Associations between oral habits, dental anxiety, dental service utilization, and maternal mental health status among 6- to 12-year-old children in Ile-Ife, Nigeria.

PURPOSE: The current study sought to determine the associations between maternal mental health and oral habits, dental anxiety, and dental service utilization of 6- to 12-year-old children in Ile-Ife, Nigeria. METHODS: Data were obtained from a household survey involving 1411 mothers and their 6- to 12-year-old children. Data collected were the confounding (maternal age, child's age at last birthday, sex at birth and socioeconomic status), independent (maternal psychological distress, and depression status) and dependent (child's non-nutritive oral habits, dental anxiety level, and most recent dental visit) variables. Bivariate analyses were conducted to test the associations between the dependent and independent variables. After controlling for confounding variables, the associations between the dependent and independent variables were determined using multivariable linear and logistic regression analyses. RESULTS: Overall, 479 (33.9%) reported one oral habit, 189 (13.4%) reported two and 99 (7.0%) children reported three or more oral habits. Only 25 (1.7%) children reported a dental visit in the year preceding the study. Higher maternal psychological distress was associated with higher dental anxiety in children (AOR: 0.094; 95% CI - 0.080 to - 0.293; p < 0.001). There was no significant association between maternal psychological distress, child's non-nutritive oral habits, and the child's most recent dental visit. There was also no association between maternal depression and the child's non-nutritive oral habits, dental anxiety level, and most recent dental visit. CONCLUSION: Maternal psychological distress was a significant risk indicator for dental anxiety, but not for dental service utilization or non-nutritive oral habits among children in Ile-Ife, Nigeria. Maternal educational status was also associated with dental anxiety. Further research is needed to elucidate the study's findings.

Antenatal Clinic Waiting Time, Patient Satisfaction, and Preference for Staggered Appointment-A Cross-Sectional Study.

Time spent in the antenatal clinic (ANC) is a major disincentive for pregnant women and constitutes a barrier to the utilization of ANC. Long waiting time and poor patient satisfaction may contribute to poor utilization. This study assessed waiting time, patients' satisfaction, and preference for staggered ANC appointments. A cross-sectional study was conducted; information obtained includes sociodemographic and obstetric characteristics, and time spent at ANC service points. Data were analyzed using International Business Machines (IBM) Statistical Products and Service Solutions (SPSS) software version 23. Descriptive statistics and chi-square test were conducted. Level of significance: P < .05. One hundred and twenty-two participants were interviewed. Mean age was 30.52 (±4.65) years, they were mostly multi-gravid, married, and with tertiary education. Mean time spent in ANC and waiting time were 191 min and 143 min, respectively. Waiting time was longest at doctor's consultation (59 min), laboratory services (38 min), and the cash pay-point (18 min). About 68.9% were satisfied with services and highest at doctors' consultation. Satisfaction was associated with waiting time of <45 min. Dissatisfaction was high at the cash pay-point (28.7%), followed by the laboratory (16.4%). About 56.5% preferred staggered appointments. Time spent in ANC should be reduced and staggered appointments may be a useful strategy to reduce waiting time and patient load.

Diagnostic accuracy of random plasma glucose and random blood capillary glucose in detecting international association of diabetes and pregnancy study groups- defined hyperglycemia in early pregnancy.

BACKGROUND: Maternal hyperglycemia first diagnosed in pregnancy, previously referred to as gestational diabetes mellitus is associated with health consequences for both the mother and her fetus/baby, not only in the short term but also in the long term. Early screening helps to identify women with overt diabetes or those with early onset GDM. AIMS: The aim of this study was to determine the diagnostic performance of two screening tests (Random plasma glucose, Random capillary glucose) in relation to 75g Oral glucose tolerance test (OGTT) done before 24 weeks gestation. METHODS: This prospective longitudinal cohort study was carried out between 1st February, 2017 and 31st July, 2017, at two teaching hospitals in Nigeria. Two hundred and eighty one (281) pregnant women who met the inclusion criteria were selected and screened with both random plasma glucose (RPG) and random capillary glucose (RCG) before 24 weeks of pregnancy. They were then made to undergo 75g OGTT a week later. The diagnostic performance of the screening tests were determined. RESULTS: A total of 270 women had 75g OG. CONCLUSION: Random plasma glucose and Random capillary glucose performed poorly compared to 75g-OGTT in detecting hyperglycemia in early pregnancy.

