Aflatoxin biocontrol effectiveness in the real world-Private sector-led efforts to manage aflatoxins in Nigeria through biocontrol-centered strategies.

Aflatoxins are toxic compounds produced by several Aspergillus species that contaminate various crops. The impact of aflatoxin on the health of humans and livestock is a concern across the globe. Income, trade, and development sectors are affected as well. There are several technologies to prevent aflatoxin contamination but there are difficulties in having farmers use them. In Nigeria, an aflatoxin biocontrol product containing atoxigenic isolates of A. flavus has been registered with regulatory authorities and is now being produced at scale by the private company Harvestfield Industries Limited (HIL). The current study reports results of biocontrol effectiveness trials in maize conducted by HIL during 2020 in several locations across Nigeria and compared to untreated maize from nearby locations. Also, maize was collected from open markets to assess levels of contamination. All treated maize met tolerance thresholds (i.e., <4 ppb total aflatoxin). In contrast, most maize from untreated fields had a higher risk of aflatoxin contamination, with some areas averaging 38.5 ppb total aflatoxin. Maize from open markets had aflatoxin above tolerance thresholds with even an average of up to 90.3 ppb. Results from the trials were presented in a National Workshop attended by key officers of Government agencies, farmer organizations, the private sector, NGOs, and donors. Overall, we report (i) efforts spearheaded by the private sector to have aflatoxin management strategies used at scale in Nigeria, and (ii) deliberations of key stakeholders to ensure the safety of crops produced in Nigeria for the benefit of farmers, consumers, and industries.

Virgin coconut oil extract mitigates testicular-induced toxicity of alcohol use in antiretroviral therapy.

The consumption of alcohol by people living with HIV/AIDS is associated with a graver prognosis. Long-term use of antiretrovirals may have certain health challenges that may be aggravated by concomitant alcohol use. This study investigated virgin coconut oil (VCO) as an adjuvant to the deleterious effects of highly active antiretroviral therapy (HAART) and alcohol on the cyto-architecture and functioning of the testis. Forty adult male Sprague-Dawley rats, weighing 165~176 g, were divided into eight groups and treated according to protocol. Testicular histology, stereological parameters, seminal fluid, testosterone, luteinizing hormone, follicle-stimulating hormone, the antioxidants marker malondialdehyde (MDA), and antioxidant glutathione (GSH) were examined. The use of ethanol alone and ethanol + HAART showed extensive degeneration in the seminiferous epithelium, decreased semen quality, disorganized basement membrane and widened, hypocellular interstitium. GSH was significantly decreased in the ethanol alone treated group with no significant effect on testosterone, LH, and MDA levels. Adjuvant treatment with VCO at low dose (2.5 mL/kg/bw) improved sperm motility with a partial restoration of the histopathological alterations. High doses of VCO (5.0 mL/kg/bw) showed greater improvement with respect to sperm counts, increased FSH hormonal and GSH antioxidant levels, and a well-preserved testicular cyto-architecture.

Histo-morphological and seminal evaluation of testicular parameters in diabetic rats under antiretroviral therapy: interactions with Hypoxis hemerocallidea.

OBJECTIVES: Broad range of metabolic changes associated with highly active antiretroviral therapy (HAART) has been reported over decades including reproductive perturbations. The current study aimed at investigating the role of Hypoxis hemerocallidea (Hyp) in the seminal and morphometric alterations in the testes of streptozotocin-nicotinamide-induced diabetic rats under HAART. MATERIALS AND METHODS: Sixty-two adult male Sprague-Dawley rats were divided into A-H groups, containing 6 rats in the control group A and 8 rats in the treatment groups B-H. Diabetes was induced by intraperitoneal injection of nicotinamide (110 mg/kg BW) followed by streptozotocin (45 mg/kg BW). The animals were then subjected to various treatments with HAART, Hyp, and melatonin. RESULTS: weights (body and testicular), histological, histochemical, seminal fluid, and morphometric analyses were carried out. Sperm count and motility were reduced in HAART (P<0.05/0.003) and Hyp200 (P<.003) groups compared with normal and diabetic controls, respectively. Sperm count was higher (P<.003) in HAART+ Mel and HAART+Hyp100 groups. Morphometry showed the reduction in germinal epithelium height and basement membrane thickness (P<.003) in the Hyp100 group compared with diabetic controls. Adjuvant use of Hyp and melatonin with HAART did not significantly raise these indices (P>.05). Histological slides showed gross distortions in HAART, diabetic and HAART +Hyp groups with marked atrophy in tubules, germ cell loss and areas of focal depletion of the cell. PAS staining revealed detached basement membrane in diabetic groups with strong PAS-stain. CONCLUSION: The use of Hyp or melatonin does not ameliorate the testicular damages in diabetic animals under antiretroviral therapy.

