An Evaluation of Platelet Factor 4, Beta-Thromboglobulin and Mean Platelet Volume in the Assessment of Thrombotic Risks in Subjects with Diabetes Mellitus at Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria.

BACKGROUND: Beta-thromboglobulin and platelet factor 4 are known platelet-specific proteins that are stored in the platelet alpha-granules and released during platelet activation. The measurement of these proteins can reflect the degree of platelet activation and indirectly suggest a pro-thrombotic state. This study aimed at determining serum levels of Betathromboglobulin, mean platelet volume, and platelet factor 4 in diabetes mellitus and control subjects in Lagos, Nigeria. MATERIALS AND METHODS: Using enzyme-linked immunosorbent assay at Lagos State University Teaching Hospital, Ikeja, this study evaluated serum concentrations of Beta-thromboglobulin, and platelet factor 4, the mean platelet volume was also determined from a Full Blood Count of all participants. Data were analyzed using Statistical Package for Social Sciences, Inc., Chicago, Ill; version 26.0. The continuous variables were given as mean ± standard deviation. The P-value was considered to be statistically significant when ≤0.05. RESULTS: Beta-thromboglobulin concentration was higher and statistically significant (7.82 ± 1.54ng/ml and 6.70 ± 2.23 ng/ml; P = 0.01), platelet factor 4 (39.86 ± 11.25 ng/ml and 47.73 ± 21.73ng/ml, P = 0.06) and mean platelet volume (10.26± 1.06fl and 10.29 ± 1.02fl P = 0.89) were not statistically significant in the diabetes mellitus group compared with non-diabetic participants, platelet factor 4 was higher in the older than younger diabetes mellitus participants. CONCLUSION: Elevated Beta-thromboglobulin may suggest a possible increase in thrombotic risks among diabetes mellitus.

CONTEXTE: La bêta-thromboglobuline et le facteur plaquettaire 4 sont des protéines spécifiques des plaquettes qui sont stockées dans les alpha-granules plaquettaires et libérées lors de l'activation des plaquettes. La mesure de ces protéines peut refléter le degré d'activation des plaquettes et suggérer indirectement un état prothrombotique. Cette étude visait à déterminer les taux sériques de bêta-thromboglobuline, le volume plaquettaire moyen et le facteur plaquettaire 4 chez des sujets atteints de diabète sucré et des sujets témoins à Lagos, au Nigéria. MATÉRIEL ET MÉTHODES: En utilisant le dosage immunoenzymatique au Lagos State University Teaching Hospital, Ikeja, cette étude a évalué les concentrations sériques de bêtathromboglobuline et de facteur plaquettaire 4, le volume plaquettaire moyen a également été déterminé à partir d'une numération globulaire complète de tous les participants. Les données ont été analysées à l'aide du logiciel Statistical Package for Social Sciences, Inc, Chicago,Ill ; version 26.0. Les variables continues ont été exprimées en moyen ± écart-type. La valeur P a été considérée comme statistiquement significative lorsqu'elle était inférieure à ≤0,05. RÉSULTATS: La concentration de bêta-thromboglobuline était plus élevée et statistiquement significative (7,82±1,54ng/ml et 6,70±2,23 ng/ml ; P=0,01), le facteur plaquettaire 4 (39,86±11,25 ng/ml et 47,73±21,73 ng/ml, P=0,06) et le volume plaquettaire moyen (10. 26± 1.06fl et 10.29±1.02fl P= 0.89) n'étaient pas statistiquement significatifs dans le groupe diabète sucré par rapport aux participants non-diabétiques, le facteur plaquettaire 4 était plus élevé chez les participants diabétiques plus âgés que chez les plus jeunes. CONCLUSION: Un taux élevé de bêta-thromboglobuline peutsuggérer une augmentation possible des risques thrombotiques chez les personnes atteintes de diabète sucré. Mots-clés: Bêta-thromboglobuline, facteur plaquettaire 4, volume plaquettaire moyen.

