Abnormal hysteroscopy findings among a cross section of infertile Nigerian women.

BACKGROUND: Intrauterine lesions are important causes of infertility. This study aims to evaluate the abnormal findings at hysteroscopy among infertile women seen in 2 new Fertility/Gynaecological Endoscopy units in Nigeria. METHODS: A prospective study of 159 infertile women who had diagnostic hysteroscopy in Nnamdi Azikiwe University Teaching hospital Nnewi and Holy Rosary Specialist Hospital, Onitsha to evaluate the intrauterine lesions seen. Data analysis was done with STATA software, version 12.0 SE (Stata Corporation, TX, USA). RESULTS: Secondary infertility was the major type of infertility seen in 56.6% (n = 91) of cases and the mean duration of infertility was 4.3+/- 2.8 years. The indication for hysteroscopy was routine evaluation for infertility in 83.6% cases (n = 133). One hundred and twelve (70.4%) of the women had abnormal findings at hysteroscopy. The lesions detected were intrauterine adhesions (47.8%; n = 76), endometrial polyps (17.6%; n = 28), submucous fibroids (11.9%; n = 19) and mullerian duct abnormalities (10.7%; n = 17). Other findings were lost intrauterine copper devices (IUCD; 6.3%, n = 10), embedded fetal bone (2.5%; n = 4) and incarcerated omentum (1.9%; n = 3). Intrauterine adhesions were mainly moderate (40.8%; n = 31) and mild (34.2, n = 26) in severity while the submucous fibroids were mostly of type 0 (63.2%; n = 12). The commonest Mullerian abnormality seen was arcuate uterus (41.2%; n = 7). CONCLUSION: There was a high prevalence of abnormal findings on hysteroscopy among the studied women mostly intrauterine adhesions, endometrial polyps and submucous fibroids. These findings indicate a need to incorporate hysteroscopy in the routine evaluation of female infertility in the region.

Proximate determinants of antenatal care utilization among women in southeastern Nigeria.

BACKGROUND: In order to scale up Antenatal services, there is need to determine the factors that deter women from accessing antenatal care. AIM: To determine the proximate factors that affect utilization of antenatal care among market women in Nnewi, southeastern Nigeria. MATERIALS/METHOD: A cross sectional survey of 400 market women using semi structured questionnaires and focus group discussions. RESULT: Out of the 398 studied women, 97.2% attended antenatal care in their last pregnancy. Most (64.5%) of them booked after the third trimester and majority of the women received antenatal care from the private specialist hospitals (37.4%), followed by the private general practice hospitals (34.7%) and government hospitals (17.8%). The main reasons for choosing antenatal care facilities were the perceived friendliness of the staff (33.9%), availability of staff always (27.4%) and proximity of the facility (17.4%). Financial considerations accounted for 4.5% of the reasons for the choice of facility. There was no significant influence of age, parity and religion on the utilization of antenatal care. However, the likelihood of ANC attendance was significantly lower among the house wives (x2 = 14.2; p = 0.0). There was no association between choice of facility for ANC and age, parity, occupation or religion. The main reasons identified by the FGD discussants for preferring the private hospitals were more friendly and available staff. Also late booking was mainly attributed to wrong advice from friends and husbands refusal to provide money. Antenatal care attendance rate was high among the studied women and most of the women utilize private hospitals for care. Staff friendliness and availability at all times were the main reasons for choice of ANC facilities. There is the need to address the negative attitudes of the staff in government hospitals.

The outcome of prevention of mother to child transmission (PMTCT) of HIV infection programme in Nnewi, southeast Nigeria.

BACKGROUND: A lot of challenges face the current efforts at reducing Mother to Child transmission of HIV infection (MTCT) in Sub Saharan Africa due to limited access to Highly active antiretroviral therapy (HAART) and breast feeding practices. A regular review of progress is necessary in order to identify areas of need. METHOD: This is a one year prospective descriptive study of seven hundred and twenty six mother-infant pairs managed in the PMTCT programme in Nnamdi Azikiwe University Teaching Hospital, Nnewi Southeast Nigeria. The babies HIV status was tested with PCR for HIV DNA while the mothers provided information on infant feeding pattern and the use of antiretroviral (ARV) drugs including prophylaxis for the baby. Information was augmented from the antenatal records. RESULT: The transmission rate was 2.8% for mothers, who were on HAART, did not breastfeed and whose babies received ARV prophylactic therapy. But for mothers who did not receive HAART, did breastfeed and whose babies did not received ARV prophylactic therapy, the transmission rate was 37.5%. When both the mother and child received ARV drugs, the transmission rate was significantly lower in those who did not breastfeed (2.8%) than in those who breastfed (12.5%)(P < 0.001). When both the mother and child did not receive ARV drugs, the transmission rate significantly lower in those who did not breastfeed (21.1%)than in those who breastfed (37.5%) (P < 0.02). CONCLUSION: The use of HAART in PMTCT programme in the under resourced areas can achieve similar success rates to that in the industrialized countries. Breastfeeding reduces the efficacy achieved by the use of ARV drugs. Provision of wider access to HAART as well as adequate counselling and support for safer infant feeding practices is recommended.

