Pregnancy Outcome Following Treatment of Premalignant Lesion of the Cervix in Southeast Nigeria; A Retrospective Case-Control Study.

BACKGROUND: Treatment of cervical pre-cancers involves ablative and excisional therapies, and these have the potential to affect future pregnancy outcomes of women. Understanding the impact of the various treatment modalities on the outcome of pregnancies can motivate the development of interventions to improve pregnancy outcomes in women who had cervical pre-cancer treatment. AIM: We aimed to the effect of cervical pre-cancer treatment on second-trimester miscarriages and preterm births. MATERIALS AND METHODS: Matched case-control study in which 373 women who had a pregnancy after cervical pre-cancer treatment were matched with 373 controls. McNemar Chi-square was used to compare the prevalence of second-trimester miscarriage and preterm birth between the study group and the matched controls. Conditional logistic regression analysis was done to determine the risk factors for second-trimester miscarriage and preterm birth. RESULTS: Second-trimester miscarriages and preterm births were higher in women who had cervical pre-cancer treatment (AOR: 2.05, 95% CI: 1.174 - 3.693, p: 0.01) and (AOR: 2.74, 95% CI: 1.591 - 4.902, p: 0.0001) respectively. In addition, large loop excision of the transformation zone (LLETZ) of the cervix increased the odds of second-trimester miscarriage (AOR: 1.22, 95% CI: 1.034 - 1.441, p: 0.019) and preterm birth (AOR: 2.98, 95% CI: 1.793 - 3.965, p: 0.001). Cryotherapy and thermocoagulation were not associated with increased miscarriage and preterm birth. Treatment to pregnancy interval of ≥ 12 months decreased the odds of second-trimester miscarriage (AOR: 0.605, 95% CI: 0.502 - 0.808, p: 0.031) and preterm birth (AOR: 0.484, 95% CI: 0.317 - 0.738, p: 0.001). CONCLUSION: There is an increased odds of second-trimester miscarriage and preterm birth in women treated with LLETZ. A treatment-to-pregnancy interval of ≥ 12 months reduces this odd. Ablative therapies do not increase the odds of miscarriages and preterm births. This information could guide decisions on the choice of method of treatment for cervical pre-cancer in women of childbearing age.

Impact of abortion laws on women's choice of abortion service providers and facilities in southeastern Nigeria.

BACKGROUND: The liberalization of abortion laws in Nigeria has been an interesting debate for a long time. Both proponents and opponents have defended their positions with similar vigor. However, the opinion of the Nigerian woman on the subject matter has received little attention. It is important to understand the opinion of the Nigerian woman, especially with regard to the potential impact of any abortion law on unsafe abortion. OBJECTIVE: The objective of this study is to determine the impact of abortion laws on women's choice of abortion service providers and facilities in Southeastern Nigeria. METHODS: Women attending the gynecological clinics of two tertiary hospitals in Southeastern Nigeria were interviewed with interviewer-administered questionnaires. Questions were asked on awareness of abortion laws, opinion on liberalization of abortion laws, and the impact of abortion laws on women's choice of abortion service providers in situations of unwanted pregnancies. RESULTS: A total of 1120 women were interviewed. More than half (57.7%) of respondents were aware of the abortion laws of Nigeria. About 59.2% of respondents had previously done abortion for unwanted pregnancies. Some (78.3%) of respondents indicated that abortion laws will not influence their choices of abortion service providers in cases of unwanted pregnancies. Majority (78%) do not support liberalization of abortion laws. CONCLUSION: The abortion laws in Nigeria do not influence women's choice of abortion service providers and facilities. Factors other than the contents of abortion laws influence women's choices. The findings of this study open a new vista toward the search for the factors that drive unsafe abortion in Nigeria.

Impact of visual inspection with acetic acid plus cryotherapy "see and treat" approach on the reduction of the population burden of cervical preinvasive lesions in Southeast Nigeria.

OBJECTIVE: The aim of this study is to determine the impact of visual inspection with acetic acid (VIA) plus immediate cryotherapy on the prevalence of VIA-detected cervical squamous intraepithelial lesion (SIL). METHODS: Women in four rural communities in Southeast Nigeria were screened with VIA. Women who tested positive to VIA were offered either immediate cryotherapy or large loop excision of the transformation zone based on predetermined eligibility criteria. Cervical biopsies were taken before cryotherapy and examined by consultant histopathologists. All participants were rescreened 1 year later. The main outcome measures were population prevalence of cervical precancers before and after intervention, cure rates, and over-treatment rates. RESULTS: A total of 653 women participated in the study. The prevalence of cervical SIL before the intervention was 8.9% (58/653). The prevalence 1 year later was 1.4% (9/649). This gave an 84.3% reduction in the population prevalence of SIL. The reduction in cervical SIL prevalence was statistically significant (P = 0.0001). The prevalence of high-grade SIL reduced significantly from 4.1% (27/653) preintervention to 0.5% (3/649) 1 year postintervention (P = 0.0001). This gave an 87.8% reduction in the population prevalence of high-grade SIL. Cryotherapy provided a cure rate of 87.9% (95% confidence interval: 76.82-94.33). CONCLUSION: Population cervical cancer prevention using VIA plus immediate cryotherapy leads to significant reduction in the population prevalence of cervical SIL. This has the potential of being an acceptable supplement to cervical cytology for cervical cancer prevention in low-income populations.

