Prevalence and Awareness about Chlamydial Infection in Women Undergoing Infertility Evaluation in Lagos; Nigeria

Purpose: To determine the prevalence and level of awareness of genital Chlamydia trachomatis infection and possible correlative factors among women undergoing infertility evaluation. Methods: The study involved analysis of demographics and results of chlamydia screening in 77 infertile women undergoing evaluation over a six month period in Lagos; Nigeria. Results: The mean age was 32 + 6.4 yr (range 20-39 yr). Chlamydia screening was positive in 14 (18.2). Awareness about the existence; symptomatology; mode of infection and complications was poor. Statistically significant correlation existed between prevalence of chlamydia infection and age; previous history of sexual infection and minimum of one sexual partner in the last one year (p 0.05). The prevalence also increased in secondarily infertile and married women. Conclusion: Chlamydia prevalence was relatively high in women undergoing infertility evaluation in Lagos; with positive correlative factors being increasing age of women; previous sexual infection and one or more sexual partners

Post-partum mental disorders in Sagamu.

BACKGROUND: Pregnancy and labour are sufficiently stressful to precipitate mental disorders in women after delivery. This may arise newly, as a recurrence or an exacerbation of previously existing mental illness in the individual woman. Postpartum mental disorders are under reported in our practices. OBJECTIVE: To determine the incidence of post-partum mental disorders in our practice, pattern of presentation and the commonly associated factors. DESIGN: A retrospective descriptive study. SETTING: Olabisi Onabanjo University, Sagamu, Nigeria. RESULTS: During the study period there were a total of 9085 deliveries and 27 cases of puerperal mental illness. This gave an incidence of 2.9 per 1000 births. The mean age and mean parity of patients were 27.3 (+/- 7.9 SD) and 2.3 (+/- 1.8 SD) respectively. The mean delivery-presentation interval and mean length of hospitalisation were 11.5 (+/- 7.15 SD) and 12.4 (+/- 5.8) respectively. CONCLUSION: Incidence of post-partum mental illness in our practice is 2.9 per 1000 births. There were preponderance of primiparity and young maternal age in the study group. Family history of psychiatric disorders and marital disharmony appear to play major role in the aetiology of these disorders in our practice.

Postpartum sexual abstinence and breastfeeding pattern in Sagamu, Nigeria.

This was a prospective study involving 371 mothers. The mean age of the mothers was 27.5 (.3.6) years with a mean years at school (Educational years) of 11.3 (2.9) years. All the mothers had previously breastfed at one of their infants for at least 6 months, while the mothers also breastfed their last child for an average (mean) of 10.3 (4.0) months. The overall mean of previous live births was 1.9 (0.8). In the first month postpartum, 84.6% of the mothers abstained from sexual intercourse, but by the 4th-5th month the proportion had dropped to 18.1%, with just 2.1% of the study population abstaining from sexual intercourse at 11-15 months post-partum. Forty seven (13.5%), 30 (8.6%) and 3 (0.9%) mothers in social classes 2,3 and 1 respectively have resumed sexual intercourse at 4-5 months, while only 12 (3.4%) and 4 (1.1%) in social classes 2 and 3 respectively continued with sexual intercourse at 11-15 months. More mothers resumed sexual intercourse from 1 to 15 months post-partum when they breast fed for 6-10 minutes and 11-15 minutes than those who breast fed for 1-5 minutes, 16-20 minutes and 21-25 minutes. Also more mothers within the 25-29 years age group resumed sexual intercourse from the first month to the fifteenth month post-partum than mothers in the other age groups.