African coastal camera network efforts at monitoring ocean, climate, and human impacts.

Regular and long-term monitoring of coastal areas is a prerequisite to avoiding or mitigating the impacts of climate and human-driven hazards. In Africa, where populations and infrastructures are particularly exposed to risk, there is an urgent need to establish coastal monitoring, as observations are generally scarce. Measurement campaigns and very high-resolution satellite imagery are costly, while freely available satellite observations have temporal and spatial resolutions that are not suited to capture the event scale. To address the gap, a network of low-cost, multi-variable, shore-based video camera systems has been installed along the African coasts. Here, we present this network and its principle of sharing data, methods, and results obtained, building toward the implementation of a common integrated coastal management policy between countries. Further, we list new contributions to the understanding of still poorly documented African beaches' evolution, waves, and sea level impacts. This network is a solid platform for the development of inter-disciplinary observations for resources and ecology (such as fisheries, and sargassum landing), erosion and flooding, early warning systems during extreme events, and science-based coastal infrastructure management for sustainable future coasts.

Maternal near-miss and death among women with postpartum haemorrhage: a secondary analysis of the Nigeria Near-miss and Maternal Death Survey.

OBJECTIVE: To investigate the burden and health service events surrounding severe maternal outcomes (SMO) related to life-threatening postpartum haemorrhage (PPH) in Nigerian public tertiary hospitals. DESIGN: Secondary analysis of a nationwide cross-sectional study. SETTING: Forty-two tertiary hospitals. POPULATION: Women admitted for pregnancy, childbirth or puerperal complications. METHODS: All cases of SMO [maternal near miss (MNM) or maternal death (MD)] due to PPH were prospectively identified using WHO criteria over a 1-year period. MAIN OUTCOME MEASURES: Incidence of SMO, health service events, case fatality rate (CFR) and mortality index (MI: % of death/SMO). RESULTS: Postpartum haemorrhage occurred in 2087 (2.2%) of the 94 835 deliveries recorded during the study period. A total of 354 (0.3%) women had an SMO (103 MD; 251 MNM). It was the most frequent obstetric haemorrhagic complication across hospitals. PPH had the highest maternal mortality ratio (112/100 000 live births) and the recorded MI (29.1%) and CFR (4.9%) were second only to that of ruptured uterus. About 83% of women with SMO were admitted in a critical condition with over 50% being referred. MD was more likely when PPH led to neurological (80.8%), renal (73.5%) or respiratory (58.7%) organ dysfunction. Although the timing of life-saving interventions was not statistically different between the cases of MD and MNM, close to one-quarter of women who died received critical intervention at least 4 hours after diagnosis of life-threatening PPH. CONCLUSIONS: Postpartum haemorrhage was a significant contributor to obstetric haemorrhage and SMO in Nigerian hospitals. Emergency obstetric services should be enhanced at the lower levels of healthcare delivery to reduce avoidable deaths from PPH. FUNDING: The original research that generated the data for this secondary analysis, and the publication of this secondary analysis, was funded by the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research Development and Research Training in Human Reproduction (HRP), a cosponsored programme executed by the World Health Organization. We have no other funding issue to declare for our study. TWEETABLE ABSTRACT: One hundred and three maternal deaths and 251 near-misses resulted from PPH in 42 Nigerian tertiary facilities in 1 year.

Community health workers' knowledge and practice in relation to pre-eclampsia in Ogun State, Nigeria: an essential bridge to maternal survival.

