A combined case of amelia and phocomelia in a neonate, at JFK Maternity Center, Liberia.

We report a case of spontaneous rare birth deformity. A case of Amelia and Phocomelia in a neonate. Amelia is a rare congenital disorder, even more so, is the combined amelia and phocomelia in a neonate. True Phocomelia was defined as the total absence of the intermediate segments of the limb. With the hand or foot (normal, almost normal, or malformed), directly attached to the trunk. The common aetiological association with phocomelia is from the use of thalidomide and genetic inheritance, as an autosomal recessive trait, involving chromosome 8. Isolated amelia is not generally considered to be of genetic origin. We present a neonate delivered by a 28-years multipara in Liberia, in West Africa Sub-Region, with amelia involving the two upper limbs, right lower limb and a Phocomelia involving the left lower limb (absence of tibia and fibula and feet with three toes). Africa is the only continent not included in the International Clearinghouse for Birth Defects Surveillance and Research. It is hoped that case reports of congenital limb deformities from Africa, will contribute to the formation of a database for birth defects shortly. Funding: None declared.

Novel use of fine needle aspiration (FNA) biopsy to diagnose cervical cancer in a low-resource setting: A case series Morovia, Liberia.

The role of pathology in improving cancer in resource-limited countries is essential, yet many barriers exist. FNA is a rapid, low-cost and efficient method for diagnosing cancer, planning treatment, and building a cancer registry.

Coverage and distribution of obstetricians and gynecologists in Nigeria.

OBJECTIVE: To determine the number, regional spread, and population ratio of obstetricians and gynecologists (OB/GYNs) in Nigeria. METHODS: Data for the present descriptive study were collected between July 1, 2012, and December 31, 2013, as part of a national survey of OB/GYNs. Information was obtained about characteristics, qualifications, place of work, primary employer, subspecialty interest, and type of practice. RESULTS: In total, 968 OB/GYNs were identified, of whom 846 (87.4%) were male. The estimated national population in 2013 was 175651197, which meant that there was one OB/GYN for every 181 458 individuals. Lagos State had the highest number of OB/GYNs (179 [18.5%]), whereas Yobe State had only 2 (0.2%) and Jigawa State 1 (0.1%). The geopolitical region with the highest number of OB/GYNs was the South West (315 [32.5%]), whereas the North East had the lowest number (45 [4.6%]). CONCLUSION: The number of OB/GYNs in Nigeria is inadequate in view of the population size, and coverage varies greatly in different states. Efforts to improve maternal health and reduce the maternal mortality ratio should include more investment in training, engagement, and equitable distribution of OB/GYNs in all parts of the country.

Efficacy of intermittent preventive treatment with sulfadoxine-pyrimethamine on placental parasitemia in pregnant women in midwestern Nigeria.

OBJECTIVE: To assess the effect of intermittent preventive treatment with sulfadoxine and pyrimethamine (IPT-SP) on placental parasitemia and maternal and perinatal outcome. METHODS: We compared placental malaria parasitemia during pregnancy and pregnancy outcome in 2 groups of women receiving antenatal care at University of Benin Teaching Hospital. One group was prophylactically treated with IPT-SP and the other was not treated. RESULTS: The parasitemia rates for peripheral, placental, and cord blood were 11.9%, 11.4%, and 2.7% in the IPT-SP group (n=370) and 19.1%, 22.6%, and 6.2% in the control group (n=371) (P=0.006, P=0.002, and P=0.02, respectively). The treatment reduced the odds of placental parasitemia by 37% (OR 0.63; 95% CI, 0.48-0.81). Peripheral (P=0.002) and placental (P=0.001) parasitemia were significantly reduced in the subgroup of women who took 2 or 3 doses of SP. Fewer women (16.2%) in the IPT-SP group than the control group (23.7%) had symptomatic malaria. Anemia at delivery was significantly lower in the IPT-SP group (10.8 vs 1.6%). The risks of abortion, preterm delivery, and low birth weight were also significantly lower in the IPT-SP group. CONCLUSION: IPT-SP is effective in preventing placental parasitemia, and reduces rates of malaria, maternal anemia, abortion, preterm delivery and low birth weight among pregnant women.

Obstetric complications, intervention rates and maternofetal outcome in teenage nullipara in Benin City, Nigeria.

An audit to determine the incidence of births to teenage nullipara, pregnancy complications, obstetric intervention rates, maternal and fetal outcomes in 114 teenage nullipara compared with 700 randomly selected older nullipara (age 20-29 years), was undertaken in a tertiary Institution. Births to teenage nullipara contributed 1.7% of all deliveries. Teenagers were significantly more likely to be unbooked for antenatal care (P < 0.0001), book late (P < 0.0001) and be single mothers (P < 0.0001). Teenagers were also significantly more likely to have primary education (P < 0.0001), secondary education (P < 0.001) or be apprentices (P < 0.0001). Teenagers had a significantly higher incidence of caesarean sections (P = 0.0002). There were no significant differences in the incidence of pregnancy complications, induction or augmentation of labour, preterm delivery, instrumental deliveries and fetal outcome. The maternal mortality ratio for teenagers was 1835 per 100,000 live births. There were no deaths among the older nullipara. It is concluded that the differences in obstetric intervention rates and maternal outcome are due to poor utilization of antenatal care and other social disparity.

Female genital mutilation: knowledge, attitude and practice among nurses.

BACKGROUND: Female genital mutilation (FGM) and cutting is a subject of global interest, with many countries of the world still practicing it despite efforts by the WHO and other agencies to discourage the practice. The highest known prevalence is in Africa. OBJECTIVES: To determine the knowledge, attitude and practice of FGM among nurses in the ancient metropolis of Benin in a Nigerian state where FGM is illegal. RESULTS: One-hundred-ninety-three nurses in the study hospital were recruited in the study out of which 182 (94.3%) appropriately filled and returned the questionnaires. The average age of respondents was 37 years, and the average duration of postgraduation experience was 14.5 years. Most respondents are of Bini (36.8%) and Esan (34.1%) ethnic origin. All respondents identified at least one form of FGM, but only 12 respondents (6.6%) could correctly identify the four types of FGM. The harmful effects of FGM identified by the majority of respondents include hemorrhage, difficult labor/childbirth, genital tears, infections and scar/keloid formation. Forty-four (24.2%) of respondents were of the opinion that some forms of FGM are harmless. Eighty nurses admitted to having undergone FGM, for a prevalence of 44%. Five respondents (2.8%) view FGM as a good practice and will encourage the practice. Twelve respondents (6.6%) routinely perform FGM out of which seven (58.3%) viewed FGM as a bad practice. Nurses performing FGM routinely were those who had spent >20 years (59%) and 11-20 years (41%) in the profession. Another 26 (14.3%) had performed FGM before, though not on a routine basis. Of this latter group, 15 will perform FGM in the future when faced with certain circumstances. Reasons for FGM practice were mainly cultural. Eight of the respondents would have their daughters circumcised. CONCLUSION: Nurses perceive FGM in Benin as cultural. Almost half have had FGM themselves, and a small percentage recommend it to their daughters. Discouraging FGM practice will require culturally sensitive education of the healthcare providers and the population at large on the ill effects of FGM, including the risk to health and violations of human rights.