Perspectives of socially disadvantaged women on oral healthcare during pregnancy.

Oral health is considered important during pregnancy, however many pregnant women, especially socially disadvantaged women such as immigrants, working poor and homeless have difficulty accessing oral healthcare. OBJECTIVE: To explore the perceptions of a sample of socially disadvantaged women on oral healthcare provision during pregnancy. BASIC RESEARCH DESIGN: Qualitative study via focus group discussions with seventeen pregnant women or new mothers receiving care at a local maternity clinic that serves a culturally diverse population facing social challenges. PARTICIPANTS: Women who met at least one of the following criteria: low socio-economic status, new immigrant or refugee, homeless or at risk of homelessness, history of incarceration or substance abuse or at risk of abuse. Discussions were audio-recorded, transcribed verbatim and analyzed thematically using the NVivo 11© software programme for coding and thematic analysis. RESULTS: All participants reported unmet oral healthcare needs. The analysis revealed three main themes: knowledge of the importance and value of oral health during pregnancy, experiences with oral healthcare and provision of oral health services to socially disadvantaged pregnant women. Participants favoured inclusion of preventive oral healthcare provided by either dental or prenatal healthcare professionals in routine prenatal care. DISCUSSION: Socially disadvantaged pregnant women did not access the oral healthcare they needed due to cost, dental fear and anxiety; some faced stigma and discrimination. They were disposed to receiving community-based, primary preventive dental services as part of prenatal care from either dental or prenatal allied healthcare professionals.

Maternal near-miss and death among women with postpartum haemorrhage: a secondary analysis of the Nigeria Near-miss and Maternal Death Survey.

OBJECTIVE: To investigate the burden and health service events surrounding severe maternal outcomes (SMO) related to life-threatening postpartum haemorrhage (PPH) in Nigerian public tertiary hospitals. DESIGN: Secondary analysis of a nationwide cross-sectional study. SETTING: Forty-two tertiary hospitals. POPULATION: Women admitted for pregnancy, childbirth or puerperal complications. METHODS: All cases of SMO [maternal near miss (MNM) or maternal death (MD)] due to PPH were prospectively identified using WHO criteria over a 1-year period. MAIN OUTCOME MEASURES: Incidence of SMO, health service events, case fatality rate (CFR) and mortality index (MI: % of death/SMO). RESULTS: Postpartum haemorrhage occurred in 2087 (2.2%) of the 94 835 deliveries recorded during the study period. A total of 354 (0.3%) women had an SMO (103 MD; 251 MNM). It was the most frequent obstetric haemorrhagic complication across hospitals. PPH had the highest maternal mortality ratio (112/100 000 live births) and the recorded MI (29.1%) and CFR (4.9%) were second only to that of ruptured uterus. About 83% of women with SMO were admitted in a critical condition with over 50% being referred. MD was more likely when PPH led to neurological (80.8%), renal (73.5%) or respiratory (58.7%) organ dysfunction. Although the timing of life-saving interventions was not statistically different between the cases of MD and MNM, close to one-quarter of women who died received critical intervention at least 4 hours after diagnosis of life-threatening PPH. CONCLUSIONS: Postpartum haemorrhage was a significant contributor to obstetric haemorrhage and SMO in Nigerian hospitals. Emergency obstetric services should be enhanced at the lower levels of healthcare delivery to reduce avoidable deaths from PPH. FUNDING: The original research that generated the data for this secondary analysis, and the publication of this secondary analysis, was funded by the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research Development and Research Training in Human Reproduction (HRP), a cosponsored programme executed by the World Health Organization. We have no other funding issue to declare for our study. TWEETABLE ABSTRACT: One hundred and three maternal deaths and 251 near-misses resulted from PPH in 42 Nigerian tertiary facilities in 1 year.

Influence of Tramadol on Anaesthetic Indices and Physiological Parameters of Epidural Lignocaine in West African Dwarf Sheep Undergoing Laparo-Ovariectomy.

