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There is a global increasing trend of complementary and alternative medicine (CAM) use among pregnant women. This study aimed at determining the maternal and perinatal outcome of CAM use among the pregnant women in South-East Nigeria. This was a prospective study in which self-administered semi-structured questionnaires were used to collate information from the consenting pregnant women who use CAM and those who did not use CAM from the gestational age of 36 weeks at four hospitals in South-East Nigeria. Both groups were matched for age, parity and address. Every participant was followed up until delivery. Data were analysed using SPSS version 23 (SPSS Inc., Chicago, IL). This study's ethical clearance number was NHREC/05/01/2008B-FWA00002458-1RB00002323 and it was obtained at UNTH and on February 15 2019. CAM use in pregnancy was associated with low haemoglobin concentration, maternal complications, high caesarean section rate, low birth weight, low APGAR score, large placental weight and high hospital admission of babies when compared with non-CAM users (p value=

INTRODUCTION Infection is one of the most common causes of maternal morbidities and mortality and has been reported to be responsible for about 15% of maternal deaths. Any woman is at risk of infection during childbirth, but women undergoing cesarean section are at higher risk. Improvement in surgical procedures with asepsis and the use of antibiotics have helped reduce postoperative infectious morbidities. However, ascending infection from the lower to the upper genital tract is a common but often neglected source of infection. Cleaning the vagina with chlorhexidine antiseptic solution before cesarean section can be a cheap and affordable source of infection control. This study is aimed at evaluating the efficacy of preoperative vaginal cleansing using 1.0% chlorhexidine in the reduction of post-cesarean section infectious morbidities. MATERIAL AND METHODS This prospective randomized control trial was conducted among 322 pregnant women who underwent an emergency cesarean section at Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AE-FUTHA). The women were randomized into two groups. The interventional group received vaginal cleansing with three standard gauzes soaked in 30 mL 1.0% chlorhexidine gluconate solution preoperatively in addition to surgical skin cleaning with chlorhexidine-alcohol. The women in the control group only had surgical skin cleaning with chlorhexidine-alcohol. All the women received pre- and postoperative antibiotics. The primary outcomes were endometritis and wound infections. RESULTS Infectious morbidity was significantly reduced from 36.8% in the control group to 12.0% in the intervention group (P = .001). Endometritis occurred significantly less frequently in the intervention group than the control group (respectively 6.6% compared with 27.6%: relative risk [RR] 0.29, 95% confidence interval [CI] 0.16-0.53; P

Background Maternal near-misses, also known as severe acute maternal morbidity, have become globally recognized as an appropriate indicator of obstetric care. Women experiencing maternal near-misses are more in number than maternal deaths, and can provide more specific and detailed evidence, as the patient herself can be a leading source of useful information. Objective To determine the frequency of maternal near-misses and maternal deaths in the University of Nigeria Teaching Hospital in Ituku-Ozalla, Enugu, document the primary determinant factor that caused these, and compare cases of maternal near-miss and maternal deaths. Methods This was a 3-year prospective study of all women admitted for delivery or within 42 days of delivery or termination of pregnancy at the hospital. Data were collected prospectively in consecutive patients in a pro forma manner and entered into SPSS version 17 for Windows. Results There was a total of 2,236 deliveries, of which 88 had severe maternal outcomes. Of the latter, 60 were maternal near-misses, while 28 suffered maternal death. The maternal near-miss:mortality ratio was found to be 2.14. The maternal mortality ratio here was 1,252 per 100,000. All the 88 women that had severe maternal outcomes lived at least 5 km from the hospital. The leading organ-system dysfunction in this study was cardiovascular, manifesting as shock and cardiac arrest, and respiratory, manifesting as gasping and cyanosis. Leading complications were severe hemorrhage, anemia, and hypertensive disorders. The pattern of complications was similar in both near-misses and maternal deaths, but cases of hypertensive disorders and exploratory laparotomy as an intervention for those with organ dysfunction were noted to be higher in near-miss cases, and differences were statistically significant. Conclusion It was concluded that despite numerous similarities in the characteristics of patients who had had maternal near-misses or died, our study points out that those who succumb to death are often 5 km and suffer maternal death within 24 hours of presentation.

Introduction: As life expectancy increases, most women spend a larger part of their lives in the postmenopausal state. This period is associated with other medical comorbidities which affect the quality of life. Knowledge and perception of postmenopausal symptoms could help them cope with such a situation. Aim: To determine the knowledge and perception of postmenopausal symptoms among postmenopausal women presented to the gynecological clinic of Alex Ekwueme Federal University Teaching Hospital, Abakaliki. Materials and Methods: This was a cross-sectional study carried out at the Gynecological clinic of Alex Ekwueme Federal University Teaching Hospital, Abakaliki. Around 408 women were administered structured questionnaires. The information obtained was analyzed using SPSS version 20. Results: Majority (50%) of the respondents were 50–54 years age group and the least (6.9%) were 55–59 years. The commonest menopausal symptom reported was hot flushes by 300 (73.5%) respondents. Tiredness and vaginal dryness were reported by 188 (46.1%) and 180 (44.1%) respondents, respectively. The knowledge of hormone replacement therapy was low (7.8%). The study showed that 356 (87.3%) women have no knowledge of hormone replacement therapy. Conclusion: There is a need for educating women in the clinics regarding menopause and hormone replacement therapy which would further enable women to make informed choices about their health postmenopause.

Background: Organized cervical cancer screening program has contributed to the reduction in incidence of cervical cancer in developed countries. Follow up, to ensure adherence to regular screenings, still poses challenges in poor resource settings. Objective: This study aims at determining the cervical cancer screening uptake, adherence to follow up instructions and interval cervical cancer screening and intervention to improve adherence through personalized reminders (phone calls and text messages). Methods: This was a prospective study of clients screened for cervical cancer at the University of Nigeria Teaching Hospital, Enugu from January 2012 to December 2016. The participants were studied for adherence to interval follow-up screening. Eligible participants were followed up using phone calls and text messages and the outcome noted. The data was analysed using statistical software for social sciences (SPSS) version 17. Results: The mean age and parity of 1146 participants screened for cervical intra-epithelial abnormalities within the study period was 44.18 ± 11.08 years and 3.78 ± 2.08 respectively. Most of the subjects (91.8%) screened negative to squamous intra-epithelial lesion (SIL) or malignancy, 8.2% (94/1146) had various grades of SIL. Thirty-five (37%), 29 (31%), 16 (17%) and 14 (15%) of the 94 SIL positive cases had atypical cells of unknown significance (ASCUS), low-grade squamous intra-epithelial lesion (LGSIL), high-grade squamous intra-epithelial lesion (HGSIL) and cervical carcinoma respectively. Adherence to instructions for repeat cytology was only 37.7% while that for 3 yearly interval rescreening was 17.5%. Phone calls and messages to clients improved adherence to appreciable extent. Conclusion: Adherence to interval and follow-up screening for cervical cancer was low. The use of phone calls and short message services (SMS) to remind clients of screening appointments increased adherence and should be employed in developing countries.

Purpose This study aimed to compare the accuracy of Papanicolaou test cytology, visual inspection with 5% acetic acid (VIA), and visual inspection with Lugol iodine (VILI) in the detection of premalignant and malignant lesions of the cervix. Materials and Methods This was a cross-sectional comparative study of 200 consenting participants at the Federal Teaching Hospital, Abakaliki over a 6-month period. All the participants had Papanicolaou test cytology. Subsequently, they were classified into two groups of 100 each through systematic random sampling: group 1 had VIA and group 2 had VILI. Thereafter, all the participants had cervical punch biopsy at the 6 and 12 o’clock cervical positions. Cervical punch biopsy was also done on the suspicious lesions of the cervix irrespective of their positions. The tests of validity of the three methods were calculated using the histology of the biopsy specimen as the gold standard. P value ≤ .05 was considered to be statistically significant. Results Among the VIA group, 19 (19%) had cervical epithelial abnormalities on Papanicolaou test cytology, and VIA was positive in 14 (14%). Histology results showed cervical neoplasia in 15 (15%) of the participants. Among the VILI group, 15 (15%) had cervical epithelial abnormalities on Papanicolaou test cytology, and VILI was positive in 19 (19%). Histology results showed cervical neoplasia in 15 (15%) of the participants. There was no significant difference in overall accuracy of Papanicolaou test cytology, VIA, and VILI. The overall accuracy of the Papanicolaou test cytology plus VIA was significantly more than Papanicolaou test cytology alone. Conclusion VIA or VILI can be used as a stand-alone cervical cancer screening test when compared with Papanicolaou test cytology, particularly in resource-limited settings. VIA can also complement Papanicolaou test cytology.

