Federal University Teaching Hospital Abakaliki Research Articles

Waiting time analysis in a paediatric outpatient clinic in South East Nigeria

Objective: Waiting time is a resource investment by the patient for the desired goal of being attended to by the physician. It is the time taken or spent in waiting to be attended to by a physician in a health facility. It is important because waiting time is an essential determinant of patient satisfaction in health care practice, and its study would expose the bottleneck areas in patient’s time-flow so that the facility can improve services with that regard.
 Materials and Methods: A cross-sectional study of time spent by paediatric patients in the outpatient department of Alex Ekwueme Federal University Teaching Hospital Abakaliki by secretly following the patients from arrival at CHOP till after consultation. Means were calculated of time spent in various areas. 
 Results: Of the 384 patients observed, the mean (SD) total time spent in the hospital was 142.58 (23.17) minutes while waiting time and consultation time were 113.15(18.01) and 24.43 (10.38) minutes respectively. The mean time spent at the nurse’s bay was 23.79 (6.47) minutes, while that spent at the queue was 22.94 (8.98) minutes. The time spent at the records unit was the highest, with a mean time of 47.2 (17.42) minutes. 
 Conclusion: The long waiting time obtained from the current study is mostly attributable to delays from the records/registration unit, therefore conceited efforts aimed at improvement of service delivery in this unit will reduce patient waiting time and invariably patient satisfaction.

Surfaces in the neonatal unit of a Nigerian tertiary hospital harbor antibiotic-resistant organisms: Implications for infection prevention and control

Background: Babies hospitalized in neonatal units have high rates of antibiotic use and are exposed to contaminated healthcare environment/equipment leading to increased risks of antibiotic resistance. This study assessed bacterial contamination and antibiotic resistance patterns of isolates from surfaces and equipment in the Neonatal Special Care Unit (NSCU) of a large tertiary hospital in Nigeria Methods and materials: Samples were collected from the equipment and inanimate surfaces in the in-born and out-born sections of the NSCU of Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi State, Nigeria. Samples were cultured in blood and chocolate agar and incubated at 37 °C for 18–24 h. Isolates were identified using morphology and standard biochemical tests. Microsoft Excel was used for data entry and analysis Results: A total of 31 and 35 items were sampled in the in-born and out-born NSCU sections respectively. The commonest equipment/surfaces sampled were incubators, resuscitaires, baby cots, phototherapy machines, air conditioner vents, and stethoscope diaphragms. In both sections, the bacterial contaminants were Bacillus species, Staphylococcus aureus, Methicillin-Resistant Staphylococcus Aureus (MRSA), coagulase-negative staphylococcus (CoNS) and Entamoeba coli. In the in-born section, Streptococcus species was identified while Klebsiella species and Pseudomonas species were only cultured from the out-born section. Lockers (9.7%), sinks (8.6%), and stethoscope diaphragms (5.4%) were the most contaminated in both sections. In the in-born subdivision, all organisms were resistant to ceftazidime, ceftriaxone, and cefuroxime except streptococcus species. All organisms were resistant to oxacillin except S.aureus and Streptococcus species. Each organism was resistant to Cloxacillin except CoNS. There was resistance to vancomycin, erythromycin, mupirocin and ofloxacin, gentamicin by S.aureus. In the out-born section, all organisms were resistant to ceftriaxone. Only S.aureus was sensitive to ceftazidime, cefuroxime, oxacillin, and augmentin. Bacillus species, E.coli, Klebsiella and Pseudomonas species were resistant to vancomycin, ofloxacin, and erythromycin while S.aureus and Bacillus species were both resistant to gentamicin and cloxacillin Conclusion: Commonly used fomites in this study harbored a variety of bacterial organisms resistant to different classes of frequently used antibiotics. We recommend intensified infection prevention and control practices, surveillance for antibiotic-resistant pathogens and training of health workers on judicious use of antibiotics

Evaluation of the effect of an educational intervention on knowledge and adherence to HIV guidelines among frontline health workers in Alex-Ekwueme Federal University Teaching Hospital Abakaliki, Nigeria.

