The efficacy of magnesium sulphate as an adjunct to local anaesthetics for perineal pain relief after episiotomy.

BACKGROUND: Episiotomy is a deliberate surgical incision of the perineum with the aim of increasing the vulval outlet to facilitate childbirth. However, it could be associated with some complications, such as pain, hemorrhage, and wound infection. It is a surgical procedure that requires adherence to basic surgical principles of providing adequate analgesia. AIM: To determine the efficacy of magnesium sulphate (MgSO4) as an adjunct to local anesthetics for analgesia during episiotomy repair among women that had vaginal delivery at Usmanu Danfodiyo University Teaching Hospital Sokoto, Sokoto, Nigeria. SUBJECT AND METHODS: This was a single-blind randomized clinical trial. Pregnant women who had episiotomy during the study period were randomized into two groups. Those in Group A had xylocaine administered alone, whereas those in Group B had xylocaine + MgSO4 administered for repair of episiotomy. Pain was assessed by numeric rating scale at commencement of the repair, at 2 and 6 h after the repair. Patient's level of satisfaction, request for additional analgesia, and side effects were also assessed. RESULTS: The pain score in the xylocaine + MgSO4 group was lower throughout the period of assessment. There was no significant difference in the pain scores between the two groups at 0 and 6 h. However, there was significant difference in the mean pain scores between the two groups at 2 h (P < 0.001). There was no significant difference in the level of satisfaction, request for additional analgesia, and side effects between the two groups. CONCLUSION: Both xylocaine alone and xylocaine with MgSO4 provide adequate perineal pain relief during episiotomy repair. MgSO4 improves the analgesic effect of xylocaine at 2 h after episiotomy repair without any significant side effect.

Adolescent maternal mortality in North-west Nigeria.

BACKGROUND: Compared to women in their twenties, adolescents are more likely to die during childbirth. Moreover, more than half of women in sub-Sahara Africa deliver their first child before the age of 20 years. OBJECTIVE: To determine the institutional maternal mortality ratio among adolescents, its risk factors/causes and suggest ways of preventing or reducing the deaths. METHODS: A descriptive study based on hospital case records of all adolescent maternal deaths at Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto between January 2000 and December 2009. RESULTS: There were 165 maternal deaths and 3,047 live births among the adolescent mothers within the period giving an adolescent maternal mortality ratio of 5415/100,000 live births. The main causes of death were eclampsia (53.9%), prolonged obstructed labour (15.3%), anaemia (14.5%) and haemorrhage (9.1%). Interestingly, abortion (2.4%) was an uncommon cause of adolescent maternal mortality in this study. Identified risk factors included lack of prenatal care/labour supervision and illiteracy. CONCLUSION: The adolescent maternal mortality ratio in the institution is remarkably high and is tragically due to preventable causes in most cases. The role of promotion of female education and utilization of family planning,prenatal and intrapartum services in reducing adolescent maternal death cannot be overemphasized.

Emergency Obstetric Hysterectomy in a Tertiary Hospital in Sokoto; Nigeria

Emergency obstetric hysterectomy (EOH) is a life-saving procedure which is often performed to treat some obstetric complications; as a last resort; to prevent maternal mortality. Objectives: This study was designed to determine the rate; indications; and complications of the EOH procedure at Usmanu Danfodito University Teaching Hospital (UDUTH); Sokoto. Materials and Methods: This retrospective study involved all the patients who had EOH at UDUTH; Sokoto; Nigeria; between January 2005 and December 2010. The case records of these patients were retrieved from the medical record library and information relating to age; parity; booking status; indications; type of hysterectomy; cadre of the surgeon; type of anesthesia; and complications of the procedure were extracted. The data were processed via SPSS version 11.5 and the ?2 test was used to analyze some of the results with the confidence limit set at 95. Results: During the 6-year period; 83 EOH were performed out of 16;249 deliveries giving the rate of the former as 0.51; i.e. 1 in 196 deliveries. However; the case records of only 74 patients (82.9) were available for the study. The rate of EOH increased with advancing maternal age and increasing parity. The majority of the patients (89.2) were available for the study. The rate of EOH increased with advancing maternal age and increasing parity. The majority of the patients (89.2) were unbooked for antenatal care; and the rate of the procedure among these patients (1.82) was significantly higher than 0.07observed amongst booked subjects (P0.001). The main indication for the procedure was ruptured uterus (93.2) and the majority of the patients (95.9) had subtotal hysterectomy. Anemia (66.2); excessive hemorrhage (35.5); septicemia (18.9); and wound infection (16.2) were the leading complications. Excessive hemorrhage was significantly higher in the procedure performed by the senior registrars (51.2) compared to those undertaken by consultants (16.2); P

Knowledge, attitude and practice of child adoption among infertile female patients in Sokoto north-west Nigeria.

