Ultrasonographic biometry: Biparietal Diameter of Nigerian foetuses.

BACKGROUND: Foetal biparietal diameter has been studied previously in Nigerian foetuses but populations have been too small to make categorical conclusions regarding the reference values/data. MATERIALS AND METHODS: In a cross sectional study, the foetal biparietal diameter (BPD) of 13,740 foetuses in Jos were measured with grey ultrasound machine in 13,740 Nigerian women during normal pregnancy and the mean BPD values for each week of pregnancy between 12 and 42 weeks were determined. RESULTS: The mean biparietal diameter value was 29.4mm at 14 weeks, 49.4mm at 20 weeks, 78.4mm at 30 weeks, 91.5 at 37 weeks and 95.6mm at 40 weeks. There was a positive relationship between gestational age and biparietal diameter with correlation coefficient of R(2) = 0.9996 (P < 0.001), and with fetal weight. The increase in BPD with increasing age in the study population showed a curve similar to that of Europeans. CONCLUSIONS: Ultrasonographic measurement of biparietal diameter in Nigerian fetuses showed a linear correlation exists between BPD and gestational age, as well as BPD and foetal weight in normal foetuses.

Analysis of cases of rape as seen at the Jos University Teaching Hospital, Jos, North Central Nigeria.

OBJECTIVE: Women are at a higher risk of being sexually harassed. There is a need to document the clinical findings of this crime and its outcome in order to improve the quality of care the victims receive. MATERIALS AND METHODS: Case notes of patients who presented with alleged rape at Jos University Teaching Hospital between January 2001 and December 2003 were retrieved and analyzed. RESULTS: During the study period, 2,135 patients were seen in the Gynaecological Emergency Unit. A total of 120 were for alleged rape, representing 5.6% of the total cases seen. However, only 105 case notes were available for analysis. Of these, 63.8% of the alleged rapes were in children, with the infantile age group accounting for 26.7%. 36.2% of the victims had experienced some form of sexual exposure prior to the rape. A previous relationship with the rapist was established in 77.4% of the cases. Most cases delayed in presenting to hospital. Thirty six percent of the cases did not have a human immunodeficiency virus screening test done. Candida albicans (13.3%) accounted for most of the infectious agents. Emergency contraception was administered to the victims when indicated. CONCLUSION: Women under 16 years of age were at an increased risk of being raped, possibly because they are defenseless and vulnerable. Three quarters (3/4) of the assailants had some form of relationship with the victims, which may account for the delays in reporting. Children and young adolescents were more at risk than adults to be raped.

Analysis of Cases of Rape as Seen at the Jos University Teaching Hospital; Jos; North Central Nigeria

Objective: Women are at a higher risk of being sexually harassed. There is a need to document the clinical findings of this crime and its outcome in order to improve the quality of care the victims receive. Materials and Methods: Case notes of patients who presented with alleged rape at Jos University Teaching Hospital between January 2001 and December 2003 were retrieved and analyzed. Results : During the study period; 2;135 patients were seen in the Gynaecological Emergency Unit. A total of 120 were for alleged rape; representing 5.6of the total cases seen. However; only 105 case notes were available for analysis. Of these; 63.8of the alleged rapes were in children; with the infantile age group accounting for 26.7. 36.2of the victims had experienced some form of sexual exposure prior to the rape. A previous relationship with the rapist was established in 77.4of the cases. Most cases delayed in presenting to hospital. Thirty six percent of the cases did not have a human immunodeficiency virus screening test done. Candida albicans (13.3) accounted for most of the infectious agents. Emergency contraception was dministered to the victims when indicated. Conclusion: Women under 16 years of age were at an increased risk of being raped; possibly because they are defenseless and vulnerable. Three quarters (3/4) of the assailants had some form of relationship with the victims; which may account for the delays in reporting. Children and young adolescents were more at risk than adults to be raped

A 10-year audit of gynaecological surgeries performed in the paediatric age group at the Jos University Teaching Hospital.

