Cervical cancer screening services have led to a significant decrease in the incidence of cervica... more Cervical cancer screening services have led to a significant decrease in the incidence of cervical cancer in countries were such services are implemented as population-based services. Cervical cancer still remains the most commonly diagnosed cancer in several countries in Sub-Saharan Africa and South Eastern Asia. This study explored the awareness, utilization and provision of cervical screening services among Primary Health Care providers in Zaria, Nigeria. A qualitative study was conducted among Primary Health Care providers in Zaria Local Government Area Kaduna State Nigeria. Five Primary Health Care centres were purposively selected for the study. Data was collected using Focus Group discussion method. The data from the discussion sessions were recorded on tape and transcribed verbatim to capture the exact messages. The transcripts were then analysed into themes. Majority of the participants were within 30-39-year age range, 75% were females, 64.3% were Community Health Extensio...
Background: Pre-eclampsia is a pregnancy-specific disorder characterized by the onset of hyperten... more Background: Pre-eclampsia is a pregnancy-specific disorder characterized by the onset of hypertension and proteinuria after the 20th week of gestation. It is characterized by an exaggerated maternal inflammatory response with a preponderance of cell-mediated immune response. Tumor necrosis factor-alpha (TNF-α) is a pro-inflammatory cytokine that induces apoptosis and restrains differentiation. Defective trophoblastic invasion is now identified as the key etiology of pre-eclampsia. The objective of this study was to determine the serum levels TNF-α and interleukin 10 (IL-10) in women with pre-eclampsia/eclampsia and the relationship between these cytokines and the severity of the disease. Patients and Method: This was a case-control study carried out in Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Forty-eight patients with a diagnosis of pre-eclampsia/eclampsia were recruited as cases. The diagnosis was according to the International Society for the Study of Hypertension in Pregnancy (ISSHP) criteria. For each case, a healthy pregnant control was selected, after matching for age, gestational age, and parity. Blood samples were taken and assayed for TNF-α and IL 10 using enzyme-linked immunosorbent assay. Data were analyzed using SPSS v 20. A P value Results: The prevalence of pre-eclampsia/eclampsia in ABUTH Zaria is 5.1%. Nulliparous women constituted 65.9% of the patients. Thirty-five percent of the women were between 20 and 24 years of age. The mean serum levels of TNF-α in women with pre-eclampsia/ eclampsia and controls were 294.8 ± 146 pg/mL and 176 ± 35.5 pg/mL, respectively. The mean serum levels of IL-10 in patients and controls with pre-eclampsia were 13.9 ± 5.7 pg/mL and 33.0 ± 11.0 pg/mL, respectively. The levels of TNF-α correlated positively with the severity of the disease. The serum levels of IL-10 did not correlate with disease severity. Conclusion: The prevalence of pre-eclampsia/eclampsia is high in ABUTH. The disease is characterized by an exaggerated inflammatory response in women in Zaria. Use of anti- TNF-α drugs may possibly have a role in the prevention of pre-eclampsia.
Uterine myoma is the most common gynecological tumor in women of the reproductive age group. The ... more Uterine myoma is the most common gynecological tumor in women of the reproductive age group. The incidence of myoma in pregnancy ranges from 0.3% to 2.6%, of which approximately 10% leads to complications. The management of uterine myoma during pregnancy in most of the cases is expectant, and its surgical removal is generally delayed until after delivery. In the last two decades, there have been increasing reports of successful myomectomy during caesarean section and even fewer cases in the first and second trimester. We report a case of huge uterine fibroids presenting to the booking clinic at approximately 13 weeks of gestation with a large for date uterus and severe lower abdominal pain. She was admitted and managed conservatively for the presumptive diagnosis of red degeneration in pregnancy. She had myomectomy on account of the distressing abdominal pain. She had an uneventful postoperative period and was discharged home on the 7th postoperative day on hematinics. She was eventually delivered a live baby weighing 2.6 kg by an emergency caesarean section following rupture of membranes prematurely at 37 weeks of gestation. We can therefore say that in carefully selected cases, particularly in cases of subserous fibroids, myomectomy in pregnancy may be safer than previously thought.
