Background: The covid-19 pandemic has heavily burdened, and in some cases overwhelmed, healthcare... more Background: The covid-19 pandemic has heavily burdened, and in some cases overwhelmed, healthcare systems throughout the world. Healthcare workers are not only at heightened risk of infection, but also of adverse mental health outcomes. Identification of organizational, collegial and individual risk and resilience factors impacting the mental health of healthcare workers are needed to inform preparedness planning and sustainable response. Methods: We performed a rapid systematic review to identify, assess and summarize available research on the mental health impact of the covid-19 pandemic on healthcare workers. On 11 May 2020, we utilized the Norwegian Institute of Public Health's Live map of covid-19 evidence, the visualization of a database of 20,738 screened studies, to identify studies for inclusion. We included studies reporting on any type of mental health outcome in any type of healthcare workers during the pandemic. We described interventions reported by the studies, an...
African Journal of Medical and Health Sciences, 2017
Objective: Stillbirth is one of the most common adverse outcomes of pregnancy, yet among the leas... more Objective: Stillbirth is one of the most common adverse outcomes of pregnancy, yet among the least studied. The objective of this study was to estimate stillbirth rate and describe maternal and obstetric characteristics of stillbirths at the Federal Teaching Hospital, Abakaliki (FETHA), Ebonyi State, southeast Nigeria. Material and Methods: This was a 4-year review of stillbirths at the FETHA, from January 2012 to December 2015. All stillbirth folders were retrieved and relevant information entered in a proforma designed for the study. Statistical analysis was performed using IBM SPSS Statistics for Windows, version 24.0 (IBM Corp., Armonk, NY). Stillbirth rate was calculated as a proportion of total births. Results were presented as mean ± standard deviation, rates, and percentages/proportions. Results: A stillbirth rate of 41.4 was calculated for this study. The mean age for stillbirth was 28.8 years ± 5.4 (range 17–45 years). The median parity was 3, with a range of 0 to 13. About 68.8% or 276/401 of the women were unbooked. Among women who had stillbirths, only about 14% had tertiary education. Women of low social class constituted the greatest percentage (73.5%) who experienced stillbirth. The proportion of male stillbirths was higher than female stillbirth (54.1% or 216/392). About 58.4% or (230/394) of the stillbirths turned out to be macerated. In about 22.4% of cases, the immediate complication leading to stillbirth was not indicated. None of the stillbirths had autopsy performed. Conclusion: The stillbirth rate of 41.4 per 1000 observed at the study center was high. This reflects the overall picture in developing countries. A major finding from the study is the absence of postmortem examination to determine cause of stillbirth. This may be a major challenge in the effort to reduce stillbirth rate in resource-poor setting like ours.
Background: There are no known effective vaccines or drugs for curing the corona 19 virus infecti... more Background: There are no known effective vaccines or drugs for curing the corona 19 virus infection as at present knowlede. This leaves the world with mainly controlling the source of infection and cutting off the transmission route through preventive measures to contain the pandemic. These entail active participation of people, high level of discipline and strict and meticulous adoption of preventive measures. Since it is known that knowledge, precautionary behavior and active social participation of the public are important to control the pandemic, this study sets out to evaluate these in the antenatal population in Ebonyi State. Objective: To evaluate the Knowledge, attitude and practice of the respondents to the corona virus 19 infection and its prevention. Methods: A self-administered pre-tested questionnaire was administered to pregnant women attending antenatal clinics in the chosen Mission hospitals and the only tertiary health institution that offer antenatal care to the bulk of antenatal population in the state. The results were analyzed using SPSS version 20 and Microsoft Excel 2016. Result: The participants had very good knowledge of corona virus 19 infection and its prevention but there were some gaps and misconceptions in knowledge and some of their attitudes and perceptions that raised concerns. Their practice of corona virus 19 preventive measures was poor despite their good knowledge. Conclusion: There
Background Only one recommendation currently exists for the treatment of Lassa fever (LF), which ... more Background Only one recommendation currently exists for the treatment of Lassa fever (LF), which is ribavirin administered in conjunction with supportive care. This recommendation is primarily based on evidence generated from a single clinical trial that was conducted more than 30 years ago–the methodology and results of which have recently come under scrutiny. The requirement for novel therapeutics and reassessment of ribavirin is therefore urgent. However, a significant amount of work now needs to be undertaken to ensure that future trials for LF can be conducted consistently and reliably to facilitate the efficient generation of evidence. Methodology We convened a consultation group to establish the position of clinicians and researchers on the core components of future trials. A Core Eligibility Criteria (CEC), Core Case Definition (CCD), Core Outcome Set (COS) and Core Data Variables (CDV) were developed through the process of a multi-stakeholder consultation that took place us...
Background: The application of invasive obstetric procedures has an end point of reducing the Cae... more Background: The application of invasive obstetric procedures has an end point of reducing the Caesarean section rate. The declining rate of use of these procedures is one of the reasons for increasing Caesarean section rates in our environment. Objective: The aim of the study was to determine the practice of operative vaginal deliveries among obstetricians practicing in Nigeria and to evaluate the reasons for non-use of these procedures. Methodology: It was a questionnaire based study. The questionnaires were administered to practitioners of Obstetrics in the various centres in Nigeria. Data was collated and analyzed with Epi-Info statistical software version 7.0 (Center for Disease Control and Prevention, USA), and conclusions were drawn by means of descriptive statistics. Results: A total of 1200 questionnaire were distributed but 1104 were returned and used for analysis. This gave a response rate of 92%. The age distribution of the respondents showed that the 20-30 year age group had the least number of respondents 22 (2%) while 41-50 age group had the highest number of respondents 486 (4%). The majority of the respondents were males 839 (76%). In terms of duration of practice, 449 (40.7%) of the respondents had more than 6 years duration of practice while 256 (23.2) had practiced for less than 3 years. Tertiary centres had highest number of respondents 71.8%. The distribution of the respondents according to the geopolitical zones in Nigeria are; SouthEast (57.6%), South-South (19.6%), South West (11.4%), NorthWest (4.9%), NorthEast (3.8%), North-Central (2.7%).
