Knowledge and use of emergency contraception by medical doctors on internship in a tertiary healthcare facility in Nigeria

CONTEXT

Emergency contraception (EC) is widely used to prevent unwanted pregnancy and it is largely adopted in many countries as over the counter drug to improve access.

AIMS

To determine and compare the correct knowledge, attitude and current use of EC among newly graduated medical doctors (MDs).

SETTINGS AND DESIGN

A cross-sectional study conducted among 255 newly graduated MDs at the University College Hospital, Ibadan, Nigeria.

MATERIALS AND METHODS

A pretested self-administered questionnaire was used to obtain data from consenting participants.

STATISTICAL ANALYSIS USED

Descriptive, bivariate, and multivariable analyses were performed, and statistical significance was set at 0.05. Statistical Package for Social Science version 15.0 (Chicago, IL, USA) software was used.

RESULTS

The mean age of the respondents was 27.2 years (standard deviation = 2.1). The commonest indication for emergency contraceptive use mentioned was rape-96.5%. About 70% support EC in Nigeria, while about a quarter (26.9%) routinely counsel women about ECP use. About 21% of respondents currently use EC. Logistic regression analysis revealed significant results for gender [odds ratio (OR) =3.64; 95% confidence interval (CI) OR = 1.31-10.01), religion (OR = 0.26; 95% CI OR = 0.11-0.630) and marital status (OR = 0.19; 95% CI = 0.07-0.56).

CONCLUSION

The correct knowledge and professional disposition toward EC as a form of contraception is low. We recommend that in-service training should focus more on EC to improve the quality of their knowledge and attitude towards it.

Uncomplicated midvaginal vesico-vaginal fistula repair in ibadan: a comparison of the abdominal and vaginal routes

BACKGROUND

Obstetric fistula is a resultant effect of prolonged obstructed labour. The best surgical management of simple uncomplicated fistula determines the outcome of care.

OBJECTIVE

To compare outcome of uncomplicated mid-vaginal fistula between vaginal and abdominal route of repair.

MATERIALS AND METHOD

This was a hospital based retrospective study conducted at the University College Hospital, Ibadan from January, 2000 till December, 2006.

RESULT

Of the 71 midvaginal fistulae managed, 40.8% had abdominal repair while the remainder were through vaginal approach. The overall repair success rate was 79.2% with comparable outcome in both groups-78.3% for the abdominal and 80% for the vaginal group (p=0.999). The duration of hospital stay did not differ significantly between the groups (p=0.972). Post operative complications were found in 41.4% of the abdominal group compared to none in the vaginal group (p<0.001). The complications were failed repair (20.7%) and urinary tract infection (20.7%). The mean estimated blood loss was 465.5ml in the abdominal group compared to 332.9ml for the vaginal group (p=0.303).

CONCLUSION

Despite the comparable surgical repair outcome of the two methods, the vaginal approach is associated with lesser blood loss and lower risk of post-operative complications. It is recommended that the vaginal route should be employed in the repair of uncomplicated midvaginal fistula unless there are other compelling reasons to the contrary.

Community health insurance as a catalyst for uptake of family planning and reproductive health services: the Obio Cottage Hospital experience

Health service delivery in the Niger Delta region of Nigeria has suffered many setbacks. Community participation may help break the barriers limiting access to health services, especially those associated with family planning and reproductive health services. This is a two-year review of family planning and reproductive health services records offered by the Obio Cottage Hospital from the onset of the Community Insurance Scheme (2010-12). Since the inception of the Community Insurance Scheme, there has been an increase in the uptake of family planning methods of more than 50%; 1,274 women in 2011 vs 3,140 in 2012. An increase in number of women seeking reproductive health services was also observed. The Community Health Insurance Scheme (CHIS) at the Obio Cottage Hospital provides evidence for expansion, as seen in the improvement in patronage for family planning and reproductive health services.

Fertility regulation among women of reproductive age in Ibadan, south-west Nigeria: contraception, abortion or both

OBJECTIVES

To assess the role of contraception and abortion in fertility regulation amongst Southwestern Nigerian women.

