CD4 Changes in HAART-Naive HIV Positive Pregnant Women on HAART: Low Resource Setting Experience

PURPOSE: PMTCT interventions, especially initiation of Highly active antiretroviral therapy (HAART) has modified the natural history of HIV infection by reducing both peripartal and neonatal HIV infections, but the pattern of the immunologic responses of these pregnant women to HAART remains speculative. It is hoped from this study, to describe the pattern of immunologic response of naïve, HIV positive pregnant women on their first initiation on HAART. METHODS: This study described the pattern of CD4 changes observed in freshly diagnosed 126 HIV positive pregnant women, stratified into the trimesters of pregnancy and commenced on HAART (Zidovudine, Lamivudine and Nevirapine) for a period of 2 months in pregnancy. CD4 counts were determined at point of recruitment and monthly thereafter using a Parteccytometer counter (Cyflow(R)). Neonatal outcome was also described. RESULTS: Our findings suggest better immunologic response and fewer neonatal infectionsin group of naïve women initiated on HAART while in the first 26 weeks of pregnancy and lesser response in those commenced in the third trimester of pregnancy.CONCLUSION: Concerted efforts should be directed towards the initiation of HAART prophylaxis before end of 2nd trimester of pregnancy.Keywords: PMTCT, pregnant women, HAART, CD4 change

Evaluation Of Loan Disbursement And Repayment Of Supervised Credit Scheme Of Nigeria Agricultural Cooperative And Rural Development Bank(Nacrbd) In Zaria And Kaduna North Local Government Areas Of Kaduna State, Nigeria

The study examined the activities of NACRBD with a view to determine the amount of loan disbursed compared to amount of loan applied for, the nature of loan repayment performance of beneficiaries of NACRDB credit loan, lapses associated with loan to disbursement and repayment schedules and impact of proper supervision on loan recovery. Data for the study were collected through questionnaires, a total number of fifty(50) beneficiaries of NACRDB credit scheme were selected randomly from the study areas . Data collected were analysed using simple descriptive statistical tools, such as mean, percentage and frequency table in order to achieve the stated objectives. From the evaluation of loan schemes, it was found that there were short fall when comparing the amount of loan applied for, to the actual amount disbursed to beneficiaries, loan were nottimely granted some sincere seekers were unable to benefit from credit scheme partially due to lack of adequate financing of NACRDB by the apex bank; the efficiency of methods employed by the bank as regard to loan supervision was scored low as a result of low rate of loan recovery, which will not augur well, if the bank’s contribution to the development agricultural sector of the economy was to be sustained. It was recommended that loans should be disbursed on time to farmers as at when due so that they can make use of it for agricultural production, NACRBD should employ better strategy to recover outstanding debts and reduce interest charge on loans

Characteristics of patients presenting with complications of abortion in a tertiary health facility in south-west Nigeria

Objectives: Abortion is associated with significant healthproblem with short- and long-term complications that affect the quality of life of those who are fortunate enough to escape mortality. This study evaluated the population of patients with complications of abortion, identified the abortion providers and the pattern of contraceptive usage in these patients managed in our hospital, and suggests strategies on the required heath intervention.Design: The design was a descriptive study of cases of abortions with complications.Setting and subjects: We reviewed all (225) cases of abortions with complications managed at Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria, over a five-year period.Outcome measures: Records of patients managed for abortion-related complications were retrieved, data were extracted and analysis was carried out for socio-demographic factors and other abortion-related characteristics.Results: The study showed a more common occurrence of abortions among middle-aged (64.4%), multiparous (53.3%) women with a low socio-economic background (62.6%), and they were performed mostly by medical doctors in private settings (37.8%). The low usage of contraception (11.1%) was of significance.Conclusion: This study provided considerable insight into the complications of abortion in a tertiary institution in Nigeria. Most of the patients were aware of contraception, but usage, which mainly constituted emergency contraception, was low. Despite prophylactic antibiotics, sepsis was the most common observed complication. Healthcare intervention should bere-focused through the encouragement of the adoption of effective methods to prevent unwanted pregnancies. Healthcare providers should re-appraise their antibiotics regimen.Keywords: unsafe abortion, abortion complications, contraception, Nigeri

Knowledge and Determinants of Emergency Contraception use Among Students in Tertiary Institution in Osun State, Nigeria