AIMS AND OBJECTIVE: To determine the knowledge, attitude and practice of child adoption among infertile female patients at Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto. PATIENTS AND METHODS: Semi structured interview questionnaire was administered to 250 consecutive infertile female patients (between January 2008 and November 2009) at UDUTH Sokoto who agreed to participate in the study after counseling. The data was analysed by simple percentages, descriptive statistics, chi-square tests and regression equations at 95% confidence level. RESULTS: Knowledge of child adoption was high (74.8%). However only 1.2% of the respondents had adopted a child while 27.2% were willing to adopt. Willingness for child adoption was significantly higher in patients whose duration of infertility was greater than 5 years (OR=6.0, P<0.001), those with secondary/tertiary education (OR=4.1, P<0.001) and in those with no living child (OR=24.9, P<0.001) compared to their reverse counterpart. Majority of the respondents (71.6%) were not willing to adopt a child and their main reason was that child adoption would not allow them fulfill their conception role as women. CONCLUSIONS: Knowledge of child adoption was high among the respondents but the willingness to adopt a child was low due to the fact that it would not allow them fulfill their conception role as women. There is need to educate and encourage our infertile patients to utilise this cheaper and available option of managing infertility.

Medical students' evaluation of physiology learning environments in two Nigerian medical schools.

The expansion of biomedical knowledge and the pursuit of more meaningful learning have led to world-wide evidence-based innovative changes in medical education and curricula. The recent emphasis on problem-based learning (PBL) and student-centred learning environments are, however, not being implemented in Nigerian medical schools. Traditional didactic lectures thus predominate, and learning is further constrained by funding gaps, poor infrastructure, and increasing class sizes. We reviewed medical students' perceptions of their exposed learning environment to determine preferences, shortcomings, and prescriptions for improvements. The results confirm declining interest in didactic lectures and practical sessions with preferences for peer-tutored discussion classes, which were considered more interactive and interesting. This study recommends more emphasis on student-centered learning with alternatives to passive lecture formats and repetitive cookbook practical sessions. The institutionalization of student feedback processes in Nigerian medical schools is also highly recommended.

Ruptured uterus in a booked patient.

Ruptured uterus, a life-threatening obstetric complication, is a rare event among booked patients. We present a case of uterine rupture in a 28-year-old Gravida 2.para 1 +0 , 1 alive with previous lower segment Caesarean scar due to neglected obstructed labor from fetal macrosomia. She presented in labor at 40 weeks of gestation after declining the advice for an elective Caesarean section (C/S) and also signed against medical advice to receive care from a traditional birth attendant. She returned 30 hours later with a ruptured uterus. Findings at operation included a macerated stillbirth weighing 4.30 kg and a lower segment transverse scar rupture. Subtotal hysterectomy and peritoneal lavage were performed.

Elective caesarean section in a tertiary hospital in Sokoto, north western Nigeria.

