Trends in maternal mortality at the University of Calabar Teaching Hospital, Nigeria, 1999-2009

BACKGROUND

Maternal mortality remains a major public health challenge, not only at the University of Calabar Teaching Hospital, but in the developing world in general.

OBJECTIVE

The objective of this study was to assess trends in maternal mortality in a tertiary health facility, the maternal mortality ratio, the impact of sociodemographic factors in the deaths, and common medical and social causes of these deaths at the hospital.

METHODOLOGY

This was a retrospective review of obstetric service delivery records of all maternal deaths over an 11-year period (01 January 1999 to 31 December 2009). All pregnancy-related deaths of patients managed at the hospital were included in the study.

RESULTS

A total of 15,264 live births and 231 maternal deaths were recorded during the period under review, giving a maternal mortality ratio of 1513.4 per 100,000 live births. In the last two years, there was a downward trend in maternal deaths of about 69.0% from the 1999 value. Most (63.3%) of the deaths were in women aged 20-34 years, 33.33% had completed at least primary education, and about 55.41% were unemployed. Eight had tertiary education. Two-thirds of the women were married. Obstetric hemorrhage was the leading cause of death (32.23%), followed by hypertensive disorders of pregnancy. Type III delay accounted for 48.48% of the deaths, followed by Type I delay (35.5%). About 69.26% of these women had no antenatal care. The majority (61.04%) died within the first 48 hours of admission.

CONCLUSION

Although there was a downward trend in maternal mortality over the study period, the extent of the reduction is deemed inadequate. The medical and social causes of maternal deaths identified in this study are preventable, especially Type III delay. Efforts must be put in place by government, hospital management, and society to reduce these figures further. Above all, there must be an attitudinal change towards obstetric emergencies by health care providers.

Letter: Skin cancer in albinos at the University of Calabar Teaching Hospital, Calabar, Nigeria

We evaluated all the albinos with a histologic diagnosis of skin cancer seen in the University of Calabar Teaching Hospital, Calabar, Nigeria, during the 7-year period, (January 2001 to December 2007). The ages, sex, clinical presentation/site(s), number of lesions per patient, type of skin cancer, treatment, outcome and follow up were analyzed. This was compared with the total number of skin cancers. Of the skin cancers diagnosed, 11 percent were in patients with albinism.

Squamous cell carcinoma in South-Eastern equatorial rain forest in calabar, Nigeria

BACKGROUND

In North America and Europe, 80% of invasive skin cancers are basal cell carcinoma while 20% are squamous cell carcinoma (SCC). In contrast, African studies reveal a preponderance of SCC. Risk factors are grouped into solar and nonsolar. Oculocutaneous albinism (OCA) is a known risk factor for skin cancer in Africans. Their contributions vary with race and geographic region. This study sought to evaluate the pattern, risk factors, and outcome of management of this lesion in our setting.

METHOD

All the patients with histologic diagnosis of SCC between January 2006 and December 2007 were prospectively studied as part of the wider study of skin cancers.

RESULTS

The 19 patients (12 males and 7 females) whose ages ranged between 16 and 70 years (mean = 46.2 years) accounted for 51.4% of skin malignancies. Marjolin's ulcers were recorded in 12 patients (63.2%) while 7 patients (36.8%) were non-Marjolin's including 2 OCA patients. The limb was the commonest site involved (57.9%). The outcomes were poor in some cases because of late presentation after topical treatment.

CONCLUSION

Chronic ulcers, inflammation, and albinism were identified predisposing factors. Public health education on prevention, early presentation, and surgical evaluation of chronic ulcers would improve outcome.

Cutaneous squamous cell carcinoma in Calabar, southern Nigeria

BACKGROUND

Several studies have shown that in Africa squamous cell carcinoma (SCC) is commoner than other skin malignancies. The risk factors are grouped generally into solar and nonsolar factors and their contributions vary with race, geographical region and site of lesion. This study attempted to identify risk factors and outcome of management of this problem in our region of southern Nigeria.

