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OBJECTIVE: As an age-old traditional practice, nursing mothers from southeastern Nigeria use the Elaeis guineensis sap (from the oil palm tree also referred to as palm wine) to induce and sustain lactation a few hours after delivery. This practice is still ongoing to date, despite the scarcity of clinical data supporting its efficacy and safety. This study aimed to generate preliminary data on the prevalence, perceptions, and behaviors related to the use of Elaeis guineensis sap as a galactagogue. STUDY DESIGN: Mothers who had breastfed or breastfeeding at the time of the survey, were invited to complete a questionnaire that asked about their, perceptions, efficacy, and possible side effects of Elaeis guineensis sap on both mother and child during breastfeeding. Chi-square analysis was used to conduct data analysis. RESULT: A total of 5002 mothers completed the survey with 61% reporting use of Elaeis guineensis sap (palm wine) following parturition. Most of the respondents (73%) attained tertiary education. The practice was mostly recommended by direct relatives (38%) while the commonest reason for this practice was perceived insufficient milk production (32.2%). The majority of the respondents (52%) were satisfied with the outcome while 44% reported no negative side effects. CONCLUSION: The use of Elaeis guineensis sap by mothers following parturition is common in south-eastern Nigeria. However, randomized control studies are needed to provide evidence for the efficacy and safety of this plant product. This will be relevant to the formation of intercultural health policies which will value and respect the positive cultural practices of a people.

Occupational hazard preventive measures are important practices because of the high rates of associated morbidity and mortality of exposed workers and include actions that can be taken to reduce the potential of exposure to the hazard. This study assessed the knowledge and practice of preventive measures of occupational health hazards among nurses working in Enugu State University Teaching Hospital (ESUTH), Parklane Enugu. This study used a descriptive cross-sectional survey design to collect data through a researcher-developed questionnaire. Utilizing the purposeful sampling technique, 214 nurses working in ESUTH, Parklane, completed the survey. A total of 214 questionnaires were filled and returned (response rate = 93.9%). A good level of knowledge (91.6%) on occupational hazard preventive measures was most evident among the respondents. There was also an associated good level of implementation of occupational hazard preventive measures among the respondents with a grand mean of 3.08±1.28. The factors found to influence the implementation of occupational hazard preventive measures among the respondents include the inadequate provision of PPE (3.47±0.58), poor attitudes of government towards workers’ working conditions (3.44±0.63), and lack of adequate staff training (2.93±0.41). Overall, the findings show that Nurses working in ESUTH showed good knowledge and practice of preventive measures of occupational health hazards. In terms of reducing hazards among Nurses in the wards, and in the hospitals, we recommend that risk assessment should be carried out regularly to identify potential hazards at a safe stage.

Background: Standard Precautions (SP) was introduced by Centre for Disease Control to minimise the risks of disease transmission in the process of healthcare. Many factors are thought to influence the knowledge and the practice of these measures. Objective: To review challenges and adherence to SP for the prevention of percutaneous injuries and exposure to patients’ blood in clinical practice. Methods: The World Wide Web sites such as, Pub Med central, Google scholar were searched using key words such as percutaneous, needle stick injuries, standard precautions, adherence. Relevant articles were reviewed and included based on defined criteria. Results: The prevalence of needle stick injuries (NSI) varies among health care workers (HCWs) and across countries and is as high as 73% among some groups. The knowledge of SP varied among HCWs in different nations; however the practice of SP was noted to be lower than knowledge across most studies. Majority of HCWs in developing countries that sustained NSI failed to report the incident to appropriate authorities. Adherence to Standard Precautions is influenced by lack of proper training, poor supplies, low commitment of HCWs and health facility managers etc. Conclusion: Needle stick injuries and exposure to patients’ blood remain a risk for disease transmission among HCWs. Despite appreciable knowledge of standard precautions, the practice has remained low across the globe. Factors that had positive influence on practice of SP such as use of devices with safety features, adherence to infection control guideline, comfortable working environment, repeated and intense training etc. should be adopted and promoted.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of tenofovir‐based antiviral combination regimens for hepatitis B virus (HBV) for the prevention of mother‐to‐child transmission of HBV, in HIV‐positive pregnant women co‐infected with HBV.

There is paucity of data on interventions to improve cancer outcome in the low-resource setting. This study aims to determine the effect of Neoadjuvant Chemotherapy (NACT) in improving operative outcomes of cervical cancer. This was a longitudinal intervention study of patients diagnosed with FIGO stage IIB - IIIA cervical cancer that had NACT. Patients were re-evaluated after treatment with 4 cycles of chemotherapy for operability. McNemar test was used to determine changes in operability of the tumour. There was a significant difference in the number of patients that converted from inoperable to operable tumor post-chemotherapy. This study shows some promise for NACT for FIGO stage IIB - IIIA cancer of the cervix, especially in low-resource settings, where radiotherapy is scarce.