BACKGROUND: Elective caesarean sections have been considered safer for both mother and the fetus compared to their emergency counterpart. However, emergency caesarean sections have continued to form bulk of caesarean deliveries in our facility. OBJECTIVE: The objective of this study was to determine the caesarean section rate together with the trend, indications, and maternal mortality associated with elective caesarean operation. MATERIALS AND METHODS: A retrospective analysis of clinical records of all the patients that had caesarean section between January 2002 and December 2010 (9 years) at Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto, Nigeria was conducted. RESULTS: During the 9 year study period, 2284 caesarean sections were performed out of 22,985 total deliveries at UDUTH Sokoto, thus giving a caesarean section rate of 9.9%. Emergency and elective operations accounted for 1784 (78.2%) and 498 (21.8%) of the cases respectively. The rate of elective caesarean section increased from 1.7% in 2002 to 3.2% in 2007. Thereafter it declined gradually to 1.8% in 2010. Repeat caesarean section (30.7%) and malpresentation (17.1%) were the most common indications for elective caesarean operation. There were 18 maternal deaths from caesarean section and only one from the elective caesarean procedure. CONCLUSION: The rising trend in the elective caesarean section rate in this study underscores the need for better and improved patient selection together with counseling on its benefits and risks. This is because despite the fact that it is safer than emergency caesarean operation, it is not entirely devoid of complications. Routine use of spinal anesthesia in performing the procedure should be encouraged.

Giant mucinous cystadenoma: case report.

Mucinous tumours are the second most common type of epithelial ovarian tumours. Majority of these tumours are benign. However, some of these benign lesion can grow to enormous size, thus stimulating malignant neoplasia. This report presents the case of a 35 year old grand multiparous woman who came to our gynaecological clinic with 5 year history of abdominal swelling associated with weight loss. Abdomino-pelvic ultrasound scan revealed a large left ovarian cyst. She had laparotomy with left oophorectomy. A huge mucinous cystadenoma weighing 33.6 kg was removed. Her post-operative course was unremarkable.

The challenges of budgeting in a newly introduced district health system: a case study.

BACKGROUND: Nigeria operates a three-tier political system consisting of a national government: 36 states, Federal Capital Territory and 768 local governments. There are three levels of health care: primary, secondary and tertiary levels corresponding to and funded by local, state and national governments, respectively. A budget prepared at the district level was not possible until 2006 when the 2007 annual budget was prepared. AIM: The goal of this study was to identify the key challenges of budgeting in a newly introduced District Health System and to share our experience with other scholars. METHODOLOGY: This study is a descriptive case study using interviews and focus group discussions of district and local health officers and the District Health Management Team as well as field notes made from participant observers and reviews of relevant documents. FINDINGS AND DISCUSSION: The study showed that a bottom-up approach was used at the district level, while the concept of business planning was introduced to underscore the seriousness of health planning and efficient resource allocation. The two systems of expenditure classifications, i.e., functional and economic classification, were used in a complementary manner. The capacity for planning and budgeting was found to be lacking among the district health officers. The crosscutting contextual issues constraining budgeting included the inadequate Health Management Information System (HMIS), a non-functional Financial Management System (FMS) and an unreliable Human Resources Management System (HRMS). RECOMMENDATIONS: There is a need for further study to be carried out to determine the factors that constrain the collection, analysis and dissemination of HMIS. In addition, there is a need to study the constraints to proper implementation of the FMS, HRMS and the linkage between the quality of the essential data-set with the efficiency of resource allocation in budgeting.

Family planning practice in a tertiary health institution in north-western Nigeria.

BACKGROUND: Family planning in our environment had remained a delicate issue that is still reluctantly being accepted based on religious belief and the perception that it is synonymous with population control. OBJECTIVE: This study was carried out with the objectives of identifying the characteristics of contraceptive acceptors in our family planning unit, their source(s) of information and methods of preference among others. MATERIALS AND METHODS: The record cards of all clients who attended the family panning clinic between January 1st 1998 and December 31st 2002 as well as the theatre records of patients that had bilateral tubal ligation (BTL) during the study period were reviewed. Relevant information on biodata, reasons for family planning, methods of choice and reasons for discontinuation were extracted and analysed. Comparative percentage was used for the analysis. RESULT: A total of 839 clients requested and were served with contraceptives during the study period with an acceptor rate of 167.8/annum.Over 75% of the acceptors were Muslims. The main reason for selecting family planning services was for child spacing (84.9%) with only 12% requiring the service to end the reproductive carrier. Antenatal/postnatal clinics were their main source(s) of information about family planning services. CONCLUSION: The study revealed that the practice rate of family planning in this community is still low. Female education, use of religious/traditional leaders along with improved dissemination of information using the mass media may go along way to increase contraceptive up take.

Awareness and utilization of insecticide treated mosquito nets among pregnant mothers at a tertiary health institution in north-western Nigeria.

