Knowledge and utilization of malaria preventive measures among pregnant women at a tertiary hospital in Nigeria's federal capital territory.

OBJECTIVE: To determine the knowledge and utilization of malaria preventive measures as well as barriers to the utilization of these measures by pregnant women. MATERIALS AND METHODS: The study was a prospective cross-sectional survey involving pregnant women at the booking clinic of the University of Abuja Teaching Hospital between May and August 2010. Close-ended pre-tested structured questionnaires were administered by interviewer method to 403 consecutive consenting women. RESULTS: The knowledge of malaria and its preventive measures in pregnancy was 71.5%. There was a statistically significant association between knowledge of malaria and educational status (X2 = 16.053, P = 0.035). Intermittent preventive treatment was used by 15.9% of the respondents. Insecticide-treated net ownership was 42.6%; however, its use declined from 28.5% before pregnancy to 24.6% during pregnancy. CONCLUSION: There is adequate knowledge about malaria and its preventive measures in pregnancy, but the utilization of these measures is poor. There is need for concerted efforts at addressing the barriers to utilization of these effective interventions.

Morphology and function of the rat oviduct: effects of thyroidectomy and thyroxine administration.

The effect of thyroidectomy and thyroxine administration on the morphology and function of the oviduct was studied in 40 albino rats. Chronic administration of 10 microg/100g for 60 days resulted in atrophy of the smooth muscle and mucosal folds. The thyroidectomized rats had reduced smooth muscle wall thickness, the epithelium reduced from columnar to cuboidal; and also flattening of mucosal folding. The contractile responses to oxytocin, acetylcholine and indeed the spontaneous contraction in the four thyroid states suggest a dependence of oviductal contraction on adequate plasma level of thyroid hormone in the vicinity of the contracting smooth muscle of the oviduct. The results suggest that thyroid hormone affects the morphology and function of the oviduct.

Mode of inhibitory actions of acute and chronic chloroquine administration on the electrically stimulated mouse diaphragm in vitro.

1. The effects of bath applied chloroquine (Chlo) and of acute and chronic Chlo administration on skeletal muscle reactivity to electrical stimulation and to drugs have been studied on mouse hemidiaphragm preparations in vitro. 2. Chlo (0.15-150 micrograms) produced a concentration-dependent inhibition twitch and tetanic contractions due to direct muscle stimulation (MS). Acute and chronic administration of Chlo (45 mg kg-1, i.p. daily, for 3-28 days) progressively shifted the concentration-response curve to bath-applied Chlo to the right, with maximum effect occurring from day 14 of Chlo pretreatment. 3. Acute and chronic administration of Chlo decreased the twitch and tetanus tension, raised the minimal fusion frequency (MFR) for tetanic contraction to occur and did not alter the twitch/tetanus tension ratio. Tetanus tension unlike twitch tension was not significantly decreased on day 3. 4. Caffeine (5-500 microM)--and isoprenaline (0.001-0.8 microM)-induced potentiations of twitch contraction were attenuated in a concentration-dependent manner by bath-applied Chlo and by acute and chronic administration of Chlo. Higher concentrations of caffeine (0.1-5 microM) and KCl (10 mM-130 mM) produced contracture of the muscle which was sensitive to inhibition by Chlo (50-150 microM). Moreover, the spike contractions superimposed on caffeine contracture were more sensitive to the inhibitory effect of Chlo than the contracture. 5. The inhibitory effects of dantrolene sodium and (+)-tubocurarine on MS and on indirectly stimulated hemidiaphragm respectively were not significantly altered by acute and chronic administration of Chlo. In contrast, the inhibitory concentration-response curve to procaine was shifted to the right. 6. The inhibitory effect of bath-appled Chlo, or acute and chronic pretreatment on twitch tension (MS) was not significantly antagonized by stepwise increase in extracellular Ca2 + (0.05-2.5 mM). Sodium thiocyanate (1-5 mM) reversed in a concentration-dependent manner the inhibitory effects of Chlo. 7. Complete recovery of twitch contractions occurred after 3 days of stopping daily Chlo administration, with partial recovery to tetanic tension after 28 days and no recovery of MFR. The reactivity of the diaphragm to bath applied Chlo was progressively restored, whereas the tension curve area to caffeine and KCI was still attenuated even 28 days after stopping Chlo pretreatment. 8. It is concluded that acute and chronic Chlo administration results in changes in reactivity of the hemidiaphragm muscle to electrical stimulation and to drugs such that there is a decrease in muscle strength and tolerance to Chlo in vitro. These effects are dependent on its direct inhibitory action on skeletal muscle and may result from interference with Ca2 + mobilization within the muscle.

