Prevalence and risk factors associated with musculoskeletal disorders among pregnant women in Enugu Nigeria.

BACKGROUND: Pregnancy usually triggers a wide range of changes that result in a variety of musculoskeletal disorders (MSDs). The scope and burden of these disorders in Nigeria are not known. AIM: The study aimed to determine the prevalence and risk factors of pregnancy-related MSDs in Enugu. PATIENTS AND METHODS: A cross-sectional study of pregnant women attending antenatal clinics at three tertiary hospitals in Enugu, Nigeria, was done using an observer-administered questionnaire. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 22. RESULTS: A total of 317 participants were studied. A majority of the participants (93.1%) had one or more MSDs. Low back pain (LBP) and muscle cramps were the two most common pregnancy-related MSDs with prevalence rates of 56.8 and 54.8%, respectively. Increasing gestational age (P = 0.001), previous pregnancies (P = 0.027), and occupation (P = 0.018) were associated with increased risk of MSDs. A majority of the MSDs were of mild and moderate severity and 10.4% of the participants had significant impairment of their daily activities. CONCLUSION: MSDs are common in pregnancy with LBP and muscle cramps as the most prevalent conditions. Increasing gestational age, multigravidity, and occupation increased the risk of MSDs among our cohorts. Preventive and therapeutic measures should be instituted when necessary to ensure optimal maternal health during pregnancy.

Assessment of Significant Bacteriuria, Bacterial Profile and Pyuria among Pregnant Women with Urinary Tract Symptoms in Enugu, South-Eastern Nigeria: A Cross-Sectional Study.

BACKGROUND: Urinary tract symptoms are common in pregnancy; thus, symptom-based diagnosis of urinary tract infection (UTI) might not be accurate. Such women are often exposed to antibiotics without urine culture and antibiotics sensitivity. Identification of pyuria on urine microscopy of pregnant women with urinary tract symptoms may predict significant bacteriuria and guide such women's treatment in under-resourced settings. METHODS: A cross-sectional study of 233 consecutive consenting pregnant women with UTI symptoms at theantenatal clinic of the University of Nigeria Teaching Hospital ItukuOzalla, Nigeria. Participants' mid-stream urine specimens were sent for microscopy, culture, and antibiotics sensitivity. Data analysis was descriptive and inferential at 95% confidence level. RESULTS: The prevalence of symptomatic UTI among pregnant women with urinary tract symptoms was 33.5% (78/233). Coliform bacilli were the most common isolates (82.0%) from participants' urine. Ceftriaxone and ampicillin-cloxacillin had the highest (76.9%) and least (12.8%) sensitivity, respectively. Using urine culture as the standard, pyuria on microscopy showed a sensitivity of 43.6% and a specificity of 93.5% for predicting symptomatic UTI. CONCLUSION: The prevalence of UTI among pregnant women with urinary tract symptoms was low, and the most common isolate was coliform bacilli. Though pyuria had reasonably good accuracy for diagnosing symptomatic UTI, it should not be used for this purpose because of the risks associated with misdiagnosis.

