Hysterectomy in Adolescents

Introduction: Hysterectomy in adolescents is a very difficult decision to take as the consequence is always a loss of future reproductive potential. However, it may be necessary sometimes as a salvage measure.Subjects and Methods: We evaluated the trends and factors that necessitated hysterectomy among adolescents seen at the University of Port Harcourt Teaching Hospital, Port-Harcourt (UPTH), Nigeria.This is a retrospective descriptive analysis of 28 cases of hysterectomies managed at the UPTH over a 17-year period. Variables analysed included socio-demographic factors, indications for and type of hysterectomy performed, decision level, duration of surgery and complications encountered.Results: Majority (78%) of the hysterectomies were in adolescents aged 16 years and above. Sixty percent of them had a secondary education, 78% were unmarried and one third had had a previous successful pregnancy. About half the cases resided in rural while half resided in urban settlements.. Seventy-one percent of the hysterectomies were abortion- related. Decisions for the hysterectomies were taken mainly byconsultants and occasionally, in dire emergencies, by senior residents to prevent death from bleeding. Mortality was 21%.Conclusion: The results suggest the need for a greater emphasis on sexuality education and expansion of sexual and reproductive health services to adolescents especially those who are sexually active. Life planning and livelihood skills training are needed to enable young people acquire value-based skills, which are essential for making safe andinformed choices . With such high level of mortality from septic abortion even with invention, the need for Youth Friendly Centres/services cannot be over emphasized

Hysterectomy in Adolescents, in Port Harcourt, Nigeria.

Background: Hysterectomy in adolescents is a very difficult decision to take as the consequence is always a loss of future reproductive potential. However, it may be necessary sometimes as a salvage measure.Methods: A retrospective descriptive analysis of 28 cases of adolescent hysterectomies managed at the University of Port-Harcourt (UPTH) over a 17-year period was carried out. Variables analysed included socio-demographic factors, indications for and type of hysterectomy performed, decision level, duration of surgery and complications encountered.Results: Majority (78%) of the hysterectomies were in adolescents aged 16 years and above. Sixty percent of them had a secondary education, 78% were unmarried and nine had a previous successful pregnancy. About half the cases resided in rural areas, while half resided in urban settlements. Seventy-one percent of the hysterectomies were abortionrelated. Decisions for the hysterectomies were taken mainly by consultants and occasionally, in dire emergencies, by senior residents to prevent death from bleeding. Mortality was 21%.Conclusion: The results suggest the need for a greater emphasis on sexuality education and expansion of sexual and reproductive health services to adolescents especially those who are sexually active. Life planning and livelihood skills training are needed to enable young people acquire valuebased skills, which are essential for making safe and informed choices. With such high level of mortality from septic abortion even with intervention, the need for Youth Friendly Centres/services cannot be over emphasized

Charcot-Marie-Tooth Disease in a Child with Acute Lymphoblastic Leukaemia: A Case Report and Review of Literature

Background: Charcot-Marie-Tooth disease (CMT) is a common inherited neurologic disorder with various modes of inheritance. Existing peripheral neuropathy is a generally accepted risk factor for increased susceptibility to neurotoxic agents and there is a general acceptance of the concept of medication-induced worsening of CMT. Several authors have reported vincristine neurotoxicity in CMT and vincristine treatment triggering the expression of asymptomatic CMT disease. We report the case of a 10 year old male patient who developed severe neuropathy following treatment with vincristine for his Acute Lymphoblastic Leukaemia.Methods: The case records of the patient and a review of the relevant literature using available books, journals and online literature search was utilized.Results: Facial nerve palsy, increasing lower extremities muscle weakness and abnormal gait were noticed 4 weeks into vincristine therapy in a ten year old male on treatment for acute lymphoblastic leukaemia (ALL). On a suspicion of vincristine neurotoxicity, vincristine was excluded from his chemotherapy regimen. Although remission of ALL was achieved within 6 weeks of treatment, the patient's neurological symptoms did not improve even with the withdrawal of vincristine. The patient was diagnosed with Charcot-Marie-Tooth disease resulting from vincristine toxicity.Conclusion: Patients with Charcot-Marie-Tooth disease may show severe toxicities with vincristine. It is therefore recommended that an extensive neurologic examination should be conducted on any paediatric patient with a diagnosis of malignancy to identify any undiagnosed neurologic deficits and screen for suitability or otherwise of a vincristine containing cytotoxic therapy regimen. This case stresses the need for an urgent health sector response to provide adequate facilities for electrophysiological screening and genetic studies in resource limited centres like ours in order to identify possible cases of undiagnosed CMT and prevent the occurrence of exacerbation by vincristine administration

Evaluation of school health instruction in public primary schools in Bonny Local Government Area, Rivers state

