Is poor maternal mortality index in Nigeria a problem of care utilization? A case study of Anambra State

Maternal mortality in Nigeria is unacceptably high. Some of the reasons may include poor socioeconomic development, weak health care system, low socioeconomic status of women and socio-cultural barriers to care utilization. A cross sectional study was carried out to assess the use of maternal services in Anambra State. A multi stage sampling technique was used to select 800 nursing mothers from the State who were interviewed on the use of maternal services during their last pregnancy. Over 95% of the subjects had formal education. Almost all the subjects (99.7%) attended antenatal clinics during their last pregnancy with 92.3% (646) of them making 4 or more visits before delivery. Over 97%(680) of the deliveries took place in formal health facilities. Obviously, the women in the study population utilize maternal health services. The problem of maternal mortality in the country may not necessarily lie with utilization but with the quality of services. Keywords: Maternal mortality, maternal services, care utilizationAfrican Journal of Reproductive Helath Vol. 12 (2) 2008: pp. 132-14

Multiple filarial species microfilaraemia: a comparative study of areas with endemic and sporadic onchocerciasis

Background & objectives: The study was aimed at determining the pattern of co-occurrence of species ofmicrofilaraemia between onchocerciasis endemic and sporadic populations.Methods: From every consenting person of one year and above, 50 μl of day and night blood samples werecollected and processed respectively with Haemotoxylin and Giemsa as vital stains. Two skin snips (one eachfrom the waist and the shoulder) were also taken from these individuals and processed.Results: Results showed single species microfilaraemia (86.4 and 82.3%), double species microfilaraemia (12.2and 16.9%) and triple species microfilaraemia (1.4 and 0.7%) for endemic and sporadic populations respectively.All the species had single species microfilaraemia mostly, but Mansonella perstans and Loa loa showed greatestt endency towa rds doubl e and t r ipl e spe c i e s mi c rof i l a r a emi a . The pr eva l enc e of Wuche re r ia banc rof t imicrofilaraemia among those positive for Onchocerca volvulus was significantly lower than the overall prevalenceof Wuchereria bancrofti. Wuchereria bancrofti microfilaraemia was most common among those who had L. loamicrofilaraemia. Wuchereria bancrofti microfilarial intensity was higher among those with M. perstansmicrofilaraemia than among those positive for any of the other filarial species. Similarly, the intensity of M.perstans microfilaraemia among those positive for W. bancrofti exceeded the overall intensity of M. perstans.Conclusion: It is concluded that there was no definite pattern in mf densities discernible from co-occurrenceinfections either in the onchocerciasis endemic or sporadic population. There could be varied outcomes ofonchocerciasis infection attributable to positive or negative regulatory effects of other pathogens harbored bythe victims

Microsoft Excel 2007 Programme for Effective Tertiary Institution Result Grading

Microsoft Excel 2007 Programme for effective Tertiary Institution result grading is an enhanced and interactive method of managing and processing key issues in Tertiary Institution, which are the problems of result grading. Grading of in course, exams and keeping track of grades in a grade book is one of the most laborious tasks a lecturer can undergo. Small errors can creep into your grade book when you add up scores, possibly resulting in your posting an incorrect student grade. Using Microsoft Excel 2007 to keep track of grades not only cuts down on the amount of work you have to do, but also cuts down or even eliminates mathematical errors. This study has addressed this key issue with a programme, from step one to step six. Keywords: Microsoft Excel 2007, Result, Grading Computation, Tertiary Institution

Changes in blood counts, serum lactate dehydrogenase activity and haptoglobin level in malaria infected subjects in Nnewi, Anambra state, Nigeria

Background: Malaria is a mosquito-borne public health problem which alters the blood counts, haptoglobin level and serum lactate dehydrogenase (sLDH) activity of the infected individuals. Some of the alterations are associated risk factors in malaria pathology. This study aims at elucidating changes in blood counts, sLDH activity and haptoglobin level in malaria infected subjects seen in a Tertiary Health Institution in Nnewi, as search for associated risk factors in malaria pathology.Methods: This cross sectional study enrolled 270 age matched subjects between 18-65 years. The test group (200) who tested positive to P. falciparium was placed into two groups based on their parasite counts with cut-off of  ≥1000 parasites x 109/L. Group one (100) had counts above the cut-off and group two (100) below. The control (70) was aparasitemic. The demographic data were noted and 4mls of blood drawn. 2mls in K3EDTA was for FBC testing using Mythic 22 hematology analyzer, and remaining dispensed into plain tubes was for sLDH assay by kinetic method and haptoglobin by ELISA technique.Results: The HCT, Hb, RBC and Platelet count of test were progressively significantly lowered (p=0.001) compared to control, with an intra-significant difference among the 3 groups (p<0.05), also the parameters were found to have an inverse significant relationship (p=0.001) to the parasite counts. This trend was also seen with haptoglobin while reverse was the case with LDH activity which rather increased significantly (p = 0.000) at opposite direction as parasite density increases.Conclusions: This study show that the degree of intravascular haemolysis is directly influenced by the parasite density, this portends that high endemicity and perennial parasiteamia in the study area could cause chronic anaemia and thrombocytopenia in the population studied

