Johnbosco I F U N A N Y A Nwafor (original) (raw)

Papers by Johnbosco I F U N A N Y A Nwafor

Ectopic pregnancy complicates 0.25%-2% of all pregnancies and is one of the most common causes of... more Ectopic pregnancy complicates 0.25%-2% of all pregnancies and is one of the most common causes of first-trimester maternal mortality in developing countries due to late diagnosis. Spontaneous ruptured bilateral tubal ectopic pregnancies are extremely rare, with very limited data on its occurrence in the literature. In a spontaneous conception, the preoperative diagnosis is difficult to make but an important one to consider at surgery for presumed unilateral tubal ectopic pregnancy because missing the diagnosis can lead to mortality. We report a case of a 38-year-old multipara with a history of amenorrhea of 8 weeks and 2 days and complaints of vaginal spotting of 4-day duration and sudden onset of abdominal pain of 4 h before presentation. On admission, a preoperative diagnosis of ruptured left tubal ectopic pregnancy was made following ultrasound findings of left adnexal mass and hemoperitoneum. However, both fallopian tubes were found to harbor ectopic gestational sac with bleeding rents on the tubal walls at surgery. She subsequently had exploratory laparotomy and bilateral salpingectomy with good outcome. In low-resource settings, ectopic pregnancy is associated with poor maternal outcome due to late presentation. Diagnosis of ruptured bilateral tubal ectopic pregnancy is difficult before surgery. Therefore, examination of both tubes at laparotomy for ectopic pregnancy should be routine and mandatory to avoid missing the diagnosis.

Background Several studies have been published on the topic of COVID-19 and pregnancy over recent... more Background Several studies have been published on the topic of COVID-19 and pregnancy over recent months. However, few studies have evaluated the impact of this pandemic on maternal mental health, particularly in low-resource settings. Aim To determine the prevalence and predictors of COVID-19-related depression, anxiety and stress symptoms among pregnant women. Methods This was a cross-sectional study that involved 456 pregnant women attending prenatal care at Abakaliki, Nigeria, during the COVID-19 lockdown. These patients were screened for psychological morbidities using the Depression Anxiety and Stress Scale-21 (DASS-21). Results Severe and extremely severe depression were reported in 7.2% (n=33) and 6.4% (n=29) of participants, respectively. Analysis also revealed that 3.3% (n=15) and 7.7% (n=35) of women had severe and extremely severe anxiety, respectively. In total, 23% (n=105) of the participating women had severe stress while 16.7% (n=76) reported extremely severe stress. Multiparity (2-4) and occupation, such as trading and farming, were predictors of depression whereas grand-multiparity, urban residence, and trading, were identified as predictors of anxiety and stress. Conclusion Symptoms of depression, anxiety and stress were relatively common among pregnant women during the COVID-19 lockdown in Abakaliki, Nigeria. There is a clear need to integrate screening for depression, anxiety and stress, in existing antenatal care programs so as to identify and prevent long-term adverse psychological outcomes related to the COVID-19 pandemic.

International Journal of Research in Medical Sciences, 2021

Background: COVID-19 is a major Public Health challenge that has affected the world’s economy. As... more Background: COVID-19 is a major Public Health challenge that has affected the world’s economy. Assessment of the knowledge, attitude and practices of Healthcare workers (HCWs) towards COVID-19 can improve or sustain the successes recorded by relevant agencies in the fight against COVID-19. Methods: a cross-sectional survey was done using semi-structured questionnaires and simple sampling technique. Data collected were analyzed using SPSS version 22. Results: Out of the 368 respondents, 205 were doctors while 150 were nurses. Others were clerical workers, administrative officers and maintenance workers. Knowledge of COVID-19 was generally high amongst respondents recording a correct response to questions about knowledge of COVID-19 in more than 90% of the case. However, the attitude and practice of COVID-19 infection, prevention and control protocols were poor. Out of the respondents, 41.8% would not stay at home if they had minor COVID-19 like symptoms; only 39.4% would take responsibility to ensure people around them follow good respiratory hygiene. Respondents who would keep social distancing while talking with co-workers, ensure safe disposal of personal protective equipment (PPEs) and safe waste management of PPEs were 56%, 39.9% and 53.8% respectively. Conclusions: Knowledge of COVID-19 prevention protocols is high but attitude/practice of these laid out protocols still desires a lot of effort from HCWs. There is need for training/retraining of HCWs on COVID-19 infection, prevention and control strategies to ensure the success being recorded against the disease is sustained while preventing the possibility of a second wave of infection.

