Prevalence and consumption pattern of kolanut among pregnant women in Ibadan metropolis.

Kolanut contains caffeine and it is widely consumed in various social contexts in Nigeria and other Sub-Saharan African countries. While some studies have suggested that kolanut is consumed by pregnant women, there is a dearth of information on the prevalence, consumption pattern and reasons for kolanut consumption among this group. This study investigated kolanut use among pregnant women in Ibadan, Oyo State, Nigeria. A cross-sectional study involving 478 consenting pregnant women in all trimesters of pregnancy was conducted. Semi-structured questionnaires were used to collect data. Associations between kolanut use and respondent characteristics were investigated using the chi-square test and logistic regression analysis. The mean age of the women was 28.7 ± 6.3 years. One hundred and sixty-two (33.9%) of women reported kolanut use during pregnancy, 140 (29.3%) in the current pregnancy. Fifty-five (39.3%) pregnant women reported frequent use and 46 (32.9%) used it in high quantities. Significant associations were found between current kolanut use and Hausa respondents (p = 0.014), educational level; secondary (p = 0.032), tertiary (p = 0.006), TBA (p = 0.005). The majority (93.7%) used kolanut to prevent spitting, nausea, and vomiting. This study showed that kolanut use is quite common among pregnant women and frequently used in large quantities.

Adverse neonatal outcomes of adolescent pregnancy in Northwest Ethiopia.

BACKGROUND: Adolescents have physical, social and psychological characteristics that are different from adults. Adolescent pregnancy results in pregnancy and childbirth complications- an area neglected in developing countries like Ethiopia. This study, therefore, was conducted to assess the adverse neonatal outcomes of adolescent pregnancy in Northwest Ethiopia. METHODS: Institutional-based study was conducted in East Gojjam zone, Northwest Ethiopia. A total of 374 adolescent (15-19 years) and 760 adult (20-34 years) women were included in this study. Data were collected among women who came to randomly selected health facilities in East Gojjam zone. Data were collected by trained research assistants using a structured data collection questionnaire. Descriptive statistics, chi-square test, and Student's t-tests were utilized. Bivariate and multivariable logistic regression analysis were employed to adjust for confounding factors of adverse neonatal outcomes. Statistical significance was declared when the p-value was less than 0.05. RESULTS: Higher proportion of adolescent than adult women were from rural area (57.2% vs 44.7%), were not married (5.1% vs 1.7%), were pregnant for the first time (91.7% vs 34.1%), didn't attend antenatal care (ANC) follow-up (12% vs 4.5%), and had late initiation of ANC follow-up. After adjusting for known confounding factors, the odds of low birth weight (LBW) was higher among adolescents than adult women (AOR 2.14; 95% CI, 1.36, 3.36, p-value = 0.001). Similarly, the odds of preterm birth was higher among adolescents than adult women (AOR 1.65; 95% CI, 1.09, 2.49, p-value = 0.017). There was no statistically significant difference in the rate of low Apgar score at first and five minutes after birth and neonatal Intensive Care Unit (ICU) admission between babies born from adolescent and adult women. CONCLUSIONS: Adolescent women were less likely to receive ANC service. Babies born from adolescent women are at higher odds of adverse neonatal outcomes like LBW and preterm birth than babies born from adult women. Use of community- and health facility-based intervention programs that can prevent adolescent pregnancy and reduce adverse neonatal outcomes among adolescent girls is recommended.

Prevalence and determinants of adolescent pregnancy in Africa: a systematic review and Meta-analysis.