The influence of tramadol on the anaesthetic indices and physiological parameters of epidural injection of lignocaine was evaluated in West African Dwarf (WAD) sheep undergoing laparo-ovariectomy. Ten female sheep weighing (16.2 ± 1.3 kg) were randomly allocated into anaesthesia with epidural injection of lignocaine (4mg/kg) (LIG), or lignocaine (2mg/kg) and tramadol (2mg/kg) (LIG-TRA). Following anaesthesia, they were aseptically prepared and subjected to laparo-ovariectomy. Behavioural changes were noted as they occur, and onset of drug action (OAN) (time between epidural injection and loss of pedal reflex), duration of analgesia (DAN) (time between disappearance and reappearance of pedal reflex) were determined. Also, duration of recumbency (DRC) (time between loss of righting reflex and returns to sternal recumbency) and recovery time (RCT) (time between re-appearance of pedal reflex and when the animal was able to stand without ataxia) were determined. Rectal temperatures (RT), respiratory rates (RR) and heart rates (HR) were determined every ten minutes for two hours. Results were expressed as mean ± standard error of mean. Anaesthetic indices were compared with Student's t-test, while physiological parameters were compared with analysis of variance (ANOVA) for repeated measures. In this study, one sheep anaesthetized with LIG-TRA had bloat while none in sheep anaesthetized with LIG had bloat. The OAN was significantly (p < 0.05) shorter in LIG-TRA (1.4 ± 0.5 mins) than with LIG (4.4 ± 2.8 mins). Although DAN and DRC were longer in LIG-TRA (133 ± 19.5 mins, 192.6 ± 43.6 mins) than LIG (119.4 ± 52.5 mins; 166.2 ± 30.6 mins) respectively, values were not statistically significant (p = 0.863). In addition, RCT was longer in LIG-TRA (56.0 ± 48.6 mins) than LIG (34.0 ± 20.6 mins). The RT, RR and HR did not differ significantly (p > 0.05) between LIG-TRA and LIG, and as well as throughout the duration of study. It was therefore concluded that tramadol did not appear to improve the anaesthetic indices of epidural lignocaine injection in sheep but increased the duration of recumbency with the tendency to cause bloat.

Caregivers' perception of oral health-related quality of life in a group of Nigerian children living with human immunodeficiency virus.

AIM: This study examined the caregivers' perception of the effect of dental conditions on general well-being and family life of a group of human immunodeficiency virus (HIV)-infected Nigerian children. A secondary aim was to investigate correlations between the children's sociodemographic and health-related variables and caregivers' global ratings of oral health and well-being. Study Design A cross-sectional questionnaire-based survey was conducted among parents/caregivers of 95 HIV-positive children receiving care at the Lagos State University Teaching Hospital, Nigeria. MATERIALS AND METHODS: The "Parental-Caregivers Perception Questionnaire" which included measures of global ratings of oral health and well-being as well as effects of oral health on domains of oral symptoms, functional limitations, emotional well-being, and family well-being/parental distress was used. Assessment was based on the child's oral health within the preceding 3 months of the study. RESULTS: The most affected subscale of the oral health-related quality of life was functional limitation followed by parental distress and then oral symptoms. Caregivers of older children were 2½ times more likely to view oral health as impacting their child's overall health (P = 0.034). Furthermore, caregivers of children who had not yet commenced antiretroviral therapy were 15% more likely to report oral symptoms (P = 0.024) and 11% were more likely to be distressed. STATISTICS: Data entry, validation, and analysis were done using SPSS version 17.0. Findings were considered to be statistically significant when 95% confidence intervals were not overlapping. CONCLUSIONS: According to caregivers' perceptions, oral symptoms, functional limitations, and parental distress outweighed emotional well-being in impacting a child's oral health quality of life. Oral health programs to improve the knowledge of caregivers on the importance of oral health in HIV-positive children are necessary for improvement in overall quality of life.

DENTAL CARIES AND NUTRITIONAL STATUS OF SCHOOL CHILDREN IN LAGOS, NIGERIA - A PRELIMINARY SURVEY.

BACKGROUND: Studies have highlighted the direct impact of caries on the nutritional status of children; few studies in Nigeria have examined the association between the two parameters. AIM: To determine the association between caries and the nutritional status of in-school children. Design of the study: A cross-sectional survey. SETTING: Two private and two public schools in Lagos state. METHODOLOGY: A total of 973 children were assessed for dental caries using the WHO diagnostic criteria. Nutritional status was assessed using the weight for age, height for age and weight for height parameters. Data entry and analysis were done using WHO Epi 3.5 nutritstat and SPSS version 20.0 software. The t test, ANOVA, chi squared test, correlation statistics and logistic regression analysis were used as tests of association. A p-value of 0.05 or less was considered statistically significant. RESULTS: Caries prevalence was 21.7% while mean Decayed Missing and Filled Teeth (DMFT) index score was 0.48 (±1.135). Overall 13.9% of the children studied were stunted, 13.6% were wasted and 10.9% were underweight. The caries prevalence was significantly higher in children with normal weight than in overweight or underweight children (p=0.009). Children who were wasted (p=0.111) and those who were underweight (p=0.659) had a higher mean DMFT score, but the relationship was not statistically significant. The DMFT score was negatively correlated with weight for age but positively correlated with height for age and weight for height. The relationships were also not statistically significant. CONCLUSION: Our results showed that underweight children had a higher risk of developing dental caries. Although both under weight and wasted children had higher mean DMFT scores, there was no significant association between dental caries and nutritional status.