METHODS

All patients with histological diagnosis of SCC presenting to the University of Calabar Teaching Hospital during the period January 2005 to December 2006 were evaluated.

RESULTS

In total, 10 patients (6 male, 4 female, mean age 39.3 years, range 16-62) were seen. There were six patients (60%) with Marjolin's ulcer (MU) of the leg, with a male:female ratio of 5:1 and a latency period of 14.7 years, with trauma as the leading cause of injury. The other four patients (40%) had non-MU SCC. Two of these four patients (one man, one woman) were albino, and had lesions that involved the head. The other two patients were both women, and had vulval lesions. All 10 patients had delayed hospital admission, after poor results with topical herbal treatment. After hospital treatment, the results were satisfactory in three patients (two with MU and the male albino patient). The other seven patients had generally poor results from treatment, which comprised various combinations of excision, adjuvant chemotherapy and radiation.

CONCLUSION

Ignorance and sociocultural factors were underlying issues in delaying treatment. Education highlighting the risk associated with chronic wounds and albinism, and the need for prevention, prompt treatment and proper surgical management, would improve prognosis with a reduction in the healthcare cost of this problem.

Salivary gland tumour of the lip: report of two cases and literature review

BACKGROUND

Salivary gland tumours (SGT'S) are uncommon. The minor glands are dispersed throughout the upper aerodigestive submucosa including the lip.

OBJECTIVE

To present two case reports of salivary gland tumour of the upper lip and highlight its diagnostic and therapeutic challenges.

CASE REPORTS

A 50-year-old female farmer presented with a two year history of swelling of the upper lip and the histology revealed a pleomorphic adenoma of the minor salivary gland. She was offered a wide excision which resulted in a huge upper lip defect managed by a two staged lip switch ABBE flap. The second patient, a 40-year-old female teacher presented with a 10 year history of a left sided upper lip swelling. Histology revealed pleomorphic adenoma. She was offered an excision with no evidence of recurrence after 26 months of follow up.

CONCLUSION

Salivary gland tumours should be considered as a differential diagnosis of tumours of the lip: Early presentation is advocated as late presentation with advanced tumour presents diagnostic and therapeutic challenges.

Kaposi sarcoma: changing trend in Calabar, south eastern Nigeria

BACKGROUND/OBJECTIVE

Kaposi sarcoma (KS) is now the most frequently reported malignant skin tumour in some areas of Africa and was endemic in Africa before the advent of the human immunodeficiency virus (HIV) infection. The prevalence has increased with the emergence of HIV infection. The objective of this report is to describe the frequency, current clinical pattern, and anatomic distribution of KS in Calabar, south-eastern Nigeria and compare this with total malignant skin tumour.

METHOD

All the patients with histologic diagnosis of KS presenting to the University of Calabar Teaching Hospital from January 2005 and December 2006 were analyzed as part of the wider study of malignant skin tumorus. Diagnosis of HIV was based upon enzyme linked immunosorbent assay.

RESULTS

In our study, there were 11 patients (7 males and 4 females), with a male: female ratio of 1.75:1. This was the commonest malignant skin tumor (38%) followed by squamous cell carcinoma (SCC) (34.5%) and the age ranged from 21-60 years (mean 42.9 years). Nine patients (81.8%) were HIV positive including the 4 females (age ranged from 21-45 years) and 2 (18.2%) HIV negative, aged 59 and 60 years. The lower limb was the commonest site (50%). Atypical lesions involved the eyelids/nose and penis.

CONCLUSION

KS is now the commonest malignant skin tumour in our region with the HIV related KS as the commonest clinical type. Successful prevention and treatment of HIV infection would reduce the prevalence of this tumour.

Family study in sickle cell disease in Nigeria

A pilot survey has been made of Nigerian families at risk of producing SS haemoglobin homozygotes. Genotypes of parents and off-spring were investigated in twenty-five families. There is a suggestion that more SS children are produced where the first born suffers from haemoglobin SS disease. Mortality among offspring was higher in the study population than in the general population.