Menstrual characteristics of secondary school girls in Ibadan, Nigeria.

BACKGROUND: Disturbances of menstrual function are the commonest complaints among adolescents. Disorders of menstruation may have implications for future reproductive health. OBJECTIVE: To assess menstrual patterns among school girls in Ibadan, south-western Nigeria. METHODS: This was cross-sectional descriptive study in which 1,213 apparently healthy school girls were selected by multistage sampling technique in fifteen secondary schools from the five local governments within the metropolis. Information about details of menstrual experience was obtained with a self-administered questionnaire. RESULTS: The girls were aged between 9 and 23 years. Majority of respondents 768 (633%) experienced normal cycle length, 391 (32.2%) had short cycles; and 55 (4.5%) had cycle length greater than 35 days. Prevalence of normal cycles increased with increasing age; abnormalities of cycle length tended to decrease with increasing age (p < 0.01). The majority, 1,152 (95%), had normal menstrual loss. The majority 882 (72.7%) experienced dysmenorrhoea; severe dysmenorrhoea was reported by 154 (12.7%). Cycle length was not associated with presence of dysmenorrhoea (p > 0.05); 695 (57.3%) had symptoms of pre-menstrual syndrome. CONCLUSION: Prevalence of menstrual abnormalities among adolescent schoolgirls is high. More attention should be paid to identify and treat these menstrual morbidities.

Determinants of post-caesarean wound infection at the University College Hospital Ibadan Nigeria.

OBJECTIVE: To determine the risk factors that predispose patients to post-caesarean wound infection at a tertiary health institution in developing country. METHOD: It was an observational study of all women that had caesarean (elective and emergency) delivery between July and September, 2004. The outcome of their post-caesarean wound was assessed. Statistical analysis (Bivariate and logistic regression) of the identified risk factors in patients who developed wound infection was performed at a 95% level of confidence. RESULTS: The post-caesarean wound infection rate was 16.2%. The identified risk factors were lower educational status, multiple pelvic examination, offensive liquor at surgery and patients that are unbooked. Following logistic regression, women with up to primary school were 20 times more likely than those with secondary education and above to develop wound infection (95% CI OR = 1.8 to 250.0). CONCLUSION: The outcome showed that the identified determinants of post-caesarean wound infection were comparable with earlier reports. Women with lower educational status are more at risk in this study. Therefore, these women need special attention to reduce the risk.

Sexual behaviour of in-school adolescents in Ibadan, South-West Nigeria.

This study was a crossectional survey conducted among 716 senior secondary school adolescents in Ibadan from March to August 2005. The result of 695 that was analyzed revealed that the mean age of 15 +/- 2.6years. 28.3% of the respondents had previous sexual exposure with higher proportions being male (p = 0.00043). Majorities' first sexual exposure was unplanned. Family settings and educational level do not have significant influence on the previous sexual exposure. The methods of sexual activity were mainly through vagina route while some had also practiced oral and anal sex. Most of those that are sexually exposed had more than one partner. About half of the respondents learn about sex from their friends while others through their parents and media. We conclude that in-school adolescents practiced unsafe sexual activity and they are therefore predisposed to STI/HIV and other reproductive health risks.

Sexual behaviour of in-school adolescents in Ibadan, South-West Nigeria

This study was a crossectional survey conducted among 716 senior secondary school adolescents in Ibadan from March to August 2005. The result of 695 that was analyzed revealed that the mean age of 15±2.6years. 28.3% of the respondents had previous sexual exposure with higher proportions being male (p=0.00043). Majorities' first sexual exposure was unplanned. Family settings and educational level do not have significant influence on the previous sexual exposure. The methods of sexual activity were mainly through vagina route while some had also practiced oral and anal sex. Most of those that are sexually exposed had more than one partner. About half of the respondents learn about sex from their friends while others through their parents and media. We conclude that in-school adolescents practiced unsafe sexual activity and they are therefore predisposed to STI/HIV and other reproductive health risks. (Afr J Reprod Health 2008; 12[2]:89-97)

The pregnant Rhesus negative Nigerian woman.

