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George O Ugwu, Chukwuemeka A Iyoke, Euzebus C Ezugwu, Leonard O Ajah, Hyacinth E Onah, Benjamin C Ozumba Department of Obstetrics and Gynaecology, College of Medicine, University of Nigeria, Nsukka, NigeriaCorrespondence: George O Ugwu Tel +234 80 3565 3435Email ugwugeo@yahoo.comBackground: 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 < 40 years of age, poorly educated, unemployed, usually present as unbooked emergencies from a distance > 5 km and suffer maternal death within 24 hours of presentation.Keywords: maternal near-miss, maternal deaths, Enugu, Nigeria

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

CA Iyoke,1 FO Ezugwu,2 OL Lawani,3 GO Ugwu,1 LO Ajah,3 SG Mba11Department of Obstetrics and Gynecology, University of Nigeria Teaching Hospital, Enugu, 2Department of Obstetrics and Gynecology, Enugu State University Teaching Hospital, Enugu; 3Department of Obstetrics and Gynecology, Federal Teaching Hospital, Abakaliki, Nigeria Purpose: To describe the methods preferred for contraception, evaluate preferences and adherence to modern contraceptive methods, and determine the factors associated with contraceptive choices among tertiary students in South East Nigeria.Methods: A questionnaire-based cross-sectional study of sexual habits, knowledge of contraceptive methods, and patterns of contraceptive choices among a pooled sample of unmarried students from the three largest tertiary educational institutions in Enugu city, Nigeria was done. ­Statistical analysis involved descriptive and inferential statistics at the 95% level of confidence.Results: A total of 313 unmarried students were studied (194 males; 119 females). Their mean age was 22.5±5.1 years. Over 98% of males and 85% of females made their contraceptive choices based on information from peers. Preferences for contraceptive methods among female students were 49.2% for traditional methods of contraception, 28% for modern methods, 10% for nonpharmacological agents, and 8% for off-label drugs. Adherence to modern contraceptives among female students was 35%. Among male students, the preference for the male condom was 45.2% and the adherence to condom use was 21.7%. Multivariate analysis showed that receiving information from health personnel/media/workshops (odds ratio 9.54, 95% confidence interval 3.5–26.3), health science-related course of study (odds ratio 3.5, 95% confidence interval 1.3–9.6), and previous sexual exposure prior to university admission (odds ratio 3.48, 95% confidence interval 1.5–8.0) all increased the likelihood of adherence to modern contraceptive methods.Conclusion: An overwhelming reliance on peers for contraceptive information in the context of poor knowledge of modern methods of contraception among young people could have contributed to the low preferences and adherence to modern contraceptive methods among students in tertiary educational institutions. Programs to reduce risky sexual behavior among these students may need to focus on increasing the content and adequacy of contraceptive information held by people through regular health worker-led, on-campus workshops. Keywords: modern contraceptives, preference, young people, sexual behavior

