Knowledge about Tuberculosis: A Precursor to Effective TB Control-Findings from a Follow-Up National KAP Study on Tuberculosis among Nigerians.

Tuberculosis (TB) constitutes a significant and major public health emergency globally. Nigeria is one of the 22 high burden Tuberculosis countries. A high level of community awareness and positive perception towards TB and its management is crucial for the success of any control strategy. A national baseline survey was conducted in 2008 and a follow-up study in 2012 to measure knowledge of TB among the general population. This study therefore evaluated the knowledge of the target population about Tuberculosis in the follow-up study. A cross-sectional study design was employed with a total of 3,021 respondents interviewed from six states selected randomly from each of the six geopolitical zones in the country. Quantitative and qualitative research methodologies were adopted. From the findings, about 60% of the respondents were aged between 21 and 40 years and more than half had secondary school education. Over 80% had ever heard about TB. Although there has been a significant improvement in correct knowledge of the cause of TB from baseline (19%) in 2008 to 26.5% in 2012 (p < 0.001), findings showed that prioritized interventions are needed to improve communication and information dissemination on Tuberculosis to the general public, to aid TB control and all prevention efforts.

Mobilizing men as partners: the results of an intervention to increase dual protection among Nigerian men.

This quasi-experimental, proof-of-concept study evaluated the effects of an intervention designed to help Nigerian men decrease risk for HIV/sexually transmitted infections and unintended pregnancy. The intervention was delivered in groups during two 5-hour workshops, with a monthly 2-hour check-in session. A comparison condition consisted of a group-based half-day didactic workshop. Based on recruitment area, 149 men were assigned to the intervention and 132 to the comparison. Men were evaluated at baseline and 3-month post-intervention. At follow-up, men assigned to the intervention were almost four times more likely than comparison men to report condom use at last intercourse (P < 0.001) and to report fewer unprotected vaginal sex occasions, greater self-efficacy for negotiation, a more egalitarian power dynamic in their primary relationship, more positive expectations for condom use and greater intention for future consistent condom use (all P values < 0.05). Findings suggest that this intervention is both feasible and effective.

Sexual and reproductive health knowledge, behaviour and education needs of in-school adolescents in northern Nigeria.

Adolescence is marked by progression from the appearance of secondary sexual characteristics to sexual and reproductive maturity. Curiosity about bodily changes is heightened. However, adolescents' perceived sexuality education needs have been poorly documented. A survey of 989 adolescents from 24 North-Eastern Nigerian secondary schools yielded information on socio-demographic characteristics, reproductive health knowledge, sexual activities and sexuality education needs. Of the interviewed respondents, 72% of females had experienced menstruation. Overall, 9% were sexually active, 3.1% knew when ovulation occurs, 47% knew pregnancy could result from first coitus and 56% knew of contraception. 84% opined that adolescents should be given sexuality education but only 48.3% had received any. Sexuality education should be provided for in-school adolescents through their preferred and reliable sources of information.

Contraceptive implants.

In response to the need of some women for long-acting, effective and safe contraceptives, the scientific community developed non-biodegradable progestational subdermal implants that act by making the cervical mucus viscous, with ovulation inhibition and thinning of the endometrial lining. The contraceptive protection is within 24 hours and the cumulative failure rate is low. Contraceptive implants require little or no motivation following adequate counselling. In current use are multirod implants (Norplant I and Norplant II Jadelle) and single rod implant (Implanon and Uniplant). Although menstrual symptoms associated with progestational regimens are the major compliance and acceptability factors within the first year of use, menstrual disturbance generally improves. Continuation rates for implant use are high among those who have had adequate pre-insertion counselling because the perceived advantages greatly outweigh the nuisance effects. Other side effects of implants are similar to those observed with hormonal pills--headache, weight changes, mood swings and abdominal bloating. Training of physicians and nurses in the art of insertion and removal techniques is a pre-requisite for a successful implant programme. This should also be backed by integration of implants into the national commodity logistics systems to ensure adequate local budgetary provision for contraceptive implant procurement rather than reliance on donor supply.

Nonmenstrual adverse events associated with subdermal contraceptive implants containing normegestrel and levonorgestrel.

