Paragonimiasis: Neglected, Re-Emerging or Expanding Frontiers. Lessons from a Case Presenting in Jos, Plateau State.

BACKGROUND AND OBJECTIVES: Paragonimiasis is endemic in Eastern Nigeria. An upsurge was recorded after the Nigeria/Biafra war as protein lack in Biafra forced people to eat fresh water crabs. Its protean manifestations create confusion with several diseases. Elimination was assumed after a while and suspicion index fell. The interest in reporting this case follows its presentation outside the traditional endemic zone. RESULTS: The patient, though living in Eastern Nigeria and manifesting several pointers of Paragonimiasis, was treated as tuberculosis despite negative sputum AFB; without improving. He then presented up-country in Jos where history led to suspicion and confirmation of Paragonimiasis. By this time he had severe cor-pulmonale and died despite treatment. CONCLUSION: In this current economic downturn in Nigeria which may drive people to cheaper protein sources, a high index of suspicion should be raised for paragonimiasis when a patient presents with chronic cough productive of AFB-negative sputum and haemoptysis.

Diabetes mellitus in pregnancy: an update on the current classification and management.

BACKGROUND: Diabetes mellitus is a common medical disorder in pregnancy. It contributes particularly to perinatal morbidity/mortality, and maternal morbidity. This review aims at improving maternal and neonatal health care especially in Sub-Saharan Africa by improving the knowledge of health practitioners on current evidences in the classification and management of diabetes mellitus in pregnancy. METHODS: Relevant texts as well as online data bases including Pubmed, Google scholar, and African journal online, were searched for literatures related to the subject. RESULTS: Classification of diabetes in pregnancy has been revised to reflect the various aetiological factors. Also, the diagnostic value of fasting plasma glucose has been lowered to mark the point at which dramatic increase in the microvascular complications of diabetes mellitus occurs. Morbidity and mortality associated with the condition would be reduced through proper management that involves preconception care, early antenatal booking, dedicated multidisciplinary antenatal care, and delivery in a center with neonatal facility. Furthermore, some oral glucose lowering agents have shown some safety after the first trimester and they have been found to give comparable result to insulin therapy. CONCLUSION: The classification of diabetes mellitus in pregnancy has been revised. Its optimal management should involve multi-disciplinary inputs and may include oral hypoglycaemic agents. Knowledge of these by clinicians would improve maternal and neonatal health.

Prevalence of cervical squamous intraepithelial lesions among HIV-positive women in Enugu, South-eastern Nigeria.

HIV infection is a risk factor for cervical cancer and both diseases are prevalent in Nigeria. The study determined the prevalence of cervical squamous intraepithelial lesion (SIL) among HIV-positive women in Enugu state, which has the highest HIV burden in South-eastern Nigeria. Pap smear was carried out on 150 HIV-positive (HIV+ve) women and 150 HIV-negative (HIV?ve) controls at the University of Nigeria Teaching Hospital, Enugu, Nigeria from December 2007 to March 2008. The prevalence of SIL for the HIV+ve group and the control group were 12.6% and 4.6%, respectively (p = 0.014). Also, the prevalence of each category of SIL identified in the study, was higher among the HIV+ve group. There is an association between HIV infection and SIL in Enugu, South-eastern Nigeria. Cervical cancer screening should be incorporated into the antiretroviral (ARV) clinics, so as to prevent the impending surge in the burden of cervical cancer in Nigeria.

Seroprevalence of Chlamydia trachomatis in Enugu, Nigeria.

