Postnatal care services use by mothers: A comparative study of defaulters versus attendees of postnatal clinics in Enugu.

INTRODUCTION: Despite much emphasis on the reproductive health of women, maternal mortality is still high, especially in postnatal period. OBJECTIVE: To assess the prevalence of postnatal care use and reasons for defaults among mothers attending the child immunization clinics in Enugu, Nigeria. METHODS: This was a cross-sectional comparative study of 400 consecutive nursing mothers who presented at the Institute of Child Health of UNTH and ESUTH, Enugu for Second dose of the Oral Polio Vaccine (OPV2) for their babies at 10 weeks postpartum. Data was collected using Interviewer-administered questionnaire and subsequently analyzed with version 22.0 IBM SPSS software, Chicago, Illinois. A p-value of less than 0.05 was considered as statistically significant. RESULT: The prevalence of the 6th week postnatal clinic attendance among the mothers was 59%. The majority of the women (60.6%) who had antenatal care by skilled birth attendants attended postnatal clinic. Unawareness and being healthy were the main reasons for not attending postnatal clinic. Following multivariate analysis, place of antenatal (OR = 2.870, 95% C.I = 1.590-5.180, p < 0.001) and mode of delivery (OR = 0.452, 95% C.I = 0.280-0.728, p = 0.001) were the only significant predictors of postnatal clinic attendance (p < 0.05). CONCLUSION: Postnatal clinic attendance by women in Enugu is still suboptimal. The main reason for non-attendance of the 6th week postnatal clinic was lack of awareness. There is need for healthcare professionals to create awareness about the importance of postnatal care and encourage mothers to attend.

Social Bullying Among Undergraduates: The Roles of Internet Gaming Disorder, Risk-Taking Behavior, and Internet Addiction.

An issue that affects the academic engagement, performance, health and wellbeing of university undergraduates is bullying. Substantial literature has examined the predictors of bullying perpetration, but there is little research on the contributions of internet-related factors and the propensity to take risks in bullying. We examined the roles of IGD, risk-taking behavior, and internet addiction in social bullying. Four instruments were used for data collection, namely: Young Adult Social Behavior Scale (YASB), the Internet Gaming Disorder Scale (IGDS9-SF), Domain-Specific Risk-Taking Scale, and the Internet Addiction Test (IAT) Scale. Participants were 552 undergraduate students from the University of Nigeria, Nsukka consisting of 143 males and 409 females (age range = 17-32 years; M = 21.45; SD = 2.71). Results of regression analysis showed that gaming disorder (GD) and risk-taking behavior had positive associations with social bullying. Thus, the more people grow addicted to internet gaming and takes more risks, the more they are likely to become bullies. Internet addiction had no significant association with social bullying. Efforts should be made to minimize the rate of dysfunctional internet use, GD and risk-taking behaviors of undergraduates in order to curtail bullying perpetration.

Formulation Development of Azadirachta indica Extract as Nanosuppository to Improve its Intrarectal Delivery for the Treatment of Malaria.

BACKGROUND: Previous folkloric and experimental reports have demonstrated the antimalarial efficacy of Azadirachta indica (AZA) extracts. However, one of the major challenges facing its application for the clinical treatment of malaria is the design of an acceptable dosage form. OBJECTIVE: Consequently, we developed AZA extract-loaded nanostructured lipid carriers (NLC) for the formulation of suppositories, denoted as nanosuppositories, for intrarectal treatment of malaria. METHODS: Various batches of NLC-bearing AZA extract were formulated based on lipid matrices prepared using graded concentrations of Softisan®154 and Tetracarpidium conophorum or walnut oil. NLC was investigated by size and differential scanning calorimetry (DSC). Suppository bearing AZA extract-loaded NLC was developed using cocoa butter or theobroma oil, and their physicochemical properties were profiled. In vitro drug release and in vivo antimalarial activity (using Plasmodium berghei-infected mice) were investigated. RESULTS: NLCs exhibited sizes in nanometers ranging from 329.5 - 806.0 nm, and were amorphized as shown by DSC thermograms. Nanosuppositories were torpedo- or bullet- shaped, weighing 138 - 368 mg, softened/liquefied between 4.10 - 6.92 min, and had controlled release behaviour. In vivo antimalarial study revealed excellent antimalarial efficacy of the nanosuppositories comparable with a commercial brand (Plasmotrim®) and better than the placebo (unloaded nanosuppository), and without toxic alterations of hepatic and renal biochemical factors. CONCLUSION: Thus, AZA extract could be rationally loaded in nanostructured lipid carriers (NLC) for further development as nanosuppository and deployed as an effective alternative with optimum convenience for intrarectal treatment of malaria.

Desire for prenatal gender disclosure among primigravidae in Enugu, Nigeria.

BACKGROUND: Prenatal gender disclosure is a nonmedical fetal ultrasonography view, which is considered ethically unjustified but has continued to grow in demand due to pregnant women's requests. OBJECTIVE: The aim of this study was to determine the proportion of primigravidae who want prenatal gender disclosure and the reasons for it. METHODS: This was a descriptive cross-sectional study of randomly selected primigravidae seen at Enugu Scan Centre. The women were randomly selected using a table of random numbers. RESULTS: Ninety percent (225/250) of 250 primigravidae who fulfilled the criteria for inclusion in this study wanted to know the gender of their unborn baby, while 10% (25/250) declined gender disclosure. Furthermore, 62% (155/250) of primigravidae had preference for male children. There was statistically significant desire for male gender (P=0.0001). Statistically significant number of primigravidae who wanted gender disclosure did so to plan for the new baby (P=0.0001), and those that declined gender disclosure "leave it to the will of GOD" (P=0.014). CONCLUSION: Ninety percent of primigravidae wanted gender disclosure because of plans for the new baby, personal curiosity, partner and in-laws' curiosity; moreover, some women wanted to test the accuracy of the findings at delivery and 62% of primigravidae had preference for male children. In view of these results, gender disclosure could be beneficial in this environment.

