Triplet Gestation: Clinical Outcome of 14 Cases

Background/Objective: To determine maternal complications and fetal outcome of triplet gestations. Method: Retrospective study of pregnant women with triplet gestation managed in 10 years. Results: Fourteen women were managed with triplet gestation, of these, (71.4%) were booked for antenatal care and four (28.6%) were unbooked. The mean age of the women was 31.3 years. The age range was between twenty seven years and thirty nine years. The mean gestational age at diagnosis for the booked women was 18.6 weeks. Of the fourteen patients, ten (71.4%) had spontaneous conception, three (21.4%) followed ovulation induction and one (7.2%) resulted from invitro fertilization and embryo transfer. Two (14.3%) patients had cervical cerclage based on their past obstetric history and assessment of the cervix. Six (42.9%) patients were hospitalized and treated for preeclampsia 3 patients, spontaneous abortion 1 patient and cervical incompetence 2 patients. Eleven (78.6%) patients had preterm birth. The mean gestational age at delivery was 33.4 weeks. Of the thirteen deliveries, nine (69.2%) had caesarean section and four (30.8%) delivered per vaginam. A total of thirty nine babies were delivered, thirty four (87.2%) babies survived and five (12.8%) died. Perinatal mortality was 11.9% and the "take home" baby rate was 81%. Conclusion: Antenatal care with initiation of specialized prenatal care and planned delivery in triplet gestation improves fetal outcome.Introduction/Objectif: D\ue9cider des complications maternales et r\ue9sultat foetal du gestation tripl\ue9e. M\ue9thodes: Etude r\ue9trospective de grossess femmes avec gestation tripl\ue9e trait\ue9es la 10 ans. R\ue9sultats: Quatorze femmes trait\ue9es avec gestation tripl\ue9e, parmis lesquelles 10, soit 71,4% ont \ue9t\ue9 inscrites pour des soins ant\ue9nataux et quatre soit 28,6% ne s'\ue9taient pas inscrites. L'\ue2ge moyen des femmes \ue9taient 31,3 ans. Tranche d'\ue2ge \ue9tait entre vingt sept et trente neuf ans. Moyen d'\ue2ge gestationnaire pendant diagnostic pour des femmes inscrites \ue9tait 18,6 semaines. Entre le quatorze patientes, dix (71,4%) avaient eu la conception spontan\ue9e, trois soit 21,4% ont suivi d\ue9clenchement ovulaire et une soit 7,2% est attribuable \ue0 la fertilisation invitro et transfert d'embryon. Deux soit 14,3% patients avaient eu un cerclage cervical \ue0 cause de leur dossier obst\ue9trique du pass\ue9 et \ue9valuation de l'ut\ue9rus. Six (42,9%) patients avaient eu accouchement pr\ue9terme. Age moyen gestational pendant accouchement \ue9tait 33,4 semaines. Parmi les trieze accouchements, neuf soit 69,2% avaient eu la c\ue9sarienne et quatre soit 30,48% ont accouch\ue9 par vaginam. Un total de trente neuf b\ue9b\ue9s ont \ue9t\ue9 accouch\ue9s, trente quatre soit 87,2% b\ue9b\ue9s suvivent et cinq soit 12,8% morts. Mortalit\ue9 p\ue9rinatale \ue9tait 11,9% et le taux de \uab take home \ubb b\ue9b\ue9 \ue9tait 81%. Conclusion: Des soins ant\ue9nataux avec initiation des soins pr\ue9nataux sp\ue9cialis\ue9s et accouchement bien organis\ue9 dans la gestation tripl\ue9e am\ue9loire le r\ue9sultat fetal

Umbilical Cord Prolapse In Kaduna, Northern Nigeria: A Study Of Incidence

Prolapse of theumbilical cord is a live threatening obstetric emergency for the fetus-infant. To determine, the incidence of cord prolapse in the hospital. A-12½year retrospective study of all women who presented with cord prolapse in labour at a university teaching hospital. During the period therewere16633 deliveries and 34women presentedwith cord prolapse, giving an incidence of 2.0 per 1000 (1 in 504 deliveries). Highest incidence occurred in women of 35 years and above (5.0 per 1000); in the 25-29 years group 2.3 per 1000 and in those less than 20 years old 1.3 per 1000. The highest incidence of cord prolapse was in the para 5 and over, 2.4 per 1000; para 0, 2.0 per1000 and paras 1 4, 1.9 per 1000.The incidence of cord prolapse in the unregisteredwomenwas 5.2 per 1000, and in the registered 1.5 per 1000. The highest incidence was in the Hausa/ Fulani ethnic group 3.4 per 1000; the Yoruba ethnic group, 2.1 per 1000 ; the Northernminority ethnic group , 2.0 per 1000; the Ibo ethnic group, 1.0 per 1000. No case of cord prolapse was recorded among women of Southern minority ethnic group. The incidence of cord prolapse among preterm births was, 62.7 per 1000, breech, 32.5 per 1000; shoulder, 133.3 per 1000 , twin births.16.8 per 1000 and cesarean births, 11.4 per 1000. Cord prolapse is an uncommon obstetric complication, the incidence of which is determined by the influence of various factors acting individually or in synergy. Keywords: Cord Prolapse, incidence,Kaduna,Nigeria. Nigerian Journal of Clinical Practice Vol. 11 (4) 2008: pp. 316-31

