Use of modern contraceptive implants the: Lagos island maternity Hospital experience

Backround: Implants are an effective and reversible long term method of fertillty regulation, particularily advantageous to women who wish an extended period of contraception protection. The development of contraceptive implants was made possible by the discovery of silicone and its bio-compatibility in the human body. Silastic tubes with sealed ends and filled with steroids provided a sustained release of the steroids in vitro over months; these models were the precursors of today's contraceptive implants. This technology resulted in the development and patent of Norplant' and Norplant-2 by the Population Council. Over the years the popularity and use of Norplant has waned due to difficulties in insertion and removal. Lagos Island Maternity Hospital (LIM H) introduced Jadelle and Implanon- the newer forms of Implants in the year 2007 with the improvement made on these newer forms, we review the use of modern contraceptive Implant in LIMH.Objectives: The objectives of this study are to demonstrate the socio-demographic and clinical variables influencing acceptors of modern contraceptive implants; to describe observed side effects associated with the use of contraceptive implants and to ascertain acceptance of contraceptive implants through determination of continuation rate.Methodology: This involved a review of clients who were counseled and accepted subdermal contraceptive implants. The contraceptive implants were inserted by sub-dermal insertion of either Jadelle consisting of 2 rods. into the medial boarder of the upper arm or insertion of Implanon single rod in a similar anatomic location Data was extracted using an established family planning proforma. Data obtained included sociodemographic features, past obstetric/gynecological history of the respondents and side effects of the implants. Extraction of data was done over a period of one year.(July 31st 2011 to June 30th 2012)Results: A total of 622 clients made use of various methods of contraception during the study period. The proportion of clients who made use of modern Implants is 11.41 % (n= 71). The average age of the respondents is 32years, with a range of 17.49years.The commonest side effect seen is amenorrhea, occurring in 12.7% of respondents (n = 9).lntermenstrual bleeding occurred in 4.2% of respondents (n =3). More of the respondents had insertion of Jadelle (69.0%: n= 49). The other respondents had insertion of Implanon (31%: n= 22). The proportion of clients who had no plan for further child bearing is 29.6% (n= 21). The majority of clients are desirous of further child bearing (70.4%: n=50).First time users constituted 52.1 % of clients (n= 37). Continuation rate was 90.1 % (0.9% discontinuation due to side effects). Some of the clients had used the cupper TIUD(19.7%: n= 14).Conclusion: Contraceptive Implants have been shown by this study to be an acceptable form of contraception. Majority of the women maintained the use of the contraceptive implants, In women who experienced side effects, amenorrhea is the commonest side effect experienced. The relatively high continuation rate of these implants is a testament of its acceptability. Scaling up its uptake and availability will be useful in reducing the unmet needs for contraception

Cytotoxicity testing of aqueous extract of bitter leaf (Vernonia amygdalina Del) and sniper 1000EC (2,3 dichlorovinyl dimethyl phosphate) using the Alium cepa test

Background: The unrefined nature of the herbal preparations from Vernonia amygdalina (VA) and toxicity potentials of Sniper may both have severe consequences on the biochemical and genetic systems.Objectives: To assess the microscopic and macroscopic effects of these substances.Methods: VA leafs and Sniper were prepared and dissolved in distilled water to give different concentrations. Series of baseline tests were carried out to establish concentration range for root growth. Series of twelve onion bulbs of three per series was prepared, with a series of three onion bulbs serving as control. Chromosomal aberrations were statistically analysed using chisquared test. Root bundle mean length was obtained after 96 hours and EC50 values at 95% confidence interval was determined from a plot of root length against sample concentrations using Microsoft Excel software.Results: Total cytotoxic effect was induced by 2% sniper and 70% VA. EC50 for VA and sniper were 33.07 and 0.346 respectively. The two substances induced chromosomal aberrations and the effect was concentration dependent.Conclusion: There are risks of these widely used substances for therapeutic and environmental purposes.Keywords: Chromosomal aberrations, Sniper 1000EC, Vernonia amygdalina, toxicit

Willingness and acceptability of cervical cancer screening among HIV positive Nigerian women

Background: The proven benefit of integrating cervical cancer screening programme into HIV care has led to its adoption as a standard of care. However this is not operational in most HIV clinics in Nigeria. Of the various reasons given for non-implementation, none is backed by scientific evidence. This study was conducted to assess the willingness and acceptability of cervical cancer screening among HIV positive Nigerian women. Methods: A cross sectional study of HIV positive women attending a large HIV treatment centre in Lagos, Nigeria. Respondents were identified using stratified sampling method. A pretested questionnaire was used to obtain information by trained research assistants. Obtained information were coded and managed using SPSS for windows version 19. Multivariate logistic regression model was used to determine independent predictor for acceptance of cervical cancer screening. Results: Of the 1517 respondents that returned completed questionnaires, 853 (56.2%) were aware of cervical cancer. Though previous cervical cancer screening was low at 9.4%, 79.8% (1210) accepted to take the test. Cost of the test (35.2%) and religious denial (14.0%) were the most common reasons given for refusal to take the test. After controlling for confounding variables in a multivariate logistic regression model, having a tertiary education (OR = 1.4; 95% CI: 1.03-1.84), no living child (OR: 1.5; 95% CI: 1.1-2.0), recent HIV diagnosis (OR: 1.5; 95% CI: 1.1-2.0) and being aware of cervical cancer (OR: 1.5; 95% CI: 1.2-2.0) retained independent association with acceptance to screen for cervical cancer. Conclusions: The study shows that HIV positive women in our environment are willing to screen for cervical cancer and that the integration of reproductive health service into existing HIV programmes will strengthen rather than disrupt the services