Background: Cervical cancer is the second most common cancer in women worldwide. Human immunodefi... more Background: Cervical cancer is the second most common cancer in women worldwide. Human immunodeficiency virus (HIV) has been suggested to be a cofactor in the association between human papillomavirus and cervical intraepithelial neoplasia (CIN). Aim: To determine the pattern of cervical cytology changes in women of different HIV status and characterise the sociodemographic factors that confound the changes seen. Methods: This was a cross-sectional comparative study. This study was conducted in Gynaecology Clinic of Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Following informed consent, 272 HIV-positive (HIV+) and 275 HIV-negative (HIV−) women had questionnaires administered and Papanicolaou smears were taken. Results: The average age of the respondents was 32.6 ± 6.8 years (range: 15–49 years). Mean parity for HIV+ women was 3.28 and 3.36 for HIV− women while 70.8% of HIV+ women were married comparable with 72.7% in HIV− women. Twenty-nine per cent of HIV+ women had positive smears for CIN compared with 16.4% in those that were HIV−. This was statistically significant (odds ratio = 2.05, P = 0.001). The high-grade lesions (CIN II and CIN III) tended to be higher in the HIV+ women (11.4%) than the HIV− women (0.7%). Conclusion: HIV+ women in Zaria, Northern Nigeria, are at higher risk of severe cervical dysplasia compared with their counterparts who are HIV−. It is recommended that greater effort should be made to have an integrated reproductive healthcare service which includes cervical cytology within the HIV clinics.
Background: Single dose antibiotic prophylaxis has been established as the standard for preventio... more Background: Single dose antibiotic prophylaxis has been established as the standard for prevention of post-caesarean wound infection in most developed centers across the world. However, this is not the case in most developing countries including Nigeria where various multiple dose regimens are still being used due to paucity of locally generated evidence, and anecdotal suggestions of a higher risk of infectious morbidity in our environment. Objectives: This study was aimed to determine whether there was a significant difference in the incidence of post-caesarean section wound infection between a single dose and a 72-hour course of intravenous ceftriazone for antibiotic prophylaxis in selected patients undergoing both elective and emergency caesarean section. Materials and methods: A randomized controlled trial was carried out among 170 consenting parturients scheduled for elective or emergency caesarean section who met a set out selection criteria, between January and June 2016. They were divided randomly into two equal groups, A and B, of 85 each using the Windows WINPEPI software version 11.65 (Copyright J.H. Abrahamson, 22 Aug 2016) for randomization. Group A patients received a single dose of 1 g, whereas Group B patients were given a 72-hour course (1 g daily) of intravenous ceftriazone. The primary outcome measure was the incidence of clinical wound infection. The secondary outcome measures were the incidences of clinical endometritis and febrile morbidity. Data were collected using a structured proforma and analyzed using Statistical Package for Social Sciences version 21. Results: The overall incidence of wound infection was 11.2%; Group A had 11.8%, and Group B had 10.6%. Endometritis was 20.6%; Group A had 20% and Group B had 21.2%. Febrile morbidity was 4.1%; Group A had 3.5% and Group B had 4.7%. There was no statistically significant difference in the incidence of wound infection (relative risk [RR] = 1.113; 95% confidence interval [CI] = 0.433, 2.927; P = 0.808), endometritis (RR = 0.943; 95% CI = 0.442, 1.953; P = 0.850), and febrile morbidity (RR = 0.745, 95% CI = 0.161, 3.415; P = 0.700) between the two groups. Group A showed similar risk of developing wound infection compared to Group B (P > 0.05). Conclusion: There was no significant difference in post-caesarean wound infection and other infectious morbidity between patients that received a single dose, and those that received a 72-hour course of ceftriazone for antibiotic prophylaxis. This suggests that single dose antibiotic prophylaxis with ceftriazone is similar to multiple dose regimens in efficacy with likely cost-effective advantage.
