Antenatal screening for syphilis at the University of Nigeria Teaching Hospital, Enugu, Nigeria--a six year survey.

Between January 1979 and December 1984, 29,083 out of 42,515 antenatal patients booking at the Antenatal Clinic of the Department of Obstetrics and Gynaecology of the University of Nigeria Teaching Hospital, Enugu, underwent full screening for syphilis. The results showed that 890 patients (3.06%) had positive VDRL test. Of those that reacted positively in the VDRL test, 103 (11.6%) had positive TPHA test. A prevalence rate of sero-positivity of 0.35% was obtained indicating a low incidence of syphilis in our pregnant women compared with results from other parts of Nigeria. A strong recommendation was made to treat all seropositive cases whether there was historical or clinical confirmation of syphilis or not.

Incidence of yeasts in pregnant and non-pregnant women in Nigeria.

The yeast flora of vagina and associated sites (cervix, urethra, perineum and rectum) in 224 pregnant and 106 non-pregnant Nigerian women was investigated. A variety of yeasts represented by 12 species were isolated. Candida albicans was the most frequently isolated species in both groups, accounting for 63.6% of the isolates from pregnant women and 44.8% of the isolates from non-pregnant women. Other species of yeasts infrequently or occasionally encountered were Torulopsis glabrata, C. tropicalis, C. pseudotropicalis, C. parapsilosis, C. krusei, C. guilliermondii, C. stellatoidea, T. candida, T. etchellsii, Saccharomyces cerevisiae, Rhodotorula rubra and Cryptococcus uniguttulatus. C. albicans was also the principal species recovered from symptomatic cases in both groups, followed by T. glabrata in pregnant women and C. parapsilosis in non-pregnant women.

Maternal mortality in Anambra State of Nigeria.

The maternal mortality rate (MMR) in 10 hospitals scattered all over Anambra State in a 5-year period was studied. The hospitals covered urban, semi-urban and rural areas. The MMR varied from 1.8 to 13 per thousand with a mean of 4.97 per thousand. The causes of and various factors influencing this high mortality rate are examined as well as the avoidable factors. Suggestions are made for its reduction based on accurate data collection, improved health facilities, improved socio-economic status and basic education.

PIP: The maternal mortality rate in 10 hospitals scattered all over Anambra State, Nigeria, in a 5-year period were studied. The hospitals covered urban, semi-urban and rural areas. The maternal mortality rate varied from 1.8 to 13/1000 with a mean of 4.97/1000. This mean is 45 times the rate in England in 1978 and also compared less favorably with some other figures from third world sources. Attributable causes included obstetric hemorrhage (23%), ruptured uterus (27.6%), obstructed labor (13%), sepsis (12.1%), eclampsia (7.9%), anemia (2.9%), septic abortion (2.1%) and other causes. 16.7% of deaths were among 16-20 year olds; 14.6% among 21-25 year olds, 27.2% among 26-30 year olds; 18.8% among 31-35 year olds; and 22.6% among women older than 35. 87.5% of the women were unbooked. Of the 239 cases, 51 delivered vaginally, 162 by cesarean section, 12 by breech, 5 by TOP and 5 by destruction. Parity and age were important influences; at highest risk were primigravida and the grandmultipara, especially between para 4 and para 5. All the major causes of death are avoidable--either by obtaining prenatal and intrapartal care or by anticipating fetopelvic disproportion or abnormal lie. Lack of access to health facilities, especially in the rural areas, poor transportation, great distances to nearest health facility, are all implicated in obstructed labor deaths. Most cases of hemorrhage are avoidable through early diagnosis and recognition of high risk cases, prophylactic measures and availablity of blood transfusion and surgical delivery. Lack of antibiotics and non-adherence to normal aseptic precautions were also problems, especially in the 5 deaths from illegal abortions. Changes in the mortality rate can be made by accurate data collection, improved health facilities, improved socioeconomic status and basic education.

Opening addresses.

