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The aim of this review is to reposition some key questions(s) into the appropriate column(s), neatly introduce new column(s) without increasing anxiety on the part of the patient(s) and avoid reopening of the sutured abdominal wall due to incomplete instrument count. The new added stems were 'clinic visit prior to proposed surgery 'and 'Before closing the rectus sheath'. Team members will be better equipped when they know the clinical and psychological status of their patients before entering the operative theatre. It is extremely important to note the workable status of key surgical instruments prior to surgery and adequate arrangement made to ensure they are in good working condition. Medical errors like Gossypiboma can be avoided by asking the necessary question before rectus sheath closure where applicable. The new proposed safety checklist, therefore, carefully inserted new stems, columns and repositioned some key stems/ sub-stems/columns to achieve this purpose. &nbsp

Background: The HIV epidemic has significantly altered the context within which women make decisions about how they will feed their infants. This study examined the antenatal infant feeding choices and actual infant feeding practices of HIV-positive mothers in order to assess adherence to the 2010 WHO national infant feeding guidelines in Nnewi, Nigeria. Methods: The study was conducted between January 2012 and February 2013 at Nnamdi-Azikiwe University Teaching Hospital (NAUTH) in Nnewi-Anambra State, Nigeria. It was a prospective cohort study of HIV positive women attending the Prevention of Mother-To-Child Transmission (PMTCT) clinic in NAUTH. Women received HIV Counseling and Testing (HCT) from trained HIV positive women working in the hospital and from members of HIV support groups. The women made an informed decision on their infant feeding choice and received antiretroviral (ARV) treatment or prophylaxis (WHO option B) following WHO 2010 guidelines. Each mother-baby pair was followed up until the HIV sero-status of the baby was determined by DNA PCR (6-8weeks after cessation of breastfeeding). Results: The overall HIV MTCT rate was 19 of 583 (3.3%; 95% confidence interval (CI): 2.0 - 5.0). Only 94 (16.1%; 95% CI: 13.2 - 19.4) mothers complied with the WHO 2010 recommendation of exclusive breastfeeding (EBF) and ARV treatment or prophylaxis. Overall, 431 (73.9%) mother-baby pairs received prophylactic ARV intervention; in 88 (15.1%) pairs, the baby or the mother received ARV; while in 64 (11.0%) pairs, neither mother nor baby received ARV. When the mother-baby pair received ARV, MTCT was 0.8%, 1.7% and 5.9% for Exclusive Formular Feeding (EFF), EBF and Mixed Feeding (MF), respectively. When either mother or baby received intervention, MTCT rates increased to 3.3%, 4.8% and 7.7% for EFF, EBF and MF, respectively. The rate of MTCT was further increased to 5.1%, 6.7% and 23.5% when neither mother nor baby received intervention for EFF, EBF and MF respectively. Conclusion: EFF is still the infant feeding option preferred and practiced by majority of our HIV positive mothers despite the promotion of the safety of EBF with ARV interventions according to WHO 2010 guideline. It will take some time to change existing belief in EFF for us to achieve the required shift to EBF in our practice area. We also demonstrated that ARV treatment/chemoprophylaxis for both mother and baby is an important measure for achieving the reduction of MTCT of HIV in breastfeeding setting mixed feeding practice is associated with an increased rate of MTCT and should be strongly discouraged. Increasing the uptake of ARV treatment/ chemoprophylaxis and ensuring appropriate counseling about infant feeding practices have the potential to markedly decrease the rate of MTCT of HIV in developing countries.

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BACKGROUND: Acquired immune deficiency syndrome (AIDS) caused by human immune deficiency virus (HIV), once dominated by infected males has become feminized especially in sub-Saharan Africa where the majority of adults living with the condition are females. Positive life styles, belonging to social support groups and stigma-free HIV services by providers may have good impact on the quality of life of HIV-positive mothers. This study was aimed at assessing the determinants of subjective health status of HIV-positive mothers accessing prevention-of-mother-to-child-transmission (PMTCT) of HIV services in Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi.METHODS: This is a descriptive study in which 288 consenting HIV positive mothers were selected using the systematic sampling technique. Data on demographics, life style, social support, contraceptive use and subjective feeling about current health status were collected from the subjects using a pre-tested, structured, interviewer-administered questionnaire. RESULTS: The mean age of the respondents was 30.46+4.86 years. Majority (89.2%) of them were married while 55.2% were traders. A significantly higher proportion of the mothers on highly active anti retroviral therapy (HAART) (70.8%) than non users (29.2%) described their current health status as 'excellent' (p