To improve counselling information to Nigerian family planning clients, we compared non-menstrual events reported by 248 Norplant users and 214 Uniplant users. Women using Norplant were significantly older and of higher parity and greater contraceptive experience than Uniplant users. Other admission characteristics of the two groups were similar. The total women-months of use of Norplant was 2,946 (mean 11.9 +/- 0.6 SE) months while that for Uniplant was 2,315 (mean 10.8 +/- 0.2 SE) months. About 36% of Norplant users and 15% of Uniplant users reported non-menstrual adverse events, the commonest ones being pain/itching at the insertion site, unexplained low abdominal pains and clinically diagnosed pelvic inflammatory disease (PID). The numbers of women reporting drug-related adverse events were 61 (24.6%) and 23 (10.8%), respectively, among Norplant and Uniplant users. Drug-related serious adverse events were reported by 3 (1.2%) Norplant users and 5 (2%) Uniplant users. The adverse events leading to Uniplant removal were severe urticaria, breast lumps, pruritus vulvae, headache with raised blood pressure, adnexal pains and ovarian cysts, and static weight while those leading to Norplant removal were breast lump and headache with raised blood pressure. Weight gain was reported by only 7 (3%) of Norplant users. Although of no serious clinical consequences, drug-related adverse events should be added to the counselling information to prospective users.

Carbohydrate metabolism in sickle cell patients using a subdermal implant containing nomegestrol acetate (Uniplant).

Uniplant, a second-generation contraceptive implant, has been demonstrated to promote a significant improvement in the overall well-being of women with sickle cell anemia. It has been suggested that the discrete increase in blood glucose levels observed in Uniplant users could be a contributory factor for clinical improvement. Ten healthy sickle cell patients were enrolled in the study. An oral glucose tolerance test was performed prior to implant insertion and at 1, 6, and 12 months of therapy. Blood glucose and insulin were measured before and at 30, 60, 120, and 180 min after a 75-g glucose load. The glucose and insulin areas under the curves were calculated. Fasting glycosylated hemoglobin was also measured. No significant changes were observed in glycosylated hemoglobin, glucose or insulin. We conclude that Uniplant is a safe contraceptive for sickle cell patients.

The management of endometriosis: a survey of patients' aspirations.

The aim of this study was to determine the aspirations of women with endometriosis in terms of the management of their disease. We interviewed 32 women with confirmed endometriosis and asked them to discuss the potential benefits of the establishment of a specialist endometriosis clinic. Eighty-eight per cent of the participants agreed that a separate specialist clinic would be beneficial. The reasons they cited can be grouped under four main themes: information provision, quality and type of care, peer support and endometriosis awareness. On the basis of these responses we propose that a strategy utilised in the management of other chronic diseases, drop-in group medical appointments, may provide a way forward. In addition, on the basis of the range of symptoms reported by our participants, we would argue that a multidisciplinary approach is necessary if endometriosis management is to be effective.

A new vaginal antimicrobial contraceptive formulation: phase I clinical pilot studies.

Pilot clinical trials were performed with a new vaginal suppository called "Long Acting, Sustained Release of Spermicide" ("LASRS"). No visual or colposcopic lesions or patient complaints occurred as a result of using LASRS with increasing doses of nonoxynol-9 (up to 20%) for 5 days or of applying the highest dose of nonoxynol-9 (20%; total 400 mg) for 8 h. Colposcopic or visual lesions were also not induced when LASRS with 20% nonoxynol-9 was used for 7 consecutive days by the study participants except for those who developed symptomatic monilia vaginitis. Symptoms were reported although these were mostly minor. A long-lasting, bioadhesive, translucent layer (film) of formulation formed over the vaginal and cervical surfaces. Postcoital spermicidal studies showed LASRS to be highly effective for prolonged periods of time. Although intercourse was delayed for 5 to 8.5 h after insertion of the formulation, an average of only 0. 2 motile sperm/HPF could be found in cervical mucus. These studies suggest LASRS to possess advantages over presently marketed formulations by having long-term efficacy and by forming a bioadhesive, presumably protective layer over the genital tract epithelium. The results also suggest the formulation to decrease the vaginal irritation caused by nonoxynol-9 as noted by colposcopy. These pilot data support a more extensive study with the LASRS suppository.

Nutrition in pregnancy: mineral and vitamin supplements.

Pregnancy is associated with physiologic changes that result in increased plasma volume and red blood cells and decreased concentrations of circulating nutrient-binding proteins and micronutrients. In many developing countries, these physiologic changes can be aggravated by undernutrition, leading to micronutrient deficiency states, such as anemia, that can have disastrous consequences for both mothers and newborn infants. Multiple micronutrients are often taken by pregnant women in developed countries, but their benefits are limited, except for prophylactic folic acid taken during the periconceptional period. Women in developing countries may benefit from multiple-micronutrient prophylaxis in pregnancy, but the underlying basis and rationale for changing from supplementation with iron and folate to supplementation with multiple micronutrients has not been debated in the context of existing program objectives. There is an urgent need for this discussion so that both program effectiveness and program efficacy can be improved.

