Hematocrit, anemia, and arm preference for blood sample collection: a cross sectional study of pregnant women in Enugu, south eastern, Nigeria

Background: Anemia in pregnancy is a common cause of maternal morbidity and mortality in developing countries. Regular review of hematocrit (HCT) and anemia patterns in pregnancy is necessary in our environment. Aim: The aim was to determine the average HCT, prevalence, and pattern of anemia, as well the arm preferences for blood sample collection among pregnant women in Enugu, South East Nigeria. Subjects and Methods: HCT was determined using venous blood of 200 antenatal women at the University of Nigeria Teaching Hospital (UNTH) Enugu, Nigeria. Questionnaires were used to assess participants’ arm preference for blood sample collection for clinical investigations. Data analysis was descriptive and inferential at 95% confidence level. Results: Participants’ mean HCT was 33.3 (3.7%). The average HCT in second trimester 33.3% (3.76%) was significantly lower than that of third trimester (34.6 [3.4%], P = 0.01,). Prevalence of anemia was 28.0% (56/200), and a majority (94.6%, 53/56) of anemic women belong to the mild category. Only parity groups had a significant association with anemia in pregnancy (P = 0.04). None of the participants reported being asked about her arm preference during blood collection for routine antenatal investigations. One hundred and five (52.5%) women expressed preference for either left (34.5%, 69/200) or right arm (18.0%, 36/200) for blood sample collection. Conclusion: The average HCT among pregnant women at the UNTH, Enugu Nigeria was within normal range and the prevalence of anemia was relatively low. The majority of women expressed a preference for either right or left arm for blood sample collection for clinical investigations and would wish their choices sought for and respected.Keywords: Anemia in pregnancy, Arm preference, Enugu, Hematocrit, Nigeri

Evaluation of some anthropometric indices for the diagnosis of obesity in pregnancy in Nigeria: a cross-sectional study

Background: Obesity in pregnancy is a global health problem which is associated with poor pregnancy outcomes. The use of weight and height, measured at about ten weeks of gestation, to produce pre-gestational body mass index is recommended for the diagnoses of the condition but limitations abound in under resourced settings.Objectives: To measure anthropometric indices such as mid upper arm circumference, calf circumference, waist circumference and waist to hip ratio, for identification of obesity in pregnancy.Methods:Anthropometric measurements were carried out on cohorts of pregnant women from 4 hospitals in Enugu, South-eastern Nigeria.Results: There were no significant difference in the mean mid upper arm circumference (MUAC) and calf circumference (CC) across the trimester groups. The mean values of waist circumferences, hip circumference and waist to hip ratios changed significantly across the trimesters. The 75th percentile of MUAC (33 cm) and CC (39 cm) in all trimesters, had sensitivity and specificity of more than 70% for identifying obesity in pregnancy.Conclusion: MUAC and CC values of 33cm and 39cm respectively might be reliable cut off points for diagnoses of obesity throughout pregnancy in Enugu, NigeriaKeywords: Anthropometric indices, Body mass index, obesity, oregnancy, NigeriaAfrican Health Sciences 2013; 13(4): 1034 - 104

Benefit incidence analysis of free insecticide treated nets distribution in urban and rural communities of Enugu state, South East Nigeria

Background: Malaria is a leading cause of mortality as well as a barrier to economic and social development in developing countries. The use of insecticide‑treated nets (ITNs) for malaria vector control is effective in controlling malaria attacks in pregnant women and under‑5 children. The Nigerian government, in its bid to achieve the Millennium Development Goal (MDG) 4 and 5 distributes free ITNs to pregnant mothers and under‑five children in the Roll Back Malaria programme (RBM).Aim: This study compared the benefit incidence analysis of this government program between urban and rural areas.Materials and Methods: Pretested, semi‑structured questionnaires were administered to 150 pregnant women and also 150 mothers of under‑5 children, who were randomly selected from each of the two communities (rural and urban) from a local government area (LGA) in Enugu state, Nigeria. The study was conducted within the rainy season periods (March–August) of 2008. The information obtained included some socio‑economic variables, accessibility, usage and benefits of usage of ITNs. Data entry and analyses were done using the Statistical Package for Social Sciences (SPSS) version 15.0(Chicago IL, USA). Student’s t‑test and Chi‑square were used for comparison where appropriate. Significant values were taken as P value. Value of less than 0.05 was considered significant.Results: The respondents’ mean monthly expenditures on food utilities and anti‑malarials in the rural area and urban areas were N266.1 (74.02), range (143.3-395) and N473 (90) range (380-495.7) respectively (P < 0.001). Within each socio‑economic stratum (SES), the average monthly expenditure in the urban community was higher than that of the rural community except for least poor SES (P < 0.05). For the urban community, 106 (71.6%) respondents used ITNs as against 99 (66.9%) in the rural community [P = 0.778, OR = 1.3 (95% CI: 0.76, 2.05)]. Also, ITNs were always accessible to 112 (75.7%) and 54 (36.5%) respondents in the urban and rural communities respectively [P < 0.001, OR = 5.4 (95% CI: 3.28, 8.96)]. In the urban community, 130 (87.7%) respondents expressed some benefit from ITNs as against 123 (83.1%) respondents from the rural community [P = 0.258, OR = 1.5 (95% CI: 0.76, 2.28)].Conclusion: Most pregnant women and mothers of under‑five children in the rural study area belong to the poorest socio‑economic classes and they spend less on anti‑malarial treatment. Majority of the free ITN’s beneficiaries in both urban and rural study areas have used and benefitted from themKey words: BIA, ITNs, nigeria, pregnanc