BACKGROUND: In-vitro fertilization(IVF) is a procedure that is one of the options in managing infertility. It involves fertilizing the egg from the female with the spermatozoa from the male outside the human body. It is a common practice in the developed world. However it is still a new phenomenon in the developing countries. This is due to the level of awareness and acceptability, worsened by cost which is still beyond the reach of the poor masses in the developing countries. AIM: To assess the level of awareness andperceptions of invitro fertilization among women attending fertility clinics in Okija, Ihiala local Government area of Anambra State, Nigeria. METHODS: The study is a cross-sectional descriptive study. A total of 500 women attending fertility clinics in Okija were recruited using systematic sampling technique. Data were collected using pre-tested, structured, interviewer administered questionnaire and analyzed manually. RESULTS: The mean age of the respondents was 30 years. The mean duration of infertility was 11 years. Secondary infertility was more common (66%) than primary infertility (34%).Only 37.6%of the respondentswere aware of in-vitro fertilization. Only 37.2% of those that that aware accepted to undergo IVF procedure. 79.7% of those who rejected IVF claimed that the babies are abnormal, while 12.7% of believedthat the cost is high. CONCLUSION: There is need to put in efforts in spreading the knowledge of in-vitro fertilization in developing countries like Nigeria. Efforts should be made to make the procedure more affordable and accessible to the masses. Keywords: Awareness, Perceptions, In-vitro fertilization (IVF), Okija.

Background: Mother to child transmission of HIV infection (vertical transmission) is of major concern, because of the attendant consequences of morbidity and mortality on the child. The success of a prevention of mother to child transmission (PMTCT) programme in reducing sero-conversion among exposed newborn infants is determined by many factors, including the administration of Anti Retroviral drugs to both HIVpositive mothers and their newborns; infant feeding practices; access to and use of well-baby care; and the health system's ability to provide care, including counseling and support to both the HIV-positive mother and her exposed newborn. Aim: This study is aimed at examining the various infant feeding choices and practices as risk factors of mother to child transmission of HIV among exposed infants in Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Anambra State, Nigeria. Method: The study design is descriptive cross-sectional. A total of 288 consenting HIV positive mothers of recruited children were selected using the systematic sampling technique. Data were collected using a pre-tested structured interviewer-administered questionnaire, and analyzed by means of the Statistical Package of Social Sciences (SPSS) software. Result: The mean age of the respondents was 30.46+4.86 years. Majority of the patients were married, and most of them were traders. Inadequate receipt of replacement feed, breastfeeding of an HIV exposed infant, duration of breast feeding among others constitute significant determinants of current health status of baby (p

Background: The Human Immunodeficiency Virus (HIV) pandemic remains a major public health issue in developing countries with the prevention of mother to child transmission (PMTCT) being a key challenge. Various reports have been published on the effect of HIV on pregnancy with conflicting results. Objective: This was to determine the effect of HIV infection on pregnancy outcome among women booked for antenatal care at Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi to provide a baseline for further studies. Methods: This is a retrospective study of cases of HIV in pregnancy managed between 1st January, 2006 and 31st December 2007, at NAUTH, Nnewi. Results: Out of a total of 2,960 pregnant women booked for ante-natal care within the study period and a seroprevalence rate of 10.5% was noted. Two hundred and fifty patients were included in the study. The majority, 170 (68%) of the patients were between 21-29 years and the majority also, 148 (59.2%) were of low parity (0-2). Only 181 (72.4%) of the patients had an entry CD4 count of = 500/ml. All the patients were on Highly Active Antiretroviral Therapy (HAART) during the pregnancy. Maternal complications were encountered in 176 (70.4%) cases, anaemia being the commonest, 100 (40.0%). The commonest foetal complications were stillbirth, 26 (10.4%) and low birth weight 54 (21.6%). Sixty three (25.2%) of the women had puerperal complications. There was no maternal or perinatal death. Conclusion: The HIV sero-prevalence rate among pregnant women booked for antenatal care at NAUTH, Nnewi was high, but the effect of HIV on pregnancy was very minimal. Key words: pregnancy outcome, HIV sero-positive, booked women Afrimedic Journal 2010; 1(2): 28-33

