An Assessment of Ovarian Cancer Histotypes Across the African Diaspora.

OBJECTIVE: Ovarian cancer in Black women is common in many West African countries but is relatively rare in North America. Black women have worse survival outcomes when compared to White women. Ovarian cancer histotype, diagnosis, and age at presentation are known prognostic factors for outcome. We sought to conduct a preliminary comparative assessment of these factors across the African diaspora. METHODS: Patients diagnosed with ovarian cancer (all histologies) between June 2016-December 2019 in Departments of Pathology at 25 participating sites in Nigeria were identified. Comparative population-based data, inclusive of Caribbean-born Blacks (CBB) and US-born Blacks (USB), were additionally captured from the International Agency for Research on Cancer and Florida Cancer Data Systems. Histology, country of birth, and age at diagnosis data were collected and evaluated across the three subgroups: USB, CBB and Nigerians. Statistical analyses were done using chi-square and student's t-test with significance set at p<0.05. RESULTS: Nigerians had the highest proportion of germ cell tumor (GCT, 11.5%) and sex-cord stromal (SCST, 16.2%) ovarian cancers relative to CBB and USB (p=0.001). CBB (79.4%) and USB (77.3%) women were diagnosed with a larger proportion of serous ovarian cancer than Nigerians (60.4%) (p<0.0001). Nigerians were diagnosed with epithelial ovarian cancers at the youngest age (51.7± 12.8 years) relative to USB (58.9 ± 15.0) and CBB (59.0± 13.0,p<0.001). Black women [CBB (25.2 ± 15.0), Nigerians (29.5 ± 15.1), and USB (33.9 ± 17.9)] were diagnosed with GCT younger than White women (35.4 ± 20.5, p=0.011). Black women [Nigerians (47.5 ± 15.9), USB (50.9 ± 18.3) and CBB (50.9 ± 18.3)] were also diagnosed with SCST younger than White women (55.6 ± 16.5, p<0.01). CONCLUSION: There is significant variation in age of diagnosis and distribution of ovarian cancer histotype/diagnosis across the African diaspora. The etiology of these findings requires further investigation.

The impact of mentor mother programs on PMTCT service uptake and retention-in-care at primary health care facilities in Nigeria: a prospective cohort study (MoMent Nigeria).

BACKGROUND: Nigeria is a key target country in the global effort toward elimination of mother-to-child transmission of HIV. Low coverage of prevention of mother-to-child transmission (PMTCT) interventions, adherence, and retention-in-care rates in HIV-positive pregnant women are contributing factors to high mother-to-child transmission of HIV (MTCT) rates. In Nigeria, rural areas, served largely by primary health care facilities, have particularly poor indicators of PMTCT coverage. Mentor Mothers are HIV-positive women who serve as peer counselors for PMTCT clients, provide guidance, and support in keeping appointments and promoting antiretroviral adherence and retention-in-care. The Mother Mentor (MoMent) study aims to investigate the impact of structured Mentor Mother programs on PMTCT outcomes in rural Nigeria. DESIGN AND METHODS: A prospective cohort study will compare rates of retention-in-care among PMTCT clients who are supported by formally-trained supervised Mentor Mothers versus clients who receive standard-of-care, informal peer support. Study sites are 20 primary health care centers (10 intervention, 10 control) in rural North-Central Nigeria. The study population is HIV-positive mothers and exposed infant pairs (MIPs) (N = 480; 240 MIPs per study arm). Primary outcome measures are the proportion of exposed infants receiving early HIV testing by age 2 months, and the proportion of MIPs retained in care at 6 months postpartum. Secondary outcome measures examine antiretroviral adherence, 12-month postpartum MIP retention, and MTCT rates. This article presents details of the study design, the structured Mentor Mother programs, and how their impact on PMTCT outcomes will be assessed.

Early outcome of incisional hernia repair using polypropylene mesh: A preliminary report.

