Knowledge and utilization of malaria preventive measures among pregnant women at a tertiary hospital in Nigeria's federal capital territory.

OBJECTIVE: To determine the knowledge and utilization of malaria preventive measures as well as barriers to the utilization of these measures by pregnant women. MATERIALS AND METHODS: The study was a prospective cross-sectional survey involving pregnant women at the booking clinic of the University of Abuja Teaching Hospital between May and August 2010. Close-ended pre-tested structured questionnaires were administered by interviewer method to 403 consecutive consenting women. RESULTS: The knowledge of malaria and its preventive measures in pregnancy was 71.5%. There was a statistically significant association between knowledge of malaria and educational status (X2 = 16.053, P = 0.035). Intermittent preventive treatment was used by 15.9% of the respondents. Insecticide-treated net ownership was 42.6%; however, its use declined from 28.5% before pregnancy to 24.6% during pregnancy. CONCLUSION: There is adequate knowledge about malaria and its preventive measures in pregnancy, but the utilization of these measures is poor. There is need for concerted efforts at addressing the barriers to utilization of these effective interventions.

The Use of Cervical Smear in the Diagnosis of Genital Tract Infections at a University Teaching Hospital

Background: Genital tract infections such as Gardnerella vaginalis vaginosis; trichomoniasis and candidiasis have continued to assume immense importance because of the particular unique features of their main causative organisms - Gardnerella vaginalis; Trichomonas vaginalis and Candida albicans; and myriads of clinical and pathological changes in affected persons. Aim: To investigate the prevalence of Gardnerella vaginalis; Candida albicans and Trichomonas vaginalis in randomly selected sexually active women and the influence of some socioeconomic and demographic factors on the prevalence of these genital infections. Methods: The subjects were 450 randomly selected sexually active women attending antenatal; postnatal; gynaecology and family planning clinics in the Department of Obstetrics and Gynaecology of the University of Maiduguri Teaching Hospital from April 2001 to May 2002. The Pap smear of these patients were examined microscopically for evidence of Candida albicans; Gardnerella vaginalis and Trichomonas vaginalis. A questionnaire assessing sociodemographic characteristics of the patients were administered. Results: Sixty six (66) of the 450 patients studied had specific infections giving a prevalence rate of 14.7. Candida albicans; Gardnerella vaginalis; Trichomonas vaginalis and Candida albicans in conjunction with gardnerella vaginalis contributed 7.1; 5.1; 2.4and 1.8respectively to this overall prevalence. Age range of 15-20 years had the highest prevalence of each of the infections; but this association with age was not statistically significant (P0.05). The prevalence of each of the infections was highest among students and was lowest among housewives and business executives. These differences were statistically significant (P = 0.034). The prevalence of these genital infections increased with increasing educational level; being lowest among those with no formal and primary education and highest in the patients with post-secondary educational qualifications. This difference was statistically significant (P = 0.034; c2 for linear trend = 0.90). About 36.5) of the married women tested had evidence of genital infections compared to 41.6of the women who were not currently married; this difference was not statistically significant (P0.05). Conclusion: This study has shown that cervical cytology is of definite value in the diagnosis of some genital tract infections especially in low resource setting

The Influence of Marital Factors on Genital Human Papilloma Virus Infection

Aim: To study the association between marital factors and human papilloma virus (HPV) infection of the cervix. Method: The subjects were 450 randomly selected sexually active women attending the antenatal; postnatal; gynaecology and family planning clinics in the Department of Obstetrics and Gynaecology of the University of Maiduguri Teaching Hospital; Nigeria between April 2001 to May 2002. The Pap smear of these patients were examined microscopically for evidence of HPV infection. A questionnaire assessing various marital characteristics of the patients were administered. Result: Abnormal smears occurred in 245 (54.5) of the patients screened. Forty eight women (10.7) had HPV associated changes constituting 19.6of all abnormal smears. Their ages ranged between 15 and 64 years; with a mean of 26+3 years. There was a statisti-cally significant association between marital status and genital HPV infection. Conclusion: Single sexually active women are at increased risk of acquiring HPV infection of the cervix and should be the target in a sporadic or an organized cervical cancer screening programme without discriminating other sexually active women

Morphology and function of the rat oviduct: effects of thyroidectomy and thyroxine administration.

