Maternal mortality among adolescent women in Jos, north-central, Nigeria.

The adolescent maternal mortality ratio is high in Jos, north-central Nigeria. The main causes of maternal deaths among the adolescents were unsafe abortion, eclampsia and sepsis. The Hausa/Fulani ethnic group constituted the largest ethnic group of adolescent maternal deaths in our study. The risk factors for adolescent maternal mortality found in our study were illiteracy, non-utilisation of antenatal services and Hausa/Fulani ethnic group.

Factors contributing to maternal mortality in north-central Nigeria: a seventeen-year review.

Maternal mortality ratio in Nigeria is one of the highest in the world. This paper reports a facility based study in north-central Nigeria to determine the magnitude, trends, causes and characteristics of maternal deaths before and after the launch of the Safe Motherhood Initiative in Nigeria, with a view to suggesting strategic interventions to reduce these deaths. The records of all deliveries and case files of all women who died during pregnancy and childbirth between January 1, 1985 and December 31, 2001, in the maternity unit of Jos University Teaching Hospital, Jos, Nigeria, were reviewed. Data collected were analysed for socio-biological variables including age, booking status, educational level, parity, ethnic group, marital status, mode of delivery, duration of hospital stay before death occurred, cause (s) of maternal deaths. There were 38,768 deliveries and 267 maternal deaths during the period under review, giving a maternal mortality ratio (MMR) of 740/ 100,000 total deliveries. The trend fluctuated between 450 in 1990 and 1,010/100.000 deliveries in 1994. The mean age of maternal death was 26.4 (SD 8.1) years. The greatest risk of MMR was among young teenagers (> 15 years) and older women (< 40 years). Parity-specific maternal mortality ratio was highest in the grand multiparous women. Unbooked as well as illiterate women were associated with very high maternal mortality ratio. The Hausa - Fulani ethnic group contributed the largest number (44%) by tribe to maternal mortality in our study. The major direct causes of deaths were haemorrhage (34.6%), sepsis (28.3%), eclampsia (23.6%) and unsafe abortion (9.6%). The most common indirect causes of death were hepatitis (18.6%), anaesthetic death (14.6%), anaemia in pregnancy (14.6%), meningitis (12.0%), HIV/AIDS (10.6%) and acute renal failure (8.0%). Seventy-nine percent of the maternal deaths occurred within 24 hours of admission. Most of the deaths were preventable. A regional-specific programme should be planned to reduce the deplorably high maternal mortality in north-central Nigeria.

Chemical, pathological and toxicological studies of the effects of RICOM-1013-J of Ricinus communis var minor on women volunteers and rodents.

RICOM-1013-J (Ricinus communis var minor) administered orally once to each of 12 women volunteers at a dose of 2.5-2.7 g per 8 months, protected against pregnancy over a period of 7-8 months of study. A study of the effect of a contraceptive dose (20 mg/kg) on metabolic parameters in rat (food and water in-take, urine and faecal output and body weight) over a period of 4 months showed a slight decrease in all the parameters in the first 1-8 weeks. This effect was reversible attaining pretreatment levels from week 16. The LD(50) in an acute toxicity test in mice was 63.1 +/- 16.0 g/kg s.c. Determination of blood urea, sodium (Na(+)), potassium (K(+)), chloride (Cl(-)) and bicarbonate (HCO$_¿3¿ ¿-¿$)as a measure of renal function and alkaline phosphatase (ALP), transaminases (GPT and GOT) and transpeptidases (GGT) as a measure of liver function showed that liver function profiles in pretreated rats were not significantly different from control (p < 0.05) on day 21 to day 150. However, serum levels of ALP and GGT at day 120 to day 150 were moderately but significantly elevated (p > 0.05) compared with the control. There were no significant changes in renal function profiles in pretreated rats (p < 0.05) compared with the control. The results of the liver and renal function profiles in women volunteers showed that there were no significant (p < 0.05) changes in renal functions on day 206 following RICOM-1013-J administration. However, serum levels of ALP and GGT showed a slight rise in about 70% of volunteers, whereas bilirubin and transaminases levels were normal. The present results indicate a very high efficacy and margin of safety of RICOM-1013-J in women volunteers. The increase in ALP and GGT in both animal and women volunteers suggest mild intrahepatic cholestatic changes which may be attributed to an oestrogenic effect of RICOM-1013-J.