BACKGROUND: Surgeries performed for gynaecological conditions in children and adolescents are not common in our environment. Adequate facilities and the skill to perform the required procedures may also be lacking. We were interested in reviewing the practice of paediatric gynaecological surgery in our facility. PATIENTS AND METHODS: A retrospective study of case files and theatre records of children below the age of 16 years who had surgeries at the Jos University Teaching Hospital over a 10 year period was undertaken. RESULTS: A total of 89 surgeries were performed in this age group during the period under review. Twenty-eight (33.4%) of the patients were below the age of 11. The most common surgical procedure was for the management of septic abortion (21.3%). Correction of congenital malformations of the genital tract accounted for 21.4% (19) of the surgeries performed. Fourteen (15.7%) laparotomies were performed for ovarian cysts. CONCLUSION: Though the number of surgeries performed on children for gynaecologic reasons may appear small, the skills required to manage them should be enhanced and the requisite facilities provided.

Underutilization of vaginal hysterectomy and its impact on residency training.

BACKGROUND: The advantages of vaginal hysterectomy over abdominal hysterectomy include lower morbidity, shorter hospital stay, and reduced cost to the patient. It is, therefore, important to pass the required skill for vaginal hysterectomy unto trainees. OBJECTIVE: To determine the proportion of vaginal hysterectomies done in a residency training institution in Nigeria and its possible impact on the proficiency of future gynaecologists in performing the procedure. METHODS: A chart review was done on all documented cases of hysterectomies for benign gynaecological conditions done in Jos University Teaching Hospital, over a four-year period (January 2002 to December 2005). Case files of patients who had hysterectomy during the study period were retrieved and the relevant information obtained for analysis of frequencies and percentages. RESULTS: A total of 94 hysterectomies for benign gynaecological conditions were done during the study period. Nine (10%) vaginal hysterectomies were done. All the vaginal hysterectomies performed were for uterovaginal prolapse by consultants. However, 45 (53%) of the abdominal hysterectomies were performed by consultants and 40 (47%) by residents. CONCLUSION: This study suggests that residents exposure and training on the act of vaginal hysterectomy is inadequate. This has potential implications on future gynaecologist proficiency to perform this method of surgery that has documented advantages and better outcome for patients.

The impact of HIV/AIDS epidemic on the choice of specialties among medical students and house officers in Jos, Nigeria.

BACKGROUND: HIV/AIDS is a scourge that has seriously compromised the lives of millions of people, especially those living in sub-Saharan Africa. With continued high prevalence, there is a high risk of healthcare workers, especially those in the surgical specialties, acquiring the infection. This study was done to investigate the impact of HIV on the choice of surgical specialties in a training institution located in Jos, north-central Nigeria. We hypothesized that the awareness of the risk of acquiring infections associated with surgical practice has no significant impact on the choice of surgical specialties among final-year medical students and house officers at our institution. METHOD: A cross-sectional questionnaire based survey was conducted on final-year medical students and house officers during their training in Jos University Teaching Hospital (JUTH), Jos. Two hundred questionnaires were randomly distributed to final year medical students and house officers who volunteered to participate in the survey. The completed questionnaires were returned to the researchers and information obtained was analyzed using Epi info 3.3. RESULTS: Of the 200 questionnaires distributed, 135 with relevant information were returned for analysis, giving a response rate of 67.5%. Of these respondents, 96.3% said they planned to specialize after their basic medical training and the majority of these (97.8%) were aware of the increased risk associated with surgical specialties, with 83.7% acknowledging the transmission of HIV and hepatitis B as being the greatest risk. About 53.0% of the respondents said they planned to pursue surgical specialties. Fifty three percent (53.3%) and sixteen percent (16.3%) based their choice of specialty on job satisfaction and favourable work schedule respectively. The knowledge of the risk of acquiring HIV/AIDS affected choice of specialty in only 21% of the respondents. CONCLUSION: The awareness of most recently graduated medical doctors and final-year medical students of the risk of acquiring HIV in surgical specialties seems to have not deterred them from wanting to pursue surgical specialties. We recommend improvements in the work environment and adherence to universal precautions to reduce the risk of transmission of HIV and other infections to surgeons practicing in the region.

