The safety and complications of Norplant use in Calabar.

Four hundred and seven Norplant insertions were performed over a 2 year period, from January 1998 to December 1999. The clients were followed up over a period of 36 months ending in June 2002. The overall complication rate was 22.6%, and the cumulative continuation rate was 84.0%. Menstrual bleeding disturbances were the most common reported complication in 50 (12.3%) clients. However, there was no significant change in packed cell volume among those clients. Desire for pregnancy was the most common reason for discontinuing Norplant use in 24 (5.9%) cases. Norplant was inadvertently inserted in a client who was pregnant, 3 months after her last confinement. The implants were removed after 8 week use, and the pregnancy was carried to term. There was no fetal abnormality. Thirty-one (7.6%) clients were lost to follow-up.

Risk factors associated with sexual assault in Calabar south eastern Nigeria.

BACKGROUND: Sexual assault inflicts significant physical and psychological trauma in the victims. Interventions to prevent this violent crime against women are a major public health concern. The aim of this study is to identify the risk factors for sexual assault as seen in victims presenting in our hospital. METHOD: Twenty-two case records of sexual assault victims treated at the University of Calabar Teaching hospital were reviewed for this study. RESULTS: The incidence of reported sexual assault in this study was 2.1% with a rising trend observed. Age range was from 4 to 23 years. Six (27.3%) victims were primary school pupils. Twelve (54.5%) victims had not attained menarche, and 20 (90.9%) cases were single. Recorded place of assault was commonly along a bush track (36.4%) and a nearby cemetery (22.7%). Time of assault was mainly in the evening (50.0%). Identity of the assailant was known in 7 (31.8%) cases. Commonest weapon used by the assailant was a knife (36.4%). CONCLUSION: Concerted effort is required to curb the rising trend of reported sexual assault. Interventions aimed at creating public awareness of the possible risk factors may reduce the incidence of this detestable event in the community.

Trauma related to sexual assault in Calabar, south eastern Nigeria.

BACKGROUND: A woman who is sexually assaulted experiences intense anxiety and fear. The associated stigmatization often results in under reporting and management difficulties. The aims of this study are to document the types of injuries seen in victims of sexual assault and to highlight problems in management of cases. METHOD: Twenty-two case files of sexual assault victims between January 1998 and December 2001 were reviewed for age, types of injuries sustained and treatment received. RESULT: Age range of all victims was 4 to 23 years. The knife was used by the perpetrator in 8 (36.4%) cases. Time interval between assault and presentation to hospital was up to 12 hours in 13 (59.1%) cases. Superficial abrasions, bruises, and lacerations were observed in 12 (54.6%) cases. Six (27.3%) victims paid for human immunodeficiency virus screen and the results were non-reactive. Ten (45.5%) victims had primary repair of perineal tear. CONCLUSION: Sexual assault is associated with multiple bruises, lacerations, and perineal tears. Commercialization of medical services was a hindrance to proper management of cases.

Spousal communication in contraceptive decisions among antenatal patients in Calabar, south eastern Nigeria.

BACKGROUND: The objective of this study was to determine how many women in Calabar urban community actually discuss with their spouses about family planning, how their spouses view family planning and how that affects their usage of family planning facilities. METHOD: The study was conducted using a structured questionnaire which was administered by house officers and medical students on one thousand consecutive patients who attended antenatal care during the study period Seven hundred patients met the inclusion criteria for the study. RESULT: Fifty six percent of the respondents in the study have never discussed family planning with their spouses. About 15% of the respondents have the same view on family planning with their husbands while 11% of the women themselves do not want family planning even though their husbands wanted it. CONCLUSION: Communication between couples about family planning should be encouraged. Whereas women have common meeting points like antenatal clinics to learn more about contraceptives and family planning, the men rarely have such opportunities. They will therefore benefit from discussing with their spouses who are opportuned to learn from the various clinics. Spousal communication should therefore be emphasized in these clinics where contraception and family planning are taught.

Laparoscopy in the management of pelvic pain in Calabar, Nigeria.