BACKGROUND: Adolescence is the period between 10 and 19 years with peculiar physical, social, psychological and reproductive health characteristics. Rates of adolescent pregnancy are increasing in developing countries, with higher occurrences of adverse maternal and perinatal outcomes. The few studies conducted on adolescent pregnancy in Africa present inconsistent and inconclusive findings on the distribution of the problems. Also, there was no meta-analysis study conducted in this area in Africa. Therefore, this systematic review and meta-analysis were conducted to estimate the prevalence and sociodemographic determinant factors of adolescent pregnancy using the available published and unpublished studies carried out in African countries. Also, subgroup analysis was conducted by different demographic, geopolitical and administrative regions. METHODS: This study used a systematic review and meta-analysis of published and unpublished studies in Africa. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was strictly followed. All studies in MEDLINE, PubMed, Cochrane Library, EMBASE, Google Scholar, CINAHL, and African Journals Online databases were searched using relevant search terms. Data were extracted using the Joanna Briggs Institute tool for prevalence studies. STATA 14 software was used to perform the meta-analysis. The heterogeneity and publication bias was assessed using the I2 statistics and Egger's test, respectively. Forest plots were used to present the pooled prevalence and odds ratio (OR) with 95% confidence interval (CI) of meta-analysis using the random effect model. RESULT: This review included 52 studies, 254,350 study participants. A total of 24 countries from East, West, Central, North and Southern African sub-regions were included. The overall pooled prevalence of adolescent pregnancy in Africa was 18.8% (95%CI: 16.7, 20.9) and 19.3% (95%CI, 16.9, 21.6) in the Sub-Saharan African region. The prevalence was highest in East Africa (21.5%) and lowest in Northern Africa (9.2%). Factors associated with adolescent pregnancy include rural residence (OR: 2.04), ever married (OR: 20.67), not attending school (OR: 2.49), no maternal education (OR: 1.88), no father's education (OR: 1.65), and lack of parent to adolescent communication on sexual and reproductive health (SRH) issues (OR: 2.88). CONCLUSIONS: Overall, nearly one-fifth of adolescents become pregnant in Africa. Several sociodemographic factors like residence, marital status, educational status of adolescents, their mother's and father's, and parent to adolescent SRH communication were associated with adolescent pregnancy. Interventions that target these factors are important in reducing adolescent pregnancy.

Awareness and attitude towards HPV and its vaccines among market women in Bodija Market, Ibadan.

Background: Cervical cancer, commonest among cancers of the female genital tract continued to pose major challenge to women of reproductive age in developing countries though infection by its causative agent, human papilloma virus (HPV) is preventable.This study aimed to assess awareness and attitude of market women concerning HPV and its vaccines in prevention of cervical cancer. Materials and Methods: A cross sectional study involving 329 market women, using multistage sampling technique. Instrument was an Interviewer--administered questionnaire on socio-demographic characteristics, knowledge and awareness of HPV and its vaccine, sexual history and attitude towards HPV vaccines. Data analysis was done using SPSS version 20.0 with statistical significance level set at p<0.05. Results: Mean age of respondents was 29.49 ± 3.65 years. All respondents were sexually active with majority (94.8%) having multiple sexual partners. Awareness of HPV vaccine and Pap smear test was among 1.2% and 9.4% respectively. Attitude towards HPV vaccination was good in 304 (92.4%) with 302 (91.8%) willing to take the HPV vaccines. There was significant association between attitude towards HPV vaccine and willingness to take HPV vaccine x2=111.8, p<0.01). Conclusions: Awareness of HPV and its vaccines is low among market women in our community. Policies and actions to step up information dissemination are urgently needed in order to stem the scourge of cervical cancer in our society.

Randomization of two dosing regimens of vaginal misoprostol for cervical ripening and labor induction in a low resource setting.

OBJECTIVES: To compare the effectiveness of two dosing regimens of vaginal misoprostol for cervical ripening and induction of labour. MATERIALS AND METHODS: Pregnant women with singleton low risk pregnancy at term scheduled for elective induction of labour were randomized to receive either 25 µg or 50 µg of vaginal misoprostol for pre-labour cervical ripening. All the patients received antenatal care and delivered at the University College Hospital (UCH) from January 1 st to May 31 st 2006. A total of 128 patients were randomized; 65 patients received 25 µg and 63 patients received 50 µg of vaginal misoprostol. RESULTS: Significantly higher number of patients in the 50 µg group progressed to active labour as compared with the 25 µg group (95.2% versus 84.6%, P < 0.05). The need for oxytocin augmentation of labour was higher among the 25 µg as compared with 50 µg (39.7% versus 16.4%, P = 0.007). There was higher proportion of patients in the 50 µg group delivering vaginally within 24 hours as compared with the 25 µg group (98.2% versus 90.0%, P = 0.063). However, the mean interval between the first dose of misoprostol and vaginal delivery was not statistically different in the two groups (754 ± 362 minutes and 885 ± 582 minutes, P = 0.152). The incidence of caesarean section was similar in the two groups (7.7% versus 11%, P = 0.580). Labour complications, such as precipitate labour, tachysystole and abnormal fetal heart rate patterns were greater in the 50 µg group. CONCLUSION: Twenty-five microgram of misoprostol appears to be as effective as 50 µg for pre-induction cervical ripening and labour induction. Though 50 µg of vaginal misoprostol resulted in relatively faster delivery and less need for oxytocin augmentation, it was associated with more labour complications as compared with 25 µg of misoprostol.

Bilateral tubal gestation associated with schistosomiasis in an african woman.