Effects of Norplant contraceptive subdermal implants on serum lipids and lipoproteins.

A longitudinal, short-term study of women using NORPLANT (levonorgestrel implants) was conducted. Cholesterol content of the major lipoproteins along with total cholesterol and triglycerides were measured in fasting blood samples from 32 women volunteers. Results for lipids and lipoproteins determined 6 and 12 months post-NORPLANT insertion were compared with values obtained for samples taken just before implantation. Total serum triglycerides was significantly reduced (p < 0.01) from 1.14 +/- 0.44mmol/l (mean +/- SD) to 0.89 +/- 0.25mmol/l at six and to 0.89 +/- 0.34mmol/l at twelve months post-insertion. Serum total cholesterol was 3.97 +/- 0.53mmol/l at the time of insertion while at six and twelve months post-insertion, they were 3.65 +/- 0.49mmol/l and 3.56 +/- 0.71mmol/l, respectively. These changes in values from the time of insertion to twelve months, were statistically significant (P < 0.02). As regards lipoprotein fractions, high density lipoprotein-cholesterol (HDL-chol) exhibited statistically significant reduction (P < 0.001) from 1.38 +/- 0.34 mmol/l to 0.71 +/- 0.30 mmol/l (mean +/- SD) six months post-insertion. Although the value had improved to 1.14 +/- 0.38mmol/l by twelve months, the value was still significantly different from the pre-insertion value. The low density lipoprotein-cholesterol (LDL-chol) had a mean value (+/- SD) of 2.08 +/- 0.45 mmol/l at the time of insertion. This was significantly elevated (P < 0.001) at six months to 2.54 +/- 0.48mmol/l (mean +/- SD). The twelve-month post-insertion value of LDL-chol (2.02 +/- 0.79) was similar to the pre-insertion value. The shift in HDL-cholesterol and LDL-cholesterol within six months followed by a virtual return to the pre-insertion values may represent only a transient change in metabolism of lipids and lipoproteins consequent upon NORPLANT contraception.

Hysterectomy in the Hausa/Fulani population in Nigeria.

Two hundred and sixty-five abdominal hysterectomies performed in Ahmadu Bello University Teaching Hospital, Zaria (ABUTHZ) Nigeria form the basis of this study. The commonest indication for operation was fibroids with or without chronic pelvic inflammatory disease. The low incidence of dysfunctional uterine bleeding and endometriosis and the high incidence of trophoblastic disease were noted. The mortality rate was 0.82%. Compared to other series the morbidity rate was high and this was attributed to advanced pathology on presentation and the poor nutritional status of most of the patients.

A complication of a traditional puerperal practice in Nigeria.

PIP: There is an ancient area in Northern Nigeria inhabited mainly by traditionally-oriented natives, mostly Hausas and Fulanis. Women of these tribes traditionally deliver their babies at home under the care of midwives, using hospitals only as a last resort. Since cold is thought to carry puerperal illnesses, it is the practice among these people to initiate hot baths for mothers immediately after delivery. 2 major complication of the practice are peripartal cardiac failure and burns. The case is reported of 1 woman who was taken to a hospital with superficial burns as a result of the practice. She had continued to follow this practice despite earlier experience of cardiac failure by doing so. It may be easier to persuade these natives to use slightly colder water than to give up completely this entrenched practice.^ieng

Pregnancy and delivery after successful repair of vesicovaginal fistula.

Pregnant women (110) with successfully repaired vesicovaginal fistula, supervised at the Ahmadu Bello University Teaching Hospital in Zaria, Nigeria, formed the study population. The obstetric complications, mode of delivery and fetal outcome are reviewed. The obstetric complications and fetal outcome were compared with a matched hospital control group. There was a higher complication rate among the women with vesicovaginal fistulae, and the commonest complication was urinary tract infection. Perinatal mortality rate was 17.2% in the cases compared to 10.2% in the controls.

Effects of oral contraceptive pills on serum lipoproteins and triglycerides.