During the study period (July 1988 to June 1993), 707 laparoscopies were performed in the maternity annex of the University of Calabar Teaching Hospital. Fifty-eight (8.2%) were for pelvic pain. Some of the cases of pelvic pain were laparoscoped only after failure of other investigative procedures and medical treatment. In 45 (77.6%) definitive diagnoses were made and 37 of these became asymptomatic after definitive treatment following the laparoscopy. Of the 12 (20.69%) with no detectable abnormalities, four became asymptomatic with explanation and reassurance. All the patients with unruptured and the two with ruptured ectopic pregnancy were managed without the need for blood transfusion. Most of the diagnostic laparoscopies were performed on a day-case basis. A complication rate of 1.7% was recorded. A more liberal use of the procedure in the investigation of pelvic pain in women is advocated.

Morbidity and mortality in booked women who deliver outside orthodox health facilities in Calabar, Nigeria.

Women who booked for antenatal care at the University of Calabar Teaching Hospital (UCTH), Calabar, but delivered outside orthodox health facilities were studied. The aims were to determine the pattern of maternal morbidity and mortality in them and to compare this with the pattern in women who booked and delivered at UCTH. One hundred and eighteen of the defaulters traced (35.1%) had complications compared with 34 (10.1%) of the control. Only 32.2% of these defaulters with complications presented in orthodox health facilities for treatment. The major complications in the study group were: perineal tear (19.0%); primary postpartum haemorrhage (12.5%); and puerperal sepsis (5.4%). These were significantly higher in the study group than in the controls (P<0.001). Maternal mortality ratio of 6.0 per 1000 live births was recorded in the study group, but there was no death in the control. Health education and public enlightenment campaigns emphasising universal antenatal care along with delivery in orthodox health facilities are strongly advocated.

Role of the spiritual churches in antenatal clinic default in Calabar, Nigeria.

OBJECTIVE: To establish the role played by spiritual churches in the observed increase rate of antenatal clinic default in Calabar, Nigeria. DESIGN: Cross sectional comparative study. SETTING: Calabar, an urban community, the capital of Cross River State in south-eastern part of Nigeria. SUBJECTS: Women who booked for antenatal care in the University of Calabar Teaching Hospital but delivered outside orthodox health facilities. RESULTS: A total of 44.3%, of our antenatal clinic defaulters delivered in spiritual churches. Fear of spiritual attack by wicked people and prophetic warning in church (48.3%) and high hospital bills (26.8%) were the major reasons for this act. Perineal tear, primary postpartum haemorrhage and prolonged labour were associated more with delivery in church than hospital delivery or home delivery or delivery by TBAs (p < 0.01). Birth asphyxia and birth trauma were also significantly higher in church than hospital and other unorthodox delivery centres (p < 0.01). All the maternal deaths occurred in church and perinatal mortality was higher in church than other delivery facilities. CONCLUSION: The spiritual churches play a major role in the increasing rate of antenatal clinic default in Calabar. The pregnancy outcome in these spiritual churches is worse than when delivered in hospital, by TBAs or at home. Adequate health education; reduction in delivery fees in hospitals and general improvement in the socio-economic status of the populace may help reduce these high maternal and perinatal morbidity and mortality in the spiritual churches.

The development of an assay for determination of monooxygenase of human foetal livers based on rate of decrease in substrate concentration.

A simple monooxygenase assay based on the rate of decrease in the concentration of the substrate "supona' [2-chloro-1(2,4-dichlorophenyl)vinyl diethyl phosphate] (1) was investigated spectrophotometrically at E246nm in the presence of oxygen and NADPH without the enzyme. The assay was found reliable for incubations at 37 degrees C for periods up to 10 minutes. Incubations in excess of 10 minutes were unreliable due to an unexpected increase in E246nm. Mechanisms of hydrolysis (Scheme 1) and of reduction (Scheme 2) of the substrate were considered, and it was concluded that hydrolysis is the cause of the increase. Using 5 and 10 minute incubations, specific activity values for monooxygenase in 13 and 16 week old human foetuses were determined as 6.47 +/- 0.84 and 5.26 +/- 0.46, respectively; no monooxygenase could be detected in 24 week old foetuses.