Sociodemographic profiles and use-dynamics of Jadelle (levonorgestrel) implants in Jos, Nigeria.

BACKGROUND: Contraceptive implants (including Jadelle) are highly effective, safe, and easy to use and have a long duration of action. They do not interfere with intercourse with immediate return to fertility after removal. However, disruption of the menstrual bleeding pattern is almost inevitable and coercive prescription may be a problem because insertion and removal of implants are provider dependent. The objective of this study was to determine the sociodemographic profiles of acceptors of Jadelle and the reasons for discontinuation in Jos, Nigeria. MATERIALS AND METHODS: This was a 6-year retrospective chart review carried out at the Jos University Teaching Hospital. RESULTS: About 1401 women accepted Jadelle with a mean (±standard deviation) of 33.4 ± 5.9 years. About 88% of the women were Christians and almost three-quarters (73.5%) had at least secondary school education. The means of parity and number of children still alive at the time of accepting Jadelle were 4.1 and 3.8, respectively. Half of the women (49.5%) were breastfeeding and over half (55.9%) had future fertility desires at the time of commencing Jadelle. About 82% had previously used other contraceptives (mostly short-acting methods such as injectables, pills, and condoms), with only 18% starting Jadelle as the first-ever contraceptive method. About 90% of the women had regular menstrual cycles. The major reason for discontinuation of Jadelle was desire for pregnancy although menstrual pattern disruption was the most common reason for removal in the first 6 months of use. CONCLUSION: The main reason for discontinuation of Jadelle was to have more children although menstrual pattern disruptions accounted for earlier discontinuation.

Quarter of a century of female sterilization in Jos, Central Nigeria.

The study was to assess the types and trend of female sterilization between January 1985 and December 2009 (25 years) in Jos, Central Nigeria. There were 25,313 new acceptors of modern contraceptive methods out of which 4,951 (19.6%) were female sterilizations. Minilaparotomy was the commonest method of female sterilization. Local anaesthesia was the commonest anaesthetic utilized. The women were mostly women of relatively older age, grandmultiparous and with large family size. The women were of mean of 38.4 years, and 60% had more than 5 children at the time of sterilization. Interval sterilization constituted 78.5% of the female sterilizations. The acceptance of female sterilization, however, has declined over the years, as acceptance of the long acting contraceptive implants increases. Female sterilization by minilaparotomy under local anaesthesia was found to be feasible, cost effective and acceptable by majority of clients, and recommended for integration into minor gynaecological procedures in our institutions.

The burden of vesico-vaginal fistula in north central Nigeria.

BACKGROUND: Vesico Vaginal Fistula (VVF), as seen in this environment, is a major cause of severe morbidity and potential mortality, which can result in marital disruption, rejection and, eventual destitution. AIMS AND OBJECTIVES: To determine the socio-demographic characteristics, fistula features, and evaluate the intervention measures in Jos, North Central Nigeria. SETTING: This study was carried out at the VVF Centre, ECWA Evangel Hospital, Jos, North Central Nigeria. DESIGN OF THE STUDY: Descriptive retrospective study. MATERIALS AND METHODS: The patients' records from January 1 to December 31, 2007 were retrieved and analyzed for the demographics, clinical features, management and outcome using EPI Info version 3.4.3, 2008. RESULTS: A total of 314 patients were treated. The patients aged between 12 to 60 years (SD 6.19) with a mean parity of 3.7. Seventy percent (70%) of the patients were married and living with their husbands, while 65% of the patients were illiterate farmers. Christians and Muslims patients made up 60% and 40% respectively. Juxta-cervical (26%) and juxta-urethral fistulae (26%) were the commonest types, with obstructed labour being the causative factor in 82% of the patients. Ninety three percent of the repairs were repaired via the vaginal approach. The success rate at repair was 69%. Post-operative complications occurred in 16% of the patients. CONCLUSION: Vesico- vaginal fistula is a problem in this environment, occurring mainly amongst the illiterate farmers after prolonged obstructed labour. Public enlightenment and appropriate ante-natal care and delivery would reduce the incidence.

Vaginal hysterectomy at jos university teaching hospital, jos, Nigeria.

