Prevalence and antimicrobial susceptibility of asymptomatic bacteriuria among women with pelvic organ prolapse in Abakaliki, South-East Nigeria.

BACKGROUND: Pelvic organ prolapse (POP) is the herniation of pelvic organs from its anatomical confines, and it is of considerable importance to the practicing gynaecologist in middle and low income countries. It is commonly associated with, urinary tract infection (UTI), both symptomatic and asymptomatic due to anatomical and physiological changes. The aim of this study was to determine the prevalence of asymptomatic bacteriuria among women with pelvic organ prolapse, to know the organisms commonly implicated and the sensitivity pattern. METHODS: This study was conducted among 96 women with POP at the National Obstetric Fistula Centre Abakaliki. A cross sectional descriptive study was done. Standard microbial technique was used to analyze the urine. Data was analysed using the Statistical Package for Social Sciences version 17. RESULTS: Out of the 96 patients, 76 were found to have asymptomatic bacteriuria giving a prevalence of 79.2%. Nine different bacteria species isolated include E. Coli (34.2%), Streptococcus pneumonia (23.7%), Staphylococcus aureus (7.9%), Proteus Spp (7.9%) others (5.3%). The highest level of microbial sensitivity to the antimicrobials was with Ciprofloxacin. CONCLUSIONS: This study suggests that prevalence of asymptomatic bacteriuria is very high among women with POP. More than 50% of the bacterial isolates were mainly E.coli and Streptococcus pneumonia. The highest level of microbial sensitivity was with ciprofloxacin while the least was with cotrimoxazole.

Audit of mammography requests in Abakaliki, South-East Nigeria.

BACKGROUND: Breast cancer is the leading cancer in women in both developed and developing countries. Screening mammography detects breast cancer even before a lump can be palpated, with better prognosis. The introduction of mammographic technique for screening breast cancer, despite its importance, has been slow to adopt and virtually non-existent in many parts of Sub-Saharan Africa including Nigeria. For this reason, the indications of mammography have not been well defined in our setting. The aim of this study was to audit our mammography requests, with a view to improving its application in our setting. METHODS: This is a descriptive study carried out on 69 female patients who had mammography at the National Obstetric Fistula Centre, Abakaliki, from January 2014 to December 2015. Findings on clinical examination were entered in a proforma. Mammography was performed in craniocaudal and mediolateral views using the Lorad M-IV (film-screen) mammography machine. Data was analysed using the Statistical Package for Social Sciences (SPSS) version 21. RESULTS: All 69 patients were females. Their mean age was 42.1 ± 11 years. Majority of the patients (69.6%) were between 30 and 49 years. The commonest indication for mammography was breast lump which was found in 46 patients (66.7%). Breast pain was present in 36 (52.2%) of patients. The different Breast Imaging Reporting and Data System (BIRADS) categories were BIRADS 0: 20 (28.99%), BIRADS 1: 8 (11.59%), BIRADS 2: 9 (13.04%), BIRADS 3: 4 (5.8%), BIRADS 4: 19 (27.54%) and BIRADS 5: 9 (13.04%). CONCLUSIONS: Diagnostic mammography remains the commonest indication for mammography in our setting. Public awareness, poverty reduction and ready availability of mammography facilities are required to improve screening mammography in our setting.

Experiences with provision of post-abortion care in a university teaching hospital in south-east Nigeria: a five year review.

The objective of the study was to review the implementation of Post Abortion Care and effective linkage to other post abortion services in Ebonyi State University Teaching Hospital, Abakaliki, Nigeria. Data on PAC over a five year period (July, 2004 to June, 2009) were analyzed and a standardized questionnaire was administered to 45 direct PAC service providers. Abortion complications constituted 41.4% of all Gynaecological admissions. Maternal mortality from complications of abortion was 11.5% of all the maternal mortality at the centre. Women aged 19 years and less were 37 (7.1%) and single women were 132, constituting 25.3% of all cases. About 31% of the PAC care providers had formal training for the implementation of the PAC services. Fifteen percent of the care givers were satisfied with the linkage between PAC and the Family Planning services. There is poor integration between emergency post abortion care and other reproductive health services in the centre.

Pregnant Nigerian women's view of cesarean section.

