44-year temporal trends and causes of maternal mortality at the Lagos University Teaching Hospital, LUTH, Lagos, Nigeria (1976-2019).

Background: Nigeria has committed to global initiatives aimed at improving maternal and child health. Institutional audit of maternal mortality over a long period can provide useful information on the trends in maternal death and the impact of interventions. Aim: To evaluate the trends in annual deliveries, maternal mortality ratio and causes of maternal death at a tertiary institution in Nigeria over a period of 44 years (1976-2019). Materials and Methods: We conducted a temporal trend analysis of annual births, maternal deaths, maternal mortality ratio (MMR), and ranking of causes of maternal deaths at a Teaching Hospital, in Southwest Nigeria using available data from 1976 to 2019. Overall and segmental annual percent change (APC) of the observed trends were conducted using Joinpoint version 4.5.0.1 software. Results: Over the 44-year study period, 1323 maternal deaths occurred at approximately 30 maternal deaths per annum. There was a four-fold increase in MMR from 881/100,000 total births in 1976 to 3389.8/100,000 total births in 2019, at an average increase of 3.1% per annum. (APC: 3.1%; P value < 0.001). The leading causes of maternal mortality were hypertension, sepsis, haemorrhage, and abortion, which together contributed to more than 70% of maternal deaths. All the leading causes of maternal deaths except abortion had constant ranking during the study period. Conclusion: The four-fold increase in MMR at our hospital from 1976-2019 is worrying and may suggest that previous efforts at reducing maternal mortality in our institution did not lead to significant improvement toward the attainment of Sustainable Development Goal 3 (SDG3). The hospital increasingly managed complex cases especially the unbooked patients who were referred to the hospital as a last resort.

A Multicenter Retrospective Cohort Study of the Profile of Seminal Fluid Analyses of Men Seeking Fertility Care at Different Hospitals.

BACKGROUND: Male infertility contributes 40 % of couple infertility. The prevalence of abnormal semen parameters has been on the increase. Age among other factors affects the fertility potential of males. This study analysed the pattern of seminal fluid parameters of males, seeking fertility treatment in hospitals and the relationship between age, volume and liquefaction time on these other semen parameters. METHODS: This is a multicentre retrospective cohort study conducted in eight secondary and tertiary hospitals in Nigeria. The case notes of couples that sort fertility care at the Gynaecology and Urology clinics of these hospitals from January 1st 2022 to December 31st 2022 were retrieved after receiving ethical approval. A purposeddesigned proforma based on the WHO manual for the examination of human semen was used for data collection. Outcome measures were time of semen collection and examination, volume of semen, sperm number, sperm concentration, PH, agglutination, liquefaction, motility,morphology, vitality, and white blood cell count. Data was analysed using SPSS version 23. Data were presented as means and proportions. P-value of < 0.05 was used as the level of significance. RESULTS: Overall, 1063 couples attended gynaecology and urology clinics with fertility-related concerns within the study period with a retrieval rate of 98.3%. The mean age of participants was 38.24 ± 8 years, while the mean semen volume and sperm concentrations were 2.62 ± 1.6 mls and 34.32 ± 7.4 million respectively. The age of participants significantly affected motility, volume and morphology (p-values of 0.001, 0.001 and 0.004 respectively). The total motility and sperm concentration have an inverse relationship with the age of the participants. CONCLUSION: This study shows that sperm motility decreases with the age of participants. It was also observed that the most common combined abnormality was oligoasthenozoospermia.

CONTEXTE: L'infertilité masculine représente 40 % de l'infertilité des couples. La prévalence des paramètres anormaux du sperme est en augmentation. L'âge, entre autres facteurs, affecte le potentiel de fertilité des hommes. Cette étude a analysé le profil des paramètres du liquide séminal des hommes cherchant un traitement de fertilité dans les hôpitaux et la relation entre l'âge, le volume et le temps de liquéfaction sur ces autres paramètres du sperme. MÉTHODES: Il s'agit d'une étude de cohorte rétrospective multicentrique menée dans huit hôpitaux secondaires et tertiaires au Nigeria. Les notes de cas des couples qui ont eu recours à des soins de fertilité dans les cliniques de gynécologie et d'urologie de ces hôpitaux entre le 1er janvier et le 31 décembre 2022 ont été récupérées après avoir reçu une approbation éthique. Un proforma conçu à dessein et basé sur le manuel de l'OMS pour l'examen du sperme humain a été utilisé pour la collecte des données. Les mesures des résultats étaient le temps de collecte et d'examen du sperme, le volume de sperme, le nombre de spermatozoïdes, la concentration en spermatozoïdes, le PH, l'agglutination, la liquéfaction, la motilité, la morphologie, la vitalité et la numération des globules blancs. Les données ont été analysées à l'aide de SPSS version 23. Les données ont été présentées sous forme de moyennes et de proportions. Une valeur P < 0,05 a été utilisée comme niveau de signification. RÉSULTATS: Dans l'ensemble, 1 063 couples ont fréquenté les cliniques de gynécologie et d'urologie pour des problèmes de fertilité au cours de la période d'étude, avec un taux de récupération de 98,3 %. L'âge moyen des participants était de 38,24 ± 8 ans, tandis que le volume moyen de sperme et les concentrations de spermatozoïdes étaient respectivement de 2,62 ± 1,6 ml et 34,32 ±7,4 millions. L'âge des participants a affecté de manière significative la motilité, le volume et la morphologie (valeurs p de 0,001, 0,001 et 0,004 respectivement). La motilité totale et la concentration en spermatozoïdes ont une relation inverse avec l'âge des participants. CONCLUSION: Cette étude montre que la mobilité des spermatozoïdes diminue avec l'âge des participants. Il a également été observé que l'anomalie combinée la plus fréquente était l'oligoasthénozoospermie. Mots-clés: Infertilité Masculine, Anomalies du Liquide séminal, Nigeria.

