Effectiveness of 3 doses of Intermittent Preventive Therapy with Sulphadoxine-Pyrimethamine in Pregnancy

Background: In 2014, Nigeria scaled up to at least 3 doses of intermittent preventive therapy in pregnancy with Sulphadoxine-Pyrimethamine (ITPp-SP). While the fact of existing evidence as to the superiority of SP3 over SP2 was shown by WHO back in 2012, the Nigerian Government domesticated it in her Federal Ministry of Health guideline for the prevention of Malaria in pregnancy of 2014. Studies leading to the pronouncement were mainly in East African Countries where the density / pattern of infection as well as the species of the plasmodium tend to vary with what is occasionally obtainable in West African sub-region including, Nigeria. There was an apparent need for the measurement of the effectiveness in hyper / holo-endemic country like Nigeria. Aim : To determine the efficacy and safety of 3-doses compared with 2-doses of intermittent preventive therapy in pregnancy with sulphadoxine-pyrimethamine (SP) for the prevention of placental malaria and associated low birth weight. Subjects and Methods: Nine hundred and twenty (920) pregnant women were randomised to receive either 2 doses (SP2) or 3 doses (SP3) of sulphadoxine-pyrimethamine between December 2013 and August, 2014. Pre-delivery blood samples were collected for maternal haemoglobin as well as placenta blood samples for placenta parasitaemia. The Neonates were weighed and followed-up. Prevalence of placental parasitaemia, low birth weight (LBW), preterm birth and anaemia were analysed using intention-to-treat (ITT) and per-protocol (PP) analysis. Results: Data from 910 women were analysed (458 in the SP2 and 452 in the SP3 group). Overall, the incidence of placenta parasitaemia, low birth weight and pre-delivery anaemia in pregnancy were significantly lower among the SP3 group compared with those that had two doses (Sp2), p < 0.001for all factors. There was no neonatal jaundice in either group. Conclusion: Addition of a third dose of SP to the current popular two doses of IPT-SP demonstrated a better outcome in the reduction of placenta parasitaemia, LBW and, anaemia in pregnancy among many more advantages. It would be worthwhile to domesticate the at least, 3 dose of IPTp-SP to all pregnant women in our current practice.Keywords: Malaria, Prevention, Pregnancy, Sulphadoxine-Pyrimethamin

Family planning practice in a tertiary health institution in north-western Nigeria

Background: Family planning in our environment had remained a delicate issue that is still reluctantly being accepted based on religious belief and the perception that it is synonymouswith population control. Objective: This study was carried out with the objectives of identifying the characteristics of contraceptive acceptors in our family planning unit, their source(s) of information andmethods of preference among others. Materials and methods: The record cards of all clientswho attended the family panning clinic between January 1 1998 and December 31 2002 as well as the theatre records of patients that had bilateral tubal ligation (BTL) during the study period were reviewed. Relevant information on biodata, reasons for family planning, methods of choice and reasons for discontinuationwere extracted and analysed.Comparative percentagewas used for the analysis. Result: A total of 839 clients requested and were served with contraceptives during the study period with an acceptor rate of 167.8/annum. Over75%of the acceptors were Muslims. The main reason for selecting family planning services was for child spacing (84.9%) with only 12% requiring the service to end the reproductive carrier. Antenatal/postnatal clinics were theirmain source(s) of information about family planning services. Conclusion: The study revealed that the practice rate of family planning in this community is still low. Female education, use of religious / traditional leaders alongwith improved dissemination of information using themass mediamay go alongway to increase  contraceptive up take. Keywords: Family planning, acceptance,Muslimcommunity

Foeto-maternal outcome of HIV-positive pregnant women on highly active antiretroviral therapy

Background: A human immunodeficiency virus (HIV) infection in pregnant women is an important medical challenge. There exist varied reports on the foeto-maternal outcome amongst HIV positive women in Africa. Aim: The study was to compare the foeto-maternal outcome among HIV-positive pregnant women who are on HAART with those that are HIV-negative. Methods: A comparative, case-control study of booked HIV-positive and HIV-negative women attending ante-natal clinic (ANC) in Abuja. One hundred and five serial eligible HIV-positive women who booked for ante-natal care between October 8, 2012 and April 29, 2013 were recruited and matched with the control. They were followed up to six weeks post-partum. Live babies were tested for HIV using DNA polymerase chain reaction (PCR) at six weeks post-partum. The data was analysed using statistical package for social science (SPSS) version 16. Chisquare at < 0.05 at confidence level of 95% and Student t-test were used to determine significant association. Results: There were 112 HIV positive pregnant women among 1683 pregnant women during the study period giving a prevalence of 6.7%. The rate of preterm delivery was significantly higher among the HIV positive women (33% Vs 18%, P= 0.005). There was no case of vertical transmission. Conclusion: Maternal HIV infection was significantly associated with preterm delivery. There was no recorded vertical transmission. Strengthening the use of HAART may maintain zero vertical transmission among other precautionary measures. Key words: HIV, HAART, pregnancy outcome, maternal and child health, vertical transmission, booked patien

