Case report of an unusual finding of intrauterine contraceptive device in the rectum.

INTRODUCTION: Intrauterine contraceptive device (IUCD) is a safe and effective method of contraception. It is however rarely associated with complications. Migration of this device to the rectum is very rare. We report a case of IUCD migrating to the rectum with the history of missing IUCD strings. PRESENTATION OF CASE: A 32-year-old multipara presented 8 weeks following IUCD insertion with missing thread, ultrasound scan done showed a viable pregnancy with IUCD in-situ. Following vaginal examination, IUCD could not be retrieved. Pregnancy was allowed to continue for IUCD to be retrieved at delivery. She presented again about 6 weeks later with IUCD strings protruding through the rectum and was subsequently removed. DISCUSSION: Uterine perforation and migration of IUCD into the pelvic organs is an uncommon but major complication following insertion of the device. The risk of perforation appears to depend on type of device, skill of the operator and position of the uterus. Postpartum insertion, lactation and atrophic uterus also increase risk of perforation. CONCLUSION: perforation and migration of IUCD to the rectum is a rare but possible complication of following insertion of the device. Family planning providers should continue to undergo training and retraining to minimize complications associated with the use of IUCD.

Association between C-Reactive Protein and low-grade Inflammation among Nigerian women with Polycystic Ovarian Syndrome.

BACKGROUND: There is evidence of a low-grade chronic inflammation reflected by minor but significant increases in circulating levels of inflammatory mediators in polycystic ovary syndrome (PCOS). There is uncertainty about the causal relationship whether it is obesity, insulin resistance, or PCOS. There is a paucity of studies from the West African subregion. OBJECTIVES: The study investigated C-reactive protein (CRP) concentration in Nigerian women with PCOS, and determined the factors that affect their concentration. METHODS: The study was conducted on 71 Nigerian women with PCOS and 76 normal ovulating women, recruited from the University of Benin Teaching Hospital and the Women's Health and Action Research Centre, in Nigeria. CRP levels were measured by the enzyme-linked immunosorbent assay (ELISA) method. Insulin resistance and insulin sensitivity were estimated using the Homeostatic Model Assessment Index and Quantitative Insulin-sensitivity Check Index respectively. RESULTS: The CRP levels were significantly elevated in Nigerian women with PCOS compared to controls (9.93 ± 8.38 vs 5.54 ± 5.93 mg/L; p=0.000). It positively correlated with age (r = 0.297, p = 0.012), Weight (r =0.313, p = 0.008) and BMI (r = 0.339, p = 0.004). Multiple linear regression analysis revealed that CRP values are positively associated with BMI (ß = 0.274, p = 0.001) and PCOS (ß = 0.382, p = 0.001). The CRP values were positively associated with BMI (ß = 0.372, p = 0.012) and negatively associated with QUICKI (ß = -0.644, p = 0.073). CONCLUSIONS: Among Nigerian women with PCOS, inflammation may be mediated through adiposity since the main predicting factor for increased CRP is BMI.