Antichlamydia antibodies and sperm quality among male partners of infertile couples ins Nigeria.

Background: The impact of Chlamydia trachomatis on semen quality has been studied with varied results. Aim: To determine the prevalence of antichlamydial antibodies and their relationship with sperm quality among male partners of infertile couples in Enugu, South-East Nigeria. Materials and Methods: It was a cross-sectional study of infertile male partners of couples attending infertility clinics at the University of Nigeria Teaching Hospital (UNTH) Ituku-Ozalla, Enugu, Nigeria. Their sera were assayed for antichlamydial antibodies, and semen analysis and culture were done for each participant. Results: Two hundred and eighty-two (282) male partners of infertile couples were studied. Infertility was commoner among participants aged 40 years or more (45.1%) and was mainly of the "primary type" (62.1%). Antichlamydia antibody was detected in 156 (55.3%) participants and was significantly associated with sperm quality (P = 002; OR = 2.294; 95% CI = 1.36-3.88). Overall, 81 (28.7%) had abnormal sperm quality. The sperm count, progressive motility, and vitality were significantly lower in participants with abnormal sperm quality than those with normal sperm quality (P < 0.001) while morphology, volume, and liquefaction time did not differ significantly (P > 0.05). Staphylococcus aureus was the predominant organism isolated from culture (122/282, 43.3%) while Streptococcus species were the least (4/262, 1.4%). There was significantly more Staphylococcus aureus isolated from the semen of participants that were seropositive to antichlamydial antibodies than those that were seronegative (80/156, 51.3% vs. 42/126, 33.3%; OR = 2.105; 95% CI = 1.30-3.42; P = 0.003). Conclusion: The prevalence of antichlamydial antibodies among male partners of infertile couples in Enugu, Nigeria is high and there is a significant association with sperm quality, sperm count, and bacterial isolates in seminal culture. Male partners of infertile couples in Enugu should be screened for antichlamydial antibodies and appropriate treatment offered wherever indicated. There is a need for increased public awareness and advocacy campaigns on the impact of Chlamydia infection on male factor infertility. This primary preventive measure may help in reducing the burden of Chlamydia infection and male factor infertility.

Seroprevalence of Hepatitis B, and C Viruses and HIV Infections among Antenatal Women in a Secondary Health Facility in Lagos, Nigeria.

BACKGROUND: Hepatitis B and C viruses and HIV infections contribute a significant proportion to maternal and perinatal morbidity and mortality in low and middle-income countries. While the burden of hepatitis B and C viruses is higher in low and middle-income countries, Nigeria also has the second largest burden of HIV. OBJECTIVES: To determine the seroprevalence of hepatitis B and C viruses and HIV infections among antenatal women who sought care at a secondary health facility in Lagos. METHODS: This was a retrospective review of patients managed in the antenatal clinic of 68 Nigerian Army Reference Hospital over one year. A study proforma was used to collect relevant data which were entered and analyzed using the IBM Statistical Package for Social Sciences (SPSS Statistics) Version 23. RESULTS: A total of 347 women attended prenatal care during the study period, however, only 329 cases with complete data were included in the final statistical analysis. The prevalence of HIV in our study was 6.4%, while HBV and HCV accounted for 6.2% and 1.8% respectively. Hepatitis B, and hepatitis C viruses and HIV Infections occurred in 3 (0.9%) of our patients, 6 (1.8%) of the women had HIV-HBV co-infection while 1 (0.3%) was infected with HIV-HCV. CONCLUSION: Our study re-emphasizes the public health importance of HBV, HCV and HIV screening in our antenatal clinics. This knowledge is very important for the implementation of effective prevention and control measures that will further decrease the mother-to-child transmission of these viruses.

