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.

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

Reasons for preference of delivery in spiritual church-based clinics by women of south-south Nigeria.

OBJECTIVES: To investigate the various reasons for patronizing the spiritual church-based clinics by women from South-South Nigeria. DESIGN: Forty seven spiritual church-based clinics were studied between 1st February 2003 and 31st July 2003. SETTING: Forty seven spiritual church-based clinics in both Akwa Ibom and Cross River State in South-South Nigeria. PATIENTS: Two thousand and sixty three pregnant women who were regular attendants of the spiritual church-based clinics. RESULTS: Various reasons for preferring church delivery included: Spiritual protection against satanic attacks and safe delivery in 975 (36.8%) lack of funds in 629 (30.5%), harsh attitude of health workers in 249 (12.1%), convenience in 212 (10.3%), faith in God and previous delivery in church 83 (4.0%) each help and good care guaranteed in 48 (2.35). CONCLUSION: It is suggested that the spiritual churches with interest in obstetric care establish properly staffed and well equipped health clinics as an annex to the church.

The prevalence of congenital malaria among neonates with suspected sepsis in Calabar, Nigeria.

We studied the prevalence of congenital malaria among neonates with suspected sepsis and its outcome at the University of Calabar Teaching Hospital, Calabar, Nigeria. All in-born neonates admitted to the newborn unit with clinical features suggestive of sepsis were recruited. They were screened for bacterial sepsis and malaria. The mothers of the neonates that had parasitaemia were further screened for malaria and anaemia. A total of 546 in-born neonates were admitted to the neonatal unit and 202 (37%) presented with clinical signs suggested of sepsis. Of these, 71 babies (35% of 202 or 13% of the total in-born nursery admissions) had congenital malaria and 14 also had sepsis. Sixty-three (88.7%) of the parasitaemic babies were delivered by mothers who received antenatal care at our centre. Eighty-six percent of the mothers of the 71 babies also had the malaria parasite in their blood. The majority (67%) of the 71 mothers were gravidae 2 and below. Thirty (42.3%) of the affected neonates were anaemic and 5 (7%) of them required a blood transfusion. Congenital malarial is not uncommon in Calabar among babies with suspected sepsis. It appears that the antenatal chemoprophylaxis with pyrimethamine (25 mg weekly) currently used for malaria in our centre no longer protects the mother and fetus. An alternative is needed in order to stem maternal, fetal and neonatal morbidity and wastage. Babies with features of sepsis should be routinely screened for malaria.

Outcome of emergency caesarean sections in Calabar, Nigeria: Impact of the seniority of the medical team.

We set out to assess the maternal outcome of emergency caesarean sections in University of Calabar Teaching Hospital (UCTH) in relationship to the seniority and experience of medical personnel involved in the operation. This was a review of 349 cases of emergency caesarean sections in UCTH over a 2-year period (January 2000-December 2001). The sociodemographic data, antenatal booking status and clinical condition of the patients as well as the seniority of the medical staff who participated in the operations were extracted from the case notes of the patients. A total of 280 (80.0%) booked patients and 69 (20.0%) unbooked mothers were delivered by emergency caesarean sections. The consultants performed only 16.4% of the emergency caesarean sections, while the residents performed 83.6%. Similarly consultant anaesthetists administered anaesthesia in 12.9% of the cases. A total of 12 maternal deaths occurred from emergency caesarean sections in which six (1.7%) were due to sepsis, three (0.8%) due to severe haemorrhage and three (0.8%) due to anaesthetic complications. None of the deaths occurred in operations in which consultant obstetricians and anaesthetists were involved. The intraoperative blood loss was more in operations performed by the residents than in those performed by the consultants. Similarly, morbidity was higher in patients operated upon by residents. The maternal morbidity and mortality associated with emergency caesarean sections in UCTH would be reduced significantly if consultant obstetricians and anaesthetists were more involved in these operative procedures.

Neonatal morbidity and mortality in Calabar, Nigeria: a hospital-based study.