Background: Emergency contraception (EC) or postcoital contraception has the potential to reduce the number of unwanted pregnancies and thus the abortion rate. Tertiary institutions’ students are a unique group with very high social interaction, but by virtue of their level of education, probably forms a group in any community, which should have an overall higher level of awareness and use of available methods of contraception, including that of EC.Aim: The aim of this study was to assess the knowledge and attitude toward EC, and as well to determine the prevalence of emergency contraceptive use among the students of tertiary institutions in Osun State, Nigeria.Subjects and Methods: A cross‑sectional study using the self‑administered structured questionnaire on questions relating to the socio‑demographic characteristics of the students, sexual relations, knowledge of contraception in general and EC, use and determinants of EC use.Results: A total of 384 of the 400 questionnaire were returned of which male respondents were178/384 (46.4%) while the females were 206/384 (53.6%). Two hundred and seven respondents 207/384 (53.9%) were university students, while 177/384 (46.1%) were polytechnic students. Most respondent 142/376 (37.8%) derived knowledge of EC from friends and family life education from school 186/373 (49.9%). More than half of respondents are in sexual relationships, with only 71/384 (18.5%) showing good knowledge of EC. However, use of EC was 106/384 (27.6%).Conclusion: Most tertiary institutions’ students are involved in a sexual relationship, have poor knowledge of EC and use of EC also. Formal family life education, partner approval, and previous use of EC encourage further use. There is a need for carefully designed education programs and promotion of family life education with deliberate awareness on safe sex practices, including EC in existing students’ health enlightenment programs on campuses. Keywords: Emergency contraception, family life education, Nigeria, students, tertiary institutio

Prevalence of end-digit preference in recorded blood pressure by nurses: a comparison of measurements taken by mercury and electronic blood pressure-measuring devices

Objectives: When compared with the use of a mercury  sphygmomanometer, the use of a validated digital blood pressure (BP) measuring device eliminates the risk of exposure to mercury. Digital devices are also associated with a lesser degree of end-digit preference (EDP). EDP refers to the occurrence of a particular end digit more frequently than would be expected through chance alone. There have been only a few reports from Africa on the occurrence of EDP in BP measurement. This study examined EDP in BP taken by nurses before and after the introduction of a digital BP-measuring device. Design: The design was a retrospective study. Settings and subjects: We reviewed the BP readings of 58 patients who presented at the dedicated clinic for people living with human immunodeficiency virus/acquired immune deficiency syndrome of Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria, before and after the introduction of the digital BP-measuring device. Outcome measures: The prevalence of end-digit zero of systolic and diastolic BP readings before and after the introduction of the digital device was compared using McNemar’s test. Results: There was a large and significant fall in end-digit zero when BP readings that were taken using the mercury and digital devices were compared (systolic 98.1% vs. 10.9%, p-value < 0.001; diastolic 97.1% vs. 14.9%, p-value < 0.001 (McNemar’s test). Conclusion: There was a significant reduction in the frequency of end-digit zero when BP was taken with the digital devicerather than the mercury device. Regular training and certification of healthcare workers in BP measurement is recommended to ensure a high quality BP measurement standard.Keywords: blood pressure measurement, mercury sphygmomanometer, digital blood pressure-measuring devices, end-digit preferenc

Colorimetric Assay Of Naproxen Tablets by Derivatization Using 4-Carboxyl-2,6-Dinitrobenzene Diazonium Ion

A colorimetric assay of naproxen tablets based on chemical derivatization with the chromogenic reagent 4-carboxyl-2,6-dinitrobenzene diazonium ion was developed. The optimal reaction time was found to be 5 min at 30 oC after vortex mixing of the drug/reagent mixture for 10 s. The optimal analytical wavelength was found to be 470 nm and linearity of response was obtained between 1-7 μgml-1 of naproxen. The diazo coupling reaction occurred in a 2:1 reagent-drug stoichiometric ratio. The method is sensitive, accurate (mean recovery 101.06±3.06 %), reproducible (imprecision 3.03 % CV) and has a low limit of detection (0.95 μgm-1). It was applied in the assay of naproxen tablets with equivalent accuracy (p>0.05) to the official (BP) UV spectrophotometric method but combined the advantages of speed and more affordable instrumentation. The method can be applied in the in-process quality control of naproxen tablets.Keywords: Naproxen assay, 4-carboxyl-2,6-dintrobenzene diazonium ion (CDNBD), colorimetry, diazo coupling reactionEast and Central African Journal of Pharmaceutical Sciences Vol. 12 (2009) 8-1

Anaemia in pregnancy maternal and perinatal outcome in Ibadan, south western Nigeria

