Adolescent and pre-pregnancy nutrition in Nigeria

Good nutrition during adolescent and pre-pregnancy period is critical towards a healthy pregnancy and normal birth weight infant. This article is a review of Adolescent and pre-pregnancy nutrition in Nigeria. Undernutrition in adolescent girls aged 15–19 years in Nigeria has been variously reported to range between 23% and 57.8%. Undernutrition was more prevalent among the rural compared to the urban adolescent, and was attributable more to socio-economic, and dietary factors. A high proportion of energy amongst adolescent, was derived from carbohydrates such as rice, yam, and cassava. Proteins were derived mainly from legumes and pulses, while fats were derived mainly from palm and vegetable oil. Iron was mainly of plant origin and had low bioavailability due to the presence of absorption inhibitors – tannins and phytates. A high levels of vitamin A was prevalent due to consumption of red palm oil. Undernourished adolescent girl and pre-pregnant women are likely to give birth to undernourished infants with the risk of transmitting undernutrition to the future generation. The recommendation towards the implementation of adolescent and pre-pregnancy nutrition in Nigeria include – The establishment of a countrywide school-based nutrition programme; Integration of Nutritional counselling with primary health care services, targeting out of school adolescents; Development of dietary guidelines and IEC materials on nutrition; and Establishment of Preconception clinic to counsel women on family planning and appropriate diet as well as monitor their body weight prior to pregnancy.Key words: Adolescent; Nigeria; nutrition; pre-pregnancy

The Role of Human Papilloma Virus (HPV) Testing in Cervical Cancer Screening

Background: Cervical cancer is the most studied gynaecologic cancer with a clear natural history. Screening for the premalignant lesions has reduced the mortality from cervical cancer mainly in developed countries. Cancer of the cervix is regarded as a sexually transmitted disease because of its association with human papilloma virus. The backbone of screening has been pap smear. The variability of the sensitivity and specificity of Pap smear has lead to development of other screening tests including HPV testing. Aim: To review the role of human papilloma virus testing in cervical cancer screening. Methodology: A medline and other internet search engines were accessed to retrieve online publications on human papilloma virus and cervical cancer. Textbooks and other hard copies of publications on human papilloma virus and cervical cancer were also accessed and information extracted. Result: HPV testing can be used either alone or as an adjunct screening test for pre-malignant lesions of the cervix. It can also be used in monitoring of treatment. It provides an explorable option in low resource countries with high disease burden and no organized screening programme. Conclusion: Development of strategies that will incooperate HPV testing will reduce the false positive results from pap smear and increase the uptake of cervical cancer screening in developed countries. The extent of the role will also be determined by the existing infrastructure. Key words: Cervical cancer, screening, human papilloma virus, testing

Review Article: Maternal nutrition in Nigeria

Introduction: Nutrition refers to intake of food necessary for optimal growth,  function, and health. A well‑nourished mother is likely to have healthy infants with appropriate birth weight.Objective: To review nutrition including the dietary habit of the pregnant and  postpartum women in Nigeria.Materials and Methods: Review involving Internet and literature search.Results: Undernutrition in women aged 15–49 years decreased from 15% (2003) to 11% (2013), while overnutrition increased from 21% (2003) to 25% (2013). Inadequate intake of calories and micronutrient is a major feature of studies on the dietary pattern of Nigerian pregnant women. Multinutrient malnutrition and  micronutrient deficiencies are a consequence of low content of macronutrients and micronutrients in diet and staple foods in Nigeria. Food restriction/taboos occur in association with  primigravidity; teenage pregnancy; lack of formal education; low household income, signifying low socio-economic status and a low body mass index. Food restrictions/taboos are common with proteins and vegetable. Commonly  consumed vegetable contain adequate mineral and vitamins. Poor food preparation habit e.g blanching of vegetable and parboiling of rice occur. Postpartum mother has poor dietary intake—malnutrition, overweight, and obese body mass index. Caloric intake is high with low intake of protein and fat. There is intake of spices and  peppery food believed to flush out lochia, and consumption of palm wine believed to assist breast flow. Consequences of anemia include—folic acid and iron deficiency, malaria, hookworm infestation, and urinary tract infections.Conclusion: Dietary habit on nutrition in pregnancy and postpartum women in Nigeria is poor. Recommendation: Recommended measures to improve maternal nutrition in Nigeria include development of dietary guideline for pregnancy and postpartum; health education on nutrition in pregnancy, using information, education and    communication materials; provision of adequate rest and reduction of workload; counselling of pregnant women on intake of diversified food, and provision of  treatment supplement; encouraging exclusive breastfeeding; and micronutrient supplementation/food fortification for postpartum mothers.Key words: Maternal; nutrition; Nigeria

