Perinatal outcome in unbooked teenage pregnancies in the university of calabar teaching hospital, calabar, Nigeria.

Background. Teenage pregnancy being a high risk condition requires skilled attention for good outcome. Objectives. To determine the influence of antenatal care on perinatal outcome in teenage pregnancies in Calabar. Materials and Methods. A review of patient records in Calabar was conducted between 1st January, 2006 and 31st December, 2010, to determine perinatal outcome in teenage pregnancy. Results. Teenage pregnancy accounted for 644 (6.5%) of the total deliveries with 245 (38.0%) booked while 399 (62.0%) were unbooked. Teenage mothers contributed significantly to the proportion of women who were delivered without prior antenatal care (χ(2) = 6.360; P < 0.05). The mean duration of labour in booked teenagers was 10.85 ± 4.2 hours, while unbooked teenagers was 23.31 ± 3.6 hours (t-value = 77.1039; P < 0.05). There was statistically more caesarean sections among unbooked teenage pregnancies than booked (χ(2) = 36.75; P < 0.05). Stillbirth was statistically significant (χ(2) = 27.096; P < 0.05) among unbooked teenagers than booked. However, early neonatal death was not significantly different between booked and unbooked teenage pregnancies(χ(2) = 0.512; P < 0.05). Conclusion. Unbooked teenage pregnancies were significantly associated with increased operative intervention and poor perinatal outcome.

Trends in maternal mortality at the University of Calabar Teaching Hospital, Nigeria, 1999-2009.

BACKGROUND: Maternal mortality remains a major public health challenge, not only at the University of Calabar Teaching Hospital, but in the developing world in general. OBJECTIVE: The objective of this study was to assess trends in maternal mortality in a tertiary health facility, the maternal mortality ratio, the impact of sociodemographic factors in the deaths, and common medical and social causes of these deaths at the hospital. METHODOLOGY: This was a retrospective review of obstetric service delivery records of all maternal deaths over an 11-year period (01 January 1999 to 31 December 2009). All pregnancy-related deaths of patients managed at the hospital were included in the study. RESULTS: A total of 15,264 live births and 231 maternal deaths were recorded during the period under review, giving a maternal mortality ratio of 1513.4 per 100,000 live births. In the last two years, there was a downward trend in maternal deaths of about 69.0% from the 1999 value. Most (63.3%) of the deaths were in women aged 20-34 years, 33.33% had completed at least primary education, and about 55.41% were unemployed. Eight had tertiary education. Two-thirds of the women were married. Obstetric hemorrhage was the leading cause of death (32.23%), followed by hypertensive disorders of pregnancy. Type III delay accounted for 48.48% of the deaths, followed by Type I delay (35.5%). About 69.26% of these women had no antenatal care. The majority (61.04%) died within the first 48 hours of admission. CONCLUSION: Although there was a downward trend in maternal mortality over the study period, the extent of the reduction is deemed inadequate. The medical and social causes of maternal deaths identified in this study are preventable, especially Type III delay. Efforts must be put in place by government, hospital management, and society to reduce these figures further. Above all, there must be an attitudinal change towards obstetric emergencies by health care providers.

Review of obstetrics genito-urinary fistulae in the University of Calabar Teaching Hospital Calabar, Nigeria.

BACKGROUND: Obstetric fistulae with Urinary incontinence are one of the most distressing maternal morbidities. It is associated with physical and social deprivation such as wife abandonment and violent reactions against the victims particularly in the developing countries of the world. AIMS AND OBJECTIVES: To study the demographic and reproductive profiles as well as management of patients with obstetric fistulae in UCTH, Calabar, Nigeria. PATIENTS AND METHOD: A five-year retrospective study of case records of 37 patients managed in Maternity Annex of University of Calabar Teaching Hospital, Calabar Nigeria for obstetric genito-urinary fistulae was carried out. RESULTS: One in every 122 parturients during the period had fistula. Eleven (29.7%) were teenagers. Many patients were married (54.1%), nulliparous (59.4%), come from low socioeconomic class (72.9%) and did not utilize modern obstetric facilities properly. Many cases resulted from prolonged obstructed labour (51.4%) and 70.2% presented with total incontinence of urine. Eighteen (48.7%) were diagnosed within 6 month of delivery. The main types encountered included were vesico-vaginal (34.4%) or complex (10.8%) fistulae who were manage conservatively (21.6%) or with bladder repairs. Majority (29.7%) were referred for further treatment. CONCLUSION: Parturient in Calabar still suffer from this age long obstetric morbidity mainly due to poor utilization of modern obstetric care facilities. Results of treatment are largely unsatisfactory; therefore resources should be channeled towards prevention.