The aim of this study was to appraise the implementation of the National HIV guidelines and determine the effect of an educational intervention on health worker knowledge and practice of the guidelines. A before and after study design without control was carried out using a self-administered questionnaire and key informant interviews. Data was also collected from client record cards. An educational intervention was carried out using pamphlets containing summarized information on the guideline. Data analysis was carried out using IBM-SPSS version 20. Results showed that 54.5% of the respondents were males and 76% were medical doctors. Baseline knowledge level of respondents was high with 97% of respondents having good knowledge with a mean score of 3.9. This increased to 4.1 out of 5 post-intervention. All respondents had good practice of the guidelines before and after intervention with a mean score of 4.5 out of 5. Client records also showed good practice. Barriers to guideline implementation include: poor knowledge, inadequate training, guideline unavailability, poor functioning of the laboratory equipment, poor funding. HIV guidelines are being implemented in the clinic to a large extent; however, trainings, funding and provision of the guideline in the clinics are recommended.

Long-Lasting Insecticide-Treated Nets: Assessment of the Awareness and Utilization of Them among Antenatal Clinic Attendees in Abakaliki, Southeast Nigeria.

Background The use of long-lasting insecticide-treated nets (LLITNs) is one of the effective strategies for the prevention of malaria, especially among pregnant women. Aim This study is aimed at assessing the awareness and utilization of LLITNs during pregnancy among antenatal clinic attendees at the Alex Ekwueme Federal University Teaching Hospital Abakaliki. Materials and Methods This was a cross-sectional study among antenatal attendees at the Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi State. A semistructured questionnaire was used to obtain relevant information from the participants. Data analysis was done using SPSS version 20. Results The mean age of the women was 26.05 ± 5.76 years. About one-third (30%) of the respondents were nulliparous. Most of the respondents had at least a secondary education. More than ninety percent of the respondents had a good knowledge of malaria with 95.8% being aware of LLITNs. The main source of information was from hospitals (54.5%). The rate of utilization of LLITNs was 37.5%; however, consistent use was only reported by about a third of this proportion. The major reasons for not utilizing the nets include discomfort/heat and fear of the chemical content. Women with tertiary education were more likely to utilize mosquito nets during pregnancy compared with women with secondary or primary education. Women who live in rural areas (OR = 0.393 95% CI 0.602–0.073) were less likely to use LLITNs during pregnancy, while those who are aware of the aetiology of malaria (OR = 4.38 95% CI 0.983–19.591) were more likely to utilize LLITNs in pregnancy. Conclusion The level of awareness of LLITNs is high; however, its utilization was discouragingly low. Rural dwellers and those without appropriate knowledge of the aetiology of malaria were less likely to use LLITNs in pregnancy.

Open inguinal hernia repair: Our experience with tertiary institution-based surgical outreach

Background: Inguinal hernia afflicts the low socioeconomic class mostly in resource-poor settings. The surgical outreach option greatly reduces this burden. Tertiary health institutions will be a good base for surgical outreaches in hernia repairs. Aim: The aim of this study was to determine the outcome of using a tertiary health-care facility for a surgical outreach program. Methods: This was a prospective clinical study conducted among 195 patients who underwent open groin hernia repair in Alex-Ekwueme Federal University Teaching hospital Abakaliki. Data were collected from admission, till discharge from hospital, and up to 3 months follow-up after the surgery. Results: Out of 206 recruited, a total of 195 patients underwent open groin hernia repair with a male: female ratio of 6.5:1. Their age ranged from 0 to 88 years with a mean age of 33.94 ± 23.40 years. Among the patients, 69.2% of the hernias occurred in ages below 50 years, 58.4% had right, 38% left and 3.6% had bilateral hernias. Open hernia repair was performed in 63.1% and herniotomy in 36.9%. In those that had an open hernia repair, majority 91.8% had tissue repair, whereas 8.2% had mesh repair. Postoperative complication rate was 9.2%. Conclusion: Surgical outreach in a tertiary health facility offers standard care with skilled surgical personnel offering a better outcome with complication rate similar to what obtains in a conventional tertiary health care. Tertiary hospitals where available should be preferred in the surgical outreach for hernias in a low-resource setting.

