Anaesthesia for minilaparotomy female sterilization in JUTH, Nigeria: a fourteen-year review.

This is a retrospective study aimed at evaluating the various anaesthetic methods used for minilaparotomy female sterilization. During the fourteen-year period, 2913 clients had minilaparotomy female sterilization. Their mean age was 36.35 +/- 4.19 years. Mean number of living children was 6.82 +/- 1.64. 74.87% of the clients did not have any formal education, but were aware of other contraceptive options. In all 98.42% of the clients were married and in a stable relationships. Local anaesthesia with 1% xylocaine (10-20 mls) was used in 83.69% of the cases. Local anaesthesia with sedation in 13.53% and general anaesthesia in only 2.78%. Above 93.55% (2725) of the sterilization was carried out as an interval procedure, while 6.45% (188) were done postpartum. Pomeroy's technique was used in 96.98% of the tubal ligation. There was no mortality. The morbidity was vomiting and hallucination and it occurred in 0.20% amongst the clients who had sedation or general anaesthesia. Minilaparotomy under local anaesthesia for female sterilization has been found to be safe an effective outpatient procedure, and it is currently and established family planning option in our institution. The use of local anaesthesia alone gradually rose from 1987 up to date. The successful outcome was attributable to psychological and emotional preparation of the clients who also had to learn abdominal breathing exercises (for easy access to the fallopian tubes) from the trained personnel before the procedure.

Twins in Jos Nigeria: a seven-year retrospective study.

INTRODUCTION: A retrospective analysis of twin pregnancy was carried out between 1st January 1992 and 31st December 1998 to determine the incidence, epidemiological variables perinatal and maternal outcome of twin pregnancy in the institution. MATERIAL AND METHODS: The case notes of the 413 twin pregnancy, 6 triplets and 1 quadruplet delivered during the period, and the labour records of all the deliveries were analyzed. Statistical analysis was with chi-squared test. The level of significance was set at 5%. RESULTS: The incidence of twin pregnancy was 28/1000, triplet 0.4/1000 and quadruplet 0.07/1000. The age range of the twin mothers was 15-47 years with a mean of 28 +/- 5.4 years. The parity range was 0-14 years with a mean of 3.3 +/- 2.6. Rising maternal age and parity were associated with twinning rate. The mean fetal weight was 2.21 +/- 0.66 kg. There was no statistical significant difference in weight between the 1st and 2nd twins. Male babies however weighed heavier (p < 0.02) than the female infants. The incidence of low birth weight babies (< 2500 g) was 58.7% with a perinatal mortality rate of 278.4/1000. The perinatal outcome was worst for the very low birth weight babies (< 1500), 817.5/1000 8.5% of twin mothers had a retained 2nd twin. The perinatal outcome of the 27 unbooked mothers who delivered their 1st twin at home was (12) 44.4/1000, compared to the rate of 12.5/1000 (1) in 8 booked mothers, who delivered the 1st twin in the hospital. Among the 771 babies who were alive at the time of presentation in the labour ward, delivery by caesarean section had a better perinatal outcome (6.8%), compared to spontaneous vaginal delivery (13.1%) and assisted breech delivery (21.4%). The unbooked twin mothers had a perinatal mortality rate of 318.7/1000 compared to booked mothers 82.3/1000. The overall perinatal mortality rate was 186.4/1000. The clinical causes of death were prematurity 74.6%, retained 2nd twin 7.3%, antepartum haemorrhage 6.1%, severe pregnancy induced hypertension/eclampsia 3.0%, birth asphyxia 2.4%, congenital malformation 1.8%. The incidence of postpartum haemorrhage was 3% and there was no maternal mortality in the series. The institution will need to put in place adequate resuscitating facilities and manpower to manage the low birth weight infants so as to reduce the current high perinatal wastage.

Breastfeeding pattern in Jos, Nigeria, before baby-friendly hospital initiative.