Ethical issues in newer assisted reproductive technologies: A view from Nigeria.

BACKGROUND: Infertility is a prevalent condition in many developing countries with significant physical and psychosocial implications. The aim of this study is to discuss briefly the ethics of newer assisted reproductive technology (ART) with special emphasis on the peculiarities in Nigeria. METHODS: MEDLINE and Google Scholar were searched for English-language articles from January 1990 to July 2014 using the search terms "ethics of ART AND Nigeria," "ethical issues in in vitro fertilization AND Nigeria." Using the above search phrases, a total of 43 articles were retrieved out of which only 5 dealt specifically with the subject matter. RESULTS: The core ethical issues found in the reviewed literature are listed in [Table 1]. Inequitable access to ART due to its high cost, lack of regulatory body, safety of the procedure, and fate of the embryos were the main themes identified from the papers. Surrogacy, sex selection, and gamete donation were additional relevant ethical issues. CONCLUSION: There is an urgent need for stakeholders in developing countries to formulate cultural and context-specific guidelines to help address some of these ethical dilemmas.

Randomization of two dosing regimens of vaginal misoprostol for cervical ripening and labor induction in a low resource setting.

OBJECTIVES: To compare the effectiveness of two dosing regimens of vaginal misoprostol for cervical ripening and induction of labour. MATERIALS AND METHODS: Pregnant women with singleton low risk pregnancy at term scheduled for elective induction of labour were randomized to receive either 25 µg or 50 µg of vaginal misoprostol for pre-labour cervical ripening. All the patients received antenatal care and delivered at the University College Hospital (UCH) from January 1 st to May 31 st 2006. A total of 128 patients were randomized; 65 patients received 25 µg and 63 patients received 50 µg of vaginal misoprostol. RESULTS: Significantly higher number of patients in the 50 µg group progressed to active labour as compared with the 25 µg group (95.2% versus 84.6%, P < 0.05). The need for oxytocin augmentation of labour was higher among the 25 µg as compared with 50 µg (39.7% versus 16.4%, P = 0.007). There was higher proportion of patients in the 50 µg group delivering vaginally within 24 hours as compared with the 25 µg group (98.2% versus 90.0%, P = 0.063). However, the mean interval between the first dose of misoprostol and vaginal delivery was not statistically different in the two groups (754 ± 362 minutes and 885 ± 582 minutes, P = 0.152). The incidence of caesarean section was similar in the two groups (7.7% versus 11%, P = 0.580). Labour complications, such as precipitate labour, tachysystole and abnormal fetal heart rate patterns were greater in the 50 µg group. CONCLUSION: Twenty-five microgram of misoprostol appears to be as effective as 50 µg for pre-induction cervical ripening and labour induction. Though 50 µg of vaginal misoprostol resulted in relatively faster delivery and less need for oxytocin augmentation, it was associated with more labour complications as compared with 25 µg of misoprostol.

Factors affecting patient satisfaction at the Lagos State University Teaching Hospital Dental Clinic.

BACKGROUND: Satisfaction is important in dental care because satisfaction with care alleviates dental anxiety, influences patients' compliance and is an important indicator of quality of care. OBJECTIVES: This study was designed to determine the factors that contribute to satisfaction with dental care among patients attending the Lagos State University (LASUTH) Dental Clinic. METHODS: Across-sectional, descriptive questionnaire-based survey was conducted among adult patients attending the LASUTH Dental Clinic. The questionnaire, a modification of the Dental Satisfaction Questionnaire (DSQ), contained 19 items on a Likert-pattern scale with scores ranging from 0 to 4. RESULTS: The scores obtained for satisfaction with the dental services ranged from 19 to 75 with a mean of 55.30 +/- 11.55. The majority of respondents (305 or 87.4%) were satisfied with the services received. The items generating the highest and lowest mean satisfaction score were cleanliness/comfort of the facility and cost of services respectively. Long waiting time was the item respondents liked least about the services. There was a statistically significant relationship between the items assessing communication and respondent's gender (p = 0.001). The relationship between the overall satisfaction score and gender (p = 0.233), age category (p = 0.842) and educational status (p = 0.565) were not statistically significant. CONCLUSION: The results indicate a high level of satisfaction with services provided at the LASUTH Dental Clinic. However, there is need for improvement in communication with patients and reduction in waiting time.