Misoprostol versus manual vacuum aspiration for treatment of first-trimester incomplete miscarriage in a low-resource setting: A randomized controlled trial.

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. 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. 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. 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) versus misoprostol, $65.76 (6.6), P = 0.86). 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.

Mortality Pattern in Intensive Care Unit: Experience at Abakaliki Southeastern Nigeria

Background: An intensive care unit (ICU) is a special unit of a hospital that provides intensive treatment for patients with severe or life-threatening illnesses and injuries, which require constant care and close monitoring with life support equipment. The mortality rate is still very high in most ICUs especially in the developing countries due to late presentation of patients, unavailability of well trained staff and lack of life support equipment. There has not been any previous study on the mortality pattern in ICU of Alex Ekwueme Federal University Teaching Hospital Abakaliki (AEFUTHA). It is against this background that we embarked on this retrospective descriptive hospital based study of the mortality pattern in ICU of a Tertiary Hospital in Abakaliki, South-eastern Nigeria. Method: This is a retrospective descriptive hospital based study. The admission and discharge registers of the ICU ward were used to extract information on biodata, diagnosis, duration and outcome of all admissions from January to December 2019 (12 months). Results: A total of 174 (male 113, female 71) patients were admitted over the 12 months period with mean age of 46.31 ± 12.28 years. Seventy-one (40.8%) of the patients died from predominantly stroke, acute abdomen, trauma, sepsis, renal failure, acute diabetic complications and cancer in descending order. Acute diabetic complications had 100% case fatality rate, followed by stroke (71%), renal failure (62.5%), cancer (60%), sepsis (55.5%), acute abdomen (34%) and trauma (23%). The mean duration of ICU admission was 4.2 days for the non-survivors and 6.3 days for survivors. Conclusion: The ICU mortality rate was high and constituted of mainly stroke, acute abdomen and trauma which are essentially preventable. Female sex, medical diagnosis and ICU admission duration of less than 6 days were associated with higher ICU mortality.

Coital trauma as seen at Alex Ekwueme Federal University Teaching Hospital Abakaliki, Nigeria

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Though pleasurable, coitus may result in morbidity and even mortality. One of such morbidities is coital trauma, a global occurrence that is grossly under reported. This study aimed to determine the causes and risk factors for coital trauma as well as its clinical presentation.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This was a 4 year retrospective study of patients that presented with coital injuries at Alex Ekwueme Federal University Teaching Hospital, Abakaliki. Data were obtained from patients’ clinical notes using a specially designed proforma. Statistical analysis was performed using Epi Info&lt;sup&gt;TM &lt;/sup&gt;7.2.1. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The majority of women that presented with coital trauma were adolescents (67.9%). Most of them were single (92.9%), nulliparous (89.3%) and had only primary education (57.1%). The commonest cause of coital trauma was rape (75%). The commonest risk factors were inadequate foreplay (57.1%) and coitarche (42.9%). Other risk factors were genital disproportion, pregnancy, puerperium and influence of drugs. The common clinical presentations were vaginal bruises (75%) and vaginal lacerations (64.3%) while the commonest site of injury was the hymen (42.9%) followed by the vulva (35.7%). Other less common sites of injury were the lower vagina and posterior fornix.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Coital trauma is relatively common and young girls are mainly affected. Rape is the major cause while inadequate foreplay and coitarche are the major predisposing factors. &lt;/p&gt;

Birth Weight Variation between the First and the Second Twin in Spontaneously Conceived Twin Pregnancies Delivered in Alex Ekwueme Federal University Teaching Hospital Abakaliki: A 5-year Retrospective Study