The cost of obstetric care could hinder the capacity of human immune-deficiency virus (HIV) positive women to receive adequate care during pregnancy and delivery. This study was aimed at determining the relationship between antenatal/delivery care cost and delivery place choice among HIV positive women in Enugu metropolis. This was a cross-sectional study of 232 post-partum HIV-positive women who came for 6-weeks post-natal visit. Data were analysed using SPSS version 20. The ethical clearance number obtained at UNTH on 18/11/2015 was NHREC/05/01/2008BFWA00002458-1RB00002323. The average obstetric care cost among the respondents was N55,405.67 (US$346.28). The delivery cost (

Aim To test whether Premaquick biomarkers were superior to modified Bishop score for preinduction cervical assessment at term. Methods A multicenter, double-blind randomized clinical trial in 151 nulliparous, cephalic presenting and singleton pregnancies was conducted. The cervix was considered 'ripe' when at least two out of three Premaquick biomarkers are positive or a Bishop score of ≥6. Main outcome measures were proportion of women who were administered or had additional prostaglandin E1 analogue (PGE1) as a preinduction agent and incidence of uterine rupture. The trial was registered in PACTR registry with approval number PACTR201604001592143. Analysis was performed by intention-to-treat principle. Results The need for initial PGE1 analogue (77.6% vs 98.7%, risk ratio [RR] =0.47, 95% confidence intervals [95% CI] =0.38-0.59, P 0.05). Conclusion Preinduction cervical assessment with Premaquick was significantly associated with higher frequency of transition to labor and reduced need for PGE1 analogue when compared to modified Bishop score. Further similar trials in other settings are necessary to strengthen or refute this observation.

Background and Aims: Although pregnancy and labor are considered physiological processes, the potential for catastrophic complications is constant and may develop rapidly. There is growing evidence that admission of high-risk patients into the Intensive Care Unit (ICU) is associated with a reduction in maternal mortality. This study was aimed at reviewing all obstetric patients admitted into the ICU. Materials and Methods: This was a retrospective study of all obstetric patients who were admitted into the ICU between January 1, 2012, and December 31, 2013. Results: There were 89 obstetric patients admitted and managed at the ICU out of 5176 deliveries, thereby accounting for 1 admission in 58 deliveries. Majority of the patients were between 26 and 30 years, primiparous, and unbooked. The indications for ICU admission in this study were ruptured uterus (36.0%), eclampsia (22.5%), obstetric hemorrhage (19.1%), septicemia (10.1%), severe preeclampsia (6.7%), and obstructed labor (6.7%). The maternal and perinatal mortality was 13.5% and 47.2%, respectively. Maternal unbooked status was significantly associated with maternal mortality ( P &*#60; 0.05). Conclusion: Ruptured uterus was the most common indication for ICU admission in the center. Maternal mortality was significantly associated with unbooked status. This underscores the importance of booking for antenatal care, prompt presentation at the hospital during emergencies, skilled birth attendance, and provision of adequate facilities for the management of critical obstetric cases in this environment.

INTRODUCTION: The high cost and associated adverse effects of conventional therapy make the patients seek complementary and alternative medicine. Complementary and alternative medicine use may contribute to the delay the patients have before seeking orthodox care. OBJECTIVES: To determine the prevalence, pattern, factors responsible for complementary and alternative medicine use and if complementary and alternative medicine use causes delay in seeking orthodox care among gynaecological cancer patients in Enugu. MATERIAL & METHODS: A pretested, semi-structured interviewer-administered questionnaire -based cross-sectional survey of 396 eligible gynaecological cancer patients recruited from both University of Nigeria Teaching Hospital, Enugu and Enugu State University of Science and Technology Teaching Hospital, Enugu between January, 2018 and June, 2020. The data was analyzed using the statistical package for social sciences version 23 (IBM SPSS, Chicago, IL). RESULTS: The mean age of the respondents was 57.3 years and it ranged from 41 to 77 years. Cervical cancer (76%) was the most common type of gynaecological cancer. A total of 283(71.5%) of the respondents used complementary and alternative medicine. Herbs (65%) were the most common type of complementary and alternative medicine used. Majority (56.9%) of complementary and alternative medicine users rarely used it. A total of 178(62.8%) complementary and alternative medicine users presumed that it would cure them while 105 (37.1%) presumed that it would relieve the symptoms of their cancer. However, 197 (69.6%) complementary and alternative medicine users stated that there was no actual benefit from its use. The low educational status has a statistically significant influence on complementary and alternative medicine use among the respondents(P-value=

Chukwuemeka Anthony Iyoke,1 Fausta Chioma Emegoakor,1 Euzebus Chinonye Ezugwu,1 Lucky Osaheni Lawani,2 Leonard Ogbonna Ajah,1 Jude Anazoeze Madu,3 Hyginus Uzo Ezegwui,1 Frank Okechukwu Ezugwu4 1Department of Obstetrics and Gynaecology, University of Nigeria, Enugu Campus, 2Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Abakaliki, 3Department of Haematology, University of Nigeria, Nsukka, 4Department of Obstetrics and Gynaecology, College of Medicine, Enugu State University, Enugu, Nigeria Background: Iron-deficiency anemia is the most common nutritional cause of anemia in pregnancy and is often responsible for puerperal anemia. Puerperal anemia can impair postpartum maternal and neonatal well-being. Objective: To determine the effect of treatment of moderate puerperal iron-deficiency anemia using a single intravenous total-dose iron dextran versus daily single dose oral iron(III)-hydroxide polymaltose. Methodology: A randomized controlled study in which postpartum women with moderate iron-deficiency anemia were randomized into treatment with either a single total-dose intravenous iron dextran or with daily single doses of oral iron(III)-hydroxide polymaltose tablets for 6 weeks. Effects on hemoglobin concentration using either method were compared at 6 weeks postpartum. Analysis was per protocol using SPSS version 17 for windows. P-values ≤0.05 were considered significant. Results: Two hundred eighty-four women were recruited for the study: 142 women received single total dose intravenous infusion of iron dextran while 142 received daily oral iron(III)-hydroxide polymaltose tablets. Approximately 84.0% (237/282) completed the study and were analyzed including 81% (115/142) of those randomized to injectable iron therapy compared to 85.9% (122/142) of those randomized to oral treatment. The proportions of women who had attained hemoglobin concentration of at least 10 g/dL by the 6 weeks postpartum visit did not differ significantly between cases and controls (95.7% vs 94.3%; P=0.73). Similarly, the mean increases in hemoglobin following either therapeutic route were comparable (1.03±0.56 g/dL for intravenous iron and 0.97±0.46 g/dL for the oral group; P=0.42). Conclusion: Single total-dose intravenous iron for treatment of puerperal iron-deficiency anemia was as effective as daily single doses of ferric iron tablets. For puerperal patients with iron-deficiency anemia in whom compliance with and tolerability of oral iron are not certain, a single total-dose intravenous iron can be safely offered. Keywords: effect, intravenous, iron, puerperal, anemia

Background: Giving birth should be a period of joy, but for more than half a million women, their pregnancy and childbirth end in death while some develop vesicovaginal fistula. Vesicovaginal fistula is an abnormal communication between the bladder and the vagina leading to continuous leakage of urine through the vagina. Little is known about the perception of pregnant women about obstetric fistula and this group of women are those who are at risk of the disease. Our aim therefore was to evaluate the level of awareness of vesicovaginal fistula among pregnant women attending antenatal clinic in a rural hospital. Methodology: This was a cross sectional study conducted at Mile 4 missionary Hospital, Abakaliki, between 1st of May and 1st of July, 2017. Data was collected with the use of questionnaire. Ethical clearance was gotten from the institutions ethical committee. Results: Their mean age was 27 ± 5 years and mean parity was 2 ± 2. Awareness of vesicovaginal fistula was 57.8%. Risk factors identified for vesicovaginal fistula were prolonged obstructed labour, instrumental vaginal delivery, caesarean section and short stature. Only 80 (39.2%) believed vesicovaginal fistula could be treated. Conclusion: Awareness of vesicovaginal fistula in the study population was 57.8%. A significant number of women were not aware that vesicovaginal fistula could be treated.