SUBJECTS AND METHODS

A survey was conducted through a self- administered questionnaire to women of reproductive age group attending gynecology clinic. Multinominal logistic regression was done to analyze the independent effects of social and demographic variables on the odds that women would adopt any fertility regulation methods instead of doing nothing.

RESULTS

Only 13% of surveyed women were using modern contraception. About 42.2% of women had had induced abortion, 15% of them neither use contraception nor abortion. Fifteen per cent of women surveyed used both contraception and abortion for fertility control. Muslims women had lower odds than Christians to use any of three fertility regulation methods instead of doing nothing. Unmarried and high levels of educational attainment were associated with significant odds of adopting each of three fertility regulation methods (Odd ratios; 1.38 - 35.5).

CONCLUSIONS

There is a need for better fertility regulation. High dependency on abortion especially among the young, unmarried and high level educational status should be discouraged. Government and non-governmental agencies should assist in making modern contraceptives widely available with adequate rural coverage.

Fertility regulation among women of reproductive age in Ibadan, south-west Nigeria: contraception, abortion or both

AIMS AND OBJECTIVES

The objective of this study is to document the prevalence and clinicopathologic features/pattern of salivary gland tumours in Ile-Ife, southwestern Nigeria.

PATIENTS AND METHODS

Fifty eight (58) cases of salivary gland tumours histologically diagnosed between January 1989 and December 2007 were identified from the biopsy records of the Departments of Morbid Anatomy and Forensic Medicine and Oral/Maxillofacial Pathology of the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria. The records of the patients were extracted and data on incidence, age, gender and site of the various tumours were analysed using descriptive statistics.

RESULTS

Pleomorphic adenoma was the most common salivary gland tumour reported accounting for twenty-five (43.1%), followed by Mucoepidermoid carcinoma (eight, 13.8%). Adenoid cystic carcinoma and myoepithelioma each accounted for six cases (10.3%). Non-Hodgkin's lymphoma of the salivary gland occurred in two patients. Twenty-six (44.8%) cases occurred in males while thirty-two (55.2%) occurred in females giving a male-to-female ratio of 1:1.2. The parotid region was the most common site accounting for twenty-eight (49.1%) cases, followed by the submandibular region 16 (28.1%) and palate 10(17.5%).

CONCLUSIONS

Pleomorphic adenoma is the most common salivary gland tumour. Contrary to other African studies, our series reveals mucoepidermoid carcinoma as the commonest malignant salivary gland tumour.

Gynaecological morbidities among adolescents in Ibadan

A descriptive retrospective study, was conducted on adolescent girls (10 to 19 years) at the University College Hospital (UCH), Ibadan to determine the common gynaecological conditions among these group of girls that attended gynaecological clinic of UCH between January 2000 and December 2007. Demographic characteristics including age, sex, occupation, religion, marital status and level of education were extracted from patients' medical records and recorded on a pre-designed data sheet. Presenting complaints and the definitive diagnosis were also recorded. A total of 243 adolescents presented within the study period. The commonest gynaecological complaint was abnormal vaginal discharge (44.4%) while the least was breast lump (1.7%). The commonest gynaecological diagnosis was reproductive tract infection (62.6%), out of which sexually transmitted infections constituted 40%. Infertility (1%) was the least diagnosed condition. Other gynaecological conditions included pregnancy related complications (6.6%), sexual abuse (3.3%), menstrual abnormalities (4.5%) and dysfunctional uterine bleeding (1.7%). Gynaecological complaints were commoner among the older (15 to 19 years) than the younger (10 to 14 years) adolescents (p < 0.01). It was concluded from this study that adolescents experience various forms of gynaecological morbidities, especially reproductive tract infections. We recommend sexual education and counselling for adolescents to help withstand peer pressure in initiating sexual activity. Pregnancy prevention programmes to encourage contraceptive use are imperative.

Awareness and practice of vasectomy among married male health workers at the University College Hospital, Ibadan, Nigeria

OBJECTIVE

To determine the awareness and practice of vasectomy among male health workers at University College Hospital, Ibadan and the influence of socio-demographic factors.