Dental caries in children--an assessment of the knowledge of Nigerian paediatricians.

BACKGROUND: A high proportion of Nigerian children with caries are left untreated resulting in complications. Paediatricians often provide primary care and maybe useful in improving oral health care. AIM: To assess the oral health knowledge on dental caries and professional experience of a sample of Nigerian paediatricians. METHODS: A self-administered questionnaire-based cross sectional survey of paediatricians attending the annual national conference of the Paediatric Association of Nigeria in January 2011 at Abuja, Nigeria was conducted. The questionnaire assessed knowledge on early childhood caries, oral health services provided and attitude to preventive dental services. Data analysis was done using EPI-info (version 3.5) statistical software. RESULTS: Of the 200 questionnaires administered, 145 were properly completed and returned (response rate of 72.5%). The respondents' gender was almost evenly distributed. Their age range was 26-77 years (mean 41.8 +/- 7.4 years). A total of 83 (57.2%) respondents reported receiving oral health education prior to this study. Over 90% of the respondents had received various dental complaints from their patients. Very few (26.2%) performed oral screening routinely although 94.2% believed that oral screening should be routinely carried out. Only 28.9% of the respondents felt adequately informed about oral health though 86.6% were willing to receive training on oral health care. Most of the respondents agreed that dental assessments and counselling should be included in routine paediatric clinical examination. CONCLUSION: Paediatricians could be useful in increasing access to oral health care for Nigerian children. Hence, oral health education should be included in the training programme of Nigerian paediatricians.

The perception of caregivers attending a Nigerian teaching hospital on teething.

BACKGROUND: in November 2008. There was a national tragedy which recorded about eighty four Nigerian infant deaths due to the consumption of adulterated teething syrup- 'my pikin' administered to children by mothers to prevent 'teething problems". This could have been prevented if they had been well informed about the teething process. OBJECTIVE: to determine the knowledge, understanding and beliefs of caregivers attending LASUTH immunization clinic about teething. METHODS: An interviewer administered questionnaire was used to collect data from 260 caregivers of children aged 4-36 months attending the immunization clinic in LASUTH over a six weeks period. The questionnaire assessed their knowledge, understanding, beliefs about teething and the teething experience in their wards. RESULTS: The mean age of the respondents was 30.4 5.3years. Fifty seven percent had tertiary education. However, none of the caregivers obtained information about teething from the dentist. There was an association between educational level and attitude to teething (p=0.002) as well as their understanding of the teething process (p=0.0009). Gum irritation was the most reported symptom observed in this study. Many of the caregivers had erroneous beliefs regarding the systemic symptoms such as fever, diarrhoea and vomiting which they attributed to teething. CONCLUSION: Many of the caregivers studied still had erroneous beliefs regarding teething. Thus there is a need to disseminate the right information about teething to care givers in this environment in order to discourage the use of the term "teething" for a serious childhood illness that might require prompt medical attention.

Knowledge of orthodontics as a dental specialty: a preliminary survey among LASUCOM students

"Awareness of malocclusion and the need to make corrections has increasingly becomes prevalent among our population. However; very few patients have presented in the orthodontic clinics with referrals from medical practitioners; an indication that the primary caregivers may be deficient in the knowledge of orthodontic practice. Objective: To assess the knowledge of orthodontics and the awareness of the effects of malocclusion on the general well-being; among medical students at the Lagos State University College of Medicine (LASUCOM). Materials and Methods: This cross-sectional study was conducted using a self-administered questionnaire. A total of 85 medical students in the institution participated in the study. Data entry and analysis was done using Epi info version 3.5. Frequency counts were generated for all variables and measures of central tendency for numerical variables. Results: All participants were medical students. Majority (75.3) were in their clinical years while 24.7were in their preclinical years. Only 45.9of the respondents had heard of the term ""orthodontics"" and only 20 correctly answered that orthodontics involves malocclusion and its management. Concerning the treatment procedures used in orthodontic clinics; 54.1of them selected rearrangement of teeth. When asked to identify the appliances used in orthodontics; 49.4 selected dentures; 40 selected removable appliances; and 57.7selected braces. Most of the respondents (81.2) agreed that as medical doctors they would refer patients for orthodontic care; while 3.5 were undecided and 15.3 disagreed. Conclusion: The medical students surveyed had limited knowledge of orthodontics as a specialty and also knew very little about the impact of malocclusion on the well-being of the individual. They would; therefore; benefit from basic education in orthodontics to stimulate their interest in the specialty and improve their ability to refer patients appropriately."

