Incidence, Determinants, and Outcomes of Spontaneous Preterm Birth at Tertiary Hospitals in Enugu, Southeast, Nigeria: A Cross-Sectional Study.

BACKGROUND: In the past five years, observational evidence suggests that the rates and determinants of preterm birth may have changed due to the effect of the coronavirus disease 2019 (COVID-19) pandemic and other humanitarian crises in our environment. AIM: This study aimed to determine the incidence, associated factors, and outcomes of preterm birth in tertiary hospitals in Enugu, southeastern Nigeria. METHODS: This cross-sectional study included 238 pregnant women from the University of Nigeria Teaching Hospital (UNTH), Enugu State University of Science and Technology Teaching Hospital (ESUT-TH) Parklane, and Mother of Christ Specialist Hospital (MOCSH), Enugu, from April 2022 to March 2023. Eligible and consenting participants were recruited from 28-36 weeks +6 days of gestational age and followed up until delivery. Relevant outcome variables, such as sociodemographic characteristics, gestational age at delivery, and pregnancy outcomes, were recorded in a pro forma. These data were analyzed using IBM Statistical Package for the Social Sciences (SPSS) statistics for Windows, version 22.0, Armonk, NY: IBM Corp. RESULTS: The incidence of preterm birth was 16.6% (37/223), with spontaneous preterm birth constituting 24 of 37 (64.5%) cases. The mean age of participants was 30.3 ± 4.8 years. Advanced maternal age (>35 years) (P = 0.01, adjusted odds ratio (AOR) =0.01, confidence interval (CI): 0.00-0.144), low socioeconomic status (P = 0.04, AOR = 0.40, CI: 0.11-1.46), and history of miscarriage (P = 0.02, AOR = 0.06, CI: 0.01-0.59) were the factors associated with spontaneous preterm birth. Neonatal death occurred in 21.6% (8/37) of cases within the first 24 hours. Rates of cesarean section and low birth weight were 73% (27/37) each. CONCLUSIONS: The incidence of preterm birth is high in Enugu, and associated factors were advanced maternal age, low socioeconomic status, and a history of miscarriage.

Effects of early oral feeding versus delayed feeding on gastrointestinal function of post-caesarean section women in a tertiary hospital in Enugu, Nigeria: A randomized controlled trial.

BACKGROUND: Initiation of oral intake after caesarean delivery influences return of bowel function, ambulation of patients, and time to recover from surgery. AIMS: To assess the effect of early versus delayed initiation of oral feeding after caesarean delivery on gastrointestinal function, pace of recovery, and maternal satisfaction at University of Nigeria Teaching Hospital (UNTH), Enugu. SETTINGS AND DESIGN: This was a randomized controlled study of women who had caesarean delivery from December 2012 to September 2013 at the Department of Obstetrics and Gynaecology UNTH, Enugu, Nigeria. In all, 282 participants were randomized equally into early and delayed oral feeding groups. Oral intake was commenced at 8 h post operation for those in early feeding group and at 48 h post operation for those in delayed feeding group. The primary outcome measure was the time interval from the end of surgery to the return of bowel sound. SUBJECTS AND METHODS: Analysis was by intention-to-treat. SPSS version 16 was used for data entry and analysis was done using cross tabulation and Fisher's exact test for categorical data and independent sample T-test for continuous data. P value of < 0.05 was regarded as statistically significant. RESULTS: Apart from gastrointestinal complications, there was significant difference between early and delayed feeding groups with respect to all the outcome variables: return of bowel sound (17.8 ± 4.3 h vs 35.2 ± 9.4 h; P < 0.001), return to regular diet 48.9 ± 5.2 h vs 85.5 ± 7.0 h; P < 0.001), postoperative time interval to ambulation (20.3 ± 7.0 h vs 30.9 ± 9.6 h; P < 0.001), and maternal satisfaction as estimated with visual analog scale (86.4 ± 10.4 mm vs 40.0 ± 25.9 mm; P < 0.001). CONCLUSION: Early initiation of oral feeding after caesarean delivery is safe and may be associated with earlier return of bowel functions, earlier ambulation, shorter postoperative time interval to become eligible for discharge, and high maternal satisfaction.

Rates and determinants of peripartum and puerperal anemia in Enugu, Nigeria.

