Ugochukwu Okafor | University of Nigeria, Nsukka (original) (raw)

Papers by Ugochukwu Okafor

Research paper thumbnail of Authours’Response to the Reviewers’Questions

Research paper thumbnail of Clinical Study Clinical and Demographic Characteristics of Women with Intrauterine Adhesion in Abuja, Nigeria

which permits unrestricted use, distribution, and reproduction in any medium, provided the origin... more which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective. Infertility menstrual abnormalities continue to constitute a significant bulk of gynecological consultation in Africa. Both of these problems are sometimes traced to intrauterine adhesions which are preventable in the majority of cases. Study Design. A retrospective analysis of intrauterine adhesions at the National Hospital Abuja, Nigeria, was carried out, covering the period from 1st September 1999 to 1st September 2004. A total of 72 cases were analyzed. Statical analysis was done using X2. Results. The incidence of intrauterine adhesions was 1.73 % of new patients. Mean age ± SD was 29.97 ± 4.82 years. Patients who were Para 0 to 1 constituted 81.9 % of the total. Intrauterine adhesions significantly (P < 0.02) occurred in nulliparae. The majority (68%) were educated only up to secondary level which was significant (P < 0.05). Menstrual abn...

Research paper thumbnail of Title Page Critical Management of Eclamptics and Seasonal Variation in the Tropics-A Study in Nigeria

Research paper thumbnail of TITLE PAGE A review of anaesthesia for emergency laparotomy in paediatric intestinal obstruction in Enugu, Nigeria

Research paper thumbnail of Use of Ketamine and Midazolam Cocktail for Pericardiectomy at the University of Nigeria Teaching Hospital

Journal of Cardiothoracic and Vascular Anesthesia, 2006

NONE

Research paper thumbnail of Page number not for citation purposes 1

© Ugochukwu Vincent Okafor et al. The Pan African Medical Journal- ISSN 1937-8688. This is an Ope... more © Ugochukwu Vincent Okafor et al. The Pan African Medical Journal- ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License

Research paper thumbnail of Disease Patterns and Outcome for Medical Neurological Patients Admitted to a Multi Disciplinary Intensive Care Unit

College of Medicine, University of Nigeria, Dec 22, 2004

Aim: To review the disease pattern and outcome for neurological patients admitted to the intensiv... more Aim: To review the disease pattern and outcome for neurological patients admitted to the intensive care unit (ICU) of the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria was undertaken. Patients and Methods: The hospital records (case notes ICU records) were reviewed retrospectively for five years and the necessary data were extracted. Neurosurgical patients were excluded. Results: There was a total of six hundred and sixty-seven admission to the ICU and twenty-three of these were neurological patients. ...

Research paper thumbnail of Using the Revised Trauma Score to Predict Outcome in Severely Head Injured Patients in a Developing Nation – A Pilot Study

International Journal of Medicine and Health Development, 2007

Background: A prospective study on the relationship between the weighted revised trauma score and... more Background: A prospective study on the relationship between the weighted revised trauma score and patient outcome (mortality) was carried out at National hospital, Abuja, Nigeria from April to December 2005. Methods: The patients\' demographics were collected. The duration of stay in the intensive care unit was also noted. The weighted RTS was used in this study. The sum of coded values of Glasgow coma scale (GCS) score, systolic blood pressure (SBP) and respiratory rate (RR) were calculated and documented. These parameters were recorded at the accident and emergency department and calculated in the ICU. Results: The records of 38 head injured trauma patients admitted to the general ICU of National Hospital, Abuja, Nigeria over a nine-month period (April - December 2005) were analyzed. The average age of the patients was 36.18 years (range 4 - 65 yr.) There were thirty-four males amongst the patients. The average duration of stay in the ICU was 9.05 days (range 1-43 days). Three...