Background: Uterine fibroids are the most common tumor of the uterus worldwide, especially in bla... more Background: Uterine fibroids are the most common tumor of the uterus worldwide, especially in blacks. While surgery remains the goal standard for definitive treatment, huge uterine fibroids pose a peculiar surgical challenge, with a possibly higher risk of complications such as hemorrhage and deep surgical site infection. Methods: A 5-year retrospective review of patients' folders who had surgical treatment for huge uterine fibroids from January 2015 to December 2019 was done. Huge uterine fibroids were defined as uterine size of ≥16 weeks. The patients' sociodemographic profiles, surgical procedure performed, early and delayed post-operative complications were all documented on a structured proforma. Data was analyzed using SPSS version 21. Results: A total of 245 patients had surgical treatments for uterine fibroids. However, 152 case notes were retrieved, of which 135 had huge uterine fibroids. The mean age of the patients was 37.85 ± 7.05 years. Abdominal myomectomy was ...
Journal of the West African College of Surgeons, Mar 17, 2023
Background: Genital Chlamydia trachomatis (Ct) is the commonest bacterial sexually transmitted in... more Background: Genital Chlamydia trachomatis (Ct) is the commonest bacterial sexually transmitted infection globally. Acquisition of Ct infection is affected by biological and behavioural factors. Aim: Determine the prevalence of Ct infection and identify risk factors associated with Ct infection in sexually active fertile women in Northern Nigeria. Materials and methods: One hundred and fifty sexually active women presenting to the Obstetrics and Gynaecology department of Ahmadu Bello University Teaching Hospital, Zaria were studied. Socio-demographic characteristics and history of risk factors for acquisition of genital Ct were obtained from the participants using a questionnaire. Their sera were tested for the presence of Ct immunoglobulin G using Enzyme-Linked Immunosorbent Assay. Results: The mean ages ± standard deviation of seropositive and seronegative women were 29.1 ± 7.3 years and 28.9 (SD 6.7) years respectively (P = 0.438). The prevalence of Ct infection was 6.7% (10/150). Occupation was associated with Ct seropositivity (P = 0.02). Number of sexual partners, age at coitarche; duration of sexual exposure and previous history suggestive of sexually transmitted infection were not associated with Ct seropositivity (P > 0.05). Conclusion: A low prevalence of Ct was found among fertile women. Lack of regular source of personal income was associated with Ct infection but the sexual behavioural factors studied were not.
International Journal of Gynecology & Obstetrics, 2019
ObjectiveTo assess women's experience of group prenatal care in a rural Nigerian community.Me... more ObjectiveTo assess women's experience of group prenatal care in a rural Nigerian community.MethodsIn an observational study, consenting pregnant women were enrolled in a group prenatal care program based on the CenteringPregnancy model from July 1, 2010, to June 30, 2011, in Tsibiri, Nigeria. Women were interviewed before joining the group and postnatally. A predesigned pro forma was used to assess group behavior during sessions. Descriptive and inferential statistics were applied to data.ResultsIn total, 161 women enrolled, and 54 of 72 scheduled prenatal sessions took place. The average number of visits was three per woman, with good group interaction and cohesion. Mothers who could mention at least five out of eight danger signs of pregnancy increased from 1.4% (2) to 13.3% (14) (P<0.001, 95% CI 4.28–19.52), while mean knowledge score for danger signs increased from 31% to 47.8% (P<0.001, 95% CI 0.86–2.16). Commitment to birth preparedness plans was impressive. The moth...
Tubal ligation is a common method of contraception, and pregnancy after this method of sterilizat... more Tubal ligation is a common method of contraception, and pregnancy after this method of sterilization is uncommon. We here present a report of Tubal pregnancy after a Bilateral Tubal Ligation (BTL). The case notes of a 35 year Nigerian female who presented with a tubal pregnancy after BTL and a review of literature on the subject was used. A 35-year-old para 4=0 had bilateral tubal ligation during caesarean section for her last childbirth. She presented 3 years later with a six weeks history of irregular vaginal bleeding and lower abdominal pain and had a laparotomy for a right tubal ectopic pregnancy. Ectopic pregnancy after bilateral tubal ligation is uncommon. Females who undergo BTL should be adequately counseled on the possibility of failure of this procedure for contraception.