BACKGROUND: The morbidity and mortality pattern amongst neonates admitted into the University of Calabar Teaching Hospital were reviewed from 1st June 2003 to 30th November 2004. RESULTS: The major indications for admission for inborn babies were infections (27.4%), jaundice (21%) and low birth weight (LBW) (18.4%). The out born babies were admitted largely for sepsis (26.8%), jaundice (17.7%), tetanus (13.9%) and low birth weight (11.2%). Staphylococcus aureus (61.2%) and unclassified coliforms (21.9%) were the dominant isolates of septicaemia. The overall mortality rate of 19.3% was largely contributed by outborn infants (73.2% of the deaths). In descending order of magnitude, the total of 153 deaths during the period was due to infections (neonatal tetanus 20.9%, septicaemia 19.6%), birth asphyxia 23.3% and LBW 19%. Most of the deaths (70.6%) occurred within the first 7 days of life. Fifty-three (34.6%) of the deaths (most outborn infants) occurred within 24 hours of admission. CONCLUSION: Nigerian government needs to improve funding of the health sector in order to reduce neonatal wastage. Training and retraining of traditional birth attendants is inevitable. More effort should be made towards improving coverage rate of tetanus toxoid among women of childbearing age.

Caesarean section in the management of singleton breech delivery in Calabar, Nigeria.

OBJECTIVE: To establish the role of Caesarean section in reducing perinatal mortality following singleton breech delivery in the University of Calabar Teaching Hospital, Calabar. METHOD: The case notes of all patients who had singleton breech delivery between 1st January 1991 and 31st December 2000 were studied. RESULTS: The incidence of singleton breech delivery was 1.4% and 37.1% of the breech deliveries were by Caesarean section. Feto-pelvic disproportion and footling breech presentation were the most common indications for Caesarean section (50.0%). Most of the breeches delivered by emergency Caesarean section (55.0%) were in unbooked patients while the booked ones were mostly delivered by elective Caesarean section (80.0%). There was a statistically significant decrease in perinatal mortality in primigravid breeches ((p = 0.018) and in fetuses estimated to weigh above 3.5 kilograms (p = 0.0005) following Caesarean section. CONCLUSION: This study shows that Caesarean section plays a very important role in the management of breech presentation in our environment. We advocate elective Caesarean section of all primigravid breeches and those whose fetuses are estimated to weigh above 3.5 kilograms.

Endometrial pathology associated with infertility among Nigerian women.

SUMMARY: One hundred and forty endometrial specimens of women with infertility were examined with oil immersion at X100 magnification for evidence of secretory activity, presence of any inflammatory cells and characteristic features suggestive of specific pathogens. Twenty-three (16.4%) had evidence of chronic endometritis the majority being non-specific. Only two (1.4%) were granulomatous. There was a significant eosinophilic infiltrate in nine cases (6.4%) some numbering up to 55 eosinophils per 5 high power fields (5 hpf). Sensitive immunohistochemical techniques would be needed to correlate findings with specific pathogens for effective treatment.

Post-partum practices among women in Calabar, Nigeria.

We carried out a study on post-partum practices amongst women in Calabar at the maternal and child health clinic at University of Calabar Teaching Hospital between 1 March and 31 May 2002. Three hundred women were interviewed. One hundred and ninety-three (64.3%) resumed coitus prior to 6 weeks of puerperium. There was no significant difference in parity (P = 0.20) and educational status (P = 0.10) between women who resumed coitus earlier than 6 weeks and those who resumed later. One out of every 10 women resumed coitus without any contraception. The majority [212 (70.7%)] sat in hot water (sitz bath) to aid perineal wound healing and improve vaginal tone.

Haemoglobin C gene in south eastern Nigeria.

Haemoglobin C (Hb C) is very rare in eastern Nigeria (east of River Niger). Isolated cases have been reported. The incidence is however as high as 6% in western Nigeria. This study was undertaken to locate the isolated cases with a view to determining their origin. Hb electrophoresis was performed on 4,263 subjects in Akwa Ibom State in south eastern region of Nigeria. The subjects were selected from all the local government areas of the state and were aged 15 years and above. They comprised secondary school children, civil servants, farmers and fishermen. The results revealed complete absence of Hb C from the upland population whereas this was present in the fishing settlement population (6 or 0.4% Hb AC and one or 0.07% Hb SC subjects). The possible entry points of Hb C gene into south eastern Nigeria is discussed.