BACKGROUND: Anemia in the peripartum or postpartum period could pose a significant risk for maternal morbidity and mortality during and after delivery. AIMS: To determine the rates of anemia at term and in the puerperium and describe the determinants of puerperal anemia among a cohort of women with both normal and cesarean deliveries, following uncomplicated term singleton pregnancies in Enugu, Nigeria. METHODS: A prospective longitudinal study involving women with uncomplicated singleton pregnancies who were recruited at term at two tertiary maternity centers and were followed up with the determination of hemoglobin and ferritin concentrations till 6 weeks after delivery. Data were analyzed with descriptive and inferential statistics at 95% level of confidence using the Statistical Package for Social Sciences computer software version 20.0 for Windows (IBM Corporation, Armonk, NY, USA). RESULTS: A total of 202 women were studied. The mean hemoglobin levels at term, 48 h, and 6 weeks postpartum were 11.1 ± 0.9 g/dL, 10.5 ± 0.8 g/dL, and 11.2 ± 1.0 g/dL, respectively. The proportions of women with anemia at term, 48 h, and at 6 weeks postpartum were 46.0%, 72.8%, and 47.5%, respectively. Forty-eight hours postdelivery, 17.3% had anemia with low serum ferritin compared to 7.4% by 6 weeks postdelivery. Anemia at term (adjusted odds ratio [aOR] 2.02; 95% confidence interval [CI] 1.01, 4.05), anemia at 48 h postdelivery (aOR 6.17; 95% CI 3.30, 11.6), and low ferritin at 48 h postdelivery (aOR 3.11; 95% CI 1.51, 5.09) all increased the likelihood of anemia at 6-week postpartum. CONCLUSIONS: A high proportion of low-risk pregnant women in the study centers could go through delivery with undetected anemia and this would predispose to high rates of postpartum anemia. Screening of low-risk women at term and in the immediate postdelivery periods may be necessary to improve detection of such cases.

Routine cervical dilatation during elective caesarean section. Should we continue?

The caesarean section rate is on the increase globally, with its attendant complications. One of the measures adopted by obstetricians to decrease complications, such as endometritis and blood loss is intraoperative cervical dilatation during elective caesarean section. A multicentre double blind randomised controlled trial was carried out in Enugu, Nigeria, to ascertain the usefulness of this practice. A total of 208 pregnant women were randomised: 104 had intraoperative cervical dilatation and the other 104 did not have their cervices dilated. All the patients had similar preoperative, intraoperative and postoperative care and were followed up to 6 weeks postpartum. There was no significant difference between the two groups. In conclusion, the study shows no benefit in routine intraoperative cervical dilation. Practitioners must make sure that neither the placenta nor fetal membrane is overlying the internal os before they close the uterine wound.

Male partner involvement in female contraceptive choices in Nigeria.

Opposition by male partners is one of the barriers to contraceptive use in sub-Saharan Africa. The study aimed at determining the extent of male partner involvement in female contraceptive (FP) choices in Enugu, south-east Nigeria. Questionnaires were administered to 243 consecutive women attendee of family planning clinic, University of Nigeria Teaching Hospital (UNTH), Enugu from January to June, 2012. A total of 137 women made contraceptive decisions jointly with their partners, which gave a male involvement rate of 56.4%. Only respondents' higher age (≥ 35 years) had significant association with male partner involvement in FP choices (odds ratio (OR) = 2.1; 95% confidence interval: 1.22, 3.51; p = 0.008). Covert contraceptive use rate was 4.9% (12/243). A majority of women attending the FP clinic of UNTH, Enugu involved their partners when making contraceptive choices. Male-partner-targeted family planning programme has the potential to increase uptake of contraception in our environment.

Asymptomatic bacteriuria among pregnant women with sickle cell trait in Enugu, South Eastern Nigeria.

CONTEXT: Asymptomatic bacteriuria (ASB) in pregnancy is a major risk factor for developing acute cystitis and pyelonephritis, especially, among women with sickle cell disease. This study compared the prevalence, pattern, and microbiological characteristics of ASB in pregnancy between sickle cell trait (HbAS) and normal hemoglobin AA (HbAA) genotype subjects. MATERIALS AND METHODS: Culture and sensitivity of mid-stream urine samples were collected from 300 HbAS women and 300 matched HbAA control at the antenatal clinic of University of Nigeria Teaching Hospital Enugu, Nigeria from August 2010 to December 2011. Analysis was both descriptive and inferential at 95% confidence levels. RESULTS: Prevalence of ASB in HbAS and HbAA women were 32.7% (98/300) and 32% (96/300) respectively (odd ratio (OR) =1.03 [95% confidence interval (CI) 0.73, 1.45]). Escherichia coli was the most common organism isolated in both the HbAS group (56.1%, 55/98) and control group (61.4%, 59/96), (OR = 0.80 [95% CI 0.45, 1.42]). The antibiotics with the highest microbial sensitivity were ciprofloxacin 90.8% (89/98) and gentamicin 100% (98/98) for HbAS and HbAA women respectively. CONCLUSIONS: The prevalence of ASB in pregnant women with HbAS in Enugu, Nigeria was high and did not vary significantly from that of woman with HbAA. Therefore, pregnant women irrespective of their sickle cell status would benefit from routine screening for ASB.