Adjuvant potential of virgin coconut oil extract on antiretroviral therapy-induced testicular toxicity: An ultrastructural study.

The effects of Virgin coconut oil as an adjuvant to highly active antiretroviral therapy (HAART) were investigated on the testicular ultrastructure and biochemical markers in rats. Twenty male Sprague-Dawley rats, weighing 153-169 g were divided into four groups and treated as follows: control A (distilled water), B (HAART), C (HAART+Virgin coconut oil 10 ml/kg) and D (Virgin coconut oil [VCO] 10 ml/kg). Testicular segments were evaluated using transmission electron microscopy. Serum was assayed for testosterone, luteinising hormone, follicle stimulating hormone and testicular tissue for malondialdehyde and glutathione. Ultrastructure of basement membrane (Bm), mitochondria and spermatocytes was normal in the control group. HAART-treated group showed significant increase (p < .01) in Bm thickness with significant decrease in Leydig cell nuclear diameter (p < .05) and volume (p < .01) when compared with control group. Mitochondrial cristae appear collapsed, and Sertoli cells showed cytoplasmic vacuolations. HAART+VCO group showed improved ultrastructural details in Bm, and Sertoli cell and Leydig cells show abundant lipid droplets. Virgin coconut oil-treated group showed thinning of Bm with otherwise normal ultrastructural features of organelles. HAART-treated group showed significant increase (p < .01) in testosterone levels. There was no significant effect on malondialdehyde and glutathione levels. Virgin coconut oil improved testicular morphology and reversed HAART-induced ultrastructural alterations. Further studies on putative mechanism are required.

Impaired expression of testicular androgen receptor and collagen fibers in the testis of diabetic rats under HAART: the role of Hypoxis hemerocallidea.

INTRODUCTION: Wide spectrum of alterations associated with highly active antiretroviral therapy (HAART) has been reported. The current study aimed at evaluating the role of Hypoxis hemerocallidea (HH) aqueous extract on the testosterone levels, expression of androgen receptors and collagen fibers in the testes of streptozoto-cin-nicotinamide-induced diabetic rats under HAART regimen. MATERIAL AND METHODS: Sixty two adult male Sprague-Dawley rats (189.0 ± 4.5 g) were divided into eight groups (8 animals in each treatment groups and 6 rats in the control group). Diabetes was induced by a single intraperi-toneal injection of nicotinamide (110 mg/kg bw) followed by streptozotocin (45 mg/kg bw) and the animals were then subjected to various treatments with HAART, HH extract or melatonin. At the end of the experiment, blood samples were collected to measure serum testosterone levels. Testes were fixed in buffered formaldehyde and paraffin processed. The expression of androgen receptor (AR) was assessed by immunohistochemistry and collagen fibers were visualized by Masson trichrome staining. RESULTS: Serum testosterone level was drastically (p < 0.0001) reduced in all rats with induced diabetes. In the testis of diabetic rats increased collagen fibers deposition with varying derangements in germinal epithelium of spermatogenic layers were observed. Intertubular hemorrhages and absence of spermatozoa were also noted in the testes of diabetic rats subjected to HAART. Reduced immunoexpression of ARs was found in the nuclei of Sertoli cells and the cytoplasm of spermatogonia and spermatocytes in III-IV stages of the seminiferous epithelium cycle of diabetic animals treated with different dosages of HH alone and those treated with HAART concomitantly with melatonin and HH. The expression of ARs was almost negative in the testes of rats treated with HAART alone. CONCLUSIONS: Concomitant treatment of rats with aqueous HH extract during the HAART did not change se-rum testosterone level nor mitigate the altered expression of collagen fibers and androgen receptor resulting from STZ-nicotinamide-induced diabetes. Therefore, anti-diabetic properties of Hypoxis extract require further investigation.