Nutrition and obstructed labor.

Obstructed labor is one of the most common preventable causes of maternal and perinatal morbidity and mortality in developing countries. Among the common causes are cephalopelvic disproportion, malpresentation, and malposition. Recognizing the causes of obstructed labor is important if the complications are to be prevented. Adequate prevention, however, can be achieved only through a multidisciplinary approach aimed in the short term at identifying high-risk cases and in the long term at improving nutrition. Early motherhood should be discouraged, and efforts are needed to improve nutrition during infancy, childhood, early adulthood, and pregnancy. Improving the access to and promoting the use of reproductive and contraceptive services will help reduce the prevalence of this complication.

The effects of nomegestrol acetate subdermal implant (Uniplant) on serum cholesterol, triglycerides, and lipoproteins in Nigerian users.

The study was conducted to assess the effects of a nomegestrol acetate subdermal contraceptive implant (Uniplant(R)) on the lipid profiles of indigenous Nigerian women. Cholesterol content of the major lipoproteins, along with total cholesterol and triglycerides, were measured in fasting blood samples collected before implant insertion and then at months 1, 3, 6, and 12 of use. All volunteers were of the reproductive age, healthy, and had no contraindications to hormonal contraception. The mean levels of cholesterol and low density lipoprotein-cholesterol (LDL-C) increased gradually, albeit insignificantly, from insertion to month 12 of implant use. An initial decline in the mean levels of high density lipoprotein-cholesterol (HDL-C), reaching a minimal level (37.31 +/- 4.95 mg/dl) at month 3 of implant use, was observed. This was followed by a gradual rise that peaked (39.73 +/- 5.53 mg/dL) at month 12. These values were, however, not significantly different from the preinsertion value. The only significant difference (p <0. 005 ) was in the mean level of triglycerides at month 12 (90.90 +/- 17.75 mg/dL) when compared with the preinsertion mean level of 81.77 +/- 24.14 mg/dL. Both values were, however, within normal limits. These results indicate that Uniplant does not have a deleterious effect on the lipid profiles of Nigerian acceptors and can be safely prescribed to women seeking contraception.

Vaginal bleeding patterns in Nigerian users of nomegestrol acetate subdermal contraceptive implant.

A 12 months longitudinal study was carried out in 214 consecutive Nigerian women using Nomegestrol acetate subdermal contraceptive implant (Uniplant) for the first time to establish the rates of different vaginal bleeding patterns according to WHO bleeding/spotting classification, and to assess their relationship with Uniplant discontinuation. The results showed an initial rise in the number of women experiencing altered vaginal bleeding which continued to fall towards the 12th month of use (57.01% vs 26.17%). Similarly, a significant increase in mean menstrual cycle length occurred in the first trimester of use and this disappeared by the third trimester. The mean numbers of bleeding/spotting days and bleeding/spotting free intervals increased significantly from first trimester to the fourth trimester. No change was noted in the mean number of bleeding/spotting episodes through, out the follow up period. The total discontinuation rate was 15.42%. Discontinuation on account of altered vaginal bleeding pattern was 3.27%. One accidental pregnancy occurred during follow up (Pearl index = 0.52). No significant change in haemoglobin levels was noted in the women. It was concluded that changes in menstrual patterns in Uniplant users occur mostly in the first six months of use and are unlikely to have any deleterious effects on the general health of the users.

Barriers to uptake and use of modern methods of contraception in developing countries.

As the next millennium approaches, the current world population of 5.9 billion will continue to increase by 81 million per year -- 93% of which will come from the developing countries. Poor uptake and utilisation of various modern methods of contraception in the developing countries is mainly responsible. In this article, we identify various barriers responsible for the low prevalence of contraceptive uptake in these countries and suggest how these barriers may be eliminated. We conclude that by increasing contraceptive availability and utilisation, population explosion can be significantly controlled.

Seminal plasma zinc level in users of gossypol.

Seminal plasma zinc levels were determined in 13 healthy male volunteers on gossypol, a triterpenoid aldehyde extracted to purity from cotton plant which has been found to be an orally active male fertility regulation agent that is simple, economical and reversible. Each subject was given 20 mg gossypol tablet daily until azoospermia occurred. Thereafter, a maintenance dose of 7.5 mg or 10 mg of gossypol was given orally to alternate subject. Each subject was followed up monthly for one year. Serial semen analysis and seminal plasma zinc levels were determined prior to and after administration of gossypol monthly for 52 weeks. The mean sperm count and motility decreased significantly until azoopermia occurred in all subjects at about the 20th week of follow up. However, there was no significant difference in the mean seminal plasma zinc levels throughout the period of observation irrespective of the dosage regimen of gossypol used by the subjects. It was concluded that gossypol has no effect on the seminal plasma zinc level in users of gossypol.