International Journal of Infectious Diseases, 2019
Background: The signs and symptoms of Lassa fever are initially indistinguishable from other febr... more Background: The signs and symptoms of Lassa fever are initially indistinguishable from other febrile illnesses common in the tropics and complications of pregnancy. Surviving Lassa fever during pregnancy is rare. Only few cases have been documented. The antiviral drug of choice is ribavirin. Case description: A 25-year-old multigravida farmer with fever who was initially thought to have malaria in pregnancy at 29 weeks gestation. Further changes in her clinical state and laboratory tests led to a confirmation of Lassa fever. The Liver enzymes were markedly deranged and the packed cell volume was 27%. She commenced on ribavirin and subsequently was delivered of a live male neonate who was RT PCR negative for Lassa fever virus. Her clinical state improved, repeat RT PCR on day 15 was negative and she made full recovery. Discussion: The case reported had similar clinical features of fever and abdominal pain and resulted in the initial diagnoses of Malaria in pregnancy. When she failed to respond to antimalarial and antibiotics treatments, a strong suspicion of viral hemorrhagic fever was made. At this time the patient was in advanced stage of the disease with bleeding from vagina and puncture sites. On the third day of admission she was delivered of a live male neonate who remained negative after 2 consecutive RT PCR tests for Lassa fever virus. Lassa fever carries a high risk of death to the fetus throughout pregnancy and to the mother in the third trimester. Mothers with Lassa fever improved rapidly after evacuation of the uterus by spontaneous abortion, or normal delivery. She was clinically stable following delivery. Her laboratory investigations were essentially normal. Throughout her management transmission based precautions were observed. None of the six close contacts developed symptoms after been followed up for 21 days. Conclusion: This report adds to the body of literature that individuals can survive Lassa fever during pregnancy with good maternal and fetal outcome.
International Journal of Case Reports and Images, 2019
Introduction: Heterotopic pregnancy is a rare clinical condition where both intrauterine and extr... more Introduction: Heterotopic pregnancy is a rare clinical condition where both intrauterine and extra uterine pregnancy coexists. In a spontaneous conception, the diagnosis is difficult to make, but an important one to consider in the presence of acute abdominal pain, hemorrhagic shock, and intrauterine pregnancy. Case Report: A 28-year-old G4P0+4 with a family history of multiple gestation who presented with acute abdomen and haemorrhagic shock at a gestational age of nine weeks and five days. The diagnosis of ruptured ectopic pregnancy coexisting with viable intrauterine gestation was made with ultrasound findings as well as clinical features necessitating emergency exploratory laparotomy. Ethical approval was obtained from the ethics and research committee of Federal Teaching Hospital Abakaliki. Successful treatment of ectopic pregnancy with uneventful convalescence and viable intrauterine pregnancy delivered at term. Conclusion: Obstetricians should keep a high index of suspicion of heterotopic pregnancy among women of reproductive age, especially
International Journal of Women's Health and Reproduction Sciences, 2018
Introduction Pain perception in labor is extremely variable among women depending on the parturie... more Introduction Pain perception in labor is extremely variable among women depending on the parturient pain threshold and reaction to pain (1). For the majority of women, labor pain is considered severe and may be likened in severity to complex regional pain syndrome or amputation of a digit without anaesthesia (2). According to the American College of Obstetricians and Gynecologists and the American Society of Anaesthesiologists, there is no circumstance where it is acceptable for an individual to experience untreated severe pain, amenable to safe intervention, while under the care of a physician (2). The development of modern analgesia and in particular regional analgesia marked a major turning point in pain management during labor and delivery. Epidural analgesia is considered as the most effective method of pain relief and recommended as the first choice analgesia for women during labor and delivery (3,4). The level of awareness and practice of labor analgesia, particularly epidural analgesia in sub-Saharan Africa is still rudimentary and obstetricians undoubtedly have an important role to play in this regard. In 2012, a survey of the practice of labor analgesia a m o n g t h e obstetricians in Nigeria revealed that only 49% of the respondents offered analgesia to women in labor and of these, a paltry 2% used epidural analgesia (5). Pain management in labor is an important component of active management of labor and even though not all women request pain relief in labor, the obstetrician has a duty to discuss the options, benefits and risks associated with various methods of labor analgesia with the parturient irrespective of his or her belief (6, 7). Optimal pain control in labor is more likely to result in a satisfactory birth experience for the parturient and her care provider (8-12). A critical step in achieving this milestone is to survey the level of awareness of epidural analgesia, determinants and deterrents of its use among obstetricians practicing in Nigeria. Currently, there is no available literature documenting the utilization pattern, determinants and deterrents of epidural analgesia among obstetric care providers such as obstetricians in Nigeria. This study, therefore,
Eclampsia is one of the most dreaded causes of adverse outcomes of pregnancy worldwide. It is one... more Eclampsia is one of the most dreaded causes of adverse outcomes of pregnancy worldwide. It is one of the greatest causes of maternal and perinatal morbidity and mortality world over. We do not know the prevalence, management outcome, and the devastation caused by this dreaded disease in our center hence the need for this work. This is a 7-year retrospective review of all cases of eclampsia managed in Mater Misericordiae Hospital Afikpo, a rural secondary cum referral Catholic Mission Hospital in Afikpo, Ebonyi State in Southeastern Nigeria. The prevalence of eclampsia in our center is 1.12% or one case of eclampsia for every 89 women that delivered in our facility. The majority of the women that had eclampsia in our center 56 (71.8%) were primigravidae. Seventeen women (21.8%) had various antenatal complications with 4 or 23.6% presenting with intrauterine fetal deaths and two (11.8%) each with intrauterine growth restriction, and domestic violence, respectively. Thirty-five or 44.9...
