Laparoscopic examination is useful in the evaluation of infertile women. To perform this test, pneumoperitoneum is required to distend the abdomen, improve visibility and displace the intestines out of the pelvis. Several gases have been used to achieve this purpose including nitrous oxide (N2O), carbon dioxide (CO2), helium, xenon and air. This is a prospective study in a private fertility centre comparing CO2 and room air pneumoperitoneum for diagnostic laparoscopy. Also the safety of room air was evaluated. One hundred and forty five patients received CO2 (group 1, n=73) or room air (group 2, n=72) pneumoperitoneum. Ketamine anaesthesia was used for all the patients and the cost of the procedure was same for the study. CO2 pneumoperitoneum offered better visibility during laparoscopy and the patients also had a better outcome: Wound infection (CO2-2/73: 2.7% Vs. Air-11/72: 15.3%); abdominal discomfort (feeling of retained gas in the abdomen) CO2-5/73: 6.9% Vs. Air-61/72: 84.7%) and shoulder pain (CO2-0/73; 0.0% Vs. Air-56/72: 77.8%). Group 1 patients returned to normal activity earlier (1.5 days +/- 1.3 SD Vs. 4.8 days +/- 2.1 SD). We conclude that CO2 pneumoperitoneum has a better outcome than Air especially for day-case diagnostic laparoscopy. However, room Air pneumoperitoneum is safe, cheap, and available and may be recommended for low resource settings.

General anaesthesia using ketamine has been shown to be safe. It is generally used in our private hospitals where there is lack of qualified personnel and sophisticated anaesthetic machines. A retrospective review of 295 cases of laparoscopy was performed over 28 months at the fertility Unit of Life Specialist Hospital Nnewi, Anambra State, Nigeria. Ketamine general anaesthesia was used for all the patients after premedication with 0.6 mg of atropine. Seventy-six and 102 patients who had additional premedication of 10 mg diazepam and 50 mg promethazine, respectively, were compared. The duration of this procedure ranged between 7 and 18 minutes, with a mean of 12 minutes. The dose of ketamine used was 100 mg mean (range 50-180 mg); 12.6% of the patients had some form of reaction. Diazepam reduced talkativeness during recovery but increased the recovery time significantly, from an average of 45 minutes to 3 hours. Promethazine significantly reduced vomiting and restlessness and did not significantly prolong the recovery time (from an average of 45 minutes to 70 minutes). Two patients who had only atropine as premedication had an idiosyncratic reaction of breathlessness and tonic-clonic-like movements. They responded to intravenous diazepam. Ketamine produces a safe, effective and simple general anaesthesia and is recommended for use in day-case laparoscopy, where standard anaesthetic machines and trained personnel are lacking. Use of promethazine premeditation is advocated for improved outcome.

Background Social determinants of health (SDH) are a critical theme for health equality for Nigeria. Nigeria is one of the countries in the world which is far from achieving targets of 2030 SDG 3 due to this inequity in health. Methods This is a cross-sectional pilot survey designed to collect information about the SDH, strengths, challenges and perceived areas to be addressed among different cadres of healthcare workers at the Chukwuemeka Odumegwu Ojukwu University Teaching Hospital (COOUTH) Awka in the South eastern part of Nigeria. This is a cross-sectional pilot survey among the different cadres of healthcare workers. Results The elements of SDH are vital for the continuing well-being of health workers because of their role in attending to the totality of their community. From our study, two elements of SDH (family and physical activity) had the greatest level of confidence (44% and 26% respectively), while the justice system (police and the legal issues) had the lowest areas of confidence (2% each), but the greatest strength of the community were found in education (70%) and family (58%). Conclusions Policies in general need to be implemented to address the economic instability in order to yield positive outcomes towards education, security of lives and property, food security and affordable healthcare and transportation. Reducing health inequities in Nigeria will depend on a focus addressing the social circumstances of individuals, families and communities using equity-based approaches on the broader structural environment. The role of formal and informal educational strategies will be beneficial in the highlighted social, economic and political factors from this study.