Intrauterine contraceptive device (IUCD): socio-demographic characteristics of acceptors, acceptability and effectiveness in a teaching hospital in Nigeria.

This paper reports the socio-demographic characteristics of acceptors and their experience with intrauterine contraceptive device (IUCD) at the University of Ilorin Teaching Hospital Family Planning Clinic between January 1st, 1992 and December 31st, 1992. A total of 1,483 new contraceptive acceptors were seen at the Family Planning Clinic during the period of study of which 822 (55.4%) were first segment IUCD acceptors. The results (net cumulative rates) were expressed as percentage during the period of study. The rates were as follows: accidental pregnancy 1.3%, expulsion 5.1%, continuation 61.4%. The events leading to termination of IUCD use include; medical reasons 6.8%, planning pregnancy 5.2% and unspecified reasons 5.2%. It is concluded that IUCD is a safe and effective contraceptive with a high acceptability. The acceptability of IUCD can be increased by health education, good clinical management, sympathetic counselling, careful client selection, careful insertion, and regular follow-up with quick access to medical care.

Anovulatory infertility: a report of four cases and literature review.

Four cases of anovulatory/dysovulatory infertility encountered in Ilorin, Nigeria are presented and the literature extensively reviewed on the up-to-date management of this aspect of infertility. All the patients had bilateral tubal patency on hysterosalpingography (HSG) and their husbands had normal seminal fluid analysis. The first case, 30 years of age, had hyperprolactinaemia with galactorrhoea, treated with bromocriptine given 2.5 mg twice daily. Another case, aged 27 years, had polycystic ovarian syndrome with hyperprolactinaemia but no galactorrhea This was treated with clomiphene citrate 100 mg daily. The third case, 34 years old, had hypothyroidism with hyperprolactinaemia and galactorrhea and was treated with thyroxine. The last case, aged 32 years, had hyperprolactinaemia and was treated with bromocriptine and clomiphene citrate. None of the patients had demonstrable pituitary adenoma. After the appropriate treatment, ovulatory menses were restored in all the patients; two have been pregnant, while the other two have not yet achieved pregnancy but have having regular ovulatory menses. All the patients are Nigerians.

Obesity--an overview.

Obesity or being overweight, often resulting from overfeeding, has become a problem of public health magnitude not only in the developed countries but also in the developing countries. The literature has been extensively reviewed to give an overview of the health problems associated with this disorder. Some of these health hazards include hypertension, stroke, coronary (ischaemic) heart disease, diabetes mellitus, premature death, increased risk of cancer and at surgery. The causes, the types, the mode of assessment of the degree of obesity and the various methods of managing obesity with particular emphasis on dieting, exercise and the possible use of drugs (anorexiants) as well as surgery, as adjuncts, have been considered.

Transient cortical blindness in gestational hypertension: report of two cases.

Transient blindness of cortical origin associated with gestational (pregnancy induced) hypertension is a terrifying and unusual experience in obstetric practice. Two cases encountered in our centre at the University of Ilorin Teaching Hospital (UITH) Ilorin, Nigeria are presented. One case occurred in pregnancy and the other in early puerperium. The two patients were Nigerians. The possible aetiology and pathophysiology of this very rare condition are discussed.

Pregnancy outcome in elderly primigravidae at University of Ilorin Teaching Hospital, Nigeria.

The outcome of pregnancy in 120 elderly primigravid patients (35 years and above) managed at the University of Ilorin Teaching Hospital (UITH), Ilorin over a 5 year period has been studied and compared with 140 randomly selected group of young primigravid patients (20-25 years) managed during the same period in the same centre. All the patients were Nigerians. There was no significant difference in the incidence of abortion, mean gestational age, preeclampsia/pregnancy related hypertension, instrumental delivery and mode of onset of labour in the two groups. There was a statistically significant difference between the two groups in the incidence of foetal malpresentational (elderly 5%, young 1.4% P < 0.001), postpartum haemorrhage (elderly 1.7%, young 0.7%, P < 0.001), caesarean section (elderly 36.7%, young 6.9% P < 0.001), foetal abnormality (elderly 1.7%, young 5.7% P < 0.001), perinatal morbidity (elderly 26.7%, young 12.9% P < 0.05) and perinatal mortality (elderly 4.2%, young 1.4% P < 0.05). The implications of these findings are discussed.