African Journal of Medical and Health Sciences, 2017
Objective: Stillbirth is one of the most common adverse outcomes of pregnancy, yet among the leas... more Objective: Stillbirth is one of the most common adverse outcomes of pregnancy, yet among the least studied. The objective of this study was to estimate stillbirth rate and describe maternal and obstetric characteristics of stillbirths at the Federal Teaching Hospital, Abakaliki (FETHA), Ebonyi State, southeast Nigeria. Material and Methods: This was a 4-year review of stillbirths at the FETHA, from January 2012 to December 2015. All stillbirth folders were retrieved and relevant information entered in a proforma designed for the study. Statistical analysis was performed using IBM SPSS Statistics for Windows, version 24.0 (IBM Corp., Armonk, NY). Stillbirth rate was calculated as a proportion of total births. Results were presented as mean ± standard deviation, rates, and percentages/proportions. Results: A stillbirth rate of 41.4 was calculated for this study. The mean age for stillbirth was 28.8 years ± 5.4 (range 17–45 years). The median parity was 3, with a range of 0 to 13. About 68.8% or 276/401 of the women were unbooked. Among women who had stillbirths, only about 14% had tertiary education. Women of low social class constituted the greatest percentage (73.5%) who experienced stillbirth. The proportion of male stillbirths was higher than female stillbirth (54.1% or 216/392). About 58.4% or (230/394) of the stillbirths turned out to be macerated. In about 22.4% of cases, the immediate complication leading to stillbirth was not indicated. None of the stillbirths had autopsy performed. Conclusion: The stillbirth rate of 41.4 per 1000 observed at the study center was high. This reflects the overall picture in developing countries. A major finding from the study is the absence of postmortem examination to determine cause of stillbirth. This may be a major challenge in the effort to reduce stillbirth rate in resource-poor setting like ours.
Background: Uterine rupture is an obstetric calamity with surgery as its management mainstay. Ute... more Background: Uterine rupture is an obstetric calamity with surgery as its management mainstay. Uterine repair without tubal ligation leaves a uterus that is more prone to repeat rupture while uterine repair with bilateral tubal ligation (BTL) or (sub)total hysterectomy predispose survivors to psychosocial problems like marital disharmony. This study aims to evaluate obstetricians' perspectives on surgical decision making in managing uterine rupture. Methods: A questionnaire-based cross-sectional study of obstetricians at the 46th annual scientific conference of Society of Gynaecology and Obstetrics of Nigeria in 2012. Data was analysed by descriptive and inferential statistics. Results: Seventy-nine out of 110 obstetricians (71.8%) responded to the survey, of which 42 (53.2%) were consultants, 60 (75.9%) practised in government hospitals and 67 (84.8%) in urban hospitals, and all respondents managed women with uterine rupture. Previous cesarean scars and injudicious use of oxytocic are the commonest predisposing causes, and uterine rupture carries very high incidences of maternal and perinatal mortality and morbidity. Uterine repair only was commonly performed by 38 (48.1%) and uterine repair with BTL or (sub) total hysterectomy by 41 (51.9%) respondents. Surgical management is guided mainly by patients' conditions and obstetricians' surgical skills. Conclusion: Obstetricians' distribution in Nigeria leaves rural settings starved of specialist for obstetric emergencies. Caesarean scars are now a rising cause of ruptures. The surgical management of uterine rupture and obstetricians' surgical preferences vary and are case scenario-dependent. Equitable redistribution of obstetricians and deployment of medical doctors to secondary hospitals in rural settings will make obstetric care more readily available and may reduce the prevalence and improve the outcome of uterine rupture. Obstetrician's surgical decision-making should be guided by the prevailing case scenario and the ultimate aim should be to avert fatality and reduce morbidity.
Background: Uterine rupture is an obstetric calamity with surgery as its management mainstay. Ute... more Background: Uterine rupture is an obstetric calamity with surgery as its management mainstay. Uterine repair without tubal ligation leaves a uterus that is more prone to repeat rupture while uterine repair with bilateral tubal ligation (BTL) or (sub)total hysterectomy predispose survivors to psychosocial problems like marital disharmony. This study aims to evaluate obstetricians' perspectives on surgical decision making in managing uterine rupture. Methods: A questionnaire-based cross-sectional study of obstetricians at the 46th annual scientific conference of Society of Gynaecology and Obstetrics of Nigeria in 2012. Data was analysed by descriptive and inferential statistics. Results: Seventy-nine out of 110 obstetricians (71.8%) responded to the survey, of which 42 (53.2%) were consultants, 60 (75.9%) practised in government hospitals and 67 (84.8%) in urban hospitals, and all respondents managed women with uterine rupture. Previous cesarean scars and injudicious use of oxytocic are the commonest predisposing causes, and uterine rupture carries very high incidences of maternal and perinatal mortality and morbidity. Uterine repair only was commonly performed by 38 (48.1%) and uterine repair with BTL or (sub) total hysterectomy by 41 (51.9%) respondents. Surgical management is guided mainly by patients' conditions and obstetricians' surgical skills. Conclusion: Obstetricians' distribution in Nigeria leaves rural settings starved of specialist for obstetric emergencies. Caesarean scars are now a rising cause of ruptures. The surgical management of uterine rupture and obstetricians' surgical preferences vary and are case scenario-dependent. Equitable redistribution of obstetricians and deployment of medical doctors to secondary hospitals in rural settings will make obstetric care more readily available and may reduce the prevalence and improve the outcome of uterine rupture. Obstetrician's surgical decision-making should be guided by the prevailing case scenario and the ultimate aim should be to avert fatality and reduce morbidity.
Background: The Bartholin's gland cysts and abscesses are one of the most common vulva cyst or ab... more Background: The Bartholin's gland cysts and abscesses are one of the most common vulva cyst or abscesses in gynaecological practice. Symptomatic cases give significant discomfort to sufferers and have a negative impact on their quality of life. Objective: To investigate the incidence, pattern of presentation and management of Barthholin's gland cysts and abscesses in the Federal Teaching Hospital Abakaliki (FETHA) Ebonyi State, Nigeria. Methodology: This was a four-year retrospective study of cases of Bartholin's gland cysts and abscesses in FETHA. We studied all cases of Bartholin's gland cysts and abscesses that were managed at the Federal Teaching Hospital Abakaliki from 1 st January 2012 to 31 st December 2015. Results: During the study period, there were 1015 gynaecological surgical cases of which 18 were for Bartholin's gland cysts or abscess giving an incidence of 1.78%. The mean age of the patients was 28.8 ± 5.6 years with 61% of the patients within the age range of 21 to 30 years. The commonest risk factor that was found for the occurrence of Bartholin's gland cyst or abscess was previous history of the disease in 14 (77.8%) followed by previous history of sexually transmitted diseases 8 (44.4%). Pain was the commonest presenting symptom in 14 (77.8%) of cases. The left vulva was the commonest site of disease as noted in 15 (83.3%) of patients. Escherichia coli and Staphylococcus aureus were the commonest isolates on swabs with 16 (88.9%) and 14 (77.8%) prevalence respectively. The disease presented commonly in form of abscess as observed in 10 (55.6%) of patients. All the patients had Marsupialization as the modality of treatment. Conclusion: Symptomatic Bartholin's gland cyst and abscess cause significant morbidity for the sufferers and decreased quality of life. Accurate diagnosis and treatment is advocated to prevent chronicity and complications. Although options of treatment abound, Marsupialization remains the mainstay of treatment in low resource setting like ours.