Introduction: Caesarean section is the delivery of a foetus through an incision made on the uterus. It is useful in situations where vaginal delivery is not feasible. Women in our setting usually see it as a reproductive failure and a sign of weakness. Our aim was to evaluate the perception of caesarean section among pregnant women attending antenatal clinic in a rural missionary hospital. Methodology: This was a cross-sectional study conducted at Mile 4 missionary hospital, Abakaliki among women attending routine antenatal clinic. Information was obtained from respondents with the aid of a questionnaire. Ethical clearance was obtained for the study. Data was analysed using the Statistical Package for Social Sciences (SPSS) version 21. Results: A total of 209 pregnant women participated in this study. Their age ranged from 14 to 43 with a mean age of 27 ± 5 years. One hundred and seventy two women (82.3%) have heard of caesarean section in the past. Eighteen (8.6%) have had caesarean section in the past while 5 were not willing to undergo the procedure again. Sixty (28.7%) are not willing to undergo caesarean section even when it is indicated. Conclusion: Despite awareness of caesarean section, women do not appear to have a positive attitude towards the procedure.

OBJECTIVE To determine the accuracy of a semi-quantitative interleukin-6 (IL-6) vaginal secretion rapid test (Chorioquick) for detecting chorioamnionitis in women with premature rupture of membranes (PROM). METHODS A prospective cohort study in five tertiary hospitals in Nigeria involved women with confirmed PROM at term and preterm PROM with or without suspected chorioamnionitis from August 1, 2017, to October 31, 2018. Cervicovaginal fluid samples were tested for chorioamnionitis using the Chorioquick test. Samples were repeated at decision to deliver. The test was considered positive if at least the indicator 'IL-6 low' of the three Chorioquick biomarkers (low, medium, high) was positive, or negative if none of the biomarkers were positive. Chorioamnionitis was histologically confirmed post-delivery using three tissue samples. Primary outcome measures were sensitivity, specificity, and accuracy. RESULTS Of 73 women, on histological confirmation, 39 were true positive and 29 were true negative (for chorioamnionitis) to the Chorioquick test at repeat assessment. Overall, the Chorioquick test had a sensitivity of 97.5% (95% confidence interval [CI] 85.3-99.9), specificity 87.9% (70.9-96.0), and accuracy 93.2% (79.5-99.1). Sub-group analysis of women

Fetal weight estimation is important in the management of labour and delivery. This study aimed to compare the accuracy of the clinical and ultrasound methods of fetal weight estimation. This was a prospective study involving 110 term cephalic singleton pregnancies delivered within 24 hours of clinical fetal weight estimation using Johnson's and Dare's formulae and ultrasound estimation at a Tertiary hospital in Abakaliki, Nigeria. The data were analysed with Stata 11 software. The sonographic estimation within 10% of the actual birth weight (ABW) of 68.2% was significantly greater than the accuracy of Johnson's (23.6%), Dare's (26.4%), and the combined clinical formulae (27.1%). The clinical methods overestimated the fetal weight. Both methods showed a positive correlation with the ABW. In conclusion, the sonographic method had a better accuracy than the clinical methods. However, fetal weight overestimation by clinical methods warrants their usefulness in resource-poor settings such that the clinical determination of a normal weight foetus will exclude fear of complications from macrosomia. Impact statement What is already known on this subject? An accurate estimation of fetal weight is important in the management of labour and delivery. However, there is limited evidence that any of the available methods of fetal weight estimation is more accurate than the others. What do the results of this study add? This study showed that the clinical methods using Johnson's and Dare's formulae had a significantly higher mean percentage and absolute mean percentage error compared to the sonographic estimation of fetal weight. The sonographic estimation within 10% of actual birth weight (ABW) of 68.2% was significantly greater than that of Johnson's and Dare's formulae with 23.6% and 26.4%, respectively. All of the methods showed a positive correlation with the ABW. What are the implications of these findings for clinical practice and/or further research? This implies that the sonographic method has a better accuracy than the clinical methods in estimating the fetal weight. However, the overestimation of fetal weight by the clinical methods warrants their usefulness in resource-poor settings such that the clinical determination of a normal weight foetus will exclude the fear of complications from macrosomia.

Background Though obesity is associated with some malignancies, its association with cervical cancer is still inconclusive. This study was aimed at determining if there was an association between obesity and cervical epithelial cell abnormalities (CEA). Methods This was a cross-sectional comparative study of obese and non-obese women at the Cervical Cancer Screening Clinic, University of Nigeria Teaching Hospital (UNTH), Enugu between January, 2012 and June, 2013. The participants whose body mass index (BMI) were ≥ 30 kg/m2 were classified as obese (200 women) while those whose BMI were 2 were classified as non-obese (200 women) and the two groups were consecutively recruited at the ratio of 1:1. Pap smear cytology, random blood sugar (RBS) and human immune-deficiency virus (HIV) screening was done for all the participants. Data was analyzed with SPSS version 20. Categorical variables were analyzed using McNemar’s test and Chi-squared test. Logistic regression analysis was used to determine the influence of socio-demographic characteristics on cervical epithelial cell abnormalities. The level of significance was set at ≤0.05. Results Among the obese women, 152(76%) had negative for intra-epithelial lesion or malignancy (NILM) while 48(24%) had cervical epithelial cell abnormalities (CEA). Also 182(91%) non-obese women had NILM while the remaining 18(9%) had CEA. The prevalence of CEA among all the study participants was 16.5%. There was an association between obesity and CEA[OR (95%CI) = 1.353(1.013–1.812); P-value = 0.04].CEA were significantly more common among women who were 40 years and above and single/separated women as well as widows (P-value = Conclusion There was an association between obesity and CEA. This underscores the need for a positive behavioural change among women in order to stem the tide of this public health problem.

BackgroundLow utilization of health facilities for delivery by pregnant women poses a public health challenge in Nigeria.AimTo determine the factors that influence the choice of birth place among antenatal clinic attendees.MethodologyThis was a cross-sectional study of the eligible antenatal clinic attendees at Mater Misericordiae Hospital, Afikpo and Saint Vincent Hospital, Ndubia in Ebonyi State from February 1, 2016 to June 30, 2016. Analysis was done using EPI Info 7.21 software (CDC Atlanta Georgia).ResultsA total of 397(99.3%) completely filled questionnaires were collated and analysed. Approximately 71% of the health facilities closest to the respondents had maternity services. It took at least 1 hour for 80.9% of the respondents to access health facilities with maternity services. Most (60.2%) of the respondents had antenatal care attendance and majority of them did so at public hospitals. Approximately 43.8% of the respondents were delivered by the skilled birth attendants. The common determinants of birth place were nearness of the health facilities, familiarity of healthcare providers, improved services, sudden labour onset and cost. Also 61.7% of the respondents chose to deliver in public health facilities due to favourable reasons but this could be hampered by the rudeness of some healthcare providers at such facilities. A significant proportion of private health facilities had unskilled manpower and shortage of drugs.ConclusionA greater proportion of women will prefer to deliver in health facilities. However there are barriers to utilization of these facilities hence the need for reversal of this ugly trend.