Incidence and risk factors for caesarean wound infection in Lagos Nigeria

<p>Abstract</p> <p>Background</p> <p>Post caesarean wound infection is not only a leading cause of prolonged hospital stay but a major cause of the widespread aversion to caesarean delivery in developing countries. In order to control and prevent post caesarean wound infection in our environment there is the need to access the relative contribution of each aetiologic factor. Though some studies in our environment have identified factors associated with post caesarean wound infection, none was specifically designed to address these issues prospectively or assess the relative contribution of each of the risk factors.</p> <p>Findings</p> <p>Prospective multicentre study over a period of 56 months in Lagos Nigeria. All consecutive and consenting women scheduled for caesarean section and meeting the inclusion criteria were enrolled into the study. Cases were all subjects with post caesarean wound infection. Those without wound infection served as controls. Data entry and analysis were performed using EPI-Info programme version 6 and SPSS for windows version 10.0.</p> <p>Eight hundred and seventeen women were enrolled into the study. Seventy six (9.3%) of these cases were complicated with wound infection. The proportion of subjects with body mass index greater than 25 was significantly higher among the subjects with wound infection (51.3%) than in the subjects without wound infection (33.9%) p = 0.011. There were also significantly higher proportions of subjects with prolonged rupture of membrane (p = 0.02), prolonged operation time (p = 0.001), anaemia (p = 0.031) and multiple vaginal examinations during labour (0.021) among the women that had wound infection compared to the women that did not have wound infection. After adjustment for confounders only prolonged rupture of membrane (OR = 4.45), prolonged operation time (OR = 2.87) and body max index > 25 (2.34) retained their association with post caesarean wound infection.</p> <p>Conclusion</p> <p>Effort should be geared towards the prevention of prolonged rupture of fetal membrane and the reduction of prolonged operation time by the use of potent antibiotics, early intervention and use of good surgical technique. In obese women improved surgical technique and use of non absorbable sutures may suffice.</p

Semen quality of male partners of infertile couples living with HIV infection

Background: Infertility among HIV positive couples are increasingly been reported in various gynaecology clinic. Unfortunately research into aetiology of infertility is out tune with this emerging trend. This study was conducted to determine the semen quality among infertile HIV positive couples.Methods: A retrospective analysis of information obtained during routine care of infertile HIV positive couple at a large HIV treatment in Lagos Nigeria.Results: Over thirty percent (31.7%) of the male partners of HIV positive couple in study had abnormal semen quality. Secondary infertility was the commonest (79.2%). The quality of semen of the HIV negative men in the study was significantly better compared to that of HIV positive men (p<0.001). Of the five semen parameters compared, HIV positive participants with more severe diseases had significantly lower mean sperm volume (p=0.003), sperm concentration (p=0.0002) and total sperm concentration (p<0.001) compared to of  HIV positive participants with less severe diseases .  Approximately 22% of the semen of the men in this study was infected, with Staph aureus, E coli and Klebsiella being the most common microbial isolates.Conclusions: Male factor contributes about one third of infertility in this study and severity of HIV diseases impacts on semen quality. Further studies are needed to evaluate if antiretroviral therapy will reverse the effect of HIV infection on semen quality

Child sexual abuse and disclosure in South Western Nigeria: a community based study

Introduction: The true burden of child sexual abuse in Nigeria is not known as most reports are institutional based. This study was designed to determine population level data on the burden and pattern of child sexual abuse among adolescents in South Western Nigeria.Methods: A community based study among adolescents in SouthWestern Nigeria. Semi- structured interviewer administered questionnaire was used to collect data from respondents selected through a multistage sampling technique. Analysis was with SPSS version 20.Results: 398 adolescents (314 females and 84 males) aged 10-19 years with a mean age of 15.6 ± 2.0 years participated in the study. Most were single (90.7%), in school (84.2%), and lived with their parents/guardians (89.4%). The prevalence of CSA was 25.7%. Penetrative abuse occurred in 7.5%, and forced abuse in 46.2% of cases. Perpetrators were mostly boyfriends (31.2%) and neighbours (16.1%). Intra-familial abuse occurred in 7.5% of cases. Only 34.4% of cases ever disclosed the abuse.Conclusion: CSA is common in the community, with perpetrators majorly persons known to the adolescents. A large number of cases are not reported. Efforts should be made to educate children and their parents on various ways to reduce child sexual abuse and its consequences.Keywords: Adolescent, child, sexual abuse