Does introduction of user fees affect the utilization of cervical cancer screening services in Nigeria?

BACKGROUND: Screening for cervical cancer improves outcome. This comes at an economic price which some may not be able to afford. OBJECTIVE: To evaluate the influence of user fees on the utilization of cervical cancer screening services in Port Harcourt. MATERIALS AND METHODS: A cross sectional study of clients presenting for cervical cancer screening. Data on the number, socio-demographic characteristics, distance from screening center following 1 month of free cancer screening and 7 months of user fee introduction, was collated and analyzed using SPSS version 20 statistical software. Results are presented in percentages, tables and charts with test of significance set at P < 0.05. RESULTS: Of the 167 women who presented for cervical cancer screening during the study period, the mean age was 42.08 ± 8.9 years and range was 20-70 years. The average parity of patients was 2.83 ± 2.24. Clients' utilization of cervical cancer screening facilities was negatively affected by the introduction of user fees P < 0.001). There is no association between the distance of patients' home from the hospital and the utilization of facility (X2 = 0.24, P = 0.887). There was sustained decrease in number of clients with the introduction of fees. CONCLUSION: The introduction of user fees had a negative impact on the utilization of cervical cancer screening facilities. Eradicating user fee and improving the socioeconomic status of patients may improve the utilization of screening services.

Prevalence of placenta Plasmodium parasitemia and pregnancy outcome in asymptomatic patients at delivery in a university teaching hospital in Nigeria.

BACKGROUND: Malaria is an important public health issue in pregnancy association with poor fetal and maternal outcome, especially in malaria endemic area like Nigeria. OBJECTIVE: The objective was to determine the prevalence of placental malaria in asymptomatic women in labor and to compare the fetal and maternal outcome between affected and unaffected women. SUBJECTS AND METHODS: A prospective cross-sectional study of 210 women who delivered at a tertiary health facility in Nigeria. Participants' peripheral venous blood, cord blood, and placental blood samples were examined microscopically for the presence of malaria parasite. Data collected were analyzed using SPSS version 16. RESULTS: Prevalence of placental malaria was 65.2%. Nulliparity was significantly associated with placental malaria (χ² = 21.32, P = 0.0000039, odds ratio [OR] =5.6). Poor compliance to intermittent preventive therapy was significantly associated with placental malaria (χ² = 16.67, P = 0.00004). The mean gestational age at delivery was 38.57 ± 1.7 weeks and 12.85% of women had preterm delivery. Sixty-seven (31.9%) women had anemia and malaria parasitemia was significantly associated with anemia (χ² = 8.34, P = 0.0039, OR = 2.6). Fourteen (6.67%) babies had low birth weight, but placental malaria was not significantly associated with low birth weight (χ² = 0.03, P = 0.87). CONCLUSION: There is a high prevalence of placental malaria in the study population. Nulliparity, poor drug compliance, and maternal anemia were associated with placental malaria.

Rupture of the gravid uterus in a tertiary health facility in the Niger delta region of Nigeria: A 5-year review.

BACKGROUND: Ruptured uterus is a major life-threatening condition encountered mostly in developing countries and is an index of failure of obstetric care at a point in time in a woman's reproductive career. With worsening economic condition, increasing caesarean section rates, and patients' aversion for operative delivery this condition would still remain a major obstetric matter for discussion. OBJECTIVE: To identify the incidence, sociodemographic variables, clinical characteristics, causes, and outcome of ruptured uterus at the University of Port Harcourt Teaching Hospital. MATERIALS AND METHODS: A 5-year retrospective study of cases of ruptured uterus at the University of Port Harcourt Teaching Hospital was carried out. The case notes of 40 patients with uterine rupture during the period 2003-2007 were analyzed. Data collected included sociodemographic characteristics, etiologic factors, clinical presentation, and outcome. Data were analyzed using Microsoft Excel version 2007 and SPSS 14.0 computer software. RESULTS: The incidence of rupture of the gravid uterus was 1:258 deliveries. In patients with rupture of the gravid uterus, 65% (26) of patients were unbooked; 37.5% (15) were aged between 25 and 29 years. A total of 42.5% (17) of patients had secondary education and 21 (52.5%) were housewives. Rupture of a previous scar was the commonest etiologic factor accounting for 32.5% (11). The commonest presentation was abdominal pain in 92.5% of cases. Perinatal mortality and maternal mortality were 80% and 17.5% respectively. CONCLUSION: Rupture of the gravid uterus still remains a major cause of maternal mortality. Injudicious use of oxytocics should be discouraged in peripheral health facilities and reinforcement of the need for hospital based deliveries in patients with previous caesarean sections should also be intensified to improve outcome.

Bronchopulmonary dysplasia in a premature infant--case report and literature review.

BACKGROUND: Bronchopulmonary dysplasia is an important cause of morbidity and mortality in premature infants. The aim of this study is to present a premature, extremely low birth weight infant with bronchopulmonary dysplasia. METHOD: A review of the case records of a child with recurrent respiratory distress and the relevant literature. RESULTS: A preterm, extremely low birth weight baby (birth weight was 0.8 Kg), delivered by emergency caesarian section for previous caesarian section and prolonged rupture of fetal membranes at 27 weeks gestational age. She had spontaneous breathing at birth (APGAR scores were 8 in one minute and 10 in 5 minutes). She developed respiratory distress with cyanosis and became oxygen dependent from the second week of life. Examination revealed severe dyspnoea with grunting respiration, tachypnoea, cyanosis and crackles in the lung fields. Chest X-ray showed hyperinflation, right lower zone patchy consolidation with obliteration of the costophrenic angle. Echocardiography was however normal. She was successively managed with intermittent oxygen, dexamethasone, salbutamol and antibiotics (ceftriaxone). She was nursed in the incubator for 3 months. There was no episode of apneic attack throughout admission. She responded to treatment and was discharged home on intermittent oxygen therapy and nebulisation. The weight on discharge was 1.6 kg. At 6 months of age, she is still having recurrent respiratory distress andsupplemental oxygen at home. She is regular to follow up with recurrent episodes of wheeze requiring admissions. CONCLUSION: Bronchopulmonary dysplasia should be suspected in a premature extremely low birth weight infant with early recurrent respiratory distress.