George O Ugwu,1 Chukwuemeka A Iyoke,1 Hyacinth E Onah,1 Vincent E Egwuatu,2 Frank O Ezugwu2 1Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu, Nigeria; 2Department of Obstetrics and Gynaecology, Enugu State University Teaching Hospital (ESUTH), Parklane, Enugu, Nigeria Background: Obstetricians in developing countries appear generally reluctant to conduct vaginal delivery in women with a previous Cesarean because of lack of adequate facilities for optimal fetomaternal monitoring. Objective: To describe delivery outcomes among women with one previous Cesarean section at a tertiary hospital in Southeast Nigeria. Methods: This was a prospective observational study to determine maternal and perinatal outcomes of attempted vaginal birth after Cesarean sections (VBAC) following one previous Cesarean section. Analysis was done with SPSS statistical software version 17.0 for Windows using descriptive and inferential statistics at 95% level of confidence. Results: Two thousand six hundred and ten women delivered in the center during the study period, of whom 395 had one previous Cesarean section. A total of 370 women with one previous Cesarean section had nonrecurrent indications, of whom 355 consenting pregnant women with one previous Cesarean section were studied. A majority of the women (320/355, 90.1%) preferred to have vaginal delivery despite the one previous Cesarean section. However, only approximately 54% (190/355) were found suitable for trial of VBAC, out of whom 50% (95/190 had successful VBAC. Ninety-five women (50.0%) had failed attempt at VBAC and were delivered by emergency Cesarean section while 35 women (9.8%) had emergency Cesarean section for other obstetric indications (apart from failed VBAC). There was no case of uterine rupture or neonatal and maternal deaths recorded in any group. Apgar scores of less than 7 in the first minute were significantly more frequent amongst women who had vaginal delivery when compared to those who had elective repeat Cesarean section (P=0.03). Conclusion: Most women who had one previous Cesarean delivery chose to undergo trial of VBAC, although only about half were considered suitable for VBAC. The maternal and fetal outcomes of trial of VBAC in selected women with one previous Cesarean delivery for nonrecurrent indications were good. Obstetricians in this area should do more to allow VBAC in women with one previous Cesarean section for nonrecurrent indications. Keywords: previous Cesarean section, vaginal birth, pregnancy, VBAC

Chukwuemeka Anthony Iyoke,1 George Onyemaechi Ugwu,1 Euzebus Chinonye Ezugwu,1 Frank Okechukwu Ezugwu,2 Osaheni Lucky Lawani,3 Azubuike Kanayo Onyebuchi3 1Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, 2Department of Obstetrics and Gynaecology, Enugu State University Teaching Hospital, Park Lane, Enugu, 3Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria Background: There are reports of increasing incidence of gynecological cancers in developing countries and this trend increases the need for more attention to gynecological cancer care in these countries. Objective: The purpose of this study was to describe the presentation and treatment of gynecological cancers and identify barriers to successful gynecological cancer treatment in a tertiary hospital in South East Nigeria. Methods: This study was a retrospective longitudinal analysis of the presentation and treatment of histologically diagnosed primary gynecological cancers from 2000 to 2010. Analysis was by descriptive and inferential statistics at the 95% level of confidence using Statistical Package for the Social Sciences version 17 software. Results: Records of 200 gynecological cancers managed during the study period were analyzed. Over 94% of cervical cancers presented in advanced stages of the disease and received palliative/symptomatic treatment. Only 1.9% of cervical cancer patients had radical surgical intervention, and postoperative mortality from these radical surgeries was 100%. Approximately 76% of patients with ovarian cancer had debulking surgery as the mainstay of treatment followed by adjuvant chemotherapy. Postoperative mortality from ovarian cancer surgery was 63%. Cutting edge cytotoxic drugs were not used as chemotherapy for ovarian and chorionic cancers. Compliance with chemotherapy was poor, with over 70% of ovarian cancer patients failing to complete the prescribed courses of chemotherapy. Most patients with endometrial and vulval cancers had only surgical treatment, as compliance with follow-up for adjuvant chemotherapy or radiotherapy was poor. Functional radiotherapy facilities were not available at the center during the study period, thereby necessitating external referrals to centers hundreds of kilometers away. Conclusion: Late presentation of cases, noncompliance with treatment regimens, lack of use of cutting edge cytotoxic drugs, the poor outcome of radical surgeries, and lack of a functional radiotherapy facility combined to create a very difficult gynecological cancer care environment at the study center. Keywords: gynecological cancer, management challenges, cancer surgery, chemotherapy