Nomegestrol acetate contraceptive implant use by women with sickle cell disease.

OBJECTIVE: To assess the contraceptive effectiveness, safety, and potential health benefits of nomegestrol acetate contraceptive implant use by women with homozygous sickle cell disease (hemoglobin SS). METHODS: This was a prospective observation before and after insertion of nomegestrol acetate of 20 women with sickle cell disease (test group) compared with 10 women with similar sociodemographic backgrounds. Changes in hematologic and biochemical parameters and symptoms of sickle cell crisis were measured during 12 months of observation. RESULTS: After use of nomegestrol acetate for 1 to 9 months, the women in the test group had symptomatic improvement, with no crisis that required hospitalization and no deaths. Sickle cell symptoms persisted in the women in the control group, with 1 recorded death. Increases in F-cell and fetal hemoglobin parallel the observed clinical improvement in the treated women. There were no adverse hematologic or biochemical changes associated with the use of nomegestrol acetate implants. CONCLUSION: Nomegestrol acetate appears to be a safe and appropriate contraceptive for women with sickle cell disease, showing evidence of being a "stimulant" for F-cell reactivation, independent of F hemoglobin total production increase.

Results of a user satisfaction study carried out in women using Uniplant contraceptive implant.

A study of the acceptability of Uniplant, a 12-month single implant of nomegestrol acetate, included 819 women from Africa, Latin America, and China, participating in a clinical trial of Uniplant. A standard, pre-coded questionnaire was specially designed for this purpose and applied at the moment of removal of implant, either at the end of 12 months of use or at the time of discontinuation for whatever reason. The level of satisfaction proved high when users' comparison with their previous contraceptive method, users' recommendation of Uniplant to others, users' intention to use the method in the future, and service satisfaction were taken into consideration. Uniplant was considered easy to use, safe (low risk of pregnancy), and also to cause fewer side effects than other methods. When asked about the least liked feature of Uniplant, almost half the respondents said that there was nothing that they disliked and about one-third mentioned the changes in their menstrual pattern. However, according to the clinical trial, over half of the Uniplant users have bleeding patterns similar to untreated cycles. The majority of respondents did not feel any discomfort during the procedure of insertion and removal of the implant. About 70% of patients in the study stated that they required contraception for more than one year and most of these women said that they did not mind having to change the implant every year.

Hysteroscopy and transvaginal sonography in menopausal women receiving hormone replacement therapy.

STUDY OBJECTIVE: To evaluate the endometrial cavity of menopausal women with irregular bleeding while receiving hormone replacement therapy. DESIGN: Comparative evaluation of hysteroscopic and biopsy findings. SETTING: A center for reproductive studies. PATIENTS: Forty-one patients receiving different regimens of hormone replacement therapy. INTERVENTIONS: Hysteroscopy, endometrial biopsy, and transvaginal sonography were performed in all 41 women. In 10 patients, endometrial polyps were removed with the resectoscope. MEASUREMENTS AND MAIN RESULTS: Irregular bleeding during hormone replacement therapy was associated with atrophic endometrium whenever transvaginal sonography showed endometrial thickness to be less than 4 mm. In patients who developed increased endometrial thickness after hormone replacement therapy, hysteroscopy revealed the presence of endometrial polyps in the uterine cavity. Histopathologic examination of excised polyps revealed cystic or adenomatous hyperplasia confined to these lesions. CONCLUSIONS: Endometrial polyps can appear in menopausal women receiving hormone replacement therapy despite the presence of progestins to oppose the action of estrogens.

Temporal relationship between Uniplant insertion and changes in cervical mucus.

