Infant feeding and lactational amenorrhea in Sagamu,Nigeria

Five hundred and twenty educated, breastfeeding women in Sagamu, Nigeria, were observed prospectively in order to describe their infant feeding practices and to determine whether any predictors of the return of menses could be identified. The women remained amenorrheic for seven months. Compared with similarly selected women in other countries, they regularly fed their infants with supplements from a very early age, yet breastfeeding frequency and duration did not decline dramatically. Semi-solid food was introduced at about four months and such supplementation, as well as earlier supplementation with milk/milk-based feedings, was associated with the return of menses. The median duration of abstinence was about four months but the mean may have been much longer. No woman became pregnant until her infant was weaned.     

Prolonged use of indwelling urinary catheter following acute urinary retention in a tertiary care centre in sub-Saharan Africa: Causes,costs and concerns

ObjectivesTo evaluate the causes, estimate out-of-pocket payments and assess concerns associated with prolonged use of urinary catheters following acute urinary retention secondary to benign prostate enlargement (BPE) and urethral stricture disease (USD) in men attending the urology out-patient clinic of a tertiary referral centre in North-central Nigeria.Patients and methodsThis was a cross-sectional survey of men attending urology clinic and who are using indwelling urinary catheter for >3 months following acute urinary retention due to BPE or USD. The study was conducted over a six-month period (1st March 2012 to 31st August 2012) at a tertiary hospital in North-central Nigeria using interviewer administered questionnaires.ResultsOf seventy-six men, 36/76 (47.4%) had BPE and 40/76 (52.6%) had USD. Median age, median duration of catheter use and median out-of-pocket payment per catheter change was 65 years (range 20–90 years), 12 months (range 3–120 months) and US$9.31 (range $3.63–18.75) respectively. There was no significant difference in the duration of catheter use and out-of-pocket payments between men with BPE and USD; however, men with USD were significantly younger than those with BPE.One-fifth and half of the men with BPE and USD, respectively attributed inability to pay for surgery as the reason for prolonged use of catheters. The second common reason was long waiting list for surgery. Men with BPE had their sexual relationships disrupted significantly more than those with USD and unexpectedly, we found that men using catheters for less than 6 months describe themselves as unhappy significantly more than those using the catheters for longer periods (p = 0.033).ConclusionsInability to pay for definitive surgery and long waiting lists are the leading causes of prolonged use of indwelling urinary catheters in men with BPE and USD in our sub-Saharan setting. Prolonged catheter use adversely affected quality of life disrupting sexual relationships especially of men with BPE. Recommendations made to reduce out-of-pocket payments and shorten waiting times may help to improve access to urologic surgical care for these men.     

The Influence of Head Size on Corrosion and Fretting Behaviour at the Head-Neck Interface of Artificial Hip Joints

The primary goal of this study was to determine if head size affects corrosion and fretting behaviour at the head-neck taper interface of modular hip prostheses. Seventy-four implants were retrieved that featured either a 28 mm or a 36 mm head with a metal-on-polyethylene articulation. The bore of the heads and the neck of the stems were divided into eight regions each and graded by three observers for corrosion and fretting damage separately using modified criteria as reported in the literature. The 36 mm head size featured a significant difference in the corrosion head scores (p = 0.022) in comparison to the 28 mm heads. This may be attributed to a greater torque acting along the taper interface due to activities of daily living.     

Teething myths among nursing mothers in a Nigerian community

Background:

Many symptoms had been associated with teething in children with the possibility of overlooking potentially fatal condition. Symptoms that had been associated with teething include diarrhoea, fever, vomiting and cough. The possibility that any of these symptoms could have been due to other causes call for thorough investigation of the child before concluding that it is only “teething”.

Objectives:

The study was carried out to assess the beliefs of nursing mothers concerning symptoms that are associated with teething among children and to identify those that would seek medical treatments in case of their children having such symptoms during teething.

Materials and Methods:

Two hundred and ninety nursing mothers whose children had erupted at least a tooth were interviewed in the immunisation clinics of the University College Hospital and Adeoyo Maternity Teaching Hospital, both in Ibadan, Nigeria, on their beliefs and practice concerning teething in children.

Results:

One hundred and eighty-eight (64.8%) of the mothers associated symptoms such as fever, cough, catarrh and diarrhoea with eruption of teeth in their children. Over half of the women agreed that a child having either fever (51.0%), ear infection (57.6%) or cough (50.3%) should be promptly taken for medical consultation and not be tagged “teething”, while for other symptoms such as gum pain (74.5%), sleepless night (56.6%), vomiting (51.4%) and diarrhoea (51.7%), over half of the mothers believed that the symptoms will resolve following the eruption of the teeth.

