Outcome of cryosurgery for cervical intraepithelial neoplasia in a developing country.

Over a 2-year period cryosurgery was used to treat 73 women who were diagnosed by colposcopy and histologic studies to have cervical intraepithelial neoplasia (CIN). Follow-up was achieved for 70% at 5 years, a significant attendance rate in a developing country. The primary cure rate was 88.5% at 1 year and 90% at 5 years (excluding those lost to follow-up) in all patients with different grades of CIN. The therapy was free of major complications and we found no adverse effect of cryosurgery on subsequent reproductive function in those desiring pregnancy. We conclude that cryosurgery has gained wide acceptance in our geographic area particularly because of its low cost, efficacy and preservation of fertility. For these reasons we would strongly recommend its use provided adequate attention is paid to meticulous pretreatment evaluation and long-term follow-up after therapy.

A comparative study of oral glucose tolerance tests in Nigerian women on three types of steroidal contraceptives.

Oral glucose tolerance tests (OGTT) were performed on 146 Nigerian women volunteers using one of three types of steroidal contraceptives: high-dose combined pills; low-dose combined pills and injectable progesterone. Twenty-six appropriately matched nonusers served as controls. The OGTT curves were analysed using the H-index (HI). Women on injectable progesterone and high-dose combined pills, respectively, had significantly higher (P less than 0.05) mean HI than the controls. The low-dose combined pills had the least effect on carbohydrate metabolism.

Screening for cervical neoplasia in an African population: simultaneous use of cytology and colposcopy.

In many countries cytologic screening for cervical cancer has become firmly established and accepted. This has not been the case in some developing countries because of limited financial and manpower resources. In a series of 1564 patients, simultaneous colposcopy and cytology revealed 31 women with varying degrees of cervical intraepithelial neoplasia. We feel that an initial combination of colposcopy and cytology provides a more reliable diagnosis of cervical lesions and a case is made for the establishment of mass cytologic screening in Nigeria.

Exercise and menstrual function in Nigerian university women.

The purpose of this investigation was to determine the prevalence of menstrual disorders among Nigerian university athletes. We designed a questionnaire to elicit information on the athletes' menarcheal age, menstruation/pregnancy histories and contraceptive habits. One hundred and thirty-three athletes randomly drawn from various Nigerian universities completed the questionnaire. For data analysis, the athletes were assigned to two main groups based on their sporting events, i.e. contact sport athletes (CSA) and non-contact sport athletes (NCSA). The data revealed that NCSA were significantly (P less than 0.05) younger, weighed less and were leaner than CSA. The two groups were comparable in height, length of sporting activities, menstrual cyclicity, incidences of dysmenorrhoea and menorrhagia. None of the athletes reported oligo- or amenorrhoea. The overall incidence of dysmenorrhoea and menorrhagia amongst the athletes was 35% and 41%, respectively. As compared to our previous data in sedentary Nigerian university women, it appears that exercise has a salutary effect on dysmenorrhoea but no appreciable effect on the incidence of other menstrual disorders.

Copper intrauterine contraceptive devices and serum essential metals.

Serum levels of the essential metals, iron (Fe), copper (Cu), magnesium (Mg), zinc (Zn), and calcium (Ca), were determined by atomic absorption spectrophotometry in one hundred and twenty randomly selected adult Nigerian female volunteers fitted with copper T or Delta T intrauterine contraceptive devices (IUDs) for a period of 3-18 months, and their normal age-matched controls. The mean serum concentration of all the essential metals was lower in the women fitted with copper IUDs than the control group. The differences, however, are not statistically significant (p greater than 0.05).

Ultrasound measurement of fetal abdominal circumference and the ratio of biparietal diameter to transverse abdominal diameter in a mixed Nigerian population.

