Haematological and Immunological Parameters in Patients with Chronic Hepatitis B Infection in Zaria, Nigeria.

Hepatitis B virus (HBV) is one of the major causes of morbidity and mortality worldwide. The aim of this study was to determine the haematological and immunological parameters in patients with chronic HBV infection in Zaria, Nigeria. Twenty individuals with confirmed chronic HBV (CHB) infection constituted the subjects while 20 non-HBV-infected individuals were monitored as controls. The subjects were enrolled purposively from the Gastroenterology Clinic of the Ahmadu Bello University Teaching Hospital Shika, Zaria Nigeria. Four millilitres of blood samples were collected from each study participants. Full blood count was conducted using the Swelab Alfa Haematology Analyzer, while CD4+ T-Cell enumeration was performed using the Sysmex Partec CyFlow® Counter IVD flow cytometer according to the manufacturers' instruction. The mean (and standard deviation) age of the 20 participants with CHB was 32.7 (±10.1) years while that of the 20 HBV negative control participants was 30.0 (±7.8) years. Mann-Whitney test showed no significant difference between the two groups in their total WBC (p=0.6634) and granulocytes (p=0.2386). There was a significant increase in the monocytes count (p=0.0151) and a significant decrease in the lymphocytes count (p=0.0006) of patients with CHB compared to the healthy control. There was no significant difference in the mean CD4+ T-lymphocytes count between subjects and controls (p=0.0633). Unpaired Student t-test showed no significant difference between the two groups in the other haematological parameters. This study showed a significant increase in monocytes and decrease in lymphocytes, a phenomenon that characterize the sustenance of infection by immune evasion mechanism.

Outdoor air particle-bound trace metals in four selected communities in Ibadan, Nigeria.

Trace metal concentrations were determined in particulate matter (PM10) in ambient air of four purposively selected residential areas in Ibadan, Nigeria namely Bodija market (BM), Ojo Park (OP), Oluyole Estate (OE) and University of Ibadan (UI). PM10 was determined in the morning (7-10 a.m.) and afternoon (2-5 p.m.) for 12 weeks in the dry season months of January-March using a volumetric sampler following standard procedures and levels compared with WHO guideline limits. Glass-fibre filter papers exposed to the particulate matter were digested using appropriate acid mixtures, and the digest analysed for trace metals including Ni, Cr, Mn, Zn, and Pb using ICPMS method and levels compared with WHO limits. Data was analysed using ANOVA and Pearson correlation test at 5 % level of significance. The highest mean PM10 concentrations 502.3 ± 39.9 µg/m(3) were recorded in the afternoon period at BM, while the lowest concentration 220.6 ± 69.9 µg/m(3) was observed in the morning hours at UI. There was a significant difference between the PM10 levels across the various locations (p < 0.05), and all the levels were higher than WHO limit of 50 µg/m(3). The highest levels of Ni, Zn and Pb were recorded at BM, which also had the highest PM10 burden. The trend in Pb levels across the locations was BM > UI > OP > OE with the highest level 5.70 µg/m(3) in BM nearly fourfolds WHO limits of 1.5 µg/m(3). There was a significant correlation between PM10 and Ni (p < 0.05).Urban communities with increased human activities especially motor traffic recorded both higher levels of PM10 and toxic trace metals. There is need to carry out source apportionment to establish the origin of these trace metals in future studies.

Presentation and outcome of eclampsia at a Nigerian university hospital.

OBJECTIVE: To review the presentation of eclampsia and its outcome on the mother and babies in our environment with a view to suggesting strategies for improvement. METHODS: A retrospective study at 93 cases of eclampsia treated at Olabisi Onabanjo University Teaching Hospital Sagamu was undertaken. Data was collected by scrutinizing the case files collected from the medical records library after collecting their numbers from the labour ward register. RESULTS: There were 93 cases of eclampsia out of a total delivery of 5423 giving an incidence of 1.7 percent. Almost all the patients (96.8%) were unbooked. Antepartum eclampsia constituted 93.5 percent of cases. Nulliparous teenagers were the most commonly affected with a relative risk of 25 when compared with multips. Caesarean delivery was more common than vaginal delivery in the ratio 6:4. There were 19 maternal deaths, a case fatality rate of 20.0 percent and this was not related to the mode of delivery. (RR 1- 1.1). The perinatal mortality was significantly less with caesarean delivery (RR 1:0.38). CONCLUSION: Eclampsia, occurring mainly in unbooked patients is still one of the major causes of maternal mortality and good antenatal care will significantly reduce the incidence and improve the outcome especially in teenage nullipara who are mostly susceptible.

