John En Okonkwo

Female sexual assault in Nigeria

Sexual assault is the non-consensual performance of acts which in consensual setting would be sexual or which involve genital structures in such a manner that the victim perceives a sexual intrusion. In the United States an estimated one in every four women and children are sexual assault victims and because of the stigma associated with sexual assault only one in 10 victims seeks help. In Nigeria a tradition and culture bound non-permissive society it goes without saying that the actual incidence of female sexual assault is unknown. Specifically rape (oral vaginal or rectal penetration with penis finger or object) victims will not face up to the hazards of reporting the offence because of stigma. These include social stigma prejudice to the chances of marriage attendant humiliation and shame embarrassment caused by appearances and cross-examination in court publicity in press fear of being taunted by others being considered promiscuous and perhaps being considered responsible for the incident the risk of losing the love and respect of society friends and probably that of her husband if she is married. (excerpt)

Accuracy and cost-analysis of placental alpha-microglobulin-1 test in the diagnosis of premature rupture of fetal membranes in resource-limited community settings

To determine accuracy and costs of placental α‐microglobulin‐1 (PAMG‐1) test compared to standard clinical assessment (SCA) for diagnosing rupture of membranes (ROM).

Antibiotic susceptibility pattern of genital tract bacteria in pregnant women with preterm premature rupture of membranes in a resource‐limited setting

To identify microbes prevalent in the genital tract of pregnant women with preterm premature rupture of membranes (PPROM) and to assess the susceptibility of the microbial isolates to a range of antibiotics to determine appropriate antibiotics for treating cases of PPROM in resource‐limited settings.

Factors contributing to urinary incontinence and pelvic prolapse in Nigeria

To examine the contributory factors to urinary incontinence and pelvic organ prolapse and their symptoms a study was conducted on Igbo women in West Africa. 3963 women were randomly selected from rural communities in the states of Enugu Anambra and Ebonyi in southeastern Nigeria. The pelvic organ prolapse questionnaire was administered to the respondents. The results revealed that 773 respondents had stress incontinence while 864 had urge incontinence. Younger respondents had greater tendency to urge incontinence although age distribution of stress and urge incontinence appeared similar. In addition no significant association was noted between stress or urge incontinence and parity. On the contrary a strong association was noted between pelvic organ prolapse urinary incontinence and pushing on the uterine fundus to accelerate labor or aid the bearing down of urge. Such fundal pressure was associated with perineal laceration urinary frequency urge incontinence hesitancy incomplete emptying of bladder awareness of the protrusion into the vagina and pain with coitus.

The prevalence of HIV sero-positivity in late pregnancy among antenatal attendees with seronegative status in first half of pregnancy in Nnewi, South East Nigeria

Background: In sub-Saharan Africa, women and children are vulnerable to HIV/AIDS with about 61% of the infections occurring in women and about 90% of the pediatrics infection through Mother-to-child transmission (MTCT). Antenatal attendees in Nigeria are offered routine HIV testing and counselling on the first visit with opt-out option irrespective of the gestational age at contact. This appears commendable but, considering the national HIV prevalence of 4.6%, our large population of >140 million, the long period of seroconversion of the virus and the fact that pregnant women continue to indulge in activities like: unprotected sexual intercourse with single or multiple partners or men with multiple sexual partners or legal polygamy, cross generational sex, intercourse with sero-discordant partners that put them at risk of new infections; a single screening test on contact may not be sufficient to detect all maternal infections. Aim and Objectives: This is to perform a second HIV testing in antenatal women late in pregnancy and determined the sero-prevalence of HIV amongst those who tested negative in the first half of pregnancy. Materials and Methods: This is a prospective cross sectional study conducted among previously HIV negative pregnant women in Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi between November 2010 and February 2011. The rapid test kits: Determine, Stat Pak and Unigold were used for detection/diagnosis of HIV antibody. Semi structured questionnaire was used to collect socio-demographic data of the subjects. Descriptive analysis of the result was done using the SPSS version 16. Results: The HIV prevalence following repeat testing in late pregnancy was 3.91% (9/230). The mean HIV prevalence at antenatal booking during the study period was 20.64% (116/562). Conclusion: The study highlights the high prevalence of HIV among previously negative attendees in late pregnancy. It brings to the fore the enormity of missed opportunity associated with a single routine antibody rapid test for pregnant women on contact/early pregnancy. Therefore, routine repeat antenatal HIV testing and counselling in late pregnancy is strongly advocated.

Successful pregnancy following refusal of laparoscopy but acceptance of hydrotubation-only procedure for bilateral tubal blockade

Background: Hydrotubation is the trans-cervical flushing of fluid through the fallopian tubes, commonly used in combination with laparoscopy for diagnostic purposes to determine the tubal patency in infertility investigation. Hydrotubation-only procedure can be done in women that refuse diagnostic laparoscopy. Case presentation: In this study, a case of 27-year-old nullipara was reported who presented to the Hospital with a history of inability to conceive. Investigations done prior to presentation to this facility included a hormonal profile which was indicative of hyperprolactinaemia. She also came in with a hysterosalpingogram which showed left cornual tubal blockage. The right tube was very poorly outlined and ended blindly with no peritoneal spill. The husband’s seminalysis was well within normal limits. She refused consent for laparoscopy but not hydrotubation. Following multiplehydrotubation, she had successful pregnancy and subsequently achieved a live birth. Conclusion: We report a case of pregnancy resulting from multiple hydrotubations. Two radiologists and a gynaecologist separately had discussed with this medical professional couple the result of the hysterosalpingography that showed bilateral tubal occlusion and they opted for hydrotubation-only procedure with resultant live birth. Correspondence to: George Uchenna Eleje, Department of Obstetrics and Gynecology, Faculty of Medicine, College of Health Sciences, NnamdiAzikiwe University, Nnewi Campus, PMB 5025, Nnewi, South-East, Nigeria. Tel: +2348068117444; E-mail: georgel21@yahoo.com