Background. The incidence of tubal ectopic gestation caused by schistosomiasis induced tubal pathology is undocumented in this environment, which may be due to rarity of this pathology. Bilateral tubal gestation is common in patients that have undergone in vitro fertilization. We report a hitherto undocumented case of spontaneous bilateral ectopic gestation following tubal schistosomiasis. Case Report. Mrs. OB was a 32-year-old G4P3(+0) (3 alive) woman who complained of abdominal pain and bleeding per vaginam of 4 and 2 days' duration respectively following 8 weeks of amenorrhea. A clinical impression of ruptured ectopic gestation was confirmed by ultrasound scanning. She had bilateral salpingectomy with histology of specimens showing bilateral ectopic gestation with Schistosoma haematobium induced salpingitis (findings of Schistosoma haematobium ova noted on slide). Conclusion. Schistosoma induced salpingitis is a rare but possible cause of bilateral tubal gestation.

An audit of vaginal hysterectomies at the University College Hospital, Ibadan.

BACKGROUND: Cost reduction, less postoperative morbidity and absence of abdominal scars are advantages of vaginal hysterectomy. The study aimed to examine the rate, indications, and complications of vaginal hysterectomies performed at University College Hospital Ibadan to derive lessons for the immediate future. METHODS: An analysis of the records of all vaginal hysterectomies performed from 1995-2004. Information on the patients' epidemiological characteristics, indications and details of surgery performed, length of duration of surgery and postoperative course was retrieved. Data was analyzed with Stata-11 software. RESULTS: Vaginal: abdominal hysterectomy ratio was 1:9, the former constituting 2.3% of major gynaecological operations done. The mean age of patients was 56.6 +/- 12.9 years and most were grandmultiparous. Twenty-two cases (81.8%) were due to genital prolapse. No uteri were larger than 12 weeks' size. Most (78.1%) were performed by consultants. Complication rate was 63.0%; the most frequent was intra-operative haemorrhage. Mean hospital stay was 7.4 +/- 3.5 days. Post-operation anaemia was associated with longer hospital stay (p = 0.02). CONCLUSION: With increasing detection rate of CIN, lesser parities and the availability of the operating laparoscope at our centre, there is need to widen case selection beyond genital prolapse (in view of known benefits of vaginal hysterectomy) for renewed skill acquisition to reduce the high complication rates and for better training of resident doctors.

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.

Pre-induction cervical ripening: transcervical foley catheter versus intravaginal misoprostol.

The object of this study was to compare the effectiveness of the intravaginal Misoprostol and transcervical Foley catheters as pre-induction cervical ripening agents, to estimate the proportion of patients achieving vaginal delivery and to compare the complications of labour and foetal outcome between the two groups. The study was a prospective, randomised study of pregnant women, with singleton pregnancies who presented for antenatal care and delivery at the University College Hospital (UCH), Ibadan, Nigeria. Ninety-nine patients were invited to participate and ninety-six (96) agreed. No patient withdrew from the study. The patients were assigned by means of computer-generated random numbers to receive transcervical Foley catheters (Size 16F, with 30 ml balloon capacity) or 50 microg intravaginal Misoprostol (Cytotec tablet, Searle & Co., Chicago). Fifty (50) patients received intravaginal Misoprostol and Forty-six (46) received Transcervical Foley catheters. The proportions of nulliparous, primiparous and multiparous patients were 52, 20 and 28% in the misoprostol group and 43.5, 26.1 and 30.4%, respectively, in the Foley catheter group. The time to achieve a favourable cervical status was significantly shorter in the Misoprostol group, with 98.0% of the subjects attaining Bishop score > or = 6 within 6-12 hours of insertion of the study agent, in contrast to 69.0% of the subjects in the Foley catheters group (P<0.001). Thirteen (26.6%) and three (6.5%) patients in the Misoprostol and Foley catheters groups, respectively, went into labour while undergoing cervical ripening and all had uneventful vaginal deliveries (P<0.05). The induction-delivery interval did not differ significantly between the groups. The incidence of caesarean delivery was 6.0% in the Misoprostol group compared with 2.2% in the Foley catheter group (P=0.62). Instrumental vaginal delivery rates were similar in both groups. Overall, the mode of delivery did not differ significantly between the groups. The number of neonates with 1-minute Apgar score <7 did not differ significantly in both groups and no neonate had 5-minute Apgar score <7. Meconium stained liquor was noticed in 5 (Misoprostol) vs 2 (Foley catheters) patients in labour. None of the neonates had any features suggestive of meconium aspiration. Labour complications were mainly precipitate labour {2 (Misoprostol) vs 1 (Foley catheters) } and 1 patient with transient tachysystole (> or =6 contractions in 10 minutes for two consecutive 10-minute periods) in the Misoprostol group. Hyperstimulation was not noticed in any of the patients in either arm of the study groups. Intravaginal Misoprostol is as effective a pre-induction cervical ripening agent as transcervical Foley catheters, with added advantages of shorter duration of cervical ripening, reduced oxytocin requirement for induction of labour and greater acceptability to patients. The incidence of caesarean sections, other labour complications and the foetal outcome were similar with both methods.

