Falls among pregnant women in Enugu, Southeast Nigeria.

BACKGROUND: Falls during pregnancy are major public health issues and a common cause of maternal injury during pregnancy. There is paucity of data on prevalence and risk factors of falls during pregnancy in African population including Nigeria. OBJECTIVE: To determine the prevalence and risk factors associated with falls during pregnancy in Enugu, Nigeria. MATERIALS AND METHODS: This was a cross-sectional study of 332 consecutive pregnant women presenting in labor for delivery at the University of Nigeria Teaching Hospital Enugu, Nigeria between 1(st) May and 31(st) December, 2012. RESULTS: The mean age of the women was 32.2 ± 2.7 (range: 20-42) years. One hundred and eight women (32.5%) reported falling at least once during the index pregnancy. Women aged ≤ 30 years had twofold risk of falling during pregnancy than women aged > 30 years [41.1% (69/168) vs. 23.8% (39/164); odds ratio (OR): 2.23; 95% confidence interval (CI): 1.39-3.58; P < 0.001)]. Similarly, women ≥ 160 cm in height had significantly higher risk of falling during pregnancy than women < 160 cm in height [43.5% (70/161) vs. 22.2% (38/171); OR: 0.37; 95% CI: 0.23-0.60; P < 0.0001)]. Furthermore, primigravidae had almost threefold risk of falling during pregnancy than multigravidae [45.3% (63/139) vs. 23.3% (45/193); OR: 2.73; 95% CI: 1.70-4.37; P < 0.0001)]. CONCLUSION: Falls during pregnancy is common in Enugu, Nigeria. It is, therefore, recommended that women should be counseled during pregnancy on this public health problem and the above-identified risk factors emphasized in order to reduce the prevalence and morbidity.

Vulnerability and Knowledge of Sexually Transmitted Infections among Female Traders of Reproductive Age in Enugu; Nigeria

Background: Sexually transmitted infections (STIs) constitute major public health concern and enigma. A comprehensive knowledge of the modes of transmission is necessary to evolve an effective preventive strategy. Aim: The aim of the study is to assess the vulnerability; knowledge and prevention of STIs among female traders of reproductive age in Enugu; Southeast Nigeria. Subjects and Methods: This was a cross-sectional descriptive study carried out on female traders aged 15-49 years at Ogbete Main Market; Enugu; Southeast Nigeria. Data was analyzed using Epi-Info 2000 version 3.3.1 Centers for Disease Control and Prevention Atlanta USA) was used to analyze the data and results were presented in tabular form. Results: A total of 200 female traders of reproductive age participated in the study. The mean (standard deviation) age was 26 (7.4) years. 16 (32/200) were adolescents. Knowledge of specific STIs was highest for human immunodeficiency virus/acquired immune deficiency syndrome 90 (130/200). Parents were poor sources of information as only 28.5 (57/200) respondents heard about STIs from their parents compared with 46 (151/200); non-use of condoms 62 (124/200) and early debut 58 (116/200). Majority 67.5 135/200) were aware that STIs could be treated by a visit to the doctor while 21.5 (43/200) preferred traditional/herbal healers. Conclusion: The inclusion of health education in schools' curricula to ensure that adolescents are adequately aware of STIs; their modes of transmission; prevention and treatment before embarking on any vocation out-of-school is advocated

Non-immune hydrops fetalis.

BACKGROUND: Non-immune hydrops fetalis (NIHF) is a rare fetal condition with a very high mortality in spite of advances in prenatal diagnostic techniques, early detection, and individualized management. Despite advancement in fetal therapy and rapidly developing new knowledge about the aetiology and prenatal diagnosis, its management has remained controversial. METHODS: This is a descriptive review ofNIHF. RESULTS: NIHF is a rare fetal condition that presents in an extremely acute manner with almost 90% mortality. Fetal cardiac anomalies are the most common cause and chromosome anomalies are the second-most-common cause. The worst prognosis was related to prematurity, severe hydrops, anaemia, cardiac malformations, chromosomal disorders and congenital infections. Fetal interventions includeboth medical and surgical modalities. CONCLUSION: NIHF is a rare condition with high prenatal mortality. The exact pathophysiology is still poorly understood. It is important to detect NIHF early, diagnose the underlying cause and institute appropriate treatment. There is need for autopsy of all fetuses or neonates who die from NIHF.