METHOD

This is a descriptive cross-sectional study in which structured self-administered questionnaires were used to interview married male health workers at the University College Hospital, Ibadan between May and July 2006.

RESULTS

Two hundred and fifty responses were analysed. The mean age was 36.7 (+/- 5.4) years. Two hundred and thirty nine (95.6%) respondents were married, 10 (4.0%) were separated while one (0.4%) was divorced. One hundred and fifty-one (60.4%) respondents were medical doctors while 34 (13.6%) were laboratory scientists. Fourteen (5.6%) respondents were pharmacists while 9 (3.6%) and 23 (9.2%) of the respondents were records officers and nurses respectively. Nineteen (7.6%) respondents belonged to other professions. Two hundred and twenty five respondents (90%) knew about vasectomy while twenty five respondents (10%) were not aware of it. One hundred and forty-five (58.0%) of the respondents were unwilling to accept sterilisation as a contraceptive procedure while 48 (19.2%) were willing to accept it and the remaining respondents 57 (22.8%) were uncertain. The cadre of medical profession and being previously aware of vasectomy were statistically significant with the willingness to accept vasectomy (chi(2) = 20.943, p= 0.021 and chi(2) = 10.666, p = 0.005 respectively). However none of the respondents had ever had vasectomy done.

CONCLUSION

Some health workers are not aware of vasectomy or have some misconceptions about it. Family planning and contraception should be inculcated into the curricula of schools producing health workers such as laboratory scientists, radiographers etc. This will go a long way in improving their knowledge and attitude to vasectomy.

Effect of oxytocics on the blood pressure of normotensive Nigerian parturients

BACKGROUND

The single most common direct obstetric disorder accounting for 25% of all maternal deaths globally is severe hemorrhage, generally occurring postpartum. Nearly all these deaths occur in the developing world. The role of oxytocic drugs in the management of the third stage of labor as a strategy to reduce maternal mortality has been emphasized. However, the adverse effects of these oxytocic agents, in particular ergometrine, have not been properly evaluated in our environment.

OBJECTIVES

To evaluate the effect of ergometrine and oxytocin on the cardiovascular system when used for active management of the third stage of labor.

STUDY DESIGN

A double-blind, randomized controlled study was carried out at the Federal Medical Centre, Makurdi over 24 months. Five hundred and ten patients were randomized to treatment with either 0.5 mg of intramuscular ergometrine or 10 IU of intravenous oxytocin, respectively, as single injections. Their effects on the cardiovascular system were observed using blood pressure as a marker.

RESULTS

Ergometrine unlike oxytocin was observed to cause a significant rise in blood pressure, and this effect was most marked in the first 24 hours of the puerperium.

CONCLUSIONS

These results suggest that ergometrine may be safe in normotensive parturients but hazardous in hypertensive parturients in whom oxytocin would be a safer option.

Ovarian cancer in Ibadan: characteristics and management

Ovarian cancer has the highest case fatality rate among gynaecological cancers worldwide because of lack of effective screening methods and non-specific early warning symptoms with late presentation. A reinvigorated study is necessary in the developing countries because of a projected increase in its incidence. The decreasing fertility rate and increasing use of ovulation induction drugs are some of the reasons. The Ovarian Cancer Service of the Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Oyo State, Nigeria commenced the first longitudinal study of this malignancy from 1 December 1998 in order to establish a regional management and research centre. It is a questionnaire survey detailing the demography, clinical and staging laparotomy findings and histology of all confirmed cases. Twenty-one staging laparotomy and histologically confirmed ovarian cancer cases were managed from 1 December 1998 to 31 July 2002, about 1.5% of the 1387 gynaecological admissions. It is the third most common of the gynaecological cancers, representing 9.8% of the 214 cases. More than 60% of the patients were 50 years or younger. Only 19% were nulliparous, with 47.6% having had five or more deliveries. Only two patients (9.5%) had used the oral contraceptive pill, for a maximum period of 1 month. Only one patient (4.8%) had a positive family history of cancer. Abdominal swelling was the most common presenting symptom. Eighty-one per cent of the patients presented in Stages III and IV. Epithelial ovarian cancer constituted about 76.2% of the cases. Only 23.8% had adjuvant therapy, consisting of combination chemotherapy using cisplatin-based regimes. The case fatality rate 6 months after surgery was 76%. The ovarian cancer patients in this environment are younger and of higher parity than expected. The risk factors for this disease require further study.