OBJECTIVE: Cesarean section (C/S) is still being perceived as an abnormal means of delivery by many antenatal women in Nigeria. This study aims to determine the perceptions of antenatal clients in the southeastern Nigeria on C/S. MATERIALS AND METHODS: The study was conducted using a structured questionnaire administered to 300 consenting pregnant clients attending the antenatal clinic. The data were analyzed and presented in a simple frequency table. RESULTS: The average C/S rate in the hospital was 16.6%. Only 4 (1.4%) viewed C/S as very good and elected to undergo C/S. Thirty-four (12.3%) considered C/S as bad and would reluctantly undergo the procedure. Two hundred and twenty-five (81.2%) would accept C/S if their life or that of their fetus is in great danger. CONCLUSION: This study affirms previous suspicion that a significant proportion of antenatal clients are averse to C/S and the negative cultural perception of the people to C/S reinforced this aversion.

Sociocultural impediments to male factor infertility evaluation in rural South-east Nigeria.

This study evaluated the rate and factors influencing male uptake of infertility investigations. Infertility constituted 11.2% of all new gynaecological consultations in the centre during the study period. A total of 61 (70.1%) males consented to seminal fluid studies without much hesitation, 12.4% after much persuasion, while the remainder (17.5%) refused. Obliging doctor's recommendation was the primary motivation for those who willingly had seminal fluid studies while the claim to be healthy and not being responsible for infertility were the commonest barriers for reluctance or refusal to be investigated. Fears of exposure of semen so obtained to witchcraft and rituals were also contributory. Gynaecologists working in rural South-east Nigeria should through systematic public enlightenment dispel misconceptions of necessary medical intervention.

Advocating the new WHO antenatal care model in a free maternity care setting in a developing country.

In a free maternity care setting the number of antenatal clients can be overwhelming for the obstetric staff. Using the World Health Organization (WHO) classifying form, most of the women can be triaged for the basic component of the new WHO antenatal care model. Our aim was to evaluate the risk status of pregnant women in a tertiary health institution providing free maternity care in Nigeria. We interviewed 1022 randomly selected clients using the WHO classifying form at our booking clinic over a 12-month period. The analysis was performed using the epi info statistical program. Seven hundred and sixty-five clients (74.9%) were found eligible for the basic component of the new antenatal care model. The associated risk in pregnancy increased with increasing parity. The basic component of the new WHO antenatal care model can safely be implemented in centres such as ours.

Radiological assessment of the uterus and fallopian tubes in infertile women at Abakaliki, Nigeria.

OBJECTIVES: This study is aimed at determining the pattern of abnormalities in the Hysterosalpingograms of patients who attended the Radiology Unit of Ebonyi State University Teaching Hospital, Abakaliki. METHOD: The 188 hysterosalpingograms conducted between January 2002 to December 2005 were analysed.. RESULTS: The mean age in this study was 31 years. Forty-one (21.8%) Hysterosalpingograms were normal. Abnormality of the Fallopian tubes constituted 54.6% of all abnormalities recorded, uterine 33.6% and cervical 11.8%. Cornual occlusion and hydrosalpinx were the leading abnormalities of the Fallopian tube, 32.2% and 20.3% respectively, while beading of the Fallopian tubes was the least tubal abnormality recorded in 1.4%. Uterine fibroid was the leading uterine abnormality in the study (44.5%), and uterine unicornis unicollis and bicornuate uterus were the least abnormalities of the uterus recorded with 0.8% respectively. Cervical synechiae was the only cervical abnormality recorded in the study (11.8%). CONCLUSION: Hysterosalpingogram is relevant in outlining abnormalities of the fallopian tube and uterus especially in patients with infertility. The study suggests that abnormalities of the Fallopian tube are probably still a prominent contributor to infertility in our community.

A 20-year review of twin births at Mater Misericordiae Hospital, Afikpo, South Eastern Nigeria.