CONTEXTE: Les virus de l'hépatite B et C et les infections par le VIH contribuent pour une part importante à la morbidité et à la mortalité maternelles et périnatales dans les pays à revenu faible et intermédiaire. Alors que le fardeau des virus de l'hépatite B et C est plus élevé dans les pays à revenu faible et moyen, le Nigeria a également le deuxième plus grand fardeau du VIH. OBJECTIFS: Déterminer la séroprévalence des virus de l'hépatite B et C et des infections par le VIH chez les femmes en période prénatale qui ont consulté dans un établissement de santé secondaire de Lagos. MÉTHODES: Il s'agit d'une étude rétrospective des patientes prises en charge dans la clinique prénatale de 68 références de l'armée nigériane sur une période d'un an. Un formulaire d'étude a été utilisé pour recueillir les données pertinentes qui ont été saisies et analysées à l'aide du progiciel statistique pour les sciences sociales IBM (SPSS Statistics) version 23. RÉSULTATS: Un total de 347 femmes ont suivi des soins prénataux pendant la période d'étude, cependant, seuls 329 cas avec des données complètes ont été inclus dans l'analyse statistique finale. La prévalence du VIH dans notre étude était de 6,4%, tandis que le VHB et le VHC représentaient respectivement 6,2% et 1,8%. Les virus de l'hépatite B et de l'hépatite C ainsi que le VIH étaient présents chez 3 (0,9%) de nos patientes, 6 (1,8%) des femmes avaient une co-infection VIHVHB tandis qu'une (0,3%) était infectée par le VIH-VHC. CONCLUSION: Notre étude souligne à nouveau l'importance pour la santé publique du dépistage du VHB, du VHC et du VIH dans nos cliniques prénatales. Ces connaissances sont très importantes pour la mise en œuvre de mesures de prévention et de contrôle efficaces qui permettront de diminuer davantage la transmission mère-enfant de ces virus. Mots clés: Hépatite B, VIH, Hépatite C, Séroprévalence, Coinfection, Lagos.

Maternal Outcomes of Eclampsia at the Lagos University Teaching Hospital: A Six-Year Retrospective Review.

BACKGROUND: Eclampsia is one of the leading causes of maternal morbidity and mortality. OBJECTIVES: To determine the incidence as well as the maternal outcomes of eclampsia at the Lagos University Teaching Hospital (LUTH). METHODS: This was a retrospective review. RESULTS: During the six-year review period, 4182 women gave birth at our facility, out of which 67 cases of eclampsia were diagnosed (16 per 1000 deliveries). Four women died constituting a case fatality rate of 5.9%. Fifteen women were admitted to the intensive care unit, 6 women had acute kidney injury while 5 had abruptio placentae. Further comparison of our data with previous studies from our institution decades ago showed a continuous decrease in total number of eclamptic cases presenting to our facility (572 eclamptics in 1977 - 1986, 299 ECLAMPTICS IN 1986 - 1995, 165 IN 1996-2005 AND 67 IN 2015-2020). CONCLUSION: The case fatality rate from eclampsia is still high in our hospital. Increased utilisation of antenatal care may play an important role in improving the maternal outcomes from this life-threatening obstetric condition. There is need for maternal education and increase awareness on the importance of antenatal care and early referral to tertiary level of care in order to reverse this trend.

CONTEXTE: L'éclampsie est l'une des principales causes de morbidité et de mortalité maternelles. OBJECTIFS: Déterminer l'incidence ainsi que les issues maternelles de l'éclampsie à l'hôpital universitaire de Lagos (LUTH). METHODES: Il s'agissait d'une revue rétrospective. RESULTATS: Au cours de la période d'examen de six ans, 4182 femmes ont accouché dans notre établissement, dont 67 cas d'éclampsie ont été diagnostiqués (9,5 pour 1 000 accouchements). Quatre femmes sont décédées, soit un taux de létalité de 5,9 %. Quinze femmes ont été admises à l'unité de soins intensifs, 6 femmes avaient une lésion rénale aiguë tandis que 5 avaient un décollement placentaire. Une comparaison plus poussée de nos données avec des études antérieures de notre institution il y a des décennies a montré une diminution continue du nombre total de cas d'éclampsie se présentant à notre établissement (572 éclamptiques en 1977­1986, 299 éclamptiques en 1986-1995, 165 en 1996-2005 et 67 en 2015­2020). CONCLUSION: Le taux de létalité de l'éclampsie est encore élevé dans notre hôpital. L'utilisation accrue des soins prénatals peut jouer un rôle important dans l'amélioration des résultats maternels de cette affection obstétricale potentiellement mortelle. Il est nécessaire d'éduquer les mères et d'accroître la sensibilisation à l'importance des soins prénatals et de l'orientation précoce vers le niveau de soins tertiaires afin d'inverser cette tendance. MOTS CLÉS: Éclampsie, issues maternelles, Grossesse, hypertension, Lagos.