INTRODUCTION: Cervical cancer screening has significantly contributed to the detection of premalignant and malignant lesions of the cervix and prevention of the morbidity and mortality associated with the disease. In the developing countries, especially sub-Saharan Africa where the burden of cervical cancer is highest, the high-risk population may not know the screening schedules or be able to pay for the services, and so fail to benefit. OBJECTIVE: To determine the level of awareness of cervical cancer screening schedule and willingness to pay for cervical screening services among women in Abakaliki, southeast Nigeria. METHOD: The study design was a descriptive cross-sectional questionnaire-based and the population comprised 800 participants who came for free cervical cancer screening at well women centre, Alex Ekwueme Federal University Teaching Hospital, Abakaliki between January and December 2017. Data were analyzed using the Statistical Package for Sciences version 20.0. RESULT: Of the 756 (94.5%) questionnaires analyzed, the mean age was 41.4 years, modal parity 4; 83.6% had prior knowledge of cervical cancer while 81.0% knew that cervical cancer screening is a diagnostic tool. Surprisingly, only 32% of those aware of cervical cancer had previously done cervical cancer screening, while 10.8% knew the interval for cervical cancer screening. On screening for cervical cancer in future, 89.2% of the respondents were willing to repeat the test while 54.2% would be willing to pay for the screening services. Being 40 years of age or less, married, educated, of high socio-economic class and having first sexual intercourse at 18 years or less were associated with willingness to pay for screening. CONCLUSION: Although the knowledge of cervical cancer is high, cervical cancer screening uptake is low, many women are aware of the interval for cervical cancer screening, and many will not be willing to pay for cervical cancer screening out of their pockets.&nbsp

BACKGROUND: Diagnostic challenge of malaria in Nigeria remarkably impedes the World Health Organization (WHO) recommendation of laboratory diagnosis before treatment. Rapid Diagnostic Test (RDT) is easier and cheaper to perform when compared with microscopy especially in resource-poor settings. However there are conflicting results on the accuracy of RDT versus microscopy from previous studies. AIM: To compare the overall accuracy of microscopy and RDT in detecting peripheral malaria among pregnant women with clinical features of malaria. MATERIALS & METHODS: This was a cross-sectional comparative studyin whichRDT, microscopy and polymerase chain reaction (PCR) were performed using the peripheral bloodof the eligible study participants at the Alex Ekwueme Federal University Teaching Hospital, Abakaliki between September 1, 2016 and March 31, 2017.The PCR was used as the gold standard in this study. Data was analyzed with the Statistical Package for Social Sciences version 18 (IBM SPSS, Chicago, USA). P value ≤ 0.05 was considered statistically significant. RESULTS: The actual prevalent rates of malaria based on RDT, microscopy and PCR results among the participants were 58.2%, 59.9% and 61.1% respectively. There was no statistical significant difference among RDT, microscopy and combined RDT and microscopy on overall accuracy. Malaria infestation was associated with self-employed and unemployed women, primigravidity, second trimester, rural residence, non-use of long lasting insecticide treated nets and intermittent preventive therapy for malaria. CONCLUSION: There was no difference in overall accuracy among RDT, microscopy and combined RDT and microscopy. This underscores the need to scale up RDT for every patient with clinical features of malaria before treatment in this environment.

Background: The scope of endoscopy is expanding more and more as experience is gained with training and collaborations, however, these expansions could be slowed by challenges.Objectives: To determine the experiences and challenges of gyne‑endoscopic surgery.Materials and Methods: This study was a prospective analysis of all women undergoing gynecologic endoscopy at Federal Teaching Hospital Abakaliki (FETHA), Nigeria from 2012 to 2014. Patients were recruited based on eligibility for endoscopy surgery. Written informed consent was obtained before any of the gyne‑endoscopic surgery. Ethical approval for the study was given by the ethics and research committee of FETHA. Laparoscopy and hysteroscopy were performed by the managing team. EPI Info version 3.5.1 statistical software (Atlanta, GA, USA) was used for data analysis.Results: Seventy‑three different gyne‑endoscopic surgeries were done, with dye test accounting for majority 28 (77.8%). The duration of surgery ranged from 23 to 248 minutes, and the surgery with the longest duration was total laparoscopic hysterectomy while laparoscopy and dye test had the shortest operating time. The mean duration of hospitalization was 20.3 ± 14.4 hours. There were 2 (5.6%) conversions to open surgery. Most common complication was abdominal pain 26 (72.2%). The challenges include third party partnership, lack of vital equipment, poor maintenance, epileptic power supply, late presentation of cases, and misconception.Conclusion: Gyne‑endoscopy is essential in contemporary medicine. Reduction in operating time occurs as skills and experience improve; the challenges are many.Keywords: Challenges; endoscopy; experience; gynecology; hysteroscopy; laparoscopy

Introduction: Obstetric ultrasound is a popular and attractive management tool in Obstetrics. In recent times, it has gained wide acceptance amongst expectant mothers in many parts of the developing world. Many Obstetricians now regard it as an integral part of antenatal care. Despite this popularity, little is known about women’s views regarding the antenatal ultrasound scan in Nigeria. Aim: The aim of the study was to explore the views of women on the routine antenatal ultrasound scan in Abakaliki, Southeast Nigeria. Materials and Methods: This was a cross-sectional descriptive study involving 335 antenatal women who booked for antenatal care at the Federal Teaching Hospital, Abakaliki (FETHA), between July 2017 to November 2017. Sampling was by non probability sampling technique. The survey instrument was a semi structured questionnaire. Statistical analysis was performed using IBM SPSS Statistics for Windows, version 24.0. Armonk, NY: IBM Corp. Data were analysed using descriptive statistics. Results: A total of 335 antenatal women were interviewed. Mean age was 27.9±4.3 years (range 17 to 44 years). Women’s knowledge of ultrasound use for antenatal care and the indications for the scan was high; 326 (97.6%) out of 334 and 244 (75.5%) out of 323 respectively. 254 (75%) out of 331 were not properly counselled before the ultrasound procedure. About 35 (10%) out of 333 thought the ultrasound scan could harm their unborn baby. 167 (52%) out of 321 of the women interacted with the sonologist during the ultrasound scan. After the procedure, 247 (76.0%) out of 325 participants had the ultrasound findings explained to them. About 275 (82%) out of 334 wanted to know the sex of their foetus. The ultrasound experience was positive for 198 (60%) out of 330 of the women. Conclusion: Knowledge of antenatal ultrasound scan and the indication for the scan was high amongst present study women. There was equally a high level of interaction between the sonologist and the pregnant women during the scan. This may have contributed to the high rate of satisfaction and positive ultrasound experience recorded in this study. There was however, lack of proper counselling of the women by the obstetricians before the ultrasound procedure. Improvement in this aspect of patient care is needed to further enhance the ultrasound experience of present study women, and to reduce anxiety and dispel any misconceptions and irrational expectations regarding the antenatal ultrasound scan.

Preconception care (PCC) is a preventive strategy for maternal and perinatal morbidity and mortality. This study aimed to assess the level of awareness and utilisation of PCC services. A descriptive cross-sectional survey was conducted at a teaching hospital. Interviewer-administered questionnaires were used to extract information. A total of 450 participants responded; 44.2% (190/450) were aware, 31.7% (143/450) had good knowledge, while only 10.3% (46/450) received PCC. Health care providers were the main source of information (77.9%). There was statistically significant correlation between awareness and participants' level of education (p .001) and residence (p .001), as well as between utilisation and education (p .001), and information from doctors (p .001). There was a low level of awareness and poor utilisation of PCC, underpinning the need to scale up health education, establishment of functional PCC clinics and formulation of evidence-based guidelines to improve uptake and pregnancy outcome. Impact statement What is already known on the subject of the paper? PCC has been known in high-income countries as a prevention-based strategy, which aims at improving obstetric outcomes. However, the level of utilisation in low-income countries like Nigeria is either unknown or far too low. What do this study add? This work has provided local data on PCC; clearly indicating that the awareness and utilisation of PCC services in Abakaliki, Nigeria is very low when compared with other regions of the world, and this was influenced by the socio-demographic factors - particularly education and place of residence (for awareness), and level of education and information from health care providers (for utilisation), thus suggesting that enlightenment and improvement in social infrastructures could improve awareness, access and utilisation of PCC. What are the implications for clinical practice and/or further research? The implications of these findings in low resource settings like ours will include introducing interventions to scaling up health education, universal establishment of functional PCC units and formulation of evidence-based guidelines aimed at improving the uptake of PCC and pregnancy outcome. Further research will also be needed in future to assess the impact of such interventions and how to sustain potential benefits.