OBJECTIVE: Alloimmunisation to Rhesus D (RhD) is a major factor in perinatal morbidity and may result in the compromise of the woman's obstetric career. In Nigeria accurate population based studies to determine the prevalence of Rhesus negative women and the incidence of alloimmunisation are lacking, hence we undertook to study pregnancy outcome in Rhesus negative women. METHOD: We studied retrospectively sixty-seven RhD negative women over a two year period; information was obtained from the case-file of all pregnant women who presented to the ante-natal clinic and were identified as Rhesus negative. This was corroborated with the blood bank record over the same period. RESULT: Forty per cent of these were nulliparae with an average of 0.5 abortions. Only 20% had the blood groups of their husbands documented, and only four babies born to these women had their Rhesus group recorded. Six of the babies appeared to have been severely affected by Rhesus isoimmunisation. Three of these had an exchange blood transfusion (EBT); all who had an EBT had a satisfactory outcome. Out of the other three, there were two neonatal deaths and one fresh stillbirth. Fourteen babies had neonatal jaundice with a mean bilirubin level of 6 mg/dl, all of which were mainly unconjugated. Evidence for the administration of anti D was obtained in only three patients; all had one ampoule (dose in i.u and/or _g not stated) administered within 72 hr. CONCLUSION: This preliminary study has shown that isoimmunisation due to Rhesus incompatibility is poorly studied among Nigerian women with many questions unanswered; therefore there is an urgent need for a management protocol for this condition, which will include both the clinicians and the laboratory physicians.

Parameters of nutrition in school girls in southwestern Nigeria.

OBJECTIVES: To document trends in parameters of nutrition in south-western Nigerian school girls in comparison with earlier reports and provide baseline data for future comparison. DESIGN: A cross-sectional study. SETTING: Fifteen secondary schools from the five local governments in Ibadan, Oyo State in south-western Nigeria. SUBJECTS: One thousand six hundred and seventy five apparently healthy female students aged between nine and twenty three years. RESULTS: One thousand six hundred and seventy three questionnaires were analysed. The mean age, mean height and mean body weight were 15.45 years +/- 2.06 (SD), 154.98cm +/- 8.4(SD) and 46.09kg +/- 8.8 (SD) respectively. The mean body fat was 11.12kg +/- 4.6 (SD); mean lean body mass (LBM) was 34.96kg +/- 4.6 (SD); mean total body water (TBW) was 25.17L +/- 3.3 (SD) and the mean body index (BMI) was 19.07kg/m2 +/- 2.7 (SD). Girls from upper socio-economic background had significantly higher values of anthropometric measurements and body composition for each age than lower socioeconomic class girls. Compared with their peers from another Nigerian city investigated two decades ago, girls in this study were significantly lighter and shorter. CONCLUSION: The study revealed a decline in nutritional parameters among adolescents. The implications of these findings for the reproductive health of Nigerian women are discussed. Serial studies to monitor trends in adolescents are recommended.

Complement levels and leucocyte phagocytosis in newborn babies.

Newborn babies face higher risk of infection than adults, but the immunological basis of this observation is yet to be fully explained particularly in babies of different gestations and birth weights. Sixty-two (62) adults, 55 full-term babies, 18 low birth weight babies and 44 normal birth weight babies were considered for the study. B-lymphocytes and T-lymphocytes were enumerated by EAC-rosette and E-rosette respectively. Leucocyte migration and intracellular killing were assessed by percentage migration index (%M.I), percentage Candidacidal index (%C.I) and bacterial stimulated nitroblue tetrazolium (NBT) dye reduction index (%NBT) respectively. Also, serum levels of C3 and C5 were measured by single radial immuno-diffusion method. Percentage T cell, C3, C5, %NBT and %C.I were lowest in low birth weight babies but % B cell was lowest in full term babies while normal birth babies had least %M.I. The present study suggests that gestational age and birth weight affect different aspects of immune response.

Effects of oral contraceptives on total serum proteins, albumin, globulins and cholesterol levels in Ibadan, Nigeria.