Prevalence of Sexual Dysfunction among Females in a University Community in Enugu; Nigeria

Background: Female sexual dysfunction is a common; condition that significantly reduces the quality-of-life of the affected persons. Unfortunately; because of the veil of secrecy that shrouds discussions on human sexuality; there has been limited research on this topic in some sociocultural settings. Aim: The aim was to determine the prevalence and some sociodemographic factors associated with sexual dysfunction in females in a university community at the University of Nigeria; Enugu Campus; Enugu State; Nigeria. Subjects and Methods: This is a cross-sectional study involving 500 females recruited randomly in a tertiary institution in Nigeria. A self-administered structured pretested questionnaire on sexual activity was administered (the Female Sexual Function Index [FSFI]). Statistical analysis was performed using SPSS software package (Version 17.0; Chicago; IL; USA). Multiple logistic regression was used to determine the relationship between the sociodemographic factors; and the total FSFI scores dichotomized as normal and reduced sexual function. In addition; multiple linear regression was used to determine the relationship between the six different domains scores and the continuous values of the total score. For all; calculations; P 0.05 was considered as statistically significant at 95 confidence interval (CI). Results: The prevalence of female sexual dysfunction (FSFI score ? 26.50) was 53.3. The highest prevalence occurred in the 41-50 years age group (73.3; 66/90); married and living together 56.4 (123/218) and had postsecondary education (56.1 CI; 0.691-0.943). Marital status; religion; ethnic group; and educational qualification had no significant effect (P 0.05). The total FSFI significantly increase as desire increases (P

Prevalence of sexual dysfunction among females in a university community in Enugu, Nigeria.

BACKGROUND: Female sexual dysfunction is a common, condition that significantly reduces the quality-of-life of the affected persons. Unfortunately, because of the veil of secrecy that shrouds discussions on human sexuality, there has been limited research on this topic in some sociocultural settings. AIM: The aim was to determine the prevalence and some sociodemographic factors associated with sexual dysfunction in females in a university community at the University of Nigeria, Enugu Campus, Enugu State, Nigeria. SUBJECTS AND METHODS: This is a cross-sectional study involving 500 females recruited randomly in a tertiary institution in Nigeria. A self-administered structured pretested questionnaire on sexual activity was administered (the Female Sexual Function Index [FSFI]). Statistical analysis was performed using SPSS software package (Version 17.0, Chicago, IL, USA). Multiple logistic regression was used to determine the relationship between the sociodemographic factors, and the total FSFI scores dichotomized as normal and reduced sexual function. In addition, multiple linear regression was used to determine the relationship between the six different domains scores and the continuous values of the total score. For all, calculations, P < 0.05 was considered as statistically significant at 95% confidence interval (CI). RESULTS: The prevalence of female sexual dysfunction (FSFI score ≤ 26.50) was 53.3%. The highest prevalence occurred in the 41-50 years age group (73.3%; 66/90), married and living together 56.4% (123/218) and had postsecondary education (56.1%; 137/244). Only age significantly predicted female sexual function (P = 0.007; 95% CI; 0.691-0.943). Marital status, religion, ethnic group, and educational qualification had no significant effect (P < 0.05). The total FSFI significantly increase as desire increases (P = 0.002; 95% CI = 0.817-3.573). CONCLUSION: Female sexual dysfunction is common in the university environment, with the highest prevalence occurring in 41-50 years age group.

Pattern and Determinants of Antenatal Booking at Abakaliki Southeast Nigeria

Background: Antenatal care is one of the pillars of SAFE Motherhood Initiative aimed at preventing adverse pregnancy outcome. Early antenatal booking is recommended for this benefit. Aim: The objective of this study was to determine the antenatal booking pattern of pregnant women and its determinants. Subjects and Methods: A cross-sectional survey of pregnant women attending the antenatal booking clinic at Federal Medical Centre Abakaliki Ebonyi State between April 6; 2011 to August 5; 2011 was undertaken. Epi info 2008 version was used for analysis. Results: The mean age of the respondents was 27.46 (5.81) years and the mean gestational age at booking was 24.33 (5.52) weeks. A total of 83.1 (286/344) of the pregnant women booked after the first trimester while the remaining 16.9 (56/344) booked early. Socio-biological variables and past obstetrics history did not contribute significantly to the gestational age at booking while sickness in index pregnancy; personal wishes; and financial constraint were statistically significant reasons given for seeking antenatal care. Majority of the pregnant women 37.2 (128/344) suggested that the second trimester was the ideal gestational age for booking while 18.3 (63/344) did not know the ideal gestational age for booking. Most pregnant women 81.1 ( 279/344) knew the benefits of early antenatal care even though they booked late 83.1 (286/344). Conclusion: Most pregnant women access antenatal care late at Abakaliki because of misconception and poverty. Health education and subsidization of cost of medical services will help in reversing the trend of late antenatal booking