INTRODUCTION: Malaria in pregnancy is a formidable misery in Africa and contributes significantly to maternal death in Nigeria. The use of insecticide treated mosquito bed nets is one of the strategies of the Roll Back Malaria initiative. It is a form of vector control measure but there exists discordance between awareness and utilization of insecticide treated nets in Nigeria. This study set out to assess the level of awareness and utilization of insecticide treated nets among pregnant mothers attending antenatal clinic. METHODS: Using a structured questionnaire, a cross sectional study of 250 consecutive pregnant mothers attending antenatal booking clinic in Usmanu Danfodiyo University Teaching Hospital Sokoto between January and March 2008 was conducted. RESULTS: Seventy four percent of the clients were aware of Insecticide treated nets. Awareness of insecticide treated nets was significantly higher in clients with post primary education (66.8%) compared to those with at most primary education (33.2%); p < 0.05. Thirteen percent of the clients were using insecticide treated nets while 67.6% were not. The main reason for non-utilization of insecticide treated nets were non availability of the nets (58.8%) and inconvenience of the barrier to the clients (29.4%). CONCLUSION: There is high level of awareness of insecticide treated nets among the study population but very low utilization largely due to non availability. For Nigeria to achieve the millennium development goal target in combating the menace of malaria in pregnancy, more effort is required to increase the availability of insecticide treated nets. In addition, proper education on the benefits of insecticide treated nets may increase its utilization.

Histo-Pathological Features of Primary Ovarian Tumours Managed in a Tertiary Hospital; Sokoto

Background: Ovarian tumours are the 2nd most common female genital tract tumour in Sokoto; northwestern; Nigeria. We determined the histo-pathological features of surgically removed ovarian tumours. Methods: A 12-year retrospective study of all surgically removed ovarian tumours at the Gynaecological department of Usmanu Danfodiyo University Teaching Hospital UDUTH) Sokoto; North- Western Nigeria. Results: The highest incidence of ovarian tumours was within the age range of 20-45 years. Of the 125 cases of surgically removed neoplastic ovarian tumours seen during the study period; 83(66.4) were benign; 40(22.4) were malignant and 2(1.6) were of borderline malignancy. Epithelial tumours were the commonest neoplasms 54(43.2); while germ cell tumours were present in 47(37.6) cases. Mucinous cystadenocarcinoma was the ommonest malignant ovarian tumour 14(35) and was closely followed by granulosa cell tumour 10(25); dysgerminoma 17.5); serous cystadenocarcinoma (12.5); malignant teratoma 2(5) and endodermal sinus tumour (5). There were 2 cases of metastatic tumours: one from Burkitts lymphoma; and the other from gestational choriocarcinoma. Conclusion: The high frequency of malignant ovarian tumours in the young age group type in this study underscores the need for histology of all surgically removed tumours irrespective of age

Abdominal pregnancy with a full term live fetus: case report.

This is a case report of an abdominal pregnancy that was carried to term with live fetus. Illiteracy, poverty and lack of antenatal care had resulted in her late presentation. Bleeding per vagina, persistence abdominal pain, weight loss and pallor were the main clinical features. She had laparotomy and delivery of a live fetus.

Effects of amodiaquine hydrochloride and artemisinin on indomethacin-induced lipid peroxidation in rats.

In this study, the effects of two antimalarials-amodiaquine hydrochloride and artemisinin were investigated in ulcerated albino rats of Wistar strain. Rats were treated with amodiaquine (30 mg kg(-1)) and Artemisinin (2.86 mg kg(-1)) for 24 h after formation of ulcers induced by indomethacin. Treatments with Amodiaquine Hydrochloride led to significantly increased gastric lesions while artemisinin led to significantly decreased gastric lesions. Also, amodiaquine hydrochloride seemed to elaborate the indomethacin induced effects on gastric juice volume, pH and acid output, while artemisinin attenuated these changes. The data indicates that the use of amodiaquine hydrochloride may be dangerous to the integrity of the stomach, especially in existing gastric ulcers, while artemisinin is mild and ameliorating, may result from their lipid peroxidation/apoptosis activity interference.

Misoprostol use for cervical ripening and induction of labour in a Nigerian teaching hospital.