BACKGROUND: Pre-eclampsia is a leading cause of maternal and fetal morbidity and mortality worldwide. Early detection and treatment have been instrumental in reducing case fatality in high-income countries. To achieve this in a low-income country, like Nigeria, community health workers who man primary health centres must have adequate knowledge and skills to identify and provide emergency care for women with pre-eclampsia. This study aimed to determine community health workers' knowledge and practice in the identification and treatment of pre-eclampsia, as they are essential providers of maternal care services in Nigeria. METHODS: This study was part of a multi-country evaluation of community treatment of pre-eclampsia. Qualitative data were obtained from four Local Government Areas of Ogun State, in south western Nigeria by focus group discussions (N = 15) and in-depth interviews (N = 19). Participants included a variety of community-based health care providers - traditional birth attendants, community health extension workers, nurses and midwives, chief nursing officers, medical officers - and health administrators. Data were transcribed and validated with field notes and analysed with NVivo 10.0. RESULTS: Community-based health care providers proved to be aware that pre-eclampsia was due to the development of hypertension and proteinuria in pregnant women. They had a good understanding of the features of the condition and were capable of identifying women at risk, initiating care, and referring women with this condition. However, some were not comfortable managing the condition because of the limitation in their 'Standing Order'; these guidelines do not explicitly authorize community health extension workers to treat pre-eclampsia in the community. CONCLUSION: Community-based health care providers were capable of identifying and initiating appropriate care for women with pre-eclampsia. These competencies combined with training and equipment availability could improve maternal health in the rural areas. There is a need for regular training and retraining to enable successful task-sharing with these cadres. TRIAL REGISTRATION: NCT01911494 .

When getting there is not enough: a nationwide cross-sectional study of 998 maternal deaths and 1451 near-misses in public tertiary hospitals in a low-income country.

OBJECTIVE: To investigate the burden and causes of life-threatening maternal complications and the quality of emergency obstetric care in Nigerian public tertiary hospitals. DESIGN: Nationwide cross-sectional study. SETTING: Forty-two tertiary hospitals. POPULATION: Women admitted for pregnancy, childbirth and puerperal complications. METHODS: All cases of severe maternal outcome (SMO: maternal near-miss or maternal death) were prospectively identified using the WHO criteria over a 1-year period. MAIN OUTCOME MEASURES: Incidence and causes of SMO, health service events, case fatality rate, and mortality index (% of maternal death/SMO). RESULTS: Participating hospitals recorded 91 724 live births and 5910 stillbirths. A total of 2449 women had an SMO, including 1451 near-misses and 998 maternal deaths (2.7, 1.6 and 1.1% of live births, respectively). The majority (91.8%) of SMO cases were admitted in critical condition. Leading causes of SMO were pre-eclampsia/eclampsia (23.4%) and postpartum haemorrhage (14.4%). The overall mortality index for life-threatening conditions was 40.8%. For all SMOs, the median time between diagnosis and critical intervention was 60 minutes (IQR: 21-215 minutes) but in 21.9% of cases, it was over 4 hours. Late presentation (35.3%), lack of health insurance (17.5%) and non-availability of blood/blood products (12.7%) were the most frequent problems associated with deficiencies in care. CONCLUSIONS: Improving the chances of maternal survival would not only require timely application of life-saving interventions but also their safe, efficient and equitable use. Maternal mortality reduction strategies in Nigeria should address the deficiencies identified in tertiary hospital care and prioritise the prevention of severe complications at lower levels of care. TWEETABLE ABSTRACT: Of 998 maternal deaths and 1451 near-misses reported in a network of 42 Nigerian tertiary hospitals in 1 year.

Postpartum sexual abstinence and breastfeeding pattern in Sagamu, Nigeria.

This was a prospective study involving 371 mothers. The mean age of the mothers was 27.5 (.3.6) years with a mean years at school (Educational years) of 11.3 (2.9) years. All the mothers had previously breastfed at one of their infants for at least 6 months, while the mothers also breastfed their last child for an average (mean) of 10.3 (4.0) months. The overall mean of previous live births was 1.9 (0.8). In the first month postpartum, 84.6% of the mothers abstained from sexual intercourse, but by the 4th-5th month the proportion had dropped to 18.1%, with just 2.1% of the study population abstaining from sexual intercourse at 11-15 months post-partum. Forty seven (13.5%), 30 (8.6%) and 3 (0.9%) mothers in social classes 2,3 and 1 respectively have resumed sexual intercourse at 4-5 months, while only 12 (3.4%) and 4 (1.1%) in social classes 2 and 3 respectively continued with sexual intercourse at 11-15 months. More mothers resumed sexual intercourse from 1 to 15 months post-partum when they breast fed for 6-10 minutes and 11-15 minutes than those who breast fed for 1-5 minutes, 16-20 minutes and 21-25 minutes. Also more mothers within the 25-29 years age group resumed sexual intercourse from the first month to the fifteenth month post-partum than mothers in the other age groups.

