucosal prolapse out of a total of 4351 gynaecological surgeries were carried out between January 1989 and December 2000 in UPTH. Of the 35 total paediatric gynaecological admissions, there were 17 (49%) cases of urethral prolapse. It occurred commonly between ages 4 and 7 years (63%). Common presenting complaints included vaginal bleeding, vaginal discharge and mass protruding from the urethral opening. Excision was found curative in all cases. CONCLUSION: There is a place for promotion of female education and community sensitization to encourage early presentation and treatment. This will reduce infectious morbidity and its sequelae in our environment.

Sero-prevalence of hepatitis B surface antigen (HBsAg) in pregnant women in Port Harcourt, Nigeria.

BACKGROUND/OBJECTIVE: Hepatitis B Virus (HBV) infection is a global public health problem and is endemic in Asia and Sub-Saharan Africa, including Nigeria. Vertical transmission of HBV infection is thought to be a major mode of transmission in endemic areas. This study was therefore undertaken to determine the sero-prevalence of Hepatitis B surface antigen (HBsAg) on pregnant women in Port Harcourt, Nigeria, in an effort to obtain baseline information on disease burden in this locality, in order to institute public health measures to reduce transmission. PATIENTS AND METHODS: Serial recruitment of 600 women attending the ante-natal clinic at the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria. HBsAg screening was done using a rapid ELISA Kit. RESULTS: 26(4.3%) of the 600 subjects tested positive to HBsAg. Blood transmission, dental manipulations, tattooing and circumcision were found not to be significant modes of transmission of HBV infection in Port Harcourt. CONCLUSION: There is an intermediate prevalence (4.3%) of HBV infection in pregnant women in Port Harcourt, Nigeria. The need to institute public health measures to reduce disease burden and transmission, including routine screening of all pregnant mothers for HBV infection and early passive/active immunisation of babies born to HBsAg--positive mothers is advocated.

Plasma lipids during pregnancy in women in Port Harcourt, Nigeria.

BACKGROUND: Pregnancy in Caucasian women is known to be associated with hyperlipidaemia. In a background of poor socio-economic conditions, early marriage, poor acceptance of contraceptives, poor spacing of pregnancies, high fertility rate and poor maternal and child health indices, this study was designed to investigate the pattern and degree of serum lipid changes during pregnancy in black African women in Port Harcourt, Nigeria. METHODS: Two hundred and thirty apparently healthy pregnant women at different stages of pregnancy and 51 non-pregnant control subjects of comparable age, height, and parity were serially recruited into the study. Plasma total cholesterol (TCHOL), LDL-Cholesterol (LDL-CHOL), HDL-Cholesterol (HDL-CHOL) and triglycerides (TG) were estimated for all study subjects and mean plasma lipid levels calculated for first, second and third trimesters of pregnancy. RESULTS: There was an increase in the mean concentration of plasma TCHOL, HDL-CHOL, and TG and a decrease in LDL-CHOL in the pregnant subjects as compared to the non-pregnant control subjects. Mean TCHOL, HDL-CHOL, LDL-CHOL and Triglycerides tended to increase with increasing gestational age. CONCLUSION: The results show that pregnancy in black Nigerian women is associated with hyperlipidaemia. The implications of this finding are discussed.

Pre-marital HIV testing in couples from faith-based organisations: experience in Port Harcourt, Nigeria.

BACKGROUND: This descriptive cross-sectional study was conducted among prospective couples referred from Faith-Based Organisations in Port Harcourt, Nigeria for pre-marital HIV screening. The study sought to establish the sero-prevalence of human immunodeficiency virus (HIV) in this peculiar study group. METHODS: A total of 84 healthy heterosexual couples who required pre-marital HIV screening were tested between January 2000 and December 2003 using a Double ELISA confirmatory test of Immunocomb and Genscreen HIV I&II Kits. RESULTS: Amongst the 168 individuals tested, 35 (20.8%) were found positive. Seroprevalence was significantly higher among females 23 (27.4%) compared to males 12 (14.3%). Infection rate was highest in the 25-29 years group (29.7%, n=22) and lowest in those of 35-39 years (6.1 %, n=2), though this difference was not statistically significant (p-value=0.058). Infection rate was significantly higher among females (p-value=0.036); among prospective couples from Orthodox churches (p-value=0.021); couples with prolonged courtship (>6 months) (p-value=0.0001); couples with history of premarital sex (p-value=0.0001); and couples with history of cohabitation (p-value=0.0001). CONCLUSION: Our findings prompt a wake-up call for faith-based organizations (FBOs) to urgently initiate or be more receptive of measures that emphasize behavioural and social changes amongst members. Government and non-governmental organizations should organise capacity building training for religious based organizations to enable them cope with the challenges of HIV/AIDS. The outcomes of this study further underscores the value of voluntary counselling and confidential HIV testing and especially pre- and post-test counselling as the basis of pre-marital HIV testing.

