Background:The essence of training traditional birth attendants (TBAs) is to attend to women in uncomplicated labor and to refer them immediately to hospitals when complications develop.Aim:The aim was to audit childbirth emergency referrals by trained TBAs to a specialist hospital in Enugu, Nigeria.Subjects and Methods:A retrospective study of 205 childbirth emergencies referred to Semino Hospital and Maternity (SHM), Enugu by trained TBAs from August 1, 2011 to January 31, 2014. Data analysis was descriptive and inferential at 95% confidence level.Results:Most of the patients (185/205, 90.2%) were married and (100/205, 48.8%) had earlier booked for antenatal care in formal health facilities. There were obstetric danger signs or previous bad obstetric histories (pregnancies with unfavorable outcome) in 110 (110/205, 53.7%) women on admission at SHM. One hundred and fifteen (115/205, 56.1%) women walked into the hospital by themselves while 50 (50/205, 24.39%) could not walk. The fetal heart sounds were normal in 94 (94/205, 45.6%), abnormal in 65 (65/205, 31.8%) and absent in 42 (42/205, 20.4%) of the women on admission. Five healthy babies were delivered by the TBAs before referring their mothers. Delays of more than 12 h had occurred in 155 (155/205, 76.6%) of the women before referrals. Prolonged labor (100/205, 48.8%), obstructed labor (40/205, 19.5%), attempted vaginal birth after previous cesarean delivery (40/205, 19.5%) and malpresentation (30/205, 14.6%) were the common indications for referrals. The maternal mortality and perinatal mortality ratios were 610/100,000 live births and 228/1000 total births respectively.Conclusion:Delays at TBA centers are common before referral and most patients are referred in poor clinical state. Further training and re-training of the TBAs with more emphasis on recognition of obstetric danger signs and bad obstetric histories may help in screening high-risk patients for prompt referral to hospitals before complications develop.

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Objective To determine the accuracy of a semi‐quantitative interleukin‐6 (IL‐6) vaginal secretion rapid test (Chorioquick) for detecting chorioamnionitis in women with premature rupture of membranes (PROM). Methods A prospective cohort study in five tertiary hospitals in Nigeria involved women with confirmed PROM at term and preterm PROM with or without suspected chorioamnionitis from August 1, 2017, to October 31, 2018. Cervicovaginal fluid samples were tested for chorioamnionitis using the Chorioquick test. Samples were repeated at decision to deliver. The test was considered positive if at least the indicator ‘IL‐6 low’ of the three Chorioquick biomarkers (low, medium, high) was positive, or negative if none of the biomarkers were positive. Chorioamnionitis was histologically confirmed post‐delivery using three tissue samples. Primary outcome measures were sensitivity, specificity, and accuracy. Results Of 73 women, on histological confirmation, 39 were true positive and 29 were true negative (for chorioamnionitis) to the Chorioquick test at repeat assessment. Overall, the Chorioquick test had a sensitivity of 97.5% (95% confidence interval [CI] 85.3–99.9), specificity 87.9% (70.9–96.0), and accuracy 93.2% (79.5–99.1). Sub‐group analysis of women <37 weeks of pregnancy showed a sensitivity of 100.0% (95% CI 83.4–100.0), specificity of 91.3% (70.5–98.5), and accuracy of 95.8% (82.5–99.5). Triple positive samples were 100.0% specific in all gestations. Conclusion Chorioquick showed favorable utility for detecting chorioamnionitis in PROM and could be a reliable, non‐invasive rapid tool in a real‐world clinical setting.

Background Medical education is considered one of the toughest college degrees to acquire. Exploring the factors that determine good academic performance in medical school will help in the planning of curriculum and assist students to navigate through medical school more effectively. Methods This cross-sectional and descriptive study enrolled 145 second year clinical students (500 level) of the Enugu State University of Science and Technology in south-east Nigeria using purposive and convenient sampling method. It assessed factors that predicted good academic performances in surveyed students. Results Medical students without membership in any campus group, those that receive(s) less than ten thousand naira (≈US$27) every month as upkeep allowance, those admitted through the University Matriculation Examination, and students who visit their families on a weekly basis were more likely to have better academic performances than those in corresponding categories. Of these significant predictors of good academic performance, mode of admission into medical school ( Rs =−0.310 P =0.001) and monthly allowance students got for upkeep ( Rs =−0.281 P =0.001) had the strongest correlation with good academic performances. Conclusion Our study identified factors that correlate with academic performances among medical students. We propose frequent appraisal of these factors and support system that will help improve performance in these students.

Background: Annually, 800, 000 die from suicide worldwide. However, suicide is believed to be rare in our environment. Suicide causes significant life disruptions in people bereaved by it. These disruptions result from associated complicated grieving pattern characterised by stigma, feeling of shame, responsibility, guilt, etc. People therefore usually want to be certain that their relation indeed died from suicide. Being certain can in part help survivors achieve closure. A pathologist is often called upon to diagnose the actual cause of death in suspected suicide. The aim of this paper is to highlight the perception and attitude of survivors to suicide in our environment. Methods: This is a prospective study carried out in Enugu State University Teaching Hospital, Enugu, Nigeria. Data was obtained by audio-recording and transcription of face-to-face interviews of 8 groups of relatives who had presented to the pathologist for autopsy of their relation suspected to have committed suicide. Transcribed data was double checked for accuracy and analysed. Informed consent was obtained from participants. Ethical clearance was obtained from the Ethical Committee of the hospital. Results: There were 8 cases of suspected suicide over a 7-year period accounting for 0.6% of all violent deaths in the period. The central attitude of survivors in all the cases was denial of the event. At all the meetings survivors desired the pathologist to report cause of death differently than suicide. Also, in all cases, the extended family felt affected by the event. The following six themes in descending order of importance were identified to underlie survivors' attitude to suicide: fear of stigma and its consequent isolation, fear of economic repercussions, a conflict of choice of cause of death stemming from religious beliefs about the afterlife, feeling of shame and anger against the deceased and fear that acknowledging the event may bring a repeat in the family. Conclusion: There is profound fear of stigma and associative concerns which leads to outright suicide-denial. There is a need to educate the society about the reality and dynamics of suicide. This will make a bereaved person open to receiving requisite care.