Background: Effective school health instruction in primary schools is  essential in addressing the health risks and needs of school age children and adolescents. This study sought to evaluate the status of schoolhealth instruction in public primary schools in Bonny Local Government Area.Method: This is a cross sectional school based study carried out in 20 public primary schools in Bonny Local Government Area, Rivers State, in March 2006. The availability of the various components of the school health instruction programme was evaluated using an evaluation scale. Components had weighted scores. The minimum acceptable and maximumattainable scores for school health instruction were 31 and 47. Data was analyzed using SPSS version 11.Results: There were a total of 100 teachers in all the schools. The teacher population per school ranged from 2 to 13 with a mean of 5±2.77SD. The pupil population of the schools ranged between 100-1460 with a mean of352±336SD. Teacher/pupil ratio per school ranged from 1: 30 to 1: 128. Fourteen (70%) schools had teacher/pupil ratio less than 1:40. There was no professional health instructor in all the schools. Four schools (20%) allotted 3 periods per week to health teaching, while the rest (80%)  allotted less than 3 periods per week. HIV/AIDS was not in the health education curriculum being used. The only teaching method used by all the schools was the direct teaching method. No school used teaching aids; noschool went on field trips. Teachers did not receive in-service training on health education. No school attained the minimum acceptable score of 31 points using the evaluation scale.Conclusion: School health instruction was poorly implemented in the primary schools investigated. Teachers were not adequately prepared for health teaching and the classrooms were overcrowded.Keywords: School; Health instruction, Evaluatio

Microalbuminuria: It's Significance, risk factors and methods of detection

Background: Microalbuminuria, though a relevant screening tool world wide, is scarcely reported with very sparse literature in our setting. Microalbuminuria is a marker of early renal involvement, compare to routine serum creatinine and electrolytes changes in hypertension and diabetes mellitus. This article attempts to review the significance, risk factors and methods of detection of Microalbuminuria.Methods: Available publications from local and international journals in addition to Medline and Google search, particularly for local references were utilized. Other sources of our data included dissertations from the library of National post graduate medical college and text books of paediatric nephrology.Results: Microalbuminuria is used extensively in diabetes mellitus as a sensitive test for the detection of preclinical kidney dysfunction prior to the development of overt proteinuria, and as a predictor of subsequent  diabetic nephropathy. It has been found to be an important prognostic indicator in meningitis, malignancy and hypertension. It has been found to be useful in the monitoring of patients with renal scarring, unilateral nephrectomy and diabetes mellitus. It is also an important marker of glomerular injury, particularly in patients with sickle cell anaemia.Conclusion: Microalbuminuria is an early maker of glomerular injury. It is important as a screening tool in a variety of disease conditions. Screening may be performed with a semiquantitative assay. If the screen is positive, UAE should be evaluated by a quantitative assay.Key words: Microalbuminuria; Screening; Risk factors; Methods of detection

An Evaluation of the Health Status of the School Environment in Public Primary Schools in bonny Local Government Area, Rivers State

Background: The provision of a Healthful School Environment is a prerequisite for the protection and promotion of the health of learners and attainment of Millennium Development Goal 2. This study sought to evaluate the availability of components of a healthful school environment in public primary schools in Bonny Local Government Area of Rivers State using an evaluation scale.Method: This was a cross sectional school based study done in March 2006. Using an evaluation scale, 20 public primary schools were assessed for the availability of the various components of a Healthful School Environmentsuch as water supply, toilet facilities, school structure, sitting comfort of pupils among others. Components had weighted scores. The minimum acceptable and maximum attainable scores were set at 52 and 64 points respectively. Data was analyzed using SPSS version 11.0Results: Pupil population in the schools ranged from 100 to 1460 with a mean of 352±336SD. Teachers population in the schools ranged from 2 to 13 with a mean of 5±2.77SD. Seventy percent of the schools had teacher- pupil ratio below 1: 40. Seven (35%) schools had water supply within their premises, 5(25%) schools had functional toilet facilities and all the schools practiced open dumping and burning as their only method of refuse disposal. By inspection, 10 (50%) schools had strong walls and were well roofed, 1(5%) school had no school structure, but had a shade made up of sticks with zinc roofing sheets. The remaining schools were at various stages of disrepair. Seventeen (85%) schools had adequate ventilation and good lighting. Seats were available for all pupils in 11(55%) out of 20 schools. None of the schools had a food service area, safety patrol team or fire extinguisher. The main hazards reported were presence of Snakes in 13 (65%) schools and flood in 12 (60%) schools. The total scores of the individual schools ranged from 8 to 37 points. No school had up to the minimum acceptable score of 52 points.Conclusion: The environments of public primary schools in Bonny Local Government lacked the basic amenities of water and sanitation and are generally unsafe.Keywords: Evaluation; Healthful School Environment; Bonny; Nigeria