Purpose: Understanding the contextualized perspectives of stakeholders involved in maternal healt... more Purpose: Understanding the contextualized perspectives of stakeholders involved in maternal health care is critical to promoting respectful maternity care. This study explored maternal, provider, institutional, community, and policy level drivers of disrespectful maternity care in Southeast Nigeria. This study also identified multi-stakeholder perspectives on solutions to implementing respectful maternity care in health facilities. Materials and Methods: This was a mixed-methods cross-sectional study conducted in two urban cities of Ebonyi State, South-eastern Nigeria. Data were collected using semistructured questionnaires, focus group discussions, and key informant interviews with mothers, providers, senior facility obstetric decision-makers, ministry of health policymaker, and community members. Quantitative data and qualitative data were analysed using SPSS version 20 and manual thematic analysis, respectively. Results: Maternal level drivers were poor antenatal clinic attendance, uncooperative clients, non-provision of birthing materials, and low awareness of rights. Provider factors included work overload/stress, training gaps, desire for good obstetric outcome, under-remuneration and under-appreciation. Institutional drivers were poor work environments including poorly designed wards for privacy, stressful hospital protocols, and non-provision of work equipment. Community-level drivers were poor female autonomy, empowerment, and normalization of disrespect and abuse during childbirth. The absence of targeted policies and the high cost of maternal health services were identified as policy-related drivers. Conclusion: A variety of multi-level drivers of disrespectful maternity care were identified. A diverse and inclusive multi-stakeholder approach should underline efforts to mitigate disrespectful maternity care and promote respectful, equitable, and quality maternal health care.

Background: Despite the availability of effective antihypertensive drugs, the quality of evide... more Background: Despite the availability of effective antihypertensive drugs, the quality of evidence regarding the best antihypertensive agent for the treatment of hypertensive emergencies in pregnancy is still poor. Aim: The aim of this study was to compare the efficacy and side effects of oral nifedipine and intravenous hydralazine for control of blood pressure (BP) in severe hypertension in pregnancy. Materials and Methods: An open‑label, parallel, randomised, controlled trial of 78 pregnant women (≥28 weeks’ gestation) with severe hypertension was conducted. Severe hypertension was defined as systolic BP of 160 mmHg or above and/or diastolic BP of 110 mmHg or above. They were randomly (1:1 ratio) administered oral nifedipine 20 mg or intravenous hydralazine 10 mg every 30 min up to 5 doses or until the target BP of 140–150 mmHg systolic and 90–100 mmHg diastolic was achieved. Intravenous labetalol was given if the primary treatment failed. The primary outcome measure was the number of doses needed to achieve targeted BP. The secondary outcome measures were the time needed to achieve desired BP, maternal adverse effects and perinatal outcome. Results: The sociodemographic characteristics did not differ between the two study groups. The average number of dosages (nifedipine; 1.4 ± 0.6 vs. hydralazine; 1.7 ± 0.5, P = 0.008) needed to control the BP was lower in the nifedipine arm. Time (min) taken to control the BP was similar between the groups (hydralazine; 43.7 ± 19.7 vs. nifedipine; 51.2 ± 18.9, P = 0.113). Adverse maternal and perinatal effects did not differ in the study groups. Conclusion: Oral nifedipine and intravenous hydralazine showed comparable efficacy in the BP control in the severe hypertensive disorders of pregnancy without significant difference in adverse maternal and perinatal outcomes. However, further studies are required to explore the role of these drugs in BP control during hypertensive emergencies in pregnancy.