Perceptions and attitudes of Nigerian women about the menopause

The attitudes of women to the menopause are strongly influenced by social, cultural and economic settings in which they live and may also reflect the differences in modes of treatment for or perception of its symptoms. The object of this study was to determine the perception and attitude of post-menopausal Nigerian women to the menopause. We interviewed 676 women who had experienced at least 24 months of amenorrhoea using a structured questionnaire. Menopause was considered a normal physiological manifestation of the ageing process by 95.56% of the respondents while 2.66% believed it was a disease condition. The majority of the women had a positive attitude to the menopause and indicated that it did not affect their relationships with their spouses or children. For most of the women (71.13%), sexual life ended with menopause. None of the women was on hormone replacement therapy but among those sexually active, reduced libido/frequency and vaginal dryness were reported by 24.59%. The most commonly reported advantage of menopause was freedom from cyclical bleeding. We conclude that although Nigerian post-menopausal women have a positive disposition towards menopause, they may have a significant reproductive health burden which has been tolerated for so long. It is important to determine the influence of sociocultural belief on sexuality after menopause and also evaluate the benefits of hormone replacement therapy in our environment.

Emergency contraception: survey of knowledge, attitudes and practice of health care professionals in Ibadan, Nigeria

This survey was conducted to determine the knowledge, and prescribing attitudes of emergency contraception among healthcare professionals in Ibadan, Nigeria. A questionnaire was administered to 735 health care professionals in selected healthcare facilities in Ibadan. These facilities were randomly selected as part of an ongoing programme designed to introduce emergency contraceptive pills (ECPs) as a clinic based method of family planning in service delivery outlets in the city. The response rate was 87.5%, comprising nurses (59.3%) and physicians (25.0%). Others were pharmacists, social workers and administrators. The results revealed that healthcare professionals' knowledge of various methods that can be used emergency contraception is very low. Less than half (35.1%) of the respondents were aware that combined oestrogen/progestin or progestin-only pills can be used as emergency contraception. Similarly, only 26.7% and 13.3% of the respondents were aware that intrauterine contraceptive devices and mifepristone respectively could be used as emergency contraception. While only 16.3% of the respondents had ever prescribed the combined pills as emergency contraception, 10.9% and 8.2% had prescribed progestin-only pills and intrauterine contraceptive devices for this purpose in the past. Circumstances under which emergency contraception could be used vary among the respondents but 71.4% and 64.4% were of the opinion that condom breakage and sexual assault would be appropriate indications for its use. Two main sources, hospitals (68.4%) and pharmacies (8.8%) were identified by participants. It is apparent that one of the major barriers to frequent use of emergency contraception in Ibadan is the lack of awareness of its use by healthcare professionals. Therefore, there is an urgent need to educate these practitioners and include emergency contraception in the family planning curriculum of nursing and medical schools.

Knowledge, attitude and concerns about voluntary surgical conception among healthcare workers in Ibadan, Nigeria

A multicentre study was conducted among healthcare workers in three major hospitals in Ibadan, south-west Nigeria. Structured questionnaires were self-administered to different cadres of healthcare workers in these hospitals with the objective of evaluating their knowledge, attitude and concerns about voluntary surgical contraception. The study revealed that though they had a generally good knowledge of voluntary surgical contraception, their attitude and concerns about the procedure was not encouraging and were largely biased. Such beliefs among healthcare workers tend to negatively influence the uptake of the procedure in the general population, further depleting the low contraceptive use in Nigeria, which has only recently attained a percentage in double figures. Strategies and means to improve on this are discussed to encourage better uptake and acceptability of the procedure among the general population.

