Hysterectomy in Adolescents

Introduction: Hysterectomy in adolescents is a very difficult decision to take as the consequence is always a loss of future reproductive potential. However, it may be necessary sometimes as a salvage measure.Subjects and Methods: We evaluated the trends and factors that necessitated hysterectomy among adolescents seen at the University of Port Harcourt Teaching Hospital, Port-Harcourt (UPTH), Nigeria.This is a retrospective descriptive analysis of 28 cases of hysterectomies managed at the UPTH over a 17-year period. Variables analysed included socio-demographic factors, indications for and type of hysterectomy performed, decision level, duration of surgery and complications encountered.Results: Majority (78%) of the hysterectomies were in adolescents aged 16 years and above. Sixty percent of them had a secondary education, 78% were unmarried and one third had had a previous successful pregnancy. About half the cases resided in rural while half resided in urban settlements.. Seventy-one percent of the hysterectomies were abortion- related. Decisions for the hysterectomies were taken mainly byconsultants and occasionally, in dire emergencies, by senior residents to prevent death from bleeding. Mortality was 21%.Conclusion: The results suggest the need for a greater emphasis on sexuality education and expansion of sexual and reproductive health services to adolescents especially those who are sexually active. Life planning and livelihood skills training are needed to enable young people acquire value-based skills, which are essential for making safe andinformed choices . With such high level of mortality from septic abortion even with invention, the need for Youth Friendly Centres/services cannot be over emphasized

Hysterectomy in Adolescents, in Port Harcourt, Nigeria.

Background: Hysterectomy in adolescents is a very difficult decision to take as the consequence is always a loss of future reproductive potential. However, it may be necessary sometimes as a salvage measure.Methods: A retrospective descriptive analysis of 28 cases of adolescent hysterectomies managed at the University of Port-Harcourt (UPTH) over a 17-year period was carried out. Variables analysed included socio-demographic factors, indications for and type of hysterectomy performed, decision level, duration of surgery and complications encountered.Results: Majority (78%) of the hysterectomies were in adolescents aged 16 years and above. Sixty percent of them had a secondary education, 78% were unmarried and nine had a previous successful pregnancy. About half the cases resided in rural areas, while half resided in urban settlements. Seventy-one percent of the hysterectomies were abortionrelated. Decisions for the hysterectomies were taken mainly by consultants and occasionally, in dire emergencies, by senior residents to prevent death from bleeding. Mortality was 21%.Conclusion: The results suggest the need for a greater emphasis on sexuality education and expansion of sexual and reproductive health services to adolescents especially those who are sexually active. Life planning and livelihood skills training are needed to enable young people acquire valuebased skills, which are essential for making safe and informed choices. With such high level of mortality from septic abortion even with intervention, the need for Youth Friendly Centres/services cannot be over emphasized

Perineal Hygiene in the Puerperium: The Niger Delta Experience

Background: The puerperium is the period after the delivery of the placenta up to end of six weeks. The postnatal mother is at high risk of morbidity and mortality from sepsis. Appropriate perineal hygienemay play a significant role in reducing the extent of the problem.Objectives: To evaluate the knowledge and practice of perineal hygiene among postnatal mothers admitted into the postnatal ward of University of Port Harcourt Teaching Hospital (UPTH).Methods: A cross sectional descriptive study among postnatal mothers admitted into the postnatal st wards of University of Port Harcourt Teaching Hospital between 1 July and 31st December 2006. A systematic random sampling method was used. Fishers Exact and Chi Square tests were used for data analysis.Results: A total of 224 questionnaires out of 250 were retrieved. Most (99.6%) of the respondents had some form of formal education. Most of the booked respondents (56.9%) used sanitary pads for perinealhygiene. The sanitary towels were mainly purchased from patent medicine stores/ open markets with burying and burning as dominating major modes of disposal. Majority of the booked respondents (90%)had knowledge regarding application of pad from vulva to anus and the cleaning of perineal area from front backwards. About 88% of the booked and 52% of the unbooked populations had knowledge and appropriate practice regarding cleaning of perineal area after each emptying of bladder/bowel. Most of the respondents (77.2%) never had any puerperal complications.Conclusion: Majority of the booked as opposed to the unbooked postnatal mothers in University of Port Harcourt Teaching Hospital had good knowledge and practice regarding perineal hygiene. Thus antenatal care and formal education may be regarded as sine-que-non in maintaining good perineal hygiene among postnatal mothers.Key Words: Perineal Hygiene, Puerperium, Niger Delt