BACKGROUND: Chlamydia infections in women cause pelvic inflammatory disease, which often results in devastating consequences of infertility, ectopic pregnancy, or chronic pelvic pain. The infection is largely asymptomatic. OBJECTIVE: To determine the seroprevalence of Chlamydia trachomatis in Enugu, South Eastern Nigeria. MATERIALS AND METHODS: A population-based prospective study comprising female residents of Enugu, South Eastern Nigeria. Indirect solid phase enzyme immunoassay of Chlamydia antibodies was done using ImmunoComb C0. Trachomatis IgG Kit (Orgenics). RESULTS: The population comprised 136 female undergraduate students and 150 non-student women. The overall prevalence of C. trachomatis in the population studied was 29.4%. The percentage of subjects who admitted to be having multiple sexual partners was higher among the student population (71.2%) compared to those from the non-student population (28.8%). The highest percentage of seroprevalence was 28 (33.3%) in the age group of 20-24 years for the student population and 18 (21.4%) in the age group of 25-29 years for the non-student population. The highest seroprevalence of C. trachomatis antibodies (69.0%) in both populations was observed in females without any history of infection. Females that had pelvic inflammatory disease, sexually transmitted infection, and secondary infertility assayed for C. trachomatis had seroprevalence levels of 19%, 9.5%, and 2.4%, respectively. There was a positive correlation between positive Chlamydia assay and the type of subject population (student or non-student) with r2 value of 1.55 at P < 0.01. CONCLUSIONS: C. trachomatis infection is largely underdiagnosed and remains a silent disease in the apparently healthy population of Enugu, South eastern Nigeria.

Knowledge and Perception of Menopause and Climacteric Symptoms among a Population of Women in Enugu; South East; Nigeria

Background: Menopause alters the physiological; biochemical and psychological environment of a woman. Thus the knowledge and perception of its symptomatology is invaluable to enable appropriate adjustment to this natural phenomenon. Objective: The objective of this study was to determine the knowledge and perception of menopause and climacteric symptoms among a sample of women in Enugu; South East Nigeria. Methods: This was a cross sectional survey of 432 women aged 45-60 and above drawn from the general population of Enugu metropolis of Nigeria. These women were randomly selected from the gynaecology clinic attendees in a tertiary health care facility in Enugu. A self administered structured pre-tested questionnaire was designed. The data were analysed using SPSS software. The primary methods used were cross tabulation (with X2 or Mantel Haenszel trend tests as appropriate) and one way analysis of variance. Results: Majority of women in the population studied experienced climacteric symptoms but relatively few regarded these symptoms as a problem. For example hot flushes and night sweats were experienced by 70.0but defined as a problem by only 30.0. Out of 432 women studied; only 33.3sought medical attention in hospital for their symptoms. 58.3of the women did not regard them as a medical problem and took them as part of aging process. Conclusion: Physicians should be aware of climacteric symptoms among women in the population so as to offer appropriate counselling and support without undue recourse to wasteful clinical assessment and investigations. Public enlightenment would also help to improve awareness of the menopause and its symptoms that may often lead to misdiagnosis in gynaecological clinics

Preconception care in South Eastern Nigeria.

The objective was to determine the awareness and practice of preconception care in a developing country. This is a cross-sectional study of women receiving antenatal care at the University of Nigeria Teaching Hospital and Enugu state university teaching hospital (ESUT) between October 2005 and March 2006. Sampling was systematic where every consenting second of two pregnant women receiving antenatal care at the hospital was mobilised for the study. Data analysis was by descriptive and inferential statistics using statistical package for social sciences (SPSS) software version 11 (SPSS Inc. 2001). A total of 1,500 questionnaires were distributed while 1,331 were completed and returned giving a response rate of 88.7%. The mean age was 30.0 + 5.0 years. Of these, 573 (43.1%) women had heard of preconception care. The respondent's awareness of preconception care and their ability to define the subject correctly increase significantly with their educational status and parity. However, there was a difference between knowledge and behaviour. The practice of preconception care was not affected significantly by the parity of the patients. The majority believed that preconception care might improve the health of mother and child. The practice of preconception care is almost non-existent in developing countries. It is important that all stake holders in maternal and child health be involved in vigorous, targeted and sustained female education to improve knowledge and utilisation of preconception care by women of reproductive age groups in developing countries. Health institutions in these underserved populations should develop, and maintain functional dedicated and multidisciplinary clinics for preconception care to decrease perinatal and maternal mortality. Preconception clinics are more important in developing countries such as Nigeria compared with the western world because they would help correct inadequate education and identify a high level of existing illness relevant to pregnancy - much higher than in the western world.

Women's experiences following failed vaginal birth after cesarean delivery.

