Vulvovaginal candidiasis in reproductive age women in Enugu Nigeria, clinical versus laboratory-assisted diagnosis.

BACKGROUND: Clinical diagnosis of acute vulvovaginal candidiasis (VVC) depends on evidence of clinical symptoms, but symptomatic treatment widely practiced in low-resource area may lead to overdiagnosis and treatment. OBJECTIVE: The objective of the study is to determine the prevalence of VVC among women attending gynecological clinic in University of Nigeria Teaching Hospital (UNTH) Enugu and the accuracy of clinical-based diagnosis versus laboratory test supported diagnosis and patients' characteristics that affect accuracy. MATERIALS AND METHODS: This study surveyed patients seen in a gynecologic clinic for VVC using a semi-structured, pretested, and interviewer-administered questionnaire. Vaginal examination was done on each patient and findings documented. A pair of swabs was taken from the vagina and cervical os and cultured for Candida species using Sabouraud Dexttose Agar. Data were analyzed using statistical software, SPSS version 15 (SPSS Inc., Chicago IL, USA). P ≤ 0.05 were considered to be statistically significant. RESULTS: The mean age of 209 women surveyed was 35.9 (standard deviation [SD] ±9.0) years. Their mean parity was 2 (SD ± 3). The prevalence of VVC was 17.7% based on symptoms and laboratory test. Clinically based diagnosis had a sensitivity of 70.3% and specificity of 83.7%. Forty-one (19.6%) of the study population had good knowledge of VVC. More than 44% of the women had self-reported and treated VVC within the year. Young women of 24 years or less (54.5%) and those who had reported other episodes of VVC within the past year (41.1%) were most commonly associated with inaccurate clinical diagnosis. CONCLUSION: Clinically based diagnosis of VVC has an unacceptably high false-positive rate which may encourage continued presumptive treatment with its attendant risks. Clinical evaluation and laboratory culture of vulvovaginal specimen should be the standard diagnostic method.

Perinatal outcome of preterm cesarean section in a resource-limited centre: a comparison between general anaesthesia and subarachnoid block.

BACKGROUND: The relationship between perinatal outcome and anesthetic technique for preterm cesarean sections has not been explored in South Eastern, Nigeria. OBJECTIVE: The objective of the following study is to evaluate perinatal outcome in preterm cesarean sections conducted under general anesthesia (GA) and subarachnoid block (SAB) with the aim to ascertain any difference in outcome between the two methods. MATERIALS AND METHODS: A retrospective observational study of consecutive preterm cesarean deliveries at the University of Nigeria Teaching Hospital from May 1999 to April 2008. Data entry and statistical analysis utilized the SPSS statistical package for the social sciences, 2008 version 15.0 for windows (SPSS Inc, Chicago IL, USA). Chi-square test was done to determine statistical significance and P ≤ 0.05 were considered to be significant at 95% confidence interval. The delivery characteristics were compared by logistic regression analysis to ascertain any associated confounding effect on perinatal outcome in those exposed to either anesthetic technique. RESULTS: There were 7568 deliveries and 1961 cesarean sections giving a cesarean section rate of 25.9%. A total of 236 cesarean sections were for preterm deliveries giving a preterm cesarean section rate of 3.1%. Of these, 151 women delivered under GA while SAB was used in 85 cases. The mean gestational ages for preterm cesarean sections were 33.2 ± 2.6 weeks and 33.8 ± 2.2 weeks for those who had GA and SAB respectively. The mean Apgar scores were 6.4 ± 3.1 and 7.6 ± 3.1 at 5 min for GA and SAB respectively. There were 24 stillbirths (15.9%) in cesarean deliveries done under GA and 7 stillbirths (8.2%) in women who had SAB ( P = 0.09). Twenty-two (14.6%) babies delivered through GA and 14 (16.4%) delivered under SAB, died within 1 week of delivery ( P = 0.7). There were more babies with low Apgar scores in parturient delivered under GA ( P = 0.0004). More preterm babies delivered under SAB were discharged from the New Born Special Care Unit within 10 days of delivery ( P = 0.006). Hypertensive disorders, though not statistically significant was the most common indication for preterm cesarean delivery among those with GA and SAB. No maternal death occurred during the study period. CONCLUSION: The study infers a strong association between anesthetic technique and immediate Apgar scores and outcome of resuscitation following preterm cesarean section. This however, failed to translate into higher differences in perinatal mortality.