OBJECTIVES: To provide information on twin deliveries among Igbos in a rural/semi-urban community of South-Eastern Nigeria, and compare the twinning rate with data from the other two major tribes. METHODS: An analysis of the records of deliveries conducted over a 20-year period in a rural/semi-urban community of South-Eastern Nigeria. RESULTS: The twinning rate of the community was 1:24, and increased with increasing maternal age, and generally with birth rank. Twin births were associated with a MMR of 895/100,000, and PMR of 213/1000 maternities, figures 3.4 and 1.7 times those of the total maternal and perinatal mortalities respectively. Ninty percent of the twin mothers delivered vaginally, 2% with the aid of symphysiotomy. Caesarean section rate was 10.6%. CONCLUSION: The twinning rate within Nigeria may probably be dictated by location rather than ethnicity. The maternal and perinatal mortalities associated with twin pregnancies in this study appear higher than for singleton births.

Implementing the new WHO antenatal care model: voices from end users in a rural Nigerian community.

CONTEXT: The recommended WHO antenatal focused visits with reduced number of visits and tests is yet to be implemented in many communities in rural Nigeria. AIM: This paper evaluated the attitude of antenatal clients in a rural mission hospital to the new antenatal model. STUDY DESIGN: Focus group discussions were carried out bi-weekly for 12 weeks with consenting booked antenatal clients. The topic guide was developed following interactions with prenatal clients at a referral tertiary center. RESULTS: One hundred and forty-four clients were interviewed. Prior to discussion, none had heard of the new antenatal care model. More than half of them will prefer the traditional policy with multiple visits to the new model. The traditional visit was said to be more reassuring and provides the clients time away from their routine chores/occupations and afford them the opportunity to interact with other expectant mothers and get acquainted with the health care providers. CONCLUSION: To realize the goals of the new WHO recommended antenatal model in rural Nigeria, mass enlightenment and education must precede its gradual and cautious introduction.

Congenital malformations in singleton and twin births in rural Nigeria.

BACKGROUND: The presence of a congenital malformation at birth is a cause of anxiety at an otherwise joyous occasion. Congenital malformations are a significant contributor to perinatal mortality. STUDY DESIGN: A retrospective study of external congenital abnormalities in singleton and twin births in rural eastern Nigeria over a 20 year period. RESULT: The incidence of congenital defects for all deliveries was 110.8/10,000 births. Of 1453 twins and 32206 singleton births, there were 58 and 315 congenital abnormalities, with incidence of 97.8/10,000 births and 399.2/10,000 births respectively. Twins were significantly (x(2) =115.22; p< 0.0000) more likely to have a congenital malformation than singletons (RR 4.08, 95% CI 3.10 - 5.7). The pattern of defects was similar for singleton and twin births and the leading system affected was the musculo-skeletal system, distantly followed by the central nervous system. For both groups the commonest malformation was ulnar polydactyly, followed by hydrocephaly and ankyloglossia. Surprisingly no conjoined twins were recorded and there were only 7 cases of congenital umbilical hernia, abnormalities previously considered to be very common in Nigerians and Africans respectively. CONCLUSION: Twins are about four times more likely to have congenital malformations than singletons. The overall prevalence of congenital malformations recorded is comparatively low. There is need for more detailed routine documentation of all birth defects including post-mortem report and the conduct of prospective population-based epidemiological surveys of birth defects in Nigeria.

Symphysiotomy at the Mater Misericordiae Hospital Afikpo, Ebonyi State of Nigeria (1982-1999): a review of 1013 cases.

One thousand and thirteen (1013) symphysiotomies were performed and 27,477 deliveries were conducted during the period. The symphysiotomy rate in the study period was 3.7%. Fifty-six percent (56%) of the patients who had symphysiotomy were aged 39 years and below, and the mean age was 27.94 +/- 7.16 years. Mothers with maternal age greater than 40 years were at a higher risk for symphysiotomy. Thirty-eight percent (38%) of those who had symphysiotomy were nulliparae, 35% were multiparae, while grandmultiparae accounted for 27%. Cephalopelvic disproportion was the leading indication for symphysiotomy (88%), while arrest of the after-coming head of the breech and previous caesarean section with mild cephalopelvic disproportion were other indications for symphysiotomy. Transient post-operative pelvic and leg pain was the leading maternal complication in the study, while stress incontinence, para urethra/vagina lacerations and vesico-vagina fistula were the other complications highlighted. In the study, 69% of the symphysiotomies performed were for babies with birth weight between 3.0 and 3.9 kg. The record of one maternal death was available and was from massive pulmonary embolism on the third day postpartum. There were 104 perinatal deaths with a perinatal mortality rate of 108.7 per 1000 total births.