Gestational age at antenatal booking and delivery outcome

Antenatal care is a form of preventive medicine that pregnant women to allows maintain a state of good health throughout pregnancy, and to improve their chances of having a safe delivery of healthy infants. To achieve this aim, it is a widely held belief that pregnant women need to book early preferable before 14 weeks gestation. This is a retrospective study which reveals among others that late booking is still a common practice in the developing countries with average gestational age at booking being 23.59 (+/- 8.45) weeks, and only 14% of the women booked before the end of first trimester. Nulliparity or low parity was found to be the only factor that favoured early booking. However, gestational age at booking as a sole factor for predicting the pregnancy outcome was found to be insignificant as the outcome was same for early and late bookers. Unbooked pregnant women were found to be twice at risk of operative delivery, four times more likely to suffer delivery complications and twice likely to have low birthweight babies when compared to booked patients. In conclusion, findings of this study confirm the importance of antenatal care for better maternal and foetal outcome, however gestational age at booking as a sole factor is a poor predictor of pregnancy outcome. It is believed that this finding which is in tandem with the new WHO antenatal care protocol will generate divergent views among the health care givers and modify our current practice of Antenatal care to a more focused and effective risk assessment system.

Female condom awareness, use and concerns among Nigerian female undergraduates

A cross-sectional study of female condom awareness, usage and concerns among the female undergraduates of the University of Ibadan was conducted in September 2004. The results of 850 out of the 879 female students interviewed were used for analysis (96.6%). Over 80% had knowledge of the female condom as a form of modern contraception and the majority of them learnt about it through the mass media (39.9%) and health workers (34.4%). However, only 11.3% had ever used the female condom, with most (40%) using it to prevent both unwanted pregnancy and sexually transmitted infections including HIV (STI/HIV). The sexual partners' approval was appreciable, accounting for about 42.7% among those that had experience of the female condom usage. Major concerns mentioned such as difficulty of inserting it into the vagina and lack of sexual satisfaction, were not different from those in earlier studies. The result of this study looks promising judging from a high awareness level of the female condom, even though its usage is low. The female condom may be an alternative strategy to combat unsafe sexual practises and its sequelae in a country like Nigeria that is male dominated.

Factors influencing gestational age at antenatal booking at the University College Hospital, Ibadan, Nigeria

In order to achieve the aim of improved outcome of pregnancy for mother and fetus, early booking (first antenatal visit), prior to 14 weeks' gestation is usually recommended. A survey of information on personal data, index pregnancy, reasons for booking at a particular gestational age, past obstetric history and medical history of 205 pregnant women attending the antenatal booking clinic at the University College Hospital, Ibadan, Nigeria was carried out using a structured questionnaire. The mean gestational age at booking was 21.82 (+/-7.0) weeks. Only 29 patients (14.1%) booked before 14 weeks. The reasons given for early booking among them were the perceived benefits of such practice (41.4%), physician's recommendation (34.5%) and occurrence of complication(s) in previous pregnancy (24.1%). Illness in the index pregnancy and nulliparity were the only factors found to significantly favour early booking. The need to educate women of the reproductive age group, who are potential mothers, on the benefits of early booking was recommended.

Repeat ipsilateral ectopic gestation: a series of 3 cases

Ectopic pregnancy remains an important cause of maternal mortality and morbidity as well as early foetal wastage in Nigeria and in other developing countries. We report 3 different cases of repeat ipsilateral ectopic pregnancy seen in the gynaecological emergency unit of the University College Hospital, Ibadan. Cases of repeat ectopic pregnancy often gives rise to diagnostic dilemma, and this becomes more difficult when it occurs at an ipsilateral location.

Discontinuation pattern among IUCD users at the family planning clinic, University College Hospital, Ibadan

Despite the high popularity of the intrauterine contraceptive device (IUCD) among family planning clients at University College Hospital, Ibadan, some users discontinued its use for a variety of reasons. This study was to determine the discontinuation rate among IUCD users at UCH, Ibadan. It was a 5-year retrospective analytical study. The records of patients using an IUCD seen at the Family Planning Clinic between 1 January, 1998 and 31 December, 2003 were analysed. A total of 867 clients were seen during the study period; 258(29.8%) clients discontinued within 5 years with the highest rate at 1 year 10.1% and least after 5 years 2.8%. The most common reason for discontinuation was the desire for pregnancy (57.0%). Other reasons included: side-effects (28.3%), husband's views (7.0%) and the menopause (8.0%). The reason for discontinuation varied significantly with the age of the clients (92.5% of clients that discontinued were less than 35 years), educational status, husband coercion, number of living children and religion. The discontinuation rate for the IUCD is high inspite of the high initial acceptability of the method in Nigeria. In a country experiencing a very rapid population growth where the prevalence of contraceptive use hardly attains double figures, it is imperative that policy makers double their efforts at ensuring an appreciable continuation rate of contraceptive use in general and IUCD in particular, among Nigerian women.

