Prevalence of vaginal group-b-streptococcus, antibiotic and antigen sensitivity amongst parturients at the federal medical center owerri, Nigeria

BACKGROUND: Group B streptococcus (GBS) is one of the principal agents of early onset neonatal sepsis, pneumonia and meningitis with significant morbidity for newborns and parturients.AIM: This study was done to determine the prevalence of vaginal group B streptococcus amongst parturients in FMC Owerri. It also aimed to elucidate the antibiotic sensitivity of the strains of GBS isolated while comparing the sensitivity of antigen detection tests of GBS to culture.PATIENTS AND METHODS: This cross-sectional study was done at the labour ward and lying-in units of the Federal Medical Center, Owerri,from February 2015 to October, 2015. It involved one hundred and eighty (180)womenrecruitedsystematically. Two swab samples, high vaginal and rectal were collected from the parturients intrapartum and cultured. The babies were examined and weighed immediately after delivery, seen on the second and tenth days after delivery for features of fever or any other complaints. RESULTS: The overall prevalence of GBS amongst parturients was found to be 6.1%. Prevalence of vaginal colonization was 3.3% and that of the rectum was 2.8%, (2c=0.1282, df=1,p=0.502). Neonates with colonized mothers all had complaints of fever postpartum which was statistically significant (=55.86, df=1, p<0.001). All the microbes showed 100% sensitivity to penicillin G, erythromycin, gentamycin and ceftriaxone. Antibiotic resistance was discovered in augmentin (67%), Cloxacillin (55.6%) and ofloxacin (33.3%). Antigen detection tests gave Sensitivity=100%, specificity=96.4%, positive predictive value (PPV) = 64.7%, negative predictive value (NPV) =100%. Detection in both vaginal (=60.290, p=0.000) and rectal (=50.799, p=0.000) samples were statistically significant. CONCLUSION: The prevalence of GBS in parturients in the Centre is low. Strains of GBS isolated amongst the sampled population in FMC Owerri had a high sensitivity to penicillin G, erythromycin, gentamycin and 3 generation cephalosporins. Antigen detection method for screening of GBS though very sensitive is however not specific with a significant false positive detection rate due to antigen cross reaction. It is however recommended that antigen detection be employed as intrapartum measure in high risk cases to reduce turnover time whilst supported by culture results later. There was associated significant neonatal sequaelae and further research to establish causal relationship will be advised

The relationship between malaria parasitemia, malaria preventive measures and average birth weight of babies in a tertiary facility in Owerri, Nigeria.

BACKGROUND: Despite the global efforts made to eradicate malaria, it continues to be a significant cause of morbidity and mortality in both neonates and the parturients. This study was done to determine the relationship between placental parasitemia, average neonatal birth weight and the relationship between the use of malaria preventive measures and the occurrence of placental parasitemia with the aim to improving maternal and neonatal outcome. PATIENTS AND METHODS: This cross-sectional study was done at the labor ward unit of the Federal Medical Center, Owerri, from December 2013 to May 2014. It involved one hundred and eighty primigravidae and baby pairs recruited consecutively. Thick and thin blood films were made from maternal peripheral blood and placenta. The babies were examined and weighed immediately after delivery. RESULTS: Most of the participants had only one dose of intermittent preventive therapy (75%) with statistically significant higher level of fever episodes (P < 0.0001). Forty participants (58.0%) did not use any form of malaria preventive measure in pregnancy (P < 0.0001) and had a significantly higher placental parasitemia when compared with their counterparts. Average birth weight of neonates with placental parasitemia in mothers who used intermittent presumptive therapy (IPT) only (t = 2.22, P = 0.005), and IPT + insecticide-treated net (ITN) (t = 7.91, P ≤ 0.000) was significantly higher than those who did not use any form of malaria prevention in pregnancy (t = 4.69, P ≤ 0.0001). CONCLUSION: Primigravidae with placental or maternal peripheral parasitemia who failed to use malaria preventive measures delivered babies with reduced average birth weight. A scheme aimed at making ITN readily available, and improving the girl child education is highly recommended.

Human immuno-deficiency virus antibody seroprevalence among pregnant women at booking at a university teaching hospital in South-Eastern Nigeria.