Contraceptive choices and practices among urban women in southeastern Nigeria.

BACKGROUND: Determining the contraceptive choices among the women is the first step in scaling up family planning methods. OBJECTIVE: To determine the contraceptive choices and practices as well as the underlining factors among market women in Nnewi, southeastern Nigeria. SUBJECTS/METHOD: This is a cross sectional descriptive study of market women, that assessed their contraceptive choices and practices. RESULT: Knowledge about family planning was 96.5%. One hundred and seventy five (44.0%) of the interviewed women were currently using a family planning method while 59.0% had ever used a method. The common methods in use were the natural method (24.1%), withdrawal method (7.5%) and the IUCDs (6.1%). The commonest ever used method was the natural method (26.7%) followed by withdrawal method (10.6%) and condom (7.8%). Fear of family planning commodities interfering with future fertility was the commonest reason for non use of family planning services (14.6), followed by the fear of the side effects (10.6%). Seventy one (17.8%) of the non-users had no reason. The use of family planning services was significantly high among the women aged 35 and above (x2 = 9.98; P = 0.04) and the (x2 = 23.8; P = 0.00). Focus group discussions indicated that husband's refusal, fear of side effects, cancer and delayed fertility were the main barriers to the use of family planning methods. CONCLUSION: The contraceptive prevalence rate among Nnewi market women is high and cuts across all religions and social classes. However, the methods in common use are associated with high failure rates. The use of the more reliable methods should be encouraged.

Awareness and practice of post abortion care services among health care professionals in southeastern Nigeria.

This study investigates knowledge and practices of post abortion care (PAC) services among health care professionals in the Anambra State of southeastern Nigeria. This was a prospective, cross-sectional, questionnaire based study conducted between 1 June and 30 September, 2006. The study involved a multi-staged sampling of all registered health facilities in Anambra State, with the selection of 60 health facilities from which 450 participants were recruited. A pre-tested, structured questionnaire was employed to obtain information from the studied respondents. Obtained data were analyzed using Epi-Info version 2001. A total of 437 questionnaires out of 450 administered were accurately completed, giving a response rate of 97.1%. The respondents were comprised of general practitioners (214, 49.0%), nurses (161, 36.8%), specialist doctors (56, 12.8%), and resident doctors (5, 1.1%). The mean age of the respondents was 38.2 +/- 10.5 years. Most participants (203, 52.6%) were males; the majority (282, 64.5%) were working in the rural areas of the State, including mission hospitals (165, 37.8%) and general hospitals (145, 33.3%). Three hundred thirty respondents (75.5%) were aware of PAC services. Twenty-seven (6.2%) and 28 (6.4%) of respondents were aware of community partnership and family planning services, respectively, as elements of PAC. Although the majority of respondents (302, 69.1%) treated abortion complications, only 155 (35.5%) used a manual vacuum aspirator. Three hundred thirty-eight (88.8%) offered counseling services, and 248 (56.8%) provided referrals to other reproductive health services.

Clinicopathological analysis of cervical cancer seen in a tertiary health facility in Nnewi, south-east Nigeria.

Cervical cancer remains the commonest gynaecological cancer among women in the developing countries. The records of all the histologically confirmed cervical cancer patients managed in Nnamdi Azikiwe University Teaching Hospital, Nnewi, over a 5 year period were analysed for the clinical presentation and histological pattern of the malignancy. A total of 75 cases of cervical cancer were managed over the period giving an incidence of 65.2% of all gynaecological cancers and 13.4% of all gynaecological admissions. The majority of the patients were grandmultiparous women (81.3%) with a mean parity of 6.8. The modal age range was 60-69 years (38.7%) and the majority (94.7%) of the patients belonged to the low socioeconomic class. Squamous cell carcinoma of varying differentiation (89.3%) was the commonest histological type seen and adenocarcinoma accounted for only 8.0%. The common clinical features were post-menopausal bleeding (84.0%), vaginal discharge (72.0%), contact bleeding (63.9%) and abdominal pain (56.2%). Most (89.3%) of the patients presented late, in advanced stages of the disease, and almost all (97.3%) were referred for radiotherapy. The incidence of cervical cancer is high in our environment. Community sensitisation and provision of free cervical screening is recommended for early detection and treatment.

Pattern of semen fluid abnormalities in male partners of infertile couples in southeastern, Nigeria.