CONTEXTE: Les symptômes des voies urinaires sont fréquents pendant la grossesse; ainsi, le diagnostic basé sur les symptômes de l'infection des voies urinaires (IVU) pourrait ne pas être exact. Ces femmes sont souvent exposées à des antibiotiques sans culture d'urine ni sensibilité aux antibiotiques. L'identification de la pyurie par microscopie urinaire chez les femmes enceintes présentant des symptômes des voies urinaires peut prédire une bactériurie importante et orienter le traitement de ces femmes dans les milieux défavorisés. BUT: Déterminer la prévalence des infections urinaires chez les femmes enceintes présentant des symptômes des voies urinaires et évaluer l'exactitude de la pyurie pour prédire les infections urinaires symptomatiques pendant la grossesse à Enugu, au Nigéria. MÉTHODES: Une étude transversale de 233 femmes enceintes consentantes consécutives présentant des symptômes d'infection urinaire à la clinique prénatale de l'hôpital universitaire d'Ituku, à Ozalla, au Nigéria. Les échantillons d'urine à mi-parcours des participants ont été envoyés pour microscopie, culture et sensibilité aux antibiotiques. L'analyse des données était descriptive et inférentielle à un niveau de confiance de 95. RÉSULTATS: La prévalence des infections urinaires symptomatiques chez les femmes enceintes présentant des symptômes des voies urinaires était de 33,5% (78/233). Les bacilles coliformes étaient les isolats les plus courants (82,0%) des urines des participants. La ceftriaxone et l'ampicilline-cloxacilline avaient respectivement la sensibilité la plus élevée (76,9%) et la moins élevée (12,8%). En utilisant la culture d'urine comme norme, la pyurie à la microscopie a montré une sensibilité de 43,6% et une spécificité de 93,5% pour prédire les infections urinaires symptomatiques. CONCLUSION: La prévalence des infections urinaires chez les femmes enceintes présentant des symptômes des voies urinaires était faible et l'isolat le plus courant était les bacilles coliformes. Bien que la pyurie ait une précision raisonnablement bonne pour diagnostiquer une infection urinaire symptomatique, elle ne doit pas être utilisée à cette fin en raison des risques associés à un diagnostic erroné. MOTS CLÉS: Grossesse, infection symptomatique des voies urinaires, culture d'urine, microscopie d'urine.

Effects of short inter-pregnancy interval on maternal and perinatal outcomes: A cohort study of pregnant women in a low-income country.

BACKGROUND: Short inter-pregnancy interval (IPI) is a potential risk factor for adverse pregnancy outcomes. Previous reports from sub-Sahara Africa documented increasing incidence of short IPI but evidence is lacking in its effect on pregnancy outcome. AIM: The study aimed to determine the effect of short IPI on pregnancy outcome in Nigeria. SUBJECTS AND METHODS: It was a prospective cohort study of 271 pregnant women receiving antenatal care in a tertiary hospital in Nigeria. For every eligible woman with short IPI (<18 months) recruited; a suitable control with IPI ≥18 months was selected. Statistical analysis was both inferential and descriptive using the statistical package for social sciences version 24 (SPSS Inc. Chicago, Illinois, USA) for windows. A P value of less than 0.05 was considered statistically significant. RESULTS: Incidence of maternal anemia was higher in women with short IPI than control (RR: 2.091; 95% CI: 1.4433.031; P < 0.001). Other maternal and perinatal outcome measures including premature rupture of membranes, preterm labor/delivery, pregnancy induced hypertension, third trimester bleeding, postpartum hemorrhage, and inadequate gestational weight gain did not show any significant association with short IPI (P > 0.05). CONCLUSION: Short IPI is associated with anemia in pregnancy in Nigeria. Public health campaigns for improvement in uptake of family planning services and breastfeeding may help reduce the incidence of short IPI and anemia in low income countries.

Prevalence and predictors of placental malaria in human immunodeficiency virus-positive women in Nigeria.

BACKGROUND: Human immunodeficiency virus (HIV)-infected pregnant women have alterations in cellular and humoral immunity that increase the risks to placental malaria infection. AIM: This study aimed at determining the prevalence and predictors of placental malaria among HIV-positive women in Nigeria. MATERIALS AND METHODS: It was a longitudinal cohort study of pregnant women receiving antenatal care at a tertiary hospital in Nigeria. Peripheral blood sample for packed cell volume estimation and placental blood sample for malaria parasite estimation were collected from each participant at a presentation in labor and upon delivery, respectively. RESULTS: The Prevalence of placenta malaria (68.6%) and anemia (66.7%) in HIV-positive women were significantly higher than the prevalence of placental malaria (35.3%) and anemia (44.1%) in HIV-negative control (P < 0.001 and P = 0.001 respectively). The employment status was the only sociodemographic factor significantly associated with the development of placental malaria in HIV-positive women (odds ratio: 21.60; 95% confidence interval: 7.1-66.2; P< 0.001). CONCLUSION: The prevalence of placental malaria is very high among HIV-positive women in Nigeria. Scaling up free distribution of insecticide treated nets in the short term and employment opportunities of HIV-positive women, in the long run, may reduce the prevalence of placental malaria in our population.