This study was undertaken to determine the time required by a single implant containing nomegestrol acetate to affect cervical mucus production and sperm penetration in women. All subjects were investigated and, if necessary, treated for any kind of cervicitis or vaginitis prior to starting cervical mucus study. The subjects had not used hormonal contraception for at least three months prior to investigation. They were counseled to use condoms during this study and also to refrain from intercourse during the period of cervical mucus sampling. Follicular development and endometrial thickness were analyzed by transvaginal sonography. Cervical mucus examination, sperm penetration test, and transvaginal sonography were performed during the control cycle and during the first cycle of Uniplant use. Blood samples were taken for the measurement of estradiol, LH, and progesterone. Cervical mucus and sperm penetration tests were evaluated according to the World Health Organization (WHO) criteria. In the treated cycle, when cervical mucus reached a score of 8-10, Uniplant was inserted, independent of the day of the cycle. Cervical mucus was then collected at 0, 4, 8, 12, 24, 48, and 96 h later until a marked change in volume, consistency, ferning spinnbarkheit, and cellularity was observed. All samples were also used for sperm penetration test. Preovulatory estradiol and LH peak decreased significantly compared to pre-implant insertion. Progesterone levels were within the normal limit. Cervical mucus and sperm penetration tests were not affected by Uniplant in the first 12 h. Twenty-four hours after Uniplant insertion, cervical mucus and sperm penetration tests were affected in 70.6% of the women. Forty-eight hours after implant insertion, the women were affected. Follicular rupture occurred in the majority of the women 48 h after implant insertion. Based on these results, it is possible to conclude that Uniplant can affect estradiol and LH preovulatory peaks and disrupt the process of cervical mucus production and sperm penetration, but it was unable to prevent ovulation when inserted in the preovulatory phase.

PIP: In Brazil, physicians inserted one single capsule of the nomegestrol acetate contraceptive implant (Uniplant) subcutaneously in the gluteal region of 17 healthy female volunteers (mean age = 24.62 years) when their cervical mucus score was 8-10. They performed cervical mucus examination, sperm penetration test, and transvaginal sonography during the control cycle and during the first cycle of Uniplant use. They took blood samples to measure estradiol, luteinizing hormone (LH), and progesterone. Uniplant contained 55 mg of nomegestrol acetate. The researchers aimed to determine the time between Uniplant insertion and changes in cervical mucus and in the ability of sperm to exhibit forward motility in the cervical mucus. When Uniplant was inserted in the early follicular phase, the preovulatory peaks of estradiol and LH were significantly lower than preinsertion peaks (539.4 vs. 1087.1 pmol/l and 12 vs. 40.4 IU/l, respectively; p 0.01). The lower progesterone levels in the treatment cycle were not significantly different than preinsertion progesterone levels (46.6 vs. 53.8 nmol/l; p = 0.055). Ultrasonography and progesterone levels indicated that 16 of the 17 treatment cycles were ovulatory. Neither cervical mucus nor sperm penetration was affected in the first 12 hours postinsertion. By 24 hours postinsertion, 70.6% of the women exhibited significant changes in both cervical mucus and sperm penetration. At the end of 48 hours, all 17 women had these changes. These findings suggest that Uniplant inserted in the periovulatory phase affects cervical mucus production, sperm penetration, and preovulatory peaks of LH and estradiol but does not affect ovulation.

Prevalence of malaria parasitaemia in transfused donor blood in Benin City, Nigeria.

In view of the problem of transfusional malaria, the prevalence of malaria parasitaemia in transfused donor blood was assessed. Blood film examination for malaria parasites on Giemsa-stained donor blood which was used for transfusion to neonates in Benin City, Nigeria was carried out over a 6-month period. Blood group O was the dominant blood type (17%). A high malarial parasite prevalence rate of 40% was noted in the transfused donor blood and Plasmodium falciparum was the dominant infecting species. All blood groups and rhesus factor types were infected with malarial parasites. There was no significantly increased malarial infection rate in any particular blood group type. The neonate, who is known to be immunologically naive, is at high risk of symptomatic malaria acquired through blood transfusion. All neonates who require blood transfusion should be given chloroquine sulphate soon after transfusion, at a dose of 5 mg/kg/day for 3 days, when the parasites are chloroquine-sensitive. In cases of chloroquine resistance, quinine sulphate or halofantrine hydrochloride is an acceptable alternative. Where feasible, donor blood screening for malaria should be carried out before transfusion to any neonate.

Multicenter clinical trial on the efficacy and acceptability of a single contraceptive implant of nomegestrol acetate, Uniplant.

Uniplant, a single Silastic implant containing nomegestrol acetate, provides contraceptive efficacy for one year. Uniplant use for one year was studied in 1,803 healthy women of reproductive age, enrolled from 10 centers in 9 countries, after informed consent. Implants were placed subdermally either in the upper arm or in the gluteal region. Two-hundred-seventy-six subjects discontinued prior to completing one year of study. Cumulative discontinuation rate at 12 months was 15.72%. Medical reasons for discontinuation were principally menstrual-related. Fifteen pregnancies occurred during the one year study period, resulting in a 12-month net cumulative pregnancy rate of 0.94%. Approximately 56% of subjects using Uniplant had bleeding patterns similar to normal menstruation. Results from this study confirm that Uniplant is an efficient, well tolerated, 12-month contraceptive implant, with the advantage of easier insertion and removal of the single implant compared to other multiple implant methods.