BACKGROUND: Hysterectomy could be performed through the abdomen, via the vagina, as an open procedure or laparoscopically. The debate on whether the uterus should be removed vaginally or abdominally was sparked off when Langenbeck first performed a successful vaginal hysterectomy in 1813. The superiority of the vaginal route was highlighted when women who underwent vaginal hysterectomy experienced significantly fewer complications when compared to the others who had abdominal hysterectomy. OBJECTIVES: To determine the prevalence of vaginal hysterectomy, common indications, and outcome. PATIENTS AND METHODS: A total number of 49 vaginal hysterectomies were performed in the Department of Obstetrics and Gynaecology, Jos University Teaching Hospital, Jos, Nigeria between January 1998 and December 2007 were studied retrospectively. RESULTS: The combined hysterectomy (abdominal & vaginal) rate comprised 25% of all major gynaecological operations in this centre during the study period; vaginal hysterectomy alone comprised 3% of all the major gynaecological operations. The commonest indication for vaginal hysterectomy was uterine prolapse in 37(83.%) patients. The complication rate was 22%, with no mortality. CONCLUSION: Vaginal hysterectomy is safe and the complication few in experienced hands. Utero-vaginal prolapse was the commonest indication; public enlightenment to prevent prolapse would reduce the incidence and the need for repair.

Quarter of a century of female sterilization in Jos, Central Nigeria

The study was to assess the types and trend of female sterilization between January 1985 and December 2009 (25 years) in Jos, Central Nigeria. There were 25,313 new acceptors of modern contraceptive methods out of which 4,951 (19.6%) were female sterilizations. Minilaparotomy was the commonest method of female sterilization. Local anaesthesia was the commonest anaesthetic utilized. The women were mostly women of relatively older age, grandmultiparous and with large family size. The women were of mean of 38.4 years, and 60% had more than 5 children at the time of sterilization. Interval sterilization constituted 78.5% of the female sterilizations. The acceptance of female sterilization, however, has declined over the years, as acceptance of the long acting contraceptive implants increases. Female sterilization by minilaparotomy under local anaesthesia was found to be feasible, cost effective and acceptable by majority of clients, and recommended for integration into minor gynaecological procedures in our institutions (Afr J Reprod Health 2011; 15[1]: 101-106)

Physician use of updated anti-virus software in a tertiary Nigerian hospital.

BACKGROUND: While physicians are becoming increasingly dependent on computers and the internet, highly lethal malware continue to be loaded into cyberspace. We sought to assess the proportion of physicians with updated anti-virus software in Jos University Teaching Hospital Nigeria and to determine perceived barriers to getting updates. METHODS: We used a pre-tested semi-structured self-administered questionnaire to conduct a cross-sectional survey among 118 physicians. RESULTS: The mean age (+/- SD) of subjects was 34 (+/- 4) years, with 94 male and 24 female physicians. Forty-two (36.5%) of 115 physicians with anti-virus software used an updated program (95% Cl: 27, 45). The top-three antivirus software were: McAfee 40 (33.9%), AVG 37 (31.4%) and Norton 17 (14.4%). Common infections were: Trojan horse 22 (29.7%), Brontok worm 8 (10.8%), and Ravmonlog.exe 5 (6.8%). Internet browsing with a firewall was an independent determinant for use of updated anti-virus software [OR 4.3, 95% CI, 1.86, 10.02; P < 0.001]. Busy schedule, 40 (33.9%) and lack of credit card 39 (33.1%) were perceived barriers to updating antivirus software. CONCLUSION: The use of regularly updated anti-virus software is sub-optimal among physicians implying vulnerability to computer viruses. Physicians should be careful with flash drives and should avoid being victims of the raging arms race between malware producers and anti-virus software developers.

Awareness, perception and practice of female genital mutilation among expectant mothers in Jos University Teaching Hospital Jos, north-central Nigeria.

BACKGROUND: WHO estimates that some 130 million women worldwide are affected, and every year another 2 million girls and young women are at risk of undergoing the practice of FGM. Although Nigeria has a prevalence of 19% in 2003,a reduction from 25% prevalence of 1999 national survey, it still has high absolute number of cases with wide regional variation. The awareness and perception of expectant mothers may give an insight as to what awaits their unborn daughters and have a bearing on the future of the practice. METHODOLOGY: Semi-structured questionnaires were administered to 260 expectant mothers at the antenatal clinic of Jos University Teaching Hospital between 1st and 31st July 2007. RESULTS: Majority of the respondents (94.6%) were aware of FGM. Mass media was the main source of information. Majority (83.8%) wanted the practice to be discontinued, 31.3% reported having had FGM, most done by traditional healers. About 14.6% have a plan to circumcise their daughters citing tradition, marriage prospects, and faithfulness to husband as their reasons. Only 16.2% wanted the practice to continue. CONCLUSION: There is high level of awareness of the FGM among respondents who also have negative attitude to the practice, even as the practice is still prevalent. More health education is needed to illustrate the dangers of the practice in order to safeguard the health of the girl-child.