Adherence to antiretroviral therapy among HIV-infected subjects in aresource - limited setting in the Niger Delta of Nigeria

Since the early days of antiretroviral therapy, adherence has emerged a milestone to success. The objective of this study was to evaluate the factors militating against adherence to antiretroviral therapy among HIV-infected individuals in the resource - limited setting of the Niger Delta of Nigeria. A structured interviewer- administered questionnaire from consecutively recruited 187 HIV-infected patients on combination antiretroviral therapy of two-nucleoside analogue; stavudine and lamivudine and one non-nucleoside (nevirapine) was used. Association between the independent variables and adherence were analyzed using chi square analysis. This study observed an adherence level of 49.2% and identified the following as factors associated with nonadherence: cost of antiretrovirals, educational status, medication adverse effect, occupational factors, and high pill burden of prescribed regimen (p < 0.05). There is an urgent need for universal access and sustainability of antiretroviral therapy particularly in resource - limited settings. There is need for supervised medication delivery. Efforts should be made towards simplifying the therapeutic regimen to reduce the pill burden and substitution with treatment combination and strategies that minimize negative adverse effects, coupled with the re-intensification of patient\'s education and counseling. African Journal of Health Sciences Vol. 13 (3-4) 2006: pp. 13-1

Awareness and practice of emergency contraception at a private university in Nigeria.

BACKGROUND: The pursuit of formal education now causes many people in developing countries to marry later in life, thereby leading to increased premarital sex and unintended pregnancies. Efforts have been made to characterize awareness and use of emergency contraception (EC) among undergraduate students in public universities in Nigeria; however, it is not known if students in private tertiary institutions adopt different practices or if having an affluent family background plays a role. This pilot study therefore aimed to assess the awareness and use of EC among students at a private Nigerian university toward assisting education planners in developing strategies in improving students' reproductive well-being. RESULTS: Out of 94 female students, 42 (44.7%) had sexual experience, but only 32 (34.0%) were currently sexually active. Six students (6.4%) had had unwanted pregnancies, of which all but one were terminated. Fifty-seven respondents (60.6%) were aware of EC, though only 10 (10.6%) ever practiced it. The greatest source of EC information was from health workers and peers; the lowest source was family or relatives. Most respondents desired orientation and availability of EC on campus. EC awareness among the students was predicted by upper social class background (adjusted odds ratio [OR], 2.73; 95% confidence interval [CI], 1.06-7.45) and upbringing in the Federal Capital Territory (adjusted OR, 4.45; 95% CI, 1.56-14.22). CONCLUSIONS: Though awareness of EC was higher among the private university students in this study than at most public universities, there was no difference in EC usage. A high pregnancy termination rate was observed; dilatation and curettage were mainly adopted. In Nigeria, youth-friendly reproductive health information and access should not be limited to government-owned tertiary institutions but also extended to private ones

Antiretroviral drug compliance and implications in a resource - poor setting

No Abstract. Nigerian Medical Practitioner Vol. 49(3) 2006: 42-4

Sociodemographic Characteristics Of Young Adults Screened For HIV In A Tertiary Health Centre In South-South Nigeria