A survey of women's knowledge and perception of hormone replacement therapy (hrt) in Enugu, South East Nigeria.

BACKGROUND: As a result of alteration in the physiological, biochemical and psychological environment of a woman due to menopause, there may be need for hormone replacement therapy (HRT). This concept is new in our poor resource setting, thus the knowledge and perception of HRT will be invaluable to appropriate adjustment to menopausal period. OBJECTIVE: The objective of this study was to determine the knowledge and perception of hormone replacement therapy among women in Enugu South-East Nigeria. METHOD: This was a cross sectional survey of gynaecology clinic attendees at the university of Nigeria Teaching Hospital (UNTH), Enugu. These women were randomly selected. Data were analyzed using SPSS software. The primary method used was cross tabulation. RESULT: The knowledge and perception of HR among women of South East Nigeria is poor and related to the level of education. One hundred and sixty eight women (38.9%) had knowledge of HRT and only 48 (11.1%) had taken it in the past. Currently none was using HRT despite experiencing menopausal symptoms. Majority of women were ignorant of HRT and took climacteric symptoms as part of aging process. CONCLUSION: The knowledge and perception of HRT is poor and limited. Public enlightenment would help to improve awareness of climacteric symptoms. Women at high risk for menopausal diseases should be advised on HRT.

Trend in the use of intra-uterine contraceptive device (IUCD ,TCU 380A), in Enugu, Nigeria.

OBJECTIVE: To estimate the acceptance rate and trend of Intrauterine Contraceptive Device (IUCD) use in Enugu, Nigeria PATIENTS AND METHODS: A review of all new acceptors of intrauterine contraceptive device (IUCD) over a nine year period (1999-2007). RESULTS: A total of 133,375 clients were seen at the UNTH family planning clinic between 1999 and 2007. Out of 6,947 users of IUCD, during the period, 1,659 were new acceptors. The IUCD acceptance rate was 5.21%. Majority of the clients (29.7%) were aged 40 years and above. Eight hundred and forty seven (51.4%) had attained post secondary education. Majority of the clients (99.4%) were married . Twenty-six percent (26.0%) had completed their desired family size. Majority 1,359 (82.4%) did not use any method contraception prior to IUCD insertion. The commonest complication was menorrhagia (5.8%) and this was responsible for removal in 3.0% of cases. Eight (0.5%) and nine (0.6%) requested for removal for fear of causing cancer and migration to the brain or heart respectively. Two (0.1%) became pregnant while having the IUCD in-situ. Majority of the clients (50.5%) had the knowledge of lUCD through friends. CONCLUSION: This study has shown that IUCD (TCU 380A) is both safe and effective in Enugu, Nigeria. Its use is for both child spacing and limiting family size.

Caesarean hysterectomy.

BACKGROUND: Caesarean hysterectomy is an obstetric emergency procedure performed to save maternal life in uncontrollable haemorrhage and few elective indications. It could be a planned procedure but more often it is an emergency operation. OBJECTIVE: To ensure adequate exposure and mastery of this emergency procedure by residents in training in Obstetrics and Gynaecology in Nigeria. METHODS: Review of the pertinent literature, selected references, and internet services through Medline search on caesarean hysterectomy. RESULTS: The incidence for emergency caesarean hysterectomy is 0.01-0.05%. The maternal death rate associated with caesarean hysterectomy from all causes is 0.7% compared to 0.05% for all caesarean sections. Porro's operation was a subtotal amputation but opinion now favours a total hysterectomy where practicable. Inexperienced surgeons may encounter identification of the lower margin of the cervix as limiting factor, for fully effaced and dilated cervix. Subtotal hysterectomy may therefore be the more prudent, safest and fastest option, but the potential problems of a residual cervical stump must always be borne in mind. CONCLUSION: Caesarean hysterectomy though a rare procedure is a life saving obstetric emergency. There is need for adequate exposure and mastery by the residents and a must for all obstetricians in their practice.

An overview of menopause associated vasomotor symptoms and options available in its management.