Chukwuemeka A Iyoke,1 Frank O Ezugwu,2 George O Ugwu,1 Osaheni L Lawani,3 Azubuike K Onyebuchi3 1Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Enugu, Nigeria; 2Department of Obstetrics and Gynaecology, Enugu State University Teaching Hospital, Enugu, Nigeria; 3Department of Obstetrics and Gynaecology, Federal Medical Centre, Abakaliki, Nigeria Background: Medical ethics is not given due priority in obstetric care in many developing countries, and the extent to which patients value compliance with ethical precepts is largely unexplored. Objective: To describe the expectations and experiences of obstetric patients in South East Nigeria with respect to how medical ethics principles were adhered to during their care. Methods: This was a cross-sectional, questionnaire-based study involving parturient women followed in three tertiary hospitals in South East Nigeria. Results: A total of 1,112 women were studied. The mean age of respondents was 29.7 ± 4.1 years. Approximately 98% had at least secondary education. Ninety-six percent considered ethical aspects of care as important. On the average, over 75% of patients expected their doctors to comply with the different principles of medical ethics and specifically, more than 76% of respondents expected their doctors to comply with ethical principles related to information and consent during their antenatal and delivery care. There was a statistically significant difference between the proportions of women who expected compliance of doctors with ethical principles and those who did not (P < 0.001). Multivariate analysis showed that increasing levels of skilled occupation (odds ratio [OR] 9.35, P < 0.001), and residence in urban areas (OR 2.41, P < 0.001) increased the likelihood of patients expecting to be informed about their medical conditions and their opinions being sought. Although the self-reported experiences of patients concerning adherence to ethical principles by doctors were encouraging, experiences fell short of expectations, as the level of expectation of patients was significantly higher than the level of observed compliance for all the principles of medical ethics. Conclusion: The level of practice of medical ethics principles by doctors during obstetric care in South East Nigeria was encouraging but still fell short of the expectations of patients. It is recommended that curriculum-based training of doctors and medical students should be implemented, and hospital policy makers should do more to promote ethical aspects of care, by providing official written guidelines for adherence to medical ethical principles during obstetric care. Keywords: medical ethics, obstetric care, principles

Chukwuemeka A Iyoke,1 George O Ugwu,1 Frank O Ezugwu,2 Osaheni L Lawani,3 Azubuike K Onyebuchi31Departments of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Enugu, 2Departments of Obstetrics and Gynaecology, Enugu State University Teaching Hospital, Enugu, 3Departments of Obstetrics and Gynaecology, Federal Medical Centre, Abakaliki, Ebonyi State, NigeriaObjective: The purpose of this study was to compare maternal weight gain in pregnancy and obstetric outcomes between women with obesity in early pregnancy and those with a normal body mass index (BMI) in early pregnancy.Methods: This was a retrospective cohort study of women with obesity in early pregnancy and those with a normal BMI who were seen at three teaching hospitals in South-East Nigeria. Statistical analysis was performed using Statistical Package for the Social Sciences version 17.0 software, with descriptive and inferential statistics at the 95% level of confidence.Results: The study sample consisted of 648 women (324 obese and 324 healthy-weight). The mean age of the obese women was 26.7 ± 5.1 years and that of the healthy-weight women was 26.6 ± 4.9 years. Although both excessive weight gain (odds ratio [OR] 0.35, 95% confidence interval [CI] 0.23–0.54) and inadequate weight gain (OR 0.08, 95% CI 0.04–0.15) were less common in women with early pregnancy obesity than in healthy-weight women, a significantly higher proportion of obese women with excessive weight gain had adverse fetomaternal outcomes. Also, a significantly higher proportion of obese women had specific complications, such as premature rupture of membranes (OR 2.36, 95% CI 1.12–5.04), gestational hypertension/pre-eclampsia (OR 2.31, 95% CI 1.12–5.04), antepartum hemorrhage (OR 2.78, 95% CI 1.02–7.93), gestational diabetes (OR 4.24, 95% CI 1.62–11.74), cesarean delivery (OR 2.3, 95% CI 1.2–5.44), macrosomia (OR 4.08, 95% CI 1.06–8.41), severe birth asphyxia (OR 2.8, 95% CI 1.2–6.63), abnormal Apgar scores (OR 2.67, 95% CI 1.46–4.93), and newborn special care admissions (OR 1.18, 95% CI 1.0–3.29).Conclusion: Early pregnancy obesity was associated with a wide range of adverse fetomaternal outcomes, and could be a genuine risk factor for increased pregnancy-related morbidity and/or mortality in this population. Interventions to reduce prepregnancy obesity could therefore be useful in this low-resource African setting.Keywords: obesity, early pregnancy, maternal weight gain, obstetric outcomes