Nutritional Status of Primary School Children in Ilorin-West LGA, Kwara State, Nigeria

Background: Malnutrition in children remains a global health problem in developing countries including Nigeria. Nearly half of all under-five deaths in Africa and South-East Asia can be traceable to malnutrition. The nutritional status of primary school children in Ilorin-West Local Government Area of Kwara State is not known, therefore the study set out to determine this and its associated factors.Methods: This study was a descriptive cross-sectional study carried out between February and May 2016 across 16 primary schools in Ilorin-West LGA. Four hundred and eighty school children aged 6-12 years were recruited into the study through a multi-stage sampling technique. Anthropometry was taken following standard procedures; weight was measured with a digital bathroom weighing scale (Camry, Model: EB9323H, China), while height was measured with a stadiometer (Seca Model: 213, USA). Anthropometric indices were determined. Data collected was analysed using the IBM Statistical Package for Social Sciences (SPSS) Tm version 20.0 for windows.Results: The prevalence of underweight, stunting, wasting and obesity were 3.0%, 5.0%, 4.4% and 1.0%, respectively. Stunting was more prevalent among female pupils, pupils attending the public primary schools and children of mothers with no formal education, while obesity was more prevalent in the private primary schools.Conclusion: The prevalence of obesity recorded in this study confirms the emerging concept of ‘the double burden of malnutrition,’ and poses a public health challenge to policy makers. It is recommended that community nutrition enlightenment campaigns be strengthened and possibly school meals be re-introduced to both private and public schools. Keywords: Nutritional status; School-aged; Stunting; Wasting; Obesit

Knowledge, practice and acceptability of HPV vaccine by mothers of adolescent girls in Ilorin, Nigeria

Background: Human Papilloma Virus (HPV) is a sexually transmitted cause of carcinoma of the cervix. An important determinant of the success of a primary preventive strategy like HPV vaccination is the knowledge and willingness of parents to vaccinate adolescents before sexual debut. Materials and methods of study: A cross sectional descriptive survey of mothers of girls in 8 secondary schools in Ilorin was carried out from February to April 2015. Schools were selected using multi staged sampling. Descriptive and inferential statistics were performed with Chi Square and ANOVA. Results: There were 470 questionnaires returned for analysis out of 600, giving a response rate of 78.3%. One hundred and sixty-one (34.3%) knew HPV to be sexually transmitted infection and 40.4% knew it was the cause of cervical cancer. While 35.1% were aware of HPV vaccine, only 1.9% had ever vaccinated their children.Less than half (44.9%) were willing to vaccinate their children. Women with good knowledge of HPV and cervical cancer were more willing to vaccinate their children than women with poor knowledge (P <0.001). Conclusion: There is poor knowledge of HPV and practice of vaccination among mothers in llorin. Willingness of mothers to vaccinate their daughters is suboptimal. Mother’s knowledge is an important determinant of HPV vaccination of adolescents

Ovarian Pregnancy Presenting as Ovarian Tumour: Report of 2 Cases

We present 2 cases of ovarian masses diagnosed as tumours but turned out to be pregnancy. Ovarian pregnancy, a form of ectopic gestation has a distinct pathology though it can be a source of diagnostic difficulty clinically and intraoperatively. A total of 71 ectopic pregnancies were seen in the department from January 2001 to December 2005, of these only two were ovarian ectopics. Both patients were nulliparous and presented with lower abdominal pains, abdominal masses and menstrual irregularity. They both had laparotomy and total right salpingo-oophorectomy. Grossly, the ovaries were enlarged, grey tan and globular. Focal ruptures in the wall of the ovaries showed protruding fetal parts. Microscopy showed chorionic villi within and in continuity with ovarian stroma and corpus luteum. They were both diagnosed ovarian ectopics. A good knowledge and understanding of the gross pathology, combination of imaging studies and high index of suspicion should help in making an intra-operative diagnosis.Nous pr\ue9sentons deux cas de masse ovariennes diagnostiques cliniquement comme des tumeurs mais apr\ue8s histologiquement ce sont r\ue9v\ue8les \ueatre des grossesses ectopiques. Les grossesses ovariennes, une forme de grossesse ectopique as une pathologie distincte est es difficilement diagnostiqu\ue9e cliniquement. Un total de 71 grossesses ectopiques a \ue9t\ue9 vues au D\ue9partement de Pathologie entre Janvier 2001 et D\ue9cembre 2005. Deux grossesses \ue9taient des grossesses ovariennes. Les deux patientes \ue9taient nullipares et ce sont pr\ue9sent\ue9es avec des douleurs au bas ventre, des tumeurs abdominales et des menstruations irr\ue9guli\ue8res. Les deux ont eu une exploration abdominale suivie d'une salpingoovarectomie. Anatomiquement, les ovaires \ue9taient, gris, globulaire, et hypertrophier. Des ruptures de la paroi ovaire montrait des protrusions d'\ue9l\ue9ments foetal. Histologiquement les ovaires ont r\ue9v\ue9l\ue9s les villosit\ue9s chorioniques dans et en continuit\ue9 avec le stroma ovarien et le corpus luteum. Les deux ovaires ont \ue9taient diagnostiqu\ue9s comme grossesse ovarienne. Une bonne connaissance et un bon entendement de l'anatomie-pathologie, une combinaison de l'imagerie et un fort taux de suspicion aide a faire un diagnostique clinique

