Awareness of human immunodeficiency virus (HIV) infection among antenatal clients in Nnewi Nigeria.

OBJECTIVE: To determine the level of awareness of Human Immunodeficiency Virus (HIV) infection among antenatal clients in Nnewi Nigeria. SUBJECTS AND METHODS: A cross sectional descriptive study of six hundred consecutive antenatal clients attending the Nnamdi Azikiwe University Teaching Hospital and five private specialist hospitals (run by Consultant Obstetricians) in Nnewi was conducted over a six-month period (1st September 2008 -28th February 2009). Anonymous, structured, pretested questionnaire designed to assess the awareness of HIV infection was used. RESULTS: The mean age of all the 600 clients was 31.4 (SD 2.8) years, majority were married (94%) and in the third trimester of pregnancy (69%). Most (58%) attended secondary school while 0.83% had no formal education. Only 2% had complete knowledge of the modes of HIV transmission while majority (96.5%) had partial knowledge. There was a statistically significant relationship between level of education and knowledge of HIV (p < 0.00001). HIV test was done on 419 (69.84%); 37 tested positive giving a seroprevalence rate of 8.83%. Among those tested, only 51.55% had counseling before testing. CONCLUSION: This study showed that the knowledge of HIV among women of child bearing age and the practice of voluntary counseling and testing are still poor in our environment. Improved public enlightenment and training of health workers are urgently needed.

Pattern and predictors of partner disclosure of HIV status among HIV positive pregnant women in Nnewi Nigeria.

BACKGROUND: Sub-Saharan Africa has continued to bear the greatest burden of HIV/AIDS epidemic in the world. Partner disclosure of status may create opportunities for support or rejection. OBJECTIVE: This study evaluated the pattern of partner disclosure of HIV positive women, their partners' reaction and factors that affect disclosure of HIV status to partners. METHODOLOGY: This was a descriptive cross-sectional study conducted among pregnant women in Nnamdi Azikiwe University Teaching Hospital Nnewi An interviewer-administered questionnaire was used to obtain relevant information from the subjects. Data was analysed using SPSS version 20 software. RESULTS: One hundred and twenty six women participated in this study. The mean age of the women was 30.4 years +/- 5 while the mean parity was 2.6 +/- 1. All the patients had at least primary education with 63.5% having secondary education as the highest educational attainment. One hundred and sixteen (92.1%) were in monogamous marriage. One hundred and fourteen 90.5%) had disclosed their HIV status to their partners. Eighty-three (66.7%) of the women did this by self. Partners initial reaction was supportive in 84 (66.7%) of the women. Partner's subsequent reaction showed that 103 (81.2%) were supportive, 7 (5.6%) were indifferent while 4 (3.2%) were abusive and violent. The partner's HIV status showed that 54 (42.9) tested positive to HIV antibodies while 52 (41.3%) tested negative to HIV antibodies and 20 (15.9%) do not know partner's HIV status. There was strong correlation between disclosure of HIV status with monogamous marriage and duration of illness. CONCLUSION: The partners' reaction to HIV status of their female partners was largely supportive. Disclosure of HIV status should be encouraged in view of the needed support of the partner in management of these women.

The pattern and obstetric outcome of hypertensive disorders of pregnancy in Nnewi, Nigeria.

BACKGROUND: Hypertension is a common medical complication of pregnancy. It is one of the leading causes of maternal and fetal mortality and morbidity worldwide. Early detection, close surveillance and timely delivery are necessary to reduce complications associated with the condition. OBJECTIVES: To determine the pattern, risk factors, maternal and fetal outcomes in women with hypertensive disorders of pregnancy. METHODOLOGY: This was a descriptive retrospective study of the pattern and obstetrics outcome of hypertensive disorders in Nnewi. The Obstetric variables from 148 women with hypertensive disorders of pregnancy at the Nnamdi Azikiwe University Teaching Hospital Nnewi, from the 1st January 2004 to 31st December 2008 were analyzed. Stastical analysis was done using Epi Info version 3.3.2. The level of statistical significance was set at P < 0.05. RESULTS: of the 4021 deliveries in the hospital during the period under review, 148 (3.7%) were managed for hypertensive disorders of pregnancy. Only 138 folders were used for analysis. The mean age of the women was 31.3 +/- 5.7 years. Majority of the women were unbooked (57.2%). Pre-eclampsia was the commonest type of hypertensive disorder of pregnancy (46.4%) with the majority presenting with severe disease. The level of proteinuria was significant in 74.6% of cases of preeclampsia. The mean gestational age at delivery was 35.3 +/- 1.5 weeks. The mean birth weight was 1.6 +/- 0.3 kg. Twenty-four intra uterine deaths were recorded giving a stillbirth rate of 17.4%. The perinatal mortality rate was 20.9%. Diagnosis was made in the ante-partum period in 92.0% of the cases while 55.2% of the women delivered through Caesarean section. Eight maternal deaths were recorded, giving a case fatality rate of 5.8%. CONCLUSION: Hypertensive disorders of pregnancy are associated with high maternal and fetal morbidity and mortality in Nnewi, Nigeria. Antenatal care will help in early diagnosis and timely intervention of the cases. There is need for strengthening of communication and referral systems in the healthcare.