The pregnant Rhesus negative Nigerian woman

OBJECTIVE

Alloimmunisation to Rhesus D (RhD) is a major factor in perinatal morbidity and may result in the compromise of the woman's obstetric career. In Nigeria accurate population based studies to determine the prevalence of Rhesus negative women and the incidence of alloimmunisation are lacking, hence we undertook to study pregnancy outcome in Rhesus negative women.

METHOD

We studied retrospectively sixty-seven RhD negative women over a two year period; information was obtained from the case-file of all pregnant women who presented to the ante-natal clinic and were identified as Rhesus negative. This was corroborated with the blood bank record over the same period.

RESULT

Forty per cent of these were nulliparae with an average of 0.5 abortions. Only 20% had the blood groups of their husbands documented, and only four babies born to these women had their Rhesus group recorded. Six of the babies appeared to have been severely affected by Rhesus isoimmunisation. Three of these had an exchange blood transfusion (EBT); all who had an EBT had a satisfactory outcome. Out of the other three, there were two neonatal deaths and one fresh stillbirth. Fourteen babies had neonatal jaundice with a mean bilirubin level of 6 mg/dl, all of which were mainly unconjugated. Evidence for the administration of anti D was obtained in only three patients; all had one ampoule (dose in i.u and/or _g not stated) administered within 72 hr.

CONCLUSION

This preliminary study has shown that isoimmunisation due to Rhesus incompatibility is poorly studied among Nigerian women with many questions unanswered; therefore there is an urgent need for a management protocol for this condition, which will include both the clinicians and the laboratory physicians.

Carcinoma of the cervix co-existing with multiple pregnancy: a case report

A case of a 38year old grandmultipara (Gravida9, Para7+1, all alive) woman with squamous cell carcinoma of the cervix co-existing with multiple pregnancy is presented. She had therapeutic termination of pregnancy with oxytocin at a gestation age of 18 weeks. This was followed by intracavitary and then extracavitary radiotherapy. The need to consider the possibility of carcinoma of cervix in bleeding disorders of early pregnancy and the importance of a thorough evaluation of such patients is emphasized.

Pattern of semen analysis of male partners of infertile couples at the University College Hospital, Ibadan

OBJECTIVES

To evaluate the seminal patterns of the male partners of the infertile couples, towards identifying the possible contribution of the male factors to overall infertility problem in our environment.

METHODOLOGY

The study is a descriptive analysis of the seminal patterns of the partners of the infertile couples, who presented at the Fertility Research Unit (a WHO collaborating centre) of the Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Nigeria, between 1st January 1990 and 31st December, 1999.

RESULTS

Result of the seminal analysis of 824 male partners of infertile couples were retrieved for the study, of which 598 (73%) were referred for secondary infertility. Overall, 225 (27.3%) of these subjects had abnormal semen analyses, with Asthenozoospermia being the most common (27.8%) of the disorders observed. Fifty-four (6.7%) subjects of the study population had Azoospermia. The most common multiple factors abnormality in the study population was Astheno/Oligozoospermia (25.5%), while three factors defect--Oligo/Astheno/Teratozoospermia was noticed in 106 (13.1%) of the subjects.

CONCLUSION

Abnormal semen quality remains a significant contribution to overall infertility in our environment and Asthenozoospermia is the most common seminal quality abnormality.

Isolated umbilical endometriosis--a rare finding

A 32 yr old multiparous Nigerian woman presented with histological confirmed umbilical endometriosis. There was no evidence of endometrotic deposits elsewhere. Apart from cyclical bleeding from the umbilicus, she was relatively free of any of the other signs and symptoms of Endometriosis. She had excision of the endometeriotic lesion and responded favourably to treatment. A high index of suspicion is required in making a diagnosis of endometriosis in remote extra pelvic sites especially with little or no characterisitic pointers to the disease.

