The Impact of Recycled Neonatal Incubators in Nigeria: A 6-Year Follow-Up Study

Nigeria has a record of high newborn mortality as an estimated 778 babies die daily, accounting for a ratio of 48 deaths per 1000 live births. The aim of this paper was to show how a deteriorating neonatal delivery system in Nigeria may have, in part, been improved by the application of a novel recycled incubator technique (RIT). Retrospective assessment of clinical, technical, and human factors in 15 Nigerian neonatal centres was carried out to investigate how the application of RIT impacted these factors. Pre-RIT and post-RIT neonatal mortalities were compared by studying case files. Effect on neonatal nursing was studied through questionnaires that were completed by 79 nurses from 9 centres across the country. Technical performance was assessed based on 10-indices scores from clinicians and nurses. The results showed an increase in neonatal survival, nursing enthusiasm, and practice confidence. Appropriately recycled incubators are good substitutes to the less affordable modern incubators in boosting neonatal practice outcome in low-income countries

Placenta percreta with bladder involvement: a case report

Placenta percreta with bladder invasion manifesting with haematuria is a relatively rare complication of pregnancy. This is a case report of Mrs. O.V; a 41 year old unbooked Para 4+1 teacher with a history of 2 previous caesarean section. She was admitted at 25 weeks for conservative management for bleeding major placenta praevia. At 28 weeks gestation she developed total haematuria. She subsequently had an emergency subtotal caesarean hysterectomy, bilateral internal iliac artery ligation and bladder repair. Keywords: placenta percreta, haematuria, urinary bladder Tropical Journal of Obstetrics and Gynaecology Vol. 22(1) 2005: 85-8

Quantitation of Proteinuria in Women With Pregnancy Induced Hypertension: Is it Time to Abandon Use of Dipstick Strips for the Spot Urine Protein to Creatinine Ratio?

Context: The presence of significant proteinuria in Pregnancy Induced Hypertension is associated with worse maternal and fetal outcome. Unfortunately, Dipstick strips, currently used widely for detection and quantitation of proteinuria, have been shown to be unreliable. This creates the need for a more accurate method for early detection and quantitation of proteinuria. Objective:To compare the accuracy of the Spot urine Protein to Creatinine ratio with that of Dipstick Tests in the quantitation of proteinuria in Nigerian women with Pregnancy Induced Hypertension. Methods: A cross-sectional survey over a 6-month period involving 86 Nigerian women with Pregnancy Induced Hypertension. Outcome measures: False Positive rates, False Negative rates, Sensitivity, Specificity, Positive Predictive value, Negative Predictive value, and Accuracy. Result: The Spot urine Protein to Creatinine ratio showed better correlation with 24-hour urine protein measurement than Dipstick Tests. Comparatively, the False positive rates were 16.2% versus 53.7%, False Negative rates 6.1% versus 28.1%, Sensitivity 91.2% versus 73.5%, Specificity 88.5% versus 44.4%, Negative predictive values 93.9% versus 71.9%, and Accuracy 89.5% versus 55.8% respectively for the Spot urine Protein to Creatinine ratio and Dipstick Tests. Conclusion: The Spot Urine Protein to Creatinine ratio is much more accurate in the quantitation of proteinuria in Nigerian women with Pregnancy Induced Hypertension than the widely used Dipstick Tests. Key Words: Quantitation, Proteinuria, Pregnancy, Hypertension. [Trop J Obstet Gynaecol, 2004;21:136, 137, 140, 141

Comparison of Vision Restoration Time With Vitamin A Levels in Pregnant Nigerian Women

Background: Vitamin A deficiency, subclinical or otherwise is associated with adverse maternal fetal and neonatal outcome, ditto excess vitamin A. The challenge in pregnancy is to detect subclinical vitamin A deficiency in patients for whom supplements or dietary manipulation will be of benefit. Objective: To compare the usefulness of the vision restoration time with biochemical methods in the determination of vitamin A status in pregnancy. Study Design And Setting: A cross sectional case controlled study in a University teaching hospital. Methods: Data was collected from Antenatal patients (142). Using serum Biochemistry three categories of patients were recognised. Patients with normal vitamin A levels (N = 100 with blood vitamin A within two standard deviation of the mean) Twenty four patient (24) had low vitamin A levels (blood vitamin A level at less than 2 standard deviation below the mean). Eighteen patients (18) had high vitamin A levels (blood vitamin A levels at greater than two standard deviation above the mean). Outcome Measures: The vision restoration time was compared for all three groups of patients. Results: The vision restoration time (VRT) was found to have a high degree of sensitivity (80%) and a high specificity (83%) in detection of patients with vitamin A deficiency. The positive predictive value was 90% with a negative predictive value of 83%. The VRT was unable however to differentiate patients with normal and high vitamin A. Conclusion: The vision Restoration time is a cheap effective method to detect subclinical vitamin A deficiency in pregnancy. It is an easy cost effective screening tool to select patients for whom dietary manipulation and or vitamin A supplementation will be beneficial. Key Words: Vitamin A, Nutrition, Supplementation Pregnancy, Vision [Trop J Obstet Gynaecol, 2004;21:7-10

Evaluation of chlorhexidine in the detection of bacteriuria in pregnancy

Context: Urine culture is the gold standard for diagnosing bacteriuria in pregnancy, which is a very serious condition with a lot of consequences to both mother and foetus. Several chemical tests can equally be used to detect presence of bacteria in urine. Objective: The aim of this study was to determine the accuracy of chlorhexidine solution in detecting significant bacteriuria in pregnancy Methods:This was a cross- sectional study in which patients with urinary tract infection had their urine samples tested with chlorhexidine and bacteriological method. The predictive value method was used to compare both methods. Results: A total of seventy-five (75) patients had clinically diagnosed urinary tract infection. Of these, only twelve (16%) were confirmed by bacteriology. Chlorhexidine detected all of these patients with laboratory- confirmed urinary tract infection and also detected other patents with abnormal components in their urine. Sensitivity was 100%, accuracy 40% and a specificity of 28.5% . The low specificity was due to the fact that chlorhexidine solution cross-reacts with bacteria and other major components of urine when present in significant amount. Conclusion: The Chlorhexidine Reaction is of little value in detecting bacteriuria per se, but it is useful for detecting other anomalies such as the presence of epithelial cells, crystals and pus cells. The test is however recommended for use as a screening tool for urinary tract infection in pregnancy because of its high sensitivity, cost effectiveness and its ease of performance. Keywords: evaluation, chlorhexidine, bacteriuria, pregnancy Tropical Journal of Obstetrics and Gynaecology Vol. 23(1) 2006: 14-1