Possible effects of a combined oral contraceptive (femenal) on blood triglycerides and high-density-lipoprotein-cholesterol (HDL-Chol) were studied in 25 women who had opted for hormonal contraception. Total serum triglycerides of 64.60 +/- 12.39 mg/dl (mean +/- SD) obtained prior to the commencement of hormonal contraception, did not reveal any statistical difference from the value of 65.49 +/- 7.96 mg/dl obtained after 9 months contraception. Similarly, precontraception HDL-Chol value of 58.05 +/- 6.58 mg/dl was also not statistically different from the treatment value of 58.82 +/- 5.42 mg/dl. Regression analysis of the values between control (precontraception) and treatment (9 months contraception) showed high correlation coefficients: (1) serum triglycerides, R2 = 0.5201; P less than 0.001; (2) serum HDL-Chol, R2 = 0.6590; P less than 0.001. Both the mean body weight and blood pressure of the study subjects remained unchanged after 9 months continuous use of femenal for contraception.

Umbilical cord venous progesterone at term delivery in relation to mode of delivery.

OBJECTIVE: To determine whether the umbilical cord venous progesterone at term delivery is related to the mode of delivery. METHODS: Thirty-nine pregnant patients at term were divided into three groups: elective cesarean section (control), spontaneous vaginal delivery, and emergency cesarean section. Umbilical cord venous and maternal serum progesterone were measured by radioimmunoassay. Statistical analysis was carried out using Student's t-test, with the level of significance set at P < 0.05. RESULTS: Umbilical cord venous progesterone was significantly higher in babies delivered by emergency cesarean section (P < 0.001) and in those who had spontaneous vaginal delivery (P < 0.02), compared with the control group. Maternal serum progesterone concentrations showed no significant differences between the three groups. The Apgar scores of the stressed group of babies were significantly lower (P < 0.001). CONCLUSION: The findings demonstrate that the fetuses exposed to stress during labor produce higher progesterone secretion. This could be one possible way the fetus protects itself against the sequelae of hypoxia.

Hysterosalpingogram, laparoscopy and hysteroscopy in the assessment of the infertile Nigerian female.

Sixty-nine infertile Nigerian females were evaluated with hysterosalpingogram (HSG), laparoscopy and hysteroscopy as part of infertility workup at the endocrine-infertility clinic of the Jos University Teaching Hospital. HSG showed evidence of tubo-peritoneal disease in 45 (65%) women. This was confirmed by laparoscopy in 41 women giving an accuracy of 91% and a false positive rate of 9%. Intrauterine abnormalities were shown on HSG in 4 women and confirmed in 3 women at hysteroscopy giving an accuracy rate of 75% or a false positive rate of 25%. Intrauterine abnormalities were detected in 21 women in whom HSG was normal, giving a false negative rate of 30.4% for HSG. Tuboperitoneal disease was found at laparoscopy in 6 women in whom HSG was normal, giving a false negative rate for HSG of 8%. Our data confirm that laparoscopy and hysteroscopy are superior to HSG in detecting tubo-peritoneal and uterine abnormalities. Despite these findings, we believe that the three procedures are complementary in the evaluation of infertile couples in this country.

How safe is motherhood in Nigeria?: the trend of maternal mortality in a tertiary health institution.

OBJECTIVE: To determine the magnitude and trend of maternal mortality in Jos University Teaching Hospital, Jos, Nigeria. DESIGN: Retrospective study. SETTING: Jos University Teaching Hospital, Jos, Nigeria. SUBJECT: All women dying in pregnancy, labour and puerperium. MAIN OUTCOME MEASURES: Maternal mortality ratio, trend of maternal mortality, age, antenatal booking status, educational status, main causes of maternal death, factors contributing to maternal deaths. RESULTS: The maternal mortality ratio was 739/100,000 total deliveries and trend rose from 450/100,000 in 1990 to 1,060/100,000 total deliveries in 1994. About 33% of all maternal deaths occurred among teenagers. The risk factors for maternal deaths included adolescence, grand multiparity, illiteracy and non-utilisation of antenatal services. The main causes of maternal mortality were haemorrhage (28.1%), sepsis (21.3%) and eclampsia (15.7%). The contributions of complicated induced abortion and anaesthetic deaths in this study are worthy of mention. CONCLUSION: The maternal mortality ratio is unacceptably high in Jos University Teaching Hospital more particularly because of the rising trend. Socio-cultural and economic factors contributed immensely to the high maternal mortality in Jos. The objective of the World Health Organisation (WHO) to reduce maternal mortality by 50% by the year 2000 will not be achieved in this part of Nigeria. Nonetheless, improvement of the nation's economy coupled with a stable policy and provision of intrastructural facilities will assist to significantly reduce maternal mortality.