Accuracy of clinical and ultrasound estimation of fetal weight in predicting actual birth weight in Enugu, Southeastern Nigeria.

BACKGROUND: Estimation of fetal weight is important for antenatal and intrapartum management of pregnant women. Sonographic methods are not readily accessible in under-resourced settings, it is therefore necessary to study the accuracy of a clinical method of estimating fetal weight where this limitation (unavailability of ultrasound) exists. OBJECTIVE: To compare the accuracy of clinical and ultrasound methods of fetal weight estimation at term. MATERIALS AND METHODS: Clinical and ultrasound fetal weights were estimated on 200 consecutive term pregnancies (37 completed weeks of gestation - 41 weeks and 6 days) at the University of Nigeria Teaching Hospital, Enugu, Nigeria from 1 st April to 30 th November 2012. Accuracy was determined using percentage error, absolute percentage error, and proportion of estimates within 10% of actual birth weight. RESULTS: Actual birth weight had strong positive correlation with both clinical and ultrasound estimated fetal weights (r = 0.71, P < 0.001 and r = 0.69, P < 0.001, respectively). Overall, both the clinical and ultrasound methods systematically overestimated the actual birth weight. The proportion of the clinical estimated weights that were within 10% of the actual birth weight was significantly lower than that of ultrasound method for babies of all birth weights (35.0 vs. 67.5%; P < 0.001) and for macrosomic babies (76 vs 100%, P = 0.009). For babies with normal birth weights (2.5-3.9 kg), ultrasound method error values were significantly lower than those of clinical method for both the mean % error (5.4 vs 19.6%; P < 0.001) and the mean absolute % error (9.97 vs 20.6%; P < 0.001). CONCLUSION: The ultrasound method is generally a better predictor of the actual birth weight than the clinical method, and thus should be used in estimating the actual birth weight when accessible.

Breast disease in children and adolescents in eastern Nigeria--a five-year study.

AIMS AND OBJECTIVES: (1) To define the spectrum of breast diseases in the children and adolescents in Eastern Nigeria. (2) To provide where possible, an international comparison of statistical variations of both benign and malignant lesions in these age groups. MATERIALS AND METHODS: The Morbid Anatomy Department of the University of Nigeria Teaching Hospital (UNTH) Enugu is a referral center for over 30 million people. The laboratory receives around 2,000 surgical pathology specimens per year. Virtually all children and adolescents (4-19) years who complained of a breast mass had a biopsy, and results of all excised breast specimens from children and adolescent age groups from 4 to 19 years were included in the study. The case files of these patients were retrieved and reviewed to ascertain the size and duration of the breast lesions. The number of phyllodes tumors seen in the child and adolescent population was compared to those seen in the adult population at the same period. Two independent pathologists reviewed the slides, and their results compared. RESULTS: A total of 1050 breast specimens were received in the department of morbid anatomy from all age groups, from January 1, 2000 to December 31, 2004, out of which 121 (11.5%) were breast specimens from the children and adolescent age groups. On the average most patients with benign breast lesions presented within 3-5 months of their symptoms, which usually was a palpable lump detected in all cases by either the child or the mother. Their sizes vary from 2-3 cm and only ten were multiple but they were all confined to one breast. Those with phyllodes presented typically within 3 months probably because of the faster rate of growth. Their sizes varied from 5-13 cm and they were all unilateral. Phyllodes tumor in this age group constitute 28.6% of all phyllodes seen in this period and were all benign. The mean age was approximately 11.5 years while the median age was 18 years. Three cases were malignant. CONCLUSION: Fibro adenoma, fibrocystic breast disease, and low grade phyllodes tumor were the most common breast lesions seen in our children and adolescent population. The three cases of malignancy observed included invasive intraductal carcinoma, a non-hodgkin lymphoma, and metastases involving the lymph nodes from an uncharacterized secondary malignancy. Phyllodes tumors were typically larger in size and tended to present earlier. Genetic characterization of such lesions is recommended for future studies as well as their relationship to lesions seen among other Africans in Diaspora.

Decreasing incidence and changing aetiological factors of vesico-vaginal fistula in south-east Nigeria.

