Unexplained left Mullerian agenesis with agenesis of left kidney: A case report.

The exact incidence of Mullerian agenesis is unknown because women with this condition might be asymptomatic and diagnosis is mostly incidental. We report an incidental finding of left Mullerian agenesis involving the left fallopian tube, left ovary, and the left kidney following evaluation and treatment for a right tubal ectopic pregnancy.

Thermo-coagulation versus cryotherapy for treatment of cervical precancers: A prospective analytical study in a low-resource African setting.

AIMS: To evaluate the outcomes of cryotherapy and thermo-coagulation in the treatment of cervical precancers. METHOD: Prospective analytical study. Women who screened positive to visual inspection with acetic acid and confirmed by colposcopy using the Swede's score were randomized to receive either cryotherapy or thermo-coagulation. Participants were re-evaluated 6 months later. RESULTS: A total of 11 124 women were screened. Only 1023 of the 1294 colposcopically confirmed positive cases were eligible for ablative therapy. Five hundred and twelve women received cryotherapy while 511 women received thermo-coagulation. Cryotherapy had similar cure rate with thermo-coagulation (85.5 vs 89.2%, P = 0.09). The mean patient satisfaction score for thermo-coagulation was higher than that for cryotherapy (3.9 ± 1.3 vs 2.8 ± 1.7; P < 0.0001). The mean duration of treatment per patient was higher for cryotherapy than thermo-coagulation (660.0 ± 0.0 vs 50.9 ± 15.3 s, P < 0.0001). The mean cost of treatment per patient was significantly higher for cryotherapy than for thermo-coagulation (2613.1 ± 254.9 vs 533.2 ± 45.2 Nigerian Naira, P < 0.0001). Higher proportion of women who had thermo-coagulation reported no side effect (55.2 vs 12.5%, P < 0.0001). CONCLUSION: Cryotherapy and thermo-coagulation have similar efficacy in the treatment of cervical precancers. Thermo-coagulation offers lower cost and lower duration of treatment, less side effects and higher patient satisfaction than cryotherapy. Thermo-coagulation should be the recommended ablative treatment method for low-resource settings of the world.

Utilisation of preconception care services and determinants of poor uptake among a cohort of women in Abakaliki Southeast Nigeria.

Preconception care (PCC) is a preventive strategy for maternal and perinatal morbidity and mortality. This study aimed to assess the level of awareness and utilisation of PCC services. A descriptive cross-sectional survey was conducted at a teaching hospital. Interviewer-administered questionnaires were used to extract information. A total of 450 participants responded; 44.2% (190/450) were aware, 31.7% (143/450) had good knowledge, while only 10.3% (46/450) received PCC. Health care providers were the main source of information (77.9%). There was statistically significant correlation between awareness and participants' level of education (p < .001) and residence (p < .001), as well as between utilisation and education (p < .001), and information from doctors (p < .001). There was a low level of awareness and poor utilisation of PCC, underpinning the need to scale up health education, establishment of functional PCC clinics and formulation of evidence-based guidelines to improve uptake and pregnancy outcome. Impact statement What is already known on the subject of the paper? PCC has been known in high-income countries as a prevention-based strategy, which aims at improving obstetric outcomes. However, the level of utilisation in low-income countries like Nigeria is either unknown or far too low. What do this study add? This work has provided local data on PCC; clearly indicating that the awareness and utilisation of PCC services in Abakaliki, Nigeria is very low when compared with other regions of the world, and this was influenced by the socio-demographic factors - particularly education and place of residence (for awareness), and level of education and information from health care providers (for utilisation), thus suggesting that enlightenment and improvement in social infrastructures could improve awareness, access and utilisation of PCC. What are the implications for clinical practice and/or further research? The implications of these findings in low resource settings like ours will include introducing interventions to scaling up health education, universal establishment of functional PCC units and formulation of evidence-based guidelines aimed at improving the uptake of PCC and pregnancy outcome. Further research will also be needed in future to assess the impact of such interventions and how to sustain potential benefits.

The impact of community health educators on uptake of cervical and breast cancer prevention services in Nigeria.

