Quarter of a Century of Female Sterilization in Jos, Central Nigeria

The study was to assess the types and trend of female sterilization between January 1985 and December 2009 (25 years) in Jos, Central Nigeria. There were 25,313 new acceptors of modern contraceptive methods out of which 4,951 (19.6%) were female sterilizations. Minilaparotomy was the commonest method of female sterilization. Local anaesthesia was the commonest anaesthetic utilized. The women were mostly women of relatively older age, grandmultiparous and with large family size. The women were of mean of 38.4 years, and 60% had more than 5 children at the time of sterilization. Interval sterilization constituted 78.5% of the female sterilizations. The acceptance of female sterilization, however, has declined over the years, as acceptance of the long acting contraceptive implants increases. Female sterilization by minilaparotomy under local anaesthesia was found to be feasible, cost effective and acceptable by majority of clients, and  recommended for integration into minor gynaecological procedures in ourinstitutions (Afr J Reprod Health 2011; 15[1]: 101-106)

Massive haemoperitoneum from endometriosis masquerading as ruptured ectopic pregnancy: Case report

Endometriosis is a puzzling disease affecting women of reproductive age .Although it is diagnosed frequently, no consensus exists as to the aetiology of this enigmatic disease . Common locations of ectopic endometrial growths are in the abdomen involving the pelvic structures. Like in the uterine lining, these extra-uterine endometrial growths usually respond to hormones of the menstrual cycle. The tissues build up each month, break down and cause bleeding. However, unlike the lining of the uterus, endometrial tissues outside the uterus have no way of leaving the body. The result is internal bleeding, which if moderate to severe, may lead to massive haemoperitoneum. Philip et al , report an unusual cause of acutehaemoperitoneum in an asymptomatic woman with bleeding from the right uterine artery eroded by pelvic endometriosis. Areport of massive haemoperitoneum in pelvic endometriosis on progestogen treatment presenting as ruptured tubal ectopic pregnancy is presented

Sero-prevalence rate of Hepatitis B among asymptomatic HIV Seropositive antenatal attendees in a Mission Hospital in Nigeria

Background: Women with HIV/HBV co-infection have increased risk of both sexual and vertical transmission of HBV during pregnancy or delivery. They are also at risk of developing liver cirrhosis and hepatocelular carcinoma.Co-infection with the two viruses may complicate the delivery of HAART by increasing the risk of drug related hepatotoxicity.Aim: To determine the sero-prevalence rate of HBV among asymptomatic HIV sero-positive antenatal attendees in a Mission Hospital in Nigeria.Subjects/Methods: This was a cross-sectional study carried out at the Sacred Heart Hospital Obudu, Nigeria, from 1st January to 30th June 2010. Eight hundred and thirty six subjects were counselled and recruited serially into the study. HBsAg screening was done using a rapid ELISA test. HIV-1 was screened and confirmed using two rapid tests.Results: Out of the 836 subjects, 38(4.5%) were positive for HIV-1 among which 5(13.2%) were positive for HBsAg (P=0.09). The mean age and mean parity of HIV sero-positive subjects were 26.7±4.8 (range 18-38 years) and 2.1±1.2 (range 0-4) respectively. Most of the subjects were engaged in commercial activities and had either none or low level of education.Conclusion: The sero-prevalence rate of HBV among HIV pregnant women in the study is 13.2%. We advocate routine screening of HIV pregnant women for HBV.Public enlightenment campaigns, women education, economic empowerment, and mass vaccination will go a long way in reversing and halting the spread of the infection in pregnancy.  Keywords: Sero-prevalence rate, HIV, HBsAg, co-infection, immunization, vertical transmission

Experience with norplant at a Nigerian Teaching Hospital

Objectives: To determine the acceptance of Norplant implants while it was in use and share our experience with other Norplant providers.Design: Retrospective descriptive study.Setting: The family planning clinic of the Jos University Teaching Hospital, Jos, Nigeria.Results: During the 21-year period, January 1985 to December 2005, a total of eighteen thousand, two hundred and ninety one (18,291) new clients accepted various modern contraceptive methods in the family planning clinic of Jos University Teaching Hospital, Nigeria. Norplant was accepted by 1,333 clients (4.9%) as against the intrauterinedevices (IUDs) 25.4%, and Oral Contraceptive Pills (OCP) 22.9%. Female sterilisation was a contraceptive method of choice in 21.2%, the injectables in 13.9%, and the male condom in 9.3%. Failure rate was 0.37% and continuity rate was high among users. The Norplant contraceptive implant was accepted by women of mean age of 29.6 years and women of all parity. The acceptance pattern demonstrated a multi-nodalpattern from the time of introduction in 1985 to December 2005 when supply came to an abrupt stop. The greatest barriers to Norplant use were non- availability and high cost of the commodity.Conclusion: Norplant implants provided contraceptive protection with high reliability, safety, independence from user compliance, rapid return of pre-existing fertility after removal, good tolerability, and relatively simple and quick insertion and removal. The capsules will definitely be used as a reference for similar contraceptive products in the contraceptive market

Factors associated with use and discontinuation of Implanon contraceptive in Jos, Nigeria