Background: Hepatitis B virus (HBV) and neonatal tetanus infections remain endemic in Nigeria despite the availability of safe, effective vaccines. We aimed to determine health facilities' capacity for hepatitis B vaccine birth dose (HepB-BD) and maternal tetanus-diphtheria (Td) vaccination and to assess knowledge, attitudes, and practices of HepB-BD and maternal Td vaccine administration among health facility staff in Nigeria., Materials and Methods: This was a cross-sectional study assessing public primary and secondary health facilities in Adamawa and Enugu States. A multistage sampling approach was used to select 40 facilities and 79 health-care workers (HCWs) from each state. A structured facility assessment tool and standardized questionnaire evaluated facility characteristics and HCW knowledge, attitudes, and practices related to HepB-BD and maternal Td vaccination. Frequencies and proportions were reported as descriptive statistics., Results: The survey of 80 facilities revealed that 73.8% implemented HepB-BD and maternal Td vaccination policies. HepB-BD was administered within 24 h of birth at 61.3% of facilities and at all times at 57.5%. However, administration seldom occurred in labor and delivery (35%) or maternity wards (16.3%). Nearly half of the facilities (46.3%) had HCWs believing there were contraindications to HepB-BD vaccination. Among 158 HCWs, 26.5% believed tetanus could be transmitted through unprotected sex, prevented by vaccination at birth (46.1%), or by avoiding sharing food and utensils. 65% of HCWs knew HBV infection had the worst outcome for newborns., Conclusions: The limited implementation of national policies on HepB-BD and maternal Td vaccination, coupled with knowledge gaps among HCWs, pose significant challenges to timely vaccination, necessitating interventions to address these gaps., (Copyright © 2024 Copyright: © 2024 Annals of African Medicine.)

Background: Son preference is known to be prevalent in developing countries and has dire consequences for the family, particularly girls and women. It is speculated that the prevalence of son preference may be high among fertility clinic attendees, and that son preference may be the reason for seeking fertility care in Nigeria., Objectives: To determine the prevalence and risk factors for son preference among fertility seekers in Enugu, Nigeria., Materials and Methods: Questionnaire-based cross-sectional study of fertility clinic attendees from the University of Nigeria Teaching Hospital Ituku-Ozalla Enugu and the Pink Petals Fertility Clinic Enugu from April 1 to September 30, 2023. Eligible and consenting participants were interviewed. Data collection was with a pretested interviewer-administered questionnaire, which contained three sections: biodata, obstetrics and gynecological data and 3-point son preference questions. The proportion of those who scored 3 (son preference) was documented. The analysis was both descriptive and inferential using IBM SPSS statistics for Windows, version 22.0 Armonk, NY, USA: IBM Corp., Results: Of the 422 participants interviewed, 416 (98.6%) completed the study with a nonresponse rate of 6 (1.4%). The overall prevalence of son preference was 10.1% (42/416) and all 42 (10.1%) were in the clinic to have a male baby. The risk factors for son preference were less than tertiary education (P < 0.001, adjusted odds ratio [AOR] = 6.46, confidence interval [CI] 2.79-14.98) and family pressure to have a male baby (P = 0.03, AOR = 3.41, CI 1.72-7.13)., Conclusions: One in 10 couples who attend an infertility clinic in Enugu, Nigeria, has a preference for son, and having a male child is the sole purpose of such a visit. Being under family pressure and not having tertiary education were the predictive risk factors for son preference in the study population., (Copyright © 2024 Copyright: © 2024 Annals of African Medicine.)