Postpartum sexual abstinence and breastfeeding pattern in Sagamu, Nigeria

This was a prospective study involving 371 mothers. The mean age of the mothers was 27.5 (.3.6) years with a mean years at school (Educational years) of 11.3 (2.9) years. All the mothers had previously breastfed at one of their infants for at least 6 months, while the mothers also breastfed their last child for an average (mean) of 10.3 (4.0) months. The overall mean of previous live births was 1.9 (0.8). In the first month postpartum, 84.6% of the mothers abstained from sexual intercourse, but by the 4th-5th month the proportion had dropped to 18.1%, with just 2.1% of the study population abstaining from sexual intercourse at 11-15 months post-partum. Forty seven (13.5%), 30 (8.6% ) and 3 (0.9 % ) mothers in social classes 2,3 and 1 respectively have resumed sexual intercourse at 4-5 months, while only 12(3.4%) and 4(1.1%) in social classes 2 and 3 respectively continued with sexual intercourse at 11-15 months. More mothers resumed sexual intercourse from 1 to 15 months post-partum when they breast fed for 6-10 minutes and 11-15 minutes than those who breast fed for 1-5 minutes, 16-20 minutes and 21-25 minutes. Also more mothers within the 25-29 years age group resumed sexual intercourse from the first month to the fifteenth month post-partum than mothers in the other age groups. (Afr Reprod Health 2008; 12[1]:96-100)

Sexual behaviour and contraceptive practice of future doctors in Southwest Nigeria.

The sexual behaviour and contraceptive practice of 498 clinical students of a randomly selected medical college in Southwest Nigeria was studied in June 2003. More than two-thirds (67.5%) of the students had (ever had) sexual intercourse while 49.8% of them had ever used contraception. Only 26.1% of the 119 sexually active students used contraception during their last sexual intercourse. The most common contraceptive methods ever used by the students were the condom (54.6%) and rhythm method (39.5%) though a third of them incorrectly identified the limits of the fertile period. Contraception for single sexually active students was disapproved by 11.2% of the participants while 9.8% of them regarded avoidance of HIV patients in the hospital as a preventive measure against HIV infection. This survey reinforces the need for integration of a suitable sexuality course into our medical undergraduate curriculum in order to facilitate the delivery of reproductive health programmes in the future.

Abdominal pregnancy: a cause of failed induction of labour.

BACKGROUND: Induction of labour is a common mode of management of intrauterine fetal deaths, and the process usually involves ripening of the cervix by traditional methods of intracervical Foley's catheter insertion or the use of prostaglandin preparations intravaginally. Such methods are usually very effective independently. The objective of this case report is to call the attention of practising obstetricians to the possibility of an abdominal pregnancy as a cause of failure to ripen the cervix and that careful re-evaluation and use of ultrasound scan can improve diagnostic acumen with favorable outcome of management in such cases METHODS: The case file of the patient was thoroughly reviewed. A literature search on the subject of abdominal pregnancy using local and international journals and relevant textbooks was done to document the current status of the management of such cases. RESULTS: A 29-year-old Gravida 4 para 3+0 (2 alive) presented at an estimated gestational age of 32 weeks with loss of fetal movement, which was suggestive of fetal death and was referred as such from a private hospital. A process of induction of labour was commenced; to ripen the cervix with intracervical Foleys catheter and misoprostol tablet and stimulate uterine contraction, but this was not successful due to failure of the cervix to ripen. This prompted further review of the patient with the aim of excluding the possibility of an abdominal ectopic pregnancy. A repeat ultrasound scan was done and this confirmed a diagnosis of abdominal pregnancy. The patient had laparotomy done to deliver a dead fetus and the placenta was removed with the right tube and ovary as they were deeply embedded in the placental mass. The definitive diagnosis was that of a secondary abdominal pregnancy. She made a satisfactory postoperative recovery and was discharged home. CONCLUSION: A high index of suspicion is needed to make a first time diagnosis of abdominal pregnancy. With timely diagnosis and appropriate management, the prognosis in most cases is favourable.

Uterine fibroid: a review.