Oral health among antenatal care attendees in Calabar, Nigeria.

The objective of this study is to determine the oral health habits, awareness, oral health education and treatment needs among pregnant women who attend the antenatal clinics at the University of Calabar Teaching Hospital, Calabar, Nigeria. A total of 252 women at different stages of pregnancy responded to an interviewer-administered structured questionnaire. Of those, 238 (94.4%) of the respondents used toothbrush and toothpaste for oral cleaning, while 12 (4.8%) used a combination of toothbrush/toothpaste and local chewing sticks. Two (0.8%) adhered to the use of chewing sticks only. A total of 34 (13.5%) respondents were aware of and used dental services while pregnant; 18 (52.9%) of those who presented with dental complaints during pregnancy had bleeding gums. Based on the level of awareness of the need to attend a dental clinic during pregnancy (26.2%) and the percentage of respondents willing to have a dental examination during pregnancy (83.3%), it is recommended that oral health education be incorporated into the antenatal counselling of pregnant women in Nigeria.

Review of Obstetrics Genito-urinary Fistulae in the University of Calabar Teaching Hospital Calabar; Nigeria

Obstetric fistulae with Urinary incontinence are one of the most distressing maternal morbidities. It is associated with physical and social deprivation such as wife abandonment and violent reactions against the victims particularly in the developing countries of the world. To study the demographic and reproductive profiles as well as management of patientswith obstetric fistulae inUCTH;Calabar;Nigeria. Afiver-year retrospective study of case records of 37 patients managed inMaternity Annex of University of Calabar Teaching Hospital; Calabar Nigeria for obstetric genito-urinary fistulae was carried out. One in every 122 parturients during the period had fistula. Eleven (29.7) were teenagers. Many patients weremarried (54.1); nulliparous (59.4); come from low socioeconomic class (72.9) and did not utilize modern obstetric facilities properly. Many cases resulted from prolonged obstructed labour (51.4) and 70.2presented with total incontinence of urine. Eighteen (48.7)were diagnosed within 6 month of delivery. Themain types encountered includedwere vesico-vaginal (34.4) or complex (10.8) fistulaewho were manage conservatively (21.6) or with bladder repairs. Majority (29.7) were referred for further treatment. Parturient in Calabar still suffer from this age long obstetric morbidity mainly due to poor utilization of modern obstetric care facilities. Results of treatment are largely unsatisfactory; therefore resources should be channeled towards prevention

Is the process of diagnosing and treating incidental medical findings a barrier to contraceptive acceptance and use?

The objective of this study is to determine the impact of diagnosing and treating incidental medical disorders on contraceptive acceptance/use. The setting was the University of Calabar Teaching Hospital, a tertiary referral centre for the South-South zone of Nigeria and South-west Cameroon. Subjects were apparently healthy women seeking contraceptive counselling at the Teaching Hospital, Calabar (2001-2005). A total of 4,990 women's records were studied for the diagnosis of incidental medical findings. Two levels of missed opportunity for contraceptive uptake were identified. Incidental medical findings were seen in 26.9% of women. Contraceptive acceptance in women with incidental medical findings was 24.8%. Defaults from the screening process and treatment of incidental medical findings were significantly associated with high parity and low social status (p < 0.5). Incidental medical disorders, although uncommon in women desiring contraception were associated with low contraceptive uptake in women with high parity and low social status.

Clinical presentation and complications in patients with unsafe abortions in University of Calabar Teaching Hospital, Calabar, Nigeria.