Postpartum sexual abstinence and breastfeeding pattern in Sagamu, Nigeria

This was a prospective study involving 371 mothers. The mean age of the mothers was 27.5 (.3.6) years with a mean years at school (Educational years) of 11.3 (2.9) years. All the mothers had previously breastfed at one of their infants for at least 6 months, while the mothers also breastfed their last child for an average (mean) of 10.3 (4.0) months. The overall mean of previous live births was 1.9 (0.8). In the first month postpartum, 84.6% of the mothers abstained from sexual intercourse, but by the 4th-5th month the proportion had dropped to 18.1%, with just 2.1% of the study population abstaining from sexual intercourse at 11-15 months post-partum. Forty seven (13.5%), 30 (8.6% ) and 3 (0.9 % ) mothers in social classes 2,3 and 1 respectively have resumed sexual intercourse at 4-5 months, while only 12(3.4%) and 4(1.1%) in social classes 2 and 3 respectively continued with sexual intercourse at 11-15 months. More mothers resumed sexual intercourse from 1 to 15 months post-partum when they breast fed for 6-10 minutes and 11-15 minutes than those who breast fed for 1-5 minutes, 16-20 minutes and 21-25 minutes. Also more mothers within the 25-29 years age group resumed sexual intercourse from the first month to the fifteenth month post-partum than mothers in the other age groups. (Afr Reprod Health 2008; 12[1]:96-100)

Does training assist medical laboratory scientists with better evaluation of sperm morphology?

This study aimed to evaluate the quality of sperm morphology evaluation skills of 16 technologists who are responsible for semen analyses in their institution. The 1-day workshop was held at the Centre for Research in Reproductive Health in Sagamu, Nigeria. Participants were requested to complete a questionnaire that provided information regarding their experience and training as technologists in their institution. The workshop consisted of 4 sections, namely (i) pre-training test, (ii) lectures on morphometric characteristics and details of normal and abnormal sperm (iii) a laboratory-based hands-on, post training test and (iv) a consensus training session. The findings of the questionnaire indicated that none of the participants had any previous formal training and that all participants had very little knowledge about the morphological appearance of normal spermatozoa. These findings were supported by the results obtained during the pre-training session that showed a mean percentage difference of 24% between the reference and participant's values. These somewhat alarming results highlight the need for training facilities for technologists who work in the clinical diagnostic field of reproductive science.

The establishment of sperm morphology satellite training laboratories in Africa.

Summary Discrepancies in the results of semen analysis can be caused by a variety of factors, for example, a microscope for semen analysis can be situated in the practice of an urologist, cytologist or microbiologist, or even in a health care office in the countryside in a developing country. The study aimed to evaluate the (i) sperm morphology assessment skills of the participants who attended WHO seminology workshops and (ii) to appraise the possibility of using trained technologists to set up satellite training facilities in their own area. The Centre for Research in Reproductive Health, Ogun State University Teaching Hospital (Nigeria) initiated training sessions in their area. Subsequently, 16 technologists were trained in three sessions. Papanicolaou-stained slides, supplied by Tygerberg were used as test material. Pre- and post-training results were used to calculate the mean percentage of normal cells as well as the percentage deviation from the reference laboratory. The mean percentage normal spermatozoa recorded by the Nigerian trainees during pre-training evaluations differed by 38% from the reference value, compared with a post-training difference of 16% (P < 0.001). Tertiary academic hospitals can play an important educational role in the region. The present results underline the power of long distance educational programmes. Similar laboratories are currently being set up in Kenya and Zambia.