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.

Choriocarcinoma in Enugu, South east Nigeria: a need for a shift from mortality to survival.

BACKGROUND: The diagnosis of cancer in Nigeria is often translated to mean an imminent death for the patients. This contrasts the situation in some developed settings where cancer survivorship and its management have evolved. Choriocarcinoma is a rare but curable tumour so; it became necessary to review cases of this curable cancer managed at a tertiary health center in a typical resourced-constrained setting. METHODS: A retrospective analysis of consecutive choriocarcinoma cases managed at a tertiary hospital in Enugu, South-eastern Nigeria over a five year period. Data analysis was descriptive. RESULTS: Five non-metastatic and 10 metastatic cases of choriocarcinoma were managed. The mean age of patients was 33.6 +/- 9.1 years. All patients had vaginal bleeding with a mean duration of 4 +/- 5.19 months. The commonest predisposing factor and metastatic site were abortion (46.7%) and lungs (40.0%) respectively. The mean unit of blood transfusion during treatment was 5.3 +/- 3.8 units. Eight patients (53.3%) died on admission while 7 (46.7%) were lost to follow-up during chemotherapy 20.0% or after chemotherapy (26.7%). CONCLUSION: The case fatality for choriocarcinoma and loss of patients to follow-up in Enugu, Nigeria were high. To shift from this situation of high mortality to that of survival, an improved follow-up of post-abortal patients and aggressive tracing of defaulters are recommended.

Choriocarcinoma in Enugu, South east Nigeria: a need for a shift from mortality to survival.

BACKGROUND: The diagnosis of cancer in Nigeria is often translated to mean an imminent death for the patient. This contrasts the situation in some developed settings where cancer survivorship and its management have evolved. Choriocarcinoma is a rare but curable tumour so; it became necessary to review cases of this curable cancer managed at a tertiary health center in a typical resourced-constrained setting. METHODS: A retrospective analysis of consecutive choriocarcinoma cases managed at a tertiary hospital in Enugu, South-eastern Nigeria over a five year period. Data analysis was descriptive. RESULTS: Five non-metastatic and 10 metastatic cases of choriocarcinoma were managed. The mean age of patients was 33.6 9.1 years. All patients had vaginal bleeding with a mean duration of 4 5.19 months. The commonest predisposing factor and metastatic site were abortion (46.7%) and lungs (40.0%) respectively. The mean unit of blood transfusion during treatment was 5.3 3.8 units. Eight patients (53.3%) died on admission while 7 (46.7%) were lost to follow-up during chemotherapy 20.0% or after chemotherapy (26.7%). CONCLUSION: The case fatality for choriocarcinoma and loss of patients to follow-up in Enugu, Nigeria were high. To shift from this situation of high mortality to that of survival, an improved follow-up of post-abortal patients and aggressive tracing of defaulters are recommended.

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.

Pattern and determinants of antenatal booking at abakaliki southeast Nigeria.

BACKGROUND: Antenatal care is one of the pillars of SAFE Motherhood Initiative aimed at preventing adverse pregnancy outcome. Early antenatal booking is recommended for this benefit. AIM: The objective of this study was to determine the antenatal booking pattern of pregnant women and its determinants. SUBJECTS AND METHODS: A cross-sectional survey of pregnant women attending the antenatal booking clinic at Federal Medical Centre Abakaliki Ebonyi State between April 6, 2011 to August 5, 2011 was undertaken. Epi info 2008 version was used for analysis. RESULTS: The mean age of the respondents was 27.46 (5.81) years and the mean gestational age at booking was 24.33 (5.52) weeks. A total of 83.1% (286/344) of the pregnant women booked after the first trimester while the remaining 16.9% (56/344) booked early. Socio-biological variables and past obstetrics history did not contribute significantly to the gestational age at booking while sickness in index pregnancy, personal wishes, and financial constraint were statistically significant reasons given for seeking antenatal care. Majority of the pregnant women 37.2% (128/344) suggested that the second trimester was the ideal gestational age for booking while 18.3% (63/344) did not know the ideal gestational age for booking. Most pregnant women 81.1% (279/344) knew the benefits of early antenatal care even though they booked late 83.1% (286/344). CONCLUSION: Most pregnant women access antenatal care late at Abakaliki because of misconception and poverty. Health education and subsidization of cost of medical services will help in reversing the trend of late antenatal booking.