Background: Undesirable changes in lipid metabolism have been reported among HIV-infected individuals undergoing anti-retroviral therapy. Considering the peculiarity of pregnant women who are also faced with similar metabolic changes, it becomes necessary to ascertain lipid changes that occur in them, and assess the effect of anti-retroviral therapy (ART), diet and physical exercise on their lipid profile.Methods: The study was conducted in Nnamdi Azikiwe University Teaching Hospital, Nnewi in Anambra State, Nigeria. One hundred subjects were recruited for this study. This comprised of 50 HIV sero-positive pregnant women (test) and 50matched HIV sero-negative, pregnant women (controls) attending ante-natal clinic. Questionnaires and patient records were used to obtain data and information on the subjects. They were categorized into three groups based on dietary intake (carbohydrate-rich, protein-rich and cholesterol-rich) and into two groups based on exposure to physical activity, at least one hour daily exercising and non-exercising. After an overnight fast, 5mls of blood was collected from all subjects into plain tubes and sera analyzed for total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol(LDL-C) and high density lipoprotein cholesterol (HDL-C) using the VITROS 350 automatic chemistry analyzer.Result: The lipid profile of HIV sero-positive pregnant women were significantly lower than in sero-negative pregnant women (p=0.028).There was no statistically significant difference in lipid profile between those on ART and those not on ART. With physical exercise decreased levels of lipids were observed in both test and control groups (p

We report a challenging case of a huge gangrenous prolapsed cervical leiomyoma in a multiparous HIV positive lady. A 37-year-old para 3 lady presented with a progressively increasing irreducible mass protruding out per vaginam, 3 months duration of heavy menses, and symptoms of a urinary tract infection. We performed a vaginal myomectomy and she did well postoperatively. A prolapsed gangrenous cervical leiomyoma is a rare condition with only a few cases reported in the literature. Vaginal myomectomy for this condition can be performed in experienced hands without difficulties.

Background: Though transmission of Human Immune-deficiency Virus (HIV) in Nigeria occurs primarily through heterosexual contact, vertical transmission of the infection remains a major concern because of the attendant health consequences for the child. The success of a Prevention-of-Mother-to-Child-Transmission (PMTCT) programme in reducing sero-conversion among exposed-infants is determined by many factors, including anti-retroviral drugs (ARVs), infant feeding practices, use of well-baby care, counselling and support to mother-newborn pair. Little is known about the effects of PMTCT interventions in Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi, and this study was aimed at assessing the knowledge of PMTCT program / services and HIV risk-perception among HIV-positive women in this center.Methodology: The study design was descriptive cross-sectional. A total of 288 consenting HIV-positive mothers of recruited children was selected using the systematic sampling technique. Data were collected using a pre-tested structured interviewer-administered questionnaire and analysed by means of the SPSS software.Results: The mean age of the respondents was 30.5+4.86years. Knowledge about HIV transmission was good (97 to 99%), while risk perception about HIV was 100%. Mothers who reported their treatment in the clinic as “very good” were more likely to declare PMTCT as “good” than mothers who were less well treated in the programme (p

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Street hawking exposes young girls to all forms of hazards, including sexual abuse. This descriptive study examines the size of the problem and the consequences of sexual abuse on juvenile female street hawkers randomly recruited from two urban towns in Anambra State of Nigeria. Data was collected with semi structured, interviewer administered questionnaires. The mean age of the female hawkers was 13.0 + 2.2 years. Out of 186 respondents, 130 (69.9%) had been sexually abused with 32 (17.2%) having had penetrative sexual intercourse (28.1% were forced and 56.3% submitted willingly) while hawking. Majority (59.4%) of the sexual partners were adults. Other types of sexual abuse experienced include inappropriate touches (106 cases; 81.5%) and verbal abuses (121 cases; 93.1%).. There was low awareness of the twin risks of pregnancy (43.1%) and sexually transmitted infections (54.3%) following sexual abuse among the respondents. Sexual abuse of young female hawkers is an issue of great public health importance. Poverty alleviation, health education and protective child right policies will decrease its prevalence and the associated risks Keywords: Adolescents, In- School, Sexual activity, Sexual exposure, NigeriaAfrican Journal of Reproductive Helath Vol. 12 (2) 2008: pp. 111-119

Background: Cervical cancer is the second commonest cancer of females worldwide and the commonest cancer of the female genital tract in our environment. It can be prevented through early detection by cervical screening (Pap smear). Objective: The objective of this study is to determine the knowledge, attitude and practice of cervical cancer screening among female undergraduates. Method: A pre tested questionnaire was administered to third and fourth year female students of the Faculty of Natural Sciences, Nnamdi Azikiwe University Awka, Nigeria. Result: Out of the 220 students involved in the study, 134 (60.9) had knowledge of cervical cancer and 118 (53.6%) were sexually active with the average age at sexual debut being 21.2 years. The mean age of the students was 23.8 years and the age range was 17 to 39 years with 175 (80%) in the age range of 20- 29 years. About 2/3 of the students did not know about Pap smear and worse still, none of them had undergone a Pap screening test before. This low participation in screening for cervical cancer was attributed to several reasons including ignorance of the existence of such a test, lack of awareness of centers where such services are obtainable, ignorance of the importance of screening and the risk factors to the development of cervical cancer. Conclusion: There is good level of awareness of cervical cancer among the female undergraduates but poor knowledge and participation in cervical cancer screening. The development of a comprehensive cervical cancer screening strategy is being recommended to improve participation with a view to prevent cervical cancer by early detection and treatment of the pre-malignant stages. Keywords: Cervical cancer, screening, female undergraduates. Nigerian Journal of Clinical Practice Vol. 11 (3) 2008: pp. 216-219