BACKGROUND: Uterine fibroid is a benign tumour of uterine smooth muscle. The purpose of this review is to bring to light the current spectra of presentation and management status of this benign and very important cause of menstrual and fertility disturbance in African women and the Black race in general. This is especially so with the trivialization of its aetological factors and treatment by claims from alternative medical practitioners. This review, therefore sought to document what is currently known about the condition and what could possibly be done to achieve better results in its management. METHODS: Literature on the subject above was reviewed using manual library search, electronic books such as CD-ROMS and journals articles published by various local and international authors on the subject; it also included internet search on relevant aspects of the topic. RESULTS: Fibroid is the commonest benign tumour of the female genital tract, it contributes about 70 to 80% of new growths in the female genital tracts, it is a cause of significant morbidity in women of reproductive age group and when complicated could be a significant cause of mortality. Spectrum of presentation mainly involves disturbance of menstruation, reduction in fertility, pressure and obstructive symptoms and rarely malignant presentations. When recognized early effective conservative and definitive therapies are available to offer relief for women and to make their menstrual and reproductive life more meaningful. CONCLUSION: From the literature reviewed, it was obvious that the subject of uterine fibroid is still not fully exhausted and there were a lot of research questions waiting to be answered on the aetiopathogenesis of the disease. There is also the need to fashion out better treatment alternatives that will reduce morbidity in the process of managing the patient as well as those that will further enhance reproductive potentials after treatment.

Infant feeding and lactational amenorrhea in Sagamu, Nigeria.

Five hundred and twenty educated, breastfeeding women in Sagamu, Nigeria, were observed prospectively in order to describe their infant feeding practices and to determine whether any predictors of the return of menses could be identified. The women remained amenorrheic for seven months. Compared with similarly selected women in other countries, they regularly fed their infants with supplements from a very early age, yet breastfeeding frequency and duration did not decline dramatically. Semi-solid food was introduced at about four months and such supplementation, as well as earlier supplementation with milk/milk-based feedings, was associated with the return of menses. The median duration of abstinence was about four months but the mean may have been much longer. No woman became pregnant until her infant was weaned.

Investigation of hormonal male contraception in African men: suppression of spermatogenesis by oral desogestrel with depot testosterone.

BACKGROUND: Suppression of spermatogenesis to azoospermia is required for effective hormonal male contraception, but the degree of suppression varies between ethnic groups. We here report the first study of hormonal suppression of spermatogenesis in two African centres using a regimen of oral progestogen with depot testosterone. METHODS A total of 31 healthy men (21 black) were recruited in Cape Town and 21 men in Sagamu, Nigeria. Subjects were randomized to take either 150 or 300 micro g desogestrel daily p.o. with testosterone pellets. In Cape Town, desogestrel was administered for 24 weeks with 400 mg testosterone re-administered 12 weekly. In Sagamu, desogestrel was administered for 52 weeks with 200 mg testosterone (later increased to 400 mg) re-administered 12-weekly. RESULTS: In Cape Town, 22 men completed at least 20 weeks treatment. Azoospermia was achieved in 8/10 and 8/12 men in the 150 micro g and 300 micro g desogestrel groups. Four men in Sagamu withdrew. Azoospermia was achieved in all 17 men in the two groups. There were no significant changes in lipoprotein or haemoglobin concentrations in any group. CONCLUSION: These data demonstrate that the combination of oral desogestrel with depot testosterone is an effective regimen for suppression of spermatogenesis in African as in Caucasian and Chinese men, with azoospermia achieved in a total of 83/98 (85%) men.

The influence of a vegetarian diet on haemostatic risk factors for cardiovascular disease in Africans.

Dietary habits have been implicated in the occurrence of cardiovascular diseases. Elevated plasma fibrinogen levels and decreased fibrinolytic activity have been identified as major independent cardiovascular risk factors. In this study, we compared the blood pressure, plasma fibrinogen concentration, and fibrinolytic activity of 40 nonvegetarians (NON-VEGs) with 36 vegetarians (8 VEGs and 28 SEMI-VEGs). The latter group consisted of students and lecturers of the Adventist Seminary Institute of West Africa, Ilishan Remo. All subjects had blood pressures below 140/90 mmHg, no underlying haemostatic disorders and were not on any medical treatment. The NON-VEGs had significantly decreased fibrinolytic activity (p<0.001) and increased plasma fibrinogen levels (p<0.001) compared with the SEMI-VEGs and VEGs. There were no significant differences between the blood pressure levels of the three groups, although the NON-VEGs had lower diastolic blood pressures. It is concluded that black African Seventh-Day Adventists who follow a vegetarian diet may be protected against premature cardiovascular disease because of beneficial dietary effects on plasma fibrinogen levels and fibrinolytic activity.