Evaluating the impact of type 2 diabetes mellitus on cardiovascular risk in persons with metabolic syndrome using the UKPDS risk engine.

BACKGROUND: The aim of this study is to evaluate the impact of coexistence of metabolic syndrome (MS) and type 2 diabetes mellitus (T2DM) on the estimated cardiovascular risk as calculated using the United Kingdom Prospective Diabetic Study risk engine (UKPDS-RE) and also to determine the impact of the coexistence of MS and T2DM on the 10-year risk of developing coronary heart disease and stroke. METHODOLOGY: This is a cross-sectional study in which convenience sampling technique was used to recruit 124 consecutive persons with T2DM and 96 controls using a questionnaire administered technique. The World Health Organization (WHO) criterion was used to define MS and the UKPDS-RE was used to identify persons with increased risk for stroke and those with increased risk for coronary heart disease. The data obtained were analyzed using SPSS version 16. Statistical comparisons were made with chi-square for comparison of proportions. A P-value of less than 0.05 was taken as statistically significant. RESULTS: Fifteen subjects were identified as having an increased 10-year risk for stroke and ten as having an increased risk for a coronary event. The odds of a T2DM subject with MS having an increased risk for stroke compared with a T2DM subject without MS was 0.9579≈1 while the odds of a T2DM subject with MS developing an increased risk for a coronary event compared with a T2DM subject without MS was =3.451≈3. CONCLUSION: MS was more common in subjects with T2DM compared with controls (irrespective of the diagnostic criteria used) and MS appears to increase the risk of a coronary event in subjects with T2DM by threefold. Also from this study, MS did not appear to cause an additional increase in the risk of stroke in subjects with T2DM.

Emergency obstetric hysterectomy in a Nigerian teaching hospital: a ten-year review.

BACKGROUND: Haemorrhage is a leading cause of maternal mortality worldwide and hysterectomy may become necessary to save life. This procedure is associated with significant morbidity and mortality. OBJECTIVE: To determine the, indications, risk factors and the management outcome for the procedure in our unit. METHODS: A retrospective case controlled study of 34 cases of emergency obstetric hysterectomy (EOH) performed at the Lagos University Teaching Hospital over a period often years was carried out. RESULTS: The incidence of EOH was 2.56 per thousand deliveries. Increasing parity, history of previous caesarean section, placenta praevia and current delivery by caesarean section were significant risk factors for the procedure. The indications were ruptured uterus (61.8%), intractable haemorrhage during caesarean section (32.4%), and uterine atony (5.9%). Majority (73.5%) of the patients had subtotal hysterectomy but the outcome indices were similar for the total and subtotal procedures. The case fatality rate was 11.8%. Post-operative complications included anemia (100%), urinary tract infection (UTI) (14.7%) and wound infection (11.7%). CONCLUSION: The incidence of EOH in our unit has increased since the last study published in 1983, but the associated mortality has decreased. The indications differed in proportion from those in developed countries although the risk factors were similar. The outcome indices were similar for the total and the subtotal procedures. EOH is still associated with considerable maternal morbidity and mortality which can be reduced by provision of better obstetric care for the population.

Morbidity and mortality in sickle cell pregnancies in Lagos, Nigeria: a case control study.

Women with sickle cell disorder are historically known to have significant maternal and perinatal complications but recent studies from developed countries show a change in this trend. This study was a retrospective, case-controlled study of 75 women with haemoglobin SS (HbSS) and 150 with haemoglobin AA (HbAA). Data were analysed using chi(2)-test and independent t-test as appropriate. There were more perinatal (18.7 vs 8.8, p<0.05) and maternal (5.3% vs 0, p<0.05) deaths in HbSS women compared with HbAA. Birth weight, gestational age at delivery and 1 and 5 min Apgar scores were also significantly lower in the HbSS women. There was no significant difference in the incidence of pre-eclampsia and urinary tract infection between the two groups. Pregnancy in HbSS women is still fraught with maternal and fetal complications. Prospective studies may help clarify the relationship between SCD and specific maternal complications.