Background: Twin pregnancies are associated with disturbed fetal growth. Studies have shown reduced fetal growth, compared to singletons, and also differences in birth weight between first and second twin. Hence, there is a need to evaluate this outcome among twin pregnancies delivered in our hospital. Aim: To determine the birth weight variation between the first and second twin in spontaneously conceived twin pregnancies delivered at the Alex Ekwueme Federal University Teaching Hospital Abakaliki. Materials and Methods: This was a 5-year retrospective study undertaken between January 2012 and December 31 2016 at our hospital. The study cohorts were parturients who were delivered twin pregnancies that were spontaneously conceived. Data collection was done using a pre-designed proforma; analysis was done using SPSS version 20. Result: During the study period, there were 11,932 deliveries and 378 were spontaneously conceived twin deliveries. This accounted for 3.2% of all hospital deliveries. The peak age group for twin gestation was 21-34 years 319(84.4%), 262(69.3%) were booked. Primigravidae were 101 (26.7%) while multiparas were 207 (54.8%) and grandmultiparas; 70 (18.5%). Those delivered through caesarean section were 186 (49.2%) while 176(42.0%) were delivered through the vaginal route. The Apgar score for the first twin in the first and fifth minute respectively were good in 287(75.9%) while in the second twin, 260(68.8%) suffered no asphyxia. Males were more in the first, 211 (58.8%) as well as in the second twins 209(55.3%). The mean birth weight of the first twin was 2.39kg while the mean birth weight of the second twin was 2.36kg. The first twin therefore weighed heavier than the second twin by 30g. Conclusion: Birth weight between the first and the second twin can vary depending on the gestational age, the socio-demographic status and the sex of the fetuses.

Uptake of Subdermal Contraceptive Implants in Alex Ekwueme Federal University Teaching Hospital Abakaliki

Background: Subdermal contraceptive implant is one of the major forms of long acting reversible progestogen-only contraceptives. It is very reliable and its acceptance is on the increase globally. There is a need to evaluate its use among women of reproductive age group in Abakaliki. Aim: To review the uptake and discontinuation of Subdermal contraceptive implants-Jadelle and Implanon at the Alex Ekwueme Federal University Teaching Hospital Abakaliki. Materials and Methods: This was a 3-year retrospective study undertaken between 1st January 2013 to 31st December, 2015 which involved 516 study participants. Client characteristics, the reason for implant uptake and reason for discontinuation of contraceptive implants were collected using a specially designed proforma. The statistical analysis was performed using SPSS version 22. Result: The implant acceptance rate over the study period was 50.2%, and it represents the highest contraceptive uptake in the facility. The mean age of the clients was 31.87±4.94 years, while the mean parity was 4.75±2.33. Majority (326/516) 63.2% had Jadelle while the remaining 190 clients (36.8%) had Implanon inserted. Most of the clients were aged between 20 and 34 years, and were multiparous. Majority (61.7%) of the clients got the information from health care personnel, while the media was the least source of contraceptive information. The discontinuation rate for implants in the facility was 20.2%, (16.1% for Jadelle and 4.1% for Implanon). There was no pregnancy recorded among the client during the study period. The commonest reasons given for discontinuation of the contraceptive method was the desire for more pregnancies. Conclusion: Contraceptive implants are the commonest form of contraceptive uptake in our facility. The pearl index was 0% with a high discontinuation rate.

Mechanism for Promoting Collaborative Behaviour among Organizational Participants: Evidence from Ae-Fetha 1, Ebonyi State Nigeria