This study retrospectively reviewed 476 cases of vesico-vaginal fistula (VVF) in the University of Nigeria Teaching Hospital Enugu, south-east Nigeria from 1981 to 2005. The majority (86.6%) of the VVFs were of obstetric origin, resulting from vaginal delivery (n = 330), caesarean section (n = 35), caesarean hysterectomy (n = 26) and instrumental delivery (n = 21). The remaining 13.4% (n = 64) resulted from pelvic surgery, malignancy and radiotherapy treatment. The contribution of obstetrics to VVF development showed a downward trend from 95% in 1981 to 60% in 2005. A success rate of 83% was recorded in the repair with large sized fistula and extensive fibrosis at the fistula site contributing mostly to failure. There is a need to increase access to trained delivery attendants to sustain the downward trend in the incidence of VVF.

Cervical cancer: socioeconomic implications of management in a developing nation.

This study, which assesses the economic, social and psychological implication of radiotherapy treatment of cervical cancer involved interviews with cervical cancer patients (and their relatives) seen at the University of Nigeria Teaching Hospital Enugu, Nigeria and subsequently referred for radiotherapy at other centres. Of the 95 cervical cancer patients referred for radiotherapy, only 19% (n = 18) actually underwent the procedure. The remaining 81% (n = 77) did not go due to financial reasons. All the patients that underwent radiotherapy were in the upper social class and spent almost 30% of their annual income on the treatment. The patients and their accompanying relatives encountered economic, emotional and social problems during the radiotherapy treatment because of absence of social health protection. There is a need to enhance institutional capabilities for preventing and treating cervical cancer through personnel training, establishment of special trust funds, regional screening and radiotherapy centres.

Emergency contraceptive knowledge and practice among unmarried women in Enugu, southeast Nigeria.

BACKGROUND: With a high incidence of unwanted pregnancies and unsafe abortion especially among unmarried women in developing countries, there is need to promote emergency contraception (EC). OBJECTIVE: To assess the unmarried women's knowledge, attitude and practice of EC. METHODS: A random sample of a cross-section of 594 unmarried women in Enugu, southeast Nigeria, was surveyed with questionnaire between January and April 2004. RESULTS: Of the 1,160 unmarried women interviewed initially, 51% had heard of EC. One hundred (16.9%) knew the correct meaning of EC and these were mainly those with higher educational qualification, previous unwanted pregnancy, or had used modern contraception (p<0.05). Other respondents mentioned vaginal douching, application of traditional remedies to the vagina as effective emergency contraceptives. Although sixty percent (n=354) of respondents had used regular modern contraception, only 20% (n=119) had ever used EC. Few respondents knew correctly how EC function and the recommended timeframe for use. The two most common sources of information about EC were mass media (49.2%) and friends (28.8%). Seventy three percent (n=87) of emergency contraceptive users had some difficulties obtaining EC due to non-availability (n=42), attitude of health service providers to unmarried women demanding contraception (n=28) and cost (n=17). The attitude of the health service providers may have accounted for the dearth of information on EC even among users. Sixty-seven percent of respondents favored the use of EC by unmarried women. Opposition to the use of EC by unmarried women is because ofbeliefthat it has some health effect (n=72), induces abortion (n=80) and for religious reasons (n=42). CONCLUSION: Provision of appropriate information and access to EC, better service providers' attitude towards unmarried women is advocated.

Avoidable maternal mortality in Enugu, Nigeria.