The acceptance rate of intrauterine contraceptive device (IUCD) amongst family planning clinic users in Lagos University Teaching Hospital (LUTH).

BACKGROUND: Intrauterine Contraceptive Device is an effective reversible long-term contraceptive method that is popular and widely used in this environment. OBJECTIVES: To determine the characteristics of women using this mode of contraception, their main reasons for acceptance, complications arising from usage and the discontinuation rate as well as reasons for discontinuing the method. METHODS: A review of case records of all the new contraceptive acceptors attending the Department of Obstetrics and Gynaecology Family Planning Clinic of the Lagos University Teaching Hospital (LUTH) from 1st January 1990 to 31st December 1994 was examined and the clients that accepted the intrauterine contraceptive device, (IUCD) during this period were identified. The records of those that opted for IUCD were thoroughly reviewed to identify the follow up events through the subsequent ten years visits to determine outcome of the contraceptive usage. RESULTS: Amongst the 2754 new contraceptive acceptors during the study period, 1602 (58.17%) clients accepted the Intrauterine Contraceptive Device (IUCD). Of these IUCD acceptors, the mean age was 31.3 +/- 5.5 years, mean parity was 3.9 +/- 2 and mean number of children alive was 3.6 +/- 1.8. Seven hundred and forty nine (46.8%) of them had previously used contraceptives and 1175 (73.3%) of them still wanted more children, thus child spacing was the main reasons for accepting this method. By 12 months, the discontinuation rate was 13.9% with the cumulative discontinuation rate of 47% as at forty-eighth month. The commonest reason for discontinuation was planning to get pregnant in 426 (26.6%) of the clients. Menstrual disorders accounted for 108 (6.7%). The mean duration of IUCD was 25.4 +/- 18.8 months with an accidental pregnancy rate of 0.3%. CONCLUSION: Intrauterine Contraceptive Device is widely accepted amongst women in the study group. Devices that reduce menstrual loss and also have long duration of action like Levonorgestrel intrauterine system (LNG-IUS) qualifies to be considered.

Knowledge and practices of traditional birth attendants in prenatal services in Lagos State, Nigeria.

A questionnaire-based study was conducted on 189 Traditional Birth Attendants (TBAs) on their knowledge and practices in prenatal services. Only 86 (45.5%) of them associated cessation of menstrual period with pregnancy while others use mystic power 46 (24.3%), early morning sickness, pallor of conjunctiva and reaction to herbs 56 (29.6%) to detect pregnancy. Fundal height n=76 (40.2%), palpation n=82 (43.4%), special soaps and soups n=52 (27.5%) and special devices n=8 (4.2%) are used to determine stages of pregnancy. Foetal health status is determined by regular foetal movements n=95 (50.3%), mystic power n=15 (8%), soap n=2 (1.1%), special concoction 9 (4.8%), health status of mother n=67 (35.4%) and foetal heart beat n=24 (12.7%). Ninety seven (51.3%) of them used herbal treatment, 77 (40.7%) used incantations, 189 (100%) used special soaps as their main methods of delivery, while only 18 (9.5%) of respondents refer difficult cases to hospitals. Instruments used for separating cord were blade 123 (65.1%) and scissors 40 (21.1%). Symptoms recognized by the TBAs as signs of complications in pregnancy were dizziness, swollen feet, pallor, tiredness, absent foetal movement, loss of appetite, heaviness, pain in back/stomach/side, weight loss, vomiting, bleeding, fever/malaria, head ache, bad dream, premature or delayed labour. Although some of them recognized some danger signs in pregnancy and labour, only very few would refer difficult cases for emergency obstetric interventions. Clear protocols for management and referral, which are necessary for improved maternal survival, should be provided through regular training of the TBAs.

Intravaginal misoprostol versus Foley catheter for cervical ripening and induction of labor.