OBJECTIVE: To determine the impact of trained community health educators on the uptake of cervical and breast cancer screening, and HPV vaccination in rural communities in southeast Nigeria. METHODS: A prospective population-based intervention study, with a before-and-after design, involved four randomly selected communities in southeast Nigeria from February 2014 to February 2016. Before the intervention, baseline data were collected on the uptake of cervical and breast cancer prevention services. The intervention was house-to-house education on cervical cancer and breast cancer prevention. Postintervention outcome measures included the uptake of cervical and breast cancer screening, and HPV vaccination within 6 months of intervention. RESULTS: In total, 1327 women were enrolled. Before the intervention, 42 (3.2%) women had undergone cervical cancer screening; afterwards, 897 (67.6%) women had received screening (P<0.001). Clinical breast examination was performed for 59 (4.4%) women before and 897 (67.6%) after the intervention (P<0.001). Only 2 (0.9%) of 214 children eligible for HPV vaccination had received the vaccine before versus 71 (33.2%) after the intervention (P<0.001). CONCLUSION: The use of community health educators for house-to-house cervical and breast cancer prevention education was associated with significant increases in the uptake of cervical cancer screening, clinical breast examination, and HPV vaccination.

Experiences and unmet needs of women undergoing Pap smear cervical cancer screening: impact on uptake of cervical cancer screening in south eastern Nigeria.

The burden of cervical cancer is on the increase in sub-Saharan Africa mainly due to inadequate provision and utilisation of cervical cancer prevention services. Several evidence-based strategies have been deployed to improve cervical cancer screening uptake without much success. However, patients' experiences and satisfaction with service provision has not been adequately studied. Inefficiencies in service delivery and less fulfilling experiences by women who attend cervical cancer screening could have considerable impact in future voluntary uptake of cervical cancer screening. Six hundred and eighty women who underwent Pap smear screening in three health care facilities in two states in south eastern Nigeria were interviewed to evaluate their satisfaction, willingness to undertake future voluntary screening, unmet needs and correlation between satisfaction level and willingness to undergo future screening. Satisfaction with Pap smear screening correlated positively with willingness to undertake future voluntary screening (Pearson's correlation coefficient = 0.78, P = 0.001). The mean satisfaction score was significantly higher among participants handled by nurses than those handled by the physicians (3.16 ± 0.94 vs 2.52 ± 0.77, P = 0.001). 'Scrapping discomfort' of the spatula was reported as the most dissatisfying aspect of Pap smear experience. The need for less invasive screening procedures was the most unmet need. It was concluded that improving the Pap smear screening experience of women and providing less invasive methods of cervical cancer screening with immediate results could improve uptake of cervical cancer screening in south eastern Nigeria.

Determinants of decision-to-intervention time in the management and therapeutic outcome of emergency gynecological surgeries in south east Nigeria.

BACKGROUND: Prompt and timely response in the management of gynecological surgical cases can significantly affect the therapeutic surgical outcome of patients in emergency situations. The aim of this study was to evaluate the decision-to-intervention time (DIT), its determinants, and the significance in the therapeutic outcome of emergency gynecological surgeries managed at a federal teaching hospital in south east Nigeria over an 18-month period. METHODS: This was a prospective descriptive study of 105 emergency gynecological cases managed at a federal teaching hospital over an 18-month period. Patients were recruited at the point of admission and followed up until discharge for outcome. Data were abstracted with a data entry pro forma and then analyzed with the Epi Info™ statistical software version 7.0. RESULTS: The incidence of gynecological surgical emergencies was 5.1% of the total gynecological cases managed during the study period. The mean DIT was 4.25 (range 1.45-5.50) hours with delay in intervention, mainly due to delays in securing blood/blood products and other materials for resuscitation (46.7%) and a lack of finance (15.2%). Six maternal deaths were recorded, giving a case fatality ratio of 5.7%, while the commonest maternal complications associated with the delays were hemorrhage (61.9%) and the need for blood transfusion (57.1%), respectively. The risk ratio of losing ≥1,000 mL of blood, anemia, hemorrhagic shock, and wound infection in those with DIT ≥120 minutes was statistically greater and significant at 95% confidence interval. CONCLUSION: Inadequacies in health care services and policies due to poor infrastructure, organizational framework, and financing were the major determinants of the prolonged DIT and therapeutic outcomes.