OBJECTIVE: The aim of this study was to identify avoidable factors in maternal mortality in Enugu, Nigeria. STUDY DESIGN: A hospital-based descriptive study. METHODS: The case records of maternal deaths in the Obstetric Unit of the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria, between January 2003 and December 2005, were studied to identify maternal characteristics and avoidable factors for maternal mortality. Booked women were those who received formal prenatal care in a medical facility. Abortion-related deaths were not included in the study. RESULTS: There were 49 maternal deaths, 2131 deliveries and 2044 live births during the study period, giving a maternal mortality ratio of 2397.3 maternal deaths per 100,000 live births. The average age of the women was 29.8 years. Twelve women (25.5%) booked in the UNTH, 23 (48.9%) booked elsewhere and 12 (25.5%) were unbooked. Ten women (21.3%) were nulliparous, 15 (31.9%) were Para 1-2, 17 (36.2%) were Para 3-4 and five (10.6%) were Para 5 or above. Twenty-one women (44.7%) first sought medical attention at a private medical clinic, six (12.8%) at the general/mission hospital, five (10.6%) at maternity/health centres, one (2.1%) from a traditional birth attendant and 14 (29.8%) at the UNTH. Fourteen women (39.8%) died within 24h of admission, 12 (25.5%) between 24 and 48h, seven (14.9%) between 48 and 96h and 14 (29.8%) after 96h. Two women (4.3%) delivered at home, eight (17.0%) in private medical clinics, 23 (48.9%) in the UNTH and 14 (29.8%) died undelivered. Major avoidable factors were substandard care (27.7%), delay in seeking care (19.1%), financial constraints (8.4%), delay in recognizing a problem (6.4%), lack of blood (4.3%), lack of drugs (2.1%) and industrial strike action by health workers (2.1%). No major avoidable factor was identified in 14 women (29.8%). CONCLUSION: Avoidable factors are still prevalent in maternal deaths in Nigeria.

The impact of health education on reproductive health knowledge among adolescents in a rural Nigerian community.

This intervention study was to evaluate the impact of reproductive health education on the knowledge and attitude of adolescents in a rural Nigerian community to reproductive health issues. It compared adolescents in a secondary school (study group), which received health education on reproductive health with another secondary school (control group), which did not receive any. The impact of the programme was evaluated with a pre-test baseline knowledge and post-test gain in the knowledge 6 weeks later, using the same questionnaire. A total of 180 students selected by systematic sampling from each of the two randomly selected schools in Item, a rural community in south-east Nigeria participated in the programme. While all the respondents have heard of reproductive health and could identify at least one of its components, their knowledge of it prior to the health education were defective and were obtained mainly from peers and the mass media. Such information was incomplete and often coloured with cultural and religious bias. However, there was a significant (p < 0.05) gain in correct knowledge following the health education. The students in the study group showed a positive and permissive attitude towards reproductive health education and there was a drop in risky sexual behaviour following the intervention. Pre-marital sex (94.3%), pregnancy prevention and abortion (88.5%) and sexually transmitted infections (82.8%) were common reproductive health problems raised by the students. Reproductive health education as part of the school curriculum will provide an effective means of improving knowledge and reducing reproductive health problems among adolescents in developing countries.

Participation in highly subsidized cervical cancer screening by women in Enugu, South-east Nigeria.

The current study was designed to evaluate the level of participation in a highly subsidized cervical screening in a resource-poor country. A total of 989 cervical smears performed on 932 women in Enugu, South-east Nigeria, over a 10-year period (January 1995-December 2004) was reviewed. The level of participation in cervical screening was very low, as <1% of the targeted women population participated. Almost 68% of the participants were referred for the screening and the majority (52.3%) were from lower social classes because the programme was highly subsidized. A total of 646 (65.3%) smears were normal. Of the abnormal smears, 193 (19.5%) had non-specific inflammatory changes, 136 (13.8%) showed dyskaryotic cells while 14 (1.4%) had neoplastic changes. A total of 57 (6.1%) women had more than one cervical cancer screening and they were characterised by increasing age, up to 59 years, higher social classes and contraceptive users in lower social classes. To reverse the low level of participation in cervical cancer screening in developing countries, there is a need to provide highly subsidized (if not free) cervical cancer screening services, which must be followed by sustained cervical cancer awareness campaign.

Pre-term premature rupture of fetal membranes: the dilemma of management in a developing nation.