Total serum protein, albumin, globulin, albumin/globulin ratio and cholesterol levels were determined in 25 subjects on oral contraceptives and 25 controls. The mean serum total protein, globulin and cholesterol levels were significantly increased in oral contraceptive and their control counterparts. The albumin/globulin ratio in subjects on oral contraceptives users is significantly decreased compared with controls. In view of the findings of this study, it is suggested that the biochemical profile of long-term oral contraceptive users be assessed periodically.

Antiphospholipid antibody syndrome: two case reports and review of literature.

Antiphospholipid antibody syndrome (APAs) is an acquired multisystemic disorder characterised by hyper coagulation. It manifest clinically with arterial and venous thrombosis. It is not a rare phenomenon, but there are paucity of reports of this disorder in our environment. We present two cases of APAs with the hope that it will stimulate the awareness of clinicians in the recognition of this disorder in our environment.

Routine antenatal syphilis screening--a case against.

To highlight the deficiencies associated with the routine antenatal syphilis screening as it is done now in the University College Hospital, Ibadan, and determine the cost effectiveness or otherwise of syphilis screening using as parameters the specificity of the method of screening as well as the gravity of the disease. The results of VDRL tests performed on pregnant women attending the antenatal clinic of the University College Hospital, Ibadan, in a 10-year period, January 1988 to December 1997 were analysed for seropositivity as well as congenital syphilis. The case notes of 110 sero-reactive patients were retrieved and analysed for pregnancy outcome. The prevalence rate of seropositive patients was 1.1%. Only 3 of the seropositive had repeated tests and were treated empirically with high doses of penicillin. There was no case of congenital syphilis. This study has shown that the syphilis screening as it is done now is not cost-effective. If VDRL test is to be continued, efforts must be made to reintroduce TPHA-test, which is more specific-specificity; it wastes a lot of time and money of the patients. Hence it is not cost effective. If VDRL test is to be continued efforts must be made to reintroduce TPHA-test, which is more specific.

Radiological ageing process in the cervical spine of Nigerian women.

The study was designed to determine the age of commencement of ageing process in Nigerian women Four hundred (400) consecutive women requesting for cervical spine radiographs where recruited for this study. A study chart was made showing different variables like osteoarthrosis, detached osteophytes, postural ulterations and disk degenerations in a four year period from 1st January, 1993 to 31st December, 1996 the modified Kellgren and Lawrence grading system was used to assess radiographic changes. The highest rate of osteoarthrosis (31.13%) was found in the fifth decade. Incidence of postural alterations of the cervical spine rose sharply in the 5th and 6th decades of life. Grade 2 osteoarthrosis (Kellgren and Lawrence) was commonest (61.3%); Grades 3 and 4 had the lowest incidence (3.45%). Disc degeneration was commonest in the 5th; the most involved disc was C5/C6 and the least involved was C2/C3. It is concluded that the ageing process in the Nigerian women commences in the fourth decade of life, and apparently shows no difference with caucasian women.

Childhood sexuality and child sexual abuse in southwest Nigeria.

There is paucity of information and research on childhood sexuality and child sexual abuse in Nigeria. This low level of information may not be unconnected with the fact that generally discussions on sexual matters still remain a taboo in our culture. It is almost abominable to discuss sex with children. There is need for a radical departure from this position in view of the fact that at least 5% of the respondents in this study admitted having had sex between 6 and 10 years of age and 81 respondents (2.1%) were sexually abused in childhood. The urgent need for more research and a multidisciplinary problem resolution approach to childhood sexuality and child sexual abuse is stressed.

Awareness and use of family planning methods among married women in Ibadan, Nigeria.