The effect of thyroidectomy and thyroxine administration on the morphology and function of the oviduct was studied in 40 albino rats. Chronic administration of 10 microg/100g for 60 days resulted in atrophy of the smooth muscle and mucosal folds. The thyroidectomized rats had reduced smooth muscle wall thickness, the epithelium reduced from columnar to cuboidal; and also flattening of mucosal folding. The contractile responses to oxytocin, acetylcholine and indeed the spontaneous contraction in the four thyroid states suggest a dependence of oviductal contraction on adequate plasma level of thyroid hormone in the vicinity of the contracting smooth muscle of the oviduct. The results suggest that thyroid hormone affects the morphology and function of the oviduct.

The influence of reproductive and marital factors on cervical dyskaryosis.

Five hundred sexually active women attending various clinics in the Department of Obstetrics and Gynaecology of the University of Maiduguri Teaching Hospital had questionnaires on their reproductive and marital characteristics randomly administered. Their 'Pap' smears were then taken for cytological examination. The aim was to determine the influence of marital and reproductive factors on the occurrence of cervical dyskaryosis and how these may be used to develop a risk-scoring criteria that could target selectively the population most at risk. Late marriage, early age at first pregnancy and grand-multiparity significantly influenced the occurrence of cervical dyskaryosis. These factors may be valuable in developing a risk score that could target women at higher risk of developing cervical dyskaryosis.

How safe is motherhood in Nigeria?: the trend of maternal mortality in a tertiary health institution.

OBJECTIVE: To determine the magnitude and trend of maternal mortality in Jos University Teaching Hospital, Jos, Nigeria. DESIGN: Retrospective study. SETTING: Jos University Teaching Hospital, Jos, Nigeria. SUBJECT: All women dying in pregnancy, labour and puerperium. MAIN OUTCOME MEASURES: Maternal mortality ratio, trend of maternal mortality, age, antenatal booking status, educational status, main causes of maternal death, factors contributing to maternal deaths. RESULTS: The maternal mortality ratio was 739/100,000 total deliveries and trend rose from 450/100,000 in 1990 to 1,060/100,000 total deliveries in 1994. About 33% of all maternal deaths occurred among teenagers. The risk factors for maternal deaths included adolescence, grand multiparity, illiteracy and non-utilisation of antenatal services. The main causes of maternal mortality were haemorrhage (28.1%), sepsis (21.3%) and eclampsia (15.7%). The contributions of complicated induced abortion and anaesthetic deaths in this study are worthy of mention. CONCLUSION: The maternal mortality ratio is unacceptably high in Jos University Teaching Hospital more particularly because of the rising trend. Socio-cultural and economic factors contributed immensely to the high maternal mortality in Jos. The objective of the World Health Organisation (WHO) to reduce maternal mortality by 50% by the year 2000 will not be achieved in this part of Nigeria. Nonetheless, improvement of the nation's economy coupled with a stable policy and provision of intrastructural facilities will assist to significantly reduce maternal mortality.

Effect of thyroxine on the contractile responses of the vas deferens to prostaglandin E2.

The effects of prostaglandin E2 (PGE2) on the contractile activity of thyroidectomized and thyroxine-treated albino rats were studied in vitro. Thyroidectomy totally inhibited the contractile response of the vas deferens to PGE2. Thyroxine treatment, on the other hand, significantly (P < .001) potentiated the response of vasa deferentia to PGE2, when compared to controls. It is suggested that thyroid hormones play a role in the contractile response of the vas deferens to PGE2.

Knowledge and attitude to cervical cancer screening among women in Maiduguri, Nigeria.

Five hundred women were studied to determine their knowledge of cervical cancer. Less than 10% of the women were aware of the disease or its symptoms. Even fewer were aware of cytological screening, the good results obtained in the premalignant stage and early invasive stages of the disease. Simple explanation showed a good recall at 4-6 weeks. At that time women would accept screening and understood its importance. This study shows clearly that education must precede a screening programme if it is to succeed.

Sexual attitudes and their relation to cervical intraepithelial neoplasia in Maiduguri, Nigeria.

Five hundred randomly selected sexually active women attending antenatal, postnatal, family planning and gynaecological clinics in the Department of Obstetrics and Gynaecology, University of Maiduguri Teaching Hospital, had questionnaires administered on their sexual attitudes/ behaviour and their 'pap'smears taken for cytological assessment. The aim was to identify any significant association between sexual attitudes/behaviour and cervical intraepithelial neoplasia (CIN) for the purpose of targeting the population most at risk. Ninety-one women had varying degrees of CIN, a prevalence rate of 18.2%. However, multiple sexual partners was the only factor incriminated to significantly increase the risk of occurrence of CIN. Targeting women with multiple sexual partners may help in directing limited screening resources to those more likely to be positive.

