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PREFACE

I HAVE PRACTISED MEDICINE IN NIGERIA FOR MORE THAN THREE DECADES AS A CONSULTANT OBSTETRICIAN/ GYNECOLOGIST AND INFERTILITY SPECIALIST. NIGERIA HAS A VERY HIGH MATERNAL AND INFANT MORBIDITY AND MORTALITY RATES. THE MOST COMMON CAUSE OF DEATH AMONG REPRODUCTIVE AGE WOMEN IS HEMORRHAGE EITHER FROM DELIVERY, PATHOLOGIC CONDITIONS BOTH BENIGN AND MALIGNANT OR SURGERY.

MOST AFRICAN WOMEN LACK ACCESS TO QUALITATIVE HEALTHCARE. THEY CANNOT AFFORD IT EVEN WHERE THEY ARE AVAILABLE.

AFRICAN WOMEN PRESENTING WITH UTERINE FIBROIDS ARE ALREADY COMPROMISED BY POOR NUTRITION, EXTREME POVERTY, LACK OF INFORMATION AND EDUCATION AND CUSTOMS BELIEFS THAT LURE THEM INTO DANGEROUS TREATMENT PRACTICES. THEY ARE MOST LIKELY TO PRESENT LATE FOR EVALUATION AND MANAGEMENT OF THEIR CONDITIONS. THEIR BELIEF THAT EVERY MARRIED WOMAN TO BE SOCIALLY AND CULTURALLY ACCEPTABLE MUST BEAR CHILDREN IS THE BANE OF THEIR INCREASED MORTALITY AMONG OTHER FACTORS.

FIBROIDS ARE FAR MORE COMMON AMONG AFRICAN WOMEN THAN THEIR COMTERPARTS IN OTHER RACES OF THE WORLD. IN MY SERIAL IMAGING OF MARRIED AFRICAN WOMEN, I HAVE FOUND FIBROIDS AS EARLY AS 18 YEARS IN QUITE SOME FEW AND THE FINDINGS INCREASE LINEARLY WITH ADVANCING AGE. CONSERVATIVELY, ABOUT 60-70% OF WOMEN ARE FOUND TO HAVE UTERINE FIBROIDS DURING THEIR FIRST ULTRASOUND EVALUATION FOR THEIR INITIAL INFERTILITY VISIT. MOST OF THESE FIBROIDS PRESENT WITH NO SYMPTOMS AT ALL AND MOST WOMEN DO NOT EVEN KNOW THAT THEY HABOR THEM.

CHOICES FOR PROPER MANAGEMENT OF FIBROID CONDITIONS IN AFRICAN WOMEN ARE FEW AND LIMITED. THEY RELY MOSTLY ON CULTURAL NORMS AND BELIEFS , USING LOCAL HERBS AND SUPLIMENTS AND VISITING PRAYER HOUSES FOR CURE.

MYOMECTOMY DEFINED AS OPEN SURGERY TO REMOVE THE FIBROIDS REMAINS THE MAIN STAY FOR MANAGEMENT OF SYMPTOMATIC UTERINE FIBROIDS AMONG AFRICAN WOMEN. UNLIKE COUNTRIES LIKE USA WHERE HYSTERECTOMY IS PRACTISED OR ADVOCATED FOR SUCH CONDITIONS, MOST AFRICAN WOMEN WILL DECLINE HYSTERECTOMY EVEN WHEN INDICATED FOR LIFE THREATHENING CONDITIONS.THEY PREFER TO RETAIN THEIR UTERUS TO THEIR GRAVE.