Sociodemographic characteristics of young adults screened for HIV in a tertiary health centre in South-South Nigeria

Background: Human immune deficiency virus (HIV) infection is endemic globally, more so in developing countries like Nigeria and is an important cause of mortality and morbidity. Objective: This study was undertaken to document the sero-prevalence of HIV infection among young adults (10 ­ 24 years). Method: HIV screening was performed on all (n = 673) young adults referred to the retrovirology unit of the Haematology Department of the University of Port Harcourt Teaching Hospital between January 2003 to December 2003 comprising of 205 males and 432 females were screened for HIV using a double ELISA confirmatory of Immunocomb and Genscreen HIV 1 & 2 kits. Result: A total of 637 young adults were screened for HIV. Two hundred and seventy-two (42.7%) were found positive to HIV. The highest infection burden occurred among the 20-24 years group 242 (50%) and lowest among the 10-14years group 4(12.1%). Infection rate was significantly higher among females 217 (50.2%), and in less educated adolescent with no formal education 56 (80%). History of alcoholism 262 (99.2%), drug use 146(60.6), number of sexual partners and age at first sexual debut were independent risk factors in adolescents for infection with HIV (P < 0.05). Conclusion: This study confirmed a high prevalence of HIV among adolescents and describes the groups more at risk as seen in other parts of Nigeria. This calls for urgent health education of the young adult population with emphasis on a combination of behavioural and social changes to curb the spread of HIV

Prevalence and medicalization of female genital mutilation.

BACKGROUND: Most traditional practices in Africa, sustained and fuelled by underdevelopment, ignorance, illiteracy, poverty and tenacious customs, have been on the decline except for female genital mutilation (FGM). AIM: To ascertain the prevalence and operators of female genital mutilation (FGM). METHOD: A cross sectional study was carried out in a semi-urban town in Rivers State of Nigeria between January and April 1988, utilizing structured questionnaires which were randomly distributed. The response of 600 respondents was analyzed. RESULTS: Prevalence of FGM amongst the study population was 53.2%. Medical doctors were the most mentioned operators (34.5%) followed by traditional birth attendants (33.8%). Control of excess female sexual desires (58.2%) and promotion of culture (39.5%) were the major reasons adduced for this practice. CONCLUSION: The enforcement of the World Health Organization (WHO) legislation against medicalization of this practice is advocated. Training and retraining of traditional birth attendants with emphases on eradication of harmful cultural practices will help.

Abdominal massage: another cause of maternal mortality.

BACKGROUND: Abdominal massage is an age long practice among obstetric and non obstetric patients in different parts of the riverine areas of Southern Nigeria. AIM: To highlight the consequences associated with this practice in pregnancy and labour even among literate clients. METHODS: Two hundred and eighty four pregnant women who presented as obstetric emergencies in pregnancy and labour at the University of Port Harcourt Teaching Hospital from 1st May 1988 to 31st July 1998 were studied. RESULTS: Forty two (14.79%) of the 284 patients had abdominal massage. Maternal mortality rate was 4.76% while the perinatal mortality rate was 14.29%. Twenty four of the patients were literate though 15 of them only had primary education. Most of the patients were unbooked (76.19%). The complication of pregnancy noted were cephalo pelvic disproportion /obstructed labour (28. 57%) and abruption placenta (23.80%); placenta previa (9.52%); retained placenta (4.76%) abortion / preterm labour (19.04%); genital injuries and tears (7.14%); perinatal death (14.28%); uterine rupture (9.52%); maternal mortality (4.76%). CONCLUSION: Abdominal massage is a silent killer, which has added to matemal and perinatal mortality and morbidity in this region. Ignorance, illiteracy and poverty have sustained this practice, while underdevelopment, inaccessibility and ill-equipped medical facilities have kept this traditional practice flourishing even amongst the educated group. The time to stop this form of avoidable losses is now. This can be achieved through public health approach, mass literacy, even distribution of affordable healthcare services, improved social services and transportation, robust economy and a grass root involvement of rural programmes aimed at eradicating harmful traditional practice.