Ruptured uterus in a booked patient

Ruptured uterus, a life-threatening obstetric complication, is a rare event among booked patients. We present a case of uterine rupture in a 28-year-old Gravida 2.para 1+0, 1 alive with previous lower segment Caesarean scar due to neglected obstructed labor from fetal macrosomia. She presented in labor at 40 weeks of gestation after declining the advice for an elective Caesarean section (C/S) and also signed against medical advice to receive care from a traditional birth attendant. She returned 30 hours later with a ruptured uterus. Findings at operation included a macerated stillbirth weighing 4.30 kg and a lower segment transverse scar rupture. Subtotal hysterectomy and peritoneal lavage were performed

Elective caesarean section in a tertiary hospital in Sokoto, north western Nigeria

Background: Elective caesarean sections have been considered safer for both mother and the fetus compared to their emergency counterpart. However, emergency caesarean sections have continued to form bulk of caesarean deliveries in our facility. Objective: The objective of this study was to determine the caesarean section rate together with the trend, indications, and maternal mortality associated with elective caesarean operation. Materials and Methods: A retrospective analysis of clinical records of all the patients that had caesarean section between January 2002 and December 2010 (9 years) at Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto, Nigeria was conducted. Results: During the 9 year study period, 2284 caesarean sections were performed out of 22,985 total deliveries at UDUTH Sokoto, thus giving a caesarean section rate of 9.9%. Emergency and elective operations accounted for 1784 (78.2%) and 498 (21.8%) of the cases respectively. The rate of elective caesarean section increased from 1.7% in 2002 to 3.2% in 2007. Thereafter it declined gradually to 1.8% in 2010. Repeat caesarean section (30.7%) and malpresentation (17.1%) were the most common indications for elective caesarean operation. There were 18 maternal deaths from caesarean section and only one from the elective caesarean procedure. Conclusion: The rising trend in the elective caesarean section rate in this study underscores the need for better and improved patient selection together with counseling on its benefits and risks. This is because despite the fact that it is safer than emergency caesarean operation, it is not entirely devoid of complications. Routine use of spinal anesthesia in performing the procedure should be encouraged.Key words: Elective caesarean section, sokoto, Nigeri

Awareness and utilization of insecticides treated mosquito nets among pregnant mothers at tertiary health institution in North-Western Nigeria

No Abstract

Cervical Ripening: How Long can the Foley Catheter Safely Remain in the Cervical Canal?

This was a prospective study involving 85 patients admitted for induction of labour with unfavourable cervix at Usman Danfodiyo University Teaching Hospital, Sokoto, Nigeria. A size 16-20 Foley catheter was passed transcervically into the extra-amniotic space under aseptic technique and the balloon inflated with 30-50mls sterile water. Each patient was placed on prophylactic antibiotics. The balloon was expelled within 12 hours in 22 (39%) patients. Twenty eight patients expelled the balloon in 12-24 hours, 14 in 25-48 hours, 6 in 49-72 hours and 4 after 72 hours. The average duration of catheter placement when the gestational age was 20-27 weeks was 44.8 hours, which was significantly longer than 19.6 hours obtained for term pregnancies (p < 0.05). Induction of labour was successful in 77 (91%) patients and there was no significant maternal morbidity. The results of our study suggest that the balloon of the Foley catheter can safely remain in the extra-amniotic space longer than 24 hours for cervical ripening if the cervix is unfavourable, provided the membranes are intact and the feto-maternal conditions remain satisfactory. (Afr J Reprod Health 2002; 6[3]: 98-102) Résumé La maturation du col: Pour combien du temps peut rester la sonde de Foley en sécurité dans la cavité du col? Il s\'agissait d\'une étude prospective concernant 85 patientes qui ont été admises au Centre Hospitalier Universitaire Usman Danfodiyo à Sokoto, Nigéria pour le déclenchement du travail avec du col hostile. Une sonde de Foley à la taille 16-20 a été introduit transcervicalement dans l\'espace extra-amniotique sous la technique aseptique, le ballon ayant été gonflé de 30-50 mls de l\'eau stérile. Chaque patiente prenait des antibiotiques prophylactiques. Le ballon fut expulsé en 12 heures chez 22(39%) des patients. 28 patientes ont explusé le ballon en 12-24 heures, 14 en 25-48 heures, 6 en 49-72 heures et 4 après 72 heures. La durée moyenne pour la mise en place d\'une sonde quand l\'âge gestationnel était 20-27 semaines était 44,8 heures, ce qui était plus long que 19,6 heures que nous avons obtenu pour les grossesses à terme (p < 0,05). Le déclenchement du travail a réussi chez 77 (91%) des patients; il n\'y avait pas de morbidité maternelle appréciable. Les résultats de notre étude ont montré que le ballonet de la sonde de Foley peut rester en toute sécurité dans l\'espace extra-amniotique plus de 24 heures pour la maturation du col si le col est hostile, pourvu que les membranes soient intactes et que les conditions foeta-maternelles restent satisfaisantes. (Rev Afr Santé Reprod 2002; 6[3]: 98-102) KEY WORDS: Catheter balloon, cervical ripening, insertion-expulsion interva