BACKGROUND: Vasomotor Symptoms are the most common and distressing menopausal complaint, for which women seek advice from their physician. OBJECTIVE: To review menopausal associated vasomotor symptoms and options available in its management. METHODS: Pertinent literature on menopause associated vasomotor symptoms, selected references, textbooks, journals and internet services using the PubMed and Medline databases were included in this review. RESULTS: Hot flushes are the most common and distressing symptom, for which women seek advice from their physician. It occurs in more than 75% of postmenopausal women. Management of hot flushes is problematic because the most recognized effective option oestrogen, is often contraindicated. This has resulted in extensive research exploring different therapeutic options for treatment of hot flushes. Currently, various safe and efficacious nonhormonal options exist but further research is still needed to improve on the treatment of hot flushes. CONCLUSION: The management of the most common and distressing vasomotor symptoms associated with menopause (hot flushes) is controversial. Regardless of the management strategy adopted, treatment options should be periodically reassessed as menopause-related vasomotor symptoms will abate with time even without any intervention in majority of postmenopausal women.

Obstetric outcome of teenage pregnancies at a tertiary hospital in Enugu, Nigeria.

CONTEXT: Maternal age, parity, and socioeconomic class are important determinants of obstetric outcome of pregnancy. Teenage pregnancy constitutes a high risk pregnancy with complications arising from a combination of physiological, anatomical, and socioeconomic factors. OBJECTIVE: The objective was to determine the current incidence of all teenage pregnancies and their obstetric outcomes at UNTH, Enugu. MATERIALS AND METHODS: This was a retrospective review of all teenage pregnancies at University of Nigeria Teaching Hospital, Enugu over a 6-year period (2000--2005). A total of 74 teenage pregnancies were analyzed and compared with 105 controls (adult mothers). RESULTS: Records of 74 teenage pregnancies were identified within the study period which constitutes 1.67% of 4422 deliveries within the period. Majority of the teenagers (78.3%) were nulliparous. There was statistically significant differences between the teenage mothers and older mothers in the rate of unemployment (75.7% vs. 24.8%, P = 0.000), booking status (41.9% vs. 100%, P = 0.000) anemia (32.4% vs. 24.8%, P = 0.001), unsure of last menstrual period (32.4% vs. 15.2%, P = 0.007), caesarean section (18.9% vs. 10.5%, P = 0.000), cephalopelvic disproportion as an indication for caesarean section (9.4% vs. 3.8%, P = 0.001), preterm delivery (18.9% vs. 11.4%, P = 0.001), low birth weight (23.0% vs. 10.5%, P = 0.005), episiotomy (61.7% vs. 28.7%, P = 0.001), instrumental delivery (6.8% vs. 2.9% P = 0.001), Apgar score at 1 minute (35.1% vs. 19.1% P = 0.005), and perinatal mortality (16.2% vs. 12.4%). There were no maternal deaths. CONCLUSION: Pregnant teenagers are at higher risk than their older counterparts. Female socioeducational development and proper use of contraceptive services will help reduce teenage pregnancy rate, while perinatal care will help to minimize it associated hazards.

The use of depot medroxyprogesterone acetate (DMPA) injectable contraceptive in Enugu, Nigeria.

CONTEXT: Contraception with Depot Medroxyprogesterone Acetate (Depo provera) is quite effective though not without side effects that may cause discontinuation amongst acceptors. OBJECTIVE: To evaluate client characteristics, their experiences and acceptability of Depo provera in Enugu and compare these with previous experiences elsewhere. MATERIALS AND METHOD: A review of the family planning records of new acceptors who used Depo provera between 1st January 2000 and 31st December 2005 at the family planning clinic of University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu. RESULTS: Within the study period, 684 new clients accepted Depo provera, accounting for 21.4% of all new acceptors for various forms of contraception. The mean [+/- SD] age and parity of the 590 acceptors whose records were available were 34.40 +/- 6.03 years and 5.52 +/- 2.02 respectively. Seventy percent (70%) of the clients had 5 or more children. Most (51.6%) had primary education. Seventy percent of clients with 5 or more children wanted no more children while 30% of those gainfully employed use of Depo provera for child spacing. Fifty seven percent of clients accepted Depo provera within a year following confinement and 80.2% of them were breast feeding. Complications occurred in 54.2% of all acceptors, with menstrual abnormalities occurring in 94.4% of them. Secondary amenorrhoea was the commonest menstrual anomaly occurring in 81.1% of clients with menstrual problems. Discontinuation in use Depo provera was 51.5% after the first one year. Irregular injection schedules and default were common with a continuation rate of 25.6% at the end of they observation period. However, the complaints of side effects appeared to wane beyond the second year of use. Three accidental pregnancies (0.5%) occurred during the study period. CONCLUSION: Depot medroxyprogesterone acetate injectable contraceptive is an effective method of contraception in Enugu. It is accepted mainly by clients that have completed their family and are breast feeding. Awareness of its side effects obviously enhances continuation.