The challenges of adherence to infant feeding choices in prevention of mother-to-child transmission of HIV infections in South East Nigeria.

BACKGROUND: Global and national efforts in the 21st century are directed toward the elimination of new pediatric HIV infections through evidence-based infant feeding interventions for the prevention of mother-to-child-transmission, with patient preference, motivation, and adherence identified as key factors for success. OBJECTIVES: This study assessed the challenges faced by HIV-infected parturients in adhering to the national infant feeding recommendations and their infant feeding preference for prevention of mother-to-child transmission in South East Nigeria. METHODS: This is a cross-sectional, descriptive, questionnaire-based study of 556 parturients infected with HIV/AIDS. RESULTS: The mean age of the participants was 28.0±5.3 years. The infant feeding choices were made jointly by both partners (61.1%) in the antepartum period. The HIV status disclosure rate was 89.2%. A large proportion (91.7%) practiced exclusive breastfeeding with highly active antiretroviral therapy, and 7.6% practiced mixed feeding because of nonadherence to their choice and national/international recommendations on infant feeding in the context of HIV/AIDS. This was mainly a result of pressure from family members (42.8%) and cultural practices (28.5%). Multivariate logistic regression analysis indicates that adherence was strongly associated with age, marital status, and employment status, but not with residence, educational status, or parity. CONCLUSION: Exclusive breastfeeding is predominately the infant feeding choice among HIV-infected parturients in South East Nigeria, but there is still a gap between infant feeding preference and adherence to standard practice as a result of sociocultural challenges associated with risk for mixed feeding and the risk for mother-to-child-transmission of HIV by nursing mothers.

Dual method use for protection of pregnancy and disease prevention among HIV-infected women in South East Nigeria.

BACKGROUND: sub-Saharan Africa continue to bear the greatest burden of HIV/AIDS epidemic due to its large population, high fertility rate and unmet contraceptive need, most especially with poor uptake of dual methods (use of condom and another effective family planning method) which protects against STIs/HIV and unplanned pregnancy. The aim of this study was to assess the awareness, pattern and practice of dual methods by HIV infected women, and factors influencing its use in southeast Nigeria. METHODS: This was a cross sectional descriptive study of 658 HIV positive women attending the PMTCT/postnatal/family planning clinics in three health facilities in southeast Nigeria. An interviewer administered semi-structured questionnaire was used to abstract needed information. The data were analyzed with Epi-info™ version 7.0 (Centers for Disease Control and Prevention, Atlanta, GA, USA), Odd ratio was determined and the test of statistical significance was with Fisher exact test at 95% CI. RESULTS: The mean age of the participants was 29 ± 4.3 years. All the respondents were aware of their HIV status, 62.4% did not know their partners status; 23.1% were sero-concordant, while 14.5% were sero-discordant. Most (67.9%) of the respondents lack awareness on dual methods with only 179/658 (27.2%) practicing it. The commonest (141/179; 78.9%) dual method used was a combination of condom and injectable hormonal contraceptives. Lack of awareness (222/479; 46.3%) and non disclosure (133/479; 27.8%) were the main reasons for non use of dual method in the present study. STI's was higher amongst non users with odd ratio of 1.74 (1.26-2.41), p-value < 0.0004. Unplanned pregnancy was higher in non users with odd ratio of 3.89 (2.52-6.00), p-value < 0.0000 at 95% CI. CONCLUSIONS: The awareness and uptake of dual methods amongst HIV infected women in southeast Nigeria is still low and thus associated with a higher risk of STIs and unplanned pregnancy. It is expected that increased awareness, uptake and consistent use will help prevention new infections of HIV/STIs and unplanned pregnancy.

Female genital mutilation and efforts to achieve Millennium Development Goals 3, 4, and 5 in southeast Nigeria.