Risk factors for placenta praevia in Jos, north central Nigeria.

BACKGROUND: Ptacento pro via, a major cause of obstetric haoemorrhage, is potentially life-threatening to the mother and frequently results in high perinatal morbidity and mortality. Several epidemiological and clinical studies report disparate data on the risk factors associated with this condition. Although several studies on risk factors for placoenta praevia have been published, data obtained from the sub-Saharan Africa remains scanty. Our objective is to describe the spectrum of risk factors for placenta praevia in Jos, north central Nigeria. METHODS: This was a retrospective cohort study of 96 women delivered form January, 1999 to December, 2002 at Jos University Teaching Hospital, Jos, Nigeria. Data on total number of deliveries, maternal age, parity, and past obstetrics history and abortion were carefully extracted from medical records and analyzed using the Epi Info 3.4.1 (CDC, Atlanta, Georgia). RESULTS: The prevalence of placenta praevia was 0.89%. Previous uterine evacuation was documented in 35.4% of cases, while previous caesarean section scar occurred in 5.2% of cases. About half (44.8%) of the cases had no known risk factor. CONCLUSION: Uterine scaring following abortion management is an important risk factor for placenta praevia. However, majority of patients with placenta praevia in this work have no identifiable risk factor.

Indications for removal of etonogestrel implant within two years of use in Jos, Nigeria.

BACKGROUND: Implanon is a new long-term and reversible sub-dermal contraceptive implant in Nigeria. It is a single rod containing 68mg of etonogestrel meant to offer contraception for three years and marketed by Organon. OBJECTIVE: To determine the indications for removal of Implanon rods from clients within a two-year period. DESIGN: A retrospective review of 30 consecutive Implanon removals within the study period. SETTING: The fertility regulation unit of the department of obstetrics and gynaecology of the Jos University Teaching Hospital, North-Central Nigeria. RESULTS: A total of 30 clients requested for and had their Implanon rods removed out of 669 insertions constituting 95.5% crude continuation rate in the second year. The clients were of mean age 31.4 +/- 6.2 years, mean parity 2.9 +/- 1.8 and mean number of living children 2.7 +/- 1.6. There was an average weight gain of 1.9 kg. The most common indication for removal was menstrual disruption (33.3%). Desire for another pregnancy closely followed (30.0%). Weight gain was another indication for discontinuation (13.3%). Two women were pregnant at insertion of the implant. There was one failure of the method with pregnancy as a result. Spousal disapproval was an indication for removal in two cases. CONCLUSION: Like all progestin-only contraceptive methods, menstrual disruption was the most common indication for removal of implants. Inadvertent insertion of implants with existing pregnancy is of concern and should be avoided as much as is possible. In doubtful cases at insertion, this insertion should be deferred or serum beta-HCG should be assessed to exclude chemical pregnancy.

Risk Factors for Placenta Praevia in Jos; North Central Nigeria

Background: Placenta praevia; a major cause of obstetric haemorrhage; is potentially lifethreatening to the mother and frequently results in high perinatal morbidity and mortality. Several epidemiological and clinical studies report disparate data on the risk factors associated with this condition. Although several studies on risk factors for placenta praevia have been published; data obtained from the sub-Saharan Africa remains scanty. Our objective is to describe the spectrum of risk factors for placenta praevia in Jos; North Central Nigeria. Methods: This was a retrospective cohort study of 96 women delivered form January; 1999 to December; 2002 at Jos University Teaching Hospital; Jos; Nigeria. Data on total number of deliveries; maternal age; parity; and past obstetrics history and abortion were carefully extracted from medical records and analyzed using the Epi Info 3.4.1 (CDC; Atlanta; Georgia). Results: The prevalence of placenta praevia was 0.89. Previous uterine evacuation was documented in 35.4of cases; while previous caesarean section scar occurred in 5.2of cases. About half (44.8) of the cases had no known risk factor. Conclusion: Uterine scaring following abortion management is an important risk factor for placenta praevia. However; majority of patients with placenta praevia in this work have no identifiable risk factor

A critical look on condoms.