International Journal of Gynecology & Obstetrics, 2014
To determine preferences, practices, and acceptance of focused versus standard prenatal-care mode... more To determine preferences, practices, and acceptance of focused versus standard prenatal-care models among Nigerian obstetricians. Methods: A cross-sectional survey was performed among clinicians who attended a conference held in Lagos, Nigeria, between November 27 and 29, 2013. The questionnaire assessed sociodemographic characteristics and opinions on prenatal care. Results: A total of 201 delegates returned complete questionnaires. All respondents were aware of both models of prenatal care. Although 70 (34.8%) respondents stated a preference for focused care, only 6 (3.0%) used this model in clinical practice. The main reason for their preference was the evidence base (23.4%). Overall, 185 (92.0%) respondents stated institutional protocol determined preference for and practice of standard care, 108 (53.7%) believed patients preferred standard care, and 89 (44.3%) felt standard care had health benefits. Preference for one model over the other was significantly associated with type and level of the healthcare practice (P = 0.002 and P b 0.001, respectively). Modification of the focused model to meet local, national, and cultural needs was recommended by 171 (85.1%) respondents. Conclusion: Most obstetricians are skeptical about focused prenatal care and have not embraced this model owing to personal, institutional, and sociocultural factors.
Background: The global rise in cesarean delivery rate has been a major source of public health co... more Background: The global rise in cesarean delivery rate has been a major source of public health concern. Aim: To appraise the cesarean deliveries and the associated fetal and maternal outcomes. Materials and methods: The study was a case series with data collected retrospectively from the records of patients delivered by cesarean section at the Ebonyi State University Teaching Hospital, Abakaliki over a 10-year period, from January 2002 to December 2011. Ethical approval was obtained. Results: Of 14,198 deliveries, 2,323/14,198 (16.4%) were by cesarean deliveries. The overall increase of cesarean delivery was 11.1/10 (1.1%) per annum from 184/1,512 (12.2%) in 2002 to 230/986 (23.3%) in 2011. Of 2,097 case folders studied, 1,742/2,097 (83.1%) were delivered at term, and in 1,576/2,097 (75.2%), the cesarean deliveries were emergencies. The common indications for cesarean delivery were previous cesarean scars 417/2,097 (19.9%) and obstructed labor 331/2,097 (15.8%). There were 296 perinatal deaths, giving a perinatal mortality rate of (296/2,197) 134.7/1,000 births. Also, 129/2,097 (6.1%) maternal case fatalities occurred, giving a maternal mortality rate of 908.6/100,000 total births. Hemorrhage 57/129 (44.2%) and sepsis 41/129 (32.6%) were the major causes. Conclusion: The study recorded a significant increase in cesarean delivery rate. Previous cesarean scars and obstructed labors were the main indications. Perinatal and maternal case fatalities were huge. Hence, there is need for continued community education for its reduction.
Information for consent to respond. This document introduced the research topic and conveyed info... more Information for consent to respond. This document introduced the research topic and conveyed information to the responder on the researchersâ intention to conduct the survey, the way and manner the data will be handled and the possible beneficial use(s) to which the outcome after analyses will be put, and requested him/her to respond if he consented. (DOCX 12Â kb)
Questionnaire used for study. This questionnaire consists of 17 items organised into two groups. ... more Questionnaire used for study. This questionnaire consists of 17 items organised into two groups. Group A consists of nine questions on respondentâ s information and group B eight questions on the respondents experience with and opinion about surgeries used in managing uterine rupture. (DOCX 16Â kb)
Tropical journal of obstetrics and gynaecology, 2002
Objective: To assess the trend in the age of primigravidae at a tertiary care centre in Enugu, Ea... more Objective: To assess the trend in the age of primigravidae at a tertiary care centre in Enugu, Eastern Nigeria. Study Design, Setting and Subjects: An analysis of the birth records of all primigravidae who delivered in the hospital over a twenty-one year period. Trends were assessed by chi-square and one-way analysis of variance (ANOVA) tests at the 95% confidence level. Results: The proportion of primigravidae significantly increased from 17.4% of all parturients in 1980 to 24.1% in 2000. The proportion of teenage primigravidae significantly decreased while that of elderly primigravidae significantly increased (p Conclusion: Over the last twenty-one years, there has been a significant increase in the mean age of primigravidae and the proportion of elderly primigravidae and a significant decrease in the proportion of teenage primigravidae in Enugu, Nigeria. Key Words: Trends, Temporal, Primigravida, Maternal Age. [Trop J Obstet Gynaecol, 2002, 19: 71-73]
Background: Nigeria bears a sizeable proportion of the global HIV burden; mother to child transmi... more Background: Nigeria bears a sizeable proportion of the global HIV burden; mother to child transmission as a major contributor and prevention of mother to child transmission the hope for a HIV-free generation. Objective: To find evaluate how booked antenatal attendees intend to utilize the labour and delivery services of the state teaching hospital in Abakaliki in their index pregnancies and if they tested HIV positive. Methods: This was a cross-sectional survey of the attendees to the booking clinic. Data on patients' ages, marital status, past obstetric history, where clients would deliver their index pregnancies normally and if they tested positive to HIV, and the reasons behind their decisions, were collected with pretested self-administered questionnaires and analyzed using SPSS version 15. Results: Four hundred and twenty-three (84.6%) of the questionnaires were analyzed. There were 288 patients who had been previously pregnant, of whom 274 (95.1%) booked for antenatal care...