OBJECTIVE: To determine the prevalence of female genital mutilation (FGM), the common forms of FGM, reasons for the practice, associated obstetric outcomes, and how these have affected efforts to achieve Millennium Development Goals (MDGs) 3, 4, and 5 in southeast Nigeria. METHODS: A prospective descriptive study of parturients in southeast Nigeria was conducted from January to December 2012. All primigravid women attending delivery services at 2 health institutions during the study period were recruited, examined, and classified using the 2008 WHO classification for FGM. RESULTS: The mean age of the 516 participants was 27.24±4.80 years and most (66.3%) had undergone FGM. Type II FGM was the most common form, accounting for 59.6% of cases. Most FGM procedures were performed in infancy (97.1%) and for cultural reasons (60.8%). Women who had undergone FGM had significantly higher risk for episiotomy, perineal tear, hemorrhage, cesarean delivery, neonatal resuscitation, fresh stillbirth/early neonatal death, and longer hospitalization, with higher risk ratios associated with higher degrees of FGM. CONCLUSION: FGM is still a common practice in southeast Nigeria, where its association with adverse reproductive outcomes militates against efforts to achieve MDGs 3, 4, and 5.

Obstetric outcome and significance of labour induction in a health resource poor setting.

Objectives. The aim of this study was to evaluate the methods, indications, outcome of induced labor and its significance in obstetric practice in the study area. Methods. This was a retrospective study of cases of induced labor at the Catholic Maternity Hospital in Ogoja, Cross-River State, Nigeria, between January 1, 2002, and December 31, 2011. Data on the sociodemographic characteristics of the parturient, induction methods, indications for induction, outcomes and reasons for failed induction were abstracted from personal case files and the hospital's maternity/delivery register. The data were analyzed with SPSS15.0 window version. Result. The induction rate in this study was 11.5%. Induction was successful in 75.9% of cases but failed in 24.1%. Misoprostol was the commonest induction method (78.2%). The commonest indication for induction was postdate pregnancy (45.8%). Failed induction was due to fetal distress, prolonged labor, cephalopelvic disproportion and cord prolapse. The induction-delivery interval was 12 ± 3.6 hours. Conclusion. Induction of labor is a common obstetric procedure which is safe and beneficial in well-selected and properly monitored high risk pregnancies where the benefits of early delivery outweigh the risk of continuing the pregnancy.

Use of a portable diathermy machine for LEEP without colposcopy during see-and-treat management of VIA-positive cervical lesions in resource-poor settings.

OBJECTIVE: To compare the effectiveness of cryotherapy and loop electrosurgical excision procedure without colposcopy (visual LEEP) in treating cervical lesions detected through visual inspection with acetic acid (VIA). METHODS: In rural southeast Nigeria, women with VIA-positive lesions who were eligible for ablative treatment were selected to undergo immediate cryotherapy with nitrous oxide. Women with VIA-positive lesions who were not eligible for ablative treatment were selected to undergo visual LEEP at the same visit. A portable diathermy machine was used for LEEP. Participants were re-evaluated 6 months later using VIA. The main outcome measures included persistent VIA positivity at 6 months, duration of procedure, second clinic visits for complications, and patient acceptability. RESULTS: In total, 304 women completed the study. Persistent VIA-positivity rates, duration of procedure, second clinic visits for complications, and patient acceptability were similar in the 2 groups. CONCLUSION: Visual LEEP and cryotherapy have similar efficacy and patient acceptability in see-and-treat management of VIA-positive cervical lesions. In see-and-treat VIA-based cervical cancer prevention programs in low-resource countries, visual LEEP can be used to treat women who do not meet the criteria for ablative treatment. This would increase the treatment coverage of women with VIA-positive lesions and improve program efficiency.

Challenges associated with the management of gynecological cancers in a tertiary hospital in South East Nigeria.