The fetal abdominal circumference (FAC) and biparietal diameter to transverse abdominal diameter ratio (BPD/TAD) were measured by ultrasound in 219 normal pregnant Nigerian women from 20 weeks until term using the cross-sectional method. There was a progressive linear growth of the FAC and a consistent standard deviation throughout the study period. When compared to caucasian growth curves, the curve shapes were identical but the FAC values were consistently less for each week of gestation in our Nigerian sample. The BPD/TAD ratio showed a progressive fall from 20 weeks until term similar to that previously noted for fetal head circumference to abdominal circumference ratio, indicating that this parameter may also be useful for predicting abnormal fetal growth.

Criteria for the oral glucose tolerance test in pregnant and non-pregnant Nigerian women.

In order to establish diagnostic criteria for detection of abnormal oral glucose tolerance test (OGTT) in pregnant and non-pregnant Nigerian women, the test was performed in 25 non-pregnant and 60 pregnant non-diabetic women at various trimesters of pregnancy. The upper limit of normal plasma glucose was the same as that from caucasian populations with respect to the fasting values but much less at 60 and 120 min. When compared to the non-pregnant controls, fasting plasma glucose was significantly lower during pregnancy, however, there was no change in glucose tolerance during pregnancy. The possible reasons for these observations are discussed and it would appear that our criteria would be the ideal ones to use for clinical purposes in Nigerian women.

Yearly trends in caesarean section and cesarean mortality at Ile-Ife, Nigeria.

PIP: The purpose of this review is to describe the changing features of cesarean section in our community over the years, to relate the observed pattern to changes in maternal and perinatal mortality rates, and to compare our findings with those from other populations. A retrospective review of 2150 consecutive cesarean sections over 9 years between January, 1977-December, 1985 at the University of Ife Teaching Hospital, Nigeria showed an overall section rate of 6.7%. However, over the years, the rate increased from 2.3% in 1977 to 10.6% in 1985 due to a higher proportion of cephalopelvic disproportion (39.9%). Analysis of the 1400 retrievable casenotes revealed that 56.8% of the patients were aged between 21 and 30 years; 24.6% aged between 31 and 40 years; 16.1% aged 20 years and only 2.5% aged 40 years. Cesarean operation is most commonly performed in primigravida and grand multipara. Overall, 78.8% of the cesarean sections were performed as emergency procedures while 15.0% were elective procedures; 6.2% of the planned elective cesarean operation were later performed as emergencies. The operation was associated with high maternal morbidity and mortality. 33.3% were morbid cases; sepsis was the most common cause followed by anemia, postpartum hemorrhage, and puerperal psychosis. Although, maternal mortality in cesarean delivery (0.71%) was significantly higher when compared to vaginal delivery (0.58%), there was no correlation between increasing section rate and maternal mortality. Similarly, increasing section rate had no detectable effect on perinatal mortality during the period; the perinatal mortality rate associated with cesarean section was 6.14%. Possible factors influencing the increasing section rate include increased cephalopelvic disproportion cases resulting from malnourished mothers with contracted pelvis and high numbers of failed induction cases. Measures that would improve maternal and fetal prognosis in cesarean section in our hospital include improved antiseptic measures, availability of blood transfusion, good screening during antenatal visits, and early recourse to the operation when indicated.^ieng

In vitro inhibition of sperm motility by some local mineral water drinks.

The effect of eight common local mineral water drinks in Ile-Ife, Nigeria (seven cola and one lemon-based) on sperm motility in vitro was carried out. There was no significant difference in the pH values of all the drinks, the pH ranged between 2.30-2.50. After one minute, Pepsi-Cola had the least inhibitory effect on sperm motility, Bitter-lemon had the strongest effect, while the other brands had varying effects between the two extremes. The percentage motility inhibition by the mineral water drinks is also a function of the initial total sperm count in the semen.

Normal growth of the fetal biparietal diameter in an African population.