Antichlamydia Antibodies and Sperm Quality among Male Partners of Infertile Couples in Nigeria

: The impact of Chlamydia trachomatis on semen quality has been studied with varied results. Aim: To determine the prevalence of antichlamydial antibodies and their relationship with sperm quality among male partners of infertile couples in Enugu, South-East Nigeria. Materials and Methods: It was a cross-sectional study of infertile male partners of couples attending infertility clinics at the University of Nigeria Teaching Hospital (UNTH) Ituku-Ozalla, Enugu, Nigeria. Their sera were assayed for antichlamydial antibodies, and semen analysis and culture were done for each participant. Results: Two hundred and eighty-two (282) male partners of infertile couples were studied. Infertility was commoner among participants aged 40 years or more (45.1%) and was mainly of the "primary type" (62.1%). Antichlamydia antibody was detected in 156 (55.3%) participants and was significantly associated with sperm quality (P = 002; OR = 2.294; 95% CI = 1.36­3.88). Overall, 81 (28.7%) had abnormal sperm quality. The sperm count, progressive motility, and vitality were significantly lower in participants with abnormal sperm quality than those with normal sperm quality (P < 0.001) while morphology, volume, and liquefaction time did not differ significantly (P > 0.05). Staphylococcus aureus was the predominant organism isolated from culture (122/282, 43.3%) while Streptococcus species were the least (4/262, 1.4%). There was significantly more Staphylococcus aureus isolated from the semen of participants that were seropositive to antichlamydial antibodies than those that were seronegative (80/156, 51.3% vs. 42/126, 33.3%; OR = 2.105; 95% CI = 1.30­3.42; P = 0.003). Conclusion: The prevalence of antichlamydial antibodies among male partners of infertile couples in Enugu, Nigeria is high and there is a significant association with sperm quality, sperm count, and bacterial isolates in seminal culture. Male partners of infertile couples in Enugu should be screened for antichlamydial antibodies and appropriate treatment offered wherever indicated. There is a need for increased public awareness and advocacy campaigns on the impact of Chlamydia infection on male factor infertility. This primary preventive measure may help in reducing the burden of Chlamydia infection and male factor infertility.

Prognostic impact of pretreatment thrombocytosis in epithelial ovarian cancer.

AIMS: This study was aimed at investigating the prognostic impact of pretreatment thrombocytosis in epithelial ovarian cancer (EOC) patients in Lagos, Nigeria. METHODS: This was a retrospective cohort study involving the review of the clinical record of 72 patients with histologically confirmed EOC who were managed at the Lagos University Teaching Hospital, Lagos, Nigeria over a 7-year period from January 2010 to December 2016. Information on the sociodemographic data and platelet counts at diagnosis of EOC were retrieved from the patients' medical records. Descriptive statistics were then computed for all baseline patients' characteristics. Survival analyses were carried out using the Kaplan-Meier estimates. Multivariate analysis of these data was performed with the Cox proportional hazards model. RESULTS: This study revealed that the prevalence of pretreatment thrombocytosis was 41.7% among the women with EOC. Fifty-three (73.6%) of the women had the advanced-stage disease (FIGO stage III-IV) while 52 (72.2%) had high-grade disease (II-III). The majority (66.7%) of the women had a serous histological type of EOC while 76.4% had documented recurrence. Pretreatment thrombocytosis was significantly associated with the women's parity (P = 0.009), serum carbohydrate antigen 125 levels (P = 0.018), median progression-free survival (PFS) (P < 0.001), 3-year median overall survival (OS) (P < 0.001), type of primary treatment (P = 0.002), extent of cytoreduction (P < 0.001), presence of ascites (P = 0.002), International Federation of Gynecology and Obstetrics (FIGO) stage (P = 0.008), and histological type (P = 0.011). Pretreatment thrombocytosis was negatively associated with PFS (hazard ratio [HR] = 0.25; 95% CI 0.83, 0.75; P = 0.014) and 3-year OS (HR = 0.03; 95% CI 0.03, 0.27; P = 0.002). CONCLUSIONS: The study suggests that pretreatment thrombocytosis may be a useful predictor of survivals in EOC patients.

ABO blood group as a biomarker of preeclampsia among antenatal clinic attendees in Nigeria.

