Factors associated with the use of maternity services in Enugu, southeastern Nigeria

The maternal mortality ratio and other maternal health indicators are worse for developing countries than for the developed world due to improved access to quality care during pregnancy and especially at delivery in the industrialized world. This study was carried out to identify the factors which influenced choice of place of delivery by pregnant women in Enugu, southeastern Nigeria, and to recommend ways to improve women's access to skilled attendants at delivery. A pre-tested questionnaire was administered by interviewers to women who had delivered within 3 months prior to date of data collection. The response rate was 75.5% (n=1098). Of the respondents, 52.9% delivered outside health institutions and 47.1% in health institutions. The major factors influencing choice of place of delivery included promptness of care, competence of midwife/doctor, affordability, health education, 24 h presence of doctors, team work among doctors and presence of specialist obstetricians. There were statistically significant associations between choice of institutional or non-institutional deliveries and socio-demographic/economic factors such as place of residence (urban/rural), religion, educational status, tribe, marital status, occupational level, husband's occupational and educational levels, age and parity (p<0.05). We conclude that factors which will positively influence women to deliver in health institutions in Enugu, Nigeria include a variety of interacting social, economic and health system factors, which operate at various levels-the household, community, the health institutions and the larger social and political environment. Attention to these factors will not only improve maternity utilization but, hopefully, also will reduce the high maternal mortality and improve other maternal health indicators in the study area.     

Antibacterial and wound healing properties of methanolic extracts of some Nigerian medicinal plants

This study was conducted to evaluate methanolic extracts of Ageratum conyzoides, Anthocleista djalonensis, Napoleona imperialis, Ocimum gratissimum, and Psidium guajava for antibacterial and wound healing properties. Antibacterial properties of the extracts were studied against eleven wound isolates (Staphylococcus aureus (four strains), E. coli (two strains), Pseudomonas aeruginosa (one strain), Proteus spp. (three strains), and Shigella spp. (one strain)) using the well diffusion method. Wound healing properties of Ageratum conyzoides, Anthocleista djalonensis, Napoleonaea imperialis, and Ocimum gratissimum were determined using the excision wound model. Extract of Napoleona imperialis inhibited growth of all the test bacterial strains while Psidium guajava and Anthocleista djalonensis extracts prevented growth of 81.8 and 72.7% of the test organisms, respectively. Ageratum conyzoides and Ocimum gratissimum extracts did not inhibit growth of any of the test organisms. More than 90% wound healing was recorded in the extract and cicatrin powder treated groups by 14 days post surgery, where as 72% healing was observed in the distilled water-treated group. The percentage healing in the distilled water-treated group was significantly different (P<0.001) from those of extract and antibiotic-treated groups.     

Obstructed inguinal hernia: role of technical aid program

AIM: The purpose of the study was to determine the influence of the presence of a surgeon on the outcome of obstructed inguinal hernia at Mongomo, in Equatorial Guinea. METHODOLOGY: A prospective study of patients with obstructed inguinal hernia seen between June 1997 and May 1999 was carried out. During the same period, all uncomplicated hernias seen at the surgical outpatient clinic were noted. RESULT: Fifteen patients presented with obstructed inguinal hernia, while 138 were uncomplicated. All the 15 patients were males, and one of them died. Death resulted from lack of treatment as he presented on our arrival on a technical aid program from Nigeria. The others (N = 14) were operated upon, and eight of them had resection of the intestine because of gangrene. The duration of obstruction was more than two days among those that had bowel resection. COMMENT: Inguinal hernia is a treatable surgical condition. When done electively, the cost and the risk of treatment are very low. Operative treatment can only be offered to patients with inguinal hernia by a surgeon in the community. CONCLUSION: The study has demonstrated that the presence of a surgeon in a community changes the outcome of obstructed inguinal hernia. Sponsorship of medical aid programs should be encouraged.     