ESTIMATION OF GLOBAL SOLAR RADIATION AT CALABAR USING TWO MODELS

In this study, the estimation of global solar radiation with Meteorological parameters at Calabar- Nigeria latitude 40N and longitude 80 E were carried out. The daily mean temperature and relative humidity for seventeen years (1991 to 2007) from Nigerian Meteorological Agency, Federal Ministry of Aviation, Oshodi, Lagos were used. The global solar radiation data were collected courtesy of Renewable Energy for Rural Industrialization and Development in Nigeria. Two models (multiple regression and artificial neural network) were used for the estimation. Comparing the graphs of correlation equation 4 and 5, and equation 6 and 7 of the first model, it is obvious that the first order correlation has better estimation power. Looking at the overview of all the Figures (1 -5A), is it is clear that the two models used in this study has estimation capacity, but Figure 5A shows better correlation with the measured values, which indicates that artificial neural network model is a better model for estimation. Therefore has been recommended for global solar radiation estimation at Calabar and its environs with similar weather condition. Alternatively, first order regression should be use for estimation in the absent of artificial neural network. Keywords: artificial neural network, regression, model, global solar radiatio

Evaluation of the diagnostic utility of leucocyte in comparison to other biomarkers in the management of patients with pulmonary tuberculosis

Background: Pulmonary tuberculosis (PTB) is an infectious and debilitating disease that affects millions of people each year. Simple, reliable and cost effective biomarkers are vital to fore-stall the morbidity and mortality that is hallmark of the infection especially in resource poor economy.Methods: This comparative study enlisted 140 subjects: 80 had PTB and 60 do not. Blood of 8mls was collected; 3mls in K2-EDTA for FBC testing with XE-2100 Sysmex and ESR by Westergreen method. The remainder was used for serum CRP assay by ELISA. The radiological extent was determined from Chest X ray report and disease severity using modified Bandim TB scoring was extracted from the case note. The aim of the study is to investigate the relationship and diagnostic utility between leucocyte with CRP, ESR, radiological extent of disease and disease severity in PTB.Results: Mean Lymphocyte count was lower while TWBC, Neutrophil and Monocyte counts were higher in subjects compared to control (p<0.05). Median CRP, ESR, NLR, NMR and MLR were higher in subjects compared to control (p<0.05), NLR and MLR showed strong positive significant correlation with ESR, disease severity, and radiological extend of disease. NMR (p= 0.00) had a negative correlation with ESR (p<0.05) and inverse correlation with disease severity and radiological extent.Conclusions: This study found NLR, MLR and NMR as a readily, easily available and inexpensive indices that are as efficient and comparable to known biomarkers in PTB infection, therefore could serve as valuable predictive biomarker in areas of high disease burden with weak economy

Serum Levels of Pro-inflammatory Cytokines in relationship to outcomes in Children with P. falciparum malaria, in Nnewi-South east Nigeria

Background and Objective: In P. falciparum malaria (PFM) infestation there are marked changes in cytokine production as the body mounts an immune response to it. Hence we set out to study these changes.Methods: A total of 158 cases of PFM among children attending the paediatric unit of our hospital and 56 healthy controls were studied. Children with febrile illness were screened for malaria using 10% Giemsa stained blood smear. Patients with positive smears were recruited; co-infected patients – those infected by another organism in addition to plasmodium specie.- were excluded. Whole blood was collected, some into plain tubes for serum cytokine testing and some into EDTA bottles for complete blood count and parasite density (PD) determination. Controls with asymptomatic parasitaemia were excluded.Results: Using the World Health Organization criteria for defining severe malaria; we identified 15 cases of severe and 143 cases of uncomplicated PFM. Significantly elevated levels of interleukin-1 (IL-1), interleukin 6 (IL-6) and tumour necrosis factor alpha (TNF-α) were seen in the uncomplicated and severe forms of PFM. It was observed that the elevated cytokine values correlated with PD (in uncomplicated PFM but not in the severe forms). The difference between PD/absolute monocyte count (AMC) ratio was not significant (p=0.13); while PD/platelet count (PC) and PC/ AMC ratios were significant (p=0.01, and 0.03 respectively) when compared between uncomplicated and severe disease.Conclusion: Our data seems to suggest that subjects with an adequate immune response to the parasite density, in terms of pro-inflammatory cytokine levels, presented with uncomplicated disease; while those who have an inadequate response presented with severe disease. The ratios of (PD/PC) and (PC/AMC), in the positive and negative directions respectively, may be predictors of increased disease severity. These observations may have implications for predicting disease outcome and PFM therapy.Key Words: plasmodium falciparum malaria, pro-inflammatory cytokines, Parasite density/Platelet count ratio, Platelet count/Absolute monocyt