Cervical ectopic pregnancy: a case report.

A 24 year old Nigerian woman with cervical pregnancy, a very rare type of ectopic pregnancy, is presented. The disorder can be life-threatening and usually there is difficulty in differentiating it from the cervical phase of an incomplete abortion as well as bleeding cervical fibroid. Ultrasound scan has been found helpful in the diagnosis of cervical ectopic pregnancy. The conservative management and the possible alternative surgical management, based on the clinical presentation, are discussed.

PIP: Cervical pregnancy is a very rare, potentially life-threatening type of ectopic pregnancy. The condition is usually difficult to differentiate from the cervical phase of an incomplete abortion or a bleeding cervical fibroid. A 24-year-old Nigerian woman was seen in a private hospital with a history of 2.5 months amenorrhea, followed by irregular, occasionally heavy, vaginal bleeding for 8 days. She denied any history of associated abdominal pain or urinary symptoms. Before this recent period of morbidity, the woman's menses had been regular every 30 days with normal blood loss of 4 days' duration. She had had two prior normal deliveries, most recently 2 years earlier, and had no history of prior abortion, dilatation, and curettage; infertility; or any contraceptive practice before consultation. Vaginal examination found no active bleeding, but a bulky, soft, 1-2 cm dilated cervix. An ultrasound scan obtained by the patient in another private clinic one day earlier identified an empty uterine cavity, but a bulky cervix with a gestational sac and fetal node. The patient was to be admitted for immediate evacuation, but left the hospital in search of money for the operation. The products of conception were evacuated at the hospital the next day. The patient was in satisfactory condition with no complaints at 4 weeks follow-up.

Surgical management of female infertility in Ilorin, Nigeria.

Three hundred and seventeen female patients with infertility surgically managed and followed up for four years at the University of Ilorin Teaching Hospital (UITH), Ilorin, Nigeria are presented. 45 (14.2%) of these patients were pregnant. A total of 61 pregnancies were achieved in these patients giving an overall pregnancy rate of 19.24% which is comparable to those reported in literature. In the study period, 68.85% full-term gestations, 14.75% pre-term gestations, 11.48% spontaneous abortions and 4.92% ectopic gestations, occurred. As over 50% of female infertility in sub-Saharan Africa is due to tubo peritoneal disorders/pelvic disease and as the desire for children among African women is very strong, the authors plead for the sustenance of surgery, possibly on selected patients, in the management of female infertility even though the success rate appears small.

Factors influencing family planning use in Ilorin, Nigeria.

Over a three-year period (1990-1992), the factors influencing the use of family planning among the 7,902 clients attending the Planned Parenthood Federation of Nigeria (PPFN) Clinic in Ilorin were studied. The patients were predominantly females (74.1%). Urban residents (66.1%), educated clients (77.4%), clients aged 25-39 years (73%), and those with three or more children (74.8%) are more likely to use family planning. More Moslems (61%) than Christians (39%) appear to embrace family planning practice in Ilorin.

PIP: The records of 7902 clients of 3 Planned Parenthood Federation of Nigeria (PPFN) centers in Ilorin were reviewed to determine whether education, place of residence, age, sex, number of children, and religion influence the use of family planning methods and how or why they motivate PPFN clients. Contraceptive users tended to be female (74.1%), literate (77.4%), urban residents (66.1%), Moslem (61%), 25-39 years old (73%), and to have at least 3 children. Urban residence probably had a positive influence on contraceptive use because: family planning centers are easily available, residents have limited need for child labor, urban areas are crowded, and it is more expensive to raise many children in urban areas. The age distribution of contraceptive use suggests that women want to bear children while they are young, they then want to space births, and, finally, they want to cease child bearing when older. The greater contraceptive use among women than men (74.1% vs. 25.9%) reflects the male domineering attitude and reluctance to use family planning in this area of Nigeria. It also reflects the belief that family planning use is the responsibility of women.

Procured abortion in Ilorin, Nigeria.