BACKGROUND: The clinical application of the ABO blood group is not limited to transfusion medicine but extends to other aspects of medicine. Its impact on preeclampsia is controversial. AIM: To determine the association of ABO blood group type with preeclampsia. SUBJECTS AND METHODS: This was a cross-sectional analytical study of 66 women with preeclampsia and 81 apparently healthy women controls carried out in a tertiary health institution. The case and control groups were consecutively recruited during antenatal clinic visits and matched for age, parity, and gestational age. Data on demographics and the ABO blood group of the two groups of individuals were obtained. The analysis was both descriptive and inferential using the statistical package for social sciences (SPSS) version 21 (Chicago Il, USA). A P value of <0.05 was considered statistically significant. RESULTS: The mean age of the participants was 30.6 (4.9), 95% CI: 27.76-33.95. The majority of the women were ≤40 years (98.5%) and multigravidae constituted 81.8%. Forty-six (69.7%) women with preeclampsia had blood group O and 20 (30.3%) had a non-O blood group. Forty-nine (60.5%) of the controls had blood group O and 32 (39.5%) had a non-O blood group. The observed difference was not statistically significant (OR 1.50; 95% CI: 0.75-3.0; P = 0.26). The odds ratio for developing preeclampsia was 0.83 (95% CI: 0.37-1.91; P = 0.67) for the primigravidae. The non-O blood groups were more likely to present with symptoms than the O group (P < 0.01). Twenty-six (39.4%) women with preeclampsia had a mild disease while 40 (60.6%) had severe disease. CONCLUSION: Women with non-O blood groups are not at increased risk of developing preeclampsia but are more likely to be symptomatic than the O group.

Pattern of blood donation and characteristics of blood donors in Enugu, Southeast Nigeria.

BACKGROUND: Despite increasing need for blood donation in medical practice, little is known about pattern of blood donation and characteristics of blood donors in some African populations like Nigeria. This information is necessary in designing strategies and policies for improving blood transfusion services in Africa. AIM: The aim of this study is to determine the pattern of blood donation and characteristics of blood donors in Enugu, Southeast, Nigeria. MATERIALS AND METHODS: A cross-sectional study of 3377 blood donors at a tertiary hospital in Enugu, Nigeria from May 1, 2016 to April 30, 2017. Information sought included donors' sociodemographic characteristics; type of blood donor: Voluntary nonremunerated donor (VNRD), family replacement donor (FRD), or paid donor (PD); willingness to become VNRD in the future after counseling and education (at point of entry to blood bank) on its benefits to clinical practice; hemoglobin (Hb) level; and transfusion transmissible infections (TTIs). RESULTS: Mean age of blood donors was 28.8 ± 8.5 years, majority were male (3011, 89.2%) and students (1289, 32.8%). FRDs were the highest in number (1998, 59.2%), followed by PDs (746, 22.1%) and finally VNRDs (633, 18.7%). Of the 3377 persons that came for blood donation, 2537 (75.1%) were found eligible to donate while 840 (24.9%) were deferred on account of low Hb (602/3377, 17.8%) or positive infectious screening test (238/3377, 7.0%). The odds of a male donor being a VNRD were about one and half times that of a female donor (582/3011 [19.3%] vs. 51/366 [13.9%]; odds ratio: 1.48; 95% confidence interval: 1.09-2.02; P = 0.01). After counseling of FRDs and PDs, majority (54.3%) were willing to become VNRDs in the future. Donors' age >30 years, being of male sex, having tertiary level of education, and being employed were strongly associated with willingness to become VNRDs in the future (P < 0.001). CONCLUSION: VNRD made up <20% of the total number of donors in Enugu, Nigeria. There is a need for improvement in public enlightenment on the need for VNRDs and employment opportunities of the populace to improve voluntary blood donation.

Determinants of compliance to iron supplementation among pregnant women in Enugu, Southeastern Nigeria.

BACKGROUND: Anemia in pregnancy is highly prevalent among antenatal clinic attendees in Enugu, Nigeria despite the practice of routine iron supplementation in pregnancy. The major problem with iron supplementation in pregnancy is compliance, and this may be a potential driver to the persistent high prevalence of anemia in this population. OBJECTIVES: To find out the compliance rate and determinants of compliance to iron supplementation among pregnant women in Enugu, southeastern Nigeria. MATERIALS AND METHODS: This was a questionnaire-based cross-sectional study of eligible pregnant women receiving antenatal care at the University of Nigeria Teaching Hospital (UNTH), Ituku/Ozalla, Enugu, Nigeria between April 1, 2012 and January 31, 2013. RESULTS: The knowledge of iron supplementation was 76.3% ( n = 302), however, the compliance rate was 65.9% ( n = 261). Tertiary level of education and high social class were factors significantly associated with compliance to iron supplementation after adjusting for other factors in the binary logistic regression analysis ( P < 0.05). The major barriers to compliance to iron supplementation included gastrointestinal side effects of iron supplements (41.7%), non-affordability of iron supplements (28.3%), and forgetfulness (15.0%) among the antenatal mothers. CONCLUSION: The compliance rate of 65.9% for iron supplementation by pregnant mothers in Enugu can further be improved by providing the drug free of charge in the short term and improvement in education and socioeconomic class of the populace in the long run.