Total ovulating period: any contribution to ovarian carcinogenesis?

The etiology of ovarian cancer has many postulates including that of incessant ovulation. Women of high parity especially those that breastfeed in addition are supposed to be protected. Ovarian cancer patients in the developing world are of higher parity than their Caucasian counterparts. Our study compared the length of reproductive career (LRC), the physiological ovulation free period (PFP) and the total ovulating period (TOP) amongst histologically proven ovarian cancer patients and age - matched controls. This is a questionnaire survey of 21 ovarian cancer patients managed by us between 1st December 1998 and 31st July 2002 and 42 gynaecological patients not known to have ovarian cancer. The mean age among the patients was 45.7+16.9 years while among the controls it was 45.4 +/- 16.1 years. The mean parity of the patients was 3.6 +/- 2.2 compared to 3.4 +/- 2.9 in the controls. The patients had a mean LRC of 23.8 +/- 11.2 years while in the controls it was 25.7+10.8 years. The mean PFP of the patients was 7.4 +/- 5.6 years and for the controls 7.1 +/- 6.5 years. The patients had a mean TOP of 15.8 +/- 8.8 years while this was 18.6 +/- 8.1 years for the controls. None of these differences was statistically significant. Our study revealed no statistically significant differences in the total ovulating periods between ovarian cancer patients and age-matched controls. Further studies will be necessary.

Comparison of changes in pre-induction cervical factors' scores following ripening with transcervical foley catheter and intravaginal misoprostol.

The study compares the changes in the cervical factors in pre-induction cervical ripening with both transcervical Foley catheter and Intravaginal Misoprostol. This was a randomised prospective study of pregnant women, with singleton gestations who presented for antenatal care and delivery at a tertiary health institution in the South-western Nigeria between 1st March 2003 and 31st March 2004. One hundred and two (102) patients received 50microg intravaginal Misoprostol and Ninety-six (96) received size 16F Transcervical Foley catheters. Both groups were similar at the baseline. Misoprostol group showed greater improvement in the final cervical length score, with 38.4% and 58.6% scoring 2 and 3 respectively, in contrast with the Foley catheter group where 77.7% had final score of 1, with only 16% scoring 2 and none scored 3 (P = 0.00). Ninety-one percent of the patients in the misoprostol group achieved the maximum cervical consistency score of 2, contrasting with the 31.9% in the Foley Catheter group (P = 0.00). 64.9% of the patients in the Foley catheter group did not achieve appreciable change in cervical consistency. Our findings indicate that intravaginal misoprostol was more effective in improving the scores of cervical length and consistency, while transcervical Foley catheter was better at improving the cervical os dilatation score at pre-induction cervical ripening. The clinical implication is that, patients for pre-induction cervical ripening can be selected for either of these ripening agents based on which cervical factors require improvement in scores

Cervico-vaginal foetal fibronectin: a predictor of cervical response at pre-induction cervical ripening.

CONTEXT: Not all pregnant women with an "unripe" cervix can be successfully ripened by the cervical ripening agents; therefore tests with predictive information are justified. OBJECTIVES: To examine the effect of the presence of foetal fibronectin (FFN) in the cervico-vaginal secretions on pre-induction cervical ripening with either intravaginal Misoprostol or transcervical Foley catheter. METHODOLOGY: Twenty (20) patients managed at a tertiary health institution in South-western Nigeria between March and May 2003 were randomised for cervical ripening by either intravaginal Misoprostol or Transcervical Foley catheters. Cervico-vaginal secretions were assessed for presence of FFN with Foetal Fibronectin Enzyme Immunoassay Kit (Adeza Corp.) prior to commencement of cervical ripening. MAIN OUTCOME MEASURES: FFN status, Pre-ripening and Pre-induction modified Bishop scores and duration of cervical ripening. RESULTS: Ten of the fifteen patients with positive membrane immunoassay for FFN achieved ripened cervix (modified Bishop score > or = 6) within 6 - 12 hours of exposure to the agents of cervical ripening. In the FFN negative group, only 2 of the five patients achieved ripe cervix within the >12 - 18 hours period, the rest being in the >18 - 24 hours period. CONCLUSION: Foetal fibronectin test may offer useful predictive information prior to institution of processes of cervical ripening in patients with unfavourable cervices.