Infant feeding and lactational amenorrhea in Sagamu, Nigeria.

Five hundred and twenty educated, breastfeeding women in Sagamu, Nigeria, were observed prospectively in order to describe their infant feeding practices and to determine whether any predictors of the return of menses could be identified. The women remained amenorrheic for seven months. Compared with similarly selected women in other countries, they regularly fed their infants with supplements from a very early age, yet breastfeeding frequency and duration did not decline dramatically. Semi-solid food was introduced at about four months and such supplementation, as well as earlier supplementation with milk/milk-based feedings, was associated with the return of menses. The median duration of abstinence was about four months but the mean may have been much longer. No woman became pregnant until her infant was weaned.

Investigation of hormonal male contraception in African men: suppression of spermatogenesis by oral desogestrel with depot testosterone.

BACKGROUND: Suppression of spermatogenesis to azoospermia is required for effective hormonal male contraception, but the degree of suppression varies between ethnic groups. We here report the first study of hormonal suppression of spermatogenesis in two African centres using a regimen of oral progestogen with depot testosterone. METHODS A total of 31 healthy men (21 black) were recruited in Cape Town and 21 men in Sagamu, Nigeria. Subjects were randomized to take either 150 or 300 micro g desogestrel daily p.o. with testosterone pellets. In Cape Town, desogestrel was administered for 24 weeks with 400 mg testosterone re-administered 12 weekly. In Sagamu, desogestrel was administered for 52 weeks with 200 mg testosterone (later increased to 400 mg) re-administered 12-weekly. RESULTS: In Cape Town, 22 men completed at least 20 weeks treatment. Azoospermia was achieved in 8/10 and 8/12 men in the 150 micro g and 300 micro g desogestrel groups. Four men in Sagamu withdrew. Azoospermia was achieved in all 17 men in the two groups. There were no significant changes in lipoprotein or haemoglobin concentrations in any group. CONCLUSION: These data demonstrate that the combination of oral desogestrel with depot testosterone is an effective regimen for suppression of spermatogenesis in African as in Caucasian and Chinese men, with azoospermia achieved in a total of 83/98 (85%) men.

Chloroquine reduces fertilizing capacity of epididyma sperm in rats.

Chloroquine diphosphate was administered intraperioneally to two groups of adult male rats at two dosage levels of 5 mg base/kg body weight and 10 mg base/kg body weight. The drug was administered over a period of fourteen days. Fertilizing ability of epididymal sperm was assessed in the rats by cohabitation with normal cycle female rats and foetal size was noted. Epididymal spermatozoa were counted in these groups of rats. Chloroquine effected a dose-related reduction in fertility of the male rats as evidenced by a reduction in average number of foetuses of cohabited females, although the sperm count in the groups was not significantly different. This suggest that the drug does play an inhibitory role in sperm function.

Chloroquine excretion in semen following antimalarial-drug administration.

The study described here was carried out to establish whether or not chloroquine was excreted in semen. Chloroquine was assayed in the semen of eight male volunteers (aged between 19 and 45 years) by a fluorimetric method before and after taking a total dose of 1.500 mg chloroquine base corresponding to the accepted dosage of the drug in malarial chemotherapy. Mean pre- and post-drug administration levels of 0.7 +/- 0.2 microM and 5.7 +/- 0.6 microM were obtained respectively, indicating a significant excretion of chloroquine in semen.

Brief description of WHO protocol for data collection.

