Misoprostol versus manual vacuum aspiration for treatment of first-trimester incomplete miscarriage in a low-resource setting: A randomized controlled trial.

BACKGROUND: Manual vacuum aspiration is a safe and effective technology for the treatment of incomplete miscarriage but it is not widely available and affordable in rural areas particularly in low-resource countries. Misoprostol is an alternative to manual vacuum aspiration for the treatment of incomplete miscarriage. AIM: To compare the effectiveness, client acceptability and satisfaction, and cost-effectiveness of misoprostol with manual vacuum aspiration for the treatment of the first-trimester incomplete miscarriage. SUBJECTS AND METHODS: This study was conducted between February 1, 2018 and August 31, 2018 at Alex Ekwueme Federal University Teaching Hospital Abakaliki, Nigeria. 100 participants were randomized to treatment with either manual vacuum aspiration or 600 µg oral misoprostol. The main outcome measures assessed at 1-week follow-up were complete uterine evacuation, client acceptability and satisfaction, and cost-effectiveness. Data were analyzed using SPSS version 25. Sociodemographic characteristics, treatment outcomes and other variables were summarized by descriptive statistics. Chi-square test was used for comparison between groups as regard categorical data while Student's't' test was used for comparison between groups for continuous data. P value of <0.05 was regarded as statistically significant. RESULTS: There was a higher failure rate in the misoprostol arm when compared with MVA. Although this difference in complete uterine evacuation rate did not reach statistical significance (81.3% versus 95.7%, RR = 4.3, 95% CI 0.98-18.9, P value = 0.05), more participants in the misoprostol arm would choose the method again when compared with women in the MVA group (47 versus 30, X[2] = 16.95, P < 0.001). The mean client satisfaction score was significantly higher among women in the misoprostol arm compared to MVA group (13.2 (2.1) versus 7.3 (4.6), P < 0.001). The mean cost of primary treatment was higher in the MVA group compared with misoprostol arm ($67.8 (8.9) versus 14.4 (4.0), P < 0.001). There was no significant difference in the mean cost of repeat uterine evacuation in both study arms (MVA, $64.9 (6.3) versus misoprostol, $65.76 (6.6), P = 0.86). CONCLUSION: Although medical treatment was associated with a higher failure rate, there was no statistically significant difference in the effectiveness of both treatment methods. However, medical treatment was associated with higher client acceptance and satisfaction and was more cost-effective than surgical treatment.

Appraisal of willingness to vaccinate daughters with human papilloma virus vaccine and cervical cancer screening uptake among mothers of adolescent students in Abakaliki, Nigeria.

BACKGROUND: By the end of 2017, human papillomavirus (HPV) vaccine had been introduced in 80 countries, but Nigeria proposes introducing the vaccine into her routine immunization program from late 2020 or early 2021. The current mode of HPV access in the country is through out-of-pocket purchase with only 1.4% of adolescent girls being vaccinated. Cervical cancer has remained the second highest cancer among women in Nigeria, and the incidence rate is significantly higher than the global rate. This study assessed the factors associated with HPV awareness and willingness to vaccinate daughters among mothers of female secondary school students in Abakaliki. MATERIALS AND METHODS: A cross-sectional study was carried out among 290 mothers of female students selected through multistage sampling technique using a pretested self-administered questionnaire. Data were analyzed with Epi Info™ version 7. RESULTS: The mean age of the mothers was 42 ± 8 years, and 72.8% attained at least secondary education, while 37.2% were traders. Their awareness of HPV and uptake of cervical cancer screening were low, 42.8% and 9%, respectively. Although 89.1% were willing to vaccinate their daughters, only 6.9% of their daughters had ever received HPV vaccine. Lack of awareness on HPV vaccine and cost of purchase were the most cited reasons for low vaccine uptake. Education, screening status, mother-daughter vaccination status, and willingness to encourage others on HPV vaccine for daughters were significantly associated with HPV awareness. CONCLUSION: Most of the mothers were willing to vaccinate their daughters with HPV vaccine, but they lack awareness and the financial resources for the access. There is an urgent need for vigorous enlightenment campaigns on HPV vaccine and cervical cancer screening. Adding HPV vaccine in the routine immunization program will improve universal access and address financial concerns.

Impact of visual inspection with acetic acid plus cryotherapy "see and treat" approach on the reduction of the population burden of cervical preinvasive lesions in Southeast Nigeria.

OBJECTIVE: The aim of this study is to determine the impact of visual inspection with acetic acid (VIA) plus immediate cryotherapy on the prevalence of VIA-detected cervical squamous intraepithelial lesion (SIL). METHODS: Women in four rural communities in Southeast Nigeria were screened with VIA. Women who tested positive to VIA were offered either immediate cryotherapy or large loop excision of the transformation zone based on predetermined eligibility criteria. Cervical biopsies were taken before cryotherapy and examined by consultant histopathologists. All participants were rescreened 1 year later. The main outcome measures were population prevalence of cervical precancers before and after intervention, cure rates, and over-treatment rates. RESULTS: A total of 653 women participated in the study. The prevalence of cervical SIL before the intervention was 8.9% (58/653). The prevalence 1 year later was 1.4% (9/649). This gave an 84.3% reduction in the population prevalence of SIL. The reduction in cervical SIL prevalence was statistically significant (P = 0.0001). The prevalence of high-grade SIL reduced significantly from 4.1% (27/653) preintervention to 0.5% (3/649) 1 year postintervention (P = 0.0001). This gave an 87.8% reduction in the population prevalence of high-grade SIL. Cryotherapy provided a cure rate of 87.9% (95% confidence interval: 76.82-94.33). CONCLUSION: Population cervical cancer prevention using VIA plus immediate cryotherapy leads to significant reduction in the population prevalence of cervical SIL. This has the potential of being an acceptable supplement to cervical cytology for cervical cancer prevention in low-income populations.

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.