Research paper thumbnail of Maternal outcome in eclamptic patients in Abuja, Nigeria--a 5 year review

Nigerian journal of clinical practice, 2007

OBJECTIVE To assess the outcome ofwomen admitted with eclampsia in the National Hospital, Abuja, ... more OBJECTIVE To assess the outcome ofwomen admitted with eclampsia in the National Hospital, Abuja, Nigeria. STUDY DESIGN/SETTING A retrospective analysis. The medical records register in the accident and emergency department, labour ward, maternity ward and the intensive care unit were searched to identify cases of eclampsia admitted at the National Hospital,Abuja (NHA) between 1st March 2000 and 28th February 2005. RESULTS The incidence of eclampsia was 7.8 per 1000 deliveries. Eclampsia significantly occured in nulliparous and unbooked mothers (p < 0.001 & p < 0.0001 respectively). Most (71.5%) of mothers delivered by Caesarean section and the most common indication for this was an unfavourable cervix (cervix thick, firm and closed when assessed at presentation in the labour ward). Nineteen (41.3%) of mothers developed complications with HELLP (hemolysis, elevated liver enzymes, low platelets) occurring in six patients (31.6%). There were 13 maternal deaths giving a case fatal...

Research paper thumbnail of Evolution of obstetric anaesthesia in West Africa: current trends

International Journal of Obstetric Anesthesia, 2006

Ionizing radiation activates IGF-1R triggering a cytoprotective signaling by interfering with Ku-... more Ionizing radiation activates IGF-1R triggering a cytoprotective signaling by interfering with Ku-DNA binding and by modulating Ku86 expression via a p38 kinase dependent mechanism

Research paper thumbnail of Maternal Deaths During Caesarean Delivery In A Developing Country-Perspective From Nigeria

The Internet Journal of Third World Medicine, 2009

OBJECTIVE: To examine the changing trend in maternal deaths during caesarean delivery in a tertia... more OBJECTIVE: To examine the changing trend in maternal deaths during caesarean delivery in a tertiary care hospital in Nigeria over an 8 year periodMATERIALS/ METHODS:An observational retrospective study was carried out at the University of Nigeria Teaching Hospital (UNTH), Nigeria to determine the causes and risk factors for maternal deaths during caesarean delivery from July 1998 to June 2006. RESULTS: A total of 6798 women delivered during the study period. There were 1579 caesarean sections (23% caesarean section rate).There were nine documented deaths during the course of anaesthesia and surgery to given an incidence of 5.6/1000 anesthetics. Six deaths were directly attributable to anaesthesia, three were indirectly attributable. CONCLUSION: The number of maternal deaths in this study was initially high. Since the increased use of spinal anaesthesia and employment of more doctors, the rates have dropped drastically.

Research paper thumbnail of Anaesthesia And Outcome For Caesarean Delivery In The Parturient With Severe Co-Morbidity

The Internet Journal of Anesthesiology, 2009

An observational retrospective review of parturient with severe co-morbidity that presented for a... more An observational retrospective review of parturient with severe co-morbidity that presented for anaesthesia for caesarean section in the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria over a five year span was carried out to determine feto-maternal outcome. METHODS The hospital records of parturient with severe co-morbidity presenting for caesarean delivery from, January 2001 to December 2005 were extracted and reviewed. RESULTS A total of 3,357 deliveries took place over the 5 year span. There were 270 patients of ASA 3 and above classification. General anesthesia was administered to 202 patients, while 68 delivered under regional anesthesia. There was a perinatal mortality of 241/1000 births and one anaesthetic death. CONCLUSION The late presentation of women with co-morbidity that present for caesarean delivery coupled with severity of illness resulted in a rather high feto-maternal morbidity/mortality in this study. Early referral of at risk patients may help reduce these high rates.

Research paper thumbnail of Challenges in critical care obstetrics in West Africa

International Journal of Obstetric Anesthesia, 2007

1. Int J Obstet Anesth. 2007 Oct;16(4):314-5. Epub 2007 Aug 14. Challenges in critical care obste... more 1. Int J Obstet Anesth. 2007 Oct;16(4):314-5. Epub 2007 Aug 14. Challenges in critical care obstetrics in West Africa. Okafor UV. University of Nigeria Teaching Hospital, Enugu, Nigeria. uvkafor@yahoo.com. PMID: 17698343 [PubMed - indexed for MEDLINE]. MeSH Terms. Africa, Western; Critical Care/economics; Critical Care/statistics & numerical data*; Critical Care/trends; Developing Countries; Female; Health Services Accessibility*; Humans; Intensive ...