OBJECTIVE: To compare the efficacy and safety of 100 microg of intravaginal misoprostol with intracervical Foley catheter for cervical ripening and induction of labor. METHOD: One hundred women being induced in the Lagos University Teaching Hospital, Nigeria, were randomized to receive a single 100 microg dose of misoprostol intravaginally or intracervical insertion of Foley catheter. Data analyses were by the Student's t-test and chi-square test. RESULT: Misoprostol was more effective in terms of induction to delivery interval (11.84+/-5.43 versus 20.03+/-4.68 h, P<0.05), change in Bishop score, and number delivered within 24 h, in patients with a one-time successful induction. Uterine hyperactivity and rupture were more frequent in the misoprostol group. CONCLUSION: A single 100 microg dose of intravaginal misoprostol is more efficacious than intracervical insertion of Foley catheter for cervical ripening and induction of labor. Further studies using lower doses are needed to determine the safest dose.

Grandmultiparity in Lagos, Nigeria.

The case-notes and records of grandmultiparous patients delivered at the Lagos University Teaching Hospital between 1st January, 1994 and 31st December, 1996 were analysed. The incidence of grandmultiparity was 4.11%. There were no cases of extreme grandmultiparity. The mean age +/- SD was 33.26 +/- 1.8 years, and the mean parity +/- SD 5.57 +/- 0.38. No patient was under 20 years and none had a parity greater than 9. Fifty-seven (42.22%) were booked patients and 78(57.78%) were unbooked. Anaemia and malpresentation were commonest in the antenatal period, whilst hypertension and disproportion were commonest intrapartum. Fifty per cent of the patients had a spontaneous vaginal delivery. The Caesarean section rate was 30.37%. The incidence of intrapartum complications, cephalopelvic disproportion, obstructed labour and Caesarean section, were found to be higher in the unbooked patients. There was an increased incidence of twin pregnancy and placenta praevia. The maternal mortality ratio was 44.4/1000 amongst the grandmultipara which was not statistically more significant than in the general obstetric population. The perinatal mortality rate was 169/1000 deliveries.

The impact of the Lagos manual vacuum aspiration (MVA) training courses on medical education.

The Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos commenced training programmes in the use of manual Vacuum Aspiration (MVA) for the treatment of septic abortion in 1989. The courses were evaluated using pre-tests and post-tests, and those of the participants from the first 5 years were analysed. 142 doctors and 72 nurses were trained from teaching hospitals, parastatal and private hospitals. The results of 154 participants (71%) were recovered and analysed. The training courses significantly increased the medical knowledge of both doctors and nurses; those from the Teaching Hospitals appearing to gain more. The amount of knowledge gained by those from the private sector, although showing a statistically significant increase was much less than the other participants. More emphasis should be placed on improving the performance of those from the private sector.

A review of referred IUCD related problems in Lagos University Teaching Hospital.

A review of 168 patients referred with IUCD related problems was done. The two most common indications for referrals were difficulty at removal (73.8%) and missing/lost IUCD thread 23.8%. In 22.5% (9) of cases referred as missing/lost IUCD, the threads were visible on inspection of the cervix during speculum examination 21.4% (36) of the referred patients had routine removal by simple traction, while the retrieval hook was successfully used in 75% of the cases, only 3 patients (1.7%) required removal under general anaesthesia. A proper speculum examination combined with uterine sounding and the use of the retrieval hook at the peripheral centres will greatly reduce the need for referring IUCD related cases to a tertiary centre.

The pattern of sickle cell disease in pregnancy in Lagos, Nigeria.