Avascular necrosis in sickle cell (homozygous S) patients: predictive clinical and laboratory indices.

BACKGROUND: Pathogenetic mechanism as well as laboratory and clinical correlates of osteonecrosis in sickle cell have not been fully investigated. The aim of this study is to investigate the predictive value of the steady state white cell and platelet count as well as the frequency of bone pain crisis per annum to detect sickle cell patients who will eventually develop avascular necrosis (AVN). PATIENTS AND METHODS: A 5 year retrospective analysis of 122 homozygous S (HbSS) patients, aged 6-49 years (mean age 24.7 ± 7 years), out of which 16 patients (13.1%) had developed AVN within the years under review. RESULTS: The prevalence of AVN in sickle cell patients was determined to be 13.1 per 1000. The steady state white cell count, platelet count, frequency of bone pain crisis and hematocrit, was compared in patients that develop AVN and those who had not over the period. Only the steady state platelet count was found to differ significantly ( P = 0.011) between these two patient groups and to correlate positively (Pearson correlation coefficient = -0.251) with development of AVN. The hematocrit, white cell count, and frequency of bone pain crisis were found neither to differ significantly nor correlate with the development of AVN. CONCLUSION: In conclusion, patients with a raised steady state platelet count may have a higher tendency to develop AVN and may require closer orthopedic review and prophylactic intervention.

Anti-malaria prescription in pregnancy among general practitioners in Enugu state, south east Nigeria.

BACKGROUND: The national policy on malaria control recommends use of intermittent preventive treatment with sulfadoxine/pyrimethamine (IPT-SP) for chemoprophylaxis against malaria in pregnancy; and use of quinine and arthemisinin-based combination therapy (ACT) for acute treatment of malaria in the first, and second/third trimesters, respectively. In Nigeria, a large proportion of pregnant women are seen by the general practitioners (GPs). OBJECTIVE: To determine the pattern of anti-malaria prescription in pregnancy among GPs in Enugu state, and access the level of conformity with the national policy on malaria control. MATERIALS AND METHODS: Questionnaires were administered to a cross-section of 147 GPs that attended the 2010 Enugu state branch of the Nigeria Medical Association Scientific Conference/Annual General Meeting/Election. RESULTS: The mean age of the GPs was 37 ± 3.6 (range 27-70) years. Quinine was the commonly (45.6% (n = 67)) prescribed anti-malaria drug in the first trimester while in the second/third trimester ACT was commonly (48.3% (n = 71)) prescribed. Seventy-six (51.7%) practitioners prescribed IPT-SP for chemoprophylaxis against malaria while the rest (48.3%) prescribed other drugs. GPs who obtained MBBS qualification less than or equal to 5 years prior to the survey were more likely to comply with the national policy on malaria control in their prescriptions (P < 0.05). CONCLUSION: The pattern of anti-malaria prescription among GPs in Enugu state is varied, and conformed poorly to the evidence-based national policy on malaria control. There is need for continuing professional development to keep the GPs abreast with current trends in malaria treatment during pregnancy.

Utilization of insecticide treated nets among pregnant women in Enugu, South Eastern Nigeria.

BACKGROUND: The goal of roll back malaria partnership is to achieve universal coverage for all populations at risk using appropriate interventions for prevention and case management. OBJECTIVE: The objective of this study is to determine the use of insecticide treated nets (ITNs) and other anti-vector measures among pregnant women in an area hyper-endemic for malaria. MATERIALS AND METHODS: Questionnaires were administered to a cross-section of 832 consecutive pregnant women attending antenatal care in three hospitals in Enugu, Nigeria that have high client flow for maternity services. Data collected were analyzed using descriptive and inferential statistics by means of the Statistical Package for Social Sciences (SPSS) version 16. P-value of less than 0.05 was considered statistically significant. RESULTS: The mean age of the women was 33.2 ± 2.9 (range: 15-45) years. Three hundred and fifty nine (43.1%) women owned insecticide treated nets (ITNs), however 325(90.5%) slept under the nets during the index pregnancies; equivalent to 39.1% utilization rate among the 832 women studied. Out of the 325 (39.1%) women that used ITNs; 236 (28.4%) used it singly, while 89 (10.7%) used it in combination with other anti-vector measures. Educational status and social class of the women had strong association with the use of ITNs (P < 0.0001). Women who used ITNs were significantly less likely to have acute malaria, anaemia and babies with low birth weight than women who did not use ITNs (P < 0.05). CONCLUSION: The use of ITNs is poor among pregnant women in Enugu, but associated with favorable maternal and feto-neonatal outcome. Future measures to increase its use should consider improvement in educational level and social class of our women.