BACKGROUND: The use of prosthetics for open repair of incisional hernia is very recent in our practice. We highlight our experience repairing incisional hernias with polypropylene mesh. PATIENTS AND METHODS: Patients presenting with incisional hernia >5 cm in length or width received open polypropylene mesh repair and were followed for two years. Data obtained included age, sex, primary surgery causing the hernia, the length of the fascial defect and previous attempts at repair. Post-operative wound complications were recorded. The integrity of the scar and patient satisfaction or concerns with the repair was assessed at each visit. RESULTS: Nineteen females with a mean age of 35 years (range 30-54) underwent repair; most arising from obstetric or gynaecological procedures. Sixteen (82.2%) had midline, 2 (10.5) transverse and 1 (5.3) Pfannenstiel scars. One patient had no previous repair (R0), 7 had undergone one repair (R1), 9 had undergone two repairs (R2) and 1 had three previous repairs (R3). The length of fascial defects ranged from 8 to 18 cm and seroma collection and stitch sinus were the common problems encountered. Two (10.5%) recurrences were recorded in two years. CONCLUSION: Open mesh repair of incisional hernia carries a low risk of infection and recurrence in two years.

Prevalence of anaemia among pregnant women at booking in the University of Uyo Teaching Hospital, Uyo, Nigeria.

BACKGROUND: Anaemia with an estimated prevalence of 35-75% among pregnant women is a major cause of maternal deaths in Nigeria. objective: To determine the prevalence of anaemia, associated sociodemographic factors and red cell morphological pattern among pregnant women during booking at the University Teaching Hospital, Uyo. MATERIAL AND METHODS: A cross-sectional analytical study of 400 women at the booking clinic over a 16-week period. The packed cell volume and red cell morphology of each pregnant woman were determined. Their biodata, obstetric and medical histories, and results of other routine investigations were obtained with questionnaires and analyzed with SPSS Package version 17.0. RESULTS: The mean packed cell volume was 31.8% ±3.2 and 54.5% of the women were anaemic. The commonest blood picture was microcytic hypochromia and normocytic hypochromia suggesting iron deficiency anaemia. Anaemia was significantly and independently related to a history of fever in the index pregnancy (OR = 0.4; P = 0.00; 95% CI = 0.3-0.7), HIV positive status (OR = 0.2; P = 0.01; 95% CI = 0.1-0.6), and low social class (OR = 0.3; P = 0.00; 95% CI = 0.2-0.7). CONCLUSION: Women need to be economically empowered and every pregnant woman should be encouraged to obtain antenatal care, where haematinics supplementation can be given and appropriate investigations and treatment of causes of fever and management of HIV can be instituted.

Self-Medication: potential risks and hazards among pregnant women in Uyo, Nigeria.

INTRODUCTION: There is increasing evidence that self-medications among pregnant women are common in many developing countries. Despite the adverse impact on pregnancy, there are few programs available for their control. The objective of this study was to assess the level of self-medication amongst Nigerian pregnant women in order to determine possible harmful effects on fetus. METHODS: Five hundred and eighteen 518 pregnant women, aged between 18 and 40 years, drawn from three General hospitals in Akwa Ibom State were assessed for self-medication and substance abuse using an instrument, adapted from a modified form of 117-item self-report questionnaire based on the WHO guidelines for students' substance use survey. RESULTS: Of the 518 pregnant women assessed, 375 (72.4%) indulged in one form of self-medication or the other; 143 (27.6%) used only drugs prescribed from the antenatal clinic. A total of 157 (41.9%) pregnant women self-medicate fever/pain relievers; 47 (9.1%) mixture of herbs and other drugs; 15 (4.0%) sedatives; 13 (3.5%) alcohol; while 5 (1.3%) used kolanuts. Reasons for using these substances range from protection from witches and witchcrafts, preventing pregnancy from coming out, for blood; poor sleep, fever and vomiting and infections. There was a significant difference in the rate of using analgesics (X2=9.43, p=0.001); and antibiotic (X2=4.43, p=0.001) among pregnant women who were highly educated compared to those with little or no education. However, the level of education has no impact in the usage of native herbs. CONCLUSION: This study shows that self-medication is common among pregnant women in our environment. There is need for adequate education of pregnant women during antenatal clinics on the potential danger of self-medication so as to prevent child and maternal morbidity and mortality.