Opposition by male partners is one of the barriers to contraceptive use in sub-Saharan Africa. The study aimed at determining the extent of male partner involvement in female contraceptive (FP) choices in Enugu, south-east Nigeria. Questionnaires were administered to 243 consecutive women attendee of family planning clinic, University of Nigeria Teaching Hospital (UNTH), Enugu from January to June, 2012. A total of 137 women made contraceptive decisions jointly with their partners, which gave a male involvement rate of 56.4%. Only respondents' higher age (≥ 35 years) had significant association with male partner involvement in FP choices (odds ratio (OR) = 2.1; 95% confidence interval: 1.22, 3.51; p = 0.008). Covert contraceptive use rate was 4.9% (12/243). A majority of women attending the FP clinic of UNTH, Enugu involved their partners when making contraceptive choices. Male-partner-targeted family planning programme has the potential to increase uptake of contraception in our environment.

Introduction: Postoperative pain is one of the main postoperative adverse outcomes following caesarean section. Its management still remains a challenge especially in a low resource setting. Aim: To compare the efficacy of intramuscular pentazocine alone and combined intramuscular pentazocine with diclofenac for pain relief within 24 hours after caesarean section. Materials and Methods: This was a double blind randomized control study of post caesarean section pain management of 140 participants between April and December, 2015 at the Federal Teaching hospital, Abakaliki. Inclusion criteria involved consenting and low risk parturients who had caesarean section under spinal anaesthesia. The participants were randomly grouped into Pentazocine-Placebo (PP) group and PentazocineDiclofenac (PD) group. The PP group received pentazocine 30 mg every 4 hours for 24 hours and 3 milliliters of water for injection as placebo 12 hourly for 24 hours while the PD group received pentazocine 30 mg every 4 hours and diclofenac 75 mg every 12 hours for 24 hours. The level of pain control was assessed using the Visual Analog Scale (VAS). The data was analysed with IBM SPSS version 20.0. The level of significance was set at < 0.05. Results: The use of PD for 24 hour post caesarean section analgesia achieved better pain relief, faster onset of postoperative ambulation, bowel sound auscultation and oral feeding than the use of PP (p-value ≤0.002). However, the use of PD is more expensive than PP (p-value =0.0001). There was no difference between the two groups of participants on the passage of flatus and duration of hospital stay (p-value≥0.05). The use of PP was associated with more maternal side effects (p-value=0.009). There was no difference on the level of satisfaction between the two groups of participants (p-value≥0.05). Conclusion: The use of PD for post caesarean section analgesia is more effective in achieving a satisfactory pain relief and has less side effects.

Introduction: Prenatal diagnosis comprises all diagnostic modalities aimed at gaining information about the embryo or fetal wellbeing. It enables antenatal care tailored to the individual need(s) of the fetus. Aim: To determine the knowledge, practice and prospect of prenatal diagnosis among reproductive health care providers in Abakaliki, Nigeria. Materials and Methods: This was a cross-sectional descriptive study in which completely filled self-administered semistructured questionnaires were retrieved from 182 reproductive healthcare providers at Federal Teaching Hospital, Abakaliki (FETHA). The questionnaires contained 17 items covering the socio-demographic data, knowledge, practice and prospects of prenatal diagnosis among the respondents. Result: A total of 179 respondents (98.4%) were aware of the prenatal diagnosis. One hundred and sixty four (90.1%) of the respondents agreed that, prenatal diagnostic services is offered in the study centre and 97% of these respondents cited ultrasound scan as the prenatal diagnostic investigation. While 133 respondents (73.1%) would allow parents to decide the next line of action after due counseling for the diagnosis of a condition not compatible with extrauterine life was made, 23(12.6%) of the respondents would offer termination of the pregnancy. Among the respondents, 173(95.1%) would encourage prenatal diagnosis at the study centre and 153(88.4%) of the 173 respondents would do so by educating the populace on the benefits of the procedure. However, 2(1.1%) of the respondent would not encourage the practice of prenatal diagnosis in FETHA citing adverse effects on the woman and her fetus. Conclusion: Reproductive healthcare providers in Abakaliki have a high level of awareness and favorable disposition to prenatal diagnosis. However, prenatal diagnosis is still rudimentary in this environment.

Introduction: Preeclampsia with severe features and eclampsia has remained a serious challenge in tropical obstetric practice. It is a major cause of maternal and perinatal morbidity and mortality in Nigeria. Aim: This study was aimed at determining the prevalence, the risk factors and feto-maternal outcome of preeclampsia with severe features and eclampsia in Abakaliki. Materials and Methods: This was a 5-year retrospective casecontrol study of preeclampsia with severe features and eclampsia at the Federal Teaching Hospital, Abakaliki. Case notes of preeclampsia with severe features and eclampsia between January 2008 and December, 2012 were retrieved. Similarly, the case file of next parturient that did not have any medical disease was included in the study. The cases and controls were selected at the ratio of 1:1. The data assessed were information on maternal age, parity, booking status, diagnosis, mode of delivery, complications, maternal and perinatal outcomes. Results: A total of 13,750 deliveries were recorded within the study period. The prevalence of preeclampsia with severe features and eclampsia were 136(0.99%) and 104(0.76%) respectively. Preeclampsia with severe features and eclampsia was more common among adolescents, rural dwellers, poorly educated, unemployed, unbooked and nulliparous women. It was more associated with preterm delivery, caesarean section, low birth weight babies, maternal and perinatal mortality. Conclusion: Preeclampsia with severe features and eclampsia is common among the adolescents, unbooked, rural, and low socio-economic group of women in this study. It has also contributed to high maternal and perinatal morbidity and mortality. There is need for policy makers to formulate policies toward female education, women empowerment and provision of social amenities in rural areas. These policies may reverse the current ugly trend in this environment.

Introduction: Fetal distress has been shown to contribute to the increasing caesarean section rate. There has been controversy on the usefulness of clinical diagnosis of fetal distress using only the intermittent counting of the fetal heart rate and/or passage of meconium-stained liquor. Aim: To evaluate the clinical diagnosis of fetal distress and the perinatal outcome. Materials and Methods: This was a retrospective study in which the case records of the patients, who were diagnosed of fetal distress at Federal Teaching Hospital, Abakaliki, Nigeria, from January 1, 2008 to December 31, 2014, were collated. The statistical analysis was done using the Statistical Package for Social Sciences version 17 software (SPSS Inc., Chicago IL,USA). Results: Out of the 15,640 deliveries carried out within the study period, 3,761 (24.05%) deliveries were through caesarean section. A total of 326 (8.9%) of the 3,761 caesarean sections were due to fetal distress within the study period. More so, a total of 227 (70.9%) babies were born with ≥ 7 Apgar score at the 1st minute of delivery. The perinatal mortality rate was 31.25 per 1000 deliveries. Though birth asphyxia was recorded more on babies of mothers that had fresh meconium-stained liquor and whose decision-intervention interval was more than 30 minutes when compared with those without any of the two conditions, there was no statistical significant difference between them. Conclusion: The clinical diagnosis of fetal distress is accurate in 29.1% of the cases. However, it has led to an unnecessary caesarean section in the remaining 70.9% of the parturients. In order to reduce this high trend of unnecessary caesarean sections due to clinical diagnosis of fetal distress in this environment, antepartum fetal assessment with non-stress test or biophysical profile and intrapartum use of continuous electronic fetal monitoring should be used to confirm or refute the fetal distress before any surgical intervention. Fetal blood sampling and fetal pulse oximetry should be performed in event of non- re-assuring or abnormal cardiotocography.

Introduction: Intrauterine Device (IUD) is a contraceptive method used by women of reproductive age group. However, there are conflicting reports on the association between IUD and cervical neoplasia. These controversies may further hamper the poor uptake of modern contraception in Nigeria. Aim: This study was therefore aimed at evaluating the association between IUD and cervical neoplasia. Materials and Methods: This was a case control study in which Pap smear results of 156 participants on IUD were compared with those of 156 non-users of modern contraception. The participants who were found to have abnormal cervical smear cytology results were further subjected to colposcopy. Biopsy specimens for histology were collected from the participants with obvious cervical lesions or those with suspicious lesions on colposcopy. The results were analysed with descriptive and inferential statistics at 95% level of confidence. Results: Seven (4.5%) and 2(1.3%) of participants using IUD had Cervical Intraepithelial Neoplasia (CIN) 1 and CIN 2 respectively. Also, 5(3.2%) and 1(0.6%) of non-users of modern contraception had CIN 1 and CIN 2 respectively. The prevalence of cervical neoplasia among all the participants was 4.8%. Although, the proportion of women who had CIN was more among participants using IUD than non-users of modern contraception, the difference was not statistically significant. Conclusion: There was no significant association between IUD and cervical neoplasia in this study.