Placenta percreta in a booked multiparous woman with minimal risk factors and challenges of management in a low resource setting.

Retained placenta membranes and tissue are responsible for 5% to 10% of postpartum hemorrhage. Placenta accreta occurs in approximately 1 in 2500 pregnancies of which placenta percreta constitutes about 5% of placenta accreta. This portends the rarity of placenta percreta especially in a 32 year old woman with minimal risk factors. Our patient was a G4P3(+0) woman with 2 living male children who presented at 39 weeks plus 2 days gestation in latent phase of labour and transverse lie. She had emergency caesarean hysterectomy due to primary postpartum haemorrhage secondary to placenta percreta. There should be a high index of suspicion of placenta percreta in women with the risk factors and whoever does caesarean section should have the skills for hysterectomy in case of any encounter with placenta percreta not amenable to conservative management.

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.

Prevalence of cervical squamous intraepithelial lesions among HIV-positive women in Enugu, South-eastern Nigeria.

HIV infection is a risk factor for cervical cancer and both diseases are prevalent in Nigeria. The study determined the prevalence of cervical squamous intraepithelial lesion (SIL) among HIV-positive women in Enugu state, which has the highest HIV burden in South-eastern Nigeria. Pap smear was carried out on 150 HIV-positive (HIV+ve) women and 150 HIV-negative (HIV?ve) controls at the University of Nigeria Teaching Hospital, Enugu, Nigeria from December 2007 to March 2008. The prevalence of SIL for the HIV+ve group and the control group were 12.6% and 4.6%, respectively (p = 0.014). Also, the prevalence of each category of SIL identified in the study, was higher among the HIV+ve group. There is an association between HIV infection and SIL in Enugu, South-eastern Nigeria. Cervical cancer screening should be incorporated into the antiretroviral (ARV) clinics, so as to prevent the impending surge in the burden of cervical cancer in Nigeria.

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.

Sexual behaviour of pregnant mothers living with HIV/AIDS in Enugu, Nigeria.

BACKGROUND: More than 80% of pregnant women world wide remain sexually active during pregnancy. Majority of them experience reduction in sexuality especially as the pregnancy progresses. Medical staff should play a more proactive role in providing information on sexuality to HIV positive pregnant women. OBJECTIVE: To evaluate sexualbehavior and activity in HIV positive pregnant women and their sources of information. METHOD: This was a cross-sectional study recruiting ninety six HIV positive pregnant women who attended Prevention of maternal to child transmission clinic (PMTCT) of University of Nigeria Teaching Hospital (UNTH) Enugu south east Nigeria from June to August 2007. Data was collected on age, parity, educational qualification and their sexual behavioral changes in pregnancy before and after diagnosis of HIV infection and their sources of information concerning sexuality in pregnancy. RESULT: Sixty (62.5%) of the pregnant women reported an overall decrease in sexual desire during pregnancy since the diagnoses of HIV in pregnancy. Seventy-eight (81.2%) reported decrease of sexual frequency. Twenty-one (21.9%) had stopped any form of sexual intercourse in the present pregnancy since they were diagnosed HIV positive. Majority of the women (94.6%) practiced vaginal intercourse both during and after the diagnosis of HIV. The majority ( 60%) use condom for sexual intercourse after the diagnoses of HIV in pregnancy as against 51.2% before the diagnoses of the disease. 69.8% of the women did not know the effect of unprotected sexual intercourse with HIV positive partner on maternal to child transmission (MTCT) of HIV. Most of the women (56.3%) got their information on sexual behavior in pregnancy from doctors and other medical staff. 76% believed that these sexual behavioral changes should be discussed with their doctors but only 47.9% had already discussed this with doctors. They want the health workers to initiate discussion on sexuality. CONCLUSION: The findings suggest a decrease in sexuality during pregnancy in HIV positive pregnant women. However some of the pregnant mothers stopped any form of sexual activity as soon as they were diagnosed HIV positive. The majority had started using condom to decrease the transmission of the virus. The health workers should encourage complete fulfillment of safe sexual activity during pregnancy in mothers living with human immunodeficiency virus and AIDS

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.

Multiple antenatal bookings among pregnant women in Enugu, Nigeria.