BACKGROUND: In Africa, human immuno-deficiency virus (HIV) infection continues to be progressively feminized. This has led to an increase in the number of paediatric HIV infections reported due to increased risk of mother-to-child transmission (MTCT) of HIV during pregnancy, labour and breastfeeding. OBJECTIVE: The objective of the study was to determine the HIV positive sero-prevalence at booking among pregnant women at the Imo State University Teaching Hospital, Orlu. METHODS: A retrospective analysis of the case records of women who booked and were screened for Human Immune-deficiency Virus at the Imo State University Teaching Hospital (IMSUTH), Orlu from 1st March 2008 to 28th February 2010 was done. Data on age, parity, educational status, gestational age at booking, and retroviral status were collected and analysed using spss version 13. RESULTS: Nine hundred and twenty one pregnant women were screened for the presence of HIV 1 & 2 antibodies in their serum. One hundred and six of them were positive, giving a sero-prevalence rate at booking of 11.5%. The highest sero prevalence rate of 45.2% occurred in the age group of 26-30 years. Petty traders contributed 97 (91.5%) of the HIV positive women, while multiparous (para 2-4) women contributed 50% of the positive pregnant women. Only 32 (30.2%) of the HIV positive women booked within the first trimester for antenatal care. Majority 53 (59.4%) of the HIV positive women had secondary education, while those that had no formal education contributed only 6 (5.7%) of the HIV positive women. CONCLUSION: There was a high HIV seroprevalence at booking among pregnant women at IMSUTH, Orlu. A lot more needs to be done in order to reduce vertical transmission of HIV in our environment.

Stillbirth Rate in a Teaching Hospital in South-eastern Nigeria: A Silent Tragedy

Stillbirths often are not seen as a major public health problem; for despite increasing attention and investment on maternal; neonatal; and child health; stillbirths remain invisible. Aim: The objective of this study was to determine the stillbirth rate at the Imo State University Teaching Hospital; Orlu. Subjects and Methods : Analysis of the case records of stillbirths that occurred in the institution over a 5-year period from 1 st July 2005 to 30 th June 2010 was made. Data retrieved was analyzed for age of the women; parity; presumptive risk factor for the stillbirth; and booking status of the women. Also; the total births during the period of study were obtained. A P-value of 0.05 is said to be significant at confidence level of 95 (95/100). Results : There were a total of 1;142 deliveries within the study period; out of which 206 resulted in stillbirths. This gave an institutional stillbirth rate of 18 (180/1000 deliveries). One-hundred and fifty-five 75.2 (155/206) of the stillbirths were macerated stillbirth. The age range of the women was 15-44 years. The modal age was 31 years. The age group of 26-30 years had the highest prevalence rate of stillbirths of 79 (38.3; 79/206); while age group of more than 40 years contributed the least with four stillbirths 4 (1.9; 4/206). Conclusion : The stillbirth rate at the institution is too high and efforts must be made to reduce it

Gestational gigantomastia with complete resolution in a Nigerian woman.

Physiological enlargement of the breasts occurs at puberty and during pregnancy. It is known as gestational gigantomastia when enlargement in pregnancy becomes excessive, uncomfortable and embarrassing. Gestational gigantomastia may have far reaching effects for the mother and fetus. This rare condition is associated with considerable morbidity but may be associated with good fetal outcome. Our case was very interesting because it was managed conservatively and postpartum there was complete spontaneous resolution.

Preliminary Outcome of the Management of Eclampsia at the Imo State University Teaching Hospital

Background: Eclampsia continues to be a major cause of maternal and perinatal mortality in developing countries. Early identification and management of pre-eclampsia will help reduce the mortality due to eclampsia. Aim: This study aims at determining the prevalence and management outcome of eclampsia in our centre with a view to proffering solutions for an optimal or near optimal care.Methods: A retrospective review of the case records of patients managed for eclampsia at the Imo State University Teaching Hospital (IMSUTH); Orlu from 1st October 2004 to 30th September 2009 was carried out. Data on socio-demographic characteristics as well as clinical management and outcome were extracted and analyzed.Results: The prevalence of eclampsia was 2.7of all the deliveries. The prevalence was significantly higher in the unbooked than the booked patients (p0.05). The prevalence was also significantly higher in primigravidae than in multiparae (p0.05). Twenty-eight (93.3) of the eclampsia occurred antepartum. Twenty-eight (93.3) had severe hypertension on presentation. Twenty nine (95.8) of the patients had 2-5 episodes of convulsions prior to presentation to the hospital. Twenty-six (86.7) of the patients had emergency Caesarean section was carried out; mostly for unfavourable cervix. The perinatal mortality was 6.7while maternal mortality was 3.3. Complications included acute renal failure; aspiration pneumonitis and abruptio placentae. Conclusion: The prevalence of eclampsia is unacceptably high in our centre. Early antenatal booking; antenatal care follow-up to identify the imminent signs and prompt treatment of cases of pre-eclampsia will reduce the burden of eclampsia in this environment

Krukenberg tumour simulating uterine fibroids and pelvic inflammatory disease.

OBJECTIVE: To report a case of cancer of the colon which presented as secondaries to the ovaries. METHOD: Case report. SUMMARY: The case presented is that of a 39-year-old female who presented with lower abdominal pain and a multinodular pelvic mass which led to an initial diagnosis of multiple uterine fibroids and pelvic inflammatory disease. The presence of a colonic mass was first suggested by ultrasound. Laparotomy revealed carcinoma of the colon with bilateral krukenberg's tumour and an insignificant fibroleiomyoma. CONCLUSION: This case is reported to alert practitioners that all multinodular pelvic masses should not be assumed to be multiple fibroids.

HIV/AIDS: what do Secondary School Students know and think ?

