Side effect profile of Jadelle implant in Nigerian women during the first 12 months of usage

Background: Most of the reasons for discontinuation of Jadelle implants by clients are related to the progestogenic side effects, which are dependent on the plasma levels of the hormone. The plasma level of levonorgestrel from Jadelle implant is about 100µg in the first month of insertion, but declines sharply in the first 12months of usage to stabilize at 30µg per day from 24 months of usage. This study was designed to assess the side effect profile of Jadelle implant in users during the first 12months of usage in a view to assessing its acceptability to the clients.Methods: Data sheet was designed to obtain demographic and clinical parameters of clients and prevailing side effects were surveyed longitudinally over the first 12months of usage.Results: There was no request for discontinuation of the method and no accidental pregnancy occurred during the period of the study. There was significant disruption of the menstrual pattern of clients over time with 31.1% developing irregular uterine bleeding from 6months of usage, whereas 16.6% of clients became amenorrheic from the 12month of usage. (p= 0.000) Changes in blood pressure and body weight of clients were not significant during the 12month period of the survey. Non menstrual side effects of Jadelle implants, which included headache, breast tenderness, dizziness among clients were noted at 6months of usage but became less prevalent by the 12month of usage.Conclusions: Jadelle implant proved to be highly effective, safe and acceptable to Nigerian clients during the study period, even though the implant had significant impact on their menstrual pattern

Attainment of menstrual hygiene by girls in boarding secondary schools in a state in Sub-Saharan Africa

Background: Menarche is the most dramatic manifestation of puberty in girls; unlike the biometric developmental changes that occur at puberty, menarche requires the personal adjustment and response of an affected girl in order to attain good menstrual hygiene. This study was designed to evaluate how boarding secondary school girls manage their menstruation in school, away from the guidance of their parents.Methods: A cross sectional survey was performed in four public boarding secondary schools in the study area with the aid of structured questionnaires to evaluate how such girls manage their menstruation while in school.Results: The study population was 975 girls whose survey revealed the mean age at menarche of 12.5±1.4 years.  Seven hundred and two (72.0%) respondents had received sexuality education before onset of menarche. Respondents who attained good menstrual hygiene were 775(79.5%). Such respondents were those who had received sexuality education (p<0.001) and those who had access to synthetic sanitary pad (p=0.005). Duration of the menstrual period and the volume of menstrual blood loss did not affect (p=0.219) the ability of respondents to attain good menstrual hygiene. Respondents who received sexuality education had about 605 chances of attaining good menstrual hygiene than those who did not receive such education.Conclusions: A vast majority of the respondents had received sexuality education before onset of menarche and a larger proportion attained good menstrual hygiene. Major factors that positively influenced the girls’ capacity to attained good menstrual hygiene were prior sexuality education and access to synthetic sanitary pad

Subdermal Contraceptive Implants: Profile of Acceptors in a Tertiary Hospital in Southern Nigeria

Background: Subdermal contraceptive implants provide safe, effective, convenient, long term reversible fertility regulation, and because of their numerous non-contraceptive benefits are particularly suitable for women in developing countries. This study determines the socio-demographic characteristics of acceptors of subdermal implants, the timing of their use and their complications at the University of Uyo Teaching Hospital, Uyo.Materials and Methods: The record cards of all clients that accepted subdermal contraceptive implants over a four year period were reviewed.Results: There were a total of 1057 new contraceptive acceptors out of which 197 (18.6%) accepted contraceptive implants. The modal age group of the clients was 30-34 years (38.0%). One hundred and fifty six patients (79.2%) were mulitparous, 97.5% of the patients had attained secondary level of education while 92.4% were Christians. About 56.9% of the clients preferred to use implants to space child births, most of the implants were inserted during the first week of the menstrual period, and majority (78.2%) of the clients obtained their information concerning implants from clinic personnel. The most common complication was abnormal vaginal bleeding.Conclusion: contraceptive implants are very effective contraceptive methods that are mostly accepted and used by young, educated parous women who mostly preferred to space births. There is also a high continuation rate among acceptors so increasing availability of implants in family planning units nationwide could increase the number of women who utilize this method of contraception

Innovative use of tourniquet in the management of an advanced abdominal pregnancy to achieve an unusually normal postoperative outcome: a case report

Mrs. UVG was an un-booked G3P1+1 petty trader, who presented with an obstetric ultrasound scan report, with an incidental diagnosis of abdominal pregnancy at 32 weeks of gestation with the placenta attached to the fundus of the uterus. Her admission packed cell volume was 24%. She had pre-operative preparation and 2 units of compatible blood were transfused to correct the anemia. Four additional units of compatible blood were made available before she was scheduled for an exploratory laparotomy at 33 weeks of gestation. A grossly normal male infant weighing 2.2 kg was delivered from the peritoneal cavity with Apgar scores of 2 at 1 minute and the same at 5 minutes. The placenta which was attached to the fundus of the uterus was removed manually completely after a tourniquet had been applied distal to the point of separation. Intra-operative blood loss was 1000 ml. The infant died 1 hour after delivery due to respiratory failure. Autopsy report revealed massive intracerebral hemorrhage and pulmonary hypoplasia. The post-operative period was uneventful and the decline in serum assay of β-human chorionic gonadotrophin postpartum was normal. She was discharged home on the 8th post-operative day and seen at the postnatal clinic twice at weekly intervals with normal serum assay of β-human chorionic gonadotrophin. Her 6 weeks postnatal visit was also uneventful