BACKGROUND: There are reports of increasing incidence of gynecological cancers in developing countries and this trend increases the need for more attention to gynecological cancer care in these countries. OBJECTIVE: The purpose of this study was to describe the presentation and treatment of gynecological cancers and identify barriers to successful gynecological cancer treatment in a tertiary hospital in South East Nigeria. METHODS: This study was a retrospective longitudinal analysis of the presentation and treatment of histologically diagnosed primary gynecological cancers from 2000 to 2010. Analysis was by descriptive and inferential statistics at the 95% level of confidence using Statistical Package for the Social Sciences version 17 software. RESULTS: Records of 200 gynecological cancers managed during the study period were analyzed. Over 94% of cervical cancers presented in advanced stages of the disease and received palliative/symptomatic treatment. Only 1.9% of cervical cancer patients had radical surgical intervention, and postoperative mortality from these radical surgeries was 100%. Approximately 76% of patients with ovarian cancer had debulking surgery as the mainstay of treatment followed by adjuvant chemotherapy. Postoperative mortality from ovarian cancer surgery was 63%. Cutting edge cytotoxic drugs were not used as chemotherapy for ovarian and chorionic cancers. Compliance with chemotherapy was poor, with over 70% of ovarian cancer patients failing to complete the prescribed courses of chemotherapy. Most patients with endometrial and vulval cancers had only surgical treatment, as compliance with follow-up for adjuvant chemotherapy or radiotherapy was poor. Functional radiotherapy facilities were not available at the center during the study period, thereby necessitating external referrals to centers hundreds of kilometers away. CONCLUSION: Late presentation of cases, noncompliance with treatment regimens, lack of use of cutting edge cytotoxic drugs, the poor outcome of radical surgeries, and lack of a functional radiotherapy facility combined to create a very difficult gynecological cancer care environment at the study center.

See-and-treat management of high-grade squamous intraepithelial lesions in a resource-constrained African setting.

OBJECTIVE: To compare the treatment outcomes of women with high-grade squamous intraepithelial lesions (HSIL) who underwent immediate loop electrosurgical excision procedure (LEEP) and those who had directed biopsies prior to subsequent LEEP. METHODS: Women who were referred for HSIL to 2 centers in southeast Nigeria were examined via colposcopy. Those with positive colposcopic findings were randomized to receive either immediate LEEP (see-and-treat group) or directed biopsies (3-step group). Women with directed biopsy-confirmed results underwent follow-up LEEP. Overtreatment rate, cost, default rate, and cytology-treatment interval were compared between the 2 groups. RESULTS: In total, 314 women were included in the study. The overtreatment rate was similar between the groups. Treatment cost and cytology-treatment interval were significantly higher in the 3-step group (P=0.0001). The default rate was significantly lower in the see-and-treat group (P=0.0001). Most (219 [69.7%]) participants preferred the see-and-treat approach. CONCLUSION: Immediate see-and-treat LEEP for women with HSIL in southeast Nigeria is cheaper, less time-consuming, and associated with better patient compliance than the 3-step management procedure. Furthermore, it does not lead to significantly higher overtreatment. The immediate see-and-treat approach may be ideal for the management of women with HSIL in low-resource countries.

Obstetrician-initiated counseling and testing for HIV infection: a cross sectional study.

OBJECTIVE: To assess the practice of provider-initiated counseling and testing (PICT) for HIV infection by Nigerian Obstetricians and estimate missed opportunities at the gynecological and family planning clinics. METHODS: Online cross-sectional survey of members of the Society of Gynaecology and Obstetrics of Nigeria (SOGON) over a 4-week period using SurveyMonkey®. Frequencies were used to present responses of participants. RESULTS: There were 201 (29%) respondents. Participants' mean age was 46 ± 7.2 (SD) years and majority (93.3%) held consultant positions. Most respondents (92.2%) cared for HIV-infected pregnant women with dedicated HIV counselors (77.4%), and in dedicated counseling rooms (71%). Majority (75.7%) had been trained on HIV management in pregnancy and 95.3% routinely counseled and tested women attending the booking antenatal clinic. Fourteen per cent (14%) and 16% of respondents conducted routine counseling and testing for women attending the gynecological and family planning clinics, respectively, for the first time. For every 100 women tested at the antenatal clinic, 317 women were missed at each of the two clinics. CONCLUSIONS: PICT of HIV infection in Nigeria has focused on pregnancy. To eliminate new HIV infections in children, PICT should be routine at the gynecological and family planning clinics.

Ethical aspects of obstetric care: expectations and experiences of patients in South East Nigeria.

