Nitric oxide in infertile females in the niger-delta region of Nigeria.

BACKGROUND: Infertility is a public health challenge and it is a distressing personal tragedy for couples, more so for the female partners. Risk factors and causes of infertility vary from region to region. Reactive species is of current interest in the pathogenesis and management of infertility, especially in the Niger-Delta Region of Nigeria where environmental hazards of oil exploration exists. AIM: The overall goal of this study was to determine and compare the serum reactive species levels (nitric oxide) in fertile and infertile women attending the infertility clinic at the Delta State University Teaching Hospital, Oghara, and Central Hospital, Warri. METHODS: This was a prospective case-control study in which 70 women evaluated for infertility were recruited into the study. A fertile patient matched for age and body mass index (BMI) attending family planning clinic was selected as control. Serum nitric oxide estimation was done using the BioVision Nitric Oxide Colorimetric Assay Kit. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS). Student's t-test was applied to compare the serum levels of nitric acid and the differences were considered significant if P < 0.05. RESULTS: Infertile women had significantly higher mean serum nitric oxide levels than fertile women: 34.33 (SD 5.93) µmol/L versus 18.27 (SD 2.63) µmol/L (P < 0.001). Women with secondary infertility had significantly higher mean levels of nitric oxide than those with primary infertility: 38.13 (SD 3.39) µmol/L versus 22.72 (SD 4.36) µmol/L (P < 0.001). CONCLUSION: The study showed that serum nitric oxide level was significantly elevated in women with infertility compared to women of proven fertility. Hence, oxidative stress from reactive species may be a contributory factor to infertility in women in the Niger-Delta Region of Nigeria.

Obstetrics and gynaecology residents' knowledge of the informed consent process and its practice in their training institutions.

INTRODUCTION: The ethical principle of autonomy as expressed in the practice of informed consent is a core tenet of clinical practice and good patient physician relationship. AIM: The aim was to identify specific gaps in the knowledge of trainee obstetricians and gynecologists in Nigeria about the informed consent process and its content. It also sought to describe the practice of informed consent in their respective institutions. MATERIALS AND METHODS: A survey of Residents in obstetrics and gynecology attending the revision course of the Faculty of obstetrics and gynecology of the national postgraduate medical college was done to determine their knowledge of the informed consent process and its practice in their institutions. RESULTS: None of the residents was able to give responses that contained all five conditions for informed consent to be valid. Furthermore, only 3 (2.22%) Residents mentioned that the name of the surgeon to perform the surgery should be part of the information provided to patients during the informed consent process. Similarly, only 8 (5.93%) mentioned that consequences of not having the surgery should be part of the informed consent process. The concept of the 'emancipated minor' being competent to give consent was known by 38% of the residents. CONCLUSION: Although Residents in obstetrics and gynecology in Nigeria have some knowledge of the informed consent process, this knowledge is deficient in key areas such as competence to give consent, content and scope of information to be disclosed to patients for surgery. There is a need to teach residents the rudiments of informed consent and bioethics in general.

Eclampsia in Irrua Specialist Teaching Hospital: a five-year review.

OBJECTIVE: The contribution of Eclampsia to maternal mortality in Nigeria is well documented. In Irrua it accounts for over 25% of maternal deaths. Addressing Eclampsia is therefore a priority programme of the Irrua Safe motherhood Initiative. AIM: The aim of this study is to determine the incidence of eclampsia, its clinical correlates and outcome. Finally strategies will formulate programme implementation. MATERIALS AND METHODS: This is a retrospective study of cases of eclampsia in Irrua Specialist Teaching Hospital, Edo state; over a five-year period. Information was retrieved using a structured proforma. Statistical analysis was done using the excel statistical package and the Epi info 2002 statistical software. RESULTS: Seventy eight (78) were admitted in the 5 year study. This accounted for 2.52% of total labour ward admission. However only 74 case notes were available for analysis. 70/74 of the patients were unbooked emergencies. Among the unbooked patients. 38/70 (54.29%) of the unbooked had not received any antenatal care whatsoever. The incidence was disproportionately higher in younger women and teenagers as well as in primigravida. 55/74 (74.32%) had preceding headache while 21.62% had a prior history of blurred vision, 14.86% had epigastric pain.16.22% had restlessness while 10.81% had nausea and vomiting each. The perinatal mortality rate was 28.38% while the maternal mortality ratio was 22.97%. Maternal mortality was associated with poor urinary output (0.0003), history of native medication (0.0199), number of fits (0.00209). Platelet count below 50,000/ml, highest systolic blood pressure above 200 mmhg (0.000018) and pulmonary oedema (0.000558). CONCLUSION: Addressing Eclampsia in Irrua will include community campaigns, capacity building, retraining of staffs within the hospital and improved facilities for the management of cases.

Congenital malformations in singleton and twin births in rural Nigeria.

