Declining prevalence of duodenal ulcer at endoscopy in Ile-Ife, Nigeria

Background. Duodenal ulcer is the most common peptic ulcer disease worldwide. In the past, sub-Saharan Africa has been described as an area of mixed prevalence for peptic ulcer disease, but recent reports have disputed this. Changes in the prevalence of duodenal ulcer have been reported, with various reasons given for these.Objective. To describe the change in endoscopic prevalence of duodenal ulcer at Obafemi Awolowo University Teaching Hospital (OAUTH), Ile-Ife, Nigeria, between January 2000 and December 2010.Methods. This was a retrospective, descriptive study of patients who underwent upper gastrointestinal endoscopy in the endoscopy unit of OAUTH between January 2000 and December 2010. The data were obtained from the endoscopy register, demographic indices, presenting symptoms and post-endoscopic diagnoses being retrieved for each patient. The study period was divided into the years 2000 - 2004 and 2005 - 2010, the frequencies of duodenal ulcer and other post-endoscopic diagnoses being compared between these two time periods to see whether there were changes.Results. Over the study period, 292 patients (15.8%) were diagnosed with duodenal ulcer, second only to 471 patients (26.2%) with acute gastritis. The prevalence of duodenal ulcer for 2000 - 2004 was 22.9% (n=211 patients) compared with 9.2% (n=81) for 2005 - 2010 (p<0.001).Conclusion. There was a significant decline in the endoscopic prevalence of duodenal ulcer over the decade.

The management of tetanus in adults in an intensive care unit in Southern Vietnam

Background: Tetanus remains common in many low- and middle-income countries (LMICs) yet the evidence base guiding management of this disease is extremely limited, particularly with respect to contemporary management options. Sharing knowledge about practice may facilitate improvement in outcomes elsewhere. Methods: We describe clinical interventions and outcomes of 180 adult patients ≥16 years-old with tetanus enrolled in prospective observational studies at a specialist infectious diseases hospital in Southern Vietnam. Patients were treated according to a holistic management protocol encompassing wound-care, antitoxin, antibiotics, symptom control, airway management, nutrition and de-escalation criteria. Results: Mortality rate in our cohort was 2.8%, with 90 (50%) patients requiring mechanical ventilation for a median 16 [IQR 12-24] days. Median [IQR] duration of ICU stay was 15 [8-23] days. Autonomic nervous system dysfunction occurred in 45 (25%) patients. Hospital acquired infections occurred in 77 (43%) of patients. Conclusion: We report favourable outcomes for patients with tetanus in a single centre LMIC ICU, treated according to a holistic protocol. Nevertheless, many patients required prolonged intensive care support and hospital acquired infections were common

Timing of antenatal care for adolescent and adult pregnant women in south-eastern Tanzania

Early and frequent antenatal care attendance during pregnancy is important to identify and mitigate risk factors in pregnancy and to encourage women to have a skilled attendant at childbirth. However, many pregnant women in sub-Saharan Africa start antenatal care attendance late, particularly adolescent pregnant women. Therefore they do not fully benefit from its preventive and curative services. This study assesses the timing of adult and adolescent pregnant women's first antenatal care visit and identifies factors influencing early and late attendance.\ud The study was conducted in the Ulanga and Kilombero rural Demographic Surveillance area in south-eastern Tanzania in 2008. Qualitative exploratory studies informed the design of a structured questionnaire. A total of 440 women who attended antenatal care participated in exit interviews. Socio-demographic, social, perception- and service related factors were analysed for associations with timing of antenatal care initiation using regression analysis. The majority of pregnant women initiated antenatal care attendance with an average of 5 gestational months. Belonging to the Sukuma ethnic group compared to other ethnic groups such as the Pogoro, Mhehe, Mgindo and others, perceived poor quality of care, late recognition of pregnancy and not being supported by the husband or partner were identified as factors associated with a later antenatal care enrolment (p < 0.05). Primiparity and previous experience of a miscarriage or stillbirth were associated with an earlier antenatal care attendance (p < 0.05). Adolescent pregnant women started antenatal care no later than adult pregnant women despite being more likely to be single. Factors including poor quality of care, lack of awareness about the health benefit of antenatal care, late recognition of pregnancy, and social and economic factors may influence timing of antenatal care. Community-based interventions are needed that involve men, and need to be combined with interventions that target improving the quality, content and outreach of antenatal care services to enhance early antenatal care enrolment among pregnant women