Pregnancy outcome and factors affecting vaginal delivery of twins at University of Nigeria Teaching Hospital, Enugu.

OBJECTIVE: The study aims to determine the differences in maternal and perinatal outcomes between caesarean and vaginal deliveries and the factors affecting vaginal delivery in twin pregnancy. MATERIALS AND METHODS: An observational study to audit twin pregnancies delivered at the University of Nigeria Teaching Hospital between 2002 and 2008. Clinical observations were entered into a questionnaire immediately after the delivery of the women and the mothers and their babies were followed up until the end of the puerperium. RESULTS: There were 5298 deliveries within the study period, out of which 117 were twin deliveries. This gives a twinning rate of 22 per 1000 deliveries. The mean age of the mothers was 30 ± 5.9 years. Twenty-five (21.4%) women were admitted into the hospital for preterm labor. The average gestational age of admission was 32 ± 5.8 weeks and the average duration of hospital stay for preterm labor was 12.6 ± 9.1 days. Other pregnancy complications observed were severe hypertension (14.5%, anemia (9.4%), postpartum hemorrhage (8.5%), puerperal fever (5.1%), abruptio placentae, and diabetic mellitus (2.7%). Fifty-nine women (50.4%) had vaginal deliveries, 5 (4.3%) had vaginal delivery of the leading twin and caesarean delivery of the retained second twin while 53 women (45.3%) were delivered by caesarean section. Forty-eight (41%) women had preterm delivery. Vaginal deliveries were more common than caesarean section among patients that were unbooked than booked P = 0.047 (OR 2.26, 95%CI:0.93-5.53) and those that had cephalic presentation of the leading twin, P = 0.0002 (OR = 4.7 95% CI:2.6-8.2). Vaginal delivery tended toward statistical significance when the fetal weight of the leading twin was 1.5 to 2.5 kg, P = 0.09. The commonest indications for caesarean section were abnormal lies and presentations and hypertension in pregnancy.Two-hundred and seventeen (92.7%) out of a total of 234 fetuses that were delivered in this study were live births and 17 (7.3%) still births. The rate of new born admissions in twin 1 was however higher in those delivered by Caesarean section (39.6%) than those delivered vaginally (29.7%). Indications for admissions into the special baby care units were; prematurity 33 (40.2%), birth asphyxia 15 (18.3%), low birth weight 12 (14.6%), neonatal jaundice 10 (12.2%), and twin-twin transfusion 4 (4.9%). There was a higher rate of early neonatal death in both vaginally delivered twin 1 (9.4%) and twin 2 (11.9%) than those delivered by Caesarean section, 3.8 and 3.5%, respectively. CONCLUSION: Cephalic presentation of the leading twin, birth weight less than 2.5 kg, and unbooked women presenting in advanced labor predisposed to vaginal delivery in twin pregnancies. There was however increased risk of still birth and early neonatal deaths especially for the leading twin in vaginal deliveries in unbooked women.