PIP: WHO Simplified Methodology (1987) is being applied in several studies: the Task Force on Methods for the Natural Regulation of Fertility of the Special Program on Human Reproduction in centers in Chendu, China; Guatemala City, Guatemala; New Delhi, India; Sagamu, Nigeria; Santiago, Chile; Uppsala, Sweden; and Westmead/Sydney, Australia. 550 lactating mothers who can read and write were examined in order to provide a better understanding of the relationship between breast-feeding duration and lactational amenorrhea, and to determine whether the longitudinal study results are applicable to the general population. Protocol involved data collection of breast-feeding frequency, timing, and duration; supplementary feeding characteristics and timing; and maternal and infant health. WHO protocol is also being examined in studies in Colombo, Sri Lanka, and Sagamu, Nigeria. The study objective was to examine the effect of maternal nutritional supplementation with skimmed milk powder in Colombo and a high protein biscuit in Sagamu on the duration of lactational amenorrhea in moderately malnourished breast-feeding mothers. Followup studies are expected. Optimally, the end product should be a measure of the presence of ovulation, however, the logistics prevented this from occurring. Instead, weekly urine samples were collected and tested for the presence of estrogen and pregnanediol glucuronide. Motivation is a key determinant in the success of these projects, since detailed record keeping over a prolonged period of time is required. Motivational interventions vary between centers and may involve social contact with investigators or health care support for the mother and infant. Some preliminary results indicate that the higher the percentage receiving supplementation, the earlier the return of the menses.^ieng

Comparative study of glycosylated haemoglobin and serum fructosamine values in children with protein-energy malnutrition.

Serum fructosamine, glycosylated haemoglobin (HbAic), fasting blood glucose and serum proteins were determined in 50 malnourished children aged 1-5 years and in 25 healthy and nutritionally normal children of the same age group. It was observed that both HbAic and fructosamine values correlated well with the blood glucose values of the patients. It was also observed that the patients had significantly elevated values of HbAic, indicating the existence of glucose intolerance in them. In contrast, the fructosamine values were significantly reduced in the patients and this was attributed to the hypoproteinaemia in such patients. It was concluded that while both HbAic frustosamine correlate well with blood glucose values, HbAic gives a better reflection of the glycaemic status of malnourished children because its level is not significantly altered by hypoproteinaemia. HbAic measurement may, therefore, be a more reliable indicator of glucose status than serum fructosamine in children with protein-energy malnutrition.

Glycosylated haemoglobin levels in children with protein-energy malnutrition.

Fasting blood glucose, serum protein and glycosylated haemoglobin level (HbA1c) were determined in 50 children (aged 1-5 years) suffering from protein-energy malnutrition and in 25 healthy and nutritionally normal children of the same age group. It was observed that HbA1c correlated well with the blood glucose values of the children. It was also observed that they had significantly higher values of HbA1c than the controls, indicating the existence in them of glucose intolerance. Long-term monitoring of the glycaemic status is therefore suggested as a means of assessing any relationship between glycosylated haemoglobin and impaired pancreatic function in such patients.

The effect of thyroid hormones on the membrane adenylate cyclase activity in sickle red blood cells in vitro.

A comparative study of thyroid hormone responsive membrane adenylate cyclase activity has been carried out on normal (Hb-AA) and sickle cell (Hb-SS) subjects. Thyroid hormones (T3 and T4) and selected analogues (TRIAC and DLT) enhanced adenylate cyclase activity in Hb-AA membranes. The interaction of Hb-SS membranes with the hormones and analogues was not significant except for T3 which moderately stimulated Hb-SS membrane adenylate cyclase. We suggest that circulating irreversibly sickled cells, in view of their membrane phospholipid defect, probably contribute to the low response of membrane adenylate cyclase to effector stimulation.

Effect of chronic chloroquine treatment on prostaglandin and human chorionic gonadotropin (hCG) stimulation of testosterone secretion by the rat testis.

The effect of chronic chloroquine administration on prostaglandin E1 (PGE1) and human chorionic gonadotropin (hCG) stimulation of testosterone secretion by the rat Leydig cells was studied. Adult albino (Wistar strain) rats were injected with 4 mg/kg body weight of chloroquine phosphate every other day for 30 days. At the end of the period of treatment, the rats were sacrificed and the Leydig cells incubated with hCG and/or PGE1 for 3 hrs. The amount of testosterone secreted was estimated by radioimmunoassay. Chronic chloroquine treatment did not affect the activity of the Leydig cells and combined PGE1 and hCG did not show any additive effects.