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=

This review aims to determine the effectiveness of the use of syndrome diagnosis in the evaluation of vaginitis and to make suggestions based on the review findings. Vaginal discharge as the main symptom of vaginitis is unspecific. A randomized study of symptom-based diagnosis and treatment of vaginitis in the USA favored symptoms used for treatment; however, this was only a pilot study. Hence, a population-based study is necessary to validate these findings. Most of the study that assessed treatment of vaginitis in pregnancy reported low diagnostic sensitivity and specificity for bacterial vaginosis and vaginal candidiasis and a wide range for trichomonas vaginalis reflecting ineffectiveness of syndrome-based treatment in pregnancy. A systematic review of the web for relevant literature was made, and appropriate articles were extracted and reviewed. Sensitivity, specificity, and positive values were used, where applicable to determine effectiveness. Forty-three full articles and abstracts were reviewed. Studies that validated or applied WHO algorithm for treatment of vaginitis reported high sensitivity (91.5–100%) but moderate to low specificity (0–27.5%) among women with vaginal symptoms. Studies that focused on symptoms for diagnosis of the three main etiologic agents of vaginitis reported low sensitivity and specificity, while such studies in pregnancy reported sensitivity and specificity ranging from 35.4 to 54% for TV, 11 to 100% for BV, and 0 to 56.2% for trichomonas vaginalis, bacterial vaginosis, and vaginal candidiasis, respectively. Studies that added point of care test reported higher sensitivity and specificity and positive predictive value. The use of WHO syndrome-based algorithm or its modification for treatment of vaginitis though moderately effective has the potential for overtreatment and physician error. Point of care testing and laboratory investigation are essential for productive intervention especially in pregnancy.

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.

In order to assess the current level of maternal mortality in health institutions with comprehensive emergency obstetric care in Enugu State, South Eastern Nigeria, a retrospective analysis of maternal deaths for the years 1999-2003 was carried out to establish the maternal mortality ratios in the eligible health institutions. Each maternal death was studied in detail to establish the socio-demographic characteristics of the women who died; their referral sources, type of delay (if any), medical causes of death and their preventability. In-depth interviews of the service providers were carried out to throw more light on the maternal mortality situation in the state. Five out of seven eligible health institutions were studied. Within the 5-year period (1999-2003), there were 141 maternal deaths and 18,257 live births giving a maternal mortality ratio of 772 maternal deaths per 100,000. The folders of 89 out of the 141 women who died were retrieved. Of these 89 maternal deaths, 51.7% of them were unemployed, 52.4% were referred from private hospitals; type 3 delay was the commonest type of delay encountered in the care of the women. Referral delay was the main cause of delay accounting for 46.4% of all cases of type 3 delay. The leading causes of maternal deaths among the women were obstetric haemorrhage (19.1%), sepsis (18.0%), prolonged obstructed labour/ruptured uterus (16.9%) and pre-eclampsia/eclampsia (16.9%). The in-depth interviews corroborated the high maternal mortality ratio recorded and the type 3 delays in tackling obstetric emergencies. It also showed some discrepancies between reality and the health providers' perception of the magnitude of maternal mortality situation in the state. It was concluded that in health institutions in Enugu State with comprehensive emergency obstetric care facilities, the maternal mortality ratio remains high due to type 3 delays. Most of the referrals come from private hospitals, hence the need to retrain the private practitioners in emergency obstetric care.

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.

Concomitant uterovaginal and rectal prolapse is an uncommon occurrence. Where laparoscopic equipment and skills are lacking, sacrohysteropexy with synthetic mesh and rectopexy can be accomplished by laparotomy, especially in women who desire to retain their uterus for either biological or psychological reasons. A 40-year-old primipara with a history of concomitant mass protruding from both her vagina and anus following a spontaneous unsupervised delivery at home. Following pelvic examination, a diagnosis of uterovaginal and rectal prolapse was made. In view of her parity and desire to retain her reproductive function, she was offered abdominal sacrohysteropexy with synthetic mesh and rectopexy with satisfactory postoperative recovery. In resource-limited settings with concomitant uterine and rectal prolapse, open abdominal sacrohysteropexy with synthetic mesh and rectopexy is an effective and safe alternative to Manchester operation in the absence of laparoscopic equipment and skills.Keywords: Concomitant, Rectal prolapse, Utero-vaginal prolapse

No Abstract. Global Journal of Medical Sciences Vol. 5(1) 2006: 13-16

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