Pregnancy Outcome and Factors Affecting Vaginal Delivery of Twins at University of Nigeria Teaching Hospital; Enugu

Objective: The study aims to determine the differences in maternal and perinatal outcomes between caesarean and vaginal deliveries and the factors affecting vaginal delivery in twin pregnancy.Materials and Methods: An observational study to audit twin pregnancies delivered at the University of Nigeria Teaching Hospital between 2002 and 2008. Clinical observations were entered into a questionnaire immediately after the delivery of the women and the mothers and their babies were followed up until the end of the puerperium.Results: There were 5298 deliveries within the study period; out of which 117 were twin deliveries. This gives a twinning rate of 22 per 1000 deliveries. The mean age of the mothers was 30 } 5.9 years. Twenty.five (21.4) women were admitted into the hospital for preterm labor. The average gestational age of admission was 32 } 5.8 weeks and the average duration of hospital stay for preterm labor was 12.6 } 9.1 days. Other pregnancy complications observed were severe hypertension (14.5; anemia (9.4); postpartum hemorrhage (8.5); puerperal fever (5.1); abruptio placentae; and diabetic mellitus (2.7). Fifty.nine women (50.4) had vaginal deliveries; 5 (4.3) had vaginal delivery of the leading twin and caesarean delivery of the retained second twin while 53 women (45.3) were delivered by caesarean section. Forty.eight (41) women had preterm delivery. Vaginal deliveries were more common than caesarean section among patients that were unbooked than booked P = 0.047 (OR 2.26; 95CI:0.93.5.53) and those that had cephalic presentation of the leading twin; P = 0.0002 (OR = 4.7 95 CI:2.6.8.2). Vaginal delivery tended toward statistical significance when the fetal weight of the leading twin was 1.5 to 2.5 kg; P = 0.09. The commonest indications for caesarean section were abnormal lies and presentations and hypertension in pregnancy.Two.hundred and seventeen (92.7) out of a total of 234 fetuses that were delivered in this study were live births and 17 (7.3) still births. The rate of new born admissions in twin 1 was however higher in those delivered by Caesarean section (39.6) than those delivered vaginally (29.7). Indications for admissions into the special baby care units were; prematurity 33 (40.2); birth asphyxia 15 (18.3); low birth weight 12 (14.6); neonatal jaundice 10 (12.2); and twin-twin transfusion 4 (4.9). There was a higher rate of early neonatal death in both vaginally delivered twin 1 (9.4) and twin 2 (11.9) than those delivered by Caesarean section; 3.8 and 3.5; respectively.Conclusion: Cephalic presentation of the leading twin; birth weight less than 2.5 kg; and unbooked women presenting in advanced labor predisposed to vaginal delivery in twin pregnancies. There was however increased risk of still birth and early neonatal deaths especially for the leading twin in vaginal deliveries in unbooked women

Percutaneous injuries and accidental blood exposure in surgical residents: awareness and use of prophylaxis in relation to HIV.

OBJECTIVE: To determine the occurrence of percutaneous injuries (PI) and accidental exposure to patients' blood (AEPB) in surgical residents in Enugu, Nigeria, their awareness of universal precautions (UP), and use of post-exposure prophylaxis (PEP). MATERIALS AND METHODS: Self-administered semi-structured pre-tested questionnaires were administered to 230 consenting trainee surgeons. RESULTS: The rate of exposure to PI/ABE was 67.5%. The number of exposures ranged from 1 to 5 with a mean of 1.9 ± 0.99. Senior registrars had the highest rate of exposure (76.9%). In 89 exposures (63.6%) needle-prick injuries were reported. Adequate knowledge of the UP and PEP to HIV virus was only 41%. In most cases (72.1%) respondents subsequently disregarded the exposure. CONCLUSION: The high rate of exposure to PI/ABE, inadequate knowledge and poor practice of UP/PEP seen in this study underscore the need for creating high level of awareness about UP/PEP, the development of clear institutional guideline and the provision of adequate materials and supervision to ensure adherence with the guideline. The practice of UP and PEP in PI and AEPB are life saving and should be emphasized in residency training.

Maternal and perinatal outcome of severe pre-eclampsia in Enugu, Nigeria after introduction of Magnesium sulfate.