Assessing the psychological well-being of caregivers of people living with HIV/AIDS in Niger Delta region, Nigeria.

Despite the availability of anti-retroviral drugs and treatment, the care and support of people living with HIV/AIDS has continued to be a major challenge, with greater impact not only on the people living the disease. The burden associated with care often results in high level of stress among caregivers, usually manifesting as anxiety and/or depression. This study assesses the levels of stress among caregivers of people living with HIV/AIDS in Niger Delta region of Nigeria, in order to determine their coping strategies. Between July and December 2008, 322 caregivers of people living with HIV/AIDS attending HIV clinic of the University of Uyo Teaching Hospital were randomly assessed for stress (anxiety and depression), using Zung's Self-Rating Depression Scale (SDS) and Self-Report Questionnaire (SRQ-20). A total of 293 caregivers comprising 98 (33.4%) males and 195 (66.6%) females were analysed. Mean age of males was 44.0 ± 4.5 years and females was 39.3 ± 4.0 years. The difference in the mean was statistically significant (p<0.001). Of the 293 caregivers, 191 (65.2%) and 115 (39.2%) were scored high on SDS and SRQ-20, respectively (representing the levels of stress). Using SDS groups on SRQ-20 subscales, 134 (45.7%) had anxiety only, 23 (7.8%) depression only, 52 (17.7%) had a mixture of anxiety and depression, while 11 (3.7%) exhibited suicidal tendencies. There is increasing level of stress in caregiving. Therefore, adequate attention must be given to the psychological well-being of caregivers to enable them contribute positively to the care of people living with HIV/AIDS.

Demographic risk factors in domestic violence among pregnant women in Uyo, a community in the Niger Delta region, Nigeria.

There has been increasing global concern about the level of violence against pregnant women. Anecdotal evidence from general observations shows that there may be higher prevalence in the Niger Delta region of Nigeria. Unfortunately, in spite of the emerging and alarming social indicators for violence against women in the area, little effort has been made to address this dangerous trend. One major concern has been the effects of violence on pregnancy and the difficulty in protecting the pregnant women, since managing violence is often unsuccessful. There is therefore the need to evaluate the magnitude, as well as the risk factors for violence and the sociodemographic characteristics of the women, for purposes of prevention.

Quality of life in people living with HIV/AIDS in Niger Delta Region, Nigeria.

BACKGROUND: Despite the global efforts and huge financial investment in HIV/AIDS, the quality of life in people living with the disease continues to deteriorate, posing serious problems with increased mortality. AIM: The objectives of the study were: (i) to assess the quality of life in people living with HIV/AIDS, and (ii) to compare quality of life in males and females living with the disease. METHODS: A total of 309 people living with HIV/AIDS from the HIV clinic, University of Uyo Teaching Hospital were randomly assessed for quality of life, using HIV/AIDS-Targeted Quality of life (HAT-QOL) questionnaire. RESULTS: A total of 265 (85.8%) respondents consisting of 113 (36.6%) males and 152 (49.2%) females were analyzed. The mean age for males was 36.8 +/- 4.0 years and females 31.9 +/- 3.3 years. The difference in mean was statistically significant (t = 31.831, p < 0.01), occupation was statistically significant (chi(2) = 11.348, p < 0.02). Females showed lower quality of life in comparable domains than males. The differences in life satisfaction (chi(2) = 10.362, p < 0.01) and health worries (chi(2) = 9.944, p < 0.01) were statistically significant. CONCLUSION: The results showed impairment in quality of life, except in medication worries and sexual function in people living with HIV/AIDS. Improvement in HAT-QoL indices will enhance positive quality of life.

Female genital tract malignancies in Uyo, South-South Nigeria.