Background: Anaemia during pregnancy is a global public health issue that may be associated with adverse pregnancy outcomes. Ante natal care should be concerned with early detection and management of all degrees of anaemia in pregnancy.Objectives: To determine the prevalence of anaemia and associated pregnancy outcomes among expectant mothers attending ante natal clinic at the University College Hospital, Ibadan.Subjects, Methods and Materials:A descriptive, longitudinal study of the maternal and perinatal outcomes of anaemia among an obstetric population at the University College Hospital, Ibadan.Results: Prevalence of anaemia in pregnancy was 6.5% with mild and moderate anaemia accounting for 4.6% and 2.2% respectively. Mild to moderate anaemia were not associated with adverse maternal and perinatal outcomes Conclusion: Prevalence of anaemia in our environment appears to be falling. Adverse maternal and perinatal outcome are unlikely with mild to moderate levels of anaemia.Keywords: Anaemia in pregnancy, prevalence, maternal outcome, perinatal outcome

Mammographic parasitic calcifications in South West Nigeria: prospective and descriptive study

Introduction: Lymphatic filariasis caused by nematode parasite Wuchereria bancrofti and Brugia Malayi is endemic in the tropics. In Nigeria, 25% of the population is infected. Lymph edema and elephantiasis are the predominant manifestations. Its infrequent manifestation is in the breast. This paper discusses the epidemiology, reviews literature, imaging options and mammographic appearances of these parasitic nematodes. Methods: This prospective descriptive study reports on 39 cases of parasitic calcifications seen during mammography in the Radiology Department, University College Hospital between 2006 and 2012 in Ibadan, South West Nigeria. Each mammogram was reported by MO and ATS: assigned a final Bi-RADs category. Parasitic calcifications were further evaluated for distribution, and types of calcification. Results: A total of 527 women had mammography done between 2006 and 2012. Thirty-nine women (7.4%) had parasitic breast calcifications. The ages of the women ranged between 38-71 years - mean of 52.36±8.72 SD. Twenty-three (59%) were post-menopausal, 16(41%) were pre-menopausal. The majority (31; 79.5%) were screeners while 8(20.5%) were follow up cases. Approximately half (51.3%) of the women had no complaints. Pain (23.1%) was the commonest presentation in the remaining half. Solitary calcifications were predominant (20) while only 3 cases had 10 calcifications. Left sided calcifications (53.8%) were the majority. Calcifications were subcutaneous in 2/3rds of the women (66.7%) while the Yoruba tribe (84.6%) was principal. Conclusion: Parasitic breast calcifications can be misdiagnosed on mammography for suspicious micro-calcification. This publication should alert radiologists in a tropical country like Nigeria to increase diagnostic vigilance thereby preventing unnecessary anxiety and invasive work-up procedures.Key words: Parasite, mammography, calcificatio

Misconception about ultrasound among Nigerian women attending specialist and tertiary health institutions in Ibadan

Background: In women health, ultrasound is well established as a safe tool, and it is often the first imaging modality employed in the, screening, investigation and treatment of conditions in obstetrics and gynaecology. However, women's misconceptions about health issues, aetiology and treatment of diseases conditions may have negative impact on their health care seeking behaviour. Client's perspective of diagnosis including investigation process is therefore crucial in health care. This study aimed at finding out the misconceptions expressed by clients about ultrasound, and the potential predictors associated with this attitude among women in Nigeria.Method: A descriptive cross-sectional survey was conducted among 3137 women who presented for transabdominal ultrasound scan between August and November 2010 in two referral hospitals in Nigeria. Data were obtained using a questionnaire. Descriptive and multivariate analysis was performed applying logistic regression analysis; predictors of misconceptions  expressed by clients about ultrasound, and misconceptions among women in Nigeria were identified using SPSS Statistics (SPSS Inc, Chicago, IL) version 17 software.Results: The mean age of the women was 33.8 years (standard deviation = 7.9), with 88.8% currently married. More than half of the responders had tertiary education (56.6%), followed by secondary school education  (34.5%), primary education (7.8%) and no formal education (1.1%). There were 59 women who held the misconception that ultrasound was dangerous to health accounting for 1.9% of the study population. The reasons given by this group of women Included; 'ultrasound can kill or destroys the body cells' (35.6%); it can cause cancer (15.3%); 'the radiation is only dangerous to some organs of the body' (6.8%); it can harm or deform the fetus (6.7%); it is only dangerous when exposure is frequent (5.1%); and only dangerous when handled by unskilled medical personnel (1.7%).Conclusion: This study provides insight to the wide range of issues about clients' perception and misconception regarding ultrasound safety. These issues have to be addressed to improve better compliance and patronage about ultrasound scans in Nigeria. We suggest that robust counseling session is imperative to address all the views and possible concerns of clients to improve better service delivery

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 1st to May 31st 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.Key words: Cervical ripening, labour induction, misoprosto