Cervical cancer screening services have led to a significant decrease in the incidence of cervica... more Cervical cancer screening services have led to a significant decrease in the incidence of cervical cancer in countries were such services are implemented as population-based services. Cervical cancer still remains the most commonly diagnosed cancer in several countries in Sub-Saharan Africa and South Eastern Asia. This study explored the awareness, utilization and provision of cervical screening services among Primary Health Care providers in Zaria, Nigeria. A qualitative study was conducted among Primary Health Care providers in Zaria Local Government Area Kaduna State Nigeria. Five Primary Health Care centres were purposively selected for the study. Data was collected using Focus Group discussion method. The data from the discussion sessions were recorded on tape and transcribed verbatim to capture the exact messages. The transcripts were then analysed into themes. Majority of the participants were within 30-39-year age range, 75% were females, 64.3% were Community Health Extensio...
Background: Pre-eclampsia is a pregnancy-specific disorder characterized by the onset of hyperten... more Background: Pre-eclampsia is a pregnancy-specific disorder characterized by the onset of hypertension and proteinuria after the 20th week of gestation. It is characterized by an exaggerated maternal inflammatory response with a preponderance of cell-mediated immune response. Tumor necrosis factor-alpha (TNF-α) is a pro-inflammatory cytokine that induces apoptosis and restrains differentiation. Defective trophoblastic invasion is now identified as the key etiology of pre-eclampsia. The objective of this study was to determine the serum levels TNF-α and interleukin 10 (IL-10) in women with pre-eclampsia/eclampsia and the relationship between these cytokines and the severity of the disease. Patients and Method: This was a case-control study carried out in Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Forty-eight patients with a diagnosis of pre-eclampsia/eclampsia were recruited as cases. The diagnosis was according to the International Society for the Study of Hypertension in Pregnancy (ISSHP) criteria. For each case, a healthy pregnant control was selected, after matching for age, gestational age, and parity. Blood samples were taken and assayed for TNF-α and IL 10 using enzyme-linked immunosorbent assay. Data were analyzed using SPSS v 20. A P value Results: The prevalence of pre-eclampsia/eclampsia in ABUTH Zaria is 5.1%. Nulliparous women constituted 65.9% of the patients. Thirty-five percent of the women were between 20 and 24 years of age. The mean serum levels of TNF-α in women with pre-eclampsia/ eclampsia and controls were 294.8 ± 146 pg/mL and 176 ± 35.5 pg/mL, respectively. The mean serum levels of IL-10 in patients and controls with pre-eclampsia were 13.9 ± 5.7 pg/mL and 33.0 ± 11.0 pg/mL, respectively. The levels of TNF-α correlated positively with the severity of the disease. The serum levels of IL-10 did not correlate with disease severity. Conclusion: The prevalence of pre-eclampsia/eclampsia is high in ABUTH. The disease is characterized by an exaggerated inflammatory response in women in Zaria. Use of anti- TNF-α drugs may possibly have a role in the prevention of pre-eclampsia.
Uterine myoma is the most common gynecological tumor in women of the reproductive age group. The ... more Uterine myoma is the most common gynecological tumor in women of the reproductive age group. The incidence of myoma in pregnancy ranges from 0.3% to 2.6%, of which approximately 10% leads to complications. The management of uterine myoma during pregnancy in most of the cases is expectant, and its surgical removal is generally delayed until after delivery. In the last two decades, there have been increasing reports of successful myomectomy during caesarean section and even fewer cases in the first and second trimester. We report a case of huge uterine fibroids presenting to the booking clinic at approximately 13 weeks of gestation with a large for date uterus and severe lower abdominal pain. She was admitted and managed conservatively for the presumptive diagnosis of red degeneration in pregnancy. She had myomectomy on account of the distressing abdominal pain. She had an uneventful postoperative period and was discharged home on the 7th postoperative day on hematinics. She was eventually delivered a live baby weighing 2.6 kg by an emergency caesarean section following rupture of membranes prematurely at 37 weeks of gestation. We can therefore say that in carefully selected cases, particularly in cases of subserous fibroids, myomectomy in pregnancy may be safer than previously thought.