This study examined mechanism for promoting collaborative behaviour among organizational participants with Evidence of Alex Ekwueme Federal University Teaching Hospital Abakaliki (AE-FETHA 1). The purpose was to; determine the outcomes of collaborative behaviours of employees on the attainment of corporate goals, explore how collaborative behaviours of employees influence the settlement of conflict in the workplace and assess how collaborative behaviour of employees in the work place can foster participation of employees in organization decision processes. The study adopted descriptive survey research design with an interpretivist philosophy, 64 questionnaires were distributed while 50 were retrieved from the respondents sampled population. Data were presented using simple percentage method and hypotheses were tested using Pearson Product correlation analysis. The findings revealed that there is a relationship between collaborative behaviours of employees and the attainment of corporate goals. It was also revealed that there is a relationship between collaborative behaviours of employees and the settlement of conflict in organizations. It was equally showed that there is no relationship between collaborative behaviour of employees and the participation of employees on organization decision processes. Based on this, it was recommended that management of organization should encourage team work practice among employees. Also, management of organization should always communicate the goals of the organization to employees and ensure practice participative management.

The Relationship between the Weight of the Placenta and Birth Weight of Term Neonate Delivered in Alex Ekwueme Federal University Teaching Hospital Abakaliki, Nigeria

Background: The placenta is in a key position to determine the final birth weight of foetuses because adequate placental function is necessary for delivery of nutrients, oxygen, and hormones to the foetus. The relationship between the placental weight and birth weight of the neonates has been reported from several publications but such reports from Abakaliki are lacking in literature. Aim: To determine the relationship between the placental weight and birth weight of the neonates delivered at term at the Alex Ekwueme Federal University Teaching Hospital Abakaliki. Materials and Method: It was a retrospective study conducted between 1st January 2015 and 31st December 2015. The statistical analysis was done using Epi Info software version 7.2.1 (CDC Atlanta Georgia). Result: The mean birth weight was 3344 ± 488 g while the mean placental weight was 617 ± 78 g. The mean placental weight to birth weight ratio (PBWR X 100) was 19.94% ± 4.2%. Increase in birth weight of the neonate was associated with a corresponding increase in placental weight with a strong statistical significance level (P = 0.968). One thousand nine hundred and five (90.5%) patients had PBWR that ranged between 15% and 24%, which was associated with good immediate neonatal outcome. The placental weight to birth weight ratio outside this range was associated with increased admission into NICU and perinatal mortality at an odd ratio of 0.5844 and a statistical significance level (P) of 0.0036. Conclusion: There is a positive correlation between placental weight and birth weight of the neonate. Knowing the PBWR at birth may help to know the foetus at risk of immediate poor neonatal outcome in order to expedite actions to prevent possible poor perinatal outcome.

Prevalence of Dyspareunia and Its Effect on Sexual Life among Gynaecological Clinic Attendees in Alex Ekwueme Federal University Teaching Hospital Abakaliki, Nigeria

Introduction: Dyspareunia is one of the most common complaints in gynae-cologic practice with tremendous effect on both quality of life and sexual rela-tionship of women. Objectives: To determine the prevalence of dyspareunia and its effect on sexual life among gynaecology clinic attendees in Alex Ekwueme Federal University Teaching Hospital, Abakaliki. Materials and Methods: A cross-sectional study was conducted on consenting participants between 12th May 2016 and 25th July 2016. Anonymous self-administered questionnaires were used collection information on dyspareunia and its effect on sexual life at the Gynaecology clinic. The data was analyzed using Epiinfo version 7.1.5. Results: One hundred and four (104) women participated in this study. Most of the women studied were Igbos (95.19%), and were mainly between the age ranges of 21 - 30 years (66.35%). Most of them were married (89.42%), and were also mainly of the Pentecostal denomination (40.78%). The mean age at coitarche was 20.6 ± 3.95 years. Prevalence of dyspareunia was 36% and only 16% sought medical help. The various responses to dyspareunia were avoidance of sex 11%, reduced frequency of intercourse 8%, less desire for sex 19%, while majority of women with dyspareunia tolerated it (62%). Conclusion: The prevalence of dyspareunia is high in our society afflicting young women in their reproductive years with associated enormous stress on their sexual life.