BACKGROUND: Medical ethics is not given due priority in obstetric care in many developing countries, and the extent to which patients value compliance with ethical precepts is largely unexplored. OBJECTIVE: To describe the expectations and experiences of obstetric patients in South East Nigeria with respect to how medical ethics principles were adhered to during their care. METHODS: This was a cross-sectional, questionnaire-based study involving parturient women followed in three tertiary hospitals in South East Nigeria. RESULTS: A total of 1,112 women were studied. The mean age of respondents was 29.7 ± 4.1 years. Approximately 98% had at least secondary education. Ninety-six percent considered ethical aspects of care as important. On the average, over 75% of patients expected their doctors to comply with the different principles of medical ethics and specifically, more than 76% of respondents expected their doctors to comply with ethical principles related to information and consent during their antenatal and delivery care. There was a statistically significant difference between the proportions of women who expected compliance of doctors with ethical principles and those who did not (P < 0.001). Multivariate analysis showed that increasing levels of skilled occupation (odds ratio [OR] 9.35, P < 0.001), and residence in urban areas (OR 2.41, P < 0.001) increased the likelihood of patients expecting to be informed about their medical conditions and their opinions being sought. Although the self-reported experiences of patients concerning adherence to ethical principles by doctors were encouraging, experiences fell short of expectations, as the level of expectation of patients was significantly higher than the level of observed compliance for all the principles of medical ethics. CONCLUSION: The level of practice of medical ethics principles by doctors during obstetric care in South East Nigeria was encouraging but still fell short of the expectations of patients. It is recommended that curriculum-based training of doctors and medical students should be implemented, and hospital policy makers should do more to promote ethical aspects of care, by providing official written guidelines for adherence to medical ethical principles during obstetric care.

Retrospective cohort study of the effects of obesity in early pregnancy on maternal weight gain and obstetric outcomes in an obstetric population in Africa.

OBJECTIVE: The purpose of this study was to compare maternal weight gain in pregnancy and obstetric outcomes between women with obesity in early pregnancy and those with a normal body mass index (BMI) in early pregnancy. METHODS: This was a retrospective cohort study of women with obesity in early pregnancy and those with a normal BMI who were seen at three teaching hospitals in South-East Nigeria. Statistical analysis was performed using Statistical Package for the Social Sciences version 17.0 software, with descriptive and inferential statistics at the 95% level of confidence. RESULTS: The study sample consisted of 648 women (324 obese and 324 healthy-weight). The mean age of the obese women was 26.7 ± 5.1 years and that of the healthy-weight women was 26.6 ± 4.9 years. Although both excessive weight gain (odds ratio [OR] 0.35, 95% confidence interval [CI] 0.23-0.54) and inadequate weight gain (OR 0.08, 95% CI 0.04-0.15) were less common in women with early pregnancy obesity than in healthy-weight women, a significantly higher proportion of obese women with excessive weight gain had adverse fetomaternal outcomes. Also, a significantly higher proportion of obese women had specific complications, such as premature rupture of membranes (OR 2.36, 95% CI 1.12-5.04), gestational hypertension/pre-eclampsia (OR 2.31, 95% CI 1.12-5.04), antepartum hemorrhage (OR 2.78, 95% CI 1.02-7.93), gestational diabetes (OR 4.24, 95% CI 1.62-11.74), cesarean delivery (OR 2.3, 95% CI 1.2-5.44), macrosomia (OR 4.08, 95% CI 1.06-8.41), severe birth asphyxia (OR 2.8, 95% CI 1.2-6.63), abnormal Apgar scores (OR 2.67, 95% CI 1.46-4.93), and newborn special care admissions (OR 1.18, 95% CI 1.0-3.29). CONCLUSION: Early pregnancy obesity was associated with a wide range of adverse fetomaternal outcomes, and could be a genuine risk factor for increased pregnancy-related morbidity and/or mortality in this population. Interventions to reduce prepregnancy obesity could therefore be useful in this low-resource African setting.

Blood transfusion trends in obstetrics at the Federal Teaching Hospital in Abakaliki, South-East Nigeria.