Nigeria is estimated to have the largest number of children worldwide, living with chronic hepatitis B virus (HBV) infection, the leading cause of liver cancer. Up to 90% of children infected at birth develop chronic HBV infection. A birth dose of the hepatitis B vaccine (HepB-BD) followed by at least two additional vaccine doses is recommended for prevention. This study assessed barriers and facilitators of HepB-BD administration and uptake, using structured interviews with healthcare providers and pregnant women in Adamawa and Enugu States, Nigeria. The Consolidated Framework for Implementation Sciences Research (CFIR) guided data collection and analysis. We interviewed 87 key informants (40 healthcare providers and 47 pregnant women) and created a codebook for data analysis. Codes were developed by reviewing the literature and reading a subsample of queries line-by-line. The overarching themes identified as barriers among healthcare providers were: the lack of hepatitis B knowledge, limited availability of HepB-BD to vaccination days only, misconceptions about HepB-BD vaccination, challenges in health facility staffing capacity, costs associated with vaccine transportation, and concerns related to vaccine wastage. Facilitators of timely HepB-BD vaccination included: vaccine availability, storage, and hospital births occurring during immunization days. Overarching themes identified as barriers among pregnant women were lack of hepatitis B knowledge, limited understanding of HepB-BD importance, and limited access to vaccines for births occurring outside of a health facility. Facilitators were high vaccine acceptance and willingness for their infants to receive HepB-BD if recommended by providers. Findings indicate the need for enhanced HepB-BD vaccination training for HCWs, educating pregnant women on HBV and the importance of timely HepB-BD, updating policies to enable HepB-BD administration within 24 hours of birth, expanding HepB-BD availability in public and private hospital maternity wards for all facility births, and outreach activities to reach home births., Competing Interests: The authors have declared that no competing interests exist., (Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.)

Introduction: The National Home Grown School Feeding Programme (NHGSFP) was re-launched in Nigeria in 2016, eleven years after it was first introduced in the country, with Enugu as one of the beneficiary States. The objectives of the programme are to improve the health of school children and aid in the realization of Universal Basic Education (UBE) goals. This study explored the opinions of heads of public primary schools on the implementation and policy benefits of NHGSFP in Enugu, southeast Nigeria., Methods: This was a cross-sectional study conducted among 24 headmasters and headmistresses purposively selected from public primary schools in the Enugu metropolis. Qualitative data were collected through the use of a pretested Key Informant Interview (KII) guide, and analyzed using a thematic approach., Results: All the participants were aware of the NHGSFP, which involved the provision of one mid-day meal per child per school day to the pupils, and all their schools were part of the programme. Most of the participants complained about the nutritional quality and quantity of the school meals which they felt were poor. None of the schools had a kitchen within the school premises, and all the participants admitted that deworming was not regularly carried out, as part of the programme. Most of the participants believed that the objectives of the feeding programme, including, reduced hunger among learners, increased school enrolment, attendance and enhanced participatory learning, were being met., Conclusion: Although the NHGSFP was implemented in every school in Enugu metropolis, Enugu State, Nigeria, regular deworming of pupils was not carried out, and there were concerns about certain aspects of the implementation, such as inadequate funding and poor quality of school meals. Thus, there is a need for the introduction of deworming and more allocation of funds to the programme to improve the quantity and nutritional quality of school meals., (© 2023. The Author(s).)