This study aims at evaluating the outcome of pregnancies complicated by pre-term premature rupture of membrane (PPROM) in a developing country and to highlight the problems of managing such cases and ways of improving future management. This was a retrospective review of 344 patients with PPROM at a University of Nigeria Teaching Hospital Enugu, Nigeria over a 10-year period (January 1994-December 2003). The prevalence of PPROM in this study was 25 per 1,000 births and patients of low parity (para 0-2) accounted for the highest number (56.4%). Previous abortion was significantly more among these women of low parity and may be a factor in the aetiology of PPROM. The gestational age range 28-30 weeks recorded the highest incidence (29.7%) of PPROM. The most common associated aetiological factor was cervical incompetence (11.6%), while chorioamnionitis, a major complication in the patients showed a statistically significant reduction with early antibiotic administration (p<0.05). About 72% (n=248) of the patients arrived at the hospital within 24 h of membrane rupture. Perinatal mortality was high (520 per 1,000 births) due to prematurity and perinatal infections. Better fetal outcomes were recorded among patients with PPROM at gestational age above 30 weeks, fetal weight above 2 kg, normal delivery, absence of maternal infection and latent period of not more than 5 days (p<0.05). The parity of the women did not significantly affect fetal outcome (p>0.05). Two (0.6%) maternal deaths were recorded. Prompt patient referral, early institution of antibiotics and improvement of neonatal facilities in tertiary health institutions in developing countries is advocated as a way of improving fetal survival in PPROM.

Factors associated with domestic violence in south-east Nigeria.

A cross-sectional survey was carried out at two tertiary health institutions in south-east Nigeria from 1 January 2005 to 31 March 2005 to determine the factors associated with domestic violence (DV). The study group comprised of 600 consecutive men seen at the General Outpatient department of the two hospitals during the study period. More than two-thirds (70%) of respondents reported abuse in their family, with 92% (n=385) of the victims being female partners and the remaining 8% (n=35) male. DV was significantly associated with lower social class, alcohol consumption, increasing age disparity between couples and spouse unemployment (p<0.05). The male victims of DV are associated with financial disparity in favour of the female, influential in-laws, educated women and couples within the same age group. The most common form of abuse was shouting at partner (93%), slapping or pushing (77%) and punching or kicking (46%). A total of 348 (83%) respondents reported physical abuse. Only one-fifth (21%) of the abuse occurred during pregnancy and financial constraints was the major reason. There was gross under-reporting (8.1%) of DV because of cultural factors, embarrassment and the repercussions that follow such reports.

Blood transfusion and caesarean section in a developing country.

Our objective was to review blood transfusion practices during caesarean section in a developing country. An audit of 463 consecutive caesarean sections and blood transfusions over a 3-year period (2000 - 2002) was undertaken. The data were collected from the records department in a pre-designed proforma and analysed, using EPI - info Statistical Software version 6. A total of 117 out of 463 (25.2%) caesarean section cases were transfused. The rate of blood transfusion for the various indications were as follows: malpresentation (excluding breech), four out of six (66.7%); placenta praevia, 28 out of 49 (59.1%); uterine rupture, five out of nine (55.6%); breech delivery, eight out of 25 (32%); obstructed labour, 35 out of 124 (28.2%); precious baby, one out of four (25%); previous caesarean section, 24 out of 141 (17.0%); severe pre-eclampsia, five out of 45 (11.1%); fetal distress, three out of 28 (10.7%); and others, three out of 29 (10.3%). A total of 78 (67.2%) of caesarean section cases were emergency. A blood transfusion rate of 25.2% during caesarean section is high. The indications for the caesarean section, preoperative anaemia and quantity of blood loss during caesarean section were significant risk factor for blood transfusion. Efforts should be made to reduce the blood transfusion without increasing maternal morbidity and mortality. This is very important because of rising HIV infection in developing country and blood-borne disease.

Knowledge, attitude and practice of modern contraception among single women in a rural and urban community in southeast Nigeria.

The contraceptive information and services offered to single women in most developing countries is compromised by stigma attached to premarital sex. This study was to ascertain the knowledge, attitude and practice of contraception among single women in a rural and urban community in southeast Nigeria, using a cross-sectional survey of 279 and 295 single women in Ngwo (rural) and Enugu (urban) community. The mean age of the population was 21.3 years. Contraceptive awareness was more among the urban than rural respondents (90.2% vs 34.1%). The major sources of contraceptive knowledge were mass media (68%) and peer groups (86.3%) for the urban and rural respondents, respectively. Most respondents in both groups had positive attitude towards contraception. More urban than rural respondents (68.3% vs 12.5%) began sexual activity during adolescence and the level of contraceptive use during first coitus were 48.4% and 13.7%, respectively. Of the currently sexually active respondents, 32.5% (rural) and 59.7% (urban) were using a form of modern contraception. Condoms, followed by oral pills were the most popular contraceptive method because they can easily procure them over the counter. Poor contraceptive information, highly critical behavior of family planning providers towards unmarried women seeking contraception and attitude of male partners militate against contraceptive practice. There is need to promote information and education on contraception among single women, their male partners and family planning providers.