PIP: The theme of the 3rd International Conference of the Society of Gynecology and Obstetrics of Nigeria (SOGON) held October 26, 1986 in Enugu was maternal morbidity and mortality in Africa. The opening addresses emphasize the high maternal mortality rate in Africa and SOGON's dedication to promoting women's health and welfare. In order to reduce maternal mortality, the scope of this problem must be made evident by gathering accurate mortality rates through maternity care monitoring and auditing. Governments, health professionals, educators, behavioral scientists, and communication specialists have a responsibility to improve maternal health services in this country. By making the population aware of this problem through education, measures can be taken to reduce the presently high maternal mortality rates. Nigerian women are physically unprepared for childbirth; therefore, balanced diets and disease prevention should be promoted. Since about 40% of deliveries are unmanaged, training for traditional birth attendants should be provided. Furthermore, family planning programs should discourage teenage pregnancies, encourage birth spacing and small families, and promote the use of family planning techniques among men. The problem of child bearing and rearing accompanied by hard work should also be investigated. For practices to change so that maternal mortality rates can be reduced, attitudes must be changed such that the current rates are viewed as unacceptable.^ieng

Maternal mortality at the University of Nigeria Teaching Hospital, Enugu: a 10-year survey.

PIP: A review of maternal mortality at the University of Nigeria Teaching Hospital (UNTH) Enugu between January 1976 and December 1985 has been made. Deaths up to 6 weeks of puerperium from direct, indirect, and incidental causes were included but abortions were excluded. There were 47,361 deliveries and 127 maternal deaths giving a maternal mortality rate of 2.7/1000. There has been a downward trend in the mortality rate from 5.46 in 1976 to 1.99 in 1985. Comparing mortality rates according to booking status, it was observed that mortality rates were 48 times higher in unbooked patients. It was observed that overall that deaths increased with increasing maternal age except in the 26-30 age group. Whereas only 0.16% of women aged 26-30 died, 2% of women 40 died. The highest mortality rates are in primigravida and grand multipara. The main causes of death were obstructed labor plus ruptured uterus (35%), obstetric hemorrhage (25.98%), eclampsial severe/preeclampsia (11%), and sepsis (10.24%). Other causes of death include anesthetic, amniotic fluid embolism, jaundice in pregnancy, congestive cardiac failure, pulmonary embolism, and severe anemia. Factors influencing this high mortality include antenatal care, maternal age, and parity. The majority of these deaths are avoidable through adequate blood transfusions, attention to details and better case management, improved medical services, recognition of severe problems by patients and family, and immediate medical care. Futhermore, faults may lie either with the patient, the hospital, the medical team, the government or the system or a combination of these factors. The ways to reduce the high maternal mortality are improved standard of living, raising the literacy level, improved structural facilities and social amenities, better communication and transportation, increased number of hospitals, blood transfusion services, better case management, and a high level of utilization of available facilities.^ieng

Appendices removed at cesarean section: histopathology.

Appendices removed from 100 healthy Nigerian Igbo women during elective cesarean operation and examined microscopically as three random cross sections showed that lesions categorized as luminal pus, luminal fibrosis, mucosal ulceration, muscular inflammation, crypt abscess and crypt necrosis were present in numerous sections. As elsewhere, these asymptomatic patients might have had clinical acute appendicitis in the puerperium. to explain the possible outcome in the rest of such patients, the crypt of Lieberkühn was advanced as a research-worthy histopathologic unit. Thus, in the natural history of the disease, both crypt abscess and crypt necrosis are contrastable bipolar lesions. In all probability, worldwide research on these intriguing lesions will reveal crucial clues to one or more facets of the pathogenesis of appendicitis. [Key words: Appendicitis, pathogenesis; appendix, histopathology]

Pelvic abscess in gynecologic patients.

A survey of an 8-year period in which 37 cases of pelvic abscess occurred in a Nigerian hospital department of obstetrics and gynecology is presented. All 37 women were surgically treated; one death occurred postoperatively. A regimen of 400 mg of metronidazole three times daily combined with appropriate antibiotics is recommended as the treatment of choice, even where laboratory confirmation of anaerobic involvement is unavailable.