A review of the prevalence and pattern of presentation of gynaecological cancers in a tertiary hospital in Nnewi, South-East Nigeria

Background: Although the battle against infections and communicable diseases is still ongoing, malignancies are increasingly becoming a health burden especially in gynaecological practice due to the late presentation of cancer patients. When these patients present with advanced forms of disease, medical personnel are often handicapped as they can only offer palliative treatment.Aim / Objective: To conduct a preliminary review (pilot study) of gynaecological cancers in our centre preparatory to the establishment of a Gynaecological Oncology unit.Method: This is a retrospective review of gynaecological cancers in our centre over a three-year period using information from patients’ folders, and theatre and admission registers.Results: Out of a total of 1849 new gynaecological patients, 57(3.1%) were malignancies, representing 10.8% of all gynaecological admissions. Cervical cancer (61.4%) remains the most common cancer, while cancers of the fallopian tube and vulva (1.8%) are the least common. About 80% of the patients either had only primary or no formal education. The mean onset-to-presentation interval for symptoms ranged from 130days for cervical cancer to 336days for endometrial cancer.Conclusion: Cervical cancer, though largely preventable, remains the most common gynaecological cancer in our environment with a strong linkage to illiteracy.Keywords: Cancers, gynaecological, Nnewi, patter

Third Degree Perineal Tear Following Sexual assault in a minor: a case report and review of literature

Background: Child sexual assault presents a major challenge to the society that is supposed to be protective. This has both short and long-term health implications for the child. Objectives: This is to highlight the presence of child sexual assault in our society, its associated complications and to proffer ways of preventing its occurrence in our society. Methods: A case report of third degree perineal tear following sexual assault in a minor that presented with vaginal bleeding. Results: The third degree perineal tear was repaired after resuscitation. There was no incontinence of flatus and faeces post repair. Conclusion: Child sexual abuse is present in our society and may be associated with severe injury. Prompt management of injuries is very important in preventing long term effects. Keywords: Perineal tear, sexual assault, minor. Afrimedic Journal 2010; 1(1): 37-3

Hysterosalpingographic Findings Among Infertile Women: Review at a Tertiary Health Care Institution in Nnewi, South-east Nigeria

BACKGROUND: Tubal pathology is a key factor in infertility particularly in the tropics. Hysterosalpinography remains a vital tool for investigating tubal patency. OBJECTIVE: This was to determine the pattern of hysterosalpingographic (HSG) findings among infertile womeninatertiaryhealth care institution. MATERIALS AND METHODS The case files of 183 infertile women who had HSG between 1 January 2006 and 31 December 2010 at the Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, South-east Nigeria were reviewed retrospectively. The data was analysed using Epiinfo 2008version5.3.1. RESULTS: A total of 183 patients out of 320 new patients investigated for tubal factor infertility were reviewed. Their ages ranged from 25 to 49 years with a mean age of 34 .1 ± 6.3 years. Forty three patients (23.5%) had primary infertility while 143(76.5%) had secondary infertility. The commonest tubal pathology was bilateral tubal blockage 71(38.8%). Nine (4.9%) patients had right tubal occlusion, 23(12.6%) had left tubal occlusion, 8(4.4%) had right-sided hydrosalpinx while 15(8.2%)had left-sided hydrosalpinx. CONCLUSION: Bilateral tubal occlusion remains the major tubal pathology in female infertility in Nnewi, Nigeria. This may probably occur following sexually transmitted infections, mismanaged pregnancies and septic abortions, since the majority of the women presented with secondary infertility. Measures to prevent the occurrence of these infectionsabinitio are paramount. Keywords: Hysterosalpingography, infertile women, Nnew