Objective: To determine the normal range of shock index (SI), blood pressure (BP), mean arterial ... more Objective: To determine the normal range of shock index (SI), blood pressure (BP), mean arterial pressure (MAP) and heart rate (HR) among postpartum women in a low-resource setting. Methods: In a prospective cohort study, vital signs were recorded 1 hour after delivery among postpartum women with normal blood loss who delivered in Abakaliki, Nigeria, Results: Among 225 women, the median (95% reference range) was 120 (100-155.8), 70 (60-94), and 90 (66.5-116.6) mm Hg for systolic BP, diastolic BP, and MAP, respectively ; 82 (65-102) bpm for HR; and 0.69 (0.48-0.89) for SI. The upper SI limit of 0.89 supported the current value of 0.9 as the upper limit; however, the lower SI limit of 0.48 corresponded to the current lower limit for a non-obstetric population (0.5). The SI of more than half of the study women (n=126; 56.0%) was within the normal range for non-obstetric women (0.5-0.7). Conclusion: Although hemodynamic changes in pregnancy widen the SI range, 56.0% of women maintained SI within the non-obstetric reference range. In low-resource settings , the current normal obstetric SI range of 0.7-0.9 should be revised to 0.5-0.9 to accommodate this lower threshold. K E Y W O R D S Immediate postpartum period; Low-resource setting; Normal range; Shock index

Background: Globally, mental health issues have become one of the predominant public health conce... more Background: Globally, mental health issues have become one of the predominant public health concerns as a result of the COVID-19 outbreak. The impact of COVID-19 pandemic on the mental health of frontline healthcare workers has not been fully described in Nigeria. Aim: To determine the mental health impact of COVID-19 pandemic and its associated factors among frontline healthcare workers in Ebonyi State, Nigeria. Materials and methods: This was an online cross-sectional study conducted among 315 frontline healthcare workers treating COVID-19 patients at Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria. The mental health outcome of the participants was assessed using the short form of the Mental Health Continuum (MHC-SF). Results: The prevalence of mental health outcome for different categories was 47% (n = 148) for flourishing, 28.3% (n = 89) for moderate and 24.7% (n = 78) for languishing mental health. The predictors of languishing mental health outcome were being married (OR = 3.12, 95%CI 1.67-4.09, p = 0.035), a physician (OR = 4.09, 95%CI 1.98-5.61, p = 0.002), a nurse (OR = 2.21, 95%CI 0.05-0.24, p < 0.001), limited access to personal protective equipment (OR = 3.25, 95%CI 1.62-6.22, p = 0.043) and self-isolation and quarantine due to SARS-CoV-2 infection (OR = 3.03, 95%CI 0.02-0.95, p < 0.001). Conclusion: Nigeria"s frontline healthcare workers, especially physicians and nurses, are experiencing COVID-19 related psychological distress. There is need to develop and implement interventions to reduce the impact of prolonged psychological distress on long-term mental wellbeing in healthcare workers treating COVID-19 patients.

Tropical Journal of Obstetrics and Gynaecology, 2020

Introduction: There have been many advances in the management of miscarriage in recent times incl... more Introduction: There have been many advances in the management of miscarriage in recent times including the introduction of expectant and medical management protocols. However, a study of the psychological impact of the condition and its management has not received similar attention.Aim: To determine the psychosocial consequences of miscarriages and perceived needs of the patients compared to the care provided by the hospital.Materials and Method: This was a prospective cohort study conducted between January 15, 2018 and April 30, 2019. Participants were recruited on admission and psychological morbidity was assessed at 1 week after a miscarriage in the gynecological clinics. They were screened for psychological morbidities using DASS 21 (Depression, Anxiety and Stress Scale).Results: Of 140 women that participated in the study, severe depression was reported in 8 (5.7%) whereas 12 (8.5%) participants reported symptoms of extremely severe depression. Moderate to severe anxiety was present in 23.5% while extremely severe anxiety was noted among 21.5% of the women. Stress was reported in over half of respondents and severe to extremely severe stress occurred in 19.9% of the participants. Factors significantly associated with psychological morbidities following miscarriage include age ≥35 years, no living child, subfertility, planned pregnancy, and assisted conception. Healthcare providers not listening to the patient’s concern, non‑participation in decision making, and dissatisfaction with care were associated with adverse psychological outcomes.Conclusion: Psychological morbidity following a miscarriage is common among participants in our study. The provision of the correct information and psychological debriefing may be useful in enabling women to adjust emotionally following miscarriage.