Two-year longitudinal survey reveals high genetic diversity of Schistosoma mansoni with adult worms surviving praziquantel treatment at the start of mass drug administration in Uganda

Background: A key component of schistosomiasis control is mass drug administration with praziquantel. While control interventions have been successful in several endemic regions, mass drug administration has been less effective in others. Here we focus on the impact of repeated praziquantel treatment on the population structure and genetic diversity of Schistosoma mansoni. Methods: We examined S. mansoni epidemiology, population genetics, and variation in praziquantel susceptibility in parasites isolated from children across three primary schools in a high endemicity region at the onset of the Ugandan National Control Programme. Children were sampled at 11 timepoints over two years, including one week and four weeks post-praziquantel treatment to evaluate short-term impacts on clearance and evidence of natural variation in susceptibility to praziquantel. Results: Prevalence of S. mansoni was 85% at baseline. A total of 3576 miracidia larval parasites, isolated from 203 individual children, were genotyped at seven loci. Overall, genetic diversity was high and there was low genetic differentiation, indicating high rates of parasite gene flow. Schistosome siblings were found both pre-treatment and four weeks post-treatment, demonstrating adult worms surviving treatment and natural praziquantel susceptibility variation in these populations at the beginning of mass drug administration. However, we did not find evidence for selection on these parasites. While genetic diversity decreased in the short-term (four weeks post-treatment), diversity did not decrease over the entire period despite four rounds of mass treatment. Furthermore, within-host genetic diversity was affected by host age, host sex, infection intensity and recent praziquantel treatment. Conclusions: Our findings suggest that praziquantel treatments have short-term impacts on these parasite populations but impacts were transient and no long-term reduction in genetic diversity was observed. High gene flow reduces the likelihood of local adaptation, so even though parasites surviving treatment were observed, these were likely to be diluted at the beginning of the Ugandan National Control Programme. Together, these results suggest that MDA in isolation may be insufficient to reduce schistosome populations in regions with high genetic diversity and gene flow

Knowledge and attitude of female healt workers towards prenatal diagnosis of sickle cell disease

No Abstract.Nigerian Journal of Medicine Vol. 16 (3) 2007: pp. 268-27

Progestogen-only injectable contraceptive: Experience of women in Osogbo, southwestern Nigeria

Background: Progestogen-only injectable contraceptive is a long-acting contraceptive given intramuscularly to give protection against unwanted pregnancy for a period of 2 or 3 months, depending on the type. Alterations in menstrual pattern are a well known side effect of this effective contraceptive method. Objectives: To determine the characteristics of women accepting the method, complications and indications for discontinuation. Materials and Methods: This was a retrospective review of clients using progestogen-only injectable contraceptive between 1 st January, 2001 and 31 st December, 2009. Relevant information extracted from the case notes was analyzed. Survival analysis was carried out using Log-Rank Chi-square test to measure association over 12-month period of usage. Level of significance was set at P value less than 0.05. Results: A total of 1,967 women used contraception during the study period and 433 (22.1%) made progestogen-only injectable their method of choice. 199(45.96%) used NET-EN, while DMPA was used by234 (54.04%) women. Many of the women (197, 45.5%) used the method for terminal fertility control. Menstrual abnormality was the commonest (264, 71.4%) complaint about progestogen-only injectable contraceptive, of which amenorrhea was experienced by constituted 176(66.7%). Eighty-three (22.4%) women had discontinued the contraceptive, and menstrual abnormality was the commonest reason for the discontinuation (68, 81.9%). No pregnancy was reported among the women that came for follow up while on the method. Conclusion: Short duration of POIC use that is within 12 months is still high. However the main reason for discontinuation was found to be due to menstrual irregularities, hence the need for effective education of the women about this side effect, thus increasing the acceptance and continuation rate of the contraceptive method

Pattern of contraceptives choice among the married women attending the family planng clinic of a tertiary health institution