Background: the contraceptive prevalence (CPR) in sub-Saharan Africa is low at 8-10% for over a decade. There is also the dominance of the less effective short-acting methods such as pills and injectables. The low CPR is the direct cause of the high total fertility of 5.7 in Nigeria. The use of contraception is the single most dominant contributory factor in fertility declines world-wide. This is especially more true with the use of long acting reversible contraceptive methods like implanon which has the potential to reduce the global burden of disease and mortality associated with a high total fertility rate.Objective: our aim was to analyse and determine the socio-demographic profiles of implanon acceptors and the factors associated with continuation or discontinuation of its use in the family planning programme of the Jos University Teaching Hospital, Jos Nigeria.Materials and Methods: This was a retrospective review carried out between March 2007 and March 2014 at the Jos University Teaching Hospital, Jos NigeriaResults: during the study period, 1482 women accepted implanon with about 85.8% having regular menstrual cycles. Sixty-one percent of these women were breastfeeding at insertion. Their mean age was 31 years with a range of 16 to 53. Christianity was the religion of 87.8% with 12.2% being Muslims. Just under half had tertiary education with over a third having attended secondary school. About 26.7% had no future fertility desires. Over 75% had previously used a contraceptive method. The mean parity in this study was 3.2 with a range of 0 to 12. The mean number of children alive was 2.9. Both the systolic and diastolic blood pressures were little affected by the use of implanon. However there was a mean weight gain among 900 of the women who came for follow up of 2.4 kg. However the weight change was highly variable with about a third of women losing between 1 to 30 kg, 10% not having any net changes and over 61% having a net weight gain of between 1 to 26 kg. About 3.8% had their implanon removed because of weight gain. The percentage loss to follow up was 28.2%. The 900 women who had follow up were exposed to the implanon for 2006.6 woman-years or 24,079 cycles. The mean number of months of exposure to the implant was 27.0 ± 14.7 months. The commonest reason for discontinuation was desire for pregnancy (36.1%) followed by those who changed to other methods (27.6%). Menstrual irregularity was the commonest side effect of implanon that led to removal. Seven in-treatment pregnancies occurred giving a pearl index of 0.35 although only one pregnancy was ultrasonographically-proven to be a method failure of the device.Conclusion: Accepting implanon was influenced by the educational attainment and religion of the women in our unit. The desire for another pregnancy was the commonest reason for discontinuation. However, menstrual irregularity was the commonest side effect of the implant that led to its removal especially in the first six months after insertion.Keywords: Implanon (etonogestrel) contraceptive, continuation rates, discontinuation, reason for discontinuation

Elevated risk of stillbirth in males: systematic review and meta-analysis of more than 30 million births

Background Stillbirth rates have changed little over the last decade, and a high proportion of cases are unexplained. This meta-analysis examined whether there are inequalities in stillbirth risks according to sex. Methods A systematic review of the literature was conducted, and data were obtained on more than 30 million birth outcomes reported in observational studies. The pooled relative risk of stillbirth was estimated using random-effects models. Results The crude mean rate (stillbirths/1,000 total births) was 6.23 for males and 5.74 for females. The pooled relative risk was 1.10 (95% confidence interval (CI): 1.07-1.13). The attributable fraction in the whole population was 4.2% (95% CI: 3.70-4.63), and the attributable fraction among male fetuses was 7.8% (95% CI: 7.0-8.66). Study populations from countries with known sex-biased sex selection issues had anomalous stillbirth sex ratios and higher overall stillbirth risks than other countries, reflecting increased mortality among females. Conclusions Risk of stillbirth in males is elevated by about 10%. The population-attributable risk is comparable to smoking and equates to approximately 100,000 stillbirths per year globally. The pattern is consistent across countries of varying incomes. Given current difficulties in reducing stillbirth rates, work to understand the causes of excess male risk is warranted. We recommend that stillbirths are routinely recorded by sex. This will also assist in exposing prenatal sex selection as elevated or equal risks of stillbirth in females would be readily apparent and could therefore be used to trigger investigation

Maternal death and obstetric care audits in Nigeria: A systematic review of barriers and enabling factors in the provision of emergency care.

Acknowledgements We would like to thank Yutaka Osakabe for co-ordinating the retrieval of full text articles. The John D. and Catherine T. MacArthur Foundation supported this study, grant number 12-100074-000-INPPeer reviewedPublisher PD

Stillbirths at the Jos University Teaching Hospital: Incidence, risk, and etiological factors

No Abstract

Implanon Sub-dermal Implants: A 10-month Review Of Acceptability In Jos, North-central Nigeria

To determine the acceptance of Implanon so far, the group of women accepting it, insertion complications and immediate post insertion problems, if any, and report our initial experiencewith themethod. This was a retrospective review study of all cases of Implanon acceptors between 1 May and 28 February 2007. Demographic and social factors were collated. Insertion and post-insertion complications were evaluated. A total of 2,608 clients accepted contraceptive methods out of which 350 clients had Implanon capsules inserted within the study period (13.4%). One hundred and ninety-one (54.6%) of the acceptors desiredmore children, and therefore using it to space pregnancies, 154 (44.0%)would notwantmore children, but opted for the temporary long term method, and 5 (1.4%) were uncertain whether to have more children in the future or not.Themean age and parity of acceptorswere 32.4 years and 3.6 respectively.Themean number of living children to the women was 3.4. All the women were married. About three-quarters (75.8%) of thewomen had secondary and tertiary education. Seventy-two (20.6%) of the women were taking a modern contraceptive method for the first time. The rest 278 (79.4%) had used one or more methods of contraception, and were only switching over to Implanon sub-dermal implants. The patients weighed between 40 and 122 kg with an average of 62.4 kg. Post-insertion complications like infection, expulsion, bruising and induration were not reported. Four women discontinued the method for varying reasons. Women are accepting the new method. Over three-quarters of the clients are switching from other methods to Implanon. The method appears to have good continuation rate and therefore a promising long term sub-dermal contraceptive method amongst our women. Nigerian Journal of Clinical Practice Vol. 11 (4) 2008: pp. 320-32