Background: Pregnancies in women of advanced maternal age have been historically regarded as high... more Background: Pregnancies in women of advanced maternal age have been historically regarded as high risk pregnancies because of the associated increase in risk of maternal and perinatal morbidity and/or mortality. Hence, there is a need to evaluate the pregnancy outcome of elderly primigravidae in our setting. Aim: To determine the pregnancy outcomes in elderly primigravidae compared to the younger primigravidae at Alex Ekwueme Federal University Teaching Hospital, Abakaliki. Materials and Method: This was a retrospective case-control study of pregnancy outcomes of 49 elderly primigravidae (case group), who delivered at the hospital over a 5-year period, were compared with those of 98 younger primigravidae (control group) (≤ 34 years old) that delivered during the same period. Data collection was done using a pre-designed proforma; analysis was done using Epi Info 7.2.1 CDC. Result: During the study period, there were 11703 deliveries. The incidence of elderly primigravidity was 0.42%. The mean age of the study group was 36.5 ± 1.7 years and that of the control group was 24.3 ± 4.2 years. Forty-four (89.8%) patients were booked in the study group, while 71 (72.8%) patients were booked in the control group. Elderly primigravidae were more likely to book before 14 weeks' gestational age compared with younger primigravidae (χ 2 =33.29, P<0.0001). The average gestational age at delivery for the study group and control group were 39.0 ± 3.7 weeks and 37.0 ± 4.1 weeks respectively. The incidence of malaria infection was higher in the younger control group while in the elderly primigravidae the rate of diabetes mellitus, hypertensive disorders, multiple gestation and anaemia were higher ; but not statistically significant ((p>0.05)). The caesarean section rate in the case group was higher but of no statistical significance (p=0.51). There was no recorded maternal death in both groups. Conclusion: Elderly primigravidity is not uncommon in our environment. Due to the anxiety associated with such pregnancies they were more likely to book earlier than the younger primigravidae. Although they were more likely to have medical complications, the maternal and perinatal outcomes were not statistically different from younger primigravidae.

Background: Obstetric ultrasound forms an essential part of antenatal care around the world. The... more Background: Obstetric ultrasound forms an essential part of antenatal care around the world. The ultrasound is now widely available and accessible in most government and private health facilities in developing countries. Aim of this study was to determine the reasons for pregnant women’s self-referral and perspectives on the use of obstetric ultrasound. Methods: This was a questionnaire-based cross-sectional study conducted among 198 consenting pregnant women attending prenatal care at Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria. Results: Of 198 participants, 182 (91.9%) reported performing obstetric ultrasound examination without doctor’s request. Determination of fetal viability (40.7%) was the commonest reason for self-referral to ultrasound examination. Other common reasons include vaginal bleeding (15.3%), estimation of gestational age (9.3%), fetal sex determination (7.7%) and estimation of date of delivery (7.6%). Over half (57.7%) of the participants reported that the prenatal ultrasonography was costly whereas 76.9% believed that ultrasound use was unsafe in pregnancy. Conclusions: The study participants were highly aware of the import of ultrasonography in pregnancy confirmation, dating and fetal wellbeing. As a result, are always willing to carryout prenatal ultrasound even without doctors’ request.