HIV/AIDS: occupational risk, attitude and behaviour of surgeons in southeast Nigeria.

Our objective was to evaluate the level of occupational risk, attitude and behaviour of surgeons towards HIV-infected patients. A questionnaire survey of 264 randomly selected surgeons in training or in practice in five different health institutions in southeast Nigeria within a five-month period was carried out. A 94% response rate was obtained with completed questionnaires from 264 surgeons. The respondents included obstetricians and gynaecologists (n = 78), general surgeons (n = 121), orthopaedic surgeons (n = 40), dental surgeons (n = 10), ophthalmologists (n = 6), urologists (n = 5), and ear, nose and throat surgeons (n = 4). Of them, 31% (n = 82) were qualified surgeons in practice, while the remaining 69% (n = 182) were resident surgeons in training. In the past five years, 40.2% (n = 106) and 26% (n = 70) of the respondents reported needle-stick injuries and blood splash, respectively, during surgery. The majority of the victims were resident surgeons, obstetricians and gynaecologists, and orthopaedic surgeons. Level of clinical experience and high patient blood loss are likely to contribute to this observation. In all, 89% (n = 236) were engaged in the risky practice of operating on patients with open wounds in their hand and the wounds were contaminated with blood in 5% of cases. During surgical procedures, all (100%) respondents wore protective apron, 65.2% (n = 172) wore double gloves and 30.3% (n = 80) used protective goggles. The use of double gloves and protective eye wear increased remarkably over the past decade, probably because the fear of occupational transmission of HIV was substantial. In total, 83% (n = 220) of the respondents had some reservations about treating patients infected with HIV, while 13.3% (n = 35) viewed them with fear. The remaining 3.4% (n = 9) had a more positive attitude towards HIV-infected patients. Further, 92% advocated preoperative screening, with special precaution during surgery, if the results are positive. In addition, 79.5% were of the view that infected patients should not be discriminated against in treatment, provided necessary protective materials are available. To ensure provision of these protective materials, 91% (n = 240) and 89.4% (n = 236) of the respondents favoured involvement of government and insurance agencies, respectively. In order to achieve a greater commitment from surgeons in developing countries towards caring for HIV-infected patients, there is a need for a comprehensive AIDS management package that would offer specific preventive and psychological training in care of HIV patients and provide requisite funds and resources.

Diabetes mellitus in pregnancy in an African population.

OBJECTIVES: To compare the pregnancy outcome among diabetic and non-diabetic Nigerian women. METHODS: A retrospective case record review of 200 pregnant diabetic patients and control was carried out over a 10-year period (1990-1999) at the Maternity unit of the University of Nigeria Teaching Hospital Enugu, Nigeria. RESULTS: The prevalence of diabetes mellitus among pregnant mothers was 1.7%. Pre-gestational diabetes mellitus accounted for 39% of cases while gestational diabetes was responsible for 61% of them. Late antenatal booking and poor control of diabetes mellitus were common features, while maternal and fetal morbidity was high. Hypertension, vulvovaginitis, premature labor, polyhydramnios and ketoacidosis were significantly higher among diabetic mothers than controls. The perinatal mortality was also higher among diabetics than controls (12.5% vs. 3.5%) with stillbirth being the major contributor. Patients with gestational diabetes were at increased risk of fetal macrosomia than controls (28.7% vs. 5.5%). The overall cesarean section rate was high (36%) among diabetics with previous cesarean section and cephalopelvic disproportion being the commonest indications. CONCLUSIONS: Health education and provision of modern affordable methods of management of diagnosed cases such as uristix and hemastix will improve maternal and fetal outcome in pregnant diabetics in Africa.