Papanicolaou Smear in Abuja Revisited

Background: Papinicolaou smear has been established as a cost effective screening method for Carcinoma of the cervix and had been used with celebrated successes in developed societies. Its utilization has remained abysmally low in Africa with attendant alarming rate of overt advanced cancer among her female population. Recent government public outreach programs abound and there is need to evaluate the effectiveness of these campaigns on the outcome of smear results with a view of future adjustment in outreach strategy.Objectives: To review the results of Pap smears conducted in University of Abuja Teaching Hospital with a view of documenting the prevalence of positive smears among the study population.Materials and Method: A three year retrospective study of Pap smears that were carried out at the University of Abuja Teaching Hospital between January 1, 2010 and December 31, 2012. The records of the patients were retrieved from medical record Department and analysed for age of the patient, parity, educational status, marital status, findings on vaginal examination, indication for pap smear and Pap smear results. The results were presented and discussed using simple percentages.Results: One thousand two hundred and seventy four (1274) women had cervical smears during the study period. Ninety eight percent of patients were having their cervical screening for the first time at the mean age of 39.13±9.7 years. Positive Pap smear result was obtained in 39.5% of symptomatic and 24.4% of asymptomatic patients while Negative smears were recorded in 63.8% of the patients. Human Papilloma Virus (HPV) changes occurred in 5.7%, while atypical cells of undetermined significance (ASCUS) were observed in 4.9% of the patients. Low grade squamous intraepithelial lesions (LSIL) were the commonest cervical smear abnormality observed in 9.6% of the patients.Conclusion: The mean age at first screening remain high with corresponding high rate of abnormal smear in both symptomatic and asymptomatic patients. The provider initiated counseling and testing is encouraged for early identification and treatment of precancerous lesions of Carcinoma of Cervix. Development and strict adherence of a National guideline for free routine screening of all women of reproductive life may increase the uptake.Key words: Cervical cancer, Screening, Pap smear, Utilization

Performance of West African Dwarf Goats fed maize stover based diet supplemented with Roxazyme G2®in the dry season in Abeokuta, Nigeria

The study was carried out to investigate the effect of exogenous fibrolytic enzyme additive (containing cellulase, xylanase and beta glucanase) on the growth performance and nutrient digestibility parameters of West African dwarf (WAD) goats fed total mixed ration in the dry season. A total of sixteen (16) WAD goats were subjected to a 70-day feeding trial in a completely randomized design. A total mixed ration was formulated with enzyme added at 0.0, 0.2, 0.4 and 0.6g/kg DM. Feed intake and weight changes of the goats were monitored. Nutrient digestibility and nitrogen utilization were also determined. Enzyme additive significantly (P&lt;0.05) improved daily feed intake and weight gain of the goats. The best feed conversion ratio (8.34) was obtained at 0.4g/kg DM enzyme inclusion level. Crude protein digestibility was also highest (81.01%) at 0.0.4g/kg DM enzyme inclusion level. The enzyme could be included in a total mixed ration for West African Dwarf goats at 0.4g/kg DM for improved feed intake, weight gain and nutrient digestibility.Keywords: Dry season, Growth performance, Nutrient Digestibility, Total mixed ratio