Novel Molecular Targets of Azadirachta indica Associated with Inhibition of Tumor Growth in Prostate Cancer

Advanced prostate cancer has significant long-term morbidity, and there is a growing interest in alternative and complimentary forms of therapy that will improve the outcomes of patients. Azadirachta indica (common name: neem) contains multiple active compounds that have potent anti-inflammatory and anticancer properties. The present study investigates the novel targets of the anticancer activity of ethanol extract of neem leaves (EENL) in vitro and evaluates the in vivo efficacy in the prostate cancer models. Analysis of the components in the EENL by mass spectrometry suggests the presence of 2′,3′-dehydrosalannol, 6-desacetyl nimbinene, and nimolinone. Treatment of C4-2B and PC-3M-luc2 prostate cancer cells with EENL inhibited the cell proliferation. Genome-wide expression profiling, using oligonucleotide microarrays, revealed genes differentially expressed with EENL treatment in prostate cancer cells. Functional analysis unveiled that most of the up-regulated genes were associated with cell death, and drug metabolism, and the down-regulated genes were associated with cell cycle, DNA replication, recombination, and repair functions. Quantitative PCR confirmed significant up-regulation of 40 genes and immunoblotting revealed increase in the protein expression levels of HMOX1, AKR1C2, AKR1C3, and AKR1B10. EENL treatment inhibited the growth of C4-2B and PC-3M-luc2 prostate cancer xenografts in nude mice. The suppression of tumor growth is associated with the formation of hyalinized fibrous tumor tissue and the induction of cell death by apoptosis. These results suggest that EENL-containing natural bioactive compounds could have potent anticancer property and the regulation of multiple cellular pathways could exert pleiotrophic effects in prevention and treatment of prostate cancer

Administrative Responsibilities of Community-Funded Health Insurance Scheme in Nigeria

Access to quality healthcare in Nigeria remains a major problem for over 70% of the population living in rural areas and a good number in semi-urban towns. Health insurance may bring quality healthcare closer to the populace at an affordable rate since it allows for cross-subsidization of the poor by the rich and the sick by the healthy. We have reviewed pilot schemes of government initiated programme (National Health Insurance Scheme) and a Non-governmental Organization initiated programme (Ndo Nwanne Health Insurance Scheme, Enugu) and propose a model for Community-funded health insurance in Nigeria. Key Words: Adverse selection, Community, Capitation, Insurance. Nig. Medical Practitioner Vol. 45(3) 2004: 26-2

Impact of some low.cost interventions on students' performance in a Nigerian medical school

Background: Studentsf poor performance in physiology examinations has been worrisome to the university community. Reported preference of peer.tutoring to didactic lectures at the University of Nigeria Medical School has not been investigated.Aim: The aim of this work is to design/implement low.cost interventions to improve teaching and learning of physiology.Materials and Methods: This is a postintervention retrospective review of medical Student's performance in 2nd Bachelor of Medicine and Bachelor of Surgery examinations physiology. Data were collected and analyzed by descriptive and inferential statistics using the MedCalc Statistical software (Turkey). The odds ratio (OR) was used to determine the chances of passing before and after the intervention. The level of significance was set at P < 0.05.Results: A total of 2152 students sat for the professional examination over the study period, and 1485 students passed the examination at first attempt giving an overall pass rate of 69%. The pass rate from 2008 when our interventions started was significantly higher than the pass rate before this reform (OR: 0.53; 95% confidence interval: 0.43-0.64; P < 0.0001).Conclusion: Results support the engagement of teachers with strong translational interests and clinicians to augment existing faculty in basic sciences, innovative alternatives to passive lecture formats and students involvement in program evaluation.Key words: Learning, low.cost innovation, medical school, Nigeri