Trends and determinants of episiotomy at the University of Nigeria Teaching Hospital (Unth), Enugu, Nigeria.

BACKGROUND: Episiotomy is the most commonly performed obstetric procedure. The indications and efficacy are poorly established and its practice has remained controversial. OBJECTIVE: To determine the rate and the determinants of episiotomy in the parturients at the UNTH, Enugu. METHODS: A five year retrospective review of episiotomy at UNTH Enugu between 1st January, 2000 and 31st December, 2004. RESULTS: Out of 3032 vaginal deliveries, 1201 women had episiotomy during vaginal delivery, giving a rate of 39.6%. The rate fluctuated between 38.7% in 2000 to 32.7% in 2004. The risk of receiving episiotomy is significantly higher among primigravidae than multigravidae [OR = 10.92, (95% CI = 8.98,13.28)]. Similarly, macrosomia (birth weight > 4 kg) significantly increases the risk of episiotomy [OR = 0.096, (95% CI = 0.06, 0.15)]. Women who had instrumental or destructive vaginal delivery are significantly more likely to receive episiotomy than those who had spontaneous vaginal delivery [OR = 0.13 (95% CI = 0.07, 0.26)]. The postpartum blood loss is significantly higher among women that received episiotomy than those who did not [t = 42.161, P > 0.0001]. CONCLUSIONS: The rate of episiotomy in UNTH, Enugu is high. Primigravidity, macrosomia and instrumental deliveries are factors associated with increased risk of episiotomy. Knowledge of these risk factors will guide in predicting episiotomy among paturients in labour ward.

Fetal macrosomia: obstetric outcome of 311 cases in UNTH, Enugu, Nigeria.

BACKGROUND: In modern obstetrics, fetal macrosomia is a major contributor to obstetric morbidity. It is an important cause of perinatal morbidity and mortality. AIM: This study aims to determine the maternal characteristics, fetal and neonatal complications associated with fetal macrosomia, and its contribution to obstetric morbidity in Enugu, Nigeria. MATERIALS AND METHODS: This was a 3-year retrospective study carried out from 1 st January 2005 to 31 st December 2007. RESULTS: There were a total of 434 cases of fetal macrosomia out of 5,365 deliveries. The incidence of fetal macrosomia was 8.1%. Only 311 case notes (71.6%) were available for analysis. Statistical analysis showed that mothers of macrosomic newborns were older (30.6 ± 5.6 vs. 27.4 ± 4.74; P = 0.001), higher parity (4.1 ± 2.7 vs. 2.5 ± 1.07; P = 0.001), and weighed more at term (89.13 ± 6.17 kg vs. 71.43 ± 5.27 kg; P = 0.002). The study group had more mothers with previous history of macrosomic babies (39.5% vs. 12.5%), diabetes (3.2% vs. 1%), significant higher cesarian section rate (27.3% vs. 11.9%, P = 0.001), and operative vaginal delivery (3.6% vs. 1%; P = 0.001) compared with the control. There was male dominance in the study group compared with the control (63% vs. 56.3%; P = 0.001), higher risk of fetal asphyxia (P = 0.001), and greater mean birth weight (3.6 ± 1.2 kg vs. 3.2 ± 0.6 kg; P = 0.002). There were 7 (2.3%) cases of shoulder dystocia in the macrosomic group and none in the non-macrosomic group. The stillbirth rate (3.2/1000) was the same in both study group and control. This was not statistically significant (P = 0.124). CONCLUSION: The precise determination of fetal weight is only done at delivery. Clinical and ultrasound determination of fetal weight are highly imprecise especially at the third trimester. The route of delivery should therefore be individualized.

Endometriosis.