Background: The covid-19 pandemic has heavily burdened, and in some cases overwhelmed, healthcare... more Background: The covid-19 pandemic has heavily burdened, and in some cases overwhelmed, healthcare systems throughout the world. Healthcare workers are not only at heightened risk of infection, but also of adverse mental health outcomes. Identification of organizational, collegial and individual risk and resilience factors impacting the mental health of healthcare workers are needed to inform preparedness planning and sustainable response. Methods: We performed a rapid systematic review to identify, assess and summarize available research on the mental health impact of the covid-19 pandemic on healthcare workers. On 11 May 2020, we utilized the Norwegian Institute of Public Health's Live map of covid-19 evidence, the visualization of a database of 20,738 screened studies, to identify studies for inclusion. We included studies reporting on any type of mental health outcome in any type of healthcare workers during the pandemic. We described interventions reported by the studies, an...
African Journal of Medical and Health Sciences, 2017
Objective: Stillbirth is one of the most common adverse outcomes of pregnancy, yet among the leas... more Objective: Stillbirth is one of the most common adverse outcomes of pregnancy, yet among the least studied. The objective of this study was to estimate stillbirth rate and describe maternal and obstetric characteristics of stillbirths at the Federal Teaching Hospital, Abakaliki (FETHA), Ebonyi State, southeast Nigeria. Material and Methods: This was a 4-year review of stillbirths at the FETHA, from January 2012 to December 2015. All stillbirth folders were retrieved and relevant information entered in a proforma designed for the study. Statistical analysis was performed using IBM SPSS Statistics for Windows, version 24.0 (IBM Corp., Armonk, NY). Stillbirth rate was calculated as a proportion of total births. Results were presented as mean ± standard deviation, rates, and percentages/proportions. Results: A stillbirth rate of 41.4 was calculated for this study. The mean age for stillbirth was 28.8 years ± 5.4 (range 17–45 years). The median parity was 3, with a range of 0 to 13. About 68.8% or 276/401 of the women were unbooked. Among women who had stillbirths, only about 14% had tertiary education. Women of low social class constituted the greatest percentage (73.5%) who experienced stillbirth. The proportion of male stillbirths was higher than female stillbirth (54.1% or 216/392). About 58.4% or (230/394) of the stillbirths turned out to be macerated. In about 22.4% of cases, the immediate complication leading to stillbirth was not indicated. None of the stillbirths had autopsy performed. Conclusion: The stillbirth rate of 41.4 per 1000 observed at the study center was high. This reflects the overall picture in developing countries. A major finding from the study is the absence of postmortem examination to determine cause of stillbirth. This may be a major challenge in the effort to reduce stillbirth rate in resource-poor setting like ours.
Background: There are no known effective vaccines or drugs for curing the corona 19 virus infecti... more Background: There are no known effective vaccines or drugs for curing the corona 19 virus infection as at present knowlede. This leaves the world with mainly controlling the source of infection and cutting off the transmission route through preventive measures to contain the pandemic. These entail active participation of people, high level of discipline and strict and meticulous adoption of preventive measures. Since it is known that knowledge, precautionary behavior and active social participation of the public are important to control the pandemic, this study sets out to evaluate these in the antenatal population in Ebonyi State. Objective: To evaluate the Knowledge, attitude and practice of the respondents to the corona virus 19 infection and its prevention. Methods: A self-administered pre-tested questionnaire was administered to pregnant women attending antenatal clinics in the chosen Mission hospitals and the only tertiary health institution that offer antenatal care to the bulk of antenatal population in the state. The results were analyzed using SPSS version 20 and Microsoft Excel 2016. Result: The participants had very good knowledge of corona virus 19 infection and its prevention but there were some gaps and misconceptions in knowledge and some of their attitudes and perceptions that raised concerns. Their practice of corona virus 19 preventive measures was poor despite their good knowledge. Conclusion: There
Background Only one recommendation currently exists for the treatment of Lassa fever (LF), which ... more Background Only one recommendation currently exists for the treatment of Lassa fever (LF), which is ribavirin administered in conjunction with supportive care. This recommendation is primarily based on evidence generated from a single clinical trial that was conducted more than 30 years ago–the methodology and results of which have recently come under scrutiny. The requirement for novel therapeutics and reassessment of ribavirin is therefore urgent. However, a significant amount of work now needs to be undertaken to ensure that future trials for LF can be conducted consistently and reliably to facilitate the efficient generation of evidence. Methodology We convened a consultation group to establish the position of clinicians and researchers on the core components of future trials. A Core Eligibility Criteria (CEC), Core Case Definition (CCD), Core Outcome Set (COS) and Core Data Variables (CDV) were developed through the process of a multi-stakeholder consultation that took place us...
Background: The application of invasive obstetric procedures has an end point of reducing the Cae... more Background: The application of invasive obstetric procedures has an end point of reducing the Caesarean section rate. The declining rate of use of these procedures is one of the reasons for increasing Caesarean section rates in our environment. Objective: The aim of the study was to determine the practice of operative vaginal deliveries among obstetricians practicing in Nigeria and to evaluate the reasons for non-use of these procedures. Methodology: It was a questionnaire based study. The questionnaires were administered to practitioners of Obstetrics in the various centres in Nigeria. Data was collated and analyzed with Epi-Info statistical software version 7.0 (Center for Disease Control and Prevention, USA), and conclusions were drawn by means of descriptive statistics. Results: A total of 1200 questionnaire were distributed but 1104 were returned and used for analysis. This gave a response rate of 92%. The age distribution of the respondents showed that the 20-30 year age group had the least number of respondents 22 (2%) while 41-50 age group had the highest number of respondents 486 (4%). The majority of the respondents were males 839 (76%). In terms of duration of practice, 449 (40.7%) of the respondents had more than 6 years duration of practice while 256 (23.2) had practiced for less than 3 years. Tertiary centres had highest number of respondents 71.8%. The distribution of the respondents according to the geopolitical zones in Nigeria are; SouthEast (57.6%), South-South (19.6%), South West (11.4%), NorthWest (4.9%), NorthEast (3.8%), North-Central (2.7%).