Global Journal of Medical Research, 2020

Background: Birth weight is an important determinant of an infant's well-being as low or large bi... more Background: Birth weight is an important determinant of an infant's well-being as low or large birth weight are associated with morbidities or mortality during pregnancy and later in life. Maternal anthropometry is a potential veritable tool in evaluation of pregnancy status and prediction of birth weight. Aim: This study was designed to determine the predictive values of the gestational variations of some anthropometric parameters in booked pregnant subjects at the antenatal clinic of Alex Ekwueme Federal University Teaching Hospital, Abakaliki andin which trimester these anthropometric parameters (weight, height, BMI, BSA) correlates better with the birth weight of a neonate. Abstract-Background: Birth weight is an important determinant of an infant's well-being as low or large birth weight are associated with morbidities or mortality during pregnancy and later in life. Maternal anthropometry is a potential veritable tool in evaluation of pregnancy status and prediction of birth weight.

Global Journal of Medical Research, 2020

Background: University undergraduates are at an age when experimentation with sex is prevalent. A... more Background: University undergraduates are at an age when experimentation with sex is prevalent. A significant number of young people still indulge in high risk sexual behavior. Hence, profiling safer sex would be important for the future health of this group. More so an improved knowledge among this group could act as a step down during peer interactions with other non-medical undergraduates. Aim: This study was designed to assess the knowledge and practice of safer sex among Medical undergraduate students and to know to what extent their practice impacts on their health as regards contraction of sexually transmitted infections and having an unwanted pregnancy. Subjects and methods: In this cross-sectional study, three hundred and fifty (350) Medical undergraduate students were interviewed using pretested semi-structured self-administered questionnaires to assess their knowledge and practice of safer sex. Abstract-Background: University undergraduates are at an age when experimentation with sex is prevalent. A significant number of young people still indulge in high risk sexual behavior. Hence, profiling safer sex would be important for the future health of this group. More so an improved knowledge among this group could act as a step down during peer interactions with other non-medical undergraduates.

the virus that causes it (SARS-Cov-2) has spread to over 110 countries, including Nigeria. 1-3 Al... more the virus that causes it (SARS-Cov-2) has spread to over 110 countries, including Nigeria. 1-3 Although the impact of COVID-19 on pregnant women is not yet clear, there are concerns over its potential effect on maternal and perinatal outcomes due to unique immunological suppression during pregnancy. 4,5 The World Health Organization (WHO) has recommended a series of preventive measures to halt the spread of the disease and its associated mortality. 3 In Nigeria, these preventive measures have been adopted, along with media campaigns to disseminate information on the measures to the general public. However, the level of knowledge and practice of these preventive measures against the spread of the virus among pregnant women, who constitute a vulnerable group, is yet to be evaluated. Between February 1 and March 31, 2020, we conducted a cross-sectional study to determine the knowledge and practice of preventive measures to protect against the virus causing COVID-19 among pregnant women attending prenatal care at Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria. The study received ethical approval from the Research and Ethics Committee of the Alex Ekwueme Federal University Teaching Hospital, Abakaliki, and participants provided written informed consent. A pretested and validated self-administered questionnaire derived from the review of literature on WHO recommendations on preventive measures against COVID-19 was used to collect the data. 6 The variables assessed were age, parity, marital status, area of residence, occupation , participant's level of education, husband's level of education, and knowledge and practice of preventive measures. The measures assessed by the study questions were: (1) frequent hand washing with soap and water or using alcohol-based hand sanitizers; (2) maintaining at least 1 m distance from others; (3) avoiding touching eyes, nose, and mouth with hands; (4) covering mouth and nose when coughing or sneezing; (5) wearing a face mask in public; and (6) staying indoors. The questionnaire had a 12-item scale (six items for knowledge and six items for practice). The scoring system was 2 (for a correct answer) or 0 (for an incorrect answer). The minimum score was 0 whereas the maximum score was 12 for both the knowledge and practice components. Participants who scored 60% or more (score of 8-12) were classified as having adequate knowledge, whereas those who scored less than 60% (score up to 6) were classified as having inadequate knowledge. Women who scored 100% (score of 12) were classified as having good practice whereas those who scored less than 100% (score below 12) were classified as having poor practice.