BACKGROUND: Female genital tract malignancies cause a significant number of deaths in the developing world. These deaths are however usually overshadowed by maternal deaths from obstetric causes. STUDY DESIGN AND SETTING: A retrospective study of all histologically confirmed female genital tract malignancies seen in the histopathology department of the University of Uyo Teaching Hospital between January 2000 and December 2004. RESULTS: Sixty five female genital tract malignancies were studied. Majority of patients were in the fifth to seventh decades of life. Carcinoma of the cervix was the commonest cancer seen (49.2%) followed by ovarian cancer (21.5%). Carcinoma of the vulva was the least common cancer seen (1.5%). Squamous cell carcinoma was the commonest histological variety. CONCLUSION: Female genital tract malignancies are major causes of morbidity and mortality in Nigeria. There is thus a need for public enlightenment to increase the awareness of risk factors and the provision of regular cervical cancer screening services which should be free to encourage utilisation.

Reasons for gynaecological consultations in children in Calabar, South Eastern Nigeria.

Childhood gynaecological disorders as seen in the University of Calabar Teaching hospital (UCTH), Calabar, Nigeria, over a 10-year period were studied. The aim was to establish the incidence and pattern of presentation of these disorders. Childhood gynaecological disorders constituted 3.1% of gynaecological admissions in UCTH. Vaginal laceration following rape was the most common disorder accounting for 54.8% of the cases. This was most common in the 8 to 11-year age group (52.2%). Vaginal bleeding was the most common presenting symptom (63.1%) and repair of vaginal laceration the most common procedure performed (54.8%).

Attitude of antenatal attendees to people living with HIV/AIDS in Uyo, south-south Nigeria.

BACKGROUND: Stigmatization and discrimination of people living with HIV/AIDS has a negative impact on the global efforts to control the HIV/AIDS pandemic. Due to fear of stigmatization and discrimination, many people are reluctant to undergo voluntary counseling and testing, infected individuals are often unwilling to disclose their status and some of them still engage in high-risk behaviours leading to increased transmission of the virus. STUDY DESIGN AND SETTING: A study of the attitudes to people living with HIV/AIDS was carried out among antenatal clinic attendees at the University of Uyo Teaching Hospital with the aim of developing site-specific information and counseling interventions to reduce stigmatization and discrimination of people living with HIV/AIDS. Information was elicited from 265 randomly selected women who booked for antenatal care between September and December 2005 with the use of a self-administered questionnaire. RESULTS: 263 questionnaires were duly completed and analyzed. The mean age of the respondents was 27 ± 5.1 years, majority of them (52.1%) were either unemployed or unskilled workers and 42.9% of them had tertiary education. Awareness and knowledge of HIV/ AIDS was high, (95.8%) and (86.7%) respectively. Majority of the respondents (55.6%) were also assessed as having a positive attitude to people living with HIV/AIDS (PLWHA). There was a statistically significant association between good knowledge of HIV/AIDS and a positive attitude to PLWHA (P=0.000) and a high educational status with a positive attitude to PLWHA (P=0.009). CONCLUSION: combating stigma and discrimination is an important process in controlling the epidemic. Specific information and counseling interventions aimed at dispelling misconceptions about HIV/AIDS should be reinforced.

Vaginal injuries during coitus in Calabar: a 10-year review.

UNLABELLED: Injuries during coitus could result in considerable morbidity and mortality in women. Identifying their pattern of presentation and predisposing factors will aid in their prevention. STUDY DESIGN AND SETTING: A descriptive study of patients with coital injuries seen in the University of Calabar Teaching Hospital (U.C.T.H) Calabar, between 1991 and 2000, with data obtained from case records. RESULTS: Coital injuries constituted 0.7/1000 gynaecological emergencies. Rape (68.0%) was the commonest aetiological factor. It was more common in nulliparous patients (88.0%) and toddlers and teenagers formed the age group most affected. The lower vagina was the most common site of injury (44.0%). Vaginal bleeding was the commonest mode of presentation and hypovolaemic shock, the most common complication. CONCLUSION: Rape is the commonest cause of coital injury in Calabar. Coital injuries should be considered as a differential diagnosis in all cases of abnormal vaginal bleeding particularly in children.