Acceptability of human papilloma virus vaccine and cervical cancer screening among female health-care workers in Enugu, Southeast Nigeria.

BACKGROUND: Cervical cancer, a leading cause of cancer deaths in women in developing countries can be prevented primarily by vaccinating adolescent girls and women against infection by the human papillomavirus (HPV) before their first sexual exposure, and secondarily through screening and treatment of identified precancerous lesions. AIM: To determine the awareness and acceptability of the HPV vaccine and screening for cervical cancer among female health-care workers in Enugu, southeastern Nigeria. MATERIALS AND METHODS: Questionnaires were administered to a cross-section of 177 female health-care workers selected systematically from the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria. Statistical analysis was both descriptive and inferential at 95% confidence level using the Statistical Package for Social Sciences (SPSS) computer software version 16. A P value of less than 0.05 was considered statistically significant. RESULTS: The awareness of screening for cervical cancer (91%) was significantly higher than that of the HPV vaccine (62.7%) [odds ratio (OR): 0.17; 95% confidence interval (CI): 0.09-0.30]. However, the acceptability rate of the HPV vaccine (91.0%) was significantly higher than that of cervical screening (71.4%) (OR: 4.04;95% CI: 1.94-8.42)]. Only 25 (14.1%) of the health-care workers had done cervical screening, but 30 (49.2%) of the 61 respondents with adolescent daughters had immunized their daughters with the HPV vaccine. Although no reason was given for the low participation in cervical screening, cost and availability of HPV vaccine was a major deterrent for the latter. CONCLUSION: With more public enlightenment, available and affordable HPV vaccine appears to hold the key for prevention of cervical cancer in developing countries where the burden is high.

Acceptability of Human Papilloma Vrus Vaccine and Cervical Cancer Screening among Female Health-Care Workers in Enugu; Southeast Nigeria

Background: Cervical cancer; a leading cause of cancer deaths in women in developing countries can be prevented primarily by vaccinating adolescent girls and women against infection by the human papillomavirus (HPV) before their first sexual exposure; and secondarily through screening and treatment of identified precancerous lesions. Aim: To determine the awareness and acceptability of the HPV vaccine and screening for cervical cancer among female health-care workers in Enugu; southeastern Nigeria. Materials and Methods: Questionnaires were administered to a cross-section of 177 female health-care workers selected systematically from the University of Nigeria Teaching Hospital (UNTH); Enugu; Nigeria. Statistical analysis was both descriptive and inferential at 95confidence level using the Statistical Package for Social Sciences (SPSS) computer software version 16. A P value of less than 0.05 was considered statistically significant. Results: The awareness of screening for cervical cancer (91) was significantly higher than that of the HPV vaccine (62.7) [odds ratio (OR): 0.17; 95 confidence interval (CI): 0.09-0.30]. However; the acceptability rate of the HPV vaccine (91.0) was significantly higher than that of cervical screening (71.4) (OR: 4.04;95 CI: 1.94-8.42)]. Only 25 (14.1) of the health-care workers had done cervical screening; but 30 (49.2) of the 61respondents with adolescent daughters had immunized their daughters with the HPV vaccine. Although no reason was given for the low participation in cervical screening; cost and availability of HPV vaccine was a major deterrent for the latter. Conclusion: With more public enlightenment; available and affordable HPV vaccine appears to hold the key for prevention of cervical cancer in developing countries where the burden is high

Pattern of gynaecological cancers in University of Nigeria Teaching Hospital, Enugu, south eastern Nigeria.

BACKGROUND: Gynaecological cancers are among the leading causes of cancer related deaths worldwide. The objective of this study was to determine the pattern and relative frequencies of gynecological cancers as seen at the University of Nigeria Teaching Hospital (UNTH), Ituku/Ozalla, Enugu, Southeastern Nigeria. METHODS: An analysis of retrospective clinical data from the ward admissions and discharge books and the operating theatre record books. RESULTS: During the 10-year period under study (2000-2009), 407 cases of gynaecological cancers were admitted into the hospital. The age range of these women was 21-80years with mean age of 54.6 +/- 14.2 years. The commonest gynaecological cancers in women less than 30 years of age were choriocarcinoma (36.1%) and ovarian cancer (33.3%). After 30 years, cervical cancer became the commonest cancer. Overall, cervical cancer was by far the commonest gynecological cancer constituting 78% of all the cases, followed by ovarian cancer (8.9%), choriocarcinoma (4.3%), endometrial cancer (4.1%), vulva cancer (4.0%) and leiomyosarcoma (0.5%). There was no case of vaginal cancer during the study period. Anaemia was the commonest sequelae, complicating 55% of the cases, followed by genital fistulae (12%), infertility (3%), renal failure (3%), and pulmonary complications (2%). CONCLUSION: Cervical cancer is by far the commonest gynaecological cancer in Enugu and there is high incidence of this cancer even in young women below the age of 30 years. The commonest gynaecological cancer in women less than 30 years is choriocarcinoma, and anaemia is the commonest sequelae of all gynaecological cancers.