Background: Laparoscopic examination is a useful investigation in the evaluation of infertile women. To perform this test, pneumoperitoneum is required to distend the abdomen, improve visibility and displace the intestines out of the pelvis. Several gases have been used to achieve this purpose including Nitrous Oxide (N2O), Carbondioxide (CO2), Helium, Xenon and Air. Study Design and Method: This was a prospective study in a private fertility centre in Nnewi, Nigeria aimed at reducing the morbidities inherent in the use Room Air pneumoperitoneum for diagnostic laparoscopy. This was sequel to an earlier study, which revealed that women who had Room Air pneumoperitoneum had a higher port wound infection rate, abdominal discomfort (feeling of retained gas in the abdomen) and shoulder pain with resultant delayed return to normal activity than women who had Co2 pneumoperitoneum. Results: This study demonstrated that the use of soda lime to purify the Room Air and a low pressure suction pump to evacuate the air after the procedure significantly reduced the wound infection rate and virtually eliminated the abdominal discomfort and shoulder pain associated with Room Air pneumoperitoneum. This was followed by early return to normal activity. Conclusion: Therefore, use of Room Air for pneumoperitoneum is safe and affordable. It is recommended for low resource settings. Keywords:Room Air, Pneumoperitoneum, Soda lime, Diagnostic Laparoscopy. Nigerian Journal of Clinical Practice Vol. 11 (2) 2008: pp. 127-129

No Abstracts.Nigerian Journal of Clinical Practice Vol.10(2) 2007: pp.169-173

No Abstract. Nigerian Journal of Clinical Practice Vol. 8(2) 2005: 136-137

A 37-year-old multiparous woman at 37th week gestation presented with an undiagnosed abdominal pregnancy and acute abdomen following forceful reduction of an associated utero-vaginal prolapse. She had an urgent laparotomy with delivery of a live female baby lying in the left broad ligament. The baby weighed 2.6kg with Apgar scores of 2 and 6 at first and fifth minutes respectively. The partially detached placenta was easily delivered complete with membranes. Haemostasis was secured by ligation and excision of the left adnexum (broad ligament with the pregnancy sac and uterine appendages). She was transfused with two units of whole blood. This case highlights the importance of excluding pregnancy in any woman of reproductive age with undiagnosed abdominal mass and utero-vaginal prolapse before any manipulation. It also underscores the importance of ultrasound scan in early pregnancy by a competent sonologist.Nigerian Journal of Clinical Practice Vol 8(1) 2005: 43-45

We report a care of acute fetal acites diagnosed by ultrasonograhy at 29 weeks gestation in a primigravida who used herbel fertility drugs for conception and through the fist 8 weeks of gestation. Under ultrasound guidance the fetal peritoneal cavity was canulated via the material abdomen with an 18G intravenous canular. A total of 3000mls of straw – coloured fluid was drained before the eventual vaginal delivery of a live 3.8kg fetus .The fetus had multiple congenital anomalies besides the massive fetal acites and died after 23 minutes despite Resuscitative efforts. There is the 4 refore the need for early anomaly scan to detect cases of this sort and institute appropriate intervention Nigerian Journal of Clinical Practice Vol.6(2) 2003: 120-121

Objectives To evaluate male circumcision and the complications associated with it amongst the Igbo people of Southeast Nigeria. Patients and Methods This study was a prospective review of male circumcision and its complications amongst the Igbo\'s of Southeast Nigeria carried out over a period of six months. It was conducted in three centers (public, private and a mission hospital) in Anambra State (a core Igbo state) of Nigeria. Circumcision was done after birth at any convenient time, and the babies were followed up at the post natal clinic (six weeks after birth) for possible complications. A questionnaire is usually filled at the time of circumcision and completed at the post natal visit. Results A total of 141 circumcisions were performed during the study period. Most of the circumcisions (73.8%) were done between 7 and 9 days after birth. The plastic bell method was used more extensively than the traditional method (68.1% and 31.2%, respectively). The method preferred by the mothers was not statistically different from the method used. The overall complication rate in this study was 24.1%. A higher complication rate was recorded with the use of the traditional method compared to the plastic bell method (43.2% vs. 15.6%, P