Background: Cervical cancer is the second most common cancer in women worldwide. Human immunodefi... more Background: Cervical cancer is the second most common cancer in women worldwide. Human immunodeficiency virus (HIV) has been suggested to be a cofactor in the association between human papillomavirus and cervical intraepithelial neoplasia (CIN). Aim: To determine the pattern of cervical cytology changes in women of different HIV status and characterise the sociodemographic factors that confound the changes seen. Methods: This was a cross-sectional comparative study. This study was conducted in Gynaecology Clinic of Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Following informed consent, 272 HIV-positive (HIV+) and 275 HIV-negative (HIV−) women had questionnaires administered and Papanicolaou smears were taken. Results: The average age of the respondents was 32.6 ± 6.8 years (range: 15–49 years). Mean parity for HIV+ women was 3.28 and 3.36 for HIV− women while 70.8% of HIV+ women were married comparable with 72.7% in HIV− women. Twenty-nine per cent of HIV+ women had positive smears for CIN compared with 16.4% in those that were HIV−. This was statistically significant (odds ratio = 2.05, P = 0.001). The high-grade lesions (CIN II and CIN III) tended to be higher in the HIV+ women (11.4%) than the HIV− women (0.7%). Conclusion: HIV+ women in Zaria, Northern Nigeria, are at higher risk of severe cervical dysplasia compared with their counterparts who are HIV−. It is recommended that greater effort should be made to have an integrated reproductive healthcare service which includes cervical cytology within the HIV clinics.
Background: Single dose antibiotic prophylaxis has been established as the standard for preventio... more Background: Single dose antibiotic prophylaxis has been established as the standard for prevention of post-caesarean wound infection in most developed centers across the world. However, this is not the case in most developing countries including Nigeria where various multiple dose regimens are still being used due to paucity of locally generated evidence, and anecdotal suggestions of a higher risk of infectious morbidity in our environment. Objectives: This study was aimed to determine whether there was a significant difference in the incidence of post-caesarean section wound infection between a single dose and a 72-hour course of intravenous ceftriazone for antibiotic prophylaxis in selected patients undergoing both elective and emergency caesarean section. Materials and methods: A randomized controlled trial was carried out among 170 consenting parturients scheduled for elective or emergency caesarean section who met a set out selection criteria, between January and June 2016. They were divided randomly into two equal groups, A and B, of 85 each using the Windows WINPEPI software version 11.65 (Copyright J.H. Abrahamson, 22 Aug 2016) for randomization. Group A patients received a single dose of 1 g, whereas Group B patients were given a 72-hour course (1 g daily) of intravenous ceftriazone. The primary outcome measure was the incidence of clinical wound infection. The secondary outcome measures were the incidences of clinical endometritis and febrile morbidity. Data were collected using a structured proforma and analyzed using Statistical Package for Social Sciences version 21. Results: The overall incidence of wound infection was 11.2%; Group A had 11.8%, and Group B had 10.6%. Endometritis was 20.6%; Group A had 20% and Group B had 21.2%. Febrile morbidity was 4.1%; Group A had 3.5% and Group B had 4.7%. There was no statistically significant difference in the incidence of wound infection (relative risk [RR] = 1.113; 95% confidence interval [CI] = 0.433, 2.927; P = 0.808), endometritis (RR = 0.943; 95% CI = 0.442, 1.953; P = 0.850), and febrile morbidity (RR = 0.745, 95% CI = 0.161, 3.415; P = 0.700) between the two groups. Group A showed similar risk of developing wound infection compared to Group B (P > 0.05). Conclusion: There was no significant difference in post-caesarean wound infection and other infectious morbidity between patients that received a single dose, and those that received a 72-hour course of ceftriazone for antibiotic prophylaxis. This suggests that single dose antibiotic prophylaxis with ceftriazone is similar to multiple dose regimens in efficacy with likely cost-effective advantage.