BACKGROUND: Endometriosis is a common mysterious and fascinating gynaecological condition with diverse clinical manifestations, highly variable and unpredictable clinical course with decreased quality of life. Despite extensive research, endometriosis is fraught with controversies. METHODS: Review of pertinent literature on endometriosis, selected references, internet services through gynaecological search which have been critical in the understanding of this puzzling gynaecologic condition were included in the review. RESULTS: Endometriosis most commonly afflict women in there late 20s and 30s. The classic symptom complex include dysmenorrhoea, dyspareunia, menorrhagia and infertility. About 30% of the patients are asymptomatic. The incidence of infertility amongst women suffering from endometriosis ranges from 30%-40%. The factors implicated in causing endometriosis-associated infertility are multiple and its management is shrouded in controversy, complex and imperfectly understood. CONCLUSION: Inspite of diverse clinical manifestations, variable and unpredictable clinical course, there is a chance to improve pregnancy rates with improvement in assisted reproductive technology.

Trends of myomectomy at the University of Nigeria Teaching Hospital (UNTH) Enugu Nigeria.

BACKGROUND: Uterine fibroid is the commonest female genital tumour occurring within the reproductive age group, and abdominal myomectomy is the most offered surgical treatment in our environment. There is need to audit this practice in our centre so as to observe the practice pattern and outcome of myomectomies in Enugu, Nigeria. OBJECTIVE: To audit myomectomies, the practice pattern and outcome at the University of Nigeria Teaching Hospital Enugu-Nigeria. METHODS: A 5-year retrospective study of myomectomies performed in UNTH Enugu between January 1, 2004 and December 31, 2008. Data relating to socio-demographic characteristics, indication for surgery, intraoperative haemostatic measures, estimated blood loss, use of drain, duration of hospital stay and complications were abstracted and analyzed. RESULT: A total of 122 abdominal myomectomies were performed and 70.5% of the patients were aged 30-39 years and 80% were nullipara. Lower abdominal swelling and discomfort were the commonest presentation and indication for the surgery. Tourniquet was used for haemostasis in 57.4% while postoperative drain was inserted in 52.6%. 24.6% received blood transfusion and the average duration of hospital stay was 8.6 days. Complications were mild, with pyrexia as the commonest complication (28.7%). There was no mortality. CONCLUSION: Though myomectomy is safe and tolerated in our centre, a consensus practice pattern through a prospective study is required to further improve outcome.

Abortion treatment by health professionals in south-eastern Nigeria.

Studies assessing the various modes of treatment for abortion and its associated complications remain relevant in the generation of data that will aid policy formulation for abortion management. This descriptive cross-sectional study was undertaken to determine the common methods of, together with the complications associated with, abortion treatment among healthcare practitioners in south-eastern Nigeria. There were 230 males and 207 females, with a mean age of 38.23+10.4 years. General practitioners accounted for 214 (49.0%) respondents; nurses, 161 (36.8%); specialist doctors, 56 (12.8%); resident doctors, 5 (1.1%); and community health officers, 1 (0.02%). As high as 388 (88.8%) of the respondents had treated abortion. Manual vacuum aspiration (MVA), and sharp curettage were the commonest methods of treatment accounting for 36.0% and 34.1%, respectively, while medication treatment was employed by 15.0% of the respondents. Only 41.0% of the respondents had been formally trained on the use of MVA. Some 285 (65.2%) of the respondents recorded complications during abortion treatment and these included incomplete evacuation, 30.2%; haemorrhage, 26.0%; and infection, 22.2%. A significantly higher number of complications occurred following sharp metal curretage compared to MVA, and includes incomplete evacuation, 54 (62.5%) vs 33 (38.0%) (p<0.05); and haemorrhage, 32 (43.2%) vs 15 (20.5%) (p<0.05). Syncope, 2 (100%) and uterine perforation, 23 (100%) occurred solely from sharp metal curettage. Building capacity of health professionals on the use of MVA, and ensuring the universal access to the equipment will enable safer abortion treatment and reduce maternal morbidity and mortality from abortion-related complications.

Seroprevalence of Chlamydia trachomatis in Enugu, Nigeria.