The Impact of HIV/AIDS Epidemic on the Choice of Specialties among Medical Students and House officers in Jos; Nigeria

Background: HIV/AIDS is a scourge that has seriously compromised the lives of millions of people; especially those living in sub-Saharan Africa. With continued high prevalence; there is a high risk of healthcare workers; especially those in the surgical specialties; acquiring the infection. This study was done to investigate the impact of HIV on the choice of surgical specialties in a training institution located in Jos; north-central Nigeria. We hypothesized that the awareness of the risk of acquiring infections associated with surgical practice has no significant impact on the choice of surgical specialties among final-year medical students and house officers at our institution. Method: A cross-sectional questionnaire based survey was conducted on final-year medical students and house officers during their training in Jos University Teaching Hospital (JUTH); Jos. Two hundred questionnaires were randomly distributed to final year medical students and house officers who volunteered to participate in the survey. The completed questionnaires were returned to the researchers and information obtained was analyzed using Epi info 3.3. Results: Of the 200 questionnaires distributed; 135 with relevant information were returned for analysis; giving a response rate of 67.5. Of these respondents; 96.3said they planned to specialize after their basic medical training and the majority of these (97.8) were aware of the increased risk associated with surgical specialties; with 83.7acknowledging the transmission of HIV and hepatitis B as being the greatest risk. About 53.0of the respondents said they planned to pursue surgical specialties. Fifty three percent (53.3) and sixteen Percent (16.3) based their choice of specialty on job satisfaction and favourable work schedule respectively. The knowledge of the risk of acquiring HIV/AIDS affected choice of specialty in only 21of the respondents. Conclusion: The awareness of most recently graduated medical doctors and final-year medical students of the risk of acquiring HIV in surgical specialties seems to have not deterred them from wanting to pursue surgical specialties. We recommend improvements in the work environment and adherence to universal precautions to reduce the risk of transmission of HIV and other infections to surgeons practicing in the region

Meigs' syndrome presenting as haemorrhagic pleural effusion.

BACKGROUND: The association of a benign ovarian tumor with ascites and hydrothorax that resolve after tumor resection, known as Meigs syndrome is a rare clinical entity. Rarer still is the haemorrhagic form of the syndrome OBJECTIVE: To describe a case of benign ovarian tumour associated with ascites and bloody pleural effusion. METHODS: A thirty-seven year old woman was referred for the further management of a pleural effusion. A detailed clinical evaluation was carried out, including pleural fluid cytology, chest CT scan and laparatomy. Treatment included antituberculous therapy and finally ovariectomy. RESULTS: The physical examination and a pelvic ultrasonographic scan revealed ascites in addition to a right sided ovarian mass. A chest CT-scan did not show any intrathoracic mass. Repeated pleural fluid cytology showed mesothelial cells but was negative for malignancy. An ovariectomy was performed and histological examination revealed a thecoma fibroma. The pleural effusion and ascites resolved spontaneously thus confirming the diagnosis of Meigs' syndrome. CONCLUSION: Meigs' syndrome should be considered in the differential diagnosis in female patients with hemorrhagic pleural effusion.

Familial polycystic kidney disease in Nigeria: a report of two cases.

A case of familial polycystic kidney disease is reported. Although isolated cases of adult polycystic kidney disease have been reported in our environment, no case to our knowledge has been reported with a familial link. Polycystic kidney disease is said to be rare in Africans. Although it commonly terminates in chronic renal failure, it hardly features in the aetiopathogenesis of end stage renal disease requiring some form of renal replacement therapy in African series. This, some workers believe may be due to misdiagnosis and under reporting. This report is to show that it may not be as rare as suspected, and that the familial link shown in the advanced countries is also applicable here. Case 1 was diagnosed in the course of evaluation of her clinical disease. Case 2, an aunt of Case 1, was diagnosed following investigation of a casual complaint of a painless abdominal mass in the wake of her senior brother's death from haemorrhagic stroke.