Background: Vasectomy is a safe alternative to bilateral tubal ligation (BTL) in achieving permanent sterilization but not popular in developing countries. As part of the efforts to increase popularity as well as acceptance of vasectomy in the developing countries, its awareness among women needs to be assessed. The study was undertaken to determine the awareness and perceptions of vasectomy among antenatal attendees in a tertiary health institution southeast Nigeria.Methods: This was a questionnaire-based cross-sectional study in which pregnant women visiting University of Nigeria Teaching Hospital, Enugu (UNTH) antenatal clinic from 1st June – 30th November 2017 were recruited. Data was collected using structured questionnaire. Two hundred (200) self-administered questionnaires were completely filled and analyzed by means of descriptive and inferential statistics including means frequencies and x^2-tests at the 95% confidence level (CL).Results: Of the 200 respondents, 146(73%) were completely unaware of the existence of vasectomy while 54(27%) were aware. Of those who were aware, 41(75.9%) accepted its use as a family planning method for men. The commonest reason for acceptance was the fear of infidelity among their husbands, 17(41.5%). The intention to use was however low as 24(44.4%) of those who accepted vasectomy disapproved of its use by their husbands and the main reason for disapproval was “weakens husband’s sexual performance,” (33.3%). Tertiary level of education of the respondents was 5.3 times independently associated with the acceptance of vasectomy.Conclusions: The awareness is low and there are several misperceptions about vasectomy among the women in Enugu. Tertiary education of the women however improves the choice of vasectomy as a permanent contraceptive option. There is the need for educational programmes in line with the numerous advantages of vasectomy so as to counteract the misperceptions especially those regarding sexual relationship.

Leonard Ogbonna Ajah,1,2 Chibuike Ogwuegbu Chigbu,2 Benjamin Chukwuma Ozumba,2 Theophilus Chimezie Oguanuo,2 Paul Olisaemeka Ezeonu1 1Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Abakaliki, Nigeria; 2Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Enugu, Nigeria Background: The association between hormonal contraception and cervical cancer is controversial. These controversies may hamper the uptake of hormonal contraceptives. Objective: To determine the association between hormonal contraceptives and cervical neoplasia. Materials and methods: This was a case-control study in which Pap-smear results of 156 participants on hormonal contraceptives were compared with those of 156 participants on no form of modern contraception. Modern contraception is defined as the use of such contraceptives as condoms, pills, injectables, intrauterine devices, implants, and female or male sterilization. Those found to have abnormal cervical smear cytology results were subjected further to colposcopy. Biopsy specimens for histology were collected from the participants with obvious cervical lesions or those with suspicious lesions on colposcopy. The results were analyzed with descriptive and inferential statistics at a 95% level of confidence. Results: A total of 71 (45.5%), 60 (38.5%), and 25 (16.0%) of the participants on hormonal contraceptives were using oral contraceptives, injectable contraceptives, and implants, respectively. Cervical neoplasia was significantly more common among participants who were ≥35 years old (6% versus 1%, P

Chukwuemeka Anthony Iyoke,1 Lucky Osaheni Lawani,2 George Onyemaechi Ugwu,1 Leonard Ogbonna Ajah,2 Euzebus Chinonye Ezugwu,1 Paul Onah,1 Chidinma Ifechi Onwuka1 1Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria; 2Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Abakaliki, Nigeria Background: Interdisciplinary team working could facilitate the efficient provision and coordination of increasingly diverse health services, thereby improving the quality of patient care. The purpose of this study was to describe knowledge of interdisciplinary team working among obstetricians and gynecologists in two teaching hospitals in South East Nigeria and to determine their attitude toward an interdisciplinary collaborative approach to patient care in these institutions. Methods: This was a questionnaire-based cross-sectional study. Data analysis involved descriptive statistics and was carried out using Statistical Package for the Social Sciences software version 17.0 for Windows. Results: In total, 116 doctors participated in the study. The mean age of the respondents was 31.9±7.0 (range 22–51) years. Approximately 74% of respondents were aware of the concept of interdisciplinary team working. Approximately 15% of respondents who were aware of the concept of interdisciplinary team working had very good knowledge of it; 52% had good knowledge and 33% had poor knowledge. Twenty-nine percent of knowledgeable respondents reported ever receiving formal teaching/training on interdisciplinary team working in the course of their professional development. About 78% of those aware of team working believed that interdisciplinary teams would be useful in obstetrics and gynecology practice in Nigeria, with 89% stating that it would be very useful. Approximately 77% of those aware of team working would support establishment and implementation of interdisciplinary teams at their centers. Conclusion: There was a high degree of knowledge of the concept and a positive attitude toward interdisciplinary team working among obstetricians and gynecologists in the study centers. This suggests that the attitude of physicians may not be an impediment to implementation of a collaborative interdisciplinary approach to clinical care in the study centers. Keywords: team working, interdisciplinary, Nigeria, obstetrics, gynecology

Paul Olisaemeka Ezeonu,1 Leonard Ogbonna Ajah,1 Robinson Chukwudi Onoh,1 Osaheni Lucky Lawani,1 Vincent Chidi Enemuo,2 Uzoma MaryRose Agwu1 1Department of Obstetrics and Gynecology, 2Department of Surgery, Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria Background: Breast cancer in pregnancy accounts for 2%–3% of all breast cancers. The increased vascularity and lymphatic drainage from the breast during pregnancy potentiate the metastatic spread of the cancer to the regional lymph nodes. However, the increased breast density in pregnancy makes it difficult to detect breast lesions early.Aim: To evaluate and compare the detection rate of breast lesions using clinical breast examination (CBE) and breast ultrasonography among pregnant women. Methodology: A cross-sectional comparative study involving antenatal clinic attendees at the Federal Teaching Hospital, Abakaliki, was conducted between March 3, 2014, and December 31, 2014. CBE and breast ultrasonography were done in the participants at booking and repeated at 6 weeks postpartum. Fine-needle aspiration cytology and histology were done in women with suspicious breast lesions on CBE or breast ultrasonography or both. Data analysis was both descriptive and inferential at the 95% confidence level using the Statistical Package for the Social Sciences (SPSS) software version 17.0. Test of significance was done using chi-square test. A P-value of less than or equal to 0.05 was considered statistically significant. Results: A total of 320 pregnant women participated in the study. Of these, 267 (83.4%) were aware of breast cancer. Although more lesions were detected with breast ultrasonography than by CBE, there was no statistically significant difference between them (25 versus 17; P=0.26).The histology of the lesions revealed 21 benign lesions and 4 normal breast tissues. The sensitivity of breast ultrasonography was 95.2%, while that of CBE was 66.7%. The specificity, positive predictive value, and negative predictive value were similar between CBE and breast ultrasonography. Conclusion: The detection rates of breast lesions by both CBE and breast ultrasonography were equivalent during pregnancy and 6 weeks postpartum, making CBE a convenient and very cost-effective method of detecting breast lesions in the low-risk population. However, both CBE and breast ultrasonography should be done in women with high risk of breast malignancy. Keywords: clinical breast examination, breast ultrasonography, pregnant women, breast lesion, Nigeria

The Roll Back Malaria initiatives were introduced to ensure that 60% of pregnant women receive intermittent preventive anti-malarial treatment by the end of 2005 in an attempt to halve the mortality from malaria by 2010. Our aim was to determine the prevalence of asymptomatic malaria parasitaemia in pregnant women on intermittent preventive treatment (IPT) with sulfadoxine-pyrimethamine (SP) compared with a control group. This comparative study involved testing the peripheral blood of pregnant women on IPT with SP and a control group that did not receive SP for the malaria parasite upon registration and at 34 weeks gestational age. The levels of parasitaemia in the intervention group upon registration (4.9%) and at 34 weeks (63.9%) were not significantly different ( P > 0.05) from that of the control group (10%) and at 34 weeks gestation (68.3%). IPT with SP during pregnancy did not significantly reduce the prevalence of the malaria parasitaemia among the pregnant women in our environment.