Research paper thumbnail of Tracheostomy In The Intensive Care Unit- A Developing Country Experience

The Internet Journal of Otorhinolaryngology, 2009

OBJECTIVE: To determine the incidence, indications and outcome for patients that had a tracheosto... more OBJECTIVE: To determine the incidence, indications and outcome for patients that had a tracheostomy in the intensive care unit of a teaching hospital in a developing nation.METHODS: This is an observational retrospective study of intensive care unit patients that received a tracheostomy in the University of Nigeria Teaching Hospital, Enugu from March 2003 to February 2007.The hospital records of the patients were reviewed for demographics, indications for admissions, duration of admission and outcome.RESULTS: Ten patients (2%) had tracheostomy while on admission in the intensive care unit from a total of 497 admissions. All the patients had surgical tracheostomy. Eight patients had post surgical tracheostomy to maintain a patent airway following postoperative airway obstruction while two patients had ST for the Gullian Barre syndrome and severe head injury. There were four deaths.CONCLUSION: Like some other studies from Nigeria, the number of patients that received a tracheostomy in the intensive care was small and the major indication was to relieve postoperative airway obstruction.

Research paper thumbnail of Acute renal failure due to HELLP syndrome and acute renal failure in mid gestation

International Journal of Obstetric Anesthesia, 2005

A 34-year-old grand multipara (para 7, 4 alive) was managed at the National Hospital, Abuja, Nige... more A 34-year-old grand multipara (para 7, 4 alive) was managed at the National Hospital, Abuja, Nigeria for acute renal failure due to HELLP syndrome following referral from a peripheral hospital. She presented with a history of vomiting, headache, epigastric pain, loss of consciousness and tonic/clonic seizures. Though she was unsure of her exact dates, clinically the gestational age was estimated at 22 weeks. She was managed in the intensive care unit, following delivery of a macerated fetus within 15 h of hospital admission. The patient received mechanical ventilation and three sessions of haemodialysis as part of her successful management while in the intensive care unit. The uncommon presentation of eclampsia and HELLP syndrome before obvious preeclampsia is discussed, as well as the other signs and symptoms and patient management. The case also highlights the resource-poor environment of peripheral and tertiary hospitals in Nigeria.

Research paper thumbnail of Critical care management of gynaecological patients in Enugu, Nigeria Caesarean myomectomy in Aba, south-eastern Nigeria

Tropical Doctor, 2007

Introduction: In developing countries, especially in Africa, reproductive health is a great conce... more Introduction: In developing countries, especially in Africa, reproductive health is a great concern to many stakeholders as maternal mortality and morbidity are very high compared to that in the developed world. Moreover, reproductive health knowledge and access to quality maternal health services in Africa are poor with significant health consequences. Appropriate reproductive health knowledge and attitude can empower women to access quality family planning services (preventive and curative), which are essential for improvement of women's reproductive health. Objectives: This research aimed to assess reproductive health knowledge, attitude, and practice on contraceptive use among women attending family planning services at Muhima district hospital. Methods and Materials: The study was cross-sectional in nature involving 326 randomly selected respondents among women attending family planning services at Muhima district hospital. The study instrument was a self-administered questionnaire. Data was analyzed using SPSS (Statistical Package for Social Science) statistics software 17.0 version.

Research paper thumbnail of Admission pattern and outcome in critical care obstetric patients

International Journal of Obstetric Anesthesia, 2004

We undertook a six-year retrospective study to determine the pattern of admission and outcome for... more We undertook a six-year retrospective study to determine the pattern of admission and outcome for obstetric patients admitted to the intensive care unit of the University of Nigeria Teaching Hospital, Enugu. The hospital records (case notes and intensive care unit records) were used to extract the necessary data. A total of 816 patients were admitted to the intensive care unit during the period under review. Eighteen (2.2%) were obstetric patients. Nine (50%) were preeclamptic and eclamptic patients. Four patients (22.2%) had obstetric haemorrhage. Five others presented with the following: asthma, postoperative respiratory distress, cervical incompetence, gestational diabetes and hypertension, and caesarean section for terminal carcinoma of the breast. There were six deaths (mortality rate 33.3%). Preeclampsia/eclampsia accounted for four deaths (44% mortality rate amongst preeclamptics/eclamptics), while two deaths accounted for a 50% mortality rate in the obstetric haemorrhage group. This study confirmed similar reports from the advanced nations and Asia that preeclampsia/eclampsia and obstetric haemorrhage are the leading causes of admission to the intensive care unit. The mortality rate in this study is however higher.

