The burden of gynecological cancer management in Northern Nigeria

Background: Carcinoma of the Cervix is one of the gynecologic cancers. Gynecological cancer is a scourge in the developing nations because of the burden of cervical cancer. Carcinoma of the cervix is the leading cause of cancer death in women. The costs of treatment of cancers generally are very high and this has made care very difficult in the developing nations. The question therefore is who bears the cost and whose responsibilities? Aims and Objective: To study the economic burden of cancers on the patient, and how they source for these funds. To determine how the lack of funds or otherwise has affected their care. To assess their perception of who should bear the cost of this care. Methodology: It is a prospective study of all consecutive patients that attended the Gynecologic clinic of our unit between 2nd January 2010 and 30th June 2010. Data were analyzed using Excel statistical package. Result: A total of 93 patients were interviewed. A majority of 70 (76%) of the patients had Carcinoma of the cervix. The mean age of there husbands was 58 years. Most of them were either farmers (21%) or retired civil/public servants (15%) and earn between 700 - 1700 dollars per year. A large group of the patients were full time House wives (48%), while Petty trading and farming account for 13.3% each. The women earn less than 500 dollars per year. Only 50% received assistance, from family members (35.8%) or relatives (29.6%). More than 50% of them have spent between 1000 - 3000 dollars for their health bills. It was sad to note that 40% of them have no hope of help/assistance from anywhere. A majority of 83.3% believe that the government should come to their aids. Conclusion: In the developing nations, poverty still remains major problem, where people still earn less than a dollar per day. In essence prevention is paramount;otherwise most of our women who escaped maternal mortality may end up being a victim of cancer death.

Obstetric Outcome of Pregnancies Complicated by Domestic Violence

Background: Domestic violence is a pattern of assault and behavior perpetrated by one partner against the other. Historically most of those oppressed by domestic violence have been women. The lifetime prevalence of domestic violence against women is 10% - 69%. Though this violence might have started or escalated during pregnancy, pregnancy specific prevalence is between 1% - 20%. The objective was to determine the prevalence and obstetric complications. Domestic violence is against pregnant women in tertiary clinic of a developing nation. Methodology: It was a hospital based cross-sectional case control study conducted within the period of one year. Close ended questionnaires were administered. Result: Two hundred and seventy patients were recruited. The lifetime prevalence of physical violence against women was 28.5%. 12.5% (5/40) of victims smoke cigarettes;the prevalence of alcohol intake by the victims was 45%. 72.5% of partners of victims smoke as compared to 25.5% of partners of non victims. Unemployed women were victims of domestic violence far more than the employed women. Pregnant women who are victims of physical violence are more likely to suffer adverse pregnancy outcome. Violence in pregnancy is quite commoner than most of the conditions routinely screened for during antenatal care. The association of such violence with significant maternal and fetal/neonatal morbidity and mortality emphasizes the fact that domestic violence is not just a social problem but a feto-maternal health hazard that requires the input of every stakeholder to address.

Clinically Diagnosed Guillain-Barre Syndrome in Pregnancy: Case Report and Review of Literature

Background: Guillain-Barre syndrome (GBS) is an autoimmune disorder characterized by a heterogeneous group of pathological and clinical entities. It is associated with ascending areflexic paralysis, some autonomic dysfunction and respiratory failure in severe cases and ultimately death if not promptly diagnosed and treated. It may be preceded by an antecedent event in about two-third of cases. This could be an upper respiratory tract infection, viral illness, recent history of vaccination, pregnancy, cancer or even trauma. The condition is exceedingly rare in pregnancy and only few cases have been reported in literature. Case Report: This is a case of a 28-year-old Gravida 3, Para 1+1 and Estimated Gestational Age of 30 weeks and 4 days. There was a history of upper respiratory tract infection eight weeks prior to presentation which spontaneously resolved. On examination, she was a young woman, anxious, weak, afebrile, not pale, the neck could not hold the head upright and there was bilateral non tender pitting pedal oedema extending to her mid-shin. There were no cranial nerve deficits and no sign of meningeal irritation. There were normal muscle bulk with global hypotonia and flaccid quadriparesis, Power was 3/5. The proximal groups of muscles were more affected than the distal parts. Reflexes were diminished globally with plantar flexor response. She had immunoglobulin as treatment. Conclusion: In a low resource setting like ours it is important to have a high index of suspicion of GBS when an apparently healthy gravid woman presents with progressive weakness of the limbs.