Background: Adequate Human Resources for Health is indispensable to achieving Universal Health Coverage and physicians play a leading role. Nigeria with low physician-population ratio, is experiencing massive exodus of physicians. This study investigated emigration intention of physicians, the factors influencing it and discussed the implications to guide policy formulation and reforms, curtail the trend and safeguard the country's health system., Methods: Through cross-sectional survey, 913 physicians from 37 States were interviewed with semi-structured questionnaire using Google form shared via WhatsApp and Telegram forums of Nigeria Medical Association. Data were analysed with IBM-SPSS version-25 and charts were created with Microsoft-Excel. Chi-square and multiple regression tests were done with p-value set at 0.05., Results: The mean age of respondents is 37.6 ± 7.9 years; majority of them are males (63.2%), married (75.5%) with postgraduate qualifications (54.1%) and working in public health facilities (85.4%). Whereas 13% and 19.3% are, respectively, satisfied with their work and willing to continue practice in Nigeria, 43.9% want to emigrate and 36.8% are undecided about future location of their practice. The commonest reasons for emigration are poor remuneration (91.3%), rising insecurity (79.8%) and inadequate diagnostic facilities (61.8%). Physicians working in public health facilities are 2.5 times less satisfied than their counterparts in non-public sector (AOR = 0.4; 95% CI = 0.3-0.8). Physicians in their thirties, forties and fifties are 3.5 (95% CI = 1.5-8.0), 5.5 (95% CI = 2.1-14.5) and 13.8 (95% CI = 3.9-49.3) times, respectively, more willing to retain practice in Nigeria than those younger and those satisfied with their work are 4.7 (AOR = 4.7, 95% CI = 2.9-7.4) times more willing to practice in Nigeria than those not satisfied., Conclusion: Majority of Nigerian physicians want to emigrate for professional practice and top among the push factors are poor remuneration, rising insecurity and inadequate diagnostic facilities. The observed trend portends danger to the country's health system due to the foreseeable negative consequences of physician deficit to the system. We recommend upward review of physician remuneration, a root cause analysis of insecurity to determine workable preventive measures and increased funding of the health sector to improve the diagnostic infrastructure, retain physicians and save the health system from imminent collapse., (© 2022. The Author(s).)

Objective: To investigate the prevalence of life-threatening complications related to pregnancies with abortive outcome and the associated health service events and performance in Nigerian public tertiary hospitals., Design: Secondary analysis of a nationwide cross-sectional study., Setting: Forty-two tertiary hospitals., Population: Women admitted for pregnancy-related complications., Methods: All cases of severe maternal outcomes (SMO: maternal near-miss or death) due to abortive pregnancy complications (defined as spontaneous or induced abortion, and ectopic pregnancy) were prospectively identified over 1 year using uniform identification criteria., Main Outcome Measures: Prevalence of SMO, mortality index (% maternal death/SMO), case fatality rate, time until death after admission, and health service performance., Results: Of 5779 women admitted with abortive pregnancy complications, 444 (7.9%) experienced an SMO: 366 maternal near-misses and 78 maternal deaths. Intra-hospital maternal mortality ratio from complicated abortive pregnancy outcome was 85/100 000 live births. Case fatality rate was worst for abortion-related infections (19.1%). A quarter of maternal deaths occurred on the same day of admission; however, the peak time of occurrence of death was 3-7 days of admission. Women experiencing cardiovascular, renal or coagulation organ dysfunction were less likely to survive. Higher level of maternal education and closer residence to a health facility improved chance of maternal survival., Conclusions: Abortive outcome remains a major contributor to SMO in Nigeria. Although early hospital presentation by women is critical to surviving abortive pregnancy complications, improved, appropriate, and timely management is essential to enhance maternal survival., Tweetable Abstract: 78 maternal deaths and 366 near-misses occurred from abortions and ectopic pregnancies in 42 Nigerian referral hospitals in 1 year., (© 2019 World Health Organization; licensed by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists.)

