Post-partum mental disorders in Sagamu.

BACKGROUND: Pregnancy and labour are sufficiently stressful to precipitate mental disorders in women after delivery. This may arise newly, as a recurrence or an exacerbation of previously existing mental illness in the individual woman. Postpartum mental disorders are under reported in our practices. OBJECTIVE: To determine the incidence of post-partum mental disorders in our practice, pattern of presentation and the commonly associated factors. DESIGN: A retrospective descriptive study. SETTING: Olabisi Onabanjo University, Sagamu, Nigeria. RESULTS: During the study period there were a total of 9085 deliveries and 27 cases of puerperal mental illness. This gave an incidence of 2.9 per 1000 births. The mean age and mean parity of patients were 27.3 (+/- 7.9 SD) and 2.3 (+/- 1.8 SD) respectively. The mean delivery-presentation interval and mean length of hospitalisation were 11.5 (+/- 7.15 SD) and 12.4 (+/- 5.8) respectively. CONCLUSION: Incidence of post-partum mental illness in our practice is 2.9 per 1000 births. There were preponderance of primiparity and young maternal age in the study group. Family history of psychiatric disorders and marital disharmony appear to play major role in the aetiology of these disorders in our practice.

Selenium and aspirin in people living with HIV and AIDS in Nigeria.

OBJECTIVES: Aspirin and selenium have been shown in vitro and in vivo to inhibit HIV production through inhibition of the transcription factor, the nuclear factor kappa binding (NF-eB). The aim of this study was to examine the efficacy or otherwise of these drugs in people living with HIV and AIDS (PLWAS) in resource limited countries. PATIENTS AND METHODS: Consenting HAART-naive PLWAS with mean CD4 count of 256.8 +/- 67.6 cells/ul were recruited into the study. Pretherapy blood count, serum biochemistry, chest x-ray, urinary glucose and protein and microscopy and culture of both urine and stool were checked in all cases. Each patient was treated for six months and CD4 counts were repeated at the end of the study. Thirty two patients (23 (72%) females and nine (28%) males), aged 22-52 (median = 36) years were recruited. Twenty-three (72%) were randomised into selenium and aspirin (SAM) and nine (28%) into selenium (SM); multivitamin was added to each arm. RESULTS: Eighteen (56.2%) patients completed the study. Sixteen (88.9%) patients are already on HAART since the termination of the study; one absconded and one died of disease progression. Fourteen (43.8%) of the initial 32 patients dropped out (11 (78.6%) were lost to follow-up, two (14.3%) died and one (7.1%) opted for HAART before completing the study). The post-treatment CD4 count was 293.0 +/-102.2 cells/ml, compared to the pre-therapy mean of 256.8 +/- 67.6 cells/ul, an average rise of 36.2 cells/ul, the difference was not statistically significant (p = 0.059). The post-therapy mean weight was significantly higher than the pretherapy weight, 61.6+/-15.2 kg versus 60.0+/-14.3 kg (p = 0.015). CONCLUSION: The SAM/SM combination regimen improved the quality of life of PLWAS, however, a greater number of patients and a longer period of follow up, are necessary to arrive at a more meaningful conclusion.

Changing patterns of emergency obstetric care at a Nigerian University hospital.

OBJECTIVE: To analyze the changing patterns of critical obstetric care over two consecutive 3-year periods and identify the factors responsible for the trend through combined audits of near miss and maternal mortality at a Nigerian University hospital. METHODS: Retrospective audit and comparison of "near misses" and maternal deaths recorded in 1999-2001 and 2002-2004 at a tertiary care center in southwest Nigeria. The definition of near miss morbidity was based on validated disease-specific criteria. For each near miss and maternal death, the local audit committee compared the actual management with local treatment protocols and explored avoidable factors. Case fatality rate was calculated for "critically ill obstetric patients" (CIOP-CFR) for both periods. The cause-specific case fatality rate (CFR) was used to assess the trend in standards of care for life-threatening obstetric conditions. Data were compared using the chi(2) or Fisher's exact test. P<0.05 was considered statistically significant. RESULTS: There were 175 near misses and 27 maternal deaths in 1999-2001 and 211 near misses and 44 maternal deaths in 2002-2004. The CIOP-CFRs for the two periods showed a declining (but non-significant) trend in the standard of emergency obstetric care for life-threatening conditions (13.4% to 17.3%, P=0.250). The CIOP-CFR for postpartum hemorrhage significantly increased from 3.1% to 21.1% in the 2nd period (P=0.033), reflecting a decline in the standard of care. Lack of blood for transfusion became a more significant administrative problem in the 2nd period occurring in 17.8% of all critically ill patients managed in 2002-2004. There was a notable though statistically insignificant increase in the non-adherence to treatment protocol among cases of maternal death in 2002-2004 compared with 1999-2001. CONCLUSIONS: The standard of critical obstetric care in this center is suboptimal with no evident improvement over the 6-year period. This audit supports the feasibility of including near miss reviews in maternal death audits to provide insights into the trend in the quality of emergency services for severe maternal complications while highlighting factors associated with deficiency or improvement in care for specific maternal conditions.

Cervical cancer screening at Ibadan.

Over a period of 44 months, 3171 smears were performed at the University College Hospital (UCH). Ibadan, Cytology Clinic. Of these, 44.2% were in asymptomatic women. Fifty-five point three percent were normal; 15.6% of the smears were reported as non-specific inflammatory changes while 20.1% were due to specific infections. Varying degrees of cervical intra-epithelial neoplasia (CIN) were diagnosed in 8.4% of the smears. The abdominal smears were treated with chemotherapy, cryocautery, diathermy, cone biopsy and hysterectomy. A simplified management plan for a patient with an abnormal smear based on our experience is also presented.

Spectrum and outcome of clinical diseases in adults living with AIDS at the Ogun State University Teaching Hospital.

OBJECTIVES: To evaluate the changing frequency of HIV/AIDS amongst medical admissions as well as the spectrum and outcome of clinical diseases among these patients. DESIGN: Retrospective study. SETTING: Tertiary hospital in Nigeria. PARTICIPANTS: Two hundred and six People Living With AIDS (PLWA) admitted at the medical wards during the period 1992 to 2002. INTERVENTION: Treatment was symptomatic in all patients and where appropriate, specific treatment was administered for indicator diseases. Highly Active Anti-retroviral Therapy (HAART) was not used. MAIN OUTCOME MEASURES: Mortality within six months of diagnosis. RESULTS: PLWA constituted 4.2% of all medical admissions. The frequency increased from 0% in 1992 to 7.6% in 2001, and dropped to 5% by the year 2002. Seventy patients (34%) died within six months of diagnosis. RESULTS: This study has demonstrated an increasing frequency of HIV/AIDS amongst our medical in-patients from none in 1992 to 7.6% in 2001, and thereafter, a decline in 2002. We suspect that this decline could be a reflection of the health education on HIV, its increasing awareness and the widespread utilisation of effective control measures. Furthermore, the administration of highly active anti retroviral therapy (HAART) to a segment of PLWA in Sagamu by the community medicine department could be contributory. CONCLUSION: A community based study would be needed to assess the efficacy or otherwise of these current control measures. The advent of saliva and urine tests for HIV detection would ease specimen collection and increase compliance and participation at the community level.