BACKGROUND: Unsafe abortion still contributes significantly to high maternal morbidity and mortality particularly in developing countries despite concerted efforts being made to reduce it. Our objective is to determine the incidence, mode presentation and complications of Unsafe abortion. METHOD: This prospective study was carried out by directly interviewing patients managed for unsafe abortion over one and half years period (1" June 2003, to 31st' December, 2004) in Maternity Annex of the University of Calabar Teaching Hospital Calabar, Nigeria. RESULTS: Incidence of Unsafe abortion of 27.6% of all gynaecological admissions was established. Most Patients (55.7%) were age 20 30 years while 25.4% were teenagers. There were 33(27.1%) students, 38.2% were single women and 38.5% had secondary education. The major reasons given for terminating the pregnancy included completion of education (25.4%), fear of parental action (18.8%) and in 17.2% the father of the pregnancy was unknown. Medical officers (32.8%) performed majority of the abortions while 10.7% were self induced by the patients themselves. Main complications encountered included retained product of conceptions, haemorrhage, sepsis, injuries to genital tracts and intra-abdomal organs. CONCLUSION: Unsafe abortion and it complications occurs in all socioeconomic groups. Efforts directed at reducing unintended pregnancy by comprehensive family planning programs and effective emergency post abortal care services will reduce the problem while the legal status of abortion is being debated.

Clinical Presentation and Complications in Patients with Unsafe Abortions in University of Calabar Teaching Hospital; Calabar; Nigeria

Background: Unsafe abortion still contributes significantly to high maternal morbidity and mortality particularly in developing countries despite concerted efforts being made to reduce it. Our objective is to determine the incidence; mode presentation and complications of Unsafe abortion. Method: This prospective study was carried out by directly interviewing patients managed for unsafe abortion over one and half years period (1st June 2003; to 31st December; 2004) in Maternity Annex of the University of Calabar Teaching Hospital Calabar; Nigeria. Results: Incidence of Unsafe abortion of 27.6of all gynaecological admissions was established. Most Patients (55.7) were age 20 30 years while 25.4were teenagers. There were 33 (27.1) students; 38.2were single women and 38.5had secondary education. The major reasons given for terminating the pregnancy included completion of education (25.4); fear of parental action (18.8) and in 17.2the father of the pregnancy was unknown. Medical officers (32.8) performed majority of the abortions while 10.7were self induced by the patients themselves. Main complications encountered included retained product of conceptions; haemorrhage; sepsis; injuries to genital tracts and intraabdomal organs. Conclusion: Unsafe abortion and it complications occurs in all socioeconomic groups. Efforts directed at reducing unintended pregnancy by comprehensive family planning programs and effective emergency post abortal care services will reduce the problem while the legal status of abortion is being debated

Awareness and acceptability of strategies for preventing mother to child transmission of HIV among antenatal clients in Calabar, Nigeria.

BACKGROUND: Mother to child transmission is the major route through which children below the age of 15 years acquire HIV infection. The most effective way to reduce childhood HIV infection is to prevent the infection in mothers and for already infected mothers use appropriate strategies to prevent transmission to their children. This study was conducted to determine the level of awareness and acceptability of strategies for preventing mother to child transmission of HIV. METHOD: Exploratory multi-centric descriptive study involving 400 antenatal attendees in Federal, State and a Private health facility was used. Interviewer-administered questionnaire was the tool for data collection. RESULT: Majority of the respondents (94.7%) were aware of transmission of HIV from an infected mother to her child. Respondents were more aware of the use of antiretroviral drugs in pregnancy (63.2%) than they were of avoiding breastfeeding (58.5%) and Cesarean delivery (22.8%) as strategies for preventing mother to child transmission. They were also more likely to accept the use of antiretroviral drugs (78.2%) than they would avoid breastfeeding (69.0%) and accept Cesarean delivery (38.0%) for preventing mother to child transmission of HIV High educational status was significantly associated with a positive attitude to these strategies. CONCLUSION: There is need for more educational programs and social support to bridge the gap between the levels of awareness and acceptability of strategies for preventing mother to child transmission of HIV among the populace.

Socio demographic profile and presentations of patients with ruptured gravid uterus in Calabar Nigeria.