Background: Human immune deficiency virus (HIV) infection is endemic globally, more so in developing countries like Nigeria and is an important cause of mortality and morbidity. Objective: This study was undertaken to document the sero-prevalence of HIV infection among young adults (10 – 24 years). Method: HIV screening was performed on all (n = 673) young adults referred to the retrovirology unit of the Haematology Department of the University of Port Harcourt Teaching Hospital between January 2003 to December 2003 comprising of 205 males and 432 females were screened for HIV using a double ELISA confirmatory of Immunocomb and Genscreen HIV 1 & 2 kits. Result: A total of 637 young adults were screened for HIV. Two hundred and seventy-two (42.7%) were found positive to HIV. The highest infection burden occurred among the 20-24 years group 242 (50%) and lowest among the 10-14years group 4(12.1%). Infection rate was significantly higher among females 217 (50.2%), and in less educated adolescent with no formal education 56 (80%). History of alcoholism 262 (99.2%), drug use 146(60.6), number of sexual partners and age at first sexual debut were independent risk factors in adolescents for infection with HIV (P < 0.05). Conclusion: This study confirmed a high prevalence of HIV among adolescents and describes the groups more at risk as seen in other parts of Nigeria. This calls for urgent health education of the young adult population with emphasis on a combination of behavioural and social changes to curb the spread of HIV. Key Words: Socio demographic, HIV infection, young adults, Nigeria Highland Medical Research Journal Vol. 3 (1) 2005: 24-3

Urethral Injury Following Genital Mutilation in Pregnancy: A Rate Cause of Postpartum Haemorrhage

OBJECTIVE: To reveal the danger in genital mutilation in pregnancy METHOD:The authors present the case of a 20-year old primigravida who was subjected to this ritual in the third trimester, sustained focal injuries to the urethra which initially healed, but during delivery 4 weeks later, and resulted in significant primary postpartum haemorrhage. RESULTS: Her pregnancy was unsupervised; she received 2 doses of tetanus toxoid 4 weeks apart in a local health center. The pregnancy was uneventful until she was subjected to the genital cutting 4 weeks earlier by an appointed lady in the community whom she recognized as a health assistant who gave her the tetanus toxoid injection. The aim was to enable her achieve “a safe vaginal delivery and be accepted as a woman in her Community”. The procedure involved slicing of the upper part of her urethral region along with the clitoris with a “sharp object”, a local herb was applied and there was no significant bleeding as her thighs were strapped together for about 2 hours when the ritual singing was completed Her cervix could barely admit two fingers; there was neither evidence of laceration nor active haemorrhage from the uterus. A diagnosis of primary post partum haemorrhage due to genital injuries secondary to female genital mutilation in pregnancy in imminent shock was made. Immediate resuscitation included rapid infusion of 1 liter of normal saline; she received two units of compatible whole blood at a pre transfusion packedcell volume of 18%. CONCLUSION: There is the need to establish National Policies and Programmes that will be effectively backed with legal instruments to abolish female genital mutilation. Health care providers and policy makers in the mean time should be aware and well trained in the management of FGM complications to decrease the risks of mortality and serious morbidity. The obvious danger of this barbaric ritual in pregnancy labour and pueperium is highlighted for increased sanctions and advocacy at all level of healthcare. Nig Jnl Orthopaedics & Trauma Vol.2(2) 2003: 130-13

Manual Vacuum Aspiration In The Management Of Post Abortal Tetanus

Eleven (11) patients with tetanus were managed by uterine evacuation using the manual vacuum aspiration at the University of Port Harcourt Teaching Hospital, Nigeria over a period of ten years. Eight (8) of the patients had uterine evacuation while in coma, while three (3) were conscious but had spasm and features of tetanus. The age range was between (19- 37) years; the uterine evacuation was performed on the patient's bed after adequate sedation to prevent spasms. The clinical improvement was remarkable KEY WORDS: Abortal tetanus, uterine evacuation, MVA. Nigerian Journal of Clinical Practice Vol.6(1) 2003: 20-2