The fetal biparietal diameter (BPD) was measured by ultrasound during normal pregnancy in 558 Nigerian women. The range of BPD values for each week of pregnancy from 12 weeks until term (713 measurements) was computed from cross-sectional data. The data were used to illustrate the variation in weekly growth rate according to fetal maturity and head size. The results revealed a curve similar to those reported from Caucasian populations but with much less flexion in the later weeks of pregnancy. The BPD values per week were also less in this study group. The reasons for these differences are discussed.

A prospective comparison of clinical and ultrasonic methods of predicting normal and abnormal fetal growth.

Charts of symphysial-fundal height (SFH) and ultrasound growth of fetal biparietal diameter (BPD) and abdominal circumference (FAC) were used simultaneously for the antenatal diagnosis of altered fetal growth in 100 patients. After delivery, infants were classified as small-for-gestational age (SGA), appropriate for gestational age (AGA) and large for gestational age (LGA) by birthweight and the postnatal diagnoses compared to antenatal diagnoses. The results indicate that although SFH is as good as ultrasound in predicting normal fetal growth, it is less sensitive than ultrasound for the diagnosis of SGA infants and even less so for macrosomia. It is concluded that SFH should be retained or instituted as a routine screening test for abnormal fetal growth.

Maternal mortality in a semi-urban Nigerian community.

PIP: Maternal mortality was examined in a semi-urban Nigerian community over a 10-year period. Maternal mortality was defined as death occurring as the direct result of childbearing and measured per 1000 births. Abortions at below 20 weeks gestation were excluded. From 1966 to 1975, there were 90 maternal deaths out of 13,182, a rate of 6.8/1000. The hospital records of the Baptist Medical Center, located in the western part of Nigeria, were carefully reviewed and cross-checked with obstetric statistical records. Only 13 of the deaths occurred in hospitalized patients. 78 (80%) were due to direct obstetric causes; 12% were from nonobstetric causes. Anemia due to blood loss was the leading casue of death, accounting for 30, or 33%, of the deaths. Anemia, with or without congestive heart failure accounted for 7 deaths. Infection was responsible for 5 deaths. Ruptured uterus, preeclampsia, and eclampsia occurred in equal percentages, 10-11%. Indirect obstetric deaths, such as sudden death, accounted for 10 deaths. 50% of these were anesthetic deaths; the remainder were due to pulmonary embolism. Sickle cell intrapartum crisis was the cause of 1 death. Associated causes included featured pneumonia, nephritis, hepatitis, meningitis, enteritis, and cerebrovascular accident. Parity ranged from 0-11. 25 babies were salvaged in this series. Prevention continues to be the cornerstone in improving maternal mortality figures in developing countries. The Baptist Medical Center's model for providing maternal care is described briefly and is identified as responsible for the encouraging decline in the maternal mortality rate.^ieng

Birth interval study in a culturally stable urban population.

Five hundred women were interviewed within 2 days of delivery to examine indigenous birth spacing among the urban and rural population of Ife township. The crude birth interval was between 30 and 40 months due mainly to cultural attitudes towards lactation and sexual abstinence. The women studied possessed considerable knowledge of Western contraceptive methods, but they rejected them. The possible cause of this rejection is examined and solutions to the problem are suggested.

PIP: To examine the indigenous birth spacing among the urban and rural population of Ife township, Nigeria, 500 women were interviewed within 2 days of delivery. Sexual abstinence and cultural attitudes towards lactation were the causes of the crude birth interval between 30-40 months. Only 20% of the women had 6 or more years of education. 50% were Protestant and 50% were Catholic, Muslim and indigenous faiths. Over 75% breast-fed their babies for more than 12 months; less than 10% had practiced modern contraception. Most women knew about modern contraception but rejected it. A male child was desired by all women. No incidence of induced abortion was found in this series. Intervals greater than 55 months may be explained by the number of co-wives of the husband, frequent absences of the husband, and prolonged postpartum invalidism. When a live birth died the intervals shortened. A family planning program that fails to consider the practices of abstinence and breast-feeding may cause more births rather than less. If the decline in the infant mortality rate continues, a reduction in family size caused by financial constraints is likely to be evident.