BACKGROUND: To protect the public health, the practice of safer sex, promoted in a sex-positive way, is necessary. It includes saying no to unwanted sex, being faithful, having fewer partners, having sex that does not include intercourse, and using condoms. This is not just to prevent HIV and Sexually transmitted infections (STIs), but also to prevent unwanted pregnancy STI-related infertility and negative pregnancy outcomes, and cervical cancer- and most importantly to protect children and for partners to protect each other. Couples in stable relationships are now changing their sexual behavior due to increasing awareness on HIV and other STIs. While some are abstaining from premarital sex, others are being faithful to their partners. However, large numbers of people are yet to adopt safer sexual behavior through correct condom use. Since the beginning of the AIDS epidemics, condom distribution has greatly increased. METHODOLOGY: Literature review on the topic was done using Pubmed. Relevant journals and topics were also reviewed. Textbooks on relevant topics were also searched. RESULTS: The consistent use of male latex condoms significantly reduces the risk of HIV infection in men and women. Consistent use of male latex condoms reduces the risk of gonorrhea in men. Laboratory studies have proved that latex condom is impermeable to the infectious agents in genital secretions, including the smallest viruses. Male condoms may be less effective in protecting against STIs that are transmitted by skin-to-skin contact, if that area is not covered by the condom. CONCLUSION: Condoms are currently the only available means of preventing the sexual transmission of HIV and some other STIs. Condoms exist for both men and women.

A Critical Look on Condoms

Background: To protect the public health; the practice ofsafer sex; promoted in a sex-positive way; is necessary. It includes saying no to unwanted sex; being faithful; havingfewer partners; having sex that does not includeintercourse; and using condoms. This is not just to preventHIV and Sexually transmitted infections (STIs); but also to prevent unwanted pregnancy; STI-related infertility and negative pregnancy outcomes; and cervical cancer- andmost importantly to protect children and for partners to protect each other. Couples in stable relationships are now changing their sexual behavior due to increasing awareness on HIV and other STIs. While some are abstaining from premarital sex; others are being faithful to their partners. However; large numbers of people are yet to adopt safer sexual behavior through correct condom use. Since the beginning of the AIDS epidemics; condom distribution has greatly increased. Methodology: Literature review on the topic was done usiong Pubmed. Relevant journals and topics were also reviewed. Textbooks on relevant topics were also searched. Results The consistent use of male latex condoms significantly reduces the risk of HIV infection in men and women.Consistent use of male latex condoms reduces the risk of gonorrhea in men. Laboratory studies have proved that latex condom is impermeable to the infectious agents in genitalsecretions; including the smallest viruses. Male condoms may be less effective in protecting against STIs that are transmitted by skin-to-skin contact; if that area is not covered by the condom Conclusion: Condoms are currently the only available means of preventing the sexual transmission of HIV and some other STIs. Condoms exist for both men and women

Assessment of the bone density of nomadic Fulani Herdsmen in northern Nigeria using calcaneal ultrasonography.

CONTEXT: Osteoporosis is characterized by decreased bone density and increased bone fragility. Genetics, diet, and physical activity are established determinants of bone density. The seminomadic Fulani of northern Nigeria trek long distances on foot daily to graze and water their animals, and have access to calcium-rich dairy products. OBJECTIVE: We sought to determine whether the high level of physical activity and presumed calcium-rich diet of the Fulani would promote a higher bone density, compared with their relatively inactive counterparts in the general population. DESIGN: Cross-sectional study. SETTING: Three Fulani settlements (Toro, Tilden Fulani, and Magaman Gumau) within 5 to 15 kilometers of Jos Metropolis on the Jos Plateau in northern Nigeria. PATIENTS: We assessed the calcaneal characteristics of a consecutive sample of 51 active seminomadic Fulani men using the Lunar Achilles+ ultrasonometer. MAIN OUTCOME MEASURES: Calcaneal broadband ultrasound attenuation (BUA), speed of sound (SOS), stiffness index (SI), and SI T-scores. RESULTS: The mean age of the herdsmen was 26 +/- 9 years (range, 16 to 49), and the mean BMI was 19.9 +/- 2.3 kg/m(2). The mean BUA was 124 +/- 13 dB/MHz (95% CI, 120 to 128), the mean SOS was 1572 +/- 33 m/s (95% CI, 1563 to 1581), the mean SI was 102 +/- 17 (95% CI, 97 to 107], and the mean SI T-score was -0.74 +/- 0.97 (95% CI, -0.47 to 1.01]. The mean SI was 1 T-score unit below that of an age-matched cohort in the general population. CONCLUSION: Fulani herdsmen have a theoretically increased risk for bone fracture in a background of low BMI and potentially high calcium intake.