Asymptomatic significant bacteriuria among pregnant and non-pregnant women in Sagamu, Nigeria.

In a study carried out among 510 pregnant and 304 non-pregnant women at Ogun State University Teaching Hospital, Sagamu, 122 (23.9%) of the pregnant women and 37 (12.2%) of the non-pregnant women had significant bacteriuria. The rate amongst the pregnant women was significantly higher than in non-pregnant women (P < 0.001). There was a correlation between pyuria and significant bacteriuria in 45 (8.8%) of the pregnant women and in 11 (3.6%) of the non-pregnant women. Significant bacteriuria was closely associated with nulliparae. Most of the pregnant women with significant bacteriuria belonged to the low socioeconomic group. Unlike in previous studies in this country, the most prevalent organism in this study was the Staphylococcus aureus. In view of the high incidence of the problem in this environment, it is important that routine screening of urine for significant bacteriuria should be part of our ante-natal clinic services at least on the first visit of pregnant women to ante-natal clinics.

Asymptomatic significant bacteriuria among pregnant and non-pregnant women in Sagam, Nigeria.

In a study carried out among 510 pregnant and 304 non-pregnant women at Ogun State University Teaching Hospital, Sagamu, 122 (23.9 pc) of the pregnant women and 37 (2.2 pc) of the non-pregnant women had significant bacteriuria. The rate amongst the pregnant women was significantly higher than in non-pregnant women (P < 0.001). There was a correlation between pyuria and significant bacteriuria in 45 (8.8 pc) of the pregnant women and in 11 (3.6 pc) of the non-pregnant women. Significant bacteriuria was closely associated with nulliparae. Most of the pregnant women with significant bacteriuria belonged to the low socio-economic group. Unlike in previous studies in this country, the most prevalent organism in this study was the Staphylococcus aureus.

Effects of oral contraceptive on fibrinogen levels in African women.

Fibrinogen levels were determined in 100 women on oral contraceptive pills (OCP), aged 17-46 years, and 100 apparently healthy women with regular menstruation and no previous history of hormonal therapy, aged 20-40 years, who served as controls. The women on OCP had significantly higher plasma fibrinogen concentration than the control (P less than 0.001). There was a cumulative increase in plasma fibrinogen level from three months of usage. We conclude that prolonged use of OCP may result in the development of circulatory and vascular disorders related to hyper-fibrinogenaemia and other clotting factors.

PIP: In Benin and Sagamu, Nigeria, health workers drew 10 ml of venous blood from 200 17-46 year old women as close as possible to their midcycle as part of a study to examine changes in plasma fibrinogen levels in women using biphasic, combined oral contraceptives (OCs). The 100 women in the OC group were younger than the 100 healthy women with regular menstruation who had not used hormones for the last 6 months (23.03 years vs. 30 years). Laboratory personnel used the clot-weight procedure to measure the plasma fibrinogen level. The plasma fibrinogen levels were significantly higher in women using OCs than they were in the controls (p .001). The levels increased with duration of OC use (3.09 g/l at 3-6 months, 3.33 g/l at 7 months-1 year, and 3.37 g/l at 1.5-4 years). 95% of the cases used the low-dose estrogen OCs, and they had lower plasma fibrinogen levels than the 5% of cases using the high-dose OCs (3 g/l vs. 3.5 g/l). In both cases, however, these increased fibrinogen levels were within the normal range. Nevertheless, these raised levels may lead to the development of thromboembolism complications, especially as duration of OC use increases. The researchers planned to conduct a more extensive prospective study to determine the importance of abnormal coagulation fibrinolytic changes in women using OCs.