Age at menarche amongst school girls in a high altitude Nigerian town.

Menarche, the first menstrual period is believed to be influenced by many factors including altitude. The data of 331 school girls in Jos (1,300 m above sea level), a high altitude Nigerian town, that attained menarche between January 1989 were analysed. The mean menarcheal age for these school girls is 13.21 +/- 1.01 years. This value was not significantly different from 13.02 +/- 1.28 years found amongst school girls at Calabar (20 m above sea level) a Nigerian sea level resident sample. Perhaps, Jos is not situated at a high enough altitude to significantly affect the age at which menarche is attained.

Umbilical cord venous progesterone at term delivery in relation to mode of delivery.

OBJECTIVE: To determine whether the umbilical cord venous progesterone at term delivery is related to the mode of delivery. METHODS: Thirty-nine pregnant patients at term were divided into three groups: elective cesarean section (control), spontaneous vaginal delivery, and emergency cesarean section. Umbilical cord venous and maternal serum progesterone were measured by radioimmunoassay. Statistical analysis was carried out using Student's t-test, with the level of significance set at P < 0.05. RESULTS: Umbilical cord venous progesterone was significantly higher in babies delivered by emergency cesarean section (P < 0.001) and in those who had spontaneous vaginal delivery (P < 0.02), compared with the control group. Maternal serum progesterone concentrations showed no significant differences between the three groups. The Apgar scores of the stressed group of babies were significantly lower (P < 0.001). CONCLUSION: The findings demonstrate that the fetuses exposed to stress during labor produce higher progesterone secretion. This could be one possible way the fetus protects itself against the sequelae of hypoxia.

Discrepancies in sperm count using improved Neubauer, Makler, and Horwells counting chambers.

Semen analysis still remains an important diagnostic procedure in male infertility evaluation. For the purpose of standardization and uniformity in the interpretation of sperm count results, the accuracy of three different counting chambers (improved Neubauer (IMN), Makler, and Horwells) were evaluated. Semen samples produced by 50 men were analyzed with the three different counting chambers using World Health Organization guidelines. The overall precision values of sperm count were: IMN 9.7%, Makler 5.9%, and Horwells 7.1%. The mean sperm counts (+/- SEM) were 78.6 (+/- 10.1), 119.1 (+/- 14.1), and 211.5 (+/- 27.5) million spermatozoa/ml respectively. Statistically significant differences were revealed when the sperm count results obtained with the different counting chambers were compared, i.e., IMN vs Makler (P < 0.05), IMN vs Horwells (P < 0.001), and Makler vs Horwells (P < 0.01). The sperm count results obtained from the 50 samples were classified into four subgroups (A = 1-20, B = 21-50, C = 51-100, and D = > 100 million spermatozoa/ml) using IMN as a reference chamber. Errors reflected as progressively poor SEM of sperm count (A = 1.1, 3.2, 4.1; B = 3.0, 6.1, 12.4; C = 3.4, 17.0, 23.9; and D = 14.1, 21.3, 46.3) were observed for IMN, Makler, and Horwells counting chamber respectively in each group. This study revealed that inherent errors abound when different counting chambers are used for sperm count. While IMN gave the lowest sperm count, Horwells recorded the highest. Makler counting chamber gave midway values and conforms with recommendations in the literature about its accuracy.

Effects of Norplant contraceptive subdermal implants on serum lipids and lipoproteins.

A longitudinal, short-term study of women using NORPLANT (levonorgestrel implants) was conducted. Cholesterol content of the major lipoproteins along with total cholesterol and triglycerides were measured in fasting blood samples from 32 women volunteers. Results for lipids and lipoproteins determined 6 and 12 months post-NORPLANT insertion were compared with values obtained for samples taken just before implantation. Total serum triglycerides was significantly reduced (p < 0.01) from 1.14 +/- 0.44mmol/l (mean +/- SD) to 0.89 +/- 0.25mmol/l at six and to 0.89 +/- 0.34mmol/l at twelve months post-insertion. Serum total cholesterol was 3.97 +/- 0.53mmol/l at the time of insertion while at six and twelve months post-insertion, they were 3.65 +/- 0.49mmol/l and 3.56 +/- 0.71mmol/l, respectively. These changes in values from the time of insertion to twelve months, were statistically significant (P < 0.02). As regards lipoprotein fractions, high density lipoprotein-cholesterol (HDL-chol) exhibited statistically significant reduction (P < 0.001) from 1.38 +/- 0.34 mmol/l to 0.71 +/- 0.30 mmol/l (mean +/- SD) six months post-insertion. Although the value had improved to 1.14 +/- 0.38mmol/l by twelve months, the value was still significantly different from the pre-insertion value. The low density lipoprotein-cholesterol (LDL-chol) had a mean value (+/- SD) of 2.08 +/- 0.45 mmol/l at the time of insertion. This was significantly elevated (P < 0.001) at six months to 2.54 +/- 0.48mmol/l (mean +/- SD). The twelve-month post-insertion value of LDL-chol (2.02 +/- 0.79) was similar to the pre-insertion value. The shift in HDL-cholesterol and LDL-cholesterol within six months followed by a virtual return to the pre-insertion values may represent only a transient change in metabolism of lipids and lipoproteins consequent upon NORPLANT contraception.

