Comparison of the prevalence of adhesions at the time of diagnostic laparoscopy for infertility between patient who had open myomectomy and those who had no previous pelvic-abdominal surgery or pelvic inflammatory disease.

OBJECTIVE: The aim of this study is to determine the prevalence and patterns of adhesions in infertile women with prior open myomectomy compared with women without prior pelvic-abdominal surgery. METHODS: A nested case-control study of infertile women who had diagnostic laparoscopy after open myomectomy between January 2008 and June 2015 in Life Institute for Endoscopy Limited, Nnewi Nigeria, was conducted. At diagnostic laparoscopy, the presence, site, and quality (density) of adhesions was noted and recorded. Women with endometriosis and documented prior pelvic infections were excluded. RESULTS: Of the 348 women who were eligible, 121 women had prior open myomectomy (study group) while 227 had none (control group). Of the 121 women, adhesions were detected in 97 women; thus, the prevalence of adhesion after open myomectomy was 80.2% versus 20.3% (46/227) in controls (odds ratio [OR] =15.90; 95% confidence interval [CI] =8.86-28.76; P < 0.001). Compared with controls, adhesions were statistically higher in these sites: uterus (68.6% vs. 14.5%), fallopian tubes (77.7% vs. 16.7%), ovaries (62.8% vs. 20.3%), cul-de-sac (66.1% vs. 16.3%), bladder (45.5% vs. 7.9%), and bowel (53.7% vs. 6.2%) (P < 0.001, for all). Cohesive form of adhesions was also statistically higher, 54 (44.6%) vs. 32 (14.1%) (P < 0.05). CONCLUSION: In infertile women, post-open myomectomy adhesions have a high prevalence of 80.2% with high predilection in fallopian tubes and uterus, compared with women without prior abdominopelvic surgery at 20.3%. Cohesive form of adhesion predominates.

Sexual abuse among juvenile female street hawkers in Anambra State, Nigeria.

Street hawking exposes young girls to all forms of hazards, including sexual abuse. This descriptive study examines the size of the problem and the consequences of sexual abuse on juvenile female street hawkers randomly recruited from two urban towns in Anambra State of Nigeria. Data was collected with semi structured, interviewer administered questionnaires. The mean age of the female hawkers was 13.0 +/- 2.2 years. Out of 186 respondents, 130 (69.9%) had been sexually abused with 32 (17.2%) having had penetrative sexual intercourse (28.1% were forced and 56.3% submitted willingly) while hawking. Majority (59.4%) of the sexual partners were adults. Other types of sexual abuse experienced include inappropriate touches (106 cases; 81.5%) and verbal abuses (121 cases; 93.1%). There was low awareness of the twin risks of pregnancy (43.1%) and sexually transmitted infections (54.3%) following sexual abuse among the respondents. Sexual abuse of young female hawkers is an issue of great public health importance. Poverty alleviation, health education and protective child right policies will decrease its prevalence and the associated risks.

Sexual abuse among juvenile female street hawkers in Anambra State, Nigeria

Street hawking exposes young girls to all forms of hazards, including sexual abuse. This descriptive study examines the size of the problem and the consequences of sexual abuse on juvenile female street hawkers randomly recruited from two urban towns in Anambra State of Nigeria. Data was collected with semi structured, interviewer administered questionnaires. The mean age of the female hawkers was 13.0 + 2.2 years. Out of 186 respondents, 130 (69.9%) had been sexually abused with 32 (17.2%) having had penetrative sexual intercourse (28.1% were forced and 56.3% submitted willingly) while hawking. Majority (59.4%) of the sexual partners were adults. Other types of sexual abuse experienced include inappropriate touches (106 cases; 81.5%) and verbal abuses (121 cases; 93.1%).. There was low awareness of the twin risks of pregnancy (43.1%) and sexually transmitted infections (54.3%) following sexual abuse among the respondents. Sexual abuse of young female hawkers is an issue of great public health importance. Poverty alleviation, health education and protective child right policies will decrease its prevalence and the associated risks. (Afr J Reprod Health 2008; 12[2]:111-119)

Knowledge, attitude and practice of family planning among Igbo women of south-eastern Nigeria.