OBJECTIVE: To assess the experience of women in whom a trial of vaginal birth after cesarean (VBAC) has failed. METHODS: Pretested self-administered questionnaires containing both open- and closed-ended questions were given to the participants while they were waiting for an antenatal check-up. The responses to the closed-ended questions were analyzed with descriptive statistics. Content analysis was used for the responses to the open-ended questions. RESULTS: The women with a history of a successful vaginal delivery reported a positive experience whereas those with no history of vaginal delivery reported a negative experience. The women found the limited options available to them the most dissatisfying aspect of attempting a VBAC. CONCLUSION: An unsuccessful trial of VBAC could have significant adverse effects on women, especially on those who have never given birth vaginally. Adequate antenatal education for women planning a trial of VBAC, postdelivery support following an unsuccessful trial of VBAC, and research aimed at expanding the options available to women as they are attempting VBAC are recommended.

The relevance of VDRL as routine test in pregnant women: a critcal study.

AIM: To critically determine the relevance of Venereal Diseases Research Laboratories (VDRL) investigation as a routine serological screening for syphilis among pregnant women who receive antenatal care at the University of Nigeria Teaching Hospital (UNTH). METHODS: A retrospective chart review of result of serological test for syphilis among pregnant women during a five year period (1st January, 1997 to 31st December 2001) was undertaken. RESULTS: A total of 7469 women booked. 7175 had routine serological test. 294 of the booked women failed to submit themselves for screening. The prevalence rate of syphilis in this study was 0.125%. VDRL seroreactivity had in previous studies in this center declined from 3.06% to 1.30%. It further declined to 0.98% in this study. CONCLUSION: The results strongly show a continuing very low prevalence rate of syphilis in Enugu. Nevertheless, we support continued screening of pregnant women inspite of this low prevalence rate, since this will eradicated the effects of undiagnosed and untreated syphilis.

Morbidity and mortality following tubal ectopic pregnancies in Enugu, Nigeria.

Our objective was to determine the current incidence, clinical pattern, surgical and medical management, maternal morbidity and mortality from tubal pregnancies in Enugu, Nigeria. The records of all patients treated for tubal pregnancy at the University of Nigeria Teaching Hospital, Enugu from 1 January 1997 to 31 December 2003 were reviewed. The number of tubal ectopic pregnancies was 136, while the total number of hospital deliveries was 6,003 giving a ratio of 1:44. There were four maternal deaths due to tubal pregnancy, out of a total of 126 maternal deaths that occurred during the same period. Ectopic pregnancy was prevalent in young single women with a previous history of induced abortion and resultant pelvic infection. The most common mode of treatment is salpingectomy. Most gynaecologists are not competent in operative laparoscopy and often do not use medical management of ectopic pregnancy. However, late presentation with haemoperitoneum limits the use of conservative treatment. Maternal morbidity and mortality due to tubal pregnancy is rising in Enugu, Nigeria. Preventive efforts should aim at health education and liberal contraceptive utilisation. Provision of more sophisticated equipment and tests in the management of ectopic pregnancies may in the long term be economically viable. Currently, autotransfusion is under utilised.

Knowledge, attitude and use of emergency contraception among female undergraduates in Eastern Nigeria.

Our objective was to investigate the knowledge, use and attitude towards emergency contraceptive pills among female undergraduates. This was done using a randomly selected sample of female undergraduate students at three tertiary institutions in Enugu, Nigeria. The majority of the respondents (95%) were aware of contraception. However, 61% of the female undergraduates had heard of emergency contraception but only 31% had actually used it. The most common source of information about emergency contraceptive pills was from friends and teachers. Most respondents (19%) used Postinor rather than other types. While using emergency contraception, 16% got pregnant, of whom 9% carried the pregnancy to term and delivered the baby while (10%) procured an illegal abortion. Increased utilization of emergency contraception is plagued with fear of infertility, anovulation, ill health and sexually transmitted infection. Though 40% of the female undergraduates accepted it when informed and would recommend it to other female students, more information dissemination is required to further create awareness and enhance wider acceptance. Awareness programmes should address the barriers to effective use of ECP preferably using peer educators and the media.

HIV/AIDS awareness and sexual practices among undergraduates in Enugu, Nigeria.