LO Ajah,1,2 CO Chigbu,1 HE Onah,1 CA Iyoke,1 OL Lawani,2 PO Ezeonu2 1Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Enugu, 2Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Abakaliki, Nigeria Background: Ideally, all patients with abnormal Papanicolaou smear cytology results should undergo colposcopic examination of the cervix, but low-grade squamous intraepithelial lesions (LSILs) can also be followed up with further Papanicolaou smear surveillance. The aim of this study was to evaluate the outcome of cytologic surveillance versus immediate colposcopy in women with a cervical smear diagnosis of LSIL. Methods: This was a prospective comparative study of 240 eligible consenting women consecutively grouped into cervical surveillance for 6 months versus immediate colposcopy at a ratio of 1:1. Free cervical smear cytology, colposcopy, and biopsy, as well as histology, were provided for all study participants. Results: The regression, persistence, and progression rates with 6 months of cytologic surveillance of LSIL were 46.1%, 43.4%, and 3.9%, respectively. The difference between the proportions of women who had an eventual histologic diagnosis of cervical intraepithelial neoplasia 2+ in both groups was not statistically significant (4.9% versus 8.7%; P=0.68). The default rates among women on cytologic surveillance and immediate colposcopy were 37% and 12.5%, respectively (P=0.0002). Conclusion: Although the progression rate of LSIL is low, a high persistence rate and higher default rate from cytologic surveillance highlight the need to consider immediate referral for colposcopy, where available, for all women with a Papanicolaou smear diagnosis of LSIL in this environment. Keywords: cytologic surveillance, immediate colposcopy, low-grade squamous intraepithelial lesions, Enugu

Leonard Ogbonna Ajah,1,2 Chukwuemeka Anthony Iyoke,1 Peter Onubiwe Nkwo,1 Boniface Nwakoby,3 Paul Ezeonu2 1Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Enugu, Nigeria; 2Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria; 3Department of Community Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria Background: The perception and prevalence of domestic violence (DV) in rural areas is poorly understood; the result is that most efforts at eradicating this harmful practice are concentrated in urban areas. The objective of the study was to compare the burden and perception of DV among women living in rural and urban Igbo communities of southeast Nigeria. Methods: This was a comparative, cross-sectional study of women residing in rural and urban communities in Enugu, Nigeria, who had gathered for an annual religious meeting from August 1–7, 2011. Data analysis involved descriptive and inferential statistics and was conducted with the Statistical Package for Social Sciences, software version 17.0, at a 95% level of confidence. Results: A total of 836 women who met the eligibility criteria participated in the survey. Of these, 376 were from Okpanku, a rural community, while 460 were from Ogui Nike, an urban community. The prevalence of DV among rural women was significantly higher than that among urban women (97% versus 81%, P

Objectives. The aim of this study was to evaluate the methods, indications, outcome of induced labor and its significance in obstetric practice in the study area.Methods. This was a retrospective study of cases of induced labor at the Catholic Maternity Hospital in Ogoja, Cross-River State, Nigeria, between January 1, 2002, and December 31, 2011. Data on the sociodemographic characteristics of the parturient, induction methods, indications for induction, outcomes and reasons for failed induction were abstracted from personal case files and the hospital’s maternity/delivery register. The data were analyzed with SPSS15.0 window version.Result. The induction rate in this study was 11.5%. Induction was successful in 75.9% of cases but failed in 24.1%. Misoprostol was the commonest induction method (78.2%). The commonest indication for induction was postdate pregnancy (45.8%). Failed induction was due to fetal distress, prolonged labor, cephalopelvic disproportion and cord prolapse. The induction-delivery interval was12±3.6 hours.Conclusion. Induction of labor is a common obstetric procedure which is safe and beneficial in well-selected and properly monitored high risk pregnancies where the benefits of early delivery outweigh the risk of continuing the pregnancy.

Background: Semen analysis has remained an objective, inexpensive and readily available means of assessing male factor infertility. There is a paucity of studies on male factor infertility in Nigeria using the current World Health Organization 2010 human values for semen characteristics. Aim: This study was aimed at determining the socio-demographic and semen characteristics of the male partners of infertile couples in Abakaliki. Materials and Methods: The case files of infertility cases managed at Federal Teaching Hospital from January 2011 to December 2015 were retrieved. Results: Out of 730 semen analysis results analysed, 297 (40.7%) have abnormal parameters ranging from abnormal motility (36.7%), to the combination of low sperm count, abnormal motility and morphology (0.68%). While older age and urban dwelling had significant effect on abnormal sperm motility, rural dwelling and low/or no educational status had a significant effect on low seminal fluid volume and sperm count (P-value ≤ 0.05). Conclusion: There is still a high rate of male factor infertility in this environment.

Objective To determine how Nigerian gynecologists perceive and use chaperones during intimate gynecologic examinations. Methods A cross-sectional survey of Nigerian gynecologists was conducted with the aid of self-administered, semi-structured questionnaires. Data were analyzed for descriptive and inferential statistics. Results In all, 97.6% of respondents considered the use of a chaperone necessary during intimate gynecologic examinations and recommended that the Society of Gynaecology and Obstetrics of Nigeria (SOGON) should endorse the routine offer of chaperones for such examinations. However, just 35.9% of male physicians always or often used chaperones, while 76.9% of female physicians used chaperones only under special circumstances. No female physician always or often used a chaperone during pelvic examination. The main obstacles to the use of chaperones were scarcity of personnel to serve in this capacity (87.6%) and patients’ refusal to be examined in the presence of a third party (12.4%). Conclusion Most Nigerian gynecologists use chaperones at least some of the time and also support a policy of routinely offering chaperones during intimate gynecologic examination while respecting patients’ right to decline this offer. Scarcity of personnel to serve as chaperones is the greatest challenge to the implementation of this policy.

Leonard Ogbonna Ajah,1 Ebele Samuel Onubogu,1 Okechukwu Bonaventure Anozie,1 Lucky Osaheni Lawani,1 Chukwuemeka Anthony Iyoke,2 Emeka Ogah Onwe,3 Monique Iheoma Ajah4 1Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Abakaliki, 2Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Ituku-Ozalla, 3Department of Paediatrics, 4Well Women Centre, Federal Teaching Hospital, Abakaliki, Nigeria Background: Reproductive health services in the form of adolescent health and contraceptive services are fundamental in the prevention of a high incidence of teenage pregnancy. The purpose of this study was to determine the age at menarche, menstrual pattern, and awareness of and use of modern contraception among secondary school girls in Abakaliki, Nigeria.Subjects and materials: This was a cross-sectional study in which self-administered questionnaires were completed by 482 adolescent girls at two girls’ secondary schools between August and September 2012.Results: The mean age at menarche was 13.13±1.37 years. The mean menstrual cycle length was 27.8±3.14 days, and the mean duration of menstrual flow was 4.8±1.14 days. Thirty-seven (7.7%) respondents were ignorant of their cycle length, while 29 (6.0%) had irregular cycles. Premenstrual syndrome and dysmenorrhea were major menstrual issues, which resulted in 69 (14.3%) and 59 (12.2%) of respondents resorting to self-medication and absenteeism from school, respectively. Mothers were the main source of their daughters’ adolescent education, while friends and mass media were the main source of contraceptive information. Though therewas a high level (75.7%) of awareness of contraceptive information among the girls, usage (8.9%) was poor. Only eight (18.6%) of the 43 respondents who had ever used modern contraception were adherent to modern contraceptives. Students who were more than 15 years old, attained menarche at 13 years or less, and whose families were of low socioeconomic classes were more likely to be sexually active.Conclusion: The declining age at menarche, menstrual challenges, and poor reproductive health status of adolescent girls in this study have made menstrual issues and contraceptive adherence critical aspects of adolescent health care, especially when appropriate sources of reproductive health information were not fully harnessed. Therefore, there is an urgent need to establish adolescent-friendly clinics and include sexuality education in the curriculum of schools in this environment. Keywords: menstrual pattern, contraception, reproductive health, adolescent girls, Nigeria