The iron status of anaemic pregnant Igbo women in Nigeria.

The iron status of 120 anaemic pregnant Igbo women was investigated. Of the 120 patients whose haemoglobin was less than 10%, 30 (25%) had iron deficiency anaemia; 89 (74%) had megaloblastic anaemia (most probably due to folate deficiency), while 1 had Hb sickle cell disease. Malaria parasites were detected in only 7.5% of our patients, and seemed not to have a important factor in the causation of anaemia.

Perforation of the appendix during pregnancy: a rare complication of endometriosis. Case report.

Perforation of the appendix in a 23-year-old Nigerian Igbo woman during the 35th week of pregnancy is reported. In the perforated area, the wall of the appendix was replaced largely by decidualized endometriotic tissue.

Child spacing and child mortality among Nigerian Igbos.

Until recently, a birth interval of at least two years was the norm in the Nigerian Igbo culture, a practice necessary for infant health and survival. A study of antenatal patients of the University of Nigeria Teaching Hospital, Enugu, Nigeria, shows that this cultural pattern has been disrupted by Westernization, urbanization and consumerism. The patients studied had an average of four pregnancies in five years. Roughly half of those conceived did not survive: 41% of the patients reported having lost at least one child. Modern family planning methods are urged as replacements for the abandoned traditional methods of child spacing.

PIP: Birth intervals and infant and child mortality among the Igbos of Nigeria were assessed using interview data collected from a random sample of married women who attended the antinatal clinic of the University of Nigeria Teaching Hospital in Enugu, Nigeria. Major findings were 1) birth intervals decreased markedly from in the past when the Igbo followed the traditional pattern of spacing children 2 years apart and 2) approximately 40% of the children born to the sample of women did not survive. The shorter birth intervals were attributed to the reduction in breast-feeding which occurred when commercial infant milk products were introduced into the culture. The closely spaced births resulted in a higher number of infant deaths. Mothers who lost their babies were in turn likely to become pregnant again in a short period of time. The interviewed women ranged in age from 14-14 and the average age was 25.19. The women were married for an average of 16.5 years. The number of pregnancies experienced by the women ranged from 1-12 and the average women experienced 3.9 pregnancies but only had 2.4 living children. Major findings were presented in 4 descriptive tables.

Bacteriologic study of IUDs removed from Nigerian Igbo women.

Intrauterine contraceptive devices (IUDs) removed from 50 Igbo women were subjected to bacteriologic studies. High vaginal swabs from the women were cultured simultaneously. In 49 of the 50 IUDs, the culture was negative. The author concludes that the African IUD wearer, like her Caucasian peer, can safely combat any bacterial nidus introduced during device insertion.

Etiological factors in infertility in Enugu, Nigeria.

PIP: 114 couples in Nigeria were studied for the causes of their infertility. Primary infertility was present in 70 cases and secondary infertility in 44; period of infertility ranged from 1-20 years and 21% of the women became pregnant during the course of investigation and treatment. A positive female causative factor such as blocked tubes, anovulatory cycle, and chronic endometritis was found in 57 patients (51.8%) and male factor was present in 48.2% of cases. 34 patients and hypospermia and 10 azoospermia; in 11 cases the motility was low and there were 2 cases of necrospermia with good sperm count. Like this study, other investigations have found a high male contribution to infertility, of as much as 51%; the cause of high levels of hypo- and azoospermia is unknown. Infection of the genital tract is the most common cause of infertility. Research is needed on normal sperm count in fertile Nigerians and the causes of male infertility.^ieng

Burst abdomen following cesarean section.

Fifty-one cases of burst abdomen occurred following 1 988 cesarean sections performed at the University of Nigeria Teaching Hospital over a 5-year period. The incidence of this occurrence was 2.6% (2.3% if all laparotomies in both obstetrics and gynecology are combined). The risk was three times as great for "unbooked" patients, who were first seen in labor. Possible etiologic factors and preventive measures are discussed.