The National Health Insurance Scheme (NHIS): a survey of knowledge and opinions of Nigerian dentists' in Lagos.

This study was designed to assess the knowledge and perceptions of Nigerian dentists to the National Health Insurance scheme (NHIS). A cross-sectional descriptive survey was conducted amongst 250 dentists employed in private and public dental clinics in Lagos State, Nigeria. The survey instrument was a self-administered questionnaire designed to assess their knowledge and attitudes towards the scheme. Data analysis was done using the Epi-Info statistical software (version 6.04). Statistical tools used included measures of central tendency, frequency distribution and chi-square test. A total of 216 dentists (response rate of 82.4%) participated in this study. Most 132 (61.1%) of the respondents had a fair knowledge of the NHIS, while 22 (10.2%) and 62 (28.7%) had poor and good knowledge respectively. Majority (70.4%) viewed the NHIS as a good idea that will succeed if properly implemented. Most (76.6%) respondents also believed that the scheme will improve access to oral health services, affordability of services (71.4%), availability of the services (68.3%) and recognition of dentistry as a profession (62.4%). Most of the respondents (66.2%) considered oral health care as not properly positioned in the NHIS and 154 respondents (74.4%) found the current position of oral health on the NHIS unacceptable. A good number of the respondents (77.3%) would like dentistry to operate at the primary care level on the NHIS. Majority of the dentists involved in this study had some knowledge of the NHIS and were generally positively disposed towards the scheme and viewed it as a good idea.

Dental attendance in a sample of Nigerian pregnant women.

BACKGROUND: Good oral health is a fungamental component of pregnant women overall health and quality of life. OBJECTIVE: To determine the proportion of dental services utilisation and the reasons for non utilisation among women receiving antenatal care at the Lagos State University Teaching Hospital (LASUTH). METHODS: A cross-sectional study of all pregnant women receiving antenatal care in a Nigerian teaching hospital (LASUTH) between July and September 2008 was conducted. The study assessed the women's opinions on regular dental visits, dental visits during pregnancy, the frequency of utilization of oral health services before and during pregnancy and their reasons for non-attendance. RESULTS: Three hundred and forty two (342) pregnant women with age range 18 to 44 years (mean 30.37 +/- 4.5) participated in the study. Only 163 respondents (33.0%) reported ever visiting a dentist, 24 (7.0%) had done so just before or during the present pregnancy. Among the dental clinic attendees the commonest reason for attendance was pain (88 women or 53.9%). Majority (62%) of those who had never visited a dentist attributed their non-attendance to the absence of dental pain. There was a significant relationship between the respondent's age and the utilization of dental services (p < 0.001). The older women had utilised dental services more often than their younger counterparts. Educational level and ethnic grouping were not significantly related to their use of dental services. CONCLUSION: A high proportion of women receiving antenatal care at LASUTH do not visit the dentist regularly. It is important to provide women in the reproductive age with information on the benefit of regular dental care especially during pregnancy.

Maternal and fetal outcomes of jaundice in pregnancy at the University College Hospital, Ibadan.

