Practice of healthy timing and spacing of pregnancy (HSTP), experience from a low resource setting

Context: Healthy Timing and Spacing of Pregnancy (HTSP) refers to the optimal time that a woman should conceive for the healthiest outcomes for the mother and the baby.Objective: This study assessed the adherence by Nigerian women of childbearing age to the WHO recommendations of optimal time to be observed by women before embarking on another pregnancy after child birth or a miscarriage.Materials and Methods: This was a cross-sectional descriptive study of 400 consecutive women attending the antenatal clinic of the University of Abuja Teaching Hospital. Interviewer administered questionnaire was used to collect information relating to healthy timing and spacing of pregnancy. The data was analyzed using SPSS windows version 20. Chi square test was used to test for associations between categorical variables with the level of significance set at p<0.05.Results: Two hundred respondents (50%) had birth to pregnancy interval of less than 24 months, while 14(3.5%) had birth to pregnancy interval of greater than 60 months. Overall, 249(62.2%) of women had an unhealthy timing or spacing of their pregnancies. Three hundred and forty (85%) were aware of at least a modern method of contraception but only 42(10.5%) had used contraceptives in the past. Awareness of normal inter-pregnancy interval of at least 24 months was seen in 271 (67.8%) women.Conclusion: Non-adherence to WHO's concept of HTSP is high in Nigeria's Federal Capital Territory. Awareness of the benefits of contraceptive use and HTSP amongst women of child bearing age needs to be stressed.Keywords: Healthy Timing and Spacing of Pregnancy, Antenatal Clinic, Abuja

Outcome of intrauterine adhesion management at a Nigerian tertiary hospital: a five-year review

Background: Intrauterine adhesion is a cause of menstrual abnormalities and infertility, which are leading complaints in gynaecological practice in Nigeria. Determining the aetiology and management option would help reduce this problem. The objective of this study was to determine the aetiology, mode of presentation, management option and outcome of intrauterine adhesionsMethods: A retrospective analysis of intrauterine adhesions at the University of Abuja Teaching Hospital over a five-year period from 2012 to 2016 was carried out. The case notes of the patients were retrieved from the records department and information extracted from these case notes using a questionnaire included the age, level of education, marital status, parity, complaints, predisposing factors, method of diagnosis, treatment method and outcome. Additional information was obtained from the theatre registered. The least follow up period was one year.Results: There were 82 patients diagnosed with Intrauterine Adhesion over the study period giving an incidence of 1.6%. Fifty-nine case notes were available for analysis. The case note retrieval rate was 72%. Majority of the patients were between the age range of 30-34 years (21, 35.6%). Those with tertiary level of education constituted the majority (34, 57%). Nullipara constituted 54.2% (32) of the total population. Menstrual abnormalities were the most common complaint with 93.2% and this includes those with menstrual abnormalities and other complaints. The commonest predisposing factor identified was a history of dilatation and curettage or uterine evacuation (28, 47.5%). Majority of the patients had partial intrauterine adhesions (51, 86.4%). All patients were treated with adhesiolysis, Foleys catheter insertion and hormonal therapy for 3 cycles. There was not statistical significance between those who had blind adhesiolysis and hysteroscopic adhesiolysis in terms of outcome. Restoration of menstrual flow was in 25, (42.4%) while 3, (5.1%) had miscarriges and an equal no of patients had term delivery.Conclusions: Dilatation and curettage is still a major predisposing factor in the development of intrauterine Adhesions. Blind adhesiolysis still has its place in the management of intrauterine adhesion in developing countries

