Assessing Folic Acid Awareness and its Usage for the Prevention of Neural Tube Defects Among Pregnant Women in Jos, Nigeria

Background: In the precent study, firm evidences indicate that folic acid supplementation during the peri‑conceptional period reduces the risk of having a baby with neural tube defects.Aim: To ascertain the level of awareness about folic acid, its use during peri‑conceptional period and the predictive factors of folic acid awareness among pregnant women in our setting.Subjects and Methods: Confidential, anonymous questionnaires were administered to consecutive 543 pregnant women seeking routine antenatal care at Bingham University Teaching Hospital, Jos between January and June 2012. Questions included enquiry on their demographic features, obstetric history, pregnancy intention, awareness and intake of folic acid during the peri‑conceptional period, and knowledge of its natural sources. Descriptive statistics and multivariate logistic regression to identify predictive factors of folic acid awareness were then performed.Results: Out of 543 pregnant women surveyed, 64.6% (351/543) reported that they were aware of folic acid as a vitamin supplement. However, only 7.4% (26/351) consistently took the vitamin during the protective periconceptional period. The common sources of information about folic acid were health workers (68.5%) and the media (14.6%). Only 26.5% (93/351) of them could correctly identify a natural source of food rich in folic acid. Multivariate logistic regression showed that maternal age >30 years (P=0.01) and higher educational status (P=0.001) were predictive factors for folic acid awareness.Conclusion: Folic acid awareness as a vitamin supplement was relatively high among the women surveyed but its intake during peri‑conceptional period was worryingly low. Antenatal and Population health educational strategies and fortification of staple foods with folic acid may improve its intake among women of child‑bearing age in our setting. Keywords: Awareness in pregnant women, folic acid, neural tube defects, peri‑conceptional usag

Transabdominal sonographic diagnosis of placenta praevia in a tertiary maternity unit in Jos, Nigeria: How accurate?

Context: Ultrasonography has revolutionalise the diagnosis and  management of placenta praevia, a high risk pregnancy associated with life threatening maternal and fetal complications. Although transabdominal sonography (TAS) is a valuable obstetric imaging technique in this maternity unit, its value in the diagnosis of placenta praevia has not been assessed.Objectives: To assess the accuracy and false positive rate of TAS in the diagnosis of placenta praevia and to determine the types of placenta praevia.Study design, Settings and Subjects: A prospective descriptive study of all women with transabdominal sonographic diagnosis of placenta praevia in the maternity unit of Jos University Teaching Hospital, Jos, Nigeria between January 2006 and June 2009. All the patients had sonographic assessment with scanner Toshiba just vision 400, with a 3.5MHz curvilinear transducer. The presence or absence of placenta praevia was confirmed at caesareandelivery.Main outcome measures: Accuracy and false positive rate of TAS in the diagnosis of placenta praevia as well as it types.Results: Placenta praevia was confirmed intra-operatively in 121 out of the 137 patients with ultrasound diagnosis. Thus, the diagnostic accuracy of TAS was 88.3% and a false positive rate of 11.7% with about 68.8% of the false positive cases having abruptio placentae. Seventy four (61.2%) and 47 (38.8%) were major and minor degree placenta praevia respectively.Conclusion: TAS is a valuable and accurate modality for the diagnosis of placenta praevia in this maternity unit but more vigilance is needed during the procedure so as to reduce the false positive rate. The use of vaginal ultrasonography in this centre may significantly improve the accuracy in the diagnosis of the condition.Keywords: Placenta praevia, Transabdominal, Sonography, accuracy, false positive rate

Pulmonary candidiasis and CD4 count in HIV positive patients seen in Jos, north central Nigeria

