Cancer Related Mortality in Port Harcourt, Southern Nigeria.

BACKGROUND: Globally, cancer is a leading cause of death and source of resistance to increasing life expectancy. In 2019, the World Health Organisation estimated cancer as the first or second leading cause of death before the age of 70 in 112 countries and third or fourth in 23 other countries. Despite the fact that cancer has been recognized as a public health problem, there is paucity of data on cancer mortality in Nigeria. The aim of this study is to determine the pattern of cancer mortality at the University of Port Harcourt Teaching Hospital. MATERIALS AND METHODS: This is a 5 year retrospective study of all cancer related deaths at the University of Port Harcourt Teaching Hospital from 1st January, 2014 to 31st December, 2018. Relevant data were extracted and analyzed using Statistical Package for Social Sciences version 24. RESULTS: There were 4449 deaths during the period under review, of which 293 were cancer related deaths, giving a mortality rate of 6.59%. There were 114 males and 179 females giving a male to female ratio of 1:1.6. Cancer of the breast was the most common cause of cancer death and accounted for 61 (20.8%) deaths within the study period. CONCLUSION: Cancer is a major cause of mortality in Nigeria. Cancer of the breast is the leading cause of cancer mortality in females and overall while cancer of the prostate remains the commonest in men.

CONTEXTE: Dans le monde entier, le cancer est l'une des principales causes de décès et une source de résistance à l'augmentation de l'espérance de vie. En 2019, l'Organisation mondiale de la santé estime que le cancer sera la première ou la deuxième cause de décès avant l'âge de 70 ans dans 112 pays et la troisième ou quatrième dans 23 autres pays. Malgré le fait que le cancer ait été reconnu comme un problème de santé publique, il y a peu de données sur la mortalité par cancer au Nigeria. L'objectif de cette étude est de déterminer le profil de la mortalité par cancer au l'hôpital universitaire de Port Harcourt. MATÉRIEL ET MÉTHODES: Il s'agit d'une étude rétrospective sur 5 ans de tous les décès liés au cancer à l'hôpital universitaire de Port Harcourt du 1er janvier 2014 au 31 décembre 2018. Les données pertinentes ont été extraites et analysées à l'aide du progiciel de statistiques pour les sciences sociales version 24. RÉSULTATS: Il y a eu 4449 décès au cours de la période examinée, dont 293 étaient liés au cancer, soit un taux de mortalité de 6,59 %. Il y avait 114 hommes et 179 femmes soit un rapport homme/femme de 1:1,6. Le cancer du sein était la cause la plus fréquente de décès par cancer et représentait 61 (20,8 %) des décès dans la région. (20,8 %) des décès survenus pendant la période d'étude. CONCLUSION: Le cancer est une cause majeure de mortalité au Nigeria. Le cancer du sein est la principale cause de mortalité par cancer chez les femmes et dans l'ensemble du pays, tandis que le cancer de la prostate reste le plus fréquent chez les hommes. Mots clés: Cancer, mortalité, Port Harcourt, Nigeria.

Pregnancy outcome in unbooked mothers at a tertiary health institution, South-South, Nigeria.

Background: Maternal complications and poor perinatal outcome are highly associated with non-utilisation of antenatal and delivery care services. The study aimed at determining the socio-demographical characteristics and feto-maternal outcome in unbooked mothers who delivered at a tertiary referral hospital. Materials and Methods: A retrospective study of all unbooked patients managed at the Obstetric unit of the University of Port Harcourt Teaching Hospital (UPTH), Nigeria from January 1, 2009 to December 31, 2013. Data obtained from the theatre records, delivery registers and case notes were analysed using the statistical package SPSS 20. Results: Unbooked mothers constituted 15.8% (2,490) of the deliveries. Majority (81.7%) of the women were aged 20-34 years with a mean age of 30.8 ± 4.5 years. More than half of the women were Para 1-4 (61.3%). Emergency caesarean section was the mode of delivery in 58.7% of the women. The commonest indication for caesarean section was cephalopelvic disproportion (40%) followed by Obstructed labour (26%). There were 149 maternal deaths, giving maternal mortality ratio of 4654.8/100,000. The perinatal mortality rate was 331.7/1000 births. Conclusion: The study showed a positive correlation between lack of proper antenatal care and adverse pregnancy outcome in unbooked patients. Improvement in the socioeconomic conditions of the populace especially women and the removal of fee for service in maternal care services will help to improve the availability and accessibility of good quality antenatal care.

Foeto-maternal outcome of diabetes in a tertiary health facility in Nigeria

Diabetes complicating pregnancy is associated with adverse maternal, foetal and neonatal outcomes. We have determined the prevalence of both pre-gestational (PGDM) and gestational diabetes mellitus (GDM), and their associated maternal and perinatal morbidities and mortalities at the University of Port-Harcourt Teaching Hospital, Nigeria. A retrospective study was carried out of all cases of diabetes in pregnancy between 2008 and 2012. The case notes of the next two non-diabetic patients, whose gestational ages and parities matched, were examined as case controls. There were 122 cases of diabetes from a total of 14, 521 deliveries (8.4 per 1000 deliveries), 21 cases of PGDM, and 101 cases of GDM (1.45 per 1000 deliveries and 6.96 per 1000 deliveries respectively). There were 60 cases of foetal macrosomia (49%). The mean birth weight was 3.75±0.76 kg. There were 11 perinatal deaths (perinatal mortality rate 90 per 1000 deliveries). The caesarean delivery rate was 89%. Sixty (60) babies (49%) required neonatal intensive care admission. There were no maternal deaths or congenitally malformed babies. We conclude that diabetes in pregnancy is associated with adverse maternal and neonatal outcomes. Patients at risk should be encouraged to attend preconception clinics and register early in well-equipped hospitals for antenatal care. Universal screening of all pregnant women at booking and patients with clinical risks characteristics at 24 and 28 weeks of gestation may be effective for the early identification and management of GDM

AN APPRAISAL OF RETAINED PLACENTA AT THE UNIVERSITY OF PORT HARCOURT TEACHING HOSPITAL: A FIVE-YEAR REVIEW.

BACKGROUND: Retained placenta is associated with an increased risk of maternal morbidity and mortality especially in developing countries. OBJECTIVE: To determine the incidence and evaluate the mode of presentation, risk factors and method of treatment of patients with retained placenta. METHODOLOGY: A retrospective review of retained placenta managed at the University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt over a 5 year period (January 2009 to December 2013). Data obtained were analyzed using statistical software SPSS 17.0. RESULTS: There were 93 cases of retained placenta out of 15,789 deliveries, giving an incidence of 0.59%.85 patients' case records were available for analysis. Majority of the patients 69 (81.2%) were unbooked (had no antenatal care) with 60 (70.6%) having home deliveries. Previous history of dilatation and curettage and preterm deliveries, accounted for the major identifiable risk factors at 55 (64.7%) and 22 (25.9%) respectively. At presentation, 22(25.9%) were in hypovolemic shock. Manual removal of the placenta was the commonest treatment modality (87.1%).There was one maternal death giving rise to a case fatality rate of 1.18%. CONCLUSION: Retained placenta is a major cause of maternal morbidity and mortality from postpartum haemorrhage and other complications related to its removal. The incidence can be reduced by antenatal care, skilled birth attendance and provision of emergency obstetrics care services.