Evaluation of Pregnancy Outcomes among Women with Pregnancies Complicated by Diabetes Mellitus in Abakaliki, South-East, Nigeria

Background: Pregnancies complicated by diabetes are associated with significant increase in maternal and perinatal morbidity and mortality. The management of diabetes in pregnancy is a great challenge in a low resource setting because of limited resources and facilities to care for these women. Aim: To determine the maternal and perinatal outcomes of diabetic pregnant women managed at Alex Ekwueme Federal University Teaching Hospital Abakaliki, Southeast, Nigeria. Materials and methods: This was a 7-year retrospective case-control study that compared pregnancy outcomes among women with pregnancies complicated by diabetes and those without diabetes managed at Alex Ekwueme Federal University Teaching Hospital, Abakalikibetween January 1st, 2012 and December 31st, 2018. The statistical analysis was done using SPSS version 22. Results: The incidence of diabetes in pregnancy in this study was 6.6 per 1000 deliveries. Of 126 women in diabetic arm of the study, 81 were diagnosed during pregnancy and 45 were known diabetic prior to conception. Over two-thirds of 126 women with pregnancy complicated by diabetes achieved good blood glucose control during pregnancy. Both groups differ in their mean BMI and women with diabetes in pregnancy were more likely to be obese compared with control (diabetic; 30.1 ± 2.5 versus control; 23.4 ± 2.1, P < 0.0001). Pregnant women with diabetes were more likely to be delivered by cesarean section when compared with non-diabetic women (86 versus 23, OR = 9.6, 95% CI: 5.35 - 17.32, P < 0.0001). Similarly, the incidence of polyhydramnious was higher in paturients with diabetes when compared with the control groups (26 versus 13, OR = 2.2, 95%CI: 1.10 - 4.63, P = 0.02). There were no differences between both study groups with regards to other maternal outcomes. The incidence of fetal macrosomia, neonatal hypoglycemia and neonatal respiratory distress syndrome were significantly higher among women whose pregnancies were complicated by diabetes when compared with the control [Diabetics; fetal macrosomia (62.7%), neonatal hypoglycemia (44.4%) and neonatal respiratory distress syndrome (22.2%) versus Control; fetal macrosomia (34.1%), neonatal hypoglycemia (7.9%) and neonatal respiratory distress syndrome (5.6%) respectively]. Conclusion: Women with pregnancies complicated by diabetes had a higher incidence of adverse maternal and perinatal outcomes. Clinical recognition of diabetes in pregnancy is important because institution of therapy, and antepartum fetal surveillance can reduce the maternal and perinatal morbidity and mortality associated with the condition.

Tranexamic Acid versus Placebo for Prevention of Primary Postpartum Haemorrhage among High Risk Women Undergoing Caesarean Section in Abakaliki: A Randomized Controlled Trial

Objective: To evaluate the efficacy of tranexamic acid for prevention of postpartum haemorrhage among women undergoing cesarean section who were at high risk of postpartum hemorrhage. Materials and Method: This was a double blind randomized controlled trial conducted at the Alex Ekwueme Federal University Teaching Hospital Abakaliki from January 2016 to December 2017. One hundred and sixty-eight parturients at high risk of postpartum haemorrhage who underwent caesarean section were randomly assigned to receive either tranexamic acid or placebo prior to skin incision. Results: The result of the study showed that the need for additional uterotonic was higher in women in the placebo arm when compared with women in the tranexamic arm of the study (7.4% versus 33.3%, respectively). The incidence of primary post-partum hemorrhage (blood loss > 1000 ml) was significantly lower in the tranexamic acid group compared to placebo group (11.9% versus 50%, respectively, P-value < 0.0001). Conclusion: Intravenous tranexamic acid given prior to skin incision at caesarean section reduced the need for additional uterotonics and incidence of primary postpartum among high risk women.