The use of peripheral blood cells as an assessment of inflammation in prostate cancer in patients attending in surgery department at ESUT teaching hospital, Parklane, Enugu, Nigeria

Background: Full blood count (FBC) is a prerequisite investigation requested from all prostate cancer (PCa) patients pre and post treatment, poor parameter influences the outcome of cancers.Methods: Total subjects consisted of 84 male subjects between the ages 41 to >80 years. Longitudinal study was conducted. Controls and test samples were collected at diagnosis and at different stages of the treatment. Demographic information was obtained using a questionnaire. The data was analyzed using IBM statistical package for social sciences (SPSS) PC, version 20.0; SPSS Inc., Chicago, III., USA; the receiver operating characteristic curve (ROC) curve was obtained via neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR) and platelet-to-lymphocyte ratio (PLR) ratios cut-off determinations. Cox proportional-hazards regression analyses the prognostic factors (duration, ratios) and overall survival (diagnosis to death or last follow-up). A paired sample t-test compared test of significance in pre/post treatment results. The analysis of variance (ANOVA) and Tukey HSD post-hoc, test susceptibility within age groups was done.Results: Increased NLR and LMR were significantly associated with increased hazard ratio (HR) and OS at p0.05 in PCa. In complete blood count (CBC) and erythrocytic sedimentation rate (ESR), control and treatment period, all red blood cell (RBC) parameters showed a significant decrease at p<0.05 in treatment results compared to the pre-treatment results while total platelet (TPLT), total white blood cells (TWBC), NC, LC, ESR showed significant increase at p<0.05 in treatment results compared to pre-treatment results. Age group 41-50 years showed more susceptibility than other age groups with significant decrease at p<0.05 in NC, LC and increased MC.Conclusions: This study supports CBC and ESR biomarkers as a prognostic tool in early detection, treatment and monitoring of disease progression in these subjects

Blood pressure indices and disease severity in patients with sickle cell anaemia

Background: Individuals with sickle cell anaemia (SCA) have lower systemic blood pressures compared to individuals with haemoglobin Hb AA phenotype.Objective: To evaluate blood pressure indices of individuals with SCA in steady state, in comparison with haematological and clinical markers of disease severity.Methodology: Seventy-nine (79) individuals with SCA (subjects) in steady state and 50 age-matched individuals with Hb AA (controls) were prospectively studied. Height, blood pressure (BP), weight, creatinine clearance (by 24-hour urine collection), full blood count (FBC) and reticulocyte count were obtained from all subjects and controls. Body mass index (BMI), corrected reticulocyte count, mean arterial pressure (MAP) and pulse pressure (PP) were calculated using standard protocols.The frequency of vaso-occlusive crises in the last one year and number of blood transfusions in the last two years were obtained from subjects.Data was analyzed using descriptive and inferential statistics and p ≤0.05 was used to define the level of statistical significance.Results: The systolic (105.52±11.75mmHg and 113.20±7.94mmHg respectively; P = 0.01), diastolic (62.59±9.33mmHg and 75.40±5.70mmHg respectively; P=0.03) and mean arterial pressures (76.90±8.81mmHg and 88.00±5.51mmHg respectively;P =0.04) were significantly lower in subjects when compared with controls. ; pulse pressure (PP) was however significantly higher in subjects than controls (42.92±10.91mmHg and 37.80±7.43mmHg respectively (P = 0.03). In female subjects, the white cell count was negatively correlated with systolic BP (r = -0.39;P = 0.01) and PP (r = -0.33; P = 0.03).Conclusion: Lower systolic and pulse pressures may predict worsening disease severity in individuals with sickle cell anaemia.Keywords: Sickle cell anaemia,disease severity,blood pressure indice