Sexually transmitted diseases and medico-social factors associated with male infertility in Nigeria.

Medico-social factors such as type of infertility, sexually transmitted diseases (STD), drug abuse, erectile dysfunction, divorce, and polygamy were evaluated among 64 infertile men (i.e. 32 oligo-asthenozoospermic and 32 azoospermic) and 23 men of proven fertility in Jos University Teaching Hospital, Jos, Nigeria. Of the 64 infertile men, 27 (42%) and 37 (58%) had primary and secondary infertility respectively. A history of STD, indicated by purulent urethral discharge, was recorded among 40 (63%) with 22 (55%) of this number having had repeated exposures to STD. While 17 (43%) of the infected infertile men were treated by qualified medical doctors, 23 (57%) either had self-medication or received treatment from quacks. Five (8%) of the 64 infertile men used hard drugs, 11 (17%) had erectile dysfunction, 15 (23%) were re-married due to broken marriage relationship or divorce, and 7 (11%) were polygamous. All the fertile men were monogamous with no history of either erectile dysfunction or usage of hard drugs. One (4%) of the fertile men had a history of a broken marriage relationships. Six (26%) had a history of STD with 5 (26%) of them having received treatment from qualified medical doctors. Although the study population is small, the results obtained in this study reveal higher incidences of STD, marital instability, and multiple marriage partnerships (polygamy) among infertile men than the fertile in Jos.

Resistance of recent Neisseria gonorrhoeae isolates in Nigeria and outcome of single-dose treatment with ciprofloxacin.

One hundred four patients (71 males, 33 females) with acute gonococcal urethritis or cervicitis were treated with a single oral 250 mg dose of ciprofloxacin at Jos University Teaching Hospital, Jos, Nigeria. All gonococcal strains were isolated from appropriate pre-treatment swabs. Penicillinase-producing Neisseria gonorrhoeae (PPNG) accounted for 72.8% of all isolates. In vitro sensitivity of gonococcal isolates to ciprofloxacin was 100%, while that to penicillin, ampicillin and co-trimoxazole was below 15%. Of the 104 patients treated with ciprofloxacin, 73 (70%) attended a follow-up visit. Seventy-three (100%) patients showed clinical cure and elimination of N. gonorrhoeae from the respective site of infection. Post-gonococcal urethritis or cervicitis believed to be due to concomitant chlamydial infection was found in 22 (30.1%) patients--18 males and four females. No adverse reactions were reported by any patient. Our findings show that a single oral dose of ciprofloxacin (250 mg) is well tolerated and effective in the treatment of uncomplicated gonorrhoea and is particularly useful in regions with a high prevalence of PPNG.

Effects of oral contraceptive pills on serum lipoproteins and triglycerides.

Possible effects of a combined oral contraceptive (femenal) on blood triglycerides and high-density-lipoprotein-cholesterol (HDL-Chol) were studied in 25 women who had opted for hormonal contraception. Total serum triglycerides of 64.60 +/- 12.39 mg/dl (mean +/- SD) obtained prior to the commencement of hormonal contraception, did not reveal any statistical difference from the value of 65.49 +/- 7.96 mg/dl obtained after 9 months contraception. Similarly, precontraception HDL-Chol value of 58.05 +/- 6.58 mg/dl was also not statistically different from the treatment value of 58.82 +/- 5.42 mg/dl. Regression analysis of the values between control (precontraception) and treatment (9 months contraception) showed high correlation coefficients: (1) serum triglycerides, R2 = 0.5201; P less than 0.001; (2) serum HDL-Chol, R2 = 0.6590; P less than 0.001. Both the mean body weight and blood pressure of the study subjects remained unchanged after 9 months continuous use of femenal for contraception.