BACKGROUND: The incidence of male infertility is increasing in our environment. There is a need to evaluate the pattern of abnormality with a view to recommending appropriate interventions. We aimed to to analyze the seminal fluid parameters of the male partners of the infertile couples managed in the hospital over a 12 month period and to identify the pattern of abnormalities. METHODS: A retrospective study of all the semen samples of male partners of infertile couples submitted for analysis to the microbiology laboratory of Nnamdi Azikiwe University Teaching Hospital, Nnewi Nigeria between 1st January 2006 and 31st December 2006 The reports of the semen fluid analysis were retrieved from the records department and supplemented with the laboratory register. RESULT: Out of the 348 semen sample reports evaluated, 237 (68.0%) had semen fluid abnormalities. 104 (30.0%) had single factor abnormalities while 133 (38.0%) had combined factor anomalies. Asthenozoospermia 58 (16.7%) was the main single abnormality, while Astheno-oligozoospermia 51 (14.7%) and Astheno-oligoteratozoospermia (13.2%) were the major combined factor abnormalities detected. Very few 5 (1.4%) of the patients had azospermia. CONCLUSION: The study showed a high rate of semen fluid abnormalities among the male partners of infertile women in our environment. The high preponderance of poor motility emphasizes the need to include men in programmes aimed at reducing sexually transmitted infections in Nigeria.

Vaginal hysterectomy in a Nigerian tertiary health facility.

BACKGROUND: Despite evidence that vaginal hysterectomy offers advantages in regard to operative time, complication rates and return to normal activities, gynaecologists remain reluctant to change their practice patterns because of concerns about safety and feasibility of the vaginal approach. We reviewed cases of vaginal hysterectomies done in Nnamdi Azikiwe University Teaching Hospital Nnewi, Nigeria over a ten year period. METHOD: This is a retrospective analysis of cases of vaginal hysterectomy that were done in the hospital between 1st January 1998 and 31st December 2007. Data was analyzed with Epi info version 3.3.2. Outcome measures include duration of hospital stay, indication for the surgery, postoperative morbidity and mortality and the need for blood transfusion. RESULT: Hysterectomy accounted for 224 of 1,370 gynaecological surgeries (16.4%). Vaginal hysterectomy was responsible for 47 (21.0%) of these 224 cases and accounted for 3.7% of all gynaecological surgeries. Majority of the patients were in the 7th decade of life with a mean age of 65.2 +/- 6.8. Most (87.5%) patients were retired farmers and grandmultiparous with a mean parity 6.5 +/- 2.4). Utero-vaginal prolapse was the only indication for the surgery. The only postoperative complication accounted was febrile morbidity which was reported in 5 (10.6%) of the patients had febrile morbidity. There were no cases of conversion to abdominal procedure. All the surgeries were done by the consultants. CONCLUSION: Vaginal hysterectomy was safe and associated with minimal morbidity to the patient. The only indication was uterovaginal prolapse and all the procedures were done by the consultants. There is need to transfer the skill to the Residents.

Inevitable caesarean myomectomy; a case report.

The standard teaching is to avoid caesarean myomectomy as much as possible for the fear of the attendant severe haemorrhage. Classical caesarean section in spite of its risk of uterine rupture in subsequent pregnancies had been prescribed in its place. We report a case of a 32 year old nullipara who had an inevitable removal of a huge intramural fibroid in order to assess the baby. A high dose oxytocin infusion, and skillful surgery ensured minimal intra operative and post operative blood loss.

Inevitable caesarean myomectomy.

The standard teaching is to avoid caesarean myomectomy as much as possible for the fear of the attendant severe haemorrhage. Classical caesarean section in spite of its risk of uterine rupture in subsequent pregnancies had been prescribed in its place. We report a case of a 32 year old nullipara who had an inevitable removal of a huge intramural fibroid in order to assess the baby. A high dose oxytocin infusion, and skillful surgery ensured minimal intra operative and post operative blood loss.

Knowledge and practice of family planning among antenatal care attendees at Nnewi, south east Nigeria.

