Community Study of Maternal Mortality in South West Nigeria: How Applicable is the Sisterhood Method

A significant reduction in maternal mortality was witnessed globally in the year 2010, yet, no significant reduction in the maternal mortality ratio (MMR) in Nigeria was recorded. The absence of accurate data on the numbers, causes and local factors influencing adverse maternal outcomes has been identified as a major obstacle hindering appropriate distribution of resources targeted towards improving maternal healthcare. This paper reports the first community based study that measures the incidence of maternal mortality in Ibadan, Nigeria using the indirect sisterhood method and explores the applicability of this method in a community where maternal mortality is not a rare event. A community-based study was conducted in Ibadan using the principles of the sisterhood method developed by Graham et al. for developing countries. Using a multi-stage sampling design with stratification and clustering, 3,028 households were selected. All persons approached agreed to take part in the study (a participation rate of 100%), with 2,877 respondents eligible for analysis. There was a high incidence of maternal mortality in the study setting: 1,324/6,519 (20.3%) sisters of the respondents had died, with 1,139 deaths reportedly related to pregnancy, childbirth or the puerperium. The MMR was 7,778 per 100,000 live births (95% CI 7,326–8,229). Adjusted for a published Total Fertility Rate of 6.0, the MMR was 6,525 per 100,000 live births (95% CI 6,144–6,909). Women in Ibadan were dying more from pregnancy related complications than from other causes. Findings of this study have implications for midwifery education, training and practice and for the first time provide policy makers and planners with information on maternal mortality in the community of Ibadan city and shed light on the causes of maternal mortality in the area.     

Maternal mortality--a twelve-year survey at the University of Ilorin Teaching Hospital (U.I.T.H.) Ilorin, Nigeria

This paper concerns an analysis of maternal death at the University of Ilorin Teaching Hospital (U.I.T.H.) Ilorin over a 12-year period (1972-1983). There were 138,577 births and 624 deaths making a maternal mortality rate of 4.50 per 1000 births. Hemorrhage, ruptured uterus and obstructed labor were the major direct obstetric causes of death. The most important indirect causes were cerebrospinal meningitis, pulmonary infections and fulminating hepatitis. The main avoidable factors were ineffective and cumbersome blood transfusion services; poor management of the third stage of labor; large number of unbooked patients and poor delivery room structure encouraging sepsis. Suggestions are made for a more integrated type of maternity services in our hospital, health education programs for the public and particularly the expectant women and availability of an effective blood bank service within the maternity hospital premises for prompt treatment of patients requiring emergency blood transfusion. The analysis underlines the great problem of maternal mortality in the developing world.     

Mammalian mitogenomic relationships and the root of the eutherian tree

The strict orthology of mitochondrial (mt) coding sequences has promoted their use in phylogenetic analyses at different levels. Here we present the results of a mitogenomic study (i.e., analysis based on the set of protein-coding genes from complete mt genomes) of 60 mammalian species. This number includes 11 new mt genomes. The sampling comprises all but one of the traditional eutherian orders. The previously unrepresented order Dermoptera (flying lemurs) fell within Primates as the sister group of Anthropoidea, making Primates paraphyletic. This relationship was strongly supported. Lipotyphla ("insectivores") split into three distinct lineages: Erinaceomorpha, Tenrecomorpha, and Soricomorpha. Erinaceomorpha was the basal eutherian lineage. Sirenia (dugong) and Macroscelidea (elephant shrew) fell within the African clade. Pholidota (pangolin) joined the Cetferungulata as the sister group of Carnivora. The analyses identified monophyletic Pinnipedia with Otariidae (sea lions, fur seals) and Odobenidae (walruses) as sister groups to the exclusion of Phocidae (true seals).     

Adolescent low back pain among secondary school students in Ibadan,Nigeria

Background

Adolescent low back pain (ALBP) can be considered a signal or precursor of a serious organic disease or telltale sign of future incidence of low back pain in adulthood. Published articles on ALBP in Nigeria are not readily available.

Objectives

The study''s objectives were to investigate the prevalence of Adolescent Low Back Pain (ALBP) among secondary school students in Ibadan, Nigeria and the prevalence''s association with some socio-demographic variables.

Methods

Participants were adolescent students from 15 secondary schools in Ibadan. Data was collected using a respondent-administered, validated questionnaire on low back pain in adolescents. Participants (Female: 298; Male: 273) aged 14.23 ±2.27 years (range 10–19) were recruited through multi-stage random sampling. Five hundred and seventy-one (83.97%) of the 680 copies of the questionnaire administered were returned. Data was analysed using mean, standard deviation, frequency, percentages, and Chi-square test with alpha level at 0.05.

Result

Lifetime, twelve-month, one-month and point prevalence rates of ALBP were 58.0%, 43.8%, 25.6% and 14.7% respectively. Age at first experience of ALBP was 11.86 ± 2.36 years. Gender was not significantly associated with any rate (p ≥0.317). Age (p ≤ 0.043) and engagement in commercial activities (p ≤ 0.025) were significantly associated with all period prevalence rates while injury to the back was significantly associated with all period prevalence rates except point prevalence (p = 0.087).

Conclusion

Adolescent low back pain is common among secondary school students in Ibadan and its prevalence is significantly associated with age and engagement in commercial activities, but not with gender.     