Age at menarche amongst school girls in a high altitude Nigerian town.

Menarche, the first menstrual period is believed to be influenced by many factors including altitude. The data of 331 school girls in Jos (1,300 m above sea level), a high altitude Nigerian town, that attained menarche between January 1989 were analysed. The mean menarcheal age for these school girls is 13.21 +/- 1.01 years. This value was not significantly different from 13.02 +/- 1.28 years found amongst school girls at Calabar (20 m above sea level) a Nigerian sea level resident sample. Perhaps, Jos is not situated at a high enough altitude to significantly affect the age at which menarche is attained.

Determination of gestational age by beta-subunit HCG measurement.

The accurate knowledge of gestational age is important in most Obstetric decisions near term. Gestational age estimation by a single measurement of beta-subunit HCG in early pregnancy was assessed in 164 Nigerian Women attending the antenatal clinic of Jos University Teaching Hospital. The mean difference between estimated gestational age by HCG concentrations and by recorded dates of last menstrual period was 2.8 +/- 1.6 days (mean +/- SD). This relationship was valid only for samples randomly selected between 35 and 56 days of gestation. We conclude that single measurement of HCG in early pregnancy provides accurate estimation of gestational age.

Levels of human chorionic gonadotropin in healthy pregnant Nigeria women.

Serum levels of human chorionic gonadotropin (hCG) were measured in venous blood samples of 100 healthy pregnant Nigerian women from weeks 5 to 40, using a batasubunit, hCG--specific radioimmunoassay. By week 5 hCG concentration was 3.39 +/- 2.35 Iu/ml (mean +/- SEM). An exponential rise occurred from week 5 to 8, during which period a direct relationship was observed between serum hCG levels and the gestational age (r2 = 0.996; p less than 0.001). The calculated mean doubling-time of hCG concentration, during this period of exponential increase was 5.08 days. A peak hCG concentration of 62.61 +/- 0.81 Iu/ml was attained at week 8, followed by a progressive decrease in concentration from week 9. The decrease in concentration reached a nadir by week 17 with a value of 4.77 +/- 2.48 Iu/ml. Between weeks 17 and 40 no significant difference in weekly mean values was detected. The respective mean values of hCG for the three trimesters were 25.79 Iu/ml for the first (n = 32), 8.91 Iu/ml for the second (n = 86) and 5.18 Iu/ml for the third (n = 110). There was no secondary peak of hcG concentration during the third trimester. The significance of these data is discussed.

Ovarian function after salpingostomy following mechanically produced hydrosalpinx in rabbits.

The discrepancy between pregnancy and patency rates after salpingostomy is explained largely by the residual functional damage to both the mucosa and smooth muscles of the fallopian tube. The function of the ovary after salpingostomy has not been extensively studied. Hydrosalpinx was mechanically induced by double clip application in thirty adult female New Zealand white rabbits. After varying periods of hydrosalpinx formation, ampullary-isthmic anastomosis and cuff-salpingostomy were carried out using full microsurgical techniques. The animals were mated 1 week after surgery. Ten days after mating, laparotomy was performed. The contralateral oviducts and oviducts from unoperated animals served as controls 1 and 2 respectively. Corpora lutea counts and ovarian venous estradiol 17B (E2) and progesterone (P) levels were measured to assess ovarian function. The mean values (+/- s.e.) for corpora lutea count on Control 1, Control 2 and operated sides were 6.46 +/- 0.43, 5.69 +/- 0.44 and 4.03 +/- 0.32 respectively. The mean values for E2 and P were 159.0 +/- 17.43 and 281.769 +/- 13.58; 133.75 +/- 18.45 and 265.89 +/- 18.12; 128.57 +/- 14.66 and 206.103 +/- 13.296 respectively. Only the differences between the mean number of corpora lutea and mean progesterone were statistically significant (P less than 0.001) (0.02 greater than P greater than 0.01) respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Fertility after salpingostomy following mechanically produced hydrosalpinx in rabbits.