Research paper thumbnail of Anaesthesia for uterine rupture in a Nigerian teaching hospital: maternal and fetal outcome

International Journal of Obstetric Anesthesia, 2006

Background: An observational retrospective study was conducted at the University of Nigeria Teach... more Background: An observational retrospective study was conducted at the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria to determine the outcome for patients with rupture of the gravid uterus who had anaesthesia for laparotomy over a four-year period, July 2000 to June 2004. Methods: The hospital records (case files, labour ward and theatre records) of patients over a four-year period with rupture of the uterus were reviewed. Results: A total of 2707 deliveries took place at UNTH, Enugu, Nigeria. There were 2556 live births (94.8% of deliveries) and 714 (26.4%) caesarean deliveries. Twenty-three cases of uterine rupture occurred, giving a prevalence of 8.5/1000 deliveries. In nine patents (39.1%) the uterus was already scarred. The patientsÕ mean age was 30.2 years. No nulliparous patients suffered ruptured uterus. General anaesthesia with muscle relaxants was administered to all patients. Twenty-two patients (95.6%) received blood transfusions. All the patients received normal saline and one patient also received Haemacel Ò. Five (21.7%) patients had preoperative hypotension and two (8.6%) had intraoperative hypotension. There was one maternal death which occurred three days after the cesarean section. Twenty-three (96.3%) fetal deaths, including the loss of a set of twins, were recorded. Fetal deaths from ruptured uterus represented 32.4% of all fetal loss following caesarean section during the study period. There were no neonatal deaths. Conclusion: Rupture of the gravid uterus presents the anaesthetist with the unique challenge of maintaining haemodynamic status before haemostasis is secured, often with the patient in shock. Choice of anaesthetic drugs and availability of blood are important, as well as the skill and experience of the anaesthetist. The maternal mortality rates in other West African studies reviewed were generally higher than those in this series. The maternal outcome re-emphasises the vital role of prompt intervention and availability of blood in reducing maternal mortality following rupture of the uterus.

Research paper thumbnail of Anaesthetic and obstetric challenges of morbid obesity in caesarean deliveries--a study in South-eastern Nigeria

African health sciences, 2012

Morbid obesity of parturient has become very important in perinatal medicine because of a worldwi... more Morbid obesity of parturient has become very important in perinatal medicine because of a worldwide obesity epidemic. Morbid obesity of parturient is reportedly associated with severely increased anaesthetic and obstetric risk. To determine the prevalence rate, anaesthetic and obstetric complications in morbidly obese parturient that had caesarean delivery in a Nigerian tertiary care centre. The obstetric theatre records and case files were reviewed for caesarean deliveries in the University of Nigeria Teaching Hospital, Enugu, Nigeria from May 2008 to December 2010. A sample size of 250 patients, calculated based on a prevalence rate of 19%, confidence interval of 95% , a power of 80% and a finite population of zero was used to determine the prevalence rate of morbid obesity (Body Mass Index of greater than or equal to 35 kg/m(2)). There were thirty-one patients with morbid obesity (12.4%). The average Body Mass Index (BMI) was 38.3 kg/m(2)(SD ± 2.99). Other findings included macro...

Research paper thumbnail of Maternal and perinatal outcome after caesarean delivery in preeclampsia or eclampsia in Enugu, Nigeria: four years on

International journal of obstetric anesthesia, 2009

Objective-Identify socioeconomic correlates of computer/Internet use among parents of overweight ... more Objective-Identify socioeconomic correlates of computer/Internet use among parents of overweight preschool-aged children. Methods-Studied 470 baseline participants in a trial to prevent obesity in children 2-6.9 years with BMI ≥ 95th percentile or 85th-95th percentile with one overweight parent. Interviews with parents used Health Information National Trends Survey (HINTS) questions. Results/Conclusions-Ninety-four percent had home computers and 93% reported Internet usage. In adjusted models, parents with ≤ college degree (OR 4.8 [95% CI 1.2, 18.3]) or with household income ≤ $50,000 (OR 7.6 [95% CI 2.2, 26.8]) had decreased likelihood of computer ownership. Of parents who reported going on-line, 63% used Internet to look for health/medical information for themselves and 42% for their children. Parents with ≤ a college degree or with BMI <25 kg/m 2 were less likely to use Internet. Results support using the Internet for early childhood obesity prevention with enhanced outreach efforts for low socioeconomic families.