International Journal of Infectious Diseases, 2019
Background: The signs and symptoms of Lassa fever are initially indistinguishable from other febr... more Background: The signs and symptoms of Lassa fever are initially indistinguishable from other febrile illnesses common in the tropics and complications of pregnancy. Surviving Lassa fever during pregnancy is rare. Only few cases have been documented. The antiviral drug of choice is ribavirin. Case description: A 25-year-old multigravida farmer with fever who was initially thought to have malaria in pregnancy at 29 weeks gestation. Further changes in her clinical state and laboratory tests led to a confirmation of Lassa fever. The Liver enzymes were markedly deranged and the packed cell volume was 27%. She commenced on ribavirin and subsequently was delivered of a live male neonate who was RT PCR negative for Lassa fever virus. Her clinical state improved, repeat RT PCR on day 15 was negative and she made full recovery. Discussion: The case reported had similar clinical features of fever and abdominal pain and resulted in the initial diagnoses of Malaria in pregnancy. When she failed to respond to antimalarial and antibiotics treatments, a strong suspicion of viral hemorrhagic fever was made. At this time the patient was in advanced stage of the disease with bleeding from vagina and puncture sites. On the third day of admission she was delivered of a live male neonate who remained negative after 2 consecutive RT PCR tests for Lassa fever virus. Lassa fever carries a high risk of death to the fetus throughout pregnancy and to the mother in the third trimester. Mothers with Lassa fever improved rapidly after evacuation of the uterus by spontaneous abortion, or normal delivery. She was clinically stable following delivery. Her laboratory investigations were essentially normal. Throughout her management transmission based precautions were observed. None of the six close contacts developed symptoms after been followed up for 21 days. Conclusion: This report adds to the body of literature that individuals can survive Lassa fever during pregnancy with good maternal and fetal outcome.
International Journal of Case Reports and Images, 2019
Introduction: Heterotopic pregnancy is a rare clinical condition where both intrauterine and extr... more Introduction: Heterotopic pregnancy is a rare clinical condition where both intrauterine and extra uterine pregnancy coexists. In a spontaneous conception, the diagnosis is difficult to make, but an important one to consider in the presence of acute abdominal pain, hemorrhagic shock, and intrauterine pregnancy. Case Report: A 28-year-old G4P0+4 with a family history of multiple gestation who presented with acute abdomen and haemorrhagic shock at a gestational age of nine weeks and five days. The diagnosis of ruptured ectopic pregnancy coexisting with viable intrauterine gestation was made with ultrasound findings as well as clinical features necessitating emergency exploratory laparotomy. Ethical approval was obtained from the ethics and research committee of Federal Teaching Hospital Abakaliki. Successful treatment of ectopic pregnancy with uneventful convalescence and viable intrauterine pregnancy delivered at term. Conclusion: Obstetricians should keep a high index of suspicion of heterotopic pregnancy among women of reproductive age, especially
International Journal of Women's Health and Reproduction Sciences, 2018
Introduction Pain perception in labor is extremely variable among women depending on the parturie... more Introduction Pain perception in labor is extremely variable among women depending on the parturient pain threshold and reaction to pain (1). For the majority of women, labor pain is considered severe and may be likened in severity to complex regional pain syndrome or amputation of a digit without anaesthesia (2). According to the American College of Obstetricians and Gynecologists and the American Society of Anaesthesiologists, there is no circumstance where it is acceptable for an individual to experience untreated severe pain, amenable to safe intervention, while under the care of a physician (2). The development of modern analgesia and in particular regional analgesia marked a major turning point in pain management during labor and delivery. Epidural analgesia is considered as the most effective method of pain relief and recommended as the first choice analgesia for women during labor and delivery (3,4). The level of awareness and practice of labor analgesia, particularly epidural analgesia in sub-Saharan Africa is still rudimentary and obstetricians undoubtedly have an important role to play in this regard. In 2012, a survey of the practice of labor analgesia a m o n g t h e obstetricians in Nigeria revealed that only 49% of the respondents offered analgesia to women in labor and of these, a paltry 2% used epidural analgesia (5). Pain management in labor is an important component of active management of labor and even though not all women request pain relief in labor, the obstetrician has a duty to discuss the options, benefits and risks associated with various methods of labor analgesia with the parturient irrespective of his or her belief (6, 7). Optimal pain control in labor is more likely to result in a satisfactory birth experience for the parturient and her care provider (8-12). A critical step in achieving this milestone is to survey the level of awareness of epidural analgesia, determinants and deterrents of its use among obstetricians practicing in Nigeria. Currently, there is no available literature documenting the utilization pattern, determinants and deterrents of epidural analgesia among obstetric care providers such as obstetricians in Nigeria. This study, therefore,
Eclampsia is one of the most dreaded causes of adverse outcomes of pregnancy worldwide. It is one... more Eclampsia is one of the most dreaded causes of adverse outcomes of pregnancy worldwide. It is one of the greatest causes of maternal and perinatal morbidity and mortality world over. We do not know the prevalence, management outcome, and the devastation caused by this dreaded disease in our center hence the need for this work. This is a 7-year retrospective review of all cases of eclampsia managed in Mater Misericordiae Hospital Afikpo, a rural secondary cum referral Catholic Mission Hospital in Afikpo, Ebonyi State in Southeastern Nigeria. The prevalence of eclampsia in our center is 1.12% or one case of eclampsia for every 89 women that delivered in our facility. The majority of the women that had eclampsia in our center 56 (71.8%) were primigravidae. Seventeen women (21.8%) had various antenatal complications with 4 or 23.6% presenting with intrauterine fetal deaths and two (11.8%) each with intrauterine growth restriction, and domestic violence, respectively. Thirty-five or 44.9...