Profiling the Socio-Demographic Characteristics and Outcome of Preterm Delivery in Alex Ekwueme Federal University Teaching Hospital Abakaliki

Background: Preterm delivery is a major cause of perinatal morbidity and mortality globally. In more than half of the cases, the exact cause is unknown and it is largely unpredictable. Certain maternal, social and demographic characteristics are risk factors and often help to predict and prognosticate the neonatal outcomes. Objective: This study was designed to determine the maternal socio-demographic characteristics and neonatal outcomes of patients managed for singleton preterm delivery in Alex Ekwueme Federal University Teaching Hospital, Abakaliki. Method: This was a 4-year retrospective analysis of patients managed for preterm birth from 1st January 2012 through 31st December 2015. Results: Over the study period there were a total number of 623 singleton preterm deliveries in the facility, while there were 9647 deliveries in the facility; the preterm birth rate was 6.5% or 65 per 1000 deliveries. The mean maternal age was 28.79 ± 5.33 while the mean parity was 1.89 ± 1.98. The mean gestational age and birth weight were 33.67 ± 2.62 and 2.30 ± 0.78 kg respectively. Apgar score in 1 minute was 6.89 ± 3.27, while in the 5th minute was 7.95 ± 3.42. Majority of the patients were multiparous and booked for antenatal care in the facility. Most of the preterm labour started spontaneously and were delivered vaginally. The caesarean section rate in this study was 35.5%. Fetal distress and preeclampsia/eclampsia were the commonest indications for caesarean section. The male to female ratio was 1.1:1. Nearly half of the neonates were born with normal birth weight and 427 (68.5%) were alive at discharge. However, 196 (31.5%) suffered early neonatal death due to prematurity. Maternal parity, booking status and fetal weight were significant determinants of fetal outcome with a p-value 0.05. Conclusion: Birth weight was the most important determinant of neonatal survival and the unbooked patient was an important determinant of poor outcome. Booking for antenatal care and ensuring optimal weight at delivery would go a long way at reducing the poor neonatal outcome associated with preterm delivery.

Gestational Trophoblastic Diseases: A Review of the Clinical Presentation and Management at the Alex Ekwueme Federal University Teaching Hospital Abakaliki

Background: Gestational trophoblastic diseases (GTD) are potentially curable with retention of reproductive function once the correct diagnosis is made and treatment is commenced early with adequate follow up. Objective: The objective of this study was to determine the incidence, clinical presentation, management and treatment outcomes of gestational trophoblastic diseases in a tertiary hospital in Abakaliki, South-east Nigeria. Materials and Methods: This was a retrospective descriptive study of gestational trophoblastic diseases managed at Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA) over a 6-year period. The statistical analysis was done using SPSS version 22. Results: The incidence of GTD was 4.6 per 1000 deliveries. Women who were less than 20 years and more than 40 years of age accounted for 5.9% and 23.5% of cases of GTD respectively. Women who were para 5 and above accounted for 76.5% of those who presented with GTD. All the patients presented with vaginal bleeding. Suction evacuation (76.5%) was the commonest form of treatment offered to women with GTD. The commonest complication was anaemia (94.1%). Maternal death due to GTD was 8.8%. Most (58.8%) of the patients did not turn up for follow-up. Conclusion: Gestational trophoblastic diseases has remained an important cause of maternal morbidity and mortality in our hospital due to poor compliance with follow-up. Call and recall system should be introduced in the management of patients with GTD to improve compliance to management standard.

Liposuction: a veritable option in management of gynecomastia case report

Introduction: Gynaecomastia is the commonest aesthetic problem in men. Treatment in our environment is mainly by open surgical excision. The practice of liposuction is still developing in our region. We present our experience in the use of liposuction in the management of bilateral gynaecomastia in Alex Ekwueme Federal University Teaching Hospital Abakaliki with a satisfactory outcome. Method: We report a case of 33-year old male with idiopathic bilateral gynaecomastia (Simon grade IIb) and resultant aesthetic concern. Treatment was by suction-assisted liposuction with satisfactory outcome. Results: The lipoaspirate from the left breast was 900 mls and 600 mls from the right breast. Male chest contour was regained several weeks post-surgery with good patient satisfaction. Conclusion: Liposuction alone offered a satisfactory outcome in the management in this case.