Research paper thumbnail of Authours’Response to the Reviewers’Questions

Research paper thumbnail of Clinical Study Clinical and Demographic Characteristics of Women with Intrauterine Adhesion in Abuja, Nigeria

which permits unrestricted use, distribution, and reproduction in any medium, provided the origin... more which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective. Infertility menstrual abnormalities continue to constitute a significant bulk of gynecological consultation in Africa. Both of these problems are sometimes traced to intrauterine adhesions which are preventable in the majority of cases. Study Design. A retrospective analysis of intrauterine adhesions at the National Hospital Abuja, Nigeria, was carried out, covering the period from 1st September 1999 to 1st September 2004. A total of 72 cases were analyzed. Statical analysis was done using X2. Results. The incidence of intrauterine adhesions was 1.73 % of new patients. Mean age ± SD was 29.97 ± 4.82 years. Patients who were Para 0 to 1 constituted 81.9 % of the total. Intrauterine adhesions significantly (P < 0.02) occurred in nulliparae. The majority (68%) were educated only up to secondary level which was significant (P < 0.05). Menstrual abn...

Research paper thumbnail of Title Page Critical Management of Eclamptics and Seasonal Variation in the Tropics-A Study in Nigeria

Research paper thumbnail of TITLE PAGE A review of anaesthesia for emergency laparotomy in paediatric intestinal obstruction in Enugu, Nigeria

Research paper thumbnail of Use of Ketamine and Midazolam Cocktail for Pericardiectomy at the University of Nigeria Teaching Hospital

Journal of Cardiothoracic and Vascular Anesthesia, 2006

NONE

Research paper thumbnail of Page number not for citation purposes 1

© Ugochukwu Vincent Okafor et al. The Pan African Medical Journal- ISSN 1937-8688. This is an Ope... more © Ugochukwu Vincent Okafor et al. The Pan African Medical Journal- ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License

Research paper thumbnail of Disease Patterns and Outcome for Medical Neurological Patients Admitted to a Multi Disciplinary Intensive Care Unit

College of Medicine, University of Nigeria, Dec 22, 2004

Aim: To review the disease pattern and outcome for neurological patients admitted to the intensiv... more Aim: To review the disease pattern and outcome for neurological patients admitted to the intensive care unit (ICU) of the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria was undertaken. Patients and Methods: The hospital records (case notes ICU records) were reviewed retrospectively for five years and the necessary data were extracted. Neurosurgical patients were excluded. Results: There was a total of six hundred and sixty-seven admission to the ICU and twenty-three of these were neurological patients. ...

Research paper thumbnail of Using the Revised Trauma Score to Predict Outcome in Severely Head Injured Patients in a Developing Nation – A Pilot Study

International Journal of Medicine and Health Development, 2007

Background: A prospective study on the relationship between the weighted revised trauma score and... more Background: A prospective study on the relationship between the weighted revised trauma score and patient outcome (mortality) was carried out at National hospital, Abuja, Nigeria from April to December 2005. Methods: The patients\' demographics were collected. The duration of stay in the intensive care unit was also noted. The weighted RTS was used in this study. The sum of coded values of Glasgow coma scale (GCS) score, systolic blood pressure (SBP) and respiratory rate (RR) were calculated and documented. These parameters were recorded at the accident and emergency department and calculated in the ICU. Results: The records of 38 head injured trauma patients admitted to the general ICU of National Hospital, Abuja, Nigeria over a nine-month period (April - December 2005) were analyzed. The average age of the patients was 36.18 years (range 4 - 65 yr.) There were thirty-four males amongst the patients. The average duration of stay in the ICU was 9.05 days (range 1-43 days). Three...