Fidelis Agwu Onu,1 Leonard Ogbonna Ajah,1 Paul Olisaemeka Ezeonu,1 Odidika Ugochukwu Joannes Umeora,1 Perpetus Chudi Ibekwe,1 Monique Iheoma Ajah2 1Department of Obstetrics and Gynaecology, Federal Teaching Hospital, 2Department of Microbiology, Ebonyi State University, Abakaliki, Nigeria Background: Detecting and treating asymptomatic bacteriuria (ASB) prevents urinary tract infection and its consequences. The cost-effectiveness of routine screening for ASB in pregnancy is controversial. In populations with high prevalence, however, it is worthwhile and justifiable. Aim: To determine the profile, prevalence, microbiological isolates, and risk factors of ASB among booking antenatal clinic attendees in Abakaliki, Nigeria. Materials and methods: This was a cross-sectional study involving booking antenatal clinic attendees at the Federal Teaching Hospital, Abakaliki, who met the inclusion criteria. This study occurred between January and December, 2012. The midstream urine samples of these women were subjected to microscopy, culture, and sensitivity. Results: A total of 300 randomly selected booking antenatal clinic attendees participated in the study; 74 of them had ASB, giving a prevalence of 24.7%. With the exception of rural residence, sociodemographic and obstetric characteristics did not influence the risk of ASB among the participants in this study. Staphylococcus aureus was the commonest organism isolated. The majority of the organisms were sensitive to ofloxacin and ceftriaxone. Conclusion: There is a high prevalence of ASB among pregnant women in Abakaliki. With the exception of rural dwelling, sociodemographic and obstetric characteristics did not significantly influence the risk of ASB among these pregnant women. Therefore, routine ASB screening of pregnant women is recommended in our environment. Keywords: asymptomatic bacteriuria, pregnant women, Abakaliki

Background: Anemia in pregnancy affects about half of pregnant women and constitutes a serious health problem. Objectives: The aim was to determine the prevalence of anemia in pregnancy, as well as its pattern and determinants. Materials and Methods: This was a prospective cross-sectional study conducted at antenatal booking clinic of Federal Teaching Hospital Abakaliki from February to July 2012. Hemoglobin

Azubuike Kanario Onyebuchi,1 Lucky Osaheni Lawani,2 Peter O Nkwo,3 Chukwuemeka Anthony Iyoke,3 Robinson Chukwudi Onoh,1 Leonard O Ajah1 1Department of Obstetrics and Gynecology, Federal Teaching Hospital Abakaliki, Ebonyi State, Nigeria; 2School of Postgraduate Studies, Department of Community Medicine, University of Nigeria, 3Department of Obstetrics and Gynecology, University of Nigeria Teaching Hospital, Enugu, Enugu State, Nigeria Background: Prompt and timely response in the management of gynecological surgical cases can significantly affect the therapeutic surgical outcome of patients in emergency situations. The aim of this study was to evaluate the decision-to-intervention time (DIT), its determinants, and the significance in the therapeutic outcome of emergency gynecological surgeries managed at a federal teaching hospital in south east Nigeria over an 18-month period. Methods: This was a prospective descriptive study of 105 emergency gynecological cases managed at a federal teaching hospital over an 18-month period. Patients were recruited at the point of admission and followed up until discharge for outcome. Data were abstracted with a data entry pro forma and then analyzed with the Epi Info™ statistical software version 7.0. Results: The incidence of gynecological surgical emergencies was 5.1% of the total gynecological cases managed during the study period. The mean DIT was 4.25 (range 1.45–5.50) hours with delay in intervention, mainly due to delays in securing blood/blood products and other materials for resuscitation (46.7%) and a lack of finance (15.2%). Six maternal deaths were recorded, giving a case fatality ratio of 5.7%, while the commonest maternal complications associated with the delays were hemorrhage (61.9%) and the need for blood transfusion (57.1%), respectively. The risk ratio of losing ≥1,000 mL of blood, anemia, hemorrhagic shock, and wound infection in those with DIT ≥120 minutes was statistically greater and significant at 95% confidence interval. Conclusion: Inadequacies in health care services and policies due to poor infrastructure, organizational framework, and financing were the major determinants of the prolonged DIT and therapeutic outcomes. Keywords: determinants, decision-to-intervention time, emergency, therapeutic outcome, gynecological surgeries, clinical risk

Background: Septate uterus is caused by incomplete resorption of the Mullerian duct during embryogenesis which may alter the reproductive outcome of the patients. It is the commonest form of structural uterine anomaly and has the highest reproductive failure rate. Case Report: A 21-year-old booked G4P2 +1 woman with two living male children admitted into the Antenatal ward through the Accident and Emergency ward at 33 weeks gestation for conservative management of preterm premature rupture of membrane. She had a previous history of miscarriage, preterm delivery, and elective caesarean section due to breech presentation in her first, second, and third pregnancies in 2007, 2008, and 2009, respectively. She, however, had an emergency caesarean section due to fetal distress at 33 weeks plus 4 days with the delivery of a live female baby that weighed 2.0 kg with APGAR scores of 7 and 8 in the 1st and 5th minutes, respectively. There was intraoperative finding of septate uterus with dimple at the fundus. The other abdominal viscera were normal. Conclusion : congenital uterine anomalies especially septate uterus, though rare, should be suspected in women with positive history of miscarriage, preterm delivery and malpresentation. Keywords : Asia, fetal distress, multiparous, preterm, septate, uterus

Background: Sexually transmitted infections and human immunodeficiency virus (HIV)/AIDS are a major public health concern owing to both their prevalence and propensity to affect offspring through vertical transmission. Aim: The aim was to determine the seroprevalence of HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), syphilis, and co‑infections among antenatal women in Enugu, South‑East Nigeria. Materials and Methods: A retrospective study of antenatal women at the University of Nigeria Teaching Hospital, Enugu, South‑East Nigeria from May 1, 2006 to April 30, 2008. A pretested data extraction form was used to obtain data on sociodemographic variables and screening test results from the antenatal records. The analysis was carried out with SPSS version 17 (Chicago, IL, USA). Results: A total of 1239 antenatal records was used for the study. The seroprevalence of HIV, HBV, HCV, and syphilis among the antenatal women were 12.4%(154/1239), 3.4%(42/1239), 2.6%(32/1239), and 0.08%(1/1239), respectively. The HIV/HBV and HIV/HCV co‑infection prevalence rates were 0.24%(3/1239) and 0.14%(2/1239), respectively. There was no HBC and HCV co‑infection among both HIV positive and negative antenatal women. There was no statistically significant difference in HBV and HCV infection between the HIV positive and negative antenatal women. The only woman that was seropositive for syphilis was also positive to HIV. Conclusion: The seroprevalence of HIV, HBV, HCV, and syphilis is still a challenge in Enugu. Community health education is necessary to reduce the prevalence of this infection among the most productive and economically viable age bracket.Keywords: Antenatal women, Co‑infection, Human immunodeficiency virus, Hepatitis C virus, Hepatitis B virus, Seroprevalence, Syphilis

Objectives: To assess the opinions, attitude, and preferences of Nigerian women to the presence of chaperones during pelvic examinations.Materials and Methods: A cross‑sectional survey of first time gynecology clinic attendees on their opinions, attitudes, and preferences with respect to the presence of chaperones during their pelvic examinations. The interview was conducted with the aid of semi‑structured, researcher‑administered questionnaires. Results: One hundred and nineteen (51.7%) of the respondents preferred female physicians for pelvic examination, 23 (10%) preferred male physicians and 88 (38.3%) had no gender preference. When the examining physician is a male, 124 (53.9%) respondents would like to have chaperones during pelvic examinations while 106 (46.1%) would not. Eighty‑three percent of respondents preferred nurse chaperones. Age, level of education, and parity did not have any significant relationship with the attitude of the respondents toward the presence of chaperones (P = 0.503, 0.525, and 0.605 respectively).Conclusions: We conclude that most southeastern Nigerian women would prefer their pelvic examinations to be done by a female physician or to be attended by a nurse chaperone if the examining physician is a male. We recommend a routine offer of chaperones during such examinations while respecting the patients’ right to refuse the offer.Keywords: Attitudes, chaperone, pelvic examination, preferences, southeast NigeriaNigerian Journal of Clinical Practice • Oct-Dec 2013 • Vol 16 • Issue 4