Microsurgical salpingostomy results in 90% of tubes remaining patent following surgery. Although pregnancy rates have improved to a slight extent, the percentage of patients having live babies after salpingostomy is still disappointing. The discrepancy between patency rates and pregnancy rates seems to be due mainly to long standing tubal damage after the original infection. Possibly, raised intraluminal pressure from accumulated fluid may be a factor. Mechanically produced hydrosalpinges in rabbits show similar morphological characteristics to human hydrosalpinges (Vasquez et al., 1981, Otubu et al., 1984). This rabbit model was used in this study to examine the relationship between the severity of these changes and fertility after salpingostomy. Mechanical hydrosalpinges were produced in thirty mature New Zealand white rabbits by double clip application. After a period varying from 8 to 52 weeks of clip application, cuff salpingostomy and ampullary-isthmic anastomosis was done. One week after surgery, the animals were mated with bucks of proven fertility. There were pregnancies in all the uterine horns on the unoperated side (control) in all animals. There were pregnancies on the operated side in only two animals giving a pregnancy rate of 6.7%. A total of sixteen tubes were patent out of thirty operated, giving a patency rate of 53.3%. Adhesion was a major problem. We conclude that fertility is reduced after salpingostomy in mechanically produced hydrosalpinges in rabbits. The significance of this finding is discussed.

Spontaneous contractile pattern of isolated circular and longitudinal muscle layers from the ampullae of normal and damaged fallopian tubes.

Ampullary biopsies were obtained from twenty-three normal fertile women and from eleven women with hydrosalpinges. The contractile activity of 4-mm muscle strips was studied isometrically in organ bath. Both normal circular and longitudinal muscle strips contracted with similar frequency, duration and amplitude. Circular and longitudinal muscle strips from hydrosalpinges contracted with a lower frequency and a longer duration and the amplitude of contractions was higher than normal. The difference in frequency and duration was statistically significant. The possible explanations for these differences in rhythmicity between normal and diseased fallopian tubes are presented and the prognostic relevance discussed.

Hysteroscopy in infertile Nigerian women.

The uterine cavity was evaluated by hysteroscopy in 20 Nigerian women aged 23-40 years, as part of the investigations of primary or secondary infertility. Intra-uterine abnormalities were detected in 45% of the patients. These abnormalities included intra-uterine adhesions (20%), endometrial polyps (10%), sub-mucous fibroids (5%), endometrial atrophy (5%), and endocervical cysts (5%). This preliminary report reveals a high diagnostic yield with hysteroscopy. The advantages and complications of the procedure are discussed.

Morphology of human and experimental hydrosalpinges: a comparative study.

Infection, and possibly raised intra-luminal pressure, may be responsible for the morphological changes and associated infertility that occur with hydrosalpinx formation. Biopsies from human hydrosalpinges were studied by light microscopy and scanning and transmission electron microscopy. Loss of mucosal folds, atrophied epithelium and varying degrees of deciliation were the main features found. Mechanical hydrosalpinges were produced in rabbits by double clip application (duration of clip application varied from 8 to 52 weeks). Morphological study of animal hydrosalpinges showed partial or complete loss of mucosal folds, atrophied epithelium and varying degrees of deciliation. The severity of morphological changes was related to duration of clip application. It is concluded that raised intra-luminal pressure plays a role in the morphological changes seen in human hydrosalpinges and infertility in women after anatomically successful salpingostomy. The rabbit would appear to provide a suitable model for the study of human hydrosalpinges. The significance of these findings is discussed in relation to the clinical management of hydrosalpinges.

Total phospholipid choline concentration of amniotic fluid in the assessment of foetal gestational and lung maturity. II. Correlation study.

Analysis of total phospholipid choline concentration was carried out on amniotic fluid samples obtained from 20 pregnant Nigerian women in established labour to determine the correlation of amniotic fluid phospholipid choline concentration with the gestational ages and maturity of the infants. There was a positive correlation between phospholipid choline concentration and gestational age. All infants whose gestational ages were estimated to be over 36 weeks had a total phospholipid concentration greater than 50 mumols/l. Four infants whose gestational ages were less than 36 weeks had total phospholipid choline concentration less than 30 mumols/l. None of these infants showed any evidence of Respiratory Distress Syndrome.