BACKGROUND: Obstetric hemorrhage has been repeatedly implicated as a leading cause of maternal mortality in Nigeria, yet there are very few studies that evaluate the practice of blood transfusion in obstetrics as a life saving measure. OBJECTIVES: The aim of this study was to evaluate the practice of obstetric blood transfusion, the mean decision-transfusion interval, and the outcome in parturients who had blood transfusions. METHODS: This was a prospective descriptive study conducted at the Federal Teaching Hospital, Abakaliki, South-East Nigeria, between 1st January, 2012 and 31st December, 2012. Statistical analysis was done using SPSS version 15.0 for Windows. RESULTS: Out of 151 parturients who received blood transfusion, 141/151 (97.4%) were knowledgeable about blood transfusion, while only 10/151 (2.6%) had no knowledge of it. The hospital was the source of information for 120/151 (80.8%) of the participants. Blood transfusion rate was 7.04% of all parturients. The mean decision-transfusion interval was 12.0 ± 4.3 hours. All participants were transfused with either whole blood or sedimented cells. The mean number of blood units transfused was 1.77 ± 0.93 units. The indications for transfusion were: anemia, 109/151 (72.2%); shock, 13/151 (8.6%); postpartum hemorrhage, 23/151 (15.2%); antepartum hemorrhage, 6 (4%). Six (4%) women died; mortality was due to renal failure in 3/6 (50%) and disseminated intravascular coagulopathy in 3/6 (50%). These deaths were due to delays and difficulty in securing blood for transfusion, while those who got transfused on time were salvaged with minimal morbidity, 21/151 (14%), or with no morbidity, 130/151 (86%). CONCLUSION: Excessive blood loss and anemia still complicate most pregnancies in our practice and the mean decision-transfusion interval is unacceptably long with debilitating maternal morbidity and mortality that can be improved with safe and effective blood transfusion with minimal or no risk.

Denial of women's rights to contraception in southeastern Nigeria.

OBJECTIVE: To evaluate the opinions and experiences of married women in southeastern Nigeria regarding their rights to contraception, in addition to the impact of the denial of women's contraceptive rights on unplanned pregnancy rate. METHODS: A cross-sectional survey of women who registered for prenatal care at 2 federal tertiary healthcare facilities in southeastern Nigeria was conducted. Randomly selected samples of participants were interviewed via a structured, pretested questionnaire. RESULTS: In total, 1204 women participated in the survey. Overall, 526 (43.7%) were unaware of their rights to contraception. Denial of contraceptive rights was reported by 522 (43.4%) women. In total, 174/317 (54.9%) women with unplanned pregnancies blamed denial of access to contraception for their pregnancies. Among the women who had used contraception previously, 61.9% reported that the decision to do so was taken by their spouse. Formal education seemed to increase women's level of awareness of their rights to contraception (P=0.001) but it did not influence the exercising of such rights. CONCLUSION: A considerable proportion of women in southeastern Nigeria are being denied their rights to contraception, mainly owing to a culture of male dominance. There may be significant health implications for women with unplanned pregnancies arising from such denials.

Motivations and preferences of rural Nigerian women undergoing cervical cancer screening via visual inspection with acetic acid.

OBJECTIVE: To determine the motivations and preferences of women participating in visual inspection with acetic acid (VIA) mass cervical cancer screening programs in southeastern Nigeria. METHODS: By means of interviewer-based questionnaires, data were collected from women participating in mass cervical cancer screenings with VIA in 3 randomly selected communities in each of 2 southeastern Nigerian states between March 1, 2011, and March 31, 2012. RESULTS: A total of 2312 women were interviewed. Support from husband and community opinion leaders were the most frequently reported factors that motivated the women to participate in the screening. Most participants expected an immediate result for the screening test and immediate treatment for any abnormalities detected. CONCLUSION: Community-based advocacy for cervical cancer screening is a very effective method of creating awareness for cervical cancer screening. Support from spouses and community leaders are important factors in a woman's decision to utilize cervical cancer screening services in southeastern Nigeria. Immediate results and treatments would make the most impact. Family and community participation should be integrated into cervical cancer prevention programs. This, together with a "see and treat" approach, may be central to overcoming the poor utilization of cervical cancer screening services in Nigeria and similar rural settings.