Some pregnant women do book concurrently with multiple antenatal care providers. Structured questionnaires were administered to women attending antenatal clinics in 12 facilities in Enugu, Nigeria. A total of 535 women responded: 372 (69.5%) were booked into more than one facility and 163 (30.5%) were booked into a single facility; 280 (52.3%) booked into the two Teaching Hospitals and 91 (12.5%) booked with a traditional birth attendant. Reasons for multiple bookings included selecting a facility with affordable prices (43.9%); selecting a facility promising vaginal delivery (35.3%); avoiding HIV testing (17.9%); avoiding caesarean section (10.8%); avoiding being regarded as unbooked (10.1%) and booking into a facility where they were not known. Possible disadvantages were confusion in deciding where to deliver (53.1%); default on expert advice (27.5%); mismanagement (18.7%); delays, complications and death (12.5%). Multiple bookings were common in this study. Disadvantages of this practice, including risk of death, were identified by the women.

Cesarean delivery in preeclampsia and seasonal variation in a tropical rainforest belt.

BACKGROUND: The pathogenesis of preeclampsia is poorly understood and recent evidence suggests that the incidence varies depending upon the season. AIM: This study was carried out to determine whether there is a seasonal variation in the presentation of preeclamptics undergoing cesarean delivery in a tropical rainforest belt. SETTING: A university teaching hospital. STUDY DESIGN: Retrospective. MATERIALS AND METHODS: The hospital records of consecutive patients (July 1996-June 2006) with preeclampsia, who underwent cesarean delivery in a tertiary care centre, were reviewed. Data collected included patient demographics, total number of deliveries, number of cesarean deliveries, and number of preeclampsia patients and time of presentation for cesarean section. Approval of the local ethical committee was obtained. STATISTICAL ANALYSIS: The EPI info software program was used for statistical analysis. RESULTS: A total of 6798 deliveries were recorded during the study period resulting in 6485 live births. There were 1579 cesarean deliveries during the period. Of these, 196 patients had toxemia of pregnancy (166 with preeclampsia and 30 with eclampsia). One hundred and forty-one patients (9% of cesarean deliveries) had cesarean delivery during the rainy season and 55 (3.5%) during the dry season (P < 0.05). Amongst preeclampsia patients, 115 presented (7%) during the rainy season and 51 (3.2%) during the dry season (P < 0.05). In the eclampsia group, 26 (1.65% of cesarean sections) presented during the rainy season and four (0.25%) during the dry season (P < 0.05). CONCLUSIONS: There was a seasonal variation in the cesarean delivery required for preeclampsia/eclampsia patients. This may help in counseling women on when to plan their pregnancy in order to reduce the morbidity and mortality associated with this apparent seasonal disease.

Dispelling the myths and beliefs toward female genital cutting of woman: assessing general outpatient services at a tertiary health institution in Enugu state, Nigeria.

CONTEXT: The practice of female genital mutilation (FGM) has continued because it is deeply entrenched in tradition and culture especially in developing countries where the victims are often its strongest proponents. This study aimed at using accurate information to dispel the traditional myths and beliefs about FGM among woman. METHODS: Using a before and after intervention evaluation research design, interviewer administered questionnaires were administered to a sample of 100 women drawn by systematic sampling from the General Outpatient Department of University of Nigeria Teaching Hospital. Information's on their knowledge, attitude and behaviour towards FGM were elicited pre-and-post intervention. RESULTS: Pre-intervention, knowledge of the respondents on the true meaning of FGM was 54% and that of the 6 complications enlisted on average was 22.2%. Seventy (70.0%) believed that FCM is good and should be continued based mainly on culture and tradition (85.7%). Among the 29(29.0%) respondents against FGM, 26(89.7%) and 24(82.8%) said it increases risk of HIV/AIDS and pregnancy complications respectively. Respondents displayed a high negative and stigmatizing attitude toward the uncircumcised women. Seventy-four (74.0%) said they are promiscuous. Additionally, 49% said they are shameful, 14% cursed/outcast while 66% would not recommend them for marriage. Post-intervention, 85% of the respondents now understood full meaning of FGM and 71.3% on the average knew the complications. While only 11% now support FGM, 83% were against the practice. The stigmatizing attitudes held against uncircumcised women decreased significantly from baseline to post-intervention as follows: promiscuous 74% to 22%, shameful 49% to 12%, outcast/cursed 14% to 2%, and not good for marriage from 66% to 19%. The differences in the baseline and post-intervention data on knowledge, beliefs and attitudes of the respondents toward FGM were statistically significant (p < 0.001). CONCLUSION: Educational intervention programme has been successful used to impact knowledge, change beliefs and negative attitudes of women toward FGM.