Background: Death is an inevitable end that comes when not expected. However, when death occurs a... more Background: Death is an inevitable end that comes when not expected. However, when death occurs as a result of violence or unclear and suspicious manner, a coroner inquest is instituted to determine the cause, manner and the mechanism of death. Aim: To determine the incidence and causes of medicolegal death in Ebonyi State. Materials and Method: This is a 5-year retrospective study of medicolegal autopsies reports of subjects whose cause of death were subject of litigation. The study analysed data between January 1, 2013, and December 31, 2017, at Alex Ekwueme Federal University Teaching Hospital, Ebonyi, Southeast, Nigeria. Data analysis was with the SPSS version 20. Results: During the study period. A total number of 202 autopsies were performed. The age range of the deceased was from 2 years to 90 years, with a mean age of 35.2 ± 16.1. The predominant age group was 30-39 years (30.2%) while the least (0.5%) were between the age of 90 and 99 years. Males accounted for 158 (78.2%), and females were 44 (21.8%). Farmers (31.2%) and students (15.3%) were mostly affected by unnatural death in this study. Accidental deaths constituted 54.5% of cases, followed by homicidal death (36.6%). Impalement by sharp objects (41.9%) was a significant cause of death due to homicide in this study. In contrast, accidental deaths were mainly as a result of a road traffic accident (95.5%). The majority (60.4%) of those who died as a result of an accident sustained an injury at multiple body sites. Conclusion: Road traffic accident and homicide were responsible for the majority of cause of death found in medicolegal autopsies in Ebonyi State. Proper road maintenance, safe driving culture, and making people adhere strictly to the rule of law are necessary to reduce the incidence of avoidable deaths in our environment.

Introduction: Despite high prevalence of pelvic organ prolapse in low-resource settings and its n... more Introduction: Despite high prevalence of pelvic organ prolapse in low-resource settings and its negative effect on the quality of life of women affected by the condition, women in resource-constrained settings often have limited knowledge about the condition which limits their ability to seek medical treatment. Aim: To assess the knowledge and associated factors of pelvic organ prolapse among women in Ebonyi State, Nigeria. Materials and Methods: This was an interviewer-administered questionnaire-based cross-sectional study conducted among 302 women from 13 th to 17 th January, 2020 in Abakaliki, Ebonyi State. The participants were randomly selected and Pelvic organ prolapse knowledge questionnaire and incontinence knowledge questionnaire (PIKQ) was used to J Women's Health Dev 2020; 3 (2): 101-113 Journal of Women's Health and Development Volume 3 No 2-June 2020 102 collect the data. SPSS version 22 was used for data processing and analysis. Descriptive statistics were calculated for most variables. Multivariable logistic regression was used to identify the associated factors. A variable was considered significant at p-value<0.05. Results: A total of 302 women participated in this study with a mean age of 56.5 ± 9.8 years. Of these participants, 286 (94.7%) had awareness of pelvic organ prolapse and 47 (19.7%) had good knowledge of the condition. Age between 46 and 50 years (AOR = 7.165, 95%CI = 1.749-29.357, P = 0.006), occupation such as farming (AOR = 16.812, 95%CI = 9.749-55.620, P < 0.0001) and civil service (AOR = 18.691, 95%CI = 6.825-86.094, P < 0.0001), having primary education (AOR = 8.098, 95%CI = 7.773-8.907, P < 0.0001) or secondary education (AOR = 12.34, 95%CI = 1.654-6.342, P = 0.01) were associated with good knowledge of pelvic organ prolapse. Conclusion: The level of knowledge regarding pelvic organ prolapse was low among study participants which indicates a need for health education intervention. Being in middle age group, educational status and occupation were the factors associated with good knowledge of participants about pelvic organ prolapse.