A prospective study of the maternal mortality and morbidity and other related social problems among 144 cases of procured abortion in Ilorin, Nigeria over a 24-month period is presented. A mortality rate of 90.3 per thousand procured abortions was recorded. Genital sepsis, haemorrhagic anaemia, gut injury, uterine perforation and vesico vaginal fistulae (VVF) were encountered. Poor referral system, late presentation, poor blood transfusion services and inadequate availability of drugs had adverse effects on the patients. The implications (the menace and frequency) of these and possible measures like improving the literacy level, the moral standards, contraceptive practice and family life education (sex education) are discussed.

PIP: A review of the cases of 144 women who presented to the University of Ilorin (Nigeria) Teaching Hospital between July 1992 and June 1994 with complications of illegal abortion underscores the health hazards associated with this procedure. There were 13 deaths (90.3/1000 procured abortions) in this series. 77 of the abortion patients were teenagers; another 35 were 20-24 years old. Teenagers were more likely than women in the older age groups to obtain their abortion in the second trimester of pregnancy. 85 women were single. Major occupations represented in the group included students (32 women), house girls/maids (23 women), and business/trading (20 women). The desire to remain in school or retain employment were the reasons most commonly cited for terminating the pregnancy. Sepsis occurred in 39 women, while 18 experienced hemorrhagic anemia. The causes of death included generalized septicemia (3 cases), sepsis with anemia (3 cases), sepsis with jaundice (2 cases), peritonitis with abscess (2 cases), uterine perforation with peritonitis (2 cases), and endotoxic shock (1 case). The maternal mortality and morbidity associated with illegal abortion in Nigeria suggest a need to make family planning services more available to adolescents and single women and to ensure that the scope of family life education is expanded.

Perinatal mortality associated with abnormal presentations at the University of Ilorin Teaching Hospital, Ilorin-Nigeria: a prospective study.

In a prospective study of perinatal mortality (PNM) rates associated with abnormal (ABN) presentations at the University of Ilorin Teaching Hospital, Ilorin, Nigeria over a four-year period, 1987-1990, it was found that out of 6,000-7,000 yearly deliveries, there was an abnormal presentation in about 4.5% of them. Compared with developed countries, this study has shown that the PNM is still alarmingly in our unit, (a reflection of the trend in Nigeria) and when associated with an ABN presentation the PNM is still higher. The overall PNM has shown a gradual fall from 346 (5.76%) in 1987 to 322 (4.37%) in 1990, but it has been observed that the mortality amongst the ABN presentations is on a steady increase from 52 (16.67%) in 1987 to 66 (18.80%) in 1990. A plea is therefore made for a very close and thorough supervision of the patients during the antenatal period and labour to detect and treat these ABN presentations so as to reduce the perinatal wastage.

Cotrimoxazole (septrin) prophylaxis in the management of vesico-vaginal fistulae in Ilorin; Nigeria

In a 5-year period (1986-1990) 83 Nigerian women with mid vaginal vesico-vaginal fistulae (VVF) were treated in the University of Ilorin Teaching Hospital; Ilorin; Nigeria. None of the patients had previous antibiotic therapy before this study. 30 patients received cotrimoxazole (Trimethoprim 80mg; sulphamethoxazole 400mg) two tablets twice daily for 7 days before surgery without sterile urine preparation; 27 similar patients had the same treatment only after surgery; while 26 other patients who had sterile urine preparation before surgery were not given any antibiotics after surgery

Adolescent fertility ; a panoramic view of the problems

The issue of adolescent fertility in developing countries has come into sharp focus of recent though the problem is recognised world wide. In many developing countries of Africa; adolescents constitute about 47 per cent of the population; giving rise to a high dependency ratio as this group is relatively unproductive economically. Curbing the problem of adolescent fertility will ease the strain on the already strained economy of many countries of developing world; particularly Nigeria with a crude birth rate of 45-48 births per 1000 population and an estimated population growth of about 3.3 per cent. A panoramic view of this problem is presented in this paper; highlighting the predisposing factors; risks and consequences. Suggestions are made as to how these problems could be resolved within the present economic situation

Instrumental (operative) vaginal deliveries: vacuum extraction compared with forceps delivery at Ilorin University Teaching Hospital, Nigeria.