Impact of Plasmodium falciparum and hookworm infections on the frequency of anaemia in pregnant women of rural communities in Enugu, South East Nigeria.

INTRODUCTION: Malaria and hookworm infections are common in sub-Saharan Africa and they increase the prevalence of anaemia in pregnancy with resultant poor pregnancy outcomes. This study was carried out to assess the impact of Plasmodium falciparum and hookworm infections on the frequency of anaemia among pregnant women in two rural communities in Enugu, South East Nigeria. METHODS: A cross sectional descriptive study was carried out in a total of 226 women attending antenatal clinics at two rural Primary Health Centres (PHC) from April 2011 to July 2011(each PHC with 113 subjects). Socio-demographic data were collected through a structured questionnaire. Blood and stool samples were evaluated for haemoglobin estimation and malaria parasites, and stool samples examined for parasitic infection in all the women. Data was analyzed using STATA 10 software statistical analysis package. Student t-test was used for comparing mean values and chi square test for comparing categorical variables and level of significance set at p<0.05 and logistic regression was used to identify the risk factors associated with malaria in pregnancy. RESULTS: The mean age of the women was 27 years with range 18-38 years and SD of 5 years. Most of the women were housewives and over 50% in their second trimester. 53% of them had malaria parasites while 27% had hookworm infection. About 40% of the women were anaemic (haemoglobin<0.001). Similar association was found between hookworm infection and anaemia (p<0.001). Though both malaria and hookworm infections greatly increase the odds for anaemia (AOR 18.06, CI 18.15 -39.99, P<0.001) and (AOR 5.28, CI 2.26-12.38, P<0.001) respectively, the odds for having anaemia in pregnancy was higher for malaria than hookworm infections. CONCLUSION: Plasmodium falciparum and hookworm infections have significant impact on the high frequency of anaemia in pregnancy in our rural communities. There is need to strengthen the control program that has been in place with an integrated intervention to combat these parasitic infections in our rural communities, with mass distribution of antihelminthics as one of the included relevant methods, among others.

An overview of vulvovaginal atrophy-related sexual dysfunction in postmenopausal women

Menopause and the climacteric period are associated with adverse risk factors for the development of vulvovaginal atrophy-related sexual dysfunction. Sexual dysfunction is a common problem in postmenopausal women; often underdiagnosed; inadequately treated; frequently overlooked; and most often impairing the quality of life of these women. To provide clinicians with current information on vulvovaginal atrophy-related sexual dysfunction in postmenopausal women. This study is a literature review on vulvovaginal atrophy-related sexual dysfunction in postmenopausal women. Relevant publications were identified through a search of PubMed and Medline; selected references; journals; and textbooks on this topic; and were included in the review. The prevalence of female sexual dysfunction increases with age. It is a common multidimensional problem for postmenopausal women that alter the physiological; biochemical; psychological; and sociocultural environment of a woman. Menopause-related sexual dysfunction may not be reversible without therapy. Estrogen therapy is the most effective option and is the current standard of care for vulvovaginal atrophy-related sexual dysfunction in postmenopausal women. Sexual dysfunction is a common multidimensional problem for postmenopausal women and often impairs the quality of life of these women. Estrogen preparations are the most effective treatment. Selective estrogen receptor modulators; vaginal dehydroepiandrostenedione; vaginal testosterone; and tissue-selective estrogen complexes are promising therapies; but further studies are required to confirm their role; efficacy; and safety

Asymptomatic malaria parasitemia does not induce additional oxidative stress in pregnant women of South East Nigeria.

OBJECTIVE: To determine the relationship between asymptomatic malaria parasitemia and some oxidative stress parameters in pregnant Nigerian women. METHODS: This is a cross-sectional study involving 130 normal pregnant women at various trimesters, who were attending antenatal clinic at the University of Nigeria Teaching Hospital (UNTH) and Kenechukwu Specialist Hospital in Enugu. A comparable group (control), made of 30 non pregnant women was also recruited. After a 24 hour dietary recall, serum levels of vitamin A, C and malondialdehyde (MDA) were determined by colorimetric method, while vitamin E was determined by absorptiometric method. RESULTS: There were no statistically significant differences in age, parity, estimated calorie, vitamins A, C and E intake between the pregnant and non pregnant groups (P> 0.05). The serum level of the vitamins (umol/L) and MDA (umol/L) in control, 1st, 2nd and 3rd trimesters respectively were: (1)Vitamin A: 1.6±0.36 vs 0.6±0.26 vs 0.62± 0.33 vs 0.46± 0.21 (P < 0.0001); (2) Vitamin C: 75.65±14.15 vs 62.97±24.4 vs 37.85±15.19 vs 28.94±8.52 (P<0.0001); (3) Vitamin E: 3.01± 1.32 vs 3.45±2.01 vs 9.36±2.75 vs 9.82±2.97 (P<0.0001); (4) MDA: 1.42± 0.02 vs 1.61±0.02 vs 1.79±0.02 vs 2.03±0.05 (P<0.0001). However, there were no significant changes in the serum level of the vitamins and MDA between the positive and the negative parasitemia subjects (P>0.05). CONCLUSIONS: Asymptomatic malaria parasitemia does not induce additional oxidative stress on pregnant women in Nigeria. The enormity of acute and complicated attack should be further investigated.