Nigerian Journal of Clinical Practice, 2020

Background: Manual vacuum aspiration is a safe and effective technology for the treatment of inco... more Background: Manual vacuum aspiration is a safe and effective technology for the treatment of incomplete miscarriage but it is not widely available and affordable in rural areas particularly in low-resource countries. Misoprostol is an alternative to manual vacuum aspiration for the treatment of incomplete miscarriage. Aim: To compare the effectiveness, client acceptability and satisfaction, and cost-effectiveness of misoprostol with manual vacuum aspiration for the treatment of the first-trimester incomplete miscarriage. Subjects and Methods: This study was conducted between February 1, 2018 and August 31, 2018 at Alex Ekwueme Federal University Teaching Hospital Abakaliki, Nigeria. 100 participants were randomized to treatment with either manual vacuum aspiration or 600 µg oral misoprostol. The main outcome measures assessed at 1-week follow-up were complete uterine evacuation, client acceptability and satisfaction, and cost-effectiveness. Data were analyzed using SPSS version 25. Sociodemographic characteristics, treatment outcomes and other variables were summarized by descriptive statistics. Chi-square test was used for comparison between groups as regard categorical data while Student's't' test was used for comparison between groups for continuous data. P value of <0.05 was regarded as statistically significant. Results: There was a higher failure rate in the misoprostol arm when compared with MVA. Although this difference in complete uterine evacuation rate did not reach statistical significance (81.3% versus 95.7%, RR = 4.3, 95% CI 0.98-18.9, P value = 0.05), more participants in the misoprostol arm would choose the method again when compared with women in the MVA group (47 versus 30, X 2 = 16.95, P < 0.001). The mean client satisfaction score was significantly higher among women in the misoprostol arm compared to MVA group (13.2 (2.1) versus 7.3 (4.6), P < 0.001). The mean cost of primary treatment was higher in the MVA group compared with misoprostol arm ($67.8 (8.9) versus 14.4 (4.0), P < 0.001). There was no significant difference in the mean cost of repeat uterine evacuation in both study arms (MVA, 64.9(6.3)versusmisoprostol,64.9 (6.3) versus misoprostol, 64.9(6.3)versusmisoprostol,65.76 (6.6), P = 0.86). Conclusion: Although medical treatment was associated with a higher failure rate, there was no statistically significant difference in the effectiveness of both treatment methods. However, medical treatment was associated with higher client acceptance and satisfaction and was more cost-effective than surgical treatment.

Background: Complications of abortion continue to contribute disproportionately to maternal morbi... more Background: Complications of abortion continue to contribute disproportionately to maternal morbidity and mortality in much of the developing world. Manual vacuum aspiration is a safe and effective technology for treatment of incomplete miscarriage but is not widely available and affordable in rural areas in low resource countries.

Uterine leiomyosarcoma accounts for 1-2% of uterine cancers. It is an extremely aggressive malign... more Uterine leiomyosarcoma accounts for 1-2% of uterine cancers. It is an extremely aggressive malignancy associated with a poor prognosis. Women affected may vary in age, but are most common between 4 th and 7 th decades of life. Presenting symptoms mimic uterine leiomyoma. Preoperative diagnosis of uterine leiomyosarcoma is difficult and often made at time of surgical resection. We report a case of Mrs A.E, a 40 year old nullipara with history of primary infertility of 20 years duration, who presented with abdominal swelling of 3 years and vaginal bleeding of 7 weeks duration. Abdominopelvic ultra-sonography done at presentation was suggestive of leiomyoma. She was scheduled for myomectomy and subsequently had total abdominal hysterectomy and omentectomy following intra-operative findings of features suggestive of leiomyosarcoma with evidence of metastasis to omentum. These findings were confirmed on histology of the specimen. She received one cycle of combination chemotherapy but was lost to follow up. Uterine LMS is an aggressive tumour, therefore, a high index of suspicion is needed especially for huge uterine nodules and such patients must be closely monitored for adequate management.

International Journal of Research in Medical Sciences, 2021

Tropical Journal of Obstetrics and Gynaecology, 2020

Global Journal of Medical Research, 2020

Nigerian Journal of Clinical Practice, 2020