A study of awareness and use of family planning methods among 1188 married women aged 15-40 years, attending antenatal clinic in four different locations, conducted in Ibadan, Nigeria between May to December 1995 is reported. Most respondents (94.3%) were aware of the use of family planning but only 12.0% had ever visited a family planning clinic. Awareness of specific methods was 82.6% for condoms, 75.7% for oral contraceptives, 75.5% for injectable contraceptives and 65.3% for intrauterine device. Current use of family planning methods was low with 10.0% using withdrawal, 8.1% oral contraceptives, 5.2% using intrauterine devices and 4.7% using condoms. Perceived constraints to the use of family planning methods included husband's opposition, fear of complications and perceived insufficient knowledge about family planning methods. It is concluded that there is a knowledge-practice gap in the use of family planning methods among married women in Ibadan, Nigeria. Improved education strategies and better access to services are needed to solve these problems.

PIP: This study examined the level of awareness and the rate of family planning method use among women of reproductive age in Ibadan, Nigeria. The participants included 1188 married women, aged 15-40 years, attending antenatal clinics at four sites in Ibadan: University College Hospital; Adeoyo State Hospital; Primary Health Center, Oiomi; and Omotayo Maternity Center, a private maternity center in Oke-Ado. Most of the respondents (94.3%) were aware of family planning methods, but only 12% had visited a family planning clinic. Awareness of specific methods was 82.6% for condoms, 75.7% for oral contraceptives, 75.5% for injectable contraceptives, and 65.3% for IUDs. Current use of family planning methods was low, with 10% using withdrawal, 8.1% using oral contraceptives, 5.2% using IUDs, and 4.7% using condoms. Perceived constraints to the use of family planning methods included husband's opposition, fear of complications, and perceived insufficient knowledge about family planning methods. Based on these results, it is concluded that there is a knowledge-practice gap concerning family planning methods among married women in Ibadan, which will require improvement in education strategies and better access to services.

Haematological values in pregnancy in Ibadan, Nigeria.

Haematological values were studied in 495 apparently healthy pregnant Nigerian women receiving antenatal care in a maternity hospital in Ibadan, Nigeria. Means, standard deviations and ranges of haematrocrit, total and differential white cell counts, absolute platelet count, erythrocyte sedimentation rte, prothrombin time (PT) and partial thromboplastin time (PTTk) were determined. The mean haematrocrit was 0.311 (SD 0.033), mean total leucocyte count was 5.765 x 10(9)/L (SD 1.753 x 10(9)/L) and mean platelet count was 193 x 10(9)/L (SD 46 x 10(9)/L). The mean erythrocyte sedimentation rate was 18.6 (SD 7.4) mm/hour, mean prothrombin time was 12.3 (SD 2.5) seconds and mean partial thromboplastin time was 38.4 (SD 2.0) seconds. There were significant differences between the second and third trimesters of pregnancy in nay of the haematological values studied. The study has presented the range of variations in haematological values (including those that measure coagulation) in apparently healthy pregnant Nigerian women. It would appear that in the population studied, there were no significant differences in these haematological values between the second and third trimesters in otherwise healthy women receiving regular antenatal care.

Infertility and other fertility related issues in the practice of traditional healers and Christian religious healers in south western Nigeria.

Traditional healers have been an established source of health care delivery in Africa for centuries while Christian religious healers (193 traditional healers and 99 Christian religious healers) with respect to infertility and some other fertility-related issues. The findings show that both types of healers believe that infertility is most commonly due to the past life of the woman, physical problems related to the womb or to male potency, and imcompatibity between the man and the woman. Traditional healers also believed that being bewitched or being cursed can lead to infertility. Both groups of healers threat infertility by sacrifices, prayer and fasting, and timing of intercourse to coincide with the fertile period. Also 61% of traditional healers and 87% of religious healers advice their-clients with infertility to do nothing at least initially. To those clients seeking advice on preventing pregnancy, traditional healers tend to recommend herbal concoctions, beads and rings while Christian healers tended to recommend condoms, withdrawal method and the safe period. Both groups are consulted on premarital sex, premarital conception, sex during pregnancy and influencing the sex of an unborn baby. It was concluded that both traditional healers and Christian faith healers are involved with infertility and other fertility-related issues in their practices. There is an overlap in beliefs about causes and treatment of such conditions among both groups although areas of differences in beliefs and practices are clearly identifiable.