CONTEXTE: Il existe des preuves d'une inflammation chronique de faible intensité, se manifestant par des augmentations mineures mais significatives des taux circulants de médiateurs inflammatoires, dans le syndrome des ovaires polykystiques (SOPK). Il existe une incertitude quant à la relation causale, qu'il s'agisse de l'obésité, de la résistance à l'insuline ou du SOPK. Les études de cette région d'Afrique de l'Ouest sont rares. OBJECTIFS: L'étude a examiné la concentration de la protéine C-réactive (CRP) chez les femmes nigérianes atteintes du SOPK et a déterminé les facteurs qui influent sur leur concentration. MÉTHODES: L'étude a été menée auprès de 71 femmes nigérianes atteintes du SOPK et de 76 femmes à ovulation normale, recrutées à l'hôpital universitaire de Benin et au Centre de recherche sur la santé des femmes et l'action (Women's Health and Action Research Centre) au Nigéria. Les niveaux de CRP ont été mesurés à l'aide de laméthode ELISA (dosage immuno-enzymatique). La résistance à l'insuline et la sensibilité à l'insuline ont été estimées à l'aide de l'indice du modèle homéostatique d'évaluation et de l'indice de vérification quantitative de la sensibilité à l'insuline. RÉSULTATS: Les taux de CRP étaient significativement élevés chez les femmes nigérianes atteintes du SOPK par rapport aux témoins (9,93 ± 8,38 contre 5,54 ± 5,93 mg/L ; p = 0,000). Ils étaient positivement corrélés à l'âge (r = 0,297, p = 0,012), au poids (r = 0,313, p = 0,008) et à l'IMC (r = 0,339, p = 0,004). L'analyse de régression linéaire multiple a révélé que les valeurs de la CRP sont positivement associées à l'IMC (ß = 0,274, p = 0,001) et au SOPK (ß = 0,382, p = 0,001). Les valeurs de la CRP étaient positivement associées à l'IMC (ß = 0,372, p = 0,012) et négativement associées au QUICKI (ß = -0,644, p = 0,073). CONCLUSIONS: Chez les femmes nigérianes atteintes du SOPK, l'inflammation pourrait être médiée par l'adiposité, car le principal facteur prédictif d'une augmentation de la CRPest l'IMC. Mots-clés: Protéine C-réactive, inflammation chronique, syndrome des ovaires polykystiques, indice de vérification quantitative de la sensibilité à l'insuline, indice du modèle homéostatique d'évaluation.

Women's perceptions of reasons for maternal deaths: Implications for policies and programs for preventing maternal deaths in low-income countries.

We investigated perceptions of the causes of maternal mortality by women attending referral hospitals in Nigeria. Focus group discussions were conducted with various categories of women. Our results showed that women were aware of the medical causes of mortality, although a few listed divine reasons. Delays in reaching hospitals or after women arrive in hospitals featured prominently as lead causes mentioned by women. Listening to women as end-users is an important approach to identify points of remediation in the provision of maternal health care. This should be taken into cognizance when policymakers or international agencies plan the prevention of maternal deaths in developing countries.

Perceptions of women on workloads in health facilities and its effect on maternal health care: A multi-site qualitative study in Nigeria.

OBJECTIVE: of the study was to explore women's perception of maternal health care providers' workload and its effects on the delivery of maternal healthcare in secondary and tertiary hospitals in Nigeria. RESEARCH DESIGN, SETTING, PARTICIPANTS: five focus groups discussions (FGDs) were conducted with women in each of eight secondary and tertiary hospitals in 8 States in four geo-political zones of the country. In all, 40 FGDs were held with women attending antenatal and post-natal clinics in the hospitals. We elicited information on women's perceptions of workloads of maternal health providers and the effects of the workloads on maternity care. The discussions were audio-taped and transcribed while thematic analysis was carried out using Atlas.ti computer software. FINDINGS: the majority of the participants submitted that the health providers are burdened with heavy workloads in the provision of maternal health care. Examples of heavy workload cited included complaints from health providers, evidence of stress and strain in care provision by providers and the sheer numbers of patients that are left unattended to in health facilities. Poor quality care, insufficient time to carry out necessary investigations on patients, and prolonged waiting time experienced by women in accessing care featured as consequences of heavy workload, with the secondary result that women are reluctant to seek care in the health facilities because of the belief that they would spend a long time in receiving care. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: we conclude that women are concerned about heavy workloads experienced by healthcare providers and may partly account for the low utilization of referral health facilities for maternal health care in Nigeria. Efforts to address this problem should include purposeful human resource policy development, the development of incentives for health providers, and the proper re-organization of the health system.

HIV-AIDS related maternal mortality in Benin City, Nigeria.