Background: Polycystic ovary syndrome is the most common gynaecological endocrine disorder in women of reproductive age yet, its prevalence and management has not been documented in our area., Objective: To determine the prevalence, presentation and management of polycystic ovary syndrome among women in Enugu, south east Nigerian., Method: A prospective descriptive study of women with polycystic ovaries seen in two major Infertility Clinics in Enugu, South East Nigeria over a 2 year period., Result: A total of 342 women presented with infertility in the centres within the two year period, out of whom 62 had PCOS. PCOS occurred in 18.1% of women in the infertility clinics of the two institutions. The common modes of presentation were: inability to conceive (infertility) in 52 (83.9%), oligomenorrhoea in 45 (72.6%), obesity in 32 (51.6%), LH/FSH ratio > 2 in 28 (45.2%), hyperprolactinaemia in 26 (41.9%) and hirsuitism in 19 (30.6%) women. Ovulation induction was carried out in 42 of the 50 women with anovulatory infertility only. For those 42 women, the mean number of induced cycles was 2.6 = 1.7 (range: 1-6) with 33 (78.6%) of the women being able to do only 3 induced cycles or less. The ovulation induction agents used were clomiphene citrate and human menopausal gonadotrophin either singly or in combination with tamoxifen or bromocryptine. Adjunctive treatments offered consisted of weight reduction in 20 (40.0%) women, metformin in 11 (22.0%) women and dexamethasone in 10 (20.0%) women., Conclusion: PCOS is fairly common occurring in approximately one in six infertile Nigerian women. Infertility, oligomenorrhoea, obesity, LH/FSH ratio > 2, hyperprolactinaemia and hirsutism are the commonest presenting features. On individualized management, about two-fifths of them conceive either spontaneously or following ovulation induction, despite poor compliance to recommended drug regimen.

Background: Majority of Pacdiatric HIV/AIDS are from infected mothers and adequate prevention of mother to child transmission (PMTCT) of HIV is a critical factor in the control of paediatric HIV/AIDS. Success of PMTCT strategies will require a high level of acceptability of these strategies by pregnant women., Methods: A cross sectional descriptive study of the impact of health education on the awareness of strategies for PMTCT was undertaken using interviewer administered questionnaire on antenatal women recruited from three health institutions in Enugu., Results: A total of 150 antenatal clients were studied. Their mean age was 29.9 1 +/- 4.0. Ninety four point seven percent (94.7%) were married and 60% of them had post secondary education. There was high level of awareness and acceptability of PMTCT measures amongst the respondents. Out of the 150 respondents, 123 (82.0%) identified correctly the meaning of HIV, 140 (93.3%) were aware it can affect the newborn, 105 (75%) knew how it is transmitted and 135 (90.0%) had awareness that we can prevent mother to child transmission of HIV. 130 (86.6%) of the respondents would accept some measures for PMTCT. Awareness that HIV can affect new born increased from 140 (93.3%) to 145 (96.7%) following health education while those who would accept PMTCT measures increased from 130 (86.6%) to 146 (97.3%). These increases were statistically significant (P<0.05)., Conclusion: Health education has a positive and significant impact on the awareness and acceptability of Prevention of Mother to Child transmission of HIV amongst antenatal clients in Enugu.

Nigeria has the highest twinning rate in the world. Increasing twinning rates have been reported from various parts of the world as a result of assisted reproductive technologies. In order to determine whether Nigeria is part of this epidemic, the current study assessed the trends in twinning rates as seen at the University of Nigeria Teaching Hospital, Enugu, South-east Nigeria. It was a retrospective analysis of twin deliveries in the hospital over a 21-year period (1985-2005). No significant change was observed in the twinning rate within the study period. It was concluded that Nigeria is not yet part of the epidemic of multiple births affecting other parts of the world.

In a free maternity care setting the number of antenatal clients can be overwhelming for the obstetric staff. Using the World Health Organization (WHO) classifying form, most of the women can be triaged for the basic component of the new WHO antenatal care model. Our aim was to evaluate the risk status of pregnant women in a tertiary health institution providing free maternity care in Nigeria. We interviewed 1022 randomly selected clients using the WHO classifying form at our booking clinic over a 12-month period. The analysis was performed using the epi info statistical program. Seven hundred and sixty-five clients (74.9%) were found eligible for the basic component of the new antenatal care model. The associated risk in pregnancy increased with increasing parity. The basic component of the new WHO antenatal care model can safely be implemented in centres such as ours.