Background: Rampant population growth is the most fundamental problem of our times. It affects adversely the advancement of nations and the wellbeing of all peoples. The fertility rate in Nigeria remains high at a national average of about 5.2 children per woman. When a woman effectively uses a modern method of contraceptive she is less likely to be exposed to the hazards of grand multiparity, and also unlikely to resort to dangerous illegal abortion. Method: This is a retrospective study, a review of the records of the family planning clinic of Ladoke Akintola University of Technology Teaching Hospital, Osogbo was undertaken. These were new clients coming for the first time to the family planning clinic of the institution from January, 2001 to December 2006. Result: A total of 1355 married women were coming for the first time to the family planning clinic within the study period, and their age range between 18 and 51 years with a mean of 33.5+6.1 years. 170 (12.5%) were Para 1, Para 2-4 were 855 (63.1%), while Para 5 and above were 330 (24.4%). The clients source of information about family planning was: family planning clinic personnel 1039 (76.7%), media (print and electronic) 152 (11.2%), friends and relatives 127 (9.4%), and community health workers 37 (2.7%). Intrauterine contraceptive device was the most chosen method by the clients 1011 (74.6%), while condom was the least chosen 3 (0.2%); 264 (19.5%), and 77 (5.7%) clients chose injectables and pills, respectively. Conclusion: An increase in the level of knowledge on modern contraceptive methods through mass and interpersonal communications could be one of the key strategies to increase the utilization rate of modern contraceptive methods. Nigerian Journal of Medicine Vol. 17 (1) 2008 pp. 67-7

Use Prevalence of Insecticide-Treated Mosquito Bed Nets among Pregnant Population in Osogbo, Nigeria

Malaria affects 40million of the world's population involving about 103 countries with estimated 2.5 billion people in the malaria shadow. Children and pregnant women are more susceptible to malaria attack compared to the general population. Intermittent preventive treatment with sulfadoxine-pyrimethamine (SP) has increasingly been used in sub-Saharan Africa. However, resistance to SP is steadily increasing in some areas in sub-Saharan Africa, and the available arsenal of alternative tools for malaria control in pregnancy is very limited. One of the most promising of these tools is insecticide-treated bed nets (ITNs). A cross sectional study of the awareness and use prevalence of ITNs among the pregnant population in Osogbo, a town in south-western Nigeria was carried out. Three hundred and eighty-two responses were obtained. The age range of the respondents was 15-39 years, and the mean age was 28.2±5.1, and most of them, 229 (59.9%) were in the third trimester. One hundred and fifty-seven (41.1%) of the respondents have heard about ITNs, but only 16 (10.2%) actually sleeps inside ITNs. Use prevalence of ITNs was very low among primigravidae who were the most at risk adult population when compared to multigravidae, 37.5%, and 62.5%, respectively. The low awareness and low use prevalence of ITNs (which had been shown to reduce all cause mortality among young children by 16–33%, and also provide protection to pregnant women), calls for education of this at risk population through the antenatal clinic, and the media. The antenatal clinic and the infant welfare clinic will also be an avenue for the distribution of ITNs at highly subsidized rate. Since these pregnant populations are the mothers of under 5 children, the other group susceptible to severe malaria, their embracing the use of ITN will mean reduction of malaria burdens in them as well as their children. Nigerian Medical Practitioner Vol. 52 (2) 2007: pp. 29-3

Predictors of request for antenatal sex determination among pregnant women in Osogbo, Nigeria

No Abstract Nigerian Journal of Medicine Vol. 16 (4) 2007: pp. 322-32

Booking status and caesarean section outcome in LAUTECH teaching hospital, Osogbo

Background: Antenatal care is concerned mainly with prevention, early diagnosis and treatment of general medical and pregnancy associated disorders. Quality of care varies across health facilities; the booking status of the women who deliver would have influence on the pregnancy outcome. Method: A comparative study of caesarean section outcome among the booked and unbooked mothers delivered at Ladoke Akintola University Teaching Hospital, Osogbo. Results: Mean age of the women was 29.7±5.9 years. The booked mothers were older than the unbooked mothers. All the maternal deaths were among the unbooked mothers. There were higher rates of preterm birth, neonatal asphyxia and neonatal admissions to intensive care units among the babies delivered by unbooked mothers compared to the booked mothers. Conclusion: Unbooked women and their babies are at higher risks of caesarean section complications than the booked mothers. Nigerian Journal of Medicine Vol. 17 (1) 2008 pp. 25-2