OBJECTIVE: To determine the causes and characteristics of maternal deaths in HIV-infected women. DESIGN: A retrospective study of maternal deaths in a cohort of HIV-infected women. SETTING: A facility-based maternal death review using case records and mortality summaries. METHODS: Thirty seven maternal deaths which occurred in HIV-infected women were reviewed in a university teaching hospital in southern Nigeria over a 4-year period. Causes and circumstances surrounding each maternal death were identified. RESULT: One in every four maternal deaths occur in women with HIV infection. Majority (64.9%) of the women presented in advanced stage (WHO stage III/IV) of HIV syndrome while 86.5% had missed opportunities for antiretroviral programme. Pregnancy-related sepsis was the commonest cause of maternal death. Other common causes were death from tuberculosis and pneumonia. CONCLUSION: HIV-related maternal death is emerging as a leading cause of pregnancy related death in Nigeria. There is need to scale-up preconception care and ensure comprehensive and sustainable prevention of mother -to-child transmission service for all pregnant women throughout Nigeria to reduce the burden of HIV/AIDS infection and minimize avoidable deaths from opportunistic infections.

Spousal disclosure of HIV serostatus among women attending antenatal care in urban Nigeria.

About 80% of HIV-positive pregnant women in our unit have a seronegative spouse. The prevalence, pattern and determinants of spousal disclosure of HIV serostatus was evaluated among 166 HIV-positive pregnant women receiving antiretroviral treatment. Although 146 women (88%) disclosed their HIV serostatus, 20 women (12%) did not disclose their status to their spouse. Non-disclosure was significantly associated with nulliparous (p=0.024) and unmarried women (p=0.026). Fear, regarding spread of the information (57.8%), stigmatisation (53%) and deterioration in the relationship with the spouse (47%) were the three commonest reasons for non-disclosure. Disclosure of HIV-positive status remains a sensitive issue among infected pregnant women. Strategies to reduce the stigma associated with HIV infection, appropriate management of the information following disclosure of seropositive status by HIV-infected persons are necessary to encourage disclosure to sexual partners and ultimately prevent new HIV infections.

Seroprevalence of Hepatitis C viral antibodies in pregnancy in a tertiary health facility in Nigeria.

BACKGROUND: Liver disease due to Hepatitis C viral (HCV) infection is the most common indication for liver transplant. It is a viral pandemic that is five times as widespread as the human immunodeficiency virus type 1 infection. In spite of this, vaccines were yet unavailable for protection of the human race due to the morphology and fastidious nature of the organism. While the scanty data available on this infection in our environment are limited to blood donors, people continue to be screened for and deprived of renal dialysis if any patient is found to have HCV infection. Also in this environment, data on HCV infection in pregnancy is virtually nonexistent even though the infection can have a deleterious effect on materno-fetal outcome. OBJECTIVE OF THE STUDY: To determine the seroprevalence of hepatitis C viral antibodies among antenatal women attending a tertiary health facility in Nigeria. METHODOLOGY: This was a prospective cross-sectional study whose subjects were booked consecutive antenatal women volunteers attending the University of Benin Teaching Hospital, Benin City, Nigeria between June 1 and December 31, 2005. Hepatitis C viral antibodies were determined and confirmed using a second and a third generation Enzyme Linked immunosorbent assay respectively. Both HCV sero-positive and seronegative women had both pre-and post-test counseling. RESULTS: Of the 269 samples screened for HCV antibodies, 5 (1.86%) samples were confirmed seropositive. None of the HCV seropositive women had liver enzyme derangement. CONCLUSION: Hepatitis C viral infection in pregnancy is not uncommon in Nigeria. It's prevalence in pregnant women South-South of Nigerian is similar to that of their Cameroonian counterparts, an immediate neighbouring country. A multi-centre study to determine the national prevalence of HCV and in addition to elevation of public awareness is suggested. Hepatitis C viral-induced liver disease remains the major indication for liver transplant for which our present levels of economy and health infrastructures can least support. With no vaccines and no cure, the time to act is now.