Squamous cell carcinoma of the cervix simulating an advanced malignancy of the ovaries.

A 40-year-old woman was diagnosed as having stage II squamous cell cervical carcinoma and managed with radiotherapy. Three months after treatment, she presented with features suggestive of an advanced ovarian tumour including gross abdominal swelling, bilateral ovarian tumours, multiple tumour seedlings in the abdominal cavity and ascites. There was also pleural effusion. Operative findings revealed widespread intra-abdominal metastases whose histology, contrary to expectations, showed squamous cell carcinoma of cervical origin. Distant metastases from squamous cell carcinoma of the cervix are rare. A high index of suspicion is necessary to detect this unusual mode of presentation.

The family planning aspects of the practice of traditional healers in Ibadan, Nigeria.

The family planning aspects of the practice of traditional healers in Ibadan, a large city in south west Nigeria, was investigated by means of a questionnaire survey of 193 traditional healers. The findings revealed that between 13% and 53% agreed with certain cultural beliefs which tend to increase fertility and that their perceptions of ideal child spacing is most commonly 2-3 years. Only 13% think a couple should have a specified number of children; a large proportion think the number should be "as God wills" (42%) or as many as the couple has resources to cope with (42%). Nearly all think that traditional healers and orthodox health professional should work together in the area of family planning. While most of them recommend traditional methods of contraception (such as beads and herbs) to their clients, up to 22% recommend modern family planning methods such as condoms and oral contraceptive pills. The implications of these findings for family planning programmes and the possibility of the involvement of traditional healers in the promotion of modern family planning methods are discussed.

PIP: The family planning aspects of the practice of traditional healers in Ibadan, a large city in southwest Nigeria, was investigated by means of a questionnaire survey of 193 traditional healers. The findings revealed that between 13% and 53% agreed with certain cultural beliefs that tend to increase fertility and that their perceptions of ideal child spacing is most commonly 2-3 years. Only 13% thought a couple should have a specified number of children; a large proportion thought the number should be "as God wills" (42%) or as many as the couple has resources to support (42%). Nearly all thought that traditional healers and orthodox health professionals should work together in the area of family planning. While most of them recommend traditional methods of contraception (such as beads and herbs) to their clients, up to 22% recommend modern family planning methods such as condoms and oral contraceptives. The implications of these findings for family planning programs and the possibility of the involvement of traditional healers in the promotion of modern family planning methods are discussed.

Obstructed labor in Ibadan.

Over a period of 13 years, 380 cases of obstructed labor were managed amongst 39,456 deliveries. Absent prenatal care and poor intrapartum care at peripheral hospitals were major contributing factors. The average duration of labor in those with obstruction was three times that in the normal obstetric population. About 82% of patients with obstruction had an emergency cesarean section while 10% had destructive operations. The main etiological factor was unrecognised positional disproportion. Common associated complications were ruptured uterus, genital and wound sepsis. Maternal and perinatal morbidity and mortality were high. Adequate health education, incorporation of traditional birth attendants into health care programs and the provision of more health care centers will reduce the occurrence of this complication.

Presentation and management of eclampsia.

Three hundred forty-seven cases of eclampsia were managed at the University College Hospital (UCH), Ibadan, Nigeria from 1977 to 1986 (9.3 per 1000 deliveries). Thirty-one percent of seizures occurred antenatally, 46.2% during labor and 23.2% postnatally. Only 5% first occurred in the hospital. Seizures were controlled with diazepam, lytic cocktail (chlorpromazine, pethidine and phenergan), sodium amylobarbitone, paraldehyde and bromethol. Maternal mortality was 2.9%, and perinatal mortality 193 per 1000, respectively. Prevention of avoidable factors (absent or poor antenatal care and prolonged labor) by the provision of comprehensive antenatal care will reduce the incidence of eclampsia. Improvement in management facilities prior to transfer to referral centers, the use of magnesium sulfate or diazepam to control seizures and the avoidance of hypotonic solutions and 50% glucose during therapy will reduce morbidity and mortality.