African Journal of Medical and Health Sciences, 2017
Objective: Stillbirth is one of the most common adverse outcomes of pregnancy, yet among the leas... more Objective: Stillbirth is one of the most common adverse outcomes of pregnancy, yet among the least studied. The objective of this study was to estimate stillbirth rate and describe maternal and obstetric characteristics of stillbirths at the Federal Teaching Hospital, Abakaliki (FETHA), Ebonyi State, southeast Nigeria. Material and Methods: This was a 4-year review of stillbirths at the FETHA, from January 2012 to December 2015. All stillbirth folders were retrieved and relevant information entered in a proforma designed for the study. Statistical analysis was performed using IBM SPSS Statistics for Windows, version 24.0 (IBM Corp., Armonk, NY). Stillbirth rate was calculated as a proportion of total births. Results were presented as mean ± standard deviation, rates, and percentages/proportions. Results: A stillbirth rate of 41.4 was calculated for this study. The mean age for stillbirth was 28.8 years ± 5.4 (range 17–45 years). The median parity was 3, with a range of 0 to 13. About 68.8% or 276/401 of the women were unbooked. Among women who had stillbirths, only about 14% had tertiary education. Women of low social class constituted the greatest percentage (73.5%) who experienced stillbirth. The proportion of male stillbirths was higher than female stillbirth (54.1% or 216/392). About 58.4% or (230/394) of the stillbirths turned out to be macerated. In about 22.4% of cases, the immediate complication leading to stillbirth was not indicated. None of the stillbirths had autopsy performed. Conclusion: The stillbirth rate of 41.4 per 1000 observed at the study center was high. This reflects the overall picture in developing countries. A major finding from the study is the absence of postmortem examination to determine cause of stillbirth. This may be a major challenge in the effort to reduce stillbirth rate in resource-poor setting like ours.
Background: Uterine rupture is an obstetric calamity with surgery as its management mainstay. Ute... more Background: Uterine rupture is an obstetric calamity with surgery as its management mainstay. Uterine repair without tubal ligation leaves a uterus that is more prone to repeat rupture while uterine repair with bilateral tubal ligation (BTL) or (sub)total hysterectomy predispose survivors to psychosocial problems like marital disharmony. This study aims to evaluate obstetricians' perspectives on surgical decision making in managing uterine rupture. Methods: A questionnaire-based cross-sectional study of obstetricians at the 46th annual scientific conference of Society of Gynaecology and Obstetrics of Nigeria in 2012. Data was analysed by descriptive and inferential statistics. Results: Seventy-nine out of 110 obstetricians (71.8%) responded to the survey, of which 42 (53.2%) were consultants, 60 (75.9%) practised in government hospitals and 67 (84.8%) in urban hospitals, and all respondents managed women with uterine rupture. Previous cesarean scars and injudicious use of oxytocic are the commonest predisposing causes, and uterine rupture carries very high incidences of maternal and perinatal mortality and morbidity. Uterine repair only was commonly performed by 38 (48.1%) and uterine repair with BTL or (sub) total hysterectomy by 41 (51.9%) respondents. Surgical management is guided mainly by patients' conditions and obstetricians' surgical skills. Conclusion: Obstetricians' distribution in Nigeria leaves rural settings starved of specialist for obstetric emergencies. Caesarean scars are now a rising cause of ruptures. The surgical management of uterine rupture and obstetricians' surgical preferences vary and are case scenario-dependent. Equitable redistribution of obstetricians and deployment of medical doctors to secondary hospitals in rural settings will make obstetric care more readily available and may reduce the prevalence and improve the outcome of uterine rupture. Obstetrician's surgical decision-making should be guided by the prevailing case scenario and the ultimate aim should be to avert fatality and reduce morbidity.
Background: Uterine rupture is an obstetric calamity with surgery as its management mainstay. Ute... more Background: Uterine rupture is an obstetric calamity with surgery as its management mainstay. Uterine repair without tubal ligation leaves a uterus that is more prone to repeat rupture while uterine repair with bilateral tubal ligation (BTL) or (sub)total hysterectomy predispose survivors to psychosocial problems like marital disharmony. This study aims to evaluate obstetricians' perspectives on surgical decision making in managing uterine rupture. Methods: A questionnaire-based cross-sectional study of obstetricians at the 46th annual scientific conference of Society of Gynaecology and Obstetrics of Nigeria in 2012. Data was analysed by descriptive and inferential statistics. Results: Seventy-nine out of 110 obstetricians (71.8%) responded to the survey, of which 42 (53.2%) were consultants, 60 (75.9%) practised in government hospitals and 67 (84.8%) in urban hospitals, and all respondents managed women with uterine rupture. Previous cesarean scars and injudicious use of oxytocic are the commonest predisposing causes, and uterine rupture carries very high incidences of maternal and perinatal mortality and morbidity. Uterine repair only was commonly performed by 38 (48.1%) and uterine repair with BTL or (sub) total hysterectomy by 41 (51.9%) respondents. Surgical management is guided mainly by patients' conditions and obstetricians' surgical skills. Conclusion: Obstetricians' distribution in Nigeria leaves rural settings starved of specialist for obstetric emergencies. Caesarean scars are now a rising cause of ruptures. The surgical management of uterine rupture and obstetricians' surgical preferences vary and are case scenario-dependent. Equitable redistribution of obstetricians and deployment of medical doctors to secondary hospitals in rural settings will make obstetric care more readily available and may reduce the prevalence and improve the outcome of uterine rupture. Obstetrician's surgical decision-making should be guided by the prevailing case scenario and the ultimate aim should be to avert fatality and reduce morbidity.
Background: The Bartholin's gland cysts and abscesses are one of the most common vulva cyst or ab... more Background: The Bartholin's gland cysts and abscesses are one of the most common vulva cyst or abscesses in gynaecological practice. Symptomatic cases give significant discomfort to sufferers and have a negative impact on their quality of life. Objective: To investigate the incidence, pattern of presentation and management of Barthholin's gland cysts and abscesses in the Federal Teaching Hospital Abakaliki (FETHA) Ebonyi State, Nigeria. Methodology: This was a four-year retrospective study of cases of Bartholin's gland cysts and abscesses in FETHA. We studied all cases of Bartholin's gland cysts and abscesses that were managed at the Federal Teaching Hospital Abakaliki from 1 st January 2012 to 31 st December 2015. Results: During the study period, there were 1015 gynaecological surgical cases of which 18 were for Bartholin's gland cysts or abscess giving an incidence of 1.78%. The mean age of the patients was 28.8 ± 5.6 years with 61% of the patients within the age range of 21 to 30 years. The commonest risk factor that was found for the occurrence of Bartholin's gland cyst or abscess was previous history of the disease in 14 (77.8%) followed by previous history of sexually transmitted diseases 8 (44.4%). Pain was the commonest presenting symptom in 14 (77.8%) of cases. The left vulva was the commonest site of disease as noted in 15 (83.3%) of patients. Escherichia coli and Staphylococcus aureus were the commonest isolates on swabs with 16 (88.9%) and 14 (77.8%) prevalence respectively. The disease presented commonly in form of abscess as observed in 10 (55.6%) of patients. All the patients had Marsupialization as the modality of treatment. Conclusion: Symptomatic Bartholin's gland cyst and abscess cause significant morbidity for the sufferers and decreased quality of life. Accurate diagnosis and treatment is advocated to prevent chronicity and complications. Although options of treatment abound, Marsupialization remains the mainstay of treatment in low resource setting like ours.