Postpartum practices among the Igbos in Nnewi Southeast, Nigeria.

BACKGROUND: Women all over the world engage in some forms of postpartum practices aimed at keeping mother and child healthy. Although some of the practices are beneficial, some are of no value while some are out rightly harmful. The objective of this study was to determine the prevailing postpartum practices engaged in by Igbo women of South Eastern Nigeria. The above knowledge could be used to reinforce the beneficial ones while discouraging the harmful ones. METHODS: This is a questionnaire survey of mothers attending infant welfare clinic of our hospital augmented by in-depth interviews of patients, nurses and nurse midwives. RESULTS: Three hundred and thirty (330) mothers were studied. The peak age group was 26 to 30 years (30%), 93% were currently married while trading was the most common occupation. Most of the mothers, 270 (81.8%) regularly drink hot water, 282(85.5%) bathed with hot water while another 270(81.8%) consistently took hot food. Three-quarter of the women or 250(75.8%) took very peppery food, 218(66.1%) tied cloth across the abdomen, 210(63.6%) applied hot compresses to the abdomen while 230(69.7%) regularly did sitz bath with hot water. One hundred and forty six (44.2%) resumed sexual intercourse within 12 weeks of delivery while menstruation returned within 12 weeks in 68(20.6%) of the mothers. Fifty four mothers(16.4%) test breast milk with ants to detect spoilt milk while 64(19.4%), 100(30.3%) and 176(53.3%) took hot water, palm wine and tea respectively to improve the flow of breast milk. Ninety four (28.5%) regularly apply mascara to their babies eyes to 'clear' the eyes. CONCLUSION: Although some of the postpartum practices engaged in by Igbo women were neither useful nor harmful, some were out rightly dangerous and should be discouraged. The findings would be incorporated in antenatal health talks.

A clinico-pathological study of cervical carcinoma in South Eastern Nigeria; a five-year retrospective study.

OBJECTIVE: To determine the pattern of clinical presentation of carcinoma of the cervix in Nnewi Southeast Nigeria with a view to determining strategies for intervention. METHOD: This is a retrospective descriptive study involving all cases of clinically diagnosed carcinoma of the cervix seen over a five year period. RESULTS: Forty three case notes were available for study. The age range was 38 to 87 years with a peak age incidence of 51 to 60 years. The commonest symptom at presentation were postmenopausal bleeding (51.2%), vaginal discharge (32.6%), postcoital bleeding (9.3%) and irregular vaginal bleeding (7%). Nearly 80% presented with the advanced form of the disease with 20 (46.5%) and 14 (32.6%) presenting in stage III and IV respectively. 27(62.8%) were lost to follow up at various stages ofmanagement. CONCLUSION: The pattern of presentation follow known trends. Lack of facilities for radiotherapy and loss to follow up are major obstacles in the management of carcinoma of the cervix.

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)

The knowledge, attitude and practice of voluntary counselling and testing (VCT) for HIV/AIDS among undergraduates in a polytechnic in southeast, Nigeria.

BACKGROUND: The identification of infected individuals is an important step in the control of the HIV epidemic. Voluntary counselling and testing (VCT) for HIV/AIDS is a concept developed in this direction. The objective of this study is to determine the level of knowledge, attitude and practice of Voluntary Counselling and Testing (VCT) for HIV/AIDS among undergraduates in a Nigerian tertiary institution. METHOD: This is a cross sectional study using a multistage sampling method to enroll students from different levels of the national diploma programme into the study. A structured questionnaire was administered to the 260 students with response rate of 70%. RESULT: Only 115 (63.2%) of the students were aware of VCT with 68 (59.1%) having heard of it at least one year prior to the study. Mass media and Churches were the highest sources of information on VCT Most of the students did not know where VCT services could be obtained and knowledge of what VCT entails was also low. However, 127 (69.8%) students approved the necessity of counselling prior to testing and 117 (64.3%) were ready to take a positive result in good fate. At least one out of every four students (54 of 182) had been sexually active within three months preceding the study Only 48 (26.4%) students had taken an HIV test at one time or the other before the study. Majority (62.5%) of those who had been tested went for the screening just to know their HIV status. Premarital testing (18.8%) was the second commonest reason for taken an HIV test. Majority of the respondents (74.2%) were willing to go for VCT Among those who were not willing to go for VCT the commonest reason given was that they were certain they were not infected. CONCLUSION: This study highlights the need to step up efforts to increase the students' awareness of VCT, deepen their knowledge and create the right attitude towards VCT through the mass media and religious bodies. Teaching on HIV/AIDS and VCT should also be incorporated into the school curriculum. A shift from the present clinic based approach to a more routine and widespread public health model will increase access to VCT Stand alone VCT centres should therefore be cited in educational institutions, community centres, marketplaces, youth friendly centres etc. for proximity to the people.