A total of 200 Nigerian women visiting Nnamdi Azikiwe University Teaching Hospital's antenatal clinic were interviewed about their knowledge, attitude and practice of family planning. About 90% were literate. Their knowledge (80%) and approval (87%) of family planning was high, but the practice of modern family planning was low (25%) with most women involved in Billings/safe period (56%). The common methods used were Billings/safe period, condom, withdrawal and the intrauterine contraceptive device (IUCD). A total of 81.5% of the respondents are still willing to give birth while 77% agreed that their last pregnancy was planned. A total of 58.5% of respondents were educated about family planning in the antenatal clinic. The most common source of family planning information was mass media, closely followed by health workers, while the most common single reason for non-practice of family planning was rejection by the husband. We therefore conclude that despite the high education/literacy with the attendant and high knowledge and approval rate of family planning in this part of Nigeria, the practice of family planning is still low, especially due to partner objection. Policy makers should therefore increase male involvement in family planning programmes and pursue a more aggressive public awareness campaign.

Comparison of carbon dioxide and room air pneumoperitoneum for day-case diagnostic laparoscopy.

Laparoscopic examination is useful in the evaluation of infertile women. To perform this test, pneumoperitoneum is required to distend the abdomen, improve visibility and displace the intestines out of the pelvis. Several gases have been used to achieve this purpose including nitrous oxide (N2O), carbon dioxide (CO2), helium, xenon and air. This is a prospective study in a private fertility centre comparing CO2 and room air pneumoperitoneum for diagnostic laparoscopy. Also the safety of room air was evaluated. One hundred and forty five patients received CO2 (group 1, n=73) or room air (group 2, n=72) pneumoperitoneum. Ketamine anaesthesia was used for all the patients and the cost of the procedure was same for the study. CO2 pneumoperitoneum offered better visibility during laparoscopy and the patients also had a better outcome: Wound infection (CO2-2/73: 2.7% Vs. Air-11/72: 15.3%); abdominal discomfort (feeling of retained gas in the abdomen) CO2-5/73: 6.9% Vs. Air-61/72: 84.7%) and shoulder pain (CO2-0/73; 0.0% Vs. Air-56/72: 77.8%). Group 1 patients returned to normal activity earlier (1.5 days +/- 1.3 SD Vs. 4.8 days +/- 2.1 SD). We conclude that CO2 pneumoperitoneum has a better outcome than Air especially for day-case diagnostic laparoscopy. However, room Air pneumoperitoneum is safe, cheap, and available and may be recommended for low resource settings.

The use of simple ketamine anaesthesia for day-case diagnostic laparoscopy.

General anaesthesia using ketamine has been shown to be safe. It is generally used in our private hospitals where there is lack of qualified personnel and sophisticated anaesthetic machines. A retrospective review of 295 cases of laparoscopy was performed over 28 months at the fertility Unit of Life Specialist Hospital Nnewi, Anambra State, Nigeria. Ketamine general anaesthesia was used for all the patients after premedication with 0.6 mg of atropine. Seventy-six and 102 patients who had additional premedication of 10 mg diazepam and 50 mg promethazine, respectively, were compared. The duration of this procedure ranged between 7 and 18 minutes, with a mean of 12 minutes. The dose of ketamine used was 100 mg mean (range 50-180 mg); 12.6% of the patients had some form of reaction. Diazepam reduced talkativeness during recovery but increased the recovery time significantly, from an average of 45 minutes to 3 hours. Promethazine significantly reduced vomiting and restlessness and did not significantly prolong the recovery time (from an average of 45 minutes to 70 minutes). Two patients who had only atropine as premedication had an idiosyncratic reaction of breathlessness and tonic-clonic-like movements. They responded to intravenous diazepam. Ketamine produces a safe, effective and simple general anaesthesia and is recommended for use in day-case laparoscopy, where standard anaesthetic machines and trained personnel are lacking. Use of promethazine premeditation is advocated for improved outcome.

HIV infection and sexual behaviour among infertile women in southeastern Nigeria.

This prospective study was carried out to estimate the prevalence of human immunodeficiency virus (HIV) infection and the risk factors for HIV infection in women undergoing laparoscopy evaluation for infertility. Of 1906 women evaluated between January 1995 and December 2000, 130 (6.82%) tested positive for HIV infection. Husbands of 58.5% of the HIV positive women also tested positive. Analysis of their sexual behaviour within the duration of the marriage revealed that the HIV positive infertile women had more sexual partners [86.2% (112/130) average of five partners vs. 38% (675/1776) average of two partners; P<0.001] and previous sexually transmitted infections [73.1% (95/130) vs. 56.8% (1009/1776); P<0.001] than the HIV negative infertile women. Previous history of induced abortion and blood transfusion was not significantly different for HIV positive and negative women (42.3% vs. 39.3%) and (1.5% vs. 1.0%), respectively, P>0.20. In conclusion, infertile women are exposed to a higher risk of HIV infection due to their promiscuous sexual behaviour in search of pregnancy.