Research paper thumbnail of Maternal outcome in eclamptic patients in Abuja, Nigeria--a 5 year review

Nigerian journal of clinical practice, 2007

OBJECTIVE To assess the outcome ofwomen admitted with eclampsia in the National Hospital, Abuja, ... more OBJECTIVE To assess the outcome ofwomen admitted with eclampsia in the National Hospital, Abuja, Nigeria. STUDY DESIGN/SETTING A retrospective analysis. The medical records register in the accident and emergency department, labour ward, maternity ward and the intensive care unit were searched to identify cases of eclampsia admitted at the National Hospital,Abuja (NHA) between 1st March 2000 and 28th February 2005. RESULTS The incidence of eclampsia was 7.8 per 1000 deliveries. Eclampsia significantly occured in nulliparous and unbooked mothers (p < 0.001 & p < 0.0001 respectively). Most (71.5%) of mothers delivered by Caesarean section and the most common indication for this was an unfavourable cervix (cervix thick, firm and closed when assessed at presentation in the labour ward). Nineteen (41.3%) of mothers developed complications with HELLP (hemolysis, elevated liver enzymes, low platelets) occurring in six patients (31.6%). There were 13 maternal deaths giving a case fatal...

Research paper thumbnail of Evolution of obstetric anaesthesia in West Africa: current trends

International Journal of Obstetric Anesthesia, 2006

Ionizing radiation activates IGF-1R triggering a cytoprotective signaling by interfering with Ku-... more Ionizing radiation activates IGF-1R triggering a cytoprotective signaling by interfering with Ku-DNA binding and by modulating Ku86 expression via a p38 kinase dependent mechanism

Research paper thumbnail of Maternal Deaths During Caesarean Delivery In A Developing Country-Perspective From Nigeria

The Internet Journal of Third World Medicine, 2009

OBJECTIVE: To examine the changing trend in maternal deaths during caesarean delivery in a tertia... more OBJECTIVE: To examine the changing trend in maternal deaths during caesarean delivery in a tertiary care hospital in Nigeria over an 8 year periodMATERIALS/ METHODS:An observational retrospective study was carried out at the University of Nigeria Teaching Hospital (UNTH), Nigeria to determine the causes and risk factors for maternal deaths during caesarean delivery from July 1998 to June 2006. RESULTS: A total of 6798 women delivered during the study period. There were 1579 caesarean sections (23% caesarean section rate).There were nine documented deaths during the course of anaesthesia and surgery to given an incidence of 5.6/1000 anesthetics. Six deaths were directly attributable to anaesthesia, three were indirectly attributable. CONCLUSION: The number of maternal deaths in this study was initially high. Since the increased use of spinal anaesthesia and employment of more doctors, the rates have dropped drastically.

Research paper thumbnail of Anaesthesia And Outcome For Caesarean Delivery In The Parturient With Severe Co-Morbidity

The Internet Journal of Anesthesiology, 2009

An observational retrospective review of parturient with severe co-morbidity that presented for a... more An observational retrospective review of parturient with severe co-morbidity that presented for anaesthesia for caesarean section in the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria over a five year span was carried out to determine feto-maternal outcome. METHODS The hospital records of parturient with severe co-morbidity presenting for caesarean delivery from, January 2001 to December 2005 were extracted and reviewed. RESULTS A total of 3,357 deliveries took place over the 5 year span. There were 270 patients of ASA 3 and above classification. General anesthesia was administered to 202 patients, while 68 delivered under regional anesthesia. There was a perinatal mortality of 241/1000 births and one anaesthetic death. CONCLUSION The late presentation of women with co-morbidity that present for caesarean delivery coupled with severity of illness resulted in a rather high feto-maternal morbidity/mortality in this study. Early referral of at risk patients may help reduce these high rates.

Research paper thumbnail of Challenges in critical care obstetrics in West Africa

International Journal of Obstetric Anesthesia, 2007

1. Int J Obstet Anesth. 2007 Oct;16(4):314-5. Epub 2007 Aug 14. Challenges in critical care obste... more 1. Int J Obstet Anesth. 2007 Oct;16(4):314-5. Epub 2007 Aug 14. Challenges in critical care obstetrics in West Africa. Okafor UV. University of Nigeria Teaching Hospital, Enugu, Nigeria. uvkafor@yahoo.com. PMID: 17698343 [PubMed - indexed for MEDLINE]. MeSH Terms. Africa, Western; Critical Care/economics; Critical Care/statistics & numerical data*; Critical Care/trends; Developing Countries; Female; Health Services Accessibility*; Humans; Intensive ...