Coitally Related Traumatic Injury of the Female Genital Tract in a Nigerian Urban Setting: A-5 year review.

BACKGROUND: Available evidence suggests that most female lower genital tract injuries are primarily of coital origin and may result in death where prompt diagnosis and treatment is not obtained. Yet there is paucity of recent reports on this clinical entity from our setting. METHODS: This was a retrospective study of the service delivery records of patients with coital trauma seen at the University of Benin Teaching Hospital over 5 years. RESULTS: The incidence of coital trauma was 0.7% of the total gynaecological patients (3,300) seen within the study period. Majority (52.2%) of the patients were nulliparous. A significant proportion (73.9%) of the patients were single and 82.2% had primary or no formal education. Coital laceration occurred in sexual intercourse with boyfriends in 39.1% of patients and casual sex partners in 30.4% of cases. Non-consensual sex was reported in 47.8% of the patients and 39.1% had consensual sex. Sex was pre-marital in 65.2% of the cases. Inadequate or lack of foreplay was a significant predisposing circumstance to coital trauma (56.5%). Pain was a presenting symptom in 60.9% of cases, and same proportion of patients had laceration > 4cm. CONCLUSION: The incidence of coitally associated trauma was low. Nulliparity, low levels of education, non-consensual and premarital sex with little or no foreplay were strongly correlated with the risk of coital trauma. Severe forms of intra-peritoneal complications were not documented in this series. Management strategies were quite adequate.

The prevalence of dual human immunodeficiency virus/hepatitis C virus (HIV/HCV) infection in asymptomatic pregnant women in Benin City, Nigeria.

Concerted efforts have been made to combat HIV infection in Nigerian. By contrast, much less attention has been paid to hepatitis C viral (HCV) infection. These viruses have similar immuno-epidemiology. The objective of this study was to determine the prevalence of HCV/HIV dual infection among 269 antenatal attendees at the University of Benin Teaching Hospital in southern Nigeria. The study was prospective and cross-sectional and consisted of the analysis of the sera of the participants for anti-HCV and HIV antibodies using ELISA. The result showed that 1.86% samples were HCV antibodies positive while 8.30% were seropositive for HIV-1 antibodies. There were no cases of dual infections. The HIV positive women and their babies had antiretroviral therapy. We conclude that dual HCV/HIV infection in pregnancy in Nigeria may be uncommon but suggest multicenter studies to determine the national prevalence while initiating strategies for their prevention.

Perceptions and attitudes of a rural community to abortion in the Niger-delta region of Nigeria.

OBJECTIVE: To determine the perceptions and beliefs relating to unwanted pregnancy, family planning and abortion, and identify issues that can be leveraged to initiate positive attitudes towards family planning and abortion in the area. MATERIALS AND METHODS: Focus group discussions (FGDs) and in-depth interviews (IDIs) were conducted in Amukpe, Delta State, Nigeria. A highly motivated and well-trained team versed in the local language and culture conducted the FGDs and IDIs. RESULTS: There was unanimity that unwanted pregnancies was quite common amongst women of reproductive age group and constitute a significant problem in the community. Abortion, particularly in the hands of quacks was a major option to handling an unwanted pregnancy. Almost all agreed that their culture and religion abhors abortion, yet widely practiced because of the odium associated with an unwanted pregnancy in the community. The knowledge of the Nigeria National abortion law even amongst the health workers and teachers was generally poor. The participants agreed that there were problems and complications (often severe) including death associated with abortion in the community. It was largely agreed that contraceptive knowledge and usage was poor. The reasons adduced for this include lack of knowledge, lack of spousal consent, socio-cultural taboos and misconceptions, as well as economic reasons. It was suggested that imbibing positive family values by parents in their wards and government leveraging the socio-economic status of the community will go a long way to stemming the tide. CONCLUSION: Unwanted pregnancy, unsafe abortion and abortion complications are reported to be common amongst women of reproductive age group in Amukpe community, whilst contraceptive awareness and usage is poor.