Conservative management of third trimester cervical spinal cord injury using Gardner-Wells tongs traction.

Spinal cord injury, though an important cause of morbidity appears to be uncommon in pregnant women or perhaps, has not been accurately documented among them. Superimposed on the many impairments resulting from spinal cord injury is the presence of the foetus in the womb which in itself normally brings about intense physiological alterations in the patient. Despite the complexities, neither the pregnancy nor the spinal cord injury needs jeopardize the optimal care of the other as long as the standard protocols are followed. In the past 10 years, the University college Hospital, Ibadan, Nigeria treated approximately 900 spinal cord injury patients, and only 3 of these were pregnant-an incident of 0.30 per 90 patients per year, or 0.33%. We report here, the conservative management of one of these pregnant patients using the Gardner-Wells' tongs traction, resulting in normal parturition and full neurological recovery.

A review of hypertensive disorders of pregnancy.

The detection and clinical management of hypertension in pregnant women are complicated by the concern for fetal development and survival as well as for the health of the mother. Preeclampsia describes a common syndrome that occurs in the second half of pregnancy and often manifesting with hypertension and proteinuria. It occurs in up to 10% of all pregnancies. The factors that initiate preeclampsia are unknown and still a subject of intense clinical research by both Obstetricians and Physicians. The blue print for the development of preeclampsia is probably laid down early in pregnancy, and delivery of the fetus and placenta remains the only effective treatment. Severaclinical, biophysical and biochemical tests have been reported in the world literature to predict the development of preeclampsia. Also, numerous reports have described the predictive value of every possible substance that can be measured in maternal blood or urine. However, the presence of microalbuminuria is an important clinical finding in pregnant women. Indeed, urinary albumin excretion when used as a single test has shown that albumin excretion was higher at booking in those that later developed hypertensive disorders of pregnancy than those that did not have the condition. It had a higher sensitivity and poor predictive value. In conclusion, the factors that are responsible for hypertensive disorders of pregnancy remain unknown and treatment is still difficult. The search for an ideal predictive test or tests should therefore be a continuous exercise.

Ovarian cancer in Ibadan: characteristics and management.

Ovarian cancer has the highest case fatality rate among gynaecological cancers worldwide because of lack of effective screening methods and non-specific early warning symptoms with late presentation. A reinvigorated study is necessary in the developing countries because of a projected increase in its incidence. The decreasing fertility rate and increasing use of ovulation induction drugs are some of the reasons. The Ovarian Cancer Service of the Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Oyo State, Nigeria commenced the first longitudinal study of this malignancy from 1 December 1998 in order to establish a regional management and research centre. It is a questionnaire survey detailing the demography, clinical and staging laparotomy findings and histology of all confirmed cases. Twenty-one staging laparotomy and histologically confirmed ovarian cancer cases were managed from 1 December 1998 to 31 July 2002, about 1.5% of the 1387 gynaecological admissions. It is the third most common of the gynaecological cancers, representing 9.8% of the 214 cases. More than 60% of the patients were 50 years or younger. Only 19% were nulliparous, with 47.6% having had five or more deliveries. Only two patients (9.5%) had used the oral contraceptive pill, for a maximum period of 1 month. Only one patient (4.8%) had a positive family history of cancer. Abdominal swelling was the most common presenting symptom. Eighty-one per cent of the patients presented in Stages III and IV. Epithelial ovarian cancer constituted about 76.2% of the cases. Only 23.8% had adjuvant therapy, consisting of combination chemotherapy using cisplatin-based regimes. The case fatality rate 6 months after surgery was 76%. The ovarian cancer patients in this environment are younger and of higher parity than expected. The risk factors for this disease require further study.

Microbiological pattern of the contents of pelvic abscess at the University College Hospital, Ibadan, Nigeria.

A retrospective analysis of 49 cases of pelvic abscess over a 10-year study period spanning 1 January 1989 to 31 December 1998 was undertaken. Forty-one patients had laparotomy to drain the pelvic abscess, while eight had colpotomy. The volume of pus drained at surgery ranged between 10 ml and 3.5 l for laparotomy, with a median value of 500 ml and 100 ml to 1 l with a median of 200 ml for colpotomy. There was no significant difference in these values. Swabs for bacteriological cultures were taken at surgery and results available in 18 patients. In two patients (11%) the cultures were sterile. In the positive cultures, Escherichia coli was isolated in seven patients. Klebsiella species and Staphylococcus aureus were isolated in four patients each. It is important to know the causative organisms for this infection in our environment because pelvic abscess is the end stage in the progression of a treatable genital tract infection and is frequently an unnecessary complication that is very expensive to treat.