Background: Uterine fibroids are the most common tumor of the uterus worldwide, especially in bla... more Background: Uterine fibroids are the most common tumor of the uterus worldwide, especially in blacks. While surgery remains the goal standard for definitive treatment, huge uterine fibroids pose a peculiar surgical challenge, with a possibly higher risk of complications such as hemorrhage and deep surgical site infection. Methods: A 5-year retrospective review of patients' folders who had surgical treatment for huge uterine fibroids from January 2015 to December 2019 was done. Huge uterine fibroids were defined as uterine size of ≥16 weeks. The patients' sociodemographic profiles, surgical procedure performed, early and delayed post-operative complications were all documented on a structured proforma. Data was analyzed using SPSS version 21. Results: A total of 245 patients had surgical treatments for uterine fibroids. However, 152 case notes were retrieved, of which 135 had huge uterine fibroids. The mean age of the patients was 37.85 ± 7.05 years. Abdominal myomectomy was ...
Journal of the West African College of Surgeons, Mar 17, 2023
Background: Genital Chlamydia trachomatis (Ct) is the commonest bacterial sexually transmitted in... more Background: Genital Chlamydia trachomatis (Ct) is the commonest bacterial sexually transmitted infection globally. Acquisition of Ct infection is affected by biological and behavioural factors. Aim: Determine the prevalence of Ct infection and identify risk factors associated with Ct infection in sexually active fertile women in Northern Nigeria. Materials and methods: One hundred and fifty sexually active women presenting to the Obstetrics and Gynaecology department of Ahmadu Bello University Teaching Hospital, Zaria were studied. Socio-demographic characteristics and history of risk factors for acquisition of genital Ct were obtained from the participants using a questionnaire. Their sera were tested for the presence of Ct immunoglobulin G using Enzyme-Linked Immunosorbent Assay. Results: The mean ages ± standard deviation of seropositive and seronegative women were 29.1 ± 7.3 years and 28.9 (SD 6.7) years respectively (P = 0.438). The prevalence of Ct infection was 6.7% (10/150). Occupation was associated with Ct seropositivity (P = 0.02). Number of sexual partners, age at coitarche; duration of sexual exposure and previous history suggestive of sexually transmitted infection were not associated with Ct seropositivity (P &gt; 0.05). Conclusion: A low prevalence of Ct was found among fertile women. Lack of regular source of personal income was associated with Ct infection but the sexual behavioural factors studied were not.
International Journal of Gynecology & Obstetrics, 2019
ObjectiveTo assess women's experience of group prenatal care in a rural Nigerian community.Me... more ObjectiveTo assess women's experience of group prenatal care in a rural Nigerian community.MethodsIn an observational study, consenting pregnant women were enrolled in a group prenatal care program based on the CenteringPregnancy model from July 1, 2010, to June 30, 2011, in Tsibiri, Nigeria. Women were interviewed before joining the group and postnatally. A predesigned pro forma was used to assess group behavior during sessions. Descriptive and inferential statistics were applied to data.ResultsIn total, 161 women enrolled, and 54 of 72 scheduled prenatal sessions took place. The average number of visits was three per woman, with good group interaction and cohesion. Mothers who could mention at least five out of eight danger signs of pregnancy increased from 1.4% (2) to 13.3% (14) (P<0.001, 95% CI 4.28–19.52), while mean knowledge score for danger signs increased from 31% to 47.8% (P<0.001, 95% CI 0.86–2.16). Commitment to birth preparedness plans was impressive. The moth...
Tubal ligation is a common method of contraception, and pregnancy after this method of sterilizat... more Tubal ligation is a common method of contraception, and pregnancy after this method of sterilization is uncommon. We here present a report of Tubal pregnancy after a Bilateral Tubal Ligation (BTL). The case notes of a 35 year Nigerian female who presented with a tubal pregnancy after BTL and a review of literature on the subject was used. A 35-year-old para 4=0 had bilateral tubal ligation during caesarean section for her last childbirth. She presented 3 years later with a six weeks history of irregular vaginal bleeding and lower abdominal pain and had a laparotomy for a right tubal ectopic pregnancy. Ectopic pregnancy after bilateral tubal ligation is uncommon. Females who undergo BTL should be adequately counseled on the possibility of failure of this procedure for contraception.
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