Factors associated with the knowledge, practice and perceptions of contraception in rural southern Nigeria.

BACKGROUND: Significant proportion of maternal deaths in Nigeria is due to complications of unsafe abortions, and these abortions are responses to unwanted pregnancies that could have been prevented by effective contraceptive programming. Despite intense programmatic efforts by the Nigerian government and various non-governmental agencies to reverse the trend, there has been little evidence to suggest a systematic improvement in these indicators. METHODOLOGY: A household random survey of 1,528 women aged between 15-49 years was undertaken at Amukpe community in Nigeria, to determine their knowledge, practice and perceptions of contraception. RESULTS: The results showed that 86.2% of the respondents had secondary or less level of education and 19.2% of the respondents were single parents. The level of contraceptive awareness was high (92.3%) and 88% of the respondents became aware of contraception in the last 14 years. Friends/relatives (40.6%), followed by nurses (31.7%) and then doctors (17.3%) were the common sources of contraceptive awareness. The most widely known contraceptive methods were injectables, condoms, POP and OCP. The specific knowledge of emergency contraception was poor. The factors associated with low contraceptive usage were poor level of training and ineffective conveyance of relevant information to clients by health personnel, low literacy levels, extremes of reproductive age and extremes of parity. Others were fear of side effects, lack of knowledge, and lack of spousal consent. CONCLUSION: Contraceptive usage remain poor despite high level of awareness. Effective educational and counseling interventions are likely to improve providers' and consumers' knowledge and subsequent uptake of contraceptive usage.

Pregnancy outcome in women with sickle cell - a five year review.

OBJECTIVES: To evaluate the cases of sickle cell anaemia in obstetric practice, and to highlight their problems in pregnancy as well as their contribution to maternal and foetal outcome in Nigeria. We believe that the findings would be useful for designing interventions to reduce the obstetric burden of sickle cell disease. PATIENTS AND MATERIALS: The service delivery record of 42 pregnancies in 39 patients with sickle cell disease was retrospectively reviewed at the University of Benin Teaching Hospital (UBTH) between January 2000 and December 2004. RESULTS: The incidence of sickle cell disease in the study was 8.7/1000 deliveries. Nearly 62% of the patients were aged 25-34 years, while 76.2% were either nulliparous (Para O) or primiparous (Para 1). There was one grandmultipara (2.38%). Anaemia (95.25%), Malaria (33.33%), Bone pain crisis (23.81%), and pneumonia (19.05%) in that order of frequency were the most common complications of pregnancy. The perinatal mortality rate was 250 per 1000 births while the maternal mortality rate was 47.6 per 1000 pregnancies. At delivery, 20% of cases had caesarean section (5% elective and 15% emergency) and the instrumental interventions include 12.5% vacuum and 27.5% forceps respectively. CONCLUSION: Early booking, good antenatal care and supervised hospital delivery produced a better obstetric outcome.

The state of political priority for safe motherhood in Nigeria.

Achieving the ambitious maternal mortality reduction aims of the Millennium Development Goals will require more than generating sufficient donor support and carrying out appropriate medical interventions. It also will necessitate convincing governments in developing countries to give the cause political priority. The generation of political priority, however, is a subject that has received minimal research attention. In this article, we assess the state of political priority for maternal mortality reduction in Nigeria, which has more maternal deaths in childbirth than any country except India. We also identify challenges that advocates face in promoting priority. We find that after decades of neglect, a policy window has opened for safe motherhood in Nigeria, giving hope for future maternal mortality reduction. However, priority is as yet in its infancy, as advocates have yet to coalesce into a potent political force pushing the government to action. The case of Nigeria suggests that there is an urgent need for safe motherhood policy communities in countries with high maternal mortality to transform their moral and technical authority into political power, pushing policy-makers to action. We offer a number of suggestions on how they may do so.