Serologic evidence of avian influenza virus infections among Nigerian agricultural workers

Nigeria has had multiple incursions of highly pathogenic avian influenza A (HPAI) H5N1 virus into its poultry population since 2006. This study aimed to determine if Nigerians exposed to poultry had evidence of avian influenza virus transmission to man. Between 2008 and 2010, 316 adult farmers and open market workers and 54 age‐group matched, non‐animal exposed controls were enrolled in a prospective, population‐based study of zoonotic influenza transmission in four towns in southeastern Nigeria. Questionnaire data and sera obtained at the time of enrollment were examined for evidence of previous infection with 10 avian influenza virus strains. Serologic studies on sera collected at the time of enrollment showed modest evidence of previous infection with three avian‐origin influenza viruses (H5N1, H5N2, and H11N1) and one avian‐like H9N2 influenza virus, with eight (2.4%) of animal‐exposed subjects and two (3.7%) unexposed subjects having elevated microneutralization assay antibody titer levels (ranging from 1:10 to 1:80). Statistical analyses did not identify specific risk factors associated with the elevated antibody titers observed for these zoonotic influenza viruses. These data suggested only occasional virus transmission to humans in areas thought to have been enzootic for avian influenza virus. Prospective data from this cohort will help the authors to better understand the occurrence of zoonotic infections due to avian influenza viruses in Nigeria. J. Med. Virol. 85:670–676, 2013. © 2013 Wiley Periodicals, Inc.     

Sonographic assessment of pregnancy co-existing with uterine leiomyoma in Owerri,Nigeria

Background

Uterine myomas co-existing with pregnancy could cause obstetric complications.

Objectives

To assess sonographically the frequency of occurrence and effect of uterine myomas co-existing with pregnancy.

Methods

A longitudinal study was conducted during a period of 23 months. A convenience sample of 816 consecutive consenting pregnant women who met the inclusion criteria was evaluated during routine prenatal ultrasound scan. The women were referred for prenatal sonography. One hundred of the subjects who had myoma co-existing with pregnancy and another 100 subjects without myoma were selected for follow-up. These groups were followed up till delivery and obstetric complications and outcomes were documented. Any changes in size and growth rate of myoma were documented.

Results

Subjects with myoma co-existing with pregnancy were 12.3%. This was commoner with increasing maternal age. An increase was observed in myoma mean size from 60mm to 63mm from the 1^st scan sequence to the 2^nd scan sequence and a reduction from 63mm to 59mm in the 3^rd scan sequence. Myoma growth rate was 0.667mm per week. Myomas in pregnancy especially large ones caused more complications during delivery when compared to pregnancies without myomas.

Conclusion

Routine sonography is important in pregnancy management of uterine myomas co-existing with pregnancy.     

Perception of intimate pelvic examination by gynaecological clinic attendees in rural Southeast Nigeria

Context  

Intimate gynaecological examinations are part of the necessary retinue in gynaecological consultation and management.     

Oculopalpebral Dimensions of Adult Nigerians: Report from the Enugu Normative Ocular Anthropometry Study

Objective

To determine the normal oculopalpebral anthropometric measurements of a Nigerian adult population. Subjects and

Subjects and Methods

A population-based prospective observational random survey was conducted in Enugu, South-Eastern Nigeria between January and April 2010. The participants were healthy adults comprising 248 males and 252 females aged 18–76 years. One thousand eyes were examined. Demographic data, and bilateral direct manual millimetre measurements of the horizontal palpebral fissure (HPF), vertical palpebral fissure (VPF), upper lid crease (ULC), brow height (BH), and margin reflex distance (MRD) were obtained from all participants. Data were categorised by demographic variables and analysed to yield frequencies, percentages and proportions. Between-gender comparisons, using the independent t test, were considered significant at p < 0.05.

Results

The mean age of the participants was 36.5 ± 14.6 years. There was no significant difference between the genders in mean age (men: 37.3 ± 15.7 vs. women: 35.8 ± 13.3, p = 0.2302). The mean values of the parameters were (male, female) HPF: 32.8 ± 2.0 vs. 32.6 ± 3.0; VPF: 10.6 ± 1.2 vs. 10.6 ± 1.2; ULC: 8.2 ± 2.5 vs. 7.9 ± 2.2; BH: 13.1 ± 2.4 vs. 13.6 ± 2.7; and MRD: 4.1 ± 0.5 vs. 4.2 ± 0.8. Significant between-gender difference was observed only in BH measurements (p = 0.029) and variable trends with age.

Conclusion

Oculopalpebral measurements of normal adult Nigerians in Enugu showed variations by age and gender. This may have implications for clinical evaluation and surgical management of oculopalpebral disorders in adult South-Eastern Nigerians. Future longitudinal studies are needed.Key Words: Oculopalpebral, Anthropometric dimensions, Adults, Nigeria