Pattern and Determinants of Antenatal Booking at Abakaliki Southeast Nigeria

Antenatal care is one of the pillars of SAFE Motherhood Initiative aimed at preventing adverse pregnancy outcome. Early antenatal booking is recommended for this benefit. Aim: The objective of this study was to determine the antenatal booking pattern of pregnant women and its determinants. Subjects and Methods: A cross-sectional survey of pregnant women attending the antenatal booking clinic at Federal Medical Centre Abakaliki Ebonyi State between April 6; 2011 to August 5; 2011 was undertaken. Epi info 2008 version was used for analysis. Results: The mean age of the respondents was 27.46 (5.81) years and the mean gestational age at booking was 24.33 (5.52) weeks. A total of 83.1 (286/344) of the pregnant women booked after the first trimester while the remaining 16.9 (56/344) booked early. Socio-biological variables and past obstetrics history did not contribute significantly to the gestational age at booking while sickness in index pregnancy; personal wishes; and financial constraint were statistically significant reasons given for seeking antenatal care. Majority of the pregnant women 37.2 (128/344) suggested that the second trimester was the ideal gestational age for booking while 18.3 (63/344) did not know the ideal gestational age for booking. Most pregnant women 81.1 ( 279/344) knew the benefits of early antenatal care even though they booked late 83.1 (286/344). Conclusion: Most pregnant women access antenatal care late at Abakaliki because of misconception and poverty. Health education and subsidization of cost of medical services will help in reversing the trend of late antenatal booking

Sexual practices of HIV-positive individuals: The need for continued intervention in developing countries.

SUMMARY: This questionnaire survey explored the sexual practices and problems of 184 HIV-positive individuals in two tertiary health institutions in south-east Nigeria over a 6 month period. It showed that many (56.5%) HIV-positive individuals continue to be sexually active and almost half (47.6%) of them do not know the sero-status of their partners. About 60% (n = 62) of sexually active respondents use condoms with 27.9% using them consistently, 31.7% inconsistently, while 40.4% engage in unprotected intercourse. Condom use was more among the male than the female respondents (p < 0.05) and the married or divorced couples than the unmarried (p > 0.05). Diagnosis of HIV resulted in increased abstinence (37.3%) due to loss of interest in sex and/or loss of partner. Almost half (49%) of the respondents had sexually related problems in the form of lack of sexual desire (82.4%), erectile dysfunction (25.5%) and ejaculatory problems (5.9%). These problems are more in the first 6 months of HIV diagnosis and are probably psychological. There is a need for continued discussion on safe sexual practices with HIV-positive individuals during the course of routine clinical consultation.

The Impact of Intervention on Sexual Practices of HIV Positive Individuals in Southeast Nigeria.

Objective. To describe the impact of repeating behavioral educational intervention on sexual practices of HIV positive individuals. Method. A prospective cohort study of HIV positive individual was conducted in southeast Nigeria from June 2007 to May 2008. Information on sexual practices was collected at initial visit; education was given and its impact was evaluated afterwards. Results. Knowledge about risk of unprotected intercourse increased by 41%, condom use by 27% (P < .001) and consistent condom use by 55% (P < .001). The significant predictors of consistent condom use include male gender, multiple sexual partner, as well as good knowledge of HIV transmission, higher educational status and being married. Non use of condom at postintervention survey were characterized by female gender (n = 4), monogamous relationship (n = 10), little or no education (n = 10), and unmarried (n = 7) respondents. Conclusion. Repeated behavioral education intervention improves consistent condom use among HIV positive individuals and will help curb the spread of HIV/AIDS.

Decreasing incidence and changing aetiological factors of vesico-vaginal fistula in south-east Nigeria.

This study retrospectively reviewed 476 cases of vesico-vaginal fistula (VVF) in the University of Nigeria Teaching Hospital Enugu, south-east Nigeria from 1981 to 2005. The majority (86.6%) of the VVFs were of obstetric origin, resulting from vaginal delivery (n = 330), caesarean section (n = 35), caesarean hysterectomy (n = 26) and instrumental delivery (n = 21). The remaining 13.4% (n = 64) resulted from pelvic surgery, malignancy and radiotherapy treatment. The contribution of obstetrics to VVF development showed a downward trend from 95% in 1981 to 60% in 2005. A success rate of 83% was recorded in the repair with large sized fistula and extensive fibrosis at the fistula site contributing mostly to failure. There is a need to increase access to trained delivery attendants to sustain the downward trend in the incidence of VVF.