Rapid HIV testing and counselling in labour in a northern Nigerian setting.

Between April and August 2004, all pregnant women in labour at JUTH, were offered rapid HIV testing and counselling with opportunity to decline testing. HIV positive women were offered the standard nevirapine mono-therapy prophylaxis regimen (HIVNET 012). Four hundred and thirty (99.8%) of the 431 pregnant women who were offered rapid HIV testing and counselling, agreed to test. A sero-conversion rate of 2.1% (5 of 235) was found among women who had previously tested negative for HIV during the index pregnancy. A seroprevalence rate of 9.6% (16 of 166) was found among women with unknown HIV status. One patient who had an indeterminate HIV status prior to labour tested positive in labour. Rapid HIV testing and counselling in labour is a useful practice in high prevalence settings since it detects a substantial number of HIV-infected women and HIV-exposed babies that would otherwise have missed interventions to prevent MTCT.

Partner disclosure of HIV status among HIV positive mothers in Northern Nigeria.

Partner consent and support can substantially enhance adherence to PMTCT interventions. This study explores the issues concerning disclosure of HIV status to partners of HIV sero-positive mothers in a PMTCT programme in Jos, Northern Nigeria. Previously field-tested questionnaires were administered by trained counsellors to 570 consenting HIV positive mothers who were participating in the PMTCT programme at Jos University Teaching Hospital (JUTH), Jos. The findings were entered into Epi Info and analysed using frequencies. The median age of respondents was 29 years while that of their partners was 37 years. Five hundred and fifty-five (99.5%) of respondents were married. Majority of the women were Christians (82.9%) while 16.9% were Moslems. Seventy four percent (419/563) of the mothers were aware of their husband's HIV sero-status. Of these, 65.4% (274/419) of the partners were HIV positive while 34.6% were sero-negative. Eighty nine percent (500/560) of the women have disclosed their HIV status to their partners. Of these, 39.6% (199/502) required the assistance of health workers while 59.4% (298/502) did it by themselves. Following disclosure of HIV status, 86.9% (430/495) of the partners were supportive, 5.7% were indifferent, 6.7% were quarrelsome and abusive while 1.0% was violent. The reactions of partners of HIV positive mothers to disclosure of their wives' HIV status are predominantly supportive. This should strengthen strategies to promote partner disclosure.

Familial polycystic kidney disease in Nigeria: A report of two cases

A case of familial polycystic kidney disease is reported. Although isolated cases of adult polycystic kidney disease have been reported in our environment; no case to our knowledge has been reported with a familial link. Polycystic kidney disease is said to be rare in Africans. Although it commonly terminates in chronic renal failure; it hardly features in the aetiopathogenesis of end stage renal disease requiring some form of renal replacement therapy in African series. This; some workers believe may be due to misdiagnosis and under reporting. This report is to show that it may not be as rare as suspected; and that the familial link shown in the advanced countries is also applicable here. Case 1 was diagnosed in the course of evaluation of her clinical disease. Case 2; an aunt of Case 1; was diagnosed following investigation of a casual complaint of a painless abdominal mass in the wake of her senior brother's death from haemorrhagic stroke

An investigation of sociomedical risk factors associated with vaginal fistula in northern Nigeria.

In some countries in Africa it is customary for early marriages involving young adolescent girls to be contracted prior to the commencement of their menses. This practice often results in premature pregnancies which in turn leads to devastating physical and social consequences such as vesico vaginal fistula (VVF). VVF is a severely demoralizing and disabling childbirth injury among women who become incontinent as a result of an opening created between the vagina and bladder. A case control study of 50 VVF patients and 50 non-VVF village women was undertaken in Katsina, Nigeria. Statistical analysis showed that VVF patients were smaller in stature, had less education and were of lower socioeconomic status. Also, the analysis showed that both groups of women married and commenced childbearing at an age too early for a safe delivery, thus placing them at risk of VVF. Predictive variables for the condition are: age at marriage, parity, husband's occupation and level of education.