CONTEXT: Induction of labor is always a challenge to many an obstetrician more so when the cervix is unfavorable. OBJECTIVES: To determine the efficacy and safety ofmisoprostol in cervical ripening and labour induction. MATERIALS AND METHOD: Aprospective study spanning 2 years and involving 151 patients admitted for cervical ripening and induction of labor at Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. 50 microgram (mcg) ofmisoprostol was inserted vaginally every 4 hours until cervix became favorable or onset of labor. RESULTS: Main indications for induction of labour were prolonged pregnancy and hypertensive diseases of pregnancy. An average of 2 insertions of 50 mcg tablet was used to achieve cervical ripening in 107 patients (71%) and 80% (120) had spontaneous labor within 10 hours of insertion. The mean insertion-labor interval was 7.86 hours (SD +/- 2.5). The average duration of labour was 9.36 hours (SD +/- 2.9). Vaginal delivery was achieved in 96% of the patients. Uterine hyperstimulation occurred in 9 patients but there was no case of uterine rupture. CONCLUSION: Misoprostol was effective and safe in cervical ripening and induction of labor with a vaginal delivery rate of 96%. It should be an essential drug in obstetric practice especially in low resource settings.

Research on medical migration from sub-Saharan medical schools: usefulness of a feasibility process to define barriers to data collection and develop a practical study.

CONTEXT: The maldistribution of physicians in sub-Saharan Africa is having serious impacts on population health. Understanding the effect requires investigation from both donor and recipient countries. However, investigation from the perspective of donor countries has been lacking. METHODS: This brief communication describes a model process for the design of a research project that addresses medical migration issues from the perspective of eight African medical schools. During an international meeting, the participants designed an initial "ideal" study, and then rapidly tested its feasibility through a brief survey, and group discussion through a listserv, teleconferences and one face-to-face meeting. FINDINGS AND PRACTICAL IMPLICATIONS: Innovative research ideas can be followed-up with surveys to test the feasibility of an "ideal" research design, modifying the design accordingly. This is currently occurring with our medical migration survey study.

Knowledge and practice of cervical screening among female health workers in Sokoto, North Western Nigeria.

BACKGROUND: Several studies have shown the importance of health care professionals as predictors of the use of cervical cancer screening. AIMS: To determine the knowledge and utilisation of cervical cancer screening services in a cohort of subjects where awareness is naturally expected to be high. METHODS: A cross sectional questionnaire survey of 159 female health care providers in Usmanu Danfodiyo University Teaching Hospital Sokoto. The sample included doctors, nurses, pharmacists, laboratory scientists and medical social workers. RESULTS: Knowledge of cervical cancer screening is high among the respondents. However, only 4.4 % had availed themselves of the opportunity for the test. CONCLUSION: Health care providers should improve on opportunistic screening. It is necessary for a national screening policy to be formulated and implemented in Nigeria.

The reproductive dysfunction effects of gasoline inhalation in albino rats.

Daily exposure to fuel vapour may pose significant health risk to exposed individuals. Fifteen each of male and female albino rats weighing between 110-230g were divided into test (10) and control (5) groups each. The test animals; were exposed to inhalation gasoline for one hour daily for twenty-one consecutive days. All animals were then bled and the serum levels of the reproductive hormones determined. The results showed significant [P < 0.05] reduction in the serum levels of all the hormones of reproduction in both the male and female test animals. The results suggest that inhalation gasoline exposure significantly [P < 0.05] lowers the levels of reproductive hormones in albino rats and may thus interfere with reproduction.

Profound Haemaological Changes In Rats Fed On Different Diet Formulae: A club To The Basis of Ethnic Leuko-Neutropenia

Persons of African origin reportedly have benign Leuko-neutropenia. This relative roles of vitamin B complex an proteins on the leucocyte counts and distribution in an animal model was investigated inbred adult male and female albino rats weighing between 100-160g (n=50) were randomised into four groups. At the end of six weeks feeding period; blood samples were obtained and total leukocyte count was done. The results of total court show that animals fed in protein supplemented diet had a profound increase in their leukocyte court when compered with the control. The study shows that specific dietary elements can induce profound charges n total and diferential leukocyte count