Sonographic estimation of gestational age from 20 to 40 weeks by fetal kidney lengths' measurements among pregnant women in Portharcourt, Nigeria.

BACKGROUND: Ultrasonography has become an indispensible tool in the management of obstetric patients. Accurate determination of fetal gestational age (FGA) has posed great challenge to patient management as the accuracy of traditional biometric parameters decreases with advance in gestation age. Accuracy of fetal kidney length (FKL) in the determination of FGA at third trimester has been documented in other population. This study is aimed to create baseline reference values of fetal kidney lengths in a Nigerian population as previous studies show population specific variations. METHODS: This prospective cross sectional study was carried out on 534 pregnant women between 20 and 40 weeks of gestation who met the inclusion criteria at Diamond Biomedical Services Ltd. A pilot study was conducted on 20 patients to determine the reproducibility and reliability of ultrasound measurement of FKL. Fetal kidney lengths were calculated as mean of three separate measurements. The 5th, 50th and 95th percentiles were calculated using least squared regression analysis. Third polynomial regression models were used to establish the relationship between right and left FKL and FGA. RESULTS: Both FKL measurements are highly reproducible with excellent correlation and agreement within and between sonographers. It correlates strongly with gestational age while the relationships between right and left kidney lengths with gestational age were established using the following regression equations: RKL = - 11.18 + 1.193 × FGA - 0.0350 × FGA2 + 0.00037 × FGA3 and LKL = - 12.57 + 1.332 × FGA - 0.0390 × FGA2 + 0.00040 × FGA3 for right and left kidneys respectively. CONCLUSION: Nigerian population specific baseline reference values of FKLs for the estimation of FGA should be adopted rather than relying on the Caucasians values as universal patterns.

Validity of common ultrasound methods of fetal weight estimation in late pregnancy among women in Kwale, Niger Delta region, Nigeria.

BACKGROUND: Accuracy of some ultrasound equations used in our locality for fetal weight estimation is doubtful. OBJECTIVE: To assess the accuracy of common ultrasound equations used for fetal weight estimation. SUBJECTS AND METHODS: A longitudinal study was conducted on selected Nigerian obstetric population at Central Hospital, Kwale between March, 2009 and January, 2011. Sonography was performed on 412 women with advanced singleton cyesis and measurements of BPD, HC, AC, and FL were obtained and figured into 12 common ultrasound equations for the estimation of fetal weight. The actual birth weight at delivery was recorded. RESULTS: The highest intraclass correlation coefficient was generated by the Hadlock 5 and Hsieh 2 equations. The least mean absolute percent error was obtained with Hsieh 2 equation, followed by Woo 3, and Hadlock 5. These equations also had the least percentage error and the least range of limits of agreement in the same order with no significant difference between their mean fetal weight estimates and that of the actual birth weight (p > 0.05). All twelve equations had strong positive correlation with the actual birth weight with Nzeh 2 equation the least. CONCLUSION: Hsieh 2 equation has the best accuracy in fetal weight estimation studied.

Sonographic evaluation of the spleen among sickle cell disease patients in a teaching hospital in Nigeria.

BACKGROUND: Regional variations in size and parenchyma echo-texture of the spleen among sickle cell disease (SCD) patients have been documented in various publications. The objectives of this study were to assess the size and parenchyma echo-texture of the spleen of SCD patients and ascertain the relationship of age, height and weight with the spleen sizes. METHODS: This was a cross sectional study involving 103 each of SCD and age matched control subjects. Aloka ST- 550 -3500 ultrasound machine with 3.5 and 5 MHz convex transducers was used to scan the subjects over a 15 months period (September, 2012 to November, 2013). The age, height and weight of each subject were recorded. RESULTS: The spleen sizes of SCD patients were generally larger than those of the controls (p < 0.05). Abnormal spleen parenchyma of varied appearances was found among the SCD subjects. There were negative correlations between mean spleen sizes and height, weight and age in SCD patients but positive correlations were found between them in the controls. CONCLUSION: Routine sonographic assessment of spleen size and echo-texture is useful in the management of SCD patients.

Strengthening contact tracing capacity of pulmonary tuberculosis patients in Enugu, southeast Nigeria: a targeted and focused health education intervention study.

BACKGROUND: Nigeria ranks 10 out of the 22 countries in the world with the highest TB burden. Contact tracing enhances case finding and increases the probability of cure. The purpose of the study is to improve the contact tracing skills of tuberculosis patients at the major TB centre in Enugu State, Nigeria. METHODS: The study is an educational intervention with a study and a control groups selected using multi-stage sampling techniques. A calculated sample size of 190 patients was used for each group. The instrument was a pre-tested semi-structured interviewer administered questionnaire. Data entry and analysis was done using Epi-info version 3.3.2. Chi-square test and student t -test were used at p < 0.05 level of significance and 95 percent confidence interval. RESULTS: Awareness of contact tracing at baseline and post intervention were respectively 18.2% and 85.2% (X2 = 158.4, DF = 1, p = 0.000; CI: 15.8-82.2) for the study group; 18.4% and 26.0% (X2 = 3.31, DF = 1, p = 0.069; CI: -9.9-24.7) for the control group. Knowledge that contact tracing involve bringing all household contacts of TB patients for screening was 79 (44.9%) and 33 (19.2%) for the study and control groups at baseline (X2 = 26.32, p = 0.000; CI: 7.2-44.1), but 151 (85.8%) and 36(20.9%) for the same at post-intervention (X2 = 147.22, p = 0.000; CI: 49.3-80.1). At baseline, only 5 (2.8%) of the study and 6(3.5%) of the control groups ( X2 = 0.12, p = 0.730; CI: -14.2-12.8 ) brought two or more contacts for screening. At post-intervention, the figure rose to 114 (64.8%) and 9 (5.2%) (X2 = 134.94, p = 0.000; CI: 44.3-74.9) for the study and control groups respectively. Over 50% of the contacts brought for screening were less than 10 years; 31 (18.3%) at baseline to 138 (81.7%) post-intervention in the study group (CI: 47.6-79.2), and 26 (35.1%) to 38 (51.4%) for the control group (X2 = 12.472, p = 0.000; CI: 0.1 -32.5). CONCLUSION: Intensive planned health education intervention has been used to improve the contact tracing skills of the TB patients in a major TB centre in Enugu State, Nigeria. Further training and re-training of TB patients on contact tracing is highly recommended.