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

The role of prophylactic antimalarial in the reduction of placental parasitemia among pregnant women in Calabar, Nigeria

Introduction: Intermittent preventive treatment of malaria with sulfadoxine-pyrimethamine is a recommendation of the World Health Organization as part of the malaria control strategy in pregnancy in areas with malaria burden. Aim: This study set out to appraise the effectiveness of this regimen in the prevention of placental parasitemia among parturients in Calabar, Nigeria. Materials and Methods: Pretested, precoded questionnaires were administered to eligible women at the antenatal clinic and later updated at the labor ward. Intermittent preventive treatment was administered under direct observation at the clinic, while packed cell volume, placental parasitemia, and other laboratory tests were measured at the labor ward. Results: The gross presence of placental malaria in the intermittent preventive treatment (IPT)-treated and the control groups was 10.6% and 11.3% respectively (P=0.76). Anemia occurred in 3.1% of the IPT-treated group compared to 11.7% among the control group (P=0.000). Only 7.9% of the IPT-treated women had moderate to severe placental parsitemia whereas as many as 53.2% of women in the control group had moderate to severe parasitemia (P=0.000). Conclusion: Intermittent preventive treatment of malaria with sulfadoxine-pyrimethamine was associated with significant reduction in the degree of placental parasitemia among women in the IPT-treated group, although it did not completely eradicate placental malaria in the treatment group

Pediatric Gastrointestinal Diseases in Nigeria: Histopathologic Analysis of 74 Cases

BACKGROUND: Children are vulnerable to a vast number of diseases including gastrointestinal disorders, which may be associated with life threatening complications that sometimes result in mortality especially if left untreated. OBJECTIVE: To establish the age and sex distribution of children in the study population as well as the histopathological characteristics of gastrointestinal diseases that occurred in those children who were aged 14years and below in Sagamu, Southwestern Nigeria. MATERIALS AND METHODS: Demographic data such as age, sex, and clinical summary of children in the study population were extracted from the medical records of Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State from January 2003 to December 2009. Based on this information, a review of paraffin embedded blocks and slides as well as histopathological reports of gastrointestinal diseases that occurred in those children aged 14years and below was undertaken at the Morbid Anatomy Department of the hospital. RESULTS: Seventy&#8211;four cases of gastrointestinal diseases were seen in children aged 14years and below. The majority (39.2%) of gastrointestinal diseases were accounted for by appendiceal lesions. Hirschsprung&#8217;s disease, intussusceptions, enterocolitis and jejunal atresia accounted for 29.7%, 10.8%, 6.8% and 4.1% of cases respectively. Adenocarcinoma of the intestine was the predominant gastrointestinal tumour, occurring in 5 out of 7 children. Two cases of non-Hodgkin lymphoma were also seen. The ages of the children ranged from 2 to 14 years, with a mean age of 8.6years and a peak age incidence of gastrointestinal disease in the 10-14year age group. Male children were more commonly affected with the exception of appendiceal lesions, which occurred more in females (M:F ratio= 1.6:1.0). Acute suppurative appendicitis was the most prevalent lesion of the appendix, occurring in 13 out of 29 appendiceal lesions. Moderately differentiated to poorly differentiated histological types were seen in the tumours- 3 adenocarcinomas and 2 mucinous carcinomas. Burkitt&#8217;s and Mucosal-associated types of non&#8211; Hodgkin lymphomas were the two histological types of lymphoma seen primarily in the stomach and small intestine respectively. CONCLUSION: Appendiceal lesion was the predominant paediatric gastrointestinal disease found in the study population with preponderance for female children. Adenocarcinoma was the most common gastrointestinal tumour found, while, Hirschsprung&#8217;s disease, intussusception, enterocolitis, jejunal atresia and non-Hodgkin lymphoma contributed to only a minority of the gastrointestinal diseases found in the study population. [J Interdiscipl Histopathol 2013; 1(5.000): 261-266

Perception and attitude of mothers toward family planning in Southern Nigeria

Background . The prevailing low utilization of modern contraceptives for family planning in developing countries in spite of an almost universal level of awareness by the populace is a cause for concern by relevant stakeholders. Objectives. The aim of this study was to determine the feeling and attitude of women toward family planning and the reasons for such attitude. Material and methods . A 7-item structured, pre-coded questionnaire was used to sample respondents’ feelings and attitude toward family planning. Results. All the respondents were aware of family planning, and 412 (90.9%) of them believed in the practice. The majority 269 (59.4%) of the respondents preferred to allow 24 months between their last delivery and the next pregnancy. 306 (74.3%) respondents believed in the use of modern contraceptives for family planning and preferred: the male condom – 160 (52.3%), intrauterine contraceptive device (IUCD) – 27 (8.8%), and hormonal contraceptives – 119 (38.9%). Those who did not believe in modern contraception preferred abstinence – 12 (11.3%), the withdrawal technique – 75, (70.8%) and the rhythm method – 19 (17.9%). The major reasons why some respondents would not use modern contraceptives for child spacing were the feeling that it is not natural - 39 (36.6%), it could fail – 13 (12.2%), fear of side effects – 41 (39.0%), and the fear that it could cause infertility – 13 (12.2%). Conclusions . The willingness to utilize modern contraceptives for family planning in Nigeria remains relatively low despite a universal level of awareness about the practice. This is due to misconceptions about modern contraception