International Journal of Gynecology & Obstetrics, 2014
To determine preferences, practices, and acceptance of focused versus standard prenatal-care mode... more To determine preferences, practices, and acceptance of focused versus standard prenatal-care models among Nigerian obstetricians. Methods: A cross-sectional survey was performed among clinicians who attended a conference held in Lagos, Nigeria, between November 27 and 29, 2013. The questionnaire assessed sociodemographic characteristics and opinions on prenatal care. Results: A total of 201 delegates returned complete questionnaires. All respondents were aware of both models of prenatal care. Although 70 (34.8%) respondents stated a preference for focused care, only 6 (3.0%) used this model in clinical practice. The main reason for their preference was the evidence base (23.4%). Overall, 185 (92.0%) respondents stated institutional protocol determined preference for and practice of standard care, 108 (53.7%) believed patients preferred standard care, and 89 (44.3%) felt standard care had health benefits. Preference for one model over the other was significantly associated with type and level of the healthcare practice (P = 0.002 and P b 0.001, respectively). Modification of the focused model to meet local, national, and cultural needs was recommended by 171 (85.1%) respondents. Conclusion: Most obstetricians are skeptical about focused prenatal care and have not embraced this model owing to personal, institutional, and sociocultural factors.
Background: The global rise in cesarean delivery rate has been a major source of public health co... more Background: The global rise in cesarean delivery rate has been a major source of public health concern. Aim: To appraise the cesarean deliveries and the associated fetal and maternal outcomes. Materials and methods: The study was a case series with data collected retrospectively from the records of patients delivered by cesarean section at the Ebonyi State University Teaching Hospital, Abakaliki over a 10-year period, from January 2002 to December 2011. Ethical approval was obtained. Results: Of 14,198 deliveries, 2,323/14,198 (16.4%) were by cesarean deliveries. The overall increase of cesarean delivery was 11.1/10 (1.1%) per annum from 184/1,512 (12.2%) in 2002 to 230/986 (23.3%) in 2011. Of 2,097 case folders studied, 1,742/2,097 (83.1%) were delivered at term, and in 1,576/2,097 (75.2%), the cesarean deliveries were emergencies. The common indications for cesarean delivery were previous cesarean scars 417/2,097 (19.9%) and obstructed labor 331/2,097 (15.8%). There were 296 perinatal deaths, giving a perinatal mortality rate of (296/2,197) 134.7/1,000 births. Also, 129/2,097 (6.1%) maternal case fatalities occurred, giving a maternal mortality rate of 908.6/100,000 total births. Hemorrhage 57/129 (44.2%) and sepsis 41/129 (32.6%) were the major causes. Conclusion: The study recorded a significant increase in cesarean delivery rate. Previous cesarean scars and obstructed labors were the main indications. Perinatal and maternal case fatalities were huge. Hence, there is need for continued community education for its reduction.
Information for consent to respond. This document introduced the research topic and conveyed info... more Information for consent to respond. This document introduced the research topic and conveyed information to the responder on the researchersâ intention to conduct the survey, the way and manner the data will be handled and the possible beneficial use(s) to which the outcome after analyses will be put, and requested him/her to respond if he consented. (DOCX 12Â kb)
Questionnaire used for study. This questionnaire consists of 17 items organised into two groups. ... more Questionnaire used for study. This questionnaire consists of 17 items organised into two groups. Group A consists of nine questions on respondentâ s information and group B eight questions on the respondents experience with and opinion about surgeries used in managing uterine rupture. (DOCX 16Â kb)
Tropical journal of obstetrics and gynaecology, 2002
Objective: To assess the trend in the age of primigravidae at a tertiary care centre in Enugu, Ea... more Objective: To assess the trend in the age of primigravidae at a tertiary care centre in Enugu, Eastern Nigeria. Study Design, Setting and Subjects: An analysis of the birth records of all primigravidae who delivered in the hospital over a twenty-one year period. Trends were assessed by chi-square and one-way analysis of variance (ANOVA) tests at the 95% confidence level. Results: The proportion of primigravidae significantly increased from 17.4% of all parturients in 1980 to 24.1% in 2000. The proportion of teenage primigravidae significantly decreased while that of elderly primigravidae significantly increased (p Conclusion: Over the last twenty-one years, there has been a significant increase in the mean age of primigravidae and the proportion of elderly primigravidae and a significant decrease in the proportion of teenage primigravidae in Enugu, Nigeria. Key Words: Trends, Temporal, Primigravida, Maternal Age. [Trop J Obstet Gynaecol, 2002, 19: 71-73]
Background: Nigeria bears a sizeable proportion of the global HIV burden; mother to child transmi... more Background: Nigeria bears a sizeable proportion of the global HIV burden; mother to child transmission as a major contributor and prevention of mother to child transmission the hope for a HIV-free generation. Objective: To find evaluate how booked antenatal attendees intend to utilize the labour and delivery services of the state teaching hospital in Abakaliki in their index pregnancies and if they tested HIV positive. Methods: This was a cross-sectional survey of the attendees to the booking clinic. Data on patients' ages, marital status, past obstetric history, where clients would deliver their index pregnancies normally and if they tested positive to HIV, and the reasons behind their decisions, were collected with pretested self-administered questionnaires and analyzed using SPSS version 15. Results: Four hundred and twenty-three (84.6%) of the questionnaires were analyzed. There were 288 patients who had been previously pregnant, of whom 274 (95.1%) booked for antenatal care...
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