Knowledge and use of the partograph among healthcare personnel at the peripheral maternity centres in Nigeria.

In an attempt to evaluate the contributory factors to the high frequency of referred cases in obstructed labour at the State's referral hospital, a questionnaire-based survey of 396 maternity care-providers from 66 randomly selected peripheral delivery units in Ogun State, Nigeria was conducted over a 2-month period, to evaluate their knowledge and use of the partograph. The majority of the personnel were nurses/midwives (45.5%) and community health extension workers (CHEW) (42.7%). Of the 216 personnel (54.5%) who were aware of the partograph, 36 (16.7%), 119 (55.5%) and 61 (28.2%) demonstrated poor, fair and good levels of knowledge, respectively. No junior CHEW had a satisfactory knowledge of the partograph. Only 39 (9.8%) of all the personnel routinely employed the partograph for labour management and almost half of these individuals had a poor level of knowledge. Efforts to limit the frequency of referred cases of established obstructed labour to the State's referral hospital should include training of care-providers at the peripheral delivery units, especially junior personnel in the effective use of the partograph, in addition to employing quality assurance measures to check inappropriate use.

Cancer of the cervix.

Cases of cancer of the cervix histologically diagnosed at the Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria between January 1991 and December 2000 were reviewed. There was 1,912 total gynaecological admissions during that period and 56 histologically diagnosed cancer of the cervix for an incidence of 2.9%. The mean age at occurrence of the cancer was 51.7 + 12.4 years. It was more common in grandmultiparous women and major presenting complaints were abnormal vaginal bleeding, (64.3%) watery discharge (25.0%) and postcoital bleeding (7.1%). Histologically, 96.4% has squamous cell carcinoma of varying degree of differentiation and most (78.6%) presented in the advanced stages. Majority (80.4) were referred for radiotherapy at either Lagos University Teaching Hospital or University College Hospital, Ibadan. Only 5.4% of cases were treated by radical hysterectomy. Measures to reduce the incidence and morbidity would include mass education of the sexually active women to have cervical smear regularly and also to report symptoms early so as to diagnose the invasive disease in the early stages.

The pattern of infertility cases at a university hospital.

Pattern of infertility cases attending the gynaecologic out patient clinic of Ogun State University Teaching Hospital, Sagamu Nigeria is presented. The incidence of infertility was found to be 14.8% with a mean duration of 3.38 +/- 1.65 years. Secondary infertility predominated with 78.3% incidence. About three quarters (71.1%) were between 25 and 34 years of age and only 6.0% were below 25 years of age Nullipara constituted majority of cases with 56.6%. Past history of induced abortion was significantly present in those with tubal blockage. Male factor only was the cause in 26.8%, female factor only in 51.8% and both male and female factors were contributory in 21.4% cases. The male partners refused semen analysis in about one third of cases (32.5%).

Ruptured uterus at Sagamu, Nigeria.

Ruptured uterus, the largest contributor to maternal deaths in our center was reviewed to find ways of reducing it and improve the outcome. Sixty cases treated at Ogun State University Teaching Hospital, Sagamu between January 1988 and December 1997 were scrutinised. During the 10 year period, total deliveries were 5,214 giving an incidence of 11.5 per 1,000. 76.7% of cases occurred in patients aged 30 years and more; and 58.6% in para 4 and more. 88.3% were unbooked. The ruptures were spontaneous in 76.7% and lower uterine segment was the most common (80%). Uterine repair with sterilisation was carried out in 46.7%, sub total hysterectomy in 26.7% and repair only in 11.7%. Most of the aetiological factors were preventable by good antenatal care and the outcome improved by early referral and efficient blood transfusion system.

Impact of asymptomatic maternal malaria parasitaemia at parturition on perinatal outcome.