BACKGROUND: Chlamydia infections in women cause pelvic inflammatory disease, which often results in devastating consequences of infertility, ectopic pregnancy, or chronic pelvic pain. The infection is largely asymptomatic. OBJECTIVE: To determine the seroprevalence of Chlamydia trachomatis in Enugu, South Eastern Nigeria. MATERIALS AND METHODS: A population-based prospective study comprising female residents of Enugu, South Eastern Nigeria. Indirect solid phase enzyme immunoassay of Chlamydia antibodies was done using ImmunoComb C0. Trachomatis IgG Kit (Orgenics). RESULTS: The population comprised 136 female undergraduate students and 150 non-student women. The overall prevalence of C. trachomatis in the population studied was 29.4%. The percentage of subjects who admitted to be having multiple sexual partners was higher among the student population (71.2%) compared to those from the non-student population (28.8%). The highest percentage of seroprevalence was 28 (33.3%) in the age group of 20-24 years for the student population and 18 (21.4%) in the age group of 25-29 years for the non-student population. The highest seroprevalence of C. trachomatis antibodies (69.0%) in both populations was observed in females without any history of infection. Females that had pelvic inflammatory disease, sexually transmitted infection, and secondary infertility assayed for C. trachomatis had seroprevalence levels of 19%, 9.5%, and 2.4%, respectively. There was a positive correlation between positive Chlamydia assay and the type of subject population (student or non-student) with r2 value of 1.55 at P < 0.01. CONCLUSIONS: C. trachomatis infection is largely underdiagnosed and remains a silent disease in the apparently healthy population of Enugu, South eastern Nigeria.

The discontinuation rate and reasons for discontinuation of implanon at the family planning clinic of University of Nigeria Teaching Hospital (UNTH) Enugu, Nigeria.

BACKGROUND: In spite of the popularity and effectiveness of the Implanon among family planning clients at University of Nigeria Teaching Hospital (U.N.T.H) Enugu Nigeria, some users discontinued its use for a variety of reasons. OBJECTIVE: To determine the Implanon discontinuation rate and reasons for discontinuation among women attending University of Nigeria Teaching Hospital (U.N.T.H) Enugu, Nigeria. MATERIALS AND METHODS: This retrospective survey comprised 63 women who had Implanon implant discontinued out of 295 women who had Implanon inserted between 2006 and 2008. The records of patient at the Family Planning Clinic of the hospital were analysed. The main outcome measured was Implanon discontinuation. RESULTS: Sixty-three (21.4%) of women who had Implanon implant during this period discontinued its use. The discontinuation rate within six months of use was 3.0%, within one year, 8.1% and within two years, 19.3%. Thirty-six (12.2%) discontinued Implanon because of side effects while 27 (9.2%) discontinued because of desire for pregnancy. Fifteen (41.7%) out of the 36 women who discontinued because of side effects had menstrual abnormalities. Headache and dizziness accounts for the majority (38.1%) of non-menstrual reasons for discontinuation. There was no pregnancy recorded. All those who discontinued Implanon within six months ofuse were because of side effects. CONCLUSION: The discontinuation of Implanon before its expiration is low once the users are adequately counseled. Implanon is well accepted among our clients but cost affect its wider use.

Survey of Women's Opinions on Female Genital Mutilation (FGM) in Southeast Nigeria: Study of Patients Attending Antenatal Clinic

Background: Female genital mutilation is known to exist especially in many third world countries including Nigeria with many women being victims of this harmful practice and its complications. The practice is rife in Southeast Nigeria and efforts have been made to discourage it. Objective: To determine women's views on aspects of female genital mutilation and the prevalence among the study population. Method: Women attending the antenatal clinics of two university teaching hospitals in Southeast Nigeria were interviewed by means of structured pre-tested interviewer- administered questionnaires. The data obtained were analysed using SPSS version 10.0 and the results expressed in descriptive statistics as percentages. Results: The prevalence of FGM was 42.1. However; only 14.3of the respondents circumcised their own daughters or showed willingness to circumcise their daughters indicating considerable reduction in uptake of the practice. A larger proportion (63.7) would support legislation against FGM. Conclusion: There is a high opinion against the practice of FGM in Southeast Nigeria; with the majority of the women showing support for legislation

Grandmultiparity: experience at Awka, Nigeria.