Research paper thumbnail of Tracheostomy In The Intensive Care Unit- A Developing Country Experience

The Internet Journal of Otorhinolaryngology, 2009

OBJECTIVE: To determine the incidence, indications and outcome for patients that had a tracheosto... more OBJECTIVE: To determine the incidence, indications and outcome for patients that had a tracheostomy in the intensive care unit of a teaching hospital in a developing nation.METHODS: This is an observational retrospective study of intensive care unit patients that received a tracheostomy in the University of Nigeria Teaching Hospital, Enugu from March 2003 to February 2007.The hospital records of the patients were reviewed for demographics, indications for admissions, duration of admission and outcome.RESULTS: Ten patients (2%) had tracheostomy while on admission in the intensive care unit from a total of 497 admissions. All the patients had surgical tracheostomy. Eight patients had post surgical tracheostomy to maintain a patent airway following postoperative airway obstruction while two patients had ST for the Gullian Barre syndrome and severe head injury. There were four deaths.CONCLUSION: Like some other studies from Nigeria, the number of patients that received a tracheostomy in the intensive care was small and the major indication was to relieve postoperative airway obstruction.

Research paper thumbnail of Acute renal failure due to HELLP syndrome and acute renal failure in mid gestation

International Journal of Obstetric Anesthesia, 2005

A 34-year-old grand multipara (para 7, 4 alive) was managed at the National Hospital, Abuja, Nige... more A 34-year-old grand multipara (para 7, 4 alive) was managed at the National Hospital, Abuja, Nigeria for acute renal failure due to HELLP syndrome following referral from a peripheral hospital. She presented with a history of vomiting, headache, epigastric pain, loss of consciousness and tonic/clonic seizures. Though she was unsure of her exact dates, clinically the gestational age was estimated at 22 weeks. She was managed in the intensive care unit, following delivery of a macerated fetus within 15 h of hospital admission. The patient received mechanical ventilation and three sessions of haemodialysis as part of her successful management while in the intensive care unit. The uncommon presentation of eclampsia and HELLP syndrome before obvious preeclampsia is discussed, as well as the other signs and symptoms and patient management. The case also highlights the resource-poor environment of peripheral and tertiary hospitals in Nigeria.

Research paper thumbnail of Critical care management of gynaecological patients in Enugu, Nigeria Caesarean myomectomy in Aba, south-eastern Nigeria

Tropical Doctor, 2007

Introduction: In developing countries, especially in Africa, reproductive health is a great conce... more Introduction: In developing countries, especially in Africa, reproductive health is a great concern to many stakeholders as maternal mortality and morbidity are very high compared to that in the developed world. Moreover, reproductive health knowledge and access to quality maternal health services in Africa are poor with significant health consequences. Appropriate reproductive health knowledge and attitude can empower women to access quality family planning services (preventive and curative), which are essential for improvement of women's reproductive health. Objectives: This research aimed to assess reproductive health knowledge, attitude, and practice on contraceptive use among women attending family planning services at Muhima district hospital. Methods and Materials: The study was cross-sectional in nature involving 326 randomly selected respondents among women attending family planning services at Muhima district hospital. The study instrument was a self-administered questionnaire. Data was analyzed using SPSS (Statistical Package for Social Science) statistics software 17.0 version.

Research paper thumbnail of Admission pattern and outcome in critical care obstetric patients

International Journal of Obstetric Anesthesia, 2004

We undertook a six-year retrospective study to determine the pattern of admission and outcome for... more We undertook a six-year retrospective study to determine the pattern of admission and outcome for obstetric patients admitted to the intensive care unit of the University of Nigeria Teaching Hospital, Enugu. The hospital records (case notes and intensive care unit records) were used to extract the necessary data. A total of 816 patients were admitted to the intensive care unit during the period under review. Eighteen (2.2%) were obstetric patients. Nine (50%) were preeclamptic and eclamptic patients. Four patients (22.2%) had obstetric haemorrhage. Five others presented with the following: asthma, postoperative respiratory distress, cervical incompetence, gestational diabetes and hypertension, and caesarean section for terminal carcinoma of the breast. There were six deaths (mortality rate 33.3%). Preeclampsia/eclampsia accounted for four deaths (44% mortality rate amongst preeclamptics/eclamptics), while two deaths accounted for a 50% mortality rate in the obstetric haemorrhage group. This study confirmed similar reports from the advanced nations and Asia that preeclampsia/eclampsia and obstetric haemorrhage are the leading causes of admission to the intensive care unit. The mortality rate in this study is however higher.