OBJECTIVE: This study is aimed at determining pregnancy outcome of cases of jaundice in pregnancy over a 10 year period at the University College Hospital, Ibadan. METHODOLOGY: All case records of patients with jaundice in pregnancy over a 10-year period from 1st January 1992 through 31st December 2001 were retrieved from the medical records office of the hospital and analysed. RESULTS: During the ten-year study period, there were 16,566 registered pregnancies in the hospital, and 52 cases of jaundice in pregnancy were seen, giving an overall incidence of 0.3% or 1 in 318 deliveries. However, 48 case records were retrievable. Viral hepatitis was the commonest cause accounting for 58.3% of cases. It was followed by malaria and sickle-cell anaemia with 20.8% and 16.7% respectively. Other causes include sepsis 14.6%, cholestasis 6.3%, and Pre-eclampsia 2.1%. Preterm delivery occurred in 39.6%, while intrauterine fetal death (IUFD) occurred in 8.3% of cases, all occurring in the third trimester. A case of early neonatal death was recorded. There was no maternal death and the mean hospital stay was 18 days (range 4-45 days) during admission. CONCLUSION: Viral hepatitis, malaria and sickle-cell anaemia are the leading causes of jaundice in pregnancy. These should be promptly diagnosed, investigated and appropriate management instituted as most of the perinatal deaths can be avoided by close fetal monitoring especially in the third trimester and with recourse to early delivery before fetal demise occurs.

Assessment of the exposure of two fish species to metals pollution in the Ogun river catchments, Ketu, Lagos, Nigeria.

The concentrations of metals (Ca, Cd, Fe, Mn, Pb and Zn) were determined by flame atomic absorption spectrophotometry in water, sediments and fish samples in the Ogun river catchments, Ketu, Lagos, which is an important bird nesting, fishing and drinking water source. The results show that the southern tip bothering the Lagos lagoon is where the highest metal concentrations are found in the fish species (Tilapia sp. and Chrysichthys sp.), whereas the Agboyi creek segment near the lagoon with higher surrounding human population density recorded higher levels of metals in sediments and water samples. The two fish species accumulated different amounts of metals. However, the differences were not statistically different at p < 0.05. There is a significant correlation (p < 0.05) for Cd concentration in water. The concentrations of Pb in sampling points 3 and 4 as well as Cd, Mn and Fe in all six sampling points exceeds the World Health Organization (WHO) limits for drinking water. Levels of metals obtained for sediments are within the range reported for Nigeria's river sediments. Based on this study, the human risks for heavy metals in the harvested fish species from the Ogun river catchments, Ketu, are low for now as the concentrations were below the recommended Food and Agriculture Organization (FAO) maximum limits for Pb (0.5 mg/Kg), Cd (0.5 mg/Kg), and Zn (30 mg/Kg) in fish.

Viral hepatitis in the aetiogenesis of jaundice in pregnancy at the University College Hospital, Ibadan.

Viral hepatitis is common in Nigeria and may present with jaundice in pregnancy. The objective of this study was to determine the contribution of viral hepatitis among other aetiological factors, to the development of jaundice during pregnancy. Data on viral hepatitis among gravidae with jaundice in pregnancy over a 10-year period from 1st January 1992 through 31st December 2001 were retrieved and analyzed. Fifty-two cases of jaundice in pregnancy were seen among 16,566 pregnancies registered in the hospital over the 10-year period. Of the 52 cases of jaundice in pregnancy, only 48 case records were retrievable, on which this analysis is based. Viral hepatitis (VH) occurred in 1 in 591.6 pregnancies and was diagnosed in 28 (58.3%) cases of jaundice in pregnancy. Other causes of jaundice were malaria 8 (16.7%), sickle-cell anaemia in pregnancy 6 (12.5%) and sepsis 2 (4.2%). Of the 28 patients with viral hepatitis, 8 (28.5%) were positive for HBsAg. The liver function tests (LFTs) were done in 26 of the 28 patients and it showed hyperbilirubinaemia in 24, 11 had serum albumin >3.5 g/dl. All had spontaneous vaginal delivery with no maternal death. Complications associated with viral hepatitis were, anaemia 14 (50%), intrauterine growth retardation (14.3%), intrauterine foetal death 2 (7.1%), congestive cardiac failure 1 (3.57%) early neonatal death 1 (3.57%) and 2 (7.1%) cases of systemic hypertension. Viral hepatitis contributes significantly to jaundice in pregnancy and there is associated fetal and maternal morbidity.

Minimum practicable and acceptable infection control recommendations for dental practice in Nigeria.

The advent of HIV/aids has led to a renewed interest in infection control and occupational safety in dentistry. The full implementation of "Universal Precautions" to prevent cross-infection of HIV, hepatitis B, and other blood borne pathogens would have a heavy financial implication on developing countries like Nigeria which are faced with the arduous problem of coping with scarce resources. Dentistry is bound to cost more when effective infection control is practised. This paper therefore proposes recommendations for minimum, practicable and acceptable infection control standards which are not only cost effective but also attainable.