Trends in female sterilization in north central Nigeria

Background: Contraception is key to the reduction of maternal mortality. Tubal ligation is a good option for women seeking out a safe, effective, permanent and convenient form of contraceptive. However, due to variety of reasons, there is aversion to it especially in developing world. The objective of this study was to determine the trends, uptake, socio-demographic characteristics of acceptors, indications and complications of bilateral tubal ligation (BTL) in our environment.Methods: A retrospective study of BTL at UATH was conducted over a five year period, from 1 January 2015 to 31 December 2019. The records of women who had BTL were retrieved from the medical records department, family planning clinic, and the theatre. The data was analyzed using SPSS 21.Results: The mean age and parity were 36.0±4.0 and 5.0±2.0 respectively. The incidence of BTL was 1.3%. Majority of those that had BTL had at least secondary level of education 100 (83.4%) and 58 (48.3%) were grand multiparous. Majority of cases 87 (72.5%) were done during caesarean section/laparotomy. Postpartum BTL accounted for 15.0%, while interval BTL accounted for 12.5%. Completed family size was the commonest indication 48.3%. No client came back with regrets. There was one case of failed BTL.Conclusions: BTL is a safe and effective method of sterilization. There is an increasing trend in utilization of BTL however the rate is still low

Digestibility and nutrient intake of African Giant Land Snails (Archachatina marginata) hatchlings fed municipal organic waste with foliage and grass/legume

Snails are important kind of micro livestock in the animal industry with a wide range of economic value and significance, the study determined the digestibility and nutrient intake of African Giant Land Snails (Archachatina marginata) hatchlings fed municipal organic waste, foliage or grass/legume using Completely Randomized Design. The experiment had four (4) treatments with five (5) replicates each, the experimental diets were diet 1 (100% municipal organic waste), diet 2 (100% grasses), diet 3 (75% grasses and 25% legume) and diet 4 (100% foliage). There were 25 hatchlings per replicate. The experiment lasted for 120 days. Snail hatchlings fed experimental diet 4, maintained higher significant (P<0.05) results for diet protein intake, digestible protein for growth, total digestible protein for gain, digestible protein, gross protein value, protein replacement value, and a better protein utilization efficiency. Dietary fibre intake was (P<0.05) higher on diet 3, 2 and 1, lower on diet 4, digestible fibre for growth showed (P<0.05) higher and similar values for diet 4 and 1, lower values for diet 3 and 2, digestible fibre and fibre replacement value decreased (P<0.05) in the order diet, 2, 3, 1 and 4, for efficiency of fibre utilization, diet 2 and 3 showed better fibre utilization efficiency. Dietary fat intake, digestible fat, fat replacement value showed (P<0.05) higher for diet 1, and with a better fat utilization efficiency. Snail’s micro-biota had high substrates dependency role on the quality of feed nutrient utilization in a symbiotic mechanism that helped in the breakdown and digestion of feed materials

Applying the WHO ICD-MM classification system to maternal deaths in a tertiary hospital in Nigeria: A retrospective analysis from 2014–2018

Background Addressing the problem of maternal mortality in Nigeria requires proper identification of maternal deaths and their underlying causes in order to focus evidence-based interventions to decrease mortality and avert morbidity. Objectives The objective of the study was to classify maternal deaths that occurred at a Nigerian teaching hospital using the WHO International Classification of Diseases Maternal mortality (ICD-MM) tool. Methods This was a retrospective observational study of all maternal deaths that occurred in a tertiary Nigerian hospital from 1st January 2014 to 31st December,2018. The WHO ICD-MM classification system for maternal deaths was used to classify the type, group, and specific underlying cause of identified maternal deaths. Descriptive analysis was performed using Statistical Package for Social Sciences (SPSS). Categorical and continuous variables were summarized respectively as proportions and means (standard deviations). Results The institutional maternal mortality ratio was 831/100,000 live births. Maternal deaths occurred mainly amongst women aged 25–34 years;30(57.7%), without formal education; 22(42.3%), married;47(90.4%), unbooked;24(46.2%) and have delivered at least twice;34(65.4%). The leading causes of maternal death were hypertensive disorders in pregnancy, childbirth, and the puerperium (36.5%), obstetric haemorrhage (30.8%), and pregnancy related infections (17.3%). Application of the WHO ICD-MM resulted in reclassification of underlying cause for 3.8% of maternal deaths. Postpartum renal failure (25.0%), postpartum coagulation defects (17.3%) and puerperal sepsis (15.4%) were the leading final causes of death. Among maternal deaths, type 1, 2, and 3 delays were seen in 30(66.7%), 22(48.9%), and 6(13.3%), respectively. Conclusion Our institutional maternal mortality ratio remains high. Hypertensive disorders during pregnancy, childbirth, and the puerperium and obstetric haemorrhage are the leading causes of maternal deaths. Implementation of evidence-based interventions both at the hospital and community levels may help in tackling the identified underlying causes of maternal mortality in Nigeria

Maternal death and obstetric care audits in Nigeria: A systematic review of barriers and enabling factors in the provision of emergency care.