BACKGROUND: Magnesium sulfate (MgSO4) is the most effective seizure prophylaxis in the management of severe pre-eclampsia, and its use is progressively spreading in our environment. It was introduced at the pioneer teaching hospital of southeastern Nigeria in 2007. A study on the outcome of its use is therefore necessary. OBJECTIVES: The objective was to determine the effect of introducing MgSO4 on the maternal and perinatal outcomes of severe pre-eclampsia in Enugu, South eastern Nigeria. MATERIALS AND METHODS: A retrospective study of all cases of severe pre-eclampsia managed at the University of Nigeria Teaching Hospital Enugu (UNTH), Nigeria, from 1 January 2005 to 31 December 2008 - 2 years before, and 2 years after the introduction of MgSO4 - was performed. RESULT: The prevalence of severe preeclampsia within the study period was 3.3%. The mean age of study participants was 24.5 ± 2.9 years. Thirty women received MgSO4 while 47 women received diazepam. Eclampsia occurred only in a member of the diazepam group but there were no maternal deaths. Babies from the diazepam group were more likely to have low 1 minute Apgar scores but the association was not significant [OR = 3.08 (95% CI 0.78, 13.33)]. Longer hospital stay was significantly lower among women who received MgSO4 [OR = 0.32 (95% CI 0.11, 0.93)]. Perinatal mortality did not differ between the groups. CONCLUSION: MgSO4 is effective in the management of severe pre-eclamptics at the UNTH, Enugu. Therefore, its accessibility and wider use should be promoted.

Voluntary counselling and testing (VCT) uptake, nevirapine use and infant feeding options at the University of Nigeria Teaching Hospital.

This study assessed voluntary counselling and testing (VCT) uptake, nevirapine use and infant feeding options among the pregnant women seen in a tertiary care centre in Enugu, South-east Nigeria, with the aim of identifying gaps (if any) in the prevention of mother-to-child transmission (PMTCT) implementation in the hospital. It was a prospective study of all antenatal clinic attendees and those who delivered at the University of Nigeria Teaching Hospital, Enugu, within a 7-month period (1 March to 30 September 2005). During the 7-month period, 635 pregnant women accessed the PMTCT services in the hospital. With respect to VCT, 25 (3.9%) of the antenatal clinic attendees had only group counselling, while 610 (96.1%) others had both group and individual pre-test counselling. A total of 87 (13.7%) of the 635 women tested were HIV positive. Some 426 (67.1%) women had post-test counselling carried out. Twenty (23.0%) of the 87 HIV-positive women had their infection diagnosed prior to the current pregnancy, while 67 (77.0%) had the disease diagnosed during the index pregnancy. Eight (9.2%) of them had previously had anti-retroviral therapy with nevirapine. Twelve (13.8%) of the women were on antiretroviral therapy in the index pregnancy - two on highly active antiretroviral therapy (HAART) and 10 on nevirapine. A total of 41 (47.1%) of the 87 HIV-positive women had delivered as at 30 September 2005. Ten of them had antiretrovirals administered to them during the antenatal period. The remaining 31 had antiretrovirals administered to them on arrival at the labour ward for delivery. Of the 41 women who delivered, 39 had intra-partum nevirapine, while the 2 women on HAART took their usual daily dosage. Regarding mode of delivery, one-third of the women had a caesarean section and two-thirds had vaginal delivery. Ten (24.4%) of the 41 women had episiotomy, while seven of the remaining 31 women who did not receive episiotomy sustained varying degrees of perineal tear. There was no maternal death. All the 41 live born babies received nevirapine syrup at birth. A total of 86 (98.9%) out of the 87 HIV-positive women had infant feeding counselling. All chose exclusive breast-milk substitutes for their babies. There was one twin delivery, giving a total of 42 babies delivered. One of the babies was a stillbirth. The rest survived the neonatal period. It was concluded that the VCT uptake at the University of Nigeria Teaching Hospital, Enugu, is high. The majority of the women and their babies received peripartum nevirapine and at delivery all the women chose to do exclusive formula-feeding. The main gaps identified by the study were that most of the women delivered vaginally and there were delays in obtaining HIV test results. It remains to be seen how these variables will affect the vertical transmission rate.