An evaluation of the copper-T 380A IUD's safety and efficacy at three African centers.

The use of intrauterine devices in Africa is low compared with other contraceptive methods such as oral contraceptives. This study, coordinated by Family Health International, evaluated the clinical performance (safety and efficacy) of the TCu 380A IUD in three African centers, respectively, in Cameroon, Egypt, and Nigeria from 1986-1989. The 12-month unintended pregnancy rates were low for all three centers, ranging from none to 1.6 per 100 women. The 12-month discontinuation rates for all reasons ranged from 8.8 to 26.9 per 100 women. Statistically significant differences were observed among clinics for discontinuation rates for bleeding and/or pain and for planned pregnancy. The overall performance of the TCu 380A IUDs was considered satisfactory. Thus, the limited use of IUD in Africa could be due to the lack of accessibility, lack of information about, and confidence in the method rather than to documented clinical performance.

Pregnancy associated alpha-glycoprotein (SP-III) in Nigerian pregnant women.

Pregnancy associated protein (SP-III) was measured by rocket electroimmunoassay in the sera of Nigerian women with normal and abnormal singleton pregnancy. A tendency to increases of SP-III levels with advancing gestational age was observed. SP-III may contribute to immunosuppression in preventing anti-allograft responsiveness and levels may also reflect the effect of infections since SP-III is also leucocyte derived. Values in PET and anaemia in pregnancy were similar to values in normal pregnant women.

A simple mass-closure technique compared with layered technique in the closure of high-risk abdominal wounds.

A retrospective comparison of the outcome of patients with ruptured gravid uterus following obstructed labour who had abdominal closure by a simple mass-closure technique (using non-absorbable Nylon suture) with their counterparts who had the more popularly used layered technique. The clinical features on admission, operation details and wound complications were compared. Thirty-one patients who had mass-closure were compared with 103 that had the layered technique. Nineteen percent of the former had wound infections or partial dehiscences while none had complete dehiscence or hernias. On the other hand these respective complications occurred in 32%, 9.7% and 1.9% of the layered group. This mass-closure technique has the advantages of low-cost, speed and safety. We advocate that it be used on all high-risk abdominal wounds.

A multicenter clinical trial in Nigeria with a low-dose oral contraceptive, Marvelon.

The monophasic combination preparation, Marvelon, is a modern, technically improved oral contraceptive. It was tested for contraceptive reliability, cycle control and acceptability in 4 clinical centers in Nigeria for a period of one year. A total of 408 women was included in these studies, and 3102 cycles were monitored. The results showed a high contraceptive reliability and an excellent cycle-control. It was well tolerated. There were very few side-effects and the symptoms during medication were minor and hardly needed any treatment. At 12 months, 43.1% of the acceptors were still in the trial. Seventy-nine women (19.4%) discontinued before the end of the study for any reason. Drop-out reasons of these women were mainly non-medical. For the remainder of drop-outs no reason was given. This study suggests that this new oral contraceptive adequately satisfies the contraceptive needs of modern women.

A multicenter clinical trial in Nigeria with Multiload-Cu250 (MLCu250) and Multiload-Cu375 (MLCu375) intrauterine devices.

A multicenter study was conducted in Nigeria, comparing the Multiload-Cu250 (MLCu250) with the Multiload-Cu375 (MLCu375). The two intrauterine devices were studied on aspects of effectiveness and acceptability. Parameters were observed and analyzed, using the life-table method of Tietze and Lewit. Continuation rates were excellent. Overall results were in line with studies done elsewhere in the world with Multiload devices, showing a slight superiority of the MLCu375 over the MLCu250.

Mycoplasmas among clients attending a family planning clinic in Zaria, Nigeria.

The effect of contraception in the incidence of genital tract mycoplasma infection was studied in 150 women practicing contraception and another 50 women attending a gynecological clinic, using no contraception. Using the chi-squared method, there was no statistically significant difference between total mycoplasma recovery in family planning clients versus the controls. The only statistically significant difference was between total positive mycoplasma in the oral contraceptive group versus IUD users.