BACKGROUND: To study the Socio-demographic profiles and mode of clinical presentations of with uterine rupture in pregnancy in Calabar, Nigeria. METHOD: Medical records of 67 patients managed for ruptured gravid uterus over 10 years in Maternity section of the University of Calabar Teaching Hospital Calabar, Nigeria were reviewed. RESULTS: An incidence of 1 in 213 of all deliveries during the period was established. Majority (49.2%) were aged between 31 to 40 years and 43.3% had no formal education. Unemployed patients were 29.9%, 42.3% did not book for antenatal care while 32.8% were attended to by traditional birth attendants (TBA) and in the churches. The Commonest clinical presentations were fetal heart rate abnormalities (52.2%) and maternal collapse (46.3%). Majority (50.7%) resulted from neglected obstructed labour. CONCLUSION: Ruptured uterus is a problem of ignorance among women of low socioeconomic group with most of them having unskilled and substandard care during pregnancy and delivery. Improvement in Socio-economic conditions and modification of some harmful cultural practices against women generally will reduce the problem of rupture uterus in our society.

Awareness and Acceptability of Strategies for Preventing Mother to Child Transmission of HIV among Antenatal Clients in Calabar; Nigeria

Background: Mother to child transmission is the major route through which children below the age of 15 years acquire HIV infection. The most effective way to reduce childhood HIV infection is to prevent the infection in mothers and for already infected mothers use appropriate strategies to prevent transmission to their children. This study was conducted to determine the level of awareness and acceptability of strategies for preventing mother to child transmission of HIV. Method: Exploratory multi-centric descriptive study involving 400 antenatal attendees in Federal; State and a Private health facility was used. Interviewer-administered questionnaire was the tool for data collection. Result: Majority of the respondents (94.7) were aware of transmission of HIV from an infected mother to her child. Respondents were more aware of the use of antiretroviral drugs in pregnancy (63.2) than they were of avoiding breastfeeding (58.5) and Cesarean delivery (22.8) as strategies for preventing mother to child transmission. They were also more likely to accept the use of antiretroviral drugs (78.2) than they would avoid breastfeeding (69.0) and accept Cesarean delivery (38.0) for preventing mother to child transmission of HIV. High educational status was significantly associated with a positive attitude to these strategies. Conclusion: There is need for more educational programs and social support to bridge the gap between the levels of awareness and acceptability of strategies for preventing mother to child transmission of HIV among the populace

The safety and complications of Norplant use in Calabar.

Four hundred and seven Norplant insertions were performed over a 2 year period, from January 1998 to December 1999. The clients were followed up over a period of 36 months ending in June 2002. The overall complication rate was 22.6%, and the cumulative continuation rate was 84.0%. Menstrual bleeding disturbances were the most common reported complication in 50 (12.3%) clients. However, there was no significant change in packed cell volume among those clients. Desire for pregnancy was the most common reason for discontinuing Norplant use in 24 (5.9%) cases. Norplant was inadvertently inserted in a client who was pregnant, 3 months after her last confinement. The implants were removed after 8 week use, and the pregnancy was carried to term. There was no fetal abnormality. Thirty-one (7.6%) clients were lost to follow-up.

Infertility among Nigerian Couples as seen in Calabar

Objective: This study was conducted to determine the infertility pattern among Nigerian couples in Calabar and to examine the outcome of our management strategies.Methods: A retrospective descriptive design study based on findings from the clinical files of infertile couples presenting at the gynaecology and the male fertility clinics of University of Calabar Teaching Hospital over a five-year period (2001-2005). Data were collected from all the documented clinical and laboratory findings.Results: The obvious causes of infertility constituted 58in females; 30in males and 12in both partners. Primary infertility was found in 69.7of males and 34.5of females and secondary infertility in 30.3of males and 65.5of females. Infection appears to be a strong predisposing factor to infertility in both male and female patients in our study population. Pregnancy was achieved in 24of our female patients who had tubal surgery; while 69of our males who had varicocelectomy had improvement in seminal fluid parameters.Conclusion: Prevention and prompt treatment of infection; particularly the sexually transmitted infections could be beneficial in the reduction of infertility among couples

Risk factors associated with sexual assault in Calabar south eastern Nigeria.