Acknowledgements We would like to thank Yutaka Osakabe for co-ordinating the retrieval of full text articles. The John D. and Catherine T. MacArthur Foundation supported this study, grant number 12-100074-000-INPPeer reviewedPublisher PD

Bio-Economics Of Feeding Cassava Root Meal Based Diets to Broiler Finisher Chickens

A study was conducted to investigate the bio-economics of feeding broiler chickens graded levels of cassava root meal based diets, as replacement for maize at 0, 25, 50, 75 and 100% to form treatment diets T1 , T2 , T3 , T4 and T5 respectively, with adjustment in soybean levels across the treatment diets to have iso-nitrogenous diets. Two hundred and forty- 4 weeks old 'Amos' strain broiler chicks were in a completely randomized design allotted randomly to five treatment groups of 48 birds each and of three replicates with each replicate having 16 birds. Parameters measured included weight gain, feed intake, feed gain ratio, price per kg of feed, price per kg of broiler and weight of carcass cuts. Data were analyzed using analysis of variances. Daily weight gain for T1 , T2 , T3 , T4 and T5 were 41.16g/b/d, 39.43, 33.47, 25.25 and 16.91 g/b/d, respectively while, daily feed intake for T1 , T2 , T3 , T4 and T5 were 113.35g, 112.75, 102.31, 93.34 and 85.94g, respectively. Results showed weight gain feed intake and feed Conversion ratio values to be significantly (P&lt;0.05) depressed as the level of replacement of maize with cassava root meal exceeded 25%. Among the carcass parameters, only the dressed carcass (%) and thigh (%) weight values showed significant (P&lt;0.05) decrease as the level of replacement level of maize with cassava root meal exceeded 25% while, spleen (%) and liver (%) values showed progressive increase (P&lt;0.05) in weight as the level of cassava root meal increased in the diets. Cost of feed decreased (p&lt;0.05) significantly with the increasing level of cassava root meal. However, it did not translate to increase in price per kg of bird. It could therefore be suggested that cassava root meal should not exceed 25% as replacement for maize in broiler finisher diets, as beyond this level growth performance is adversely impaired.</jats:p

Emergency extraction of accidental impacted upper denture in the Association of American Anesthesiologist IV elderly patient: A case report and review of literature

A 78-year-old retired civil servant being managed for hypertensive heart disease and combined mixed cardiac valvular diseases (aortic stenosis and incompetence, mitral stenosis and incompetence), who has been on routine medication, accidentally swallowed his upper denture during the process of his medication. He presented to the private ENT hospital about 2 h post-ingestion. His other complaints were throat pain, dysphagia, and odynophagia. Clinical examination revealed an elderly man in painful distress and anxious looking. The throat and neck examination revealed tenderness at the level of the 6th cervical vertebrae and on the right side with some pooling of saliva in the throat. The oral cavity also revealed missing upper incisor tooth. His cardiovascular system revealed his apex beat at the 7th left intercostal space, heaving with irregular heart sounds and mixed beats and pansystolic murmur. His pulse rate and blood pressure were 64 beats/min and 170/65 mmHg, respectively. The other systems were essentially normal. A review by an experienced anesthetist (ME) placed the patient in the Association of American Anesthesiologist IV (ASA IV). An assessment of emergency impacted upper denture in elderly patient with cardiac valvular lesion and ASA 1V category was made. Cervical X-ray could not be done because the X-ray machine was faulty. The patient had the denture extracted under local anesthetic agent (10% lignocaine spray) and was successfully escorted out of the theater very excited. He was sent home 2 h post-extraction.</jats:p