The outcome of pregnancy and labour in patients with sickle cell disease delivered at the Lagos University Teaching Hospital (LUTH) under one obstetrician between 1st January 1985 and 31st December, 1989 is analysed. There were 31 pregnancies in 28 patients with sickle cell anaemia (HbSS) and 10 pregnancies in seven patients with sickle cell haemoglobin C disease (HbSc). Six pregnancies in HbSS patients and two in HbSC were in patients who had not had specialized preconceptual care. There was one abortion in a patient with HbSC and one pair of twins in a patient with HbSS. The complication rate was high in HbSC patients as compared to a previous series but not as high as in patients with HbSS. The perinatal mortality rates were 233 and 111 per 1000 deliveries in HbSS and HbSC patients respectively. The maternal mortality rates were 129 and 111 per 1000 deliveries in HbSS and HbSC patients respectively. Two of the maternal deaths and four of the perinatal deaths occurred in HbSS patients who had had no preconceptual specialist care as opposed to those receiving specialist treatment. In the case of perinatal mortality, this was found to be statistically significant (p < 0.001).

PIP: Improvement in the medical care of patients with sickle cell disease has increased the numbers surviving into adulthood, increasing the numbers seen in pregnancy. Pregnancy aggravates the medical complications of the disease, and the disease complicates pregnancy, leading to high levels of maternal and perinatal mortality. There is evidence that the presence of the "S" gene affects the fetus adversely and rarely may contribute to maternal death. This paper reviews the pregnancies of patients with sickle cell disease who delivered between January 1, 1985, and December 31, 1989, at the Lagos University Teaching Hospital. All subjects were referred to one obstetrician. There were 31 pregnancies in 28 patients with sickle cell anemia (HbSS) and 10 pregnancies in 7 patients with sickle cell hemoglobin C disease (HbSc). 6 pregnancies in HbSS patients and 2 in HbSc were in patients who had not had specialized preconceptual care. There was one abortion in a patient with HbSC and one pair of twins in a patient with HbSS. The complication rate was high in HbSC patients compared to a previous series, but not as high as in patients with HbSS. Perinatal mortality rates were 233 and 111 per 1000 deliveries in HbSS and HbSC patients, respectively, while maternal mortality rates were 129 and 111 per 1000 deliveries in HbSS and HbSC patients, respectively. Two of the maternal deaths and four of the perinatal deaths occurred in HbSS patients who had had no preconceptual specialist care as opposed to those receiving specialist treatment.

Erect lateral pelvimetry and the outcome of labor in Lagos.

The erect lateral radiograph pelvimetry measurements was related to the outcome of labor in 173 patients. The most common indication for pelvimetry was one previous caesarean section in 90 (52%) patients. Sixty-nine (39.9%) pelvimetry measurements were performed because of suspected cephalopelvic disproportion, while 20 (11.6%) were done because of breech presentation. In patients with a cephalic presentation at delivery, the mean +/- standard deviation (SD) obstetric conjugate for the 87 women who delivered vaginally (group 1) was 11.42 +/- 1.5 cm, while that of the 45 women who had emergency caesarean section (group 2) was 10.77 +/- 1.5 cm. The mean +/- SD anteroposterior outlet diameter for groups 1 and 2 were 12.24 +/- 1.9 cm and 11.84 +/- 1.7 cm respectively. Both differences were found to be statistically significant (p < 0.001 and p < 0.05 respectively). The mean +/- SD birthweight of the babies in groups 1 and 2 were 3.34 +/- 0.79 kg and 3.42 +/- 0.86 kg respectively. There was no statistically significant difference between the two groups (p < 0.05). The critical obstetric conjugate for safe vaginal delivery was 9.88 cm while the corresponding value for the anteroposterior pelvic outlet diameter was 10.24 cm.

Failed contraception in Nigerian women: outcome of pregnancy and subsequent contraceptive choice.

The outcome of pregnancy in 56 patients who had contraceptive failure out of the 5,431 new acceptors at the Family Planning Clinic of the Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, between 1 January 1981 and 31 December 1989, were analysed. There were 40 IUD, 6 OC, and 4 injectable failures. Three patients had had voluntary surgical contraception (VSC) and 3 used barrier methods. The mean +/- SD age and parity were 32.2 +/- 4.4 years and 4.4 +/- 1.9, respectively. There were 17 (30.1%) live births, 34 (56.6%) terminations of pregnancy and 3 (5.2%) spontaneous abortions. Two (3.0%) patients were lost to follow-up. There was neither any statistically significant difference in the outcome of pregnancy between patients with 5 or more children and less than 5 children (p greater than 0.05), nor between patients less than 31 years of age and those older. Fifty per cent of the patients who had used the IUD continued with the method. Seven patients subsequently requested VSC. None of the patients using the injectable contraceptive or barrier methods continued with the method (p greater than 0.05).