OBJECTIVE: To assess the knowledge of HIV/AIDS among Nigeria undergraduates and to determine how the knowledge has influenced their sexual behaviour. MATERIALS AND METHODS: A pre-tested self - administered questionnaire survey of a random sample of undergraduates of two University Campuses in Enugu, Nigeria. RESULTS: All the 505 respondents had heard of HIV/AIDS. The respondents exhibited a high knowledge of HIV/AIDS. For the 348 (68.9% ) respondents who had ever had sexual intercourse, the mean number of sexual partners, which they had before and after they became aware of HIV/AIDS did not differ significantly 93.2+ 1.7 versus 2.9+1.5; p = 0.3). However, there was a significant tendency towards a more consistent condom use after the respondents became aware of HIV/AIDS. On univariate logistic regression, being married (OR=2.8, <0.001), previous risky sexual behaviour (OR= 2.5, <0.0001) and being more than 20 years old (OR=1.4, p < 0.02) (but not respondents' level of knowledge of HIV/AIDS etc) were significant predictors of risky sexual behaviour after the respondents became aware of HIV/AIDS. On multivariate logistic regression - previous risky sexual behaviour (OR =2.5, <0.00001) and being married (OR = 2.1, p< 0.001) remained significant. CONCLUSION: High knowledge of HIV/AIDS has no correlation with subsequent sexual behaviour among Nigerian undergraduates.

Histological analysis of endometrial curettings performed for infertility in Nigeria.

Over a 10-year period (January 1985 - December 1994) 1060 consecutive infertile patients had endometrial biopsy as part of the infertility evaluation protocol. Four hundred and six patients (38.3%) had primary infertility while 654 (61.7%) had secondary infertility. The mean age was 31.7 years. The histology results of the endometrial currettings were as follows: secretory endometrium (56.7%), endometrial hypoplasia (20%), proliferative endometrium (16.6%), pregnancy (5%) and non-specific endometritis (1.7%). Secretory endometrium was the most frequent histological finding. The employment of dilatation and curettage can inadvertently disrupt an ongoing early pregnancy, as seen from the study. In conclusion, lack of infrastructure and investigatory facilities due to poor funding makes comprehensive infertility management impossible in developing countries. In such countries, centres of excellence for infertility management should be designated together with the provision of an enabling environment for private-sector involvement.

Correlation between intrapartum fundal height and birth weight.

In a prospective cross-sectional study, the correlation between symphysiofundal height (SFH) and birth weight was evaluated in 2646 consecutive parturients at the University of Nigeria Teaching Hospital, Enugu, over a 19-month period. The standard deviations of the observed birth weight were least when the SFH measured 33-39 cm, which corresponded to the birth weight range 2500-3999 g. The overall standard deviation was 275 g. A second order polynomial fitted the data best, giving the equation y +/- 258.1-62.9x -3.8x2, where y represents the observed birth weight in grams and x the SFH in centimetres. The R2 statistic for the model was 0.82. This and other assessment showed a good model fit. The birth weight centiles for the various SFH measurements were derived and their usefulness discussed. It was concluded that the SFH-derived birth weight centiles are useful alternatives to ultrasonography especially in the birth weight range 2500-3999 g.

The management of Hyperttension in Nigerians

A review on the present state of management of hypertension is presented. The methods for case detection and investigation of cases are described. Treatment modes; patient education; society awareness are all factors that are important in the control of hypertension and limiting its complications. The role of primary health care workers in detecting and promoting complianceis being advocated

Hypertension studies in developing countries.

Developing countries vary considerably with respect to the behaviour of the blood pressure among its populations. In many countries hypertension is the commonest cardiovascular disorder; but communities also exist within many of these countries that do not manifest hypertension. Some of the characteristics of such communities include primitive social structures and low dietary salt intake. Some special features of hypertension among African populations and persons of African descent may be related to fundamental differences in cellular handling of cations. Difficulties with hypertension control in developing countries are largely economic. The next decade should attempt to ascertain whether observed variations in hypertension prevalence might provide the key to the pathogenesis of high blood pressure and whether primary prevention might resolve the difficulties the developing world encounters in instituting hypertension control.

Pregnancy in women after repair of bladder exstrophy. Two case reports.

Improved techniques in urinary diversion operations have enabled a large number of patients with bladder exstrophy to achieve urinary control. They can live fairly normal lives and some have achieved pregnancy. Case reports of such exist in the literature. Two more cases are reported in this paper, the pregnancies and their outcome are discussed.