Attitudes and practices of private medical providers towards family planning and abortion services in Nigeria.

CONTEXT: The study was designed to investigate the attitudes and practices of private medical practitioners towards abortion, postabortion care and postabortion family planning in Nigeria. METHODS: Three hundred and twenty-three private practitioners who were proprietors of private clinics in three states of the country were interviewed with a structured questionnaire that elicited information on their knowledge and experiences of abortion and postabortion care in the cities. RESULTS: Twenty-four percent of the doctors reported that they routinely terminate unwanted pregnancies when requested to do so by women, while 82% reported that they frequently treat women who experience complications of unsafe abortion. Over 45% reported that they use manual vacuum aspiration (MVA) for the management of abortion in the first trimester, while 25% use dilatation and curettage (D and C). Nearly 28% reported the use of MVA followed by D and C in the first trimester. Fifty-seven percent reported their lack of expertise in managing second-trimester abortions, while those admitting that they manage second-trimester abortions reported nonstandard methods and procedures. In addition, there was evidence of inadequate counseling of women, lack of institutional protocols and poor use of postabortion family planning by the doctors. CONCLUSIONS: These results suggest the need for a program of retraining of private practitioners on the principles and practices of safe abortion, postabortion care and family planning in Nigeria and the integration of these topics into medical training curricula in the country.

Knowledge, attitudes and experiences of sex trafficking by young women in Benin City, South-South Nigeria.

Benin City, the headquarters of Edo State, is known to have one of the highest rates of international sex trafficking of young women in Nigeria. This study was designed to determine the knowledge, attitudes and experiences of young women in Benin City, towards international sex trafficking. A random household sample of 1456 women aged 15-25 years was interviewed with a structured questionnaire that elicited information on women's experiences of, and attitudes towards international sex trafficking. The results indicate that 97.4% of the women have heard of international sex trafficking; 70% had female relatives who lived in the receiving countries of Italy, Spain, and the Netherlands; while 44.0% knew of someone who was currently engaged in sex work abroad. Up to 32% of the women reported that they had been approached by someone offering to assist them to travel abroad. Women of poorer socio-economic status (being out-of-school, unemployed, parents uneducated and unemployed) were more likely to report having been offered assistance to travel abroad. Up to 81.5% of the women supported the notion that sex trafficking should be stopped, while 18.5% felt it should be allowed to continue. The perception that sex trafficking leads to wealth creation and economic gains for women was the most common reason proffered by those wanting the practice to continue. By contrast, the fear of adverse health consequences and the need to maintain social and religious morals were the reasons given by those wanting the practice to discontinue. These results suggest that programs that promote the economic well being of women, and social advocacy focusing on harm reduction will be most helpful in reducing the rate of sex trafficking in Benin City.

Knowledge, attitude and practice of private medical practitioners in Calabar towards post-abortion care.

This study examined the knowledge, attitude and practice of private medical practitioners in Calabar on abortion, post-abortion case and post-abortion family planning. Forty eight private practitioners who were proprietors of private clinics in the city were interviewed using a structured questionnaire. The results showed that 22.9% of the doctors routinely terminate unwanted pregnancies when requested to do so by women, while 83.3% of them treat women who experience complications of unsafe abortion. The major reasons given by some of the doctors for not terminating unwanted pregnancies were religious, moral and ethical considerations rather than respect for the Nigerian abortion law. Only 18.2% of the doctors use standard procedures such as manual vacuum aspiration (MVA) for the management of patients with abortion and abortion complications. A good number of them did not routinely practice integrated post-abortion family planning and STDs management. There is need for a comprehensive programme of retraining of private medical practitioners in Calabar on the principles and practices of safe abortion, post-abortion care and family planning. These aspects of reproductive health need to be integrated into the medical training curricula in Nigeria. It is believed that this approach would help reduce the present high rate of abortion-related morbidity and mortality in Nigeria.