PIP: Pregnancy outcome in 56 patients who experienced contraceptive failure out of a pool of 5431 acceptors at the Family Planning Clinic of the Department of Obstetrics and Gynecology, College of Medicine, University of Lagos, Nigeria was analyzed during the period January 1981-December 1989. There were 40 IUD, 6 oral contraceptive, and 4 injectable failures. 3 patients had undergone voluntary surgical contraception (VSC) and 3 used barrier methods. The mean +or- SD age and parity were 32.2 +or- 4.4 years and 4.4 +or- 1.9, respectively. There were 17 (30.1%) live births, 34 (56.5%) pregnancy terminations, and 3 (5.2%) spontaneous abortions. 2 (3.0%) patients were lost to follow up. There was neither any statistically significant difference in the outcome of pregnancy between those patients with 5 or more children and less than 5 children (p.05), nor between patients less than 31 years old and those who were older. 50% of those who had used the IUD continued with that method; 7 patients subsequently requested VSC. None of the patients using injectables or barrier methods continued with that method (p.05).

The attitude of fertile Nigerian women to sterilization.

PIP: 250 women selected at random from outpatients of the Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Nigeria, were interviewed about their attitudes toward female sterilization by nurses with a standard questionnaire. Factors affecting attitudes toward sterilization were multiple and results are reported as percentages. The study population excluded women with infertility, a common problem, and further differed from the general population because the women were older and more highly educated. The number of living children was 3 or more in 59%; the ideal family size was at least 5 in 48%. 48% had used some type of contraception. 87.6% had heard of female sterilization, most often from medical personnel. Factors reported as affecting attitudes included: number of living children (59.6%); age of patient (52%); experience with complications of pregnancy and labor (45.2%); other medical disorders (36%); effect on reincarnation (17.6%); sex of living children (17.2%); fear of impotence (7.2%); and religion or culture (3.2%). The average age for female sterilization is 40 in Nigeria. A more extensive study of resistance to sterilization is indicated.^ieng

The hemoglobinopathies and pregnancy in Lagos.

Thirty-four patients with abnormal hemoglobin were studied through 42 pregnancies under one obstetrician. There were 30 patients with sickle cell anemia (HbSS), two with sickle cell hemoglobin C disease (HbSC) and two with homozygous hemoglobin C disease (HbCC). There were 39 live births (including one pair of twins), and four perinatal deaths. The patients with HbSC and HbCC had five uncomplicated pregnancies and deliveries. Of the 36 pregnancies in patients with HbSS one aborted at 12 weeks. Intra-uterine growth retardation (14.3%) and pregnancy-induced hypertension (14.3%) were the most serious pregnancy complications. No patient had more than one crisis. Only one out of the 10 patients transfused needed more than two units of blood throughout pregnancy. The mean gestation at delivery was 37.5 +/- 3.2 (S.D.) weeks. The mean birth weight was 2.7 +/- 0.6 (S.D.) kg. The perinatal mortality was 114.3 per thousand live births and there was one maternal death.

Antenatal iron supplementation in sickle cell disease.

Fourteen pregnant women with sickle cell disease (11 SS and 3 SC) were randomized into two groups to receive routine antenatal supplementation either with ferrous gluconate or with placebo tablets. Their hemoglobin levels and bone marrow iron content were determined prenatally and 6 weeks post partum. The fetal weights and the incidence of pain crisis in both groups were recorded. Using an iron content grading from 0 to 5, no marrow of any subject showed iron depletion. The placebo group showed an aggregate postnatal loss of 4 grades of iron repletion while the iron supplemented group showed an aggregate gain of 2 grades. There were no significant differences between the birth weight or the incidence of pain crises in both groups. We conclude that routine iron supplementation is not justified in pregnant women with sickle cell disease, as it would tend to increase already adequate or excessive iron body stores. We recommend that a clear need for iron should be established before iron supplementation is prescribed to them.