BACKGROUND: The presence of a congenital malformation at birth is a cause of anxiety at an otherwise joyous occasion. Congenital malformations are a significant contributor to perinatal mortality. STUDY DESIGN: A retrospective study of external congenital abnormalities in singleton and twin births in rural eastern Nigeria over a 20 year period. RESULT: The incidence of congenital defects for all deliveries was 110.8/10,000 births. Of 1453 twins and 32206 singleton births, there were 58 and 315 congenital abnormalities, with incidence of 97.8/10,000 births and 399.2/10,000 births respectively. Twins were significantly (x(2) =115.22; p< 0.0000) more likely to have a congenital malformation than singletons (RR 4.08, 95% CI 3.10 - 5.7). The pattern of defects was similar for singleton and twin births and the leading system affected was the musculo-skeletal system, distantly followed by the central nervous system. For both groups the commonest malformation was ulnar polydactyly, followed by hydrocephaly and ankyloglossia. Surprisingly no conjoined twins were recorded and there were only 7 cases of congenital umbilical hernia, abnormalities previously considered to be very common in Nigerians and Africans respectively. CONCLUSION: Twins are about four times more likely to have congenital malformations than singletons. The overall prevalence of congenital malformations recorded is comparatively low. There is need for more detailed routine documentation of all birth defects including post-mortem report and the conduct of prospective population-based epidemiological surveys of birth defects in Nigeria.

A comparison of booked and unbooked patients with ruptured uterus in A referral hospital in the Niger Delta region of Nigeria.

OBJECTIVE: To document differences in characteristics and outcome between booked and unbooked patients with ruptured uterus METHODS: A 10 year retrospective comparative analysis of booked and unbooked patients with ruptured uterus at the Baptist medical center, Eku, Delta State. RESULTS: The overall incidence of ruptured uterus was 1 in 271 deliveries while the incidence among booked and unbooked patients was 1 in 556 and 1 in 140 respectively. There were a statistically significant difference in number of booked patients with formal education beyond the primary level compared with the unbooked patients (p = 0.0206; 95% CI 1.92-14.79). A higher proportion of booked patients with ruptured uterus had history of previous uterine scar. All the three maternal deaths occured in the unbooked patients. The overall case fatality rate for ruptured uterus was 23% or 1 in 4.3. CONCLUSION: Booked and unbooked patients with ruptured uterus have different characteristics and outcome. Subsequent studies on ruptured uterus should disaggregate their data according to the booking category of the patients. This will assist in making effective intervention plans that will impact both groups.

The demographic characteristics and health seeking behaviour of unbooked patients in Irrua Specialist Teaching Hospital.

BACKGROUND: The Obstetric outcome of the patients who receive antenatal care and deliver at the Irrua Specialist Teaching Hospital is reasonably satisfactory. Our major challenges arise from unbooked emergencies. The aim of this study was to determine the frequency of unbooked patients in the Irrua Specialist Teaching Hospital, their clinical presentation, their demographic characteristics as well as their obstetric outcome. METHODS: A structured proforma was used to collect relevant information over a one-year period from patients' case notes, theatre records and labour ward records. RESULTS: During the study period, unbooked patients constituted 14.7% of all deliveries. They had a higher proportion of teenagers (p < 0.0000) and women over 40 years (p < 0.0000) when compared to the booked patients. There were also a higher proportion of primigravidas and grandmultiparous women but these did not reach statistical significance. Unbooked patients are also more likely to be single (p < 0.001) and polygamous (p < 0.0002) when compared to the booked patients. The diagnosis on admission included obstructed labour (18.2%), intrauterine fetal death (14.9%), ante partum haemorrhage (12.4%), post date (12.4%) and eclampsia (8.3%). Eighteen (14.9%) of the unbooked patients had no antenatal care whatsoever, while sixteen 13.2% had been visiting TBAs for some care in pregnancy. Maternal mortality for the unbooked patients was 5/121 (4.1%). There was no maternal death amongst booked patients during the study. CONCLUSION: The unbooked patients are relatively high-risk patients with some social disadvantage. They have a high maternal mortality.

The Demographic Characteristics and Health Seeking Behaviour of Unbooked Patients in Irrua Specialist Teaching Hospital

Background: The Obstetric outcome of the patients who receive antenatal care and deliver at the Irrua Specialist Teaching Hospital is reasonably satisfactory. Our major challenges arise from unbooked emergencies. The aim of this study was to determine the frequency of unbooked patients in the Irrua Specialist Teaching Hospital; their clinical presentation; their demographic characteristics as well as their obstetric outcome. Methods: A structured proforma was used to collect relevant information over a one-year period from patients' case notes; theatre records and labour ward records. Results: During the study period; unbooked patients constituted 14.7of all deliveries. They had a higher proportion of teenagers (p

The Demographic Characteristics and Health Seeking Behaviour of Unbooked Patients in Irrua Specialist Teaching Hospital