Epidemiology of congenital malaria in Nigeria: a multi-centre study

Objective To determine the burden of congenital malaria in newborns in Nigeria. Methods In a prospective multi‐centre study, 1875 consecutive mother–baby pairs were enrolled over a continuous 12‐month period. Blood smears were prepared from mothers, neonates, placental aspirates and cord blood within 4 h of delivery. Outcome variables were patent parasitaemia in the mother, placenta, cord and neonate in addition to maternal and neonatal haematocrit. Results Patent parasitaemia was detected in 95 neonates (5.1%). The occurrence varied between study centres, but was found year round in all sites. The mean parasite density among infected neonates was low (48 asexual forms per μl, range 8–200/μl). Maternal and placental parasitaemia were the most important risk factors for patent neonatal parasitaemia (P < 0.0001). Spontaneous clearance of parasitaemia occurred in 62.1% of neonates before day 2. 33.7% were symptomatic within 3 days of birth. Conclusion Congenital malaria is often asymptomatic, clears spontaneously and may not warrant treatment. However, newborns with unexplained fever and refusal to feed in malaria endemic areas should be tested for malaria.     

Evaluation of directly observed treatment short courses at a secondary health institution in Ibadan,Oyo State,Southwestern Nigeria

ObjectiveTo evaluate the success rate of tuberculosis intervention programme at a specialist hospital in Ibadan, Nigeria through a retrospective study as well as carry out physicochemical evaluation of anti-tuberculous agents as a way of eliminating drug-related failure.MethodsThe retrospective study involved the use of quarterly tuberculosis central register at the Government Chest Hospital, Ibadan between 1st quarter (2003) to 4th quarter (2009). Relevant data were extracted from these register with the aid of data collection forms. The basic physicochemical analyses of the drugs given to the patients were also carried out using the International Pharmacopoeia methods.ResultsAll the drugs examined for their physicochemical properties passed the International Pharmacopeia recommended tests. A total number of 1 260 patients enrolled at the hospital were assessed through case notes. This comprises of 59.4% males of which 69.23% new cases were also males. There was a significant (P<0.05) patient enrollment across the quarters for the seven years. An overall 80.24% cure rate over the 7-period was obtained which is less than the WHO target of 85%. Cure rates were better in females than males. Failure treatment outcomes such as positive (1.51%), deaths (8.73%), defaulted (3.33%) and transferred out (5.95%) were recorded though not statistically significant (P>0.05). Failure rates in all categories were higher in males than females (P>0.05).ConclusionsMore enlightenment and counseling is still required to meet up with the target for TB control.     

A genome-wide search for type 2 diabetes susceptibility genes in West Africans: the Africa America Diabetes Mellitus (AADM) Study

The incidence of type 2 diabetes is growing rapidly, not only in developed countries but also worldwide. We chose to study type 2 diabetes in West Africa, where diabetes is less common than in the U.S., reasoning that in an environment where calories are less abundant, incident cases of type 2 diabetes might carry a proportionately greater genetic component. Through the Africa America Diabetes Mellitus (AADM) study, we carried out a genome-wide linkage analysis of type 2 diabetes in a cohort of 343 affected sibling pairs (691 individuals) enrolled from five West African centers in two countries (Ghana: Accra and Kumasi; Nigeria: Enugu, Ibadan, and Lagos). A total of 390 polymorphic markers were genotyped, and multipoint linkage analysis was conducted using the GENEHUNTER-PLUS and ASM programs. Suggestive evidence of linkage was observed in four regions on three chromosomes (12, 19, and 20). The two largest logarithm of odds scores of 2.63 and 1.92 for chromosomes 20q13.3 and 12q24, respectively, are particularly interesting because these regions have been reported to harbor diabetes susceptibility genes in several other populations and ethnic groups. Given the history of forced migration of West African populations during the slave trade, these results should have considerable relevance to the study of type 2 diabetes in African Americans.     

Socio-biological factors influencing infertility in a rural Nigerian community

An assessment of factors influencing infertility in a rural Nigerian community revealed a prevalence rate of 12.9% primary infertility. Secondary infertility among the subjects was 54.1%. Age, education and religion of respondents had statistically significant influence on infertility (P less than 0.05) but not income (P greater than 0.05). The correlation between age of respondents and infertility was statistically significant (P less than 0.05). Primary health care efforts aimed at implementing maternal and child health care should explore the traditional customs on infertility in rural areas of developing countries.     

Fasting plasma glucose and cholesterol levels in pregnant Nigerian women

There are numerous reports of altered carbohydrate metabolism in pregnancy. Normal pregnancy is sometimes characterised by mild fasting hypoglycaemia, postprandial hyperglycaemia and hyperinsulinaemia. Pregnancy has also been observed to be associated with a hypercholesterolaemic state in some individuals with pregnancy-induced hypertension. The aim of the present study was to assess the fasting plasma levels of glucose and cholesterol in pregnant Nigerian women, and to find out any differences from previously reported observations. Twenty pregnant consenting females were used for the study while twenty non-pregnant females were used as controls. Blood samples were taken from each subject after an overnight fast, and assayed for plasma glucose and cholesterol. Results obtained showed a decrease in fasting plasma glucose (from 3.96 mmo1/L to 3.12 mmo1/L) in early pregnancy (p < 0.05) but no change in late pregnancy. Plasma cholesterol was significantly higher (p < 0.05) in pregnant subjects (3.89 mmo1/L) than in the non-pregnant (2.40 mmo1/L), the increase being more appreciable in early pregnancy. These results are similar to data from non-African blacks and Caucasians.