Interviews were conducted amongst 800 mothers attending Jos University Teaching Hospital, Nigeria, to obtain information on prenatal care, knowledge, attitudes, and practices relating to breastfeeding. Of the 653 women who had antenatal care, 75 per cent had breastfeeding education, though devoid of practical demonstration of breastfeeding techniques. Breastfeeding was universal, but only 439 (55 per cent) mothers started breastfeeding within 24 hours of delivery with a mean initiation time of 1.9 days. Prelacteal feeds were often offered. Only 51 (6 per cent) mothers exclusively breastfed at 3 months while early supplementation was common. Acquisition of secondary or post-secondary education was associated with significantly shorter duration of breastfeeding, P < 0.01 and P < 0.001, respectively, when compared with those with or without primary education. These problems are being effectively countered by appropriate health education, training of health workers, and effective lactation management.

Mothers' attitudes towards donated breastmilk in Jos, Nigeria.

In many developing countries, the use of pooled human milk is not widely accepted. Six hundred eighty breastfeeding mothers were interviewed to ascertain their acceptance of donated breastmilk. Their attitudes toward stored breastmilk, human milk banking, and breastfeeding in the event of human immunodeficiency virus (HIV) positivity were solicited. About 71 percent would not accept donated breastmilk for their baby while the rest would consent only if the donor were a close family relative, owing to fear of transfer of diseases (28 percent), fear of transfer of genetic traits (22 percent), and religious and cultural taboos (14 percent). However, 60 percent were willing to donate breastmilk. Only 38 percent would accept milk from a breastmilk bank. None would breastfeed if she were HIV positive.

PIP: In the Jos community of Plateau state, Nigeria, a survey was conducted among mothers who were specifically questioned in relation to transmissible diseases such as HIV. Their attitudes regarding pooled breast milk, breast milk banks, and offering stored breast milk to their babies were also ascertained. 680 breast-feeding mothers attending the Jos University Teaching Hospital (JUTH) were interviewed at the Pediatric Outpatient Department, Postnatal and Immunization clinics using a structured pretested questionnaire. The ethnic distribution reflected the major tribes in Nigeria (Ibo, Yoruba, and Hausa). Most of the women had at least a primary school education, were Christians, were employed, and had nursed babies previously. 70% were unwilling to accept donated breast milk. The remaining mothers would accept it only if the donor was a close family relation. Among the 92 health workers (90 nurses and 2 doctors) included in the study, only 11 (12%) would consent to using donated breast milk. Mothers who were employed were less willing to accept donated breast milk when compared with unemployed mothers (p .001). Similarly, mothers with secondary or postsecondary education as a group were significantly less willing to accept donated breast milk in comparison to those with primary or no formal education (p .02). The majority of employed or well- educated mothers opted for manufactured baby milk feeds. Under HIV-positive status, none would breast feed regardless of their educational or employment status. 410 (60%) of the women were willing to donate breast milk, but they preferred to do so for a relative's baby; 25% feared producing insufficient breast milk to sustain their own infants if they had to donate milk. On the whole, 63% believed that stored breast milk was unsafe after 6 hours in a home refrigerator. Breast milk from a well- established human milk bank was acceptable to 38% of the respondents. Negative responses were due to religious injunction (27%), fear of transfer of genetic traits (17%), possible transfer of disease (11%), cultural inhibition (4%), and personal dislike (2%).

Hysteroscopy in infertile Nigerian women.

The uterine cavity was evaluated by hysteroscopy in 20 Nigerian women aged 23-40 years, as part of the investigations of primary or secondary infertility. Intra-uterine abnormalities were detected in 45% of the patients. These abnormalities included intra-uterine adhesions (20%), endometrial polyps (10%), sub-mucous fibroids (5%), endometrial atrophy (5%), and endocervical cysts (5%). This preliminary report reveals a high diagnostic yield with hysteroscopy. The advantages and complications of the procedure are discussed.