Background: The Obstetric outcome of the patients who receive antenatal care and deliver at the Irrua Specialist Teaching Hospital is reasonably satisfactory. Our major challenges arise from unbooked emergencies. The aim of this study was to determine the frequency of unbooked patients in the Irrua Specialist Teaching Hospital; their clinical presentation; their demographic characteristics as well as their obstetric outcome. Methods: A structured proforma was used to collect relevant information over a one-year period from patients' case notes; theatre records and labour ward records. Results: During the study period; unbooked patients constituted 14.7of all deliveries. They had a higher proportion of teenagers (p

A comparison of Booked and Unbooked Patients with Ruptured Uterus in a Referral Hospital in the Niger Delta Region of Nigeria

Objective: To document differences in characteristics and outcome between booked and unbooked patients with ruptured uterus. Methods : A 10 year retrospective comparative analysis of booked and unbooked patients with ruptured uterus at the Baptist medical center; Eku; Delta State. Results: The overall incidence of ruptured uterus was 1 in 271 deliveries while the incidence among booked and unbooked patients was 1 in 556 and 1 in 140 respectively. There were a statistically significant difference in number of booked patients with formal education beyond the primary level compared with the unbooked patients (p =0.0206; 95CI 1.92-14.79). A higher proportion ofbooked patientswith ruptured uterus had history ofprevious uterinescar. All the three maternal deathsoccure in theunbooked patients. The overallcasefatality rate for ruptured uterus was 23or 1 in 4.3. Conclusion : Booked and unbooked patients with ruptured uterus have different characteristics and outcome. Subsequent studies on ruptured uterus should disaggregate their data according to the booking category of the patients. This will assist in making effective intervention plans that will impact both groups

Relationship between knowledge of HIV/AIDS and sexual behaviour among in-school adolescents in Delta State, Nigeria.

OBJECTIVE: To determine if there is any correlation between the knowledge of HIV/AIDS among in-school adolescents in Delta state of Nigeria and their sexual behaviour. METHOD: A questionnaire based descriptive study of randomly selected secondary school students in Asaba. Delta state. RESULTS: A total of 437 students were recruited for the study. About 47% of respondents had good knowledge of HIV/AIDS. The electronic media were their main sources of information. Fifty-eight percent had been sexually initiated but only 10% were currently sexually active. About 73% of the males and 58% of the females reported condom use in their last sexual act. Seventy-three percent of the students that had poor knowledge of HIV/AIDS had ever had sex compared with 69.5% of students with good knowledge. Similarly 45.6% of students with poor knowledge used condom compared with 58.8% who had good knowledge. However these observed differences were not statistically significant. CONCLUSION: Knowledge of HIV/AIDS by in-school adolescents in Asaba has not significantly influenced their sexual behavior. Program planners should explore and integrate other factors that could impact positively on adolescent sexual behavior.

Obstetric hysterectomy: fifteen years' experience in a Nigerian tertiary centre.

The aim of this study was to determine the incidence, indications, associations and complications of obstetric hysterectomy in our centre with a view to suggesting ways of improving outcome. This is a descriptive study of patients who had obstetric hysterectomy in the University of Benin Teaching Hospital from January 1986 to December 2000. Data obtained from hospital records were analysed using appropriate computer statistical software for graphs and chi(2) test. In the period under study there were 20 344 deliveries. There were 46 obstetric hysterectomies, resulting in an incidence of 0.226%. Incidence increased with increasing maternal age from 0.10% at 20 years to 0.706% at 40 years and above. Incidence also increased with parity from 0.028% at para 0 to 1.298% for grandmultiparous women. The indications for the procedure were ruptured uterus 14/40 (35.0%), atonic postpartum haemorrhage 13/40 (32.5%) and placenta praevia 9/40 (22.5%); 12/40 (30.0%) of patients had previous caesarean sections. Subtotal hysterectomy had been undertaken in 43.5% of cases. There was a maternal mortality rate of 12.5%. Mortality was associated with torrential continuing haemorrhage and septicaemia. Urinary tract injury occurred in 7.50% of patients. Injury to the urinary tract was associated with previous caesarean section and total hysterectomy. Obstetric hysterectomy can have grave consequences. Availability of blood products, intensive monitors and limitation of family size is advised.

Exploring the causes of and risk factors for maternal deaths in a rural Nigerian referral hospital.

A 10-year (1990-9) review of all maternal deaths at Mater Misericordiae Hospital is presented. A total of 104 deaths occurred out of 13,391 deliveries (MMR 777/100,000). Haemorrhage, sepsis and Hypertensive diseases in pregnancy were the leading causes of death. Age below 15, Nulliparity, Grandmultiparity, low socio-economic class, lack of formal education and being unbooked were also significant risk factors. Delay in accessing health facility was also an identified contributing factor. Public enlightenment to encourage utilisation of antenatal facilities, prompt referral of complicated cases and adequate equipping of the referral hospital is suggested.