Conclusion:

The study demonstrated that mothers in the study attributes several symptoms to teething, which could be detrimental to the survival of their children as the symptom could have been due to other causes. There is, therefore, need for public enlightenment to create awareness on the possible effect of presumptuous belief that childhood diseases are due to teething process.     

Cardiac autonomic dysfunction in sickle cell anaemia and its correlation with QT parameters

Background:

Abnormalities of QT parameters together with cardiac autonomic neuropathy (CAN) confer significant risks of cardiac morbidity and mortality in patients with diabetes mellitus. We questioned whether or not CAN influences occurrence of QT interval prolongation and dispersion in patients with sickle cell anaemia (SCA).

Materials and Methods:

Forty stable adult sickle cell patients with 44 healthy haemoglobin AA controls were studied. Baseline electrocardiograms were obtained and cardiovascular autonomic function tests were performed using standard protocols.

Results:

Mean corrected QT (QTc) in sickle cell patients was significantly higher (P = 0.001) than the mean of controls. Similarly, mean QT dispersion (QTcd) was higher (P = 0.001) in the former than in the latter. Mean QTc in patients with CAN was longer than patients with normal autonomic function (461 ± 26 ms versus 411 ± 23 ms), P = 0.001 (OR of 17.1, CI 3.48–83.71). Similarly, QTcd was higher (P = 0.001) in patients with CAN than those with normal cardiac autonomic function. Positive correlations were found between CAN with QTc and QTcd (r = 0.604, P = 0.001, r = 0.523, P = 0.001, respectively).

Conclusion:

CAN is a risk factor for abnormalities of QT parameters in SCA and both may be harbinger for cardiac death.     

Determinants of perinatal mortality in Nigeria

Objective

To determine risk factors for perinatal mortality among hospital-based deliveries in Nigeria.

Methods

The WHO Global Maternal and Perinatal Health Survey was implemented in Nigeria as a first step in establishing a global system for monitoring maternal and perinatal health. Twenty-one health facilities with more than 1000 deliveries annually were selected by a stratified multistage cluster sampling strategy. Information was recorded on all women who delivered and their neonates within a 3-month period.

Results

Overall, there were 9208 deliveries, comprising 8526 live births, 369 fresh stillbirths, 282 macerated stillbirths, 70 early neonatal deaths, and 721 perinatal deaths. The stillbirth and perinatal mortality rates were, respectively, 71 and 78 per 1000 deliveries; the early neonatal death rate was 8 per 1000 live births. Approximately 10% of all newborns weighed less than 2500 g, and 12.3% were born at less than 37 weeks of gestation. Predictors of perinatal mortality were mother's age, lack of prenatal care, unbooked status, prematurity, and birth asphyxia.

Conclusion

The perinatal mortality rate remains unacceptably high in Nigeria. Fresh stillbirth accounted for most perinatal deaths. Interventions to improve the utilization and quality of prenatal care, in addition to the quality of intrapartum care, would considerably reduce perinatal death.     

Occurrence of Selected Polybrominated Diphenyl Ethers and 2,2′,4,4′,5,5′-Hexabromobiphenyl (BB-153) in Sewage Sludge and Effluent Samples of a Wastewater-Treatment Plant in Cape Town,South Africa

The reuse of treated effluent from wastewater treatment plants (WWTPs) as alternative water source for sport-field or landscape irrigation, agricultural, and other industrial purposes is growing significantly. Similarly, the application of treated sludge (biosolid) to agricultural soils is now being considered globally as the most economic means of sludge disposal. However, the presence of emerging organic contaminants in these matrices, including polybrominated diphenyl ethers (PBDEs), which are potential endocrine disruptors, portends a high health risk to humans and the environment in general. In this study, effluent and sewage sludge samples collected from a WWTP were analysed for some selected PBDE congeners (BDE congeners 28, 47, 99 100 153 154 183, and 209) as well as BB-153 using a high-capillary gas chromatograph equipped with an electron capture detector. The sum of the eight PBDE congeners ranged from 369 to 4370, 19.2 to 2640, and 90.4 to 15,100 ng/l for raw water, secondary effluent, and final effluent, respectively. A similar result was observed for sewage sludge samples, which ranged between 13.1 and 652 ng/g dry weight (dw). The results obtained for BB-153 were generally lower compared with those found for most PBDE congeners. These ranged from ND to 18.4 ng/l and ND to 9.97 ng/g dw for effluents and sewage sludge, respectively. In both matrices, BDE 47 and 209 congeners were found to contribute significantly to the overall sum of PBDEs. The reuse of the treated effluent, particularly for agricultural purposes, could enhance the possibility of these contaminants entering into the food chain, thus causing undesirable health problems in exposed subjects.