Background: Early screening for cervical cancer is a key intervention in reduction of maternal deaths. Health care workers have a significant role to improve cervical cancer screening practice among women. Their attitude and practice to such an issue might positively or negatively influence people they come into contact with. Objective: To determine the knowledge, uptake and barriers to Pap smear test among female workers in the Rivers State University Teaching Hospital. Methodology: A hospital-based cross-sectional study was conducted between September and November 2015. A structured and pre-tested questionnaire was used to collect data from 265 female hospital workers on socio-demographic characteristics, knowledge of Pap smear, attitude towards, as well as utilization of Pap smear test. The data obtained were analyzed using SPSS version 20.0. Results: Of the 265 respondents, 237 (89.4%) were aware of Pap smear while 28 (10.6%) had no knowledge; of those that had knowledge only 40 (16.9%) had Pap smear test done at least once Awoyesuku et al.; JAMMR, 30(4): 1-9, 2019; Article no.JAMMR.50502 2 previously. There is significant difference in the knowledge of Pap smear among the professionals and those with tertiary education. Common sources of information about Pap smear were Books (58.2%) and Medical Workers (50.6%). Most common reason for not wanting to be screened was No interest (43.6%). Conclusion: Although the knowledge of Pap smear is high, the uptake is low among hospital workers. To improve utilization, public health education on the need for health workers to take up screening is crucial as it will impact positively on the general populace. Original Research Article

Background: Infection with hepatitis B (HBV) and human immunodeficiency virus (HIV) are global public health problems. These infections during pregnancy increase the risk of maternal morbidity and mortality, and also pose a risk to the fetus due to mother to child transmission. Objective: To determine the prevalence of seropositive HIV and HBsAg cases amongst pregnant women at the Rivers State University Teaching Hospital (RSUTH). Methodology: A retrospective review of hospital and laboratory records of all pregnant women booked at RSUTH in two years, from May 2017 to April 2019, was carried out. Data on patients’ age, parity and educational level and reactivity of HIV and HBsAg test at booking were retrieved using structured proforma and analyzed using Epi Info Version 7. Test for significance using Chi-square was set at a significant level of P<0.05. Results: 3560 patients had HIV and HBsAg screening out of which 148 (4.2%) and 9 (0.3%) respectively were positive. The comorbidity rate in this study was 0.06%. The mean age was 31.5±4.7 years and the mean gestational age at booking was 22.1±6.8 weeks. There was no significant relationship between their age (χ2 = 2.690, p-value=0.442) and parity (χ2 = 3.759, p-value = 0.145) with HIV seropositivity, but these were significant for HBsAg (χ2 = 13.691, p-value = 0.003) (χ2 = 13.121, p-value=0.001).  Educational status was significant for HIV (χ2 = 16.188, p-value=0.000) but not for HBsAg (χ2 = 0.229, p-value=0.892). Conclusion: The seroprevalence rate of HIV and HBsAg in this study were low. HIV seroprevalence was significantly affected by lower education, while HBsAg seroprevalence was significantly affected by younger maternal age and nulliparity. Continued screening of pregnant women for these infections remains valuable and further community-based studies to identify risk factors are recommended.

Background: Maternal mortality ratios (MMR) are still unacceptably high in many low- and middle-income countries especially in sub-Saharan Africa. Background Data for the causes of maternal deaths are needed to inform policies to improve maternal healthcare and reduce maternal mortality. Objective: This study sought to determine the magnitude and trend in maternal mortality and the causes at a tertiary hospital over a seven-year study period. Methodology: This was a retrospective review of maternal mortality and causes from 2012 to 2018. Data on number of maternal deaths, deliveries and causes of death were retrieved from the departmental annual reports and hospital records and entered into Microsoft Excel 2013. Data were presented as line graphs, charts and frequency tables. Results: One hundred and ten (110) maternal deaths occurred out of 17,080 total births during the study period giving an overall MMR of 644. The MMR increased progressively from 580 in 2012 to 785 in 2018 with a sharp rise to the highest and subsequent decline to the lowest, values at the midpoint. The commonest causes of maternal deaths were Pre-eclampsia (PET) and Eclampsia 44(40%), Postpartum Haemorrhage (PPH) 25(22.7%) and Ruptured Uterus 13(11.8%). Conclusion: The maternal mortality ratio is high and the trend is worsening. The leading causes of maternal deaths were PET/Eclampsia and Postpartum haemorrhage accounting for about two-thirds of all deaths. Efforts must be geared towards improvements in the management of these cases, if this trend is to be reversed.