Preliminary clinical investigation of the contraceptive efficacy and chemical pathological effects of RICOM-1013-J of Ricinus communis var minor on women volunteers.

The seeds of Ricinus communis Linn, RICOM-1013-J, administered as a single oral dose of 2.3-2.5 g once per 12 months protected against pregnancy in 50 women volunteers for a period of one year. The antifertility and contraceptive efficacy of the seed was demonstrated in this study. Clinical observation revealed very minimal side effects. Some of the side effects investigated included headache, nausea, vomiting, weight gain, loss of appetite, raised blood pressure and dysmenorrhoea. Furthermore, both the renal and liver functions were not affected as revealed by urea, electrolyte and creatinine values as well as total bilirubin, conjugated bilirubin, serum albumin, total protein and transaminases values when compared with control values. In addition cholesterol and phospholipids were not significantly altered. When all these results are considered together, it seems unlikely that the antifertility and contraceptive efficacy of RICOM-1013-J is due to hormonal mechanisms alone since side effects, renal and liver function, and cholesterol effects attributable to oestrogen and/or progesterone were minimal in the volunteers.

How safe is motherhood in Nigeria?: the trend of maternal mortality in a tertiary health institution.

OBJECTIVE: To determine the magnitude and trend of maternal mortality in Jos University Teaching Hospital, Jos, Nigeria. DESIGN: Retrospective study. SETTING: Jos University Teaching Hospital, Jos, Nigeria. SUBJECT: All women dying in pregnancy, labour and puerperium. MAIN OUTCOME MEASURES: Maternal mortality ratio, trend of maternal mortality, age, antenatal booking status, educational status, main causes of maternal death, factors contributing to maternal deaths. RESULTS: The maternal mortality ratio was 739/100,000 total deliveries and trend rose from 450/100,000 in 1990 to 1,060/100,000 total deliveries in 1994. About 33% of all maternal deaths occurred among teenagers. The risk factors for maternal deaths included adolescence, grand multiparity, illiteracy and non-utilisation of antenatal services. The main causes of maternal mortality were haemorrhage (28.1%), sepsis (21.3%) and eclampsia (15.7%). The contributions of complicated induced abortion and anaesthetic deaths in this study are worthy of mention. CONCLUSION: The maternal mortality ratio is unacceptably high in Jos University Teaching Hospital more particularly because of the rising trend. Socio-cultural and economic factors contributed immensely to the high maternal mortality in Jos. The objective of the World Health Organisation (WHO) to reduce maternal mortality by 50% by the year 2000 will not be achieved in this part of Nigeria. Nonetheless, improvement of the nation's economy coupled with a stable policy and provision of intrastructural facilities will assist to significantly reduce maternal mortality.

Uterotonic properties of the methanol extract of Monechma ciliatum.

The oxytocic activity of the hot methanol extract (HME) of the leaves of Monechma ciliatum was compared with other uterine stimulants like ergometrine, oxytocin, 5-hydroxytryptamine (5-HT), acetylcholine (ACh) and prostaglandins (PGs) E2 and F2alpha (PGE2 and PGF2alpha) in the presence of some antagonists in an attempt to explain the mechanism of action of the extract. The effects of the reference drugs on uteri isolated from rats pretreated with HME for 2 weeks were also observed. Atropine blocked the effect of ACh and partially blocked those of HME while L-366-948 blocked only the effect of oxytocin. Indomethacin inhibited the effects of HME as well as all the other drugs, except the PGs and ACh. D-600 blocked the effect of all the drugs including HME. Methysergide antagonised only the effect of 5-HT and partially blocked ergometrine. Prolonged treatment altered the uterine musculature and the activity profile of the reference drugs. These results suggest that the HME may be acting by more than one mechanism to contract the uterus and explains the mechanism of the anti-implantation activity of the plant.

Effects of oral contraceptive pills on serum lipoproteins and triglycerides.

Possible effects of a combined oral contraceptive (femenal) on blood triglycerides and high-density-lipoprotein-cholesterol (HDL-Chol) were studied in 25 women who had opted for hormonal contraception. Total serum triglycerides of 64.60 +/- 12.39 mg/dl (mean +/- SD) obtained prior to the commencement of hormonal contraception, did not reveal any statistical difference from the value of 65.49 +/- 7.96 mg/dl obtained after 9 months contraception. Similarly, precontraception HDL-Chol value of 58.05 +/- 6.58 mg/dl was also not statistically different from the treatment value of 58.82 +/- 5.42 mg/dl. Regression analysis of the values between control (precontraception) and treatment (9 months contraception) showed high correlation coefficients: (1) serum triglycerides, R2 = 0.5201; P less than 0.001; (2) serum HDL-Chol, R2 = 0.6590; P less than 0.001. Both the mean body weight and blood pressure of the study subjects remained unchanged after 9 months continuous use of femenal for contraception.