A five-year survey of caesarean delivery at a Nigerian tertiary hospital.

BACKGROUND: The rising global rate in caesarean delivery has been a source of concern to obstetricians worldwide. In spite of remarkable improvement in the safety of anaesthesia and surgical techniques, caesarean section has higher risks of maternal death when compared with normal vaginal delivery. Thus, the current emphasis is to limit the rising rate of caesarean section to as much as possible. OBJECTIVE: To determine the rate of caesarean section, pregnancy out-come, major indications and complications of caesarean section. METHODS: A five year (January 1(st) 2005 to December 31(st) 2009) retrospective analysis of clinical data from the ward admissions and discharge books, patients' folders and the operating theatre record books at the University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu. RESULTS: Out of the 3,554 deliveries during the study period, 980 cases were by caesarean section, giving a rate of 27.6%. Most cases 918 (93.7%) were by emergency caesarean sections, with elective procedure accounting only for 6.3% of the cases. The age range of the women was between 16-48yrs. Four hundred and seven (41.5%) were primigravidae, 503(51.4%) were between para one and para four, while 70 (7.1%) were grand-multipara. The rate of caesarean section was higher amongst the booked patients, 563 (57.5%) than the unbooked patients 355 (36.2%). Two previous caesarean section was the commonest indication for caesarean section 211(21.5%), followed by cephalopelvic disproportion 198 (20.2%), and foetal distress188 (19.2%). A total of 1009 babies were delivered through caesarean section by the 980 women; 955 cases of singleton gestations and 25 cases of multiple gestations (21 twins and 4 triplets). Majority of the babies 918 (91%) were delivered by emergency procedure. More than half of the babies 582(57.7%) had birth asphyxia and there were 39 (3.9%) perinatal deaths. All the cases of perinatal deaths and 549 (94.3%) of birth asphyxia were following emergency procedure. Anaemia was the commonest postpartum morbidity and the maternal case fatality rate was 0.7%. CONCLUSION: There is now a further rise in rate of caesarean section after a slight drop that followed the initial high 1.5fold rise from previous studies. The perinatal outcome is poor especially following emergency caesarean section. Reducing primary caesarean section rate and more encouragement of vaginal delivery after one previous caesarean section may reduce the prevalence of two previous caesarean sections which is the leading indication for caesarean section in the hospital.

A Five-year Survey of Caesarean Delivery at a Nigerian Tertiary Hospital

Background: The rising global rate in caesarean delivery has been a source of concern to obstetricians worldwide. In spite of remarkable improvement in the safety of anaesthesia and surgical techniques; caesarean section has higher risks of maternal death when compared with normal vaginal delivery. Thus; the current emphasis is to limit the rising rate of caesarean section to as much as possible. Objective: To determine the rate of caesarean section; pregnancy out-come; major indications and complications of caesarean section. Methods: A five year (January 1st 2005 to December 31st 2009) retrospective analysis of clinical data from the ward admissions and discharge books; patients' folders and the operating theatre record books at the University of Nigeria Teaching Hospital; Ituku Ozalla; Enugu. Results: Out of the 3;554 deliveries during the study period; 980 cases were by caesarean section; giving a rate of 27.6. Most cases 918 (93.7) were by emergency caesarean sections; with elective procedure accounting only for 6.3of the cases. The age range of the women was between 16-48yrs. Four hundred and seven (41.5) were primigravidae; 503(51.4) were between para one and para four; while 70 (7.1) were grand-multipara. The rate of caesarean section was higher amongst the booked patients; 563 (57.5) than the unbooked patients 355 (36.2). Two previous caesarean section was the commonest indication for caesarean section 211(21.5); followed by cephalopelvic disproportion 198 (20.2); and foetal distress188 (19.2). A total of 1009 babies were delivered through caesarean section by the 980 women; 955 cases of singleton gestations and 25 cases of multiple gestations (21 twins and 4 triplets). Majority of the babies 918 (91) were delivered by emergency procedure. More than half of the babies 582(57.7) had birth asphyxia and there were 39 (3.9) perinatal deaths. All the cases of perinatal deaths and 549 (94.3) of birth asphyxia were following emergency procedure. Anaemia was the commonest postpartum morbidity and the maternal case fatality rate was 0.7. Conclusion: There is now a further rise in rate of caesarean section after a slight drop that followed the initial high 1.5fold rise from previous studies. The perinatal outcome is poor especially following emergency caesarean section. Reducing primary caesarean section rate and more encouragement of vaginal delivery after one previous caesarean section may reduce the prevalence of two previous caesarean sections which is the leading indication for caesarean section in the hospital