AIMS AND OBJECTIVES: Entrenching an effective family planning program has being a major challenge in Sub Saharan Africa. Determining the knowledge, attitude and practice of family planning among the women is very necessary in order to achieve success. The aim of this study iS to determine the knowledge, and practice of family planning among antenatal women in Nnewi, South East, Nigeria. A descriptive cross sectional study of 356 women attending antenatal clinic at Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria was carried out over a 5-month period. MATERIALS AND METHODS: With the aid of pre-tested interviewer-administered semi structured questionnaires, information on biosocial characteristics, knowledge of, and practice of family planning as well as sources of information on family planning were obtained from the respondents. Data was analysis was done with Epi info statistical package, version 3.5.2 (2008) RESULTS: Three hundred and forty (95.5%) of the respondents knew about family planning out of which 260 (76.5%) had ever used a modern method. The male condom (256; 75.3%) and the natural method (Billings method) (150; 44.1%) were the commonly known methods. Also the commonest used methods were the male condom (144; 55.4%) and Billings method (96; 36.9%). Birth spacing (248; 72.9%) and limiting births (138, 40.6%) were mainly identified as the benefits of family planning and only 6 (1.7%) of the respondents identified family planning as being important in the reduction of maternal mortality. The major sources of information on family planning were health workers (224; 65.9%) and the radio (126; 37.1%). CONCLUSION: The knowledge and practice of family planning has improved among our women. However, the methods commonly used are those associated with high failure rates. Family panning program managers should recognize this limitation. There is need for public sensitization on the correct use of the Billings method and the male condom. Ultimately, our women should be encouraged to accept the more reliable methods of family planning.

Inevitable caesarean myomectomy.

The standard teaching is to avoid caesarean myomectomy as much as possible for the fear of the attendant severe haemorrhage. Classical caesarean section in spite of its risk of uterine rupture in subsequent pregnancies had been prescribed in its place. We report a case of a 32 year old nullipara who had an inevitable removal of a huge intramural fibroid in order to assess the baby. A high dose oxytocin infusion, and skillful surgery ensured minimal intra operative and post operative blood loss.

Orthodox versus unorthodox care: A qualitative study on where rural women seek healthcare during pregnancy and childbirth in Southwest, Nigeria.

INTRODUCTION: Utilization of orthodox health facilities for maternal health services is determined by factors operating at the individual, household, community and state level. The prevalence of small family norm is one of the identified variables operating within the community which influences the decision of where to access care (orthodox/traditional). The objective of the study was to determine the use of orthodox versus unorthodox maternity healthcare and determinants among rural women in southwest Nigeria. METHODS: A qualitative study was done and involved three focus group discussions. A semi-structured interview guide was used to collect information from women of reproductive age group within a rural Local Government Area in Lagos state. RESULTS: Most of the women access some form of healthcare during pregnancy, orthodox, unorthodox or both. Those who patronize both services concurrently do so to benefit from the two as each has some unique features such as herbal concoctions for traditional, ultrasound and immunization of babies for orthodox. Traditional belief exerts a strong influence on decision of where to access maternal healthcare services. Actual place of delivery is determined by individual and household factors including financial resources. CONCLUSION: Rural women utilize one or both orthodox and unorthodox maternal health services for different reasons. Ward Development Committees should be strengthened so as to reach the communities, educate and convince women to dispel myths which limit their use of orthodox care. Training and monitoring of Traditional Birth Attendants (TBAs) are vital to eliminate harmful practices. We also recommend improved financial access to orthodox healthcare.

Pattern of Semen Fluid Abnormalities in Male Partners of Infertile Couples in Southeastern; Nigeria

Background: A retrospective study of all the semen samples of male partners of infertile couples sumitted for analysis to the microbiology laboratory of Nnamdi Azikiwe University Teaching Hospital; Nnewi Nigeria between 1 January 2006 and 31 December 2006 The reports of the semen fluid analysis were retrieved from the records department and suplemented with the laboratory register. Methods:Aretrospective study of all the semen samples of male partners of infertile couples sumitted for analysis to the microbiology laboratory of Nnamdi Azikiwe University Teaching Hospital; Nnewi Nigeria between 1 January 2006 and 31 December 2006 The reports of the semen fluid analysis were retrieved from the records department and suplemented with the laboratory register. Results :Out of the 348 semen sample reports evaluated; 237 (68.0) had semen fluid abnormalities. 104(30.0) had single factor abnormalities while 133(38.0) had combined factor anomalies. Asthenozoospermia 58(16.7) was the main single abnormality; while Astheno-oligozoospermia 51(14.7) and Astheno-oligoteratozoospermia (13.2) were the major combined factor abnormalities detected. Very few 5(1.4) of the patients had azospermia.Conclusion : The study showed a high rate of semen fluid abnormalities among the male partners of infertile women in our environment. The high preponderance of poor motility emphasizes the need to include men in programmes aimed at reducing sexually transmitted infections in Nigeria

Inevitable Caesarean Myomectomy

The standard teaching is to avoid caesarean myomectomy as much as possible for the fear of the attendant severe haemorrhage. Classical caesarean section in spite of its risk of uterine rupture in subsequent pregnancies had been prescribed in its place.We report a case of a 32 year old nullipara who had an inevitable removal of a huge intramural fibroid in order to assess the baby. A high dose oxytocin infusion; and skillful surgery ensured minimal intra operative and post operative blood loss