Background: Accurate and reliable diagnosis of HIV opportunistic infections plays a central role in effective HIV intervention programmes. Pulmonary infections are the leading cause of  morbidity and mortality in HIV infected individuals.Objectives: We set out to determine the prevalence of Pulmonary candidiasis by isolating Candida species from the sputum of HIV sero-positive patient’s presenting to hospital with complaint of cough for more than two weeks and related the level of CD4 count to Pulmonary candidiasis.Methods: Using sterile wire loop, each sputum sample was inoculated into duplicate SDA (Thermo Scientific, UK); one tube without antibiotics, another tube supplemented with Chloramphenicol (0.05%) and Cycloheximide (0.5%) antibiotics. The patient’s CD4 count was determined using a Cyflow machine (PARTECR, Germany).Result: Fifty two (54.2%) female and 44(45.8%) male HIV positive subjects were compared with a control group made up of, 52(54.2%) female and 44(45.8%) male HIV negative subjects. Twenty one (21.9%) HIV positive subjects had Candida species in their sputum samples compared to 12(12.5%) in the HIV negative subjects. Among HIV positive subjects, 17(17.7%) had Candida albicans isolated from their sputum, 11(11.5%) of whom had a CD4 count of <200 cells/ul.Conclusion: We concluded that, there is a risk of pulmonary candidiasis occurring in HIV infected patients with CD4 count <200cells/ul and that, Candida species contributes to chronic cough experienced by HIV infected patients. We recommend that HIV positive patients who have chronic cough and whose CD4 count is <200cells/ul be placed on systemic antifungal medication.Keywords: Candida, Cough, Nigeria, Sputu

Placenta Praevia: Incidence, Risk Factors, Maternal and Fetal Outcomes in a Nigerian Teaching Hospital

Background: Placenta praevia is a major cause of antepartum haemorrhage and is potentially life threatening to both the mother and the fetus. This study sought to determine the magnitude of the condition, its risk factors, maternal and fetal outcomes in a tertiary health centre in Jos, Nigeria.Materials and Methods: A prospective cross-sectional study conducted in all women diagnosed with placenta praevia that spanned over a three and half-year periods (January 2006-June 2009) in Jos University Teaching Hospital, Jos. The patients were followed up until discharged from the hospital. Relevant information was obtained from each patient using a pre-designed study case report form. Statistical analysis was performed using simple percentages.Results: During the study period, there were 10,895 deliveries and 135 cases of placenta praevia, thus an incidence of 1.24% or 1 in 81 deliveries. The average age of the patients was 30.2 years and majority of them were multi-parous (63.7%). The identified risk factors included previous caesarean section, grand­multiparity, previous uterine evacuation of retained products of conception, multiple pregnancy and history of placenta praevia. Maternal complications included post-partum anaemia, postpartum haemorrhage & operative site infection. There were two maternal deaths (1.48%) and the perinatal mortality rate was 18.7%.Conclusion: The incidence of Placenta praevia was relatively high and associated with high maternal and perinatal complications. Screening ultrasonography in women with history of multiple caesarean sections in the third trimester and timely delivery may help to reduce the maternal and perinatal morbidity and mortality associated with placenta praevia

Total Abdominal Hysterectomy for Benign Gynaecological Conditions at a University Teaching Hospital in Nigeria

No Abstract

Case Report - Persistent Haematuria and Chronic Pelvic Pain Due to a Way-Ward Intra-Uterine Contraceptive Device

Background: The bladder is one of the organs that an intra-uterine contraceptive device can migrate into because of its close proximity to the uterus. Its complication of bladder perforation is seldom diagnosed prior to intervention probably as a result of its rarity.Method: A case report of a Nigerian female who presented with persistent filling-phase lower urinarytract symptoms, haematuria and chronic pelvic pain as a result of a migrated IUCD into the bladder. The device was inserted after uterine evacuation of retained products of conception following an incomplete spontaneous miscarriage with the consent of the husband. It was discovered at cystoscopy, retrieved and she was followed up.Result: The patient was a 29-year old woman who presented with a 2-yearhistoryof persistent haematuria, dysuria, and chronic pelvic pain despite several episodes of antibiotic treatment for suspected urinary tract infection. Intra-uterine contraceptive device was discovered in the urinary bladderat a diagnostic cystoscopy and was retrieved. Further history revealed that an IUCD was inserted without her knowledge by health personnel immediately after evacuation of the uterus of retained products of conception following an incomplete miscarriage. She recovered without complication within 2 weeks of its removal.Conclusion: This report highlights the need to discourage the insertion of IUCD by untrained health workers and to consider intra-vesical migration of IUCD in women of reproductive age with recurrent or persistent urinary tract symptoms recalcitrant to antibiotic treatment