In a four-year period (1984 to 1987) a total of 141 Nigerian women who had instrumental vaginal deliveries at term in the Obstetric unit of University of Ilorin Teaching Hospital, Ilorin, were studied. Out of this number 79 had forceps delivery while 62 had vacuum extraction. The forceps delivery rate had fluctuated between 0.11% and 0.46% while the vacuum extraction rate had steadily increased from 0.08% to 0.39% (Table 1) in our unit over the 4-year period. With the exception of fetal distress, there were no significant differences found in the indications for forceps delivery and vacuum extraction. The preapplication station, position and cervical dilatation differ in both groups (Table 4). There was less maternal trauma in vacuum extraction than forceps (Table 5). The vacuum extraction was more associated with cephalhaematoma and neonatal jaundice but less with neonatal mortality compared with forceps (Table 7). Vacuum extraction had gradually assumed more prominence as an alternative to midforceps delivery in our unit in the study period. There was no maternal mortality in the two groups.

Skin closure of laparotomy wounds: absorbable subcuticular sutures vs. non-absorbable interrupted sutures.

In a five year period (1984-1988) in the department of obstetrics and gynaecology of the University of Ilorin Teaching Hospital, Ilorin, 304 laparotomy patients whose skin incisions were closed with the traditional method of interrupted non-absorbable sutures or with absorbable subcuticular sutures were analysed. Out of these 304 patients, 164 had non-absorbable skin sutures while 140 had absorbable subcuticular sutures. The results of the two methods of skin closure were compared immediately on discharge, at 6 weeks and at 6 months after the operation. The appearance of the wounds and scar were better in the absorbable subcuticular group than in the non-absorbable interrupted group. The differences between the two groups were statistically significant in the cross-scar formation, Keloid/hypertrophic scar formation, period of hospitalisation and the acceptance rate. Subcuticular skin closure had the advantages of short stay in hospital, non stitch removal, better scar formation and being more acceptable to patients. There was no significant difference in the age between the two groups. All the patients were Africans.

Vaginal trauma at sexual intercourse in Ilorin, Nigeria. An analysis of 36 cases.

Over a six-year period (1982-1987), 36 cases of vaginal trauma at sexual intercourse managed in the gynaecological unit of the University of Ilorin Teaching Hospital are presented. The serious nature of this accident is stressed. The frequent involvement of the posterior fornix of the vagina, accounting for 50% of the cases is shown. Perforation of the pouch of Douglas with possible intestinal prolapse, and involvement of the urinary bladder resulting in vesicovaginal fistula are not common in Ilorin. The predisposing factors like rough coitus, first sexual intercourse, puerperium, surgical alteration of the vagina, peno-vaginal disproportion and multiparity are discussed. The importance of adequately preparing the women emotionally and physically for coitus, a matter which certain males tend to ignore, is emphasized. The necessity for thorough digital as well as speculum examination in all cases of vaginal bleeding is made. There was no death recorded, while the morbidity was mainly hypovolaemic shock with haemorrhagic anaemia.

Family planning practice among Nigerian student midwives.

An analysis of the various contraceptive methods practiced by a total of 462 student midwives from the Northern and Southern parts of Nigeria over a 3-years period is presented. The differences in age distribution, the type of contraceptive agents used, the reasons for using them, and the side effects in the two groups are statistically significant. The need to provide acceptable contraceptive advice to the rural communities by the midwives is discussed.

PIP: An analysis of the various contraceptive methods practiced by a total of 462 student midwives from the Northern and Southern parts of Nigeria over a 3-year period is presented. The differences in age distribution, the type of contraceptive agents used, the reasons for using them, and the side effects in the 2 groups are statistically significant. In order for the midwives to provide acceptable contraceptive advice to the rural communities they need a positive attitude toward contraception, a more involved role in family planning policy, program planning and implementation, special training in family planning practice, and to be equipped to train various community health workers on how to distribute different types of family planning techniques in all the rural areas, especially outside of the hospital setting. This survey showed that there is a high level of awareness of contraception among the Nigerian midwives studied. It also suggests that Nigerian student midwives practice family planning although many probably use less effective methods. Respondents were mostly single and young and a majority were only 3-4 years post-secondary school. The condom was highly favored, but its use requires a high degree of responsibility and self-control. 27.9% practiced the rhythm method, and 16.2% used oral contraceptives, a relatively low proportion. IUD users were few in number. Incidence of side effects for all methods was low. The midwives are in a unique position, by their practice in rural communities, to preach awareness of contraception in order to reduce the high fertility and population rate in developing countries.