A cross-sectional study involving 564 parturients who delivered singleton babies and 214 matched non-pregnant controls was carried out to determine the prevalence and impact of asymptomatic maternal malaria parasitaemia at parturition on the perinatal outcome. One hundred and forty (24.8%) parturients and 50 (23.4%) non-pregnant women were found to have asymptomatic malaria parasitaemia, respectively, while the congenital malaria rate in the neonates of the parasitaemic parturients was 0.7%. The incidence of malaria parasitaemia was higher in the para 2 and over (29.33%) as compare to the para 1 (21.43%) and primigravid (18.42%). There was no significant difference between the mean birth weight of infants delivered by parasitaemic parturients (2.93+/-0.61 kg) and aparasitaemic parturients (3.07+/-0.32 kg) (P=0.501). There was also no significant difference when comparing the mean placental weight of the parasitaemic mothers (0.60+/-0.15 kg) with that of the aparasitaemic mothers (0.62+/-0.20 kg) (P=0.329). Only in the para 2 and over was the mean placental weight of the parasitaemic mothers significantly lower than that of the aparasitaemia mothers (0.46+/-0.16 kg; 0.66+/-0.23 kg P=0.035). The mean packed cell volume of the parasitaemics parturients (30.89+/-1.87) was significantly lower than the aparasitaemic parturients (31.98+/-2.25) (P<0.001). Significant difference was not achieved between the parasitaemics and aparasitaemics inrespect of apgar score at 1 minute, or at 5 minutes, premature births (16.43%; 15.33%; P>0.05), stillbirth rate (3.57%; 2.59, P>0.05), mean placental index (0.204, 0.202, P>0.50) and mode of delivery. The findings in this study show that even though malaria parasitaemia is prevalent in our locality, the effects on maternal and fetal wellbeing are comparable with the aparasitaemics.

Complicated induced abortion in Sagamu, Nigeria.

A review of cases of induced abortion managed at Ogun State University Teaching Hospital, Sagamu from January 1988 to December 1997 is presented. One hundred and two cases were treated for various complaints and complications of induced abortion during the period of review. The mean age in years was 24.6+/-5.8. The groups 20-24 years, 15-19 years and 25-29 years constituted 39.2%, 23.5% and 18.6%, respectively, of the patients. Mean parity was 1.7+/-1.8. Thirty-eight point two per cent, 30.4% and 17.6% were para zero, 2-4 and 1, respectively. Fifty-one per cent of the patients were single. Thirty-four point three per cent, 15.7% and 2.0% of the patients have had one, two and three induced abortions before. Forty-five point one per cent of the patients refused to disclose where and who performed the abortion, while 31.4%, 10.8% and 7.8% of the abortions were carried out by physicians, quacks and nurses. Forty-five point one per cent of the patients procured the abortion at the gestational age of 13-24 weeks, while 26.5% waited for 10 days and over after the abortions before seeking for medical help. Thirty-six point eight per cent and 26.3% of operators in fatal cases were physicians and nurses, respectively. The mean admission interval after abortion for fatal cases was 11.1+/-3.2 days and 4.0+/-3.5 days for other cases that survived and the difference was significant (t=8.0930; P<0.001). Eighty-five point three per cent had never used any form of contraception. Seventy-nine point four per cent, 61.8% and 6.9% of the patients presented with bleeding per vaginam, abdominal pains and fever, respectively. The most common complications were anaemia (56.9%), haemorrhages (46.1%), sepsis (33.3%) and maternal death (18.6%). The maternal mortality ratio was 18 627.5 per 100 000. The difference between maternal mortality ratio due to abortion and the general population (1578.9) was statistically significant (chi(2)=126.4281, P<0.001). Sunction aspiration (76.5%) and exploratory laparatomy (9.8%) were the most common operations performed. The findings in this series further highlight the urgent need to eliminate or reduce substantially the factors responsible for septic induced abortion.

Maternal mortality at Sagamu, Nigeria--a ten year review (1988 - 1997).

A review of maternal deaths at the Ogun State University Teaching Hospital, Sagamu, Nigeria over a 10 year period is presented. During the period, there were 92 maternal deaths, those from abortion and ectopic pregnancy inclusive. The total deliveries were 5423 giving a maternal mortality ratio of 1700 per 100,000. Ruptured uterus was the most common cause followed by eclampsia, postpartum haemorrhage and complications of abortion in that order. Unbooked patients constituted about one third of the total (29. 1 %). Primipara and grandmultipara were the most at risk of maternal death and the risk of dying following operative delivery was six times that of vaginal delivery. Easy access to affordable antenatal care, good blood transfusion services, more widespread use of contraceptives and training of traditional birth attendants would help reduce the risk of maternal death.