Objective: To determine the level of awareness; knowledge and attitude of secondary school students in Owerri to HIV/AIDS. Methods: Semi-structured questionnaires were administered to six hundred randomly selected secondary school students from four secondary schools and the results were analyzed. Results: There was no significant difference in results from both sexes. All the students were aware of the disease. Viral aetiology was mentioned by 77.2 of all the students while 74.8 and 85.4 mentioned mother- to- child transmission and sexual intercourse respectively as modes of transmission. Blood transfusion and sharing of needles and syringes were mentioned by 92.8 and 96.4 of the students respectively. Only 58.1 knew about the condom as a method of prevention. The students demonstrated a poor attitude to HIV/AIDS positive patients as 78.2 would not employ them while 10.6 want them isolated and 36.8 would avoid them. Mass media ;television ( (32.4 ) ; radio ( 23.5)) and health sources ( 26;1 ) were the major means of information. Conclusion: Because of the deficiencies in knowledge and the poor attitude of the students; these highlighted areas should be emphasized in media adverts. The introduction of reproductive health studies in secondary school curricula may also help in addressing these identified deficiencies

Delayed presentation of clitoridal cyst: a case report.

BACKGROUND: Genital mutilation (female circumcision) is a common practice in Africa which is done for a variety of reasons. The complications of this practice often present early, but are sometimes delayed. METHOD AND RESULTS: The case presented is that of a large clitoridal cyst which presented in the post menopausal period twenty eight years after it's onset. The aetiology, types and complications of genital mutilation are discussed. CONCLUSION: The harmful practice of genital mutilation is deeply ingrained in sub Saharan Africa. It's elimination will be facilitated by education and media campaigns highlighting it's harmful effects.

Awareness and uptake of cervical cancer screening in Owerri, South-Eastern Nigeria.

BACKGROUND: Cancer of the cervix is the most common cancer of the female genital tract and accounts for about two hundred and fifty thousand deaths yearly most of which occur in the developing countries. It has assumed greater prominence with the decrease in deaths due to infective causes and the increase in the incidence of HIV/AIDS which is a predisposing factor. A significant drop in its incidence has been recorded in the developed countries as a result of intensive program of cervical screening. This study determines the level of awareness and uptake of cervical screening in Owerri, South Eastern part of Nigeria. METHOD: This is a cross sectional study in which self administered questionnaires returned by eight hundred and forty six respondents were analysed using simple percentages. RESULTS: The level of awareness of cervical screening was 52.8% (447), while 7.1% (60) had ever done the test. The major sources of information about cervical smear were hospital/health facilities (31.3%) and friends (30.9%). The most common reasons given for not doing the test were lack of awareness 390 (46.1%), no need for it 106 (12.5%) and fear of a bad result 98 (11.6%). CONCLUSION: The level of awareness of cervical screening is low and worse still, is the level of uptake at the present level of uptake no significant impact will be made on the incidence of cervical cancer which needs to be reduced. A national cervical smear screening policy is advocated but in the interim, greater public education and the greater use of opportunistic screening by physicians should be vigorously pursued.

Pregnancy and delivery after successful repair of vesicovaginal fistula.

Pregnant women (110) with successfully repaired vesicovaginal fistula, supervised at the Ahmadu Bello University Teaching Hospital in Zaria, Nigeria, formed the study population. The obstetric complications, mode of delivery and fetal outcome are reviewed. The obstetric complications and fetal outcome were compared with a matched hospital control group. There was a higher complication rate among the women with vesicovaginal fistulae, and the commonest complication was urinary tract infection. Perinatal mortality rate was 17.2% in the cases compared to 10.2% in the controls.

Hysterectomy in the Hausa/Fulani population in Nigeria.

Two hundred and sixty-five abdominal hysterectomies performed in Ahmadu Bello University Teaching Hospital, Zaria (ABUTHZ) Nigeria form the basis of this study. The commonest indication for operation was fibroids with or without chronic pelvic inflammatory disease. The low incidence of dysfunctional uterine bleeding and endometriosis and the high incidence of trophoblastic disease were noted. The mortality rate was 0.82%. Compared to other series the morbidity rate was high and this was attributed to advanced pathology on presentation and the poor nutritional status of most of the patients.

A complication of a traditional puerperal practice in Nigeria.

PIP: There is an ancient area in Northern Nigeria inhabited mainly by traditionally-oriented natives, mostly Hausas and Fulanis. Women of these tribes traditionally deliver their babies at home under the care of midwives, using hospitals only as a last resort. Since cold is thought to carry puerperal illnesses, it is the practice among these people to initiate hot baths for mothers immediately after delivery. 2 major complication of the practice are peripartal cardiac failure and burns. The case is reported of 1 woman who was taken to a hospital with superficial burns as a result of the practice. She had continued to follow this practice despite earlier experience of cardiac failure by doing so. It may be easier to persuade these natives to use slightly colder water than to give up completely this entrenched practice.^ieng