Ultrasound assessment of the effect of parity on postpartum uterine involution

A longitudinal study of 300 women in the puerperium was undertaken in an African population. The aim was to determine the influence of parity on postpartum uterine diameters during involution. The patients were divided into two groups, nulliparous and multiparous based on parity. The uterine diameters were larger in the multiparous group when compared with the nulliparous group. Further analysis revealed positive (Pearson's) correlation between parity and uterine diameters and uterine volume. There was no significant correlation between parity and uterine volume on the 42nd puerperal day. In conclusion, Negroid patients have large uteri, which correlate in size positively with parity.

Effects of oral contraceptives on total serum proteins, albumin, globulins and cholesterol levels in Ibadan, Nigeria

Total serum protein, albumin, globulin, albumin/globulin ratio and cholesterol levels were determined in 25 subjects on oral contraceptives and 25 controls. The mean serum total protein, globulin and cholesterol levels were significantly increased in oral contraceptive and their control counterparts. The albumin/globulin ratio in subjects on oral contraceptives users is significantly decreased compared with controls. In view of the findings of this study, it is suggested that the biochemical profile of long-term oral contraceptive users be assessed periodically.

Serum immunoglobulins, total protein and albumin levels during UniplantR use by Nigerian women

The effects of UniplantR (a new, long-acting, 19-nor-progesterone derivative contraceptive) on serum immunoglobulins, albumin and total proteins were determined in Nigerian women during one year of use. Blood samples were collected prior to implant insertion and then at the third, sixth and twelfth months of use. All volunteers were in the reproductive age, healthy and had no contraindications to hormonal contraception. The mean levels of IgG (+/- SD) increased from pre-insertion to the twelfth month. When compared with the pre-insertion level (1,393.93 +/- 93.51 mg/dL), there are statistically significant increases in the mean values of IgG at three (1,457.19 +/- 78.41 mg/dL, p < 0.05), six (1,458.12 +/- 65.26 mgd/L, p < 0.05) and 12 months (1,499.56 +/- 87.60 mg/dL, p < 0.001). There were no statistically significant changes observed in the mean serum levels of IgA, IgM and total proteins during twelve months of implant use. These results indicate that while Uniplant does not seem to alter the levels of IgA, IgM, albumin and total proteins over a period of twelve months, it may induce significant increase in IgG levels. The raised mean serum levels of IgG may suggest an improved humoral immunity of Uniplant--a change that is potentially beneficial.

Three decades of acquired gynaetresia in Ibadan: clinical presentation and management

A retrospective analysis of acquired gynaetresia (Vaginal Stenosis) managed at the University College Hospital Ibadan, Nigeria between 1967 and 1996 was conducted in terms of clinical presentation and management. The prevalence rate was 7/1000. The peak age incidence was 20-30 years. Chemical vaginitis resulting from insertion of caustic vaginal pessaries for various reasons was the major cause of acquired gynaetresia. Dyspareunia/apyreunia and vaginal stenosis/occlusion were the most common symptoms and clinical findings respectively. The various surgical treatment of acquired gynaetresia included one stage vaginoplasty, McIndole-Read's two stage vaginplasty, separation of labial agglutination, Williams's operation, and simple dilatation of the vagina. Successful correction was recorded in 68% of the patients while 28% had residual partial stenosis, 4% had complete stenosis and 6% were lost to follow-up. It was concluded that acquired gynaetresia is preventable. Efforts should be made by authorities to address this issue and create designated centres in the country for the management of these cases and training of junior gynaecologists.

Hodgkin's disease in siblings: a case report

Two male siblings (ages 12 and 16 years) presenting with Hodgkin's disease are reported. They were both diagnosed as stage IVB with identical histological type--lymphocyte depleted. The presence of identical sex, shared environment and the closeness of the time of onset suggested a combination of both environmental and genetic factors in the aetiology of the disease in these siblings.