Background: Caesarean section commonly causes moderate to severe pain in the first 24 hours after surgery with associated discomfort, delayed ambulation, difficulty initiating breastfeeding and prolonged hospital stay. Receiving adequate analgesia after caesarean section is very important for the patient’s comfort, overall wellbeing and recovery. Objective: To compare the efficacy, time to rescue-analgesia and side effects of single agent rectal diclofenac versus its combination with intramuscular pentazocine for pain management after caesarean section in Rivers State University Teaching Hospital (RSUTH). Methodology: A randomized double-blind clinical trial was carried out at the RSUTH. A total of 120 patients scheduled for either elective or emergency caesarean section were recruited. Group ‘A’ received rectal diclofenac 100 mg and intramuscular placebo (unimodal group) while group ‘B’ received rectal diclofenac 100mg and intramuscular pentazocine 30 mg (multimodal group). Socio-demographic information was collected via structured proforma, while Visual Analog Scale (VAS) was used to assess the level of pain. Data were analyzed using SPSS version 20 and statistical significance was set at p < 0.05. Results: The mean ages of respondents in unimodal and multimodal groups were 31.7 ± 4.3 years and 31.3 ± 5.2 years respectively. The difference in the median pain score and range was significant only at 8 hours between the groups, there was no significant difference before and after 8 hours. Although the mean time (in minutes) to first rescue-analgesia was shorter in the unimodal (147.5 ± 60.1) as compared to the multimodal group (170.0), this difference was not statistically significant. There was no side effect noticed in either of the two groups. Conclusion: The combined agents (diclofenac and pentazocine) had a superior analgesic effect to the single agent (diclofenac alone) when given as used in the study.

Background: Gestational diabetes mellitus (GDM) is a common cause of hyperglycaemia in pregnancy accounting for about 90% of all diabetic pregnancies. Women with GDM are at increased risk of maternal and fetal morbidity and mortality which are preventable through early diagnosis and treatment. Objective: The aim was to determine the prevalence of GDM, compare the maternal and neonatal complications among GDM and non-GDM pregnant women, and the risk factors associated with GDM. Methodology: A prospective cohort study was carried out among 105 pregnant women attending the antenatal clinic of RSUTH between February and August 2017. They were interviewed using a pre-structured questionnaire that covered variables related to socio-demographic factors and family, medical, and social history. Fasting blood sugar (FBS) was done after an overnight fast. Women who had FBS less than 7 mmol/L had 75 g Oral Glucose Tolerant Test (OGTT) done. Those diagnosed with gestational diabetes mellitus were the exposed group while those negative for GDM were the non-exposed group. Both groups were followed up to delivery, and maternal and fetal outcomes were noted. Statistical analysis was carried out using SPSS version 20 and significance set at p < 0.05. Results: The prevalence of GDM was 10.5%. Positive history of GDM in previous pregnancy was the only independent risk factor (p=0.04, Adj OR: 26.89, 95% CI 2.86 to 252.61). GDM mothers had a significantly higher risk of developing pre-eclampsia (RR=7.48; 95% CI =3.36 to 16.63). Neonates of GDM mothers were at increased risk of fetal macrosomia (RR =9.00; 95% CI=1.36 to 59.4) and neonatal admissions (RR=8.00; C.I =1.19 to 53.67). Conclusion: The study revealed that the prevalence of GDM was high and that those with GDM were at increased risk of developing fetal and maternal complications. A history of GDM in previous pregnancy was an essential risk factor for subsequent GDM.