Research paper thumbnail of Anaesthesia for uterine rupture in a Nigerian teaching hospital: maternal and fetal outcome

International Journal of Obstetric Anesthesia, 2006

Background: An observational retrospective study was conducted at the University of Nigeria Teach... more Background: An observational retrospective study was conducted at the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria to determine the outcome for patients with rupture of the gravid uterus who had anaesthesia for laparotomy over a four-year period, July 2000 to June 2004. Methods: The hospital records (case files, labour ward and theatre records) of patients over a four-year period with rupture of the uterus were reviewed. Results: A total of 2707 deliveries took place at UNTH, Enugu, Nigeria. There were 2556 live births (94.8% of deliveries) and 714 (26.4%) caesarean deliveries. Twenty-three cases of uterine rupture occurred, giving a prevalence of 8.5/1000 deliveries. In nine patents (39.1%) the uterus was already scarred. The patientsÕ mean age was 30.2 years. No nulliparous patients suffered ruptured uterus. General anaesthesia with muscle relaxants was administered to all patients. Twenty-two patients (95.6%) received blood transfusions. All the patients received normal saline and one patient also received Haemacel Ò. Five (21.7%) patients had preoperative hypotension and two (8.6%) had intraoperative hypotension. There was one maternal death which occurred three days after the cesarean section. Twenty-three (96.3%) fetal deaths, including the loss of a set of twins, were recorded. Fetal deaths from ruptured uterus represented 32.4% of all fetal loss following caesarean section during the study period. There were no neonatal deaths. Conclusion: Rupture of the gravid uterus presents the anaesthetist with the unique challenge of maintaining haemodynamic status before haemostasis is secured, often with the patient in shock. Choice of anaesthetic drugs and availability of blood are important, as well as the skill and experience of the anaesthetist. The maternal mortality rates in other West African studies reviewed were generally higher than those in this series. The maternal outcome re-emphasises the vital role of prompt intervention and availability of blood in reducing maternal mortality following rupture of the uterus.

Research paper thumbnail of Anaesthetic and obstetric challenges of morbid obesity in caesarean deliveries--a study in South-eastern Nigeria

African health sciences, 2012

Morbid obesity of parturient has become very important in perinatal medicine because of a worldwi... more Morbid obesity of parturient has become very important in perinatal medicine because of a worldwide obesity epidemic. Morbid obesity of parturient is reportedly associated with severely increased anaesthetic and obstetric risk. To determine the prevalence rate, anaesthetic and obstetric complications in morbidly obese parturient that had caesarean delivery in a Nigerian tertiary care centre. The obstetric theatre records and case files were reviewed for caesarean deliveries in the University of Nigeria Teaching Hospital, Enugu, Nigeria from May 2008 to December 2010. A sample size of 250 patients, calculated based on a prevalence rate of 19%, confidence interval of 95% , a power of 80% and a finite population of zero was used to determine the prevalence rate of morbid obesity (Body Mass Index of greater than or equal to 35 kg/m(2)). There were thirty-one patients with morbid obesity (12.4%). The average Body Mass Index (BMI) was 38.3 kg/m(2)(SD ± 2.99). Other findings included macro...

Research paper thumbnail of Maternal and perinatal outcome after caesarean delivery in preeclampsia or eclampsia in Enugu, Nigeria: four years on

International journal of obstetric anesthesia, 2009

Objective-Identify socioeconomic correlates of computer/Internet use among parents of overweight ... more Objective-Identify socioeconomic correlates of computer/Internet use among parents of overweight preschool-aged children. Methods-Studied 470 baseline participants in a trial to prevent obesity in children 2-6.9 years with BMI ≥ 95th percentile or 85th-95th percentile with one overweight parent. Interviews with parents used Health Information National Trends Survey (HINTS) questions. Results/Conclusions-Ninety-four percent had home computers and 93% reported Internet usage. In adjusted models, parents with ≤ college degree (OR 4.8 [95% CI 1.2, 18.3]) or with household income ≤ $50,000 (OR 7.6 [95% CI 2.2, 26.8]) had decreased likelihood of computer ownership. Of parents who reported going on-line, 63% used Internet to look for health/medical information for themselves and 42% for their children. Parents with ≤ a college degree or with BMI <25 kg/m 2 were less likely to use Internet. Results support using the Internet for early childhood obesity prevention with enhanced outreach efforts for low socioeconomic families.