BACKGROUND: Sexual assault inflicts significant physical and psychological trauma in the victims. Interventions to prevent this violent crime against women are a major public health concern. The aim of this study is to identify the risk factors for sexual assault as seen in victims presenting in our hospital. METHOD: Twenty-two case records of sexual assault victims treated at the University of Calabar Teaching hospital were reviewed for this study. RESULTS: The incidence of reported sexual assault in this study was 2.1% with a rising trend observed. Age range was from 4 to 23 years. Six (27.3%) victims were primary school pupils. Twelve (54.5%) victims had not attained menarche, and 20 (90.9%) cases were single. Recorded place of assault was commonly along a bush track (36.4%) and a nearby cemetery (22.7%). Time of assault was mainly in the evening (50.0%). Identity of the assailant was known in 7 (31.8%) cases. Commonest weapon used by the assailant was a knife (36.4%). CONCLUSION: Concerted effort is required to curb the rising trend of reported sexual assault. Interventions aimed at creating public awareness of the possible risk factors may reduce the incidence of this detestable event in the community.

KAP of HIV prevention and screening among pregnant women attending specialist antenatal clinics in Calabar, Nigeria.

BACKGROUND: There is a growing concern globally to reverse the growing incidence of HIV especially in Sub-Saharan Africa. This study was conducted to determine the level of awareness, attitude and practice of antenatal HIV screening in Calabar. METHOD: Descriptive multi-centric study of 400 antenatal attendees in Calabar, carried out in October 2005 using pre-tested, semi-structured and interviewer-administered questionnaire for data collection. RESULT: Of the 96.7% women with knowledge of HIV infection, 41.2% were assessed to have excellent knowledge of the mode of transmission. Awareness of antenatal HIV screening was observed in 96.2% women; while 93.7% approved of antenatal HIV screening. Awareness and approval of antenatal HIV screening was significantly related to age and educational status. The proportion of women who had HIV test in current pregnancy was 70.2%. Pre-test counseling was done in 65.8% of women. Most women (78.2%) who had not been screened were willing to undergo HIV testing. Spousal disapproval (23.1%) was the main reason for unwillingness to undergo HIV testing. CONCLUSION: The study revealed high levels of awareness, approval and practice of antenatal HIV screening. However, pre test counseling was not consistently given in cases tested.

Trauma related to sexual assault in Calabar, south eastern Nigeria.

BACKGROUND: A woman who is sexually assaulted experiences intense anxiety and fear. The associated stigmatization often results in under reporting and management difficulties. The aims of this study are to document the types of injuries seen in victims of sexual assault and to highlight problems in management of cases. METHOD: Twenty-two case files of sexual assault victims between January 1998 and December 2001 were reviewed for age, types of injuries sustained and treatment received. RESULT: Age range of all victims was 4 to 23 years. The knife was used by the perpetrator in 8 (36.4%) cases. Time interval between assault and presentation to hospital was up to 12 hours in 13 (59.1%) cases. Superficial abrasions, bruises, and lacerations were observed in 12 (54.6%) cases. Six (27.3%) victims paid for human immunodeficiency virus screen and the results were non-reactive. Ten (45.5%) victims had primary repair of perineal tear. CONCLUSION: Sexual assault is associated with multiple bruises, lacerations, and perineal tears. Commercialization of medical services was a hindrance to proper management of cases.

Spousal communication in contraceptive decisions among antenatal patients in Calabar, south eastern Nigeria.

BACKGROUND: The objective of this study was to determine how many women in Calabar urban community actually discuss with their spouses about family planning, how their spouses view family planning and how that affects their usage of family planning facilities. METHOD: The study was conducted using a structured questionnaire which was administered by house officers and medical students on one thousand consecutive patients who attended antenatal care during the study period Seven hundred patients met the inclusion criteria for the study. RESULT: Fifty six percent of the respondents in the study have never discussed family planning with their spouses. About 15% of the respondents have the same view on family planning with their husbands while 11% of the women themselves do not want family planning even though their husbands wanted it. CONCLUSION: Communication between couples about family planning should be encouraged. Whereas women have common meeting points like antenatal clinics to learn more about contraceptives and family planning, the men rarely have such opportunities. They will therefore benefit from discussing with their spouses who are opportuned to learn from the various clinics. Spousal communication should therefore be emphasized in these clinics where contraception and family planning are taught.