Mode of inhibitory actions of acute and chronic chloroquine administration on the electrically stimulated mouse diaphragm in vitro.

1. The effects of bath applied chloroquine (Chlo) and of acute and chronic Chlo administration on skeletal muscle reactivity to electrical stimulation and to drugs have been studied on mouse hemidiaphragm preparations in vitro. 2. Chlo (0.15-150 micrograms) produced a concentration-dependent inhibition twitch and tetanic contractions due to direct muscle stimulation (MS). Acute and chronic administration of Chlo (45 mg kg-1, i.p. daily, for 3-28 days) progressively shifted the concentration-response curve to bath-applied Chlo to the right, with maximum effect occurring from day 14 of Chlo pretreatment. 3. Acute and chronic administration of Chlo decreased the twitch and tetanus tension, raised the minimal fusion frequency (MFR) for tetanic contraction to occur and did not alter the twitch/tetanus tension ratio. Tetanus tension unlike twitch tension was not significantly decreased on day 3. 4. Caffeine (5-500 microM)--and isoprenaline (0.001-0.8 microM)-induced potentiations of twitch contraction were attenuated in a concentration-dependent manner by bath-applied Chlo and by acute and chronic administration of Chlo. Higher concentrations of caffeine (0.1-5 microM) and KCl (10 mM-130 mM) produced contracture of the muscle which was sensitive to inhibition by Chlo (50-150 microM). Moreover, the spike contractions superimposed on caffeine contracture were more sensitive to the inhibitory effect of Chlo than the contracture. 5. The inhibitory effects of dantrolene sodium and (+)-tubocurarine on MS and on indirectly stimulated hemidiaphragm respectively were not significantly altered by acute and chronic administration of Chlo. In contrast, the inhibitory concentration-response curve to procaine was shifted to the right. 6. The inhibitory effect of bath-appled Chlo, or acute and chronic pretreatment on twitch tension (MS) was not significantly antagonized by stepwise increase in extracellular Ca2 + (0.05-2.5 mM). Sodium thiocyanate (1-5 mM) reversed in a concentration-dependent manner the inhibitory effects of Chlo. 7. Complete recovery of twitch contractions occurred after 3 days of stopping daily Chlo administration, with partial recovery to tetanic tension after 28 days and no recovery of MFR. The reactivity of the diaphragm to bath applied Chlo was progressively restored, whereas the tension curve area to caffeine and KCI was still attenuated even 28 days after stopping Chlo pretreatment. 8. It is concluded that acute and chronic Chlo administration results in changes in reactivity of the hemidiaphragm muscle to electrical stimulation and to drugs such that there is a decrease in muscle strength and tolerance to Chlo in vitro. These effects are dependent on its direct inhibitory action on skeletal muscle and may result from interference with Ca2 + mobilization within the muscle.

Hysterosalpingogram, laparoscopy and hysteroscopy in the assessment of the infertile Nigerian female.

Sixty-nine infertile Nigerian females were evaluated with hysterosalpingogram (HSG), laparoscopy and hysteroscopy as part of infertility workup at the endocrine-infertility clinic of the Jos University Teaching Hospital. HSG showed evidence of tubo-peritoneal disease in 45 (65%) women. This was confirmed by laparoscopy in 41 women giving an accuracy of 91% and a false positive rate of 9%. Intrauterine abnormalities were shown on HSG in 4 women and confirmed in 3 women at hysteroscopy giving an accuracy rate of 75% or a false positive rate of 25%. Intrauterine abnormalities were detected in 21 women in whom HSG was normal, giving a false negative rate of 30.4% for HSG. Tuboperitoneal disease was found at laparoscopy in 6 women in whom HSG was normal, giving a false negative rate for HSG of 8%. Our data confirm that laparoscopy and hysteroscopy are superior to HSG in detecting tubo-peritoneal and uterine abnormalities. Despite these findings, we believe that the three procedures are complementary in the evaluation of infertile couples in this country.

Determination of gestational age by beta-subunit HCG measurement.

The accurate knowledge of gestational age is important in most Obstetric decisions near term. Gestational age estimation by a single measurement of beta-subunit HCG in early pregnancy was assessed in 164 Nigerian Women attending the antenatal clinic of Jos University Teaching Hospital. The mean difference between estimated gestational age by HCG concentrations and by recorded dates of last menstrual period was 2.8 +/- 1.6 days (mean +/- SD). This relationship was valid only for samples randomly selected between 35 and 56 days of gestation. We conclude that single measurement of HCG in early pregnancy provides accurate estimation of gestational age.