BACKGROUND/AIM: The grandmultiparae have basically been regarded as high risk obstetric patients. This study was undertaken to estimate the prevalence in this area as well as evaluate the problems, associated factors and ways of reducing the burden. METHODOLOGY: This was a retrospective study of the problems of grandmultiparity (five or more previous viable babies) at Amaku General Hospital, Awka over a three year period, January 2006 to December 2008. One hundred and thirty five (135) grandmultiparous women (study group) were matched with a similar number of women of lower parity (Para 2 and 3), who attended and delivered in the hospital during the same period. The problems seen in both groups during pregnancy and labour, mode of delivery, birth weight, perinatal and maternal mortalities were compared. The soccio-demographic characteristics were also compared. RESULTS: The incidence of grandmultiparae was 7.53%. Twenty nine (21.5%) of the grandmultiparae were unbooked compared to 6 (4.4%) of the control group. Ninety four (69.7%) of the study group belonged to the low social class IV and V compared to 27 (20%) of the control. Anaemia in pregnancy was commoner in study than in the control group (49 (36.3%) versus 12 (8.9%). There was a high caesarean section rate in the study group compared to the control (31 (23.0%) versus 6 (4.4%). The maternal mortality rate in the study group was 22.2/1000. There was no maternal death in the control. CONCLUSION: Improving the socio-economic standard of our women and increased awareness in the importance of family planning will reduce the incidence and complications of grandmultiparity.

Awareness and practice of post abortion care services among health care professionals in southeastern Nigeria.

This study investigates knowledge and practices of post abortion care (PAC) services among health care professionals in the Anambra State of southeastern Nigeria. This was a prospective, cross-sectional, questionnaire based study conducted between 1 June and 30 September, 2006. The study involved a multi-staged sampling of all registered health facilities in Anambra State, with the selection of 60 health facilities from which 450 participants were recruited. A pre-tested, structured questionnaire was employed to obtain information from the studied respondents. Obtained data were analyzed using Epi-Info version 2001. A total of 437 questionnaires out of 450 administered were accurately completed, giving a response rate of 97.1%. The respondents were comprised of general practitioners (214, 49.0%), nurses (161, 36.8%), specialist doctors (56, 12.8%), and resident doctors (5, 1.1%). The mean age of the respondents was 38.2 +/- 10.5 years. Most participants (203, 52.6%) were males; the majority (282, 64.5%) were working in the rural areas of the State, including mission hospitals (165, 37.8%) and general hospitals (145, 33.3%). Three hundred thirty respondents (75.5%) were aware of PAC services. Twenty-seven (6.2%) and 28 (6.4%) of respondents were aware of community partnership and family planning services, respectively, as elements of PAC. Although the majority of respondents (302, 69.1%) treated abortion complications, only 155 (35.5%) used a manual vacuum aspirator. Three hundred thirty-eight (88.8%) offered counseling services, and 248 (56.8%) provided referrals to other reproductive health services.

Influence of formal maternal education on the use of maternity services in Enugu, Nigeria.

Although some previous studies have suggested formal maternal education as the most potent tool for reducing the mortality ratio in Nigeria, other studies found that the depressed Nigerian economy since 1986 has marginalised the benefits of education with the result that educated women stopped making use of existing health facilities because they could not afford the cost of health services. This study was carried out to determine the current influence of formal maternal education and other factors on the choice of place of delivery by pregnant women in Enugu, south-eastern Nigeria. It was a pre-tested interviewer-administered questionnaire study of women who delivered within 3 months before the date of data collection in the study area. In an increasing order of level of care, the outcome variable (place where the last delivery took place) was categorised into seven, with home deliveries representing the lowest category and private hospitals run by specialist obstetricians as the highest category. These were further sub-categorised into non-institutional deliveries and institutional deliveries. Maternal educational level was the main predictor variable. Other predictor variables were sociodemographic factors. Data analysis was by means of descriptive and inferential statistics including means, frequencies and chi2-tests at the 95% confidence (CI) level. Out of a total of 1,450 women to whom the questionnaires were administered, 1,095 women responded (a response rate of 75.5%). A total of 579 (52.9%) of the respondents delivered outside health institutions, while the remaining 516 (47.1%) delivered within health institutions. Regarding the educational levels of the respondents, 301 (27.5%) had no formal education; 410 (37.4%) had primary education; 148 (13.5%) secondary education and 236 (21.5%) post-secondary education. There was a significant positive correlation between the educational levels of the respondents and their husbands (r=0.86, p=0.000). With respect to occupational categories of the respondents, 88 (8.0%) of them belonged to occupational class I, 158 (14.4%) to occupational class II, 107 (9.8%) to occupational class III, 14 (1.3%) to occupational class IV and 728 to occupational class V. There was a significant positive correlation between the respondents' and their husbands' occupational levels (r=0.89, p=0.000). There were statistically significant associations between choice of institutional or non-institutional deliveries and respondents' educational level as well as place of residence (urban/rural), religion, tribe, marital status, occupational level, husband's occupational and educational levels, age and parity (p