Knowledge, attitude and practice of cervical cancer screening (pap smear) among female nurses in Nnewi, South Eastern Nigeria.

OBJECTIVE: To determine the knowledge and practice of cervical cancer screening among practicing female nurses with a view to sensitizing them as a first step towards increasing screening uptake in the community. METHOD: A self administered questionnaire survey of all the female nurses working in Nnamdi Azikiwe university Teaching Hospital Nnewi center. RESULTS: 144 out of 166 questionnaires were correctly completed and returned. 122 (87%) were aware of the existence of screening services. Although 9.3% had lost relations to cancer of the cervix, only 5.7% had ever undergone a pap smear. While 52 (37.1%) had no reason for not screening, 21 (15%) were afraid of the possible outcome and 35 (25%) felt they were not likely candidates for cancer of the cervix. CONCLUSION: knowledge of cervical cancer screening services among female nurses in Nnewi is high while uptake rate is abysmally poor. There is need to further educate the nurses who will play a major role in enlightening the public on the availability and need for cervical screening services.

Malaria and anaemia in pregnancy in Enugu, south east Nigeria.

Malaria and anaemia contribute tremendously to maternal and prenatal morbidity and mortality. This study was carried out to document the magnitude of the problem in pregnancy with a view to identifying areas of intervention. The subjects were 108 consecutive pregnant women aged 18 to 44 years recruited from the antenatal clinics. 23 (21.3%) had malaria, 35 (32.4%) had anaemia while 20(18.5%) had both malaria and anaemia. The highest incidence of malaria occurred in the second trimester, while anaemia was most prevalent in the third trimester (62.86%) and among primigravidae (37.14%). All the cases of malaria were due to plasmodium falciparum. Six out of the 20 women with both anemia and malaria were admitted and treated. Two low birth weight babies were delivered among the malaria and anaemia group. The incidence rates of malaria and anaemia were 215 and 327 per 1000 pregnant women respectively while the incidence rate of anaemia due to malaria was 571 per 1000 infected pregnant women. There is a need for a more effective intervention to reduce the incidence of both malaria and anaemia in pregnancy.

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.

Contraceptive practice in a teaching hospital in south-east Nigeria.

During the study period of 31 months (1 November 1994-31 May 1997), the sociodemographic characteristics of 200 women attending the family planning clinic of Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi, South East Nigeria were studied. The peak age group of the family planning acceptors was 31-35, constituting 82 (42%) of the study population. Women of parity 5-7 constituted 99 (49.5%) of the study population; 66 (33%) women sought contraception less than 4 months after delivery and 120 (60%) within 1 year of delivery; 104 (52%) were still breastfeeding at time of visit; 120 (60%) had never used any form of contraception. The intrauterine contraceptive device was the most popular method, being chosen by 128 (64%) women, while only five (2.5%) women accepted bilateral tubal ligation. One hundred and eight (54%) women wanted more children in future. Most of the patients acquired knowledge of family planning through clinic personnel (nurses). The contraceptive prevalence rate in relation to deliveries at the hospital over the period of study was only 12.8%. There is a need for increased awareness on the availability and benefits of family planning on child spacing, family health and ultimately population control and society health.

Teenage pregnancy: still an obstetric risk.

A 30-month retrospective and comparative study of the obstetric performance of teenagers and females between 20 and 24 years was performed at Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria. The prevalence of teenage birth was 21.8 per 1000 deliveries. Females aged 2024 years performed better than teenagers with respect to booking status, marital status, preterm delivery, low birth weight and perinatal morbidity. There was no difference with respect to pre-eclampsia caesarean section and perinatal mortality. Teenage birth is still an obstetric risk factor. There is need to foster the advocacy and reproductive health programmes against adolescent pregnancy and teenage marriage.