Mothers Perception of Sexuality Education for Children

Sexuality education is the process of acquiring information and forming attitudes and beliefs about sex, sexual identity, relationships and intimacy. It develops young people's skills so that they make informed choices about their behaviour, and feel confident and competent about acting on these choices. It also equips children to face developmental challenges and empowers them against the ills of abuse, exploitation, unwanted pregnancies amongst others. Mothers who are the primary caregivers should be well informed about sexuality issues. The objective of the study is to determine mothers' perception of sexuality education in children, in Port Harcourt.A structured, anonymous and selfadministered questionnaire, used as instrument for data collection, was distributed amongst a convenient sample of women attending a Christian women's convention in Port Harcourt.One hundred and fifty eight women participated in the study. Most of them were married (80.4%), and belonged to the 30-49 years age bracket. Seventy one (44.9%) of the respondents had tertiary education. Over 80% agreed that children needed sexuality education but only 15 women (9.5%) had a good knowledge of the concept of sexuality education. One hundred and eleven (70.2%) believed it was the responsibility of both parents to educate their children and over 70% acknowledged that the home was the best place for such education. 64 (40.5%) believed that 6-10 years was the ideal age for starting sex education while 49% thought that the ideal age was 11-15 years. 65% of respondents discussed sexuality issues with their children at least occasionally,the content mostly involved description of body parts and reproductive organs. The average age of menarche amongst respondents was 14.0. One hundred (63%) of the women had prior knowledge of menstruation before menarche. About half of them had received information from their mothers.  The study highlights the need for enlightenment of women on sexuality education to enable them empower their children against the ills of child abuse.

Relationship between head lice infestation and hair grooming practices in primary school children in Port Harcourt

Background: Hair grooming practices and hair characteristics are some of the host related risk factors for head lice infestation. Certain hair groomingpractices and characteristics have been reported to affect head lice infestation.Objective: To determine the relationship between head lice infestationand hair grooming practices in Primary school children in Port Harcourt.Methods: A cross-sectional study was conducted, using a stratified multi-staged sampling technique. A total of 1350 pupils from thirteen primary schools located in three School Districts were recruited. Data was collected using  a proforma completed by parents /guardians. The heads of the pupils were inspected for head lice and nits with the aid of a battery  operated Robi lice comb, magnifying glass and a torch as light source. Results: Ten (0.7%) of the 1350 pupils had head lice infestation, all of whom were females. Seven (2.5%) of the 276 pupils with long hair (hair length greater than 5cm) had a significantly higher prevalence of head lice infestation, compared to 3 (0.3%) of the 1074 pupils with short hair (p < 0.001). Head lice infestation significantly increased with a reducing  frequency of hair wash from 3 (0.3%) in those that washed daily to 1(1.5%) in those that washed monthly (p = 0.034) but was not significantly associated with the use of chemicals to straighten hair. Head lice infestation significantly increased with reducing social class from 0 (0%) in social class I to 3 (9.1%) in social class V (p < 0.001).Conclusion: A higher prevalence of head lice infestation is significantly associated with longer hair and reduced frequency of hair wash.Key words: Head lice, Hair grooming, School childre

Adolescent blood pressure pattern in Rivers State, Nigeria: A rural - urban comparison

Background: Childhood and adolescent blood pressure pattern have been known to predict adult blood pressure levels and development of hypertension. Hypertension, once rare in traditional African societies, is now the commonest non-communicable disease in Nigeria. There are few studies on adolescent blood pressure pattern, especially in adolescents living in rural areas. It is therefore important to identify blood pressure differences, if any, between adolescents living in rural areas compared to their urban counterparts.Objective: To determine and compare the blood pressure pattern of apparently healthy adolescents in rural and urban areas, and to determine the association between blood pressure and body mass index in these children.Subjects and Methods: A cross sectional population based blood pressure survey was carried out on 2,136 Nigerian school adolescents (1080 were resident in rural areas and 1056 in urban areas) aged 10-18 years, selected from 26 secondary schools using a multi-stage stratified sampling technique. Blood pressure measurements were taken by auscultatory method. An average of three readings was taken as the actual blood pressure.Results: Systolic and diastolic blood pressure increased with age in both rural and urban subjects. The mean systolic blood pressure of the rural subjects (111.10 ± 14.72 mm Hg) was significantly (p= < 0.001) higher than that of the urban subjects (108.09 ±15.40 mm Hg), whilst the mean diastolic blood pressure of the urban subjects (66.88 ± 11.27 mmHg) was slightly higher than those of  the rural subjects (66.32±11.71 mmHg. Urban subjects had a higher mean body mass index (19.82± 3.57kg/m2) than their ruralcounterparts (19.59±2.78 kg/ m2).Systolic and diastolic blood pressure showed a positive significant (p= <0.001) correlation with BMI in subjects in rural and urban schools.Conclusion: Significant differences in blood pressure were observed between rural and urban adolescents in Rivers State, with a positive significant correlation between BMI and blood pressure. We recommend blood pressure surveillance as part of the School Health Programme.Keywords: adolescent, blood pressure, rural-urban, Nigeri