Haematological values in pregnancy in Jos.

Blood samples taken from 270 women, 30 in first trimester of pregnancy, 90 in second trimester and 150 in third trimester, were analysed for haemoglobin (Hb) packed cell volume (pcv), white blood cell count (wbc) and differentials and platelet count. The values for 95%, range for first trimester was Hb 122 +/- 19.8, pcv .37 +/- .0568L/L, wbc 6.189 +/- 2.484 x 10(9)/L and platelet 200.428 +/- 101.828 x 10(9)/L, for the second trimester, Hb 117.5 +/- 25.2 g/L pcv .36 +/- .0706L/L, wbc 6.414 +/- 2.884 x 10(9)/L and platelet 189.168 +/- 101.828 x 10(9)/L, and for third trimester Hb 119.6 +/- 24 pcv .36 +/- .072L/L, wbc 7.119 +/- 2.356 x 10(9)/L and platelet 193.786 +/- 103.016 x 10(9)/L. These results were compared with those of 150 non-pregnant women whose haematological indices were Hb. 130.5 +/- 17.89g/L, pcv .3994 +/- .0716L/L, wbc 5.255 +/- 2.900 x 10(9)/L and platelet 242.600 +/- 105.416. These results show that there is a significant fall in Hb, pcv, and platelet in pregnancy, while wbc count shows a significant rise in pregnancy due to neutrophilia.

Determination of gestational age by beta-subunit HCG measurement.

The accurate knowledge of gestational age is important in most Obstetric decisions near term. Gestational age estimation by a single measurement of beta-subunit HCG in early pregnancy was assessed in 164 Nigerian Women attending the antenatal clinic of Jos University Teaching Hospital. The mean difference between estimated gestational age by HCG concentrations and by recorded dates of last menstrual period was 2.8 +/- 1.6 days (mean +/- SD). This relationship was valid only for samples randomly selected between 35 and 56 days of gestation. We conclude that single measurement of HCG in early pregnancy provides accurate estimation of gestational age.

Liposarcoma of the cervix.

The case of a 45-year-old woman with a fungating cervical mass which was diagnosed as liposarcoma is described. She had a recurrence which was excised six months later and there was no clinical evidence of metastasis. No report of a similar case has been found in the African literature and this is probably the first documented report.

Levels of human chorionic gonadotropin in healthy pregnant Nigeria women.

Serum levels of human chorionic gonadotropin (hCG) were measured in venous blood samples of 100 healthy pregnant Nigerian women from weeks 5 to 40, using a batasubunit, hCG--specific radioimmunoassay. By week 5 hCG concentration was 3.39 +/- 2.35 Iu/ml (mean +/- SEM). An exponential rise occurred from week 5 to 8, during which period a direct relationship was observed between serum hCG levels and the gestational age (r2 = 0.996; p less than 0.001). The calculated mean doubling-time of hCG concentration, during this period of exponential increase was 5.08 days. A peak hCG concentration of 62.61 +/- 0.81 Iu/ml was attained at week 8, followed by a progressive decrease in concentration from week 9. The decrease in concentration reached a nadir by week 17 with a value of 4.77 +/- 2.48 Iu/ml. Between weeks 17 and 40 no significant difference in weekly mean values was detected. The respective mean values of hCG for the three trimesters were 25.79 Iu/ml for the first (n = 32), 8.91 Iu/ml for the second (n = 86) and 5.18 Iu/ml for the third (n = 110). There was no secondary peak of hcG concentration during the third trimester. The significance of these data is discussed.

Post-operative chemotherapy for ovarian carcinoma: a prospective study with cyclophosphamide.

Seventy consecutive patients with carcinoma of the ovary were managed in our unit by laparotomy and extensive debulking procedures over a period of 8 years. Intensive post-operative chemotherapy was given with intravenous cyclophosphamide. The mean follow-up period was 2.6 years. Our results showed that 19 patients with early disease (stages I and II) showed complete remission but seven subsequently died of recurrent disease. The others with more advanced disease showed little response to treatment.