Antimicrobial susceptibility of Leptospira isolates from dogs and rats to 12 antimicrobial agents

Abstract. This study determined the antimicrobial susceptibilities of 67 isolates of Leptospira from dogs (suspect canine cases: n=7 and stray dogs: n=6) and rodents (n=54) in Trinidad to 12 antimicrobial agents using broth microdilution and macrodilution techniques. Commonly used antimicrobial agents such as the penicillin G and ceftriaxone had relatively low minimal inhibitory concentrations (MICs) while doxycycline displayed a relatively higher value but was still considered to be effective. While imipenem was the most effective with low MIC values in vitro, sulphamethoxazole-trimethoprim had the highest i.e. least effective. Based on these results, the drugs commonly used in the treatment of leptospirosis (penicillin G, penicillin-streptomycin, doxycycline and ceftriaxone) in both humans and animals in Trinidad appear to have similar MICs and MBCs in vitro when compared with published reports. The serovar of Leptospira spp. and in most cases the origin of the isolates did not significantly (P>0.05) influence their susceptibilities to the antimicrobial agents tested

Epidemiology of Coxiella burnetii infection in Africa: a OneHealth systematic review

Background: Q fever is a common cause of febrile illness and community-acquired pneumonia in resource-limited settings. Coxiella burnetii, the causative pathogen, is transmitted among varied host species, but the epidemiology of the organism in Africa is poorly understood. We conducted a systematic review of C. burnetii epidemiology in Africa from a “One Health” perspective to synthesize the published data and identify knowledge gaps.<p></p> Methods/Principal Findings: We searched nine databases to identify articles relevant to four key aspects of C. burnetii epidemiology in human and animal populations in Africa: infection prevalence; disease incidence; transmission risk factors; and infection control efforts. We identified 929 unique articles, 100 of which remained after full-text review. Of these, 41 articles describing 51 studies qualified for data extraction. Animal seroprevalence studies revealed infection by C. burnetii (≤13%) among cattle except for studies in Western and Middle Africa (18–55%). Small ruminant seroprevalence ranged from 11–33%. Human seroprevalence was <8% with the exception of studies among children and in Egypt (10–32%). Close contact with camels and rural residence were associated with increased seropositivity among humans. C. burnetii infection has been associated with livestock abortion. In human cohort studies, Q fever accounted for 2–9% of febrile illness hospitalizations and 1–3% of infective endocarditis cases. We found no studies of disease incidence estimates or disease control efforts.<p></p> Conclusions/Significance: C. burnetii infection is detected in humans and in a wide range of animal species across Africa, but seroprevalence varies widely by species and location. Risk factors underlying this variability are poorly understood as is the role of C. burnetii in livestock abortion. Q fever consistently accounts for a notable proportion of undifferentiated human febrile illness and infective endocarditis in cohort studies, but incidence estimates are lacking. C. burnetii presents a real yet underappreciated threat to human and animal health throughout Africa.<p></p&gt

Psychosocial implications of tubal ligation in a rural health district: A phenomenological study

<p>Abstract</p> <p>Background</p> <p>Tubal ligation is the most popular family planning method worldwide. While its benefits, such as effectiveness in protecting against pregnancies, minimal need for long-term follow-up and low side-effects profile are well documented, it has many reported complications. However, to date, these complications have not been described by residents in Congo. Therefore, the study aimed at exploring the experience of women who had undergone tubal ligation, focusing on perceptions of physical, psychological and contextual experiences of participants.</p> <p>Methods</p> <p>This qualitative study used a semi-structured questionnaire in a phenomenological paradigm to collect data. Fifteen participants were purposefully selected among sterilized women who had a ligation procedure performed, were aged between 30 and 40 years, and were living within the catchment area of the district hospital. Data were collected by two registered nurses, tape-recorded, and transcribed verbatim. Reading and re-reading cut and paste techniques, and integration were used to establish codes, categories, themes, and description.</p> <p>Results</p> <p>Diverse and sometimes opposite changes in somatic symptoms, psychological symptoms, productivity, ecological relationships, doctor-client relationships, ethical issues, and change of life style were the major problem domains.</p> <p>Conclusions</p> <p>Clients reported conflicting experiences in several areas of their lives after tubal sterilization. Management, including awareness of the particular features of the client, is needed to decrease the likelihood of psychosocial morbidity and/or to select clients in need of sterilization.</p