Influence of duration of sexual cohabitation on the risk of hypertension in nulliparous parturients in Ibadan: A cohort study

Background:  Hypertensive disorders of pregnancy are an important cause of maternal mortality in this environment, it accounts for about 20% of all maternal deaths in pregnancy in Nigeria.
Aim:  This study aims to determine the effect of the length of sexual cohabitation on the development of hypertension in pregnancy in a Nigerian population.
Materials and methods:  The study was a prospective cohort study; three centres were involved in the study between July 2006 and February 2009. For this study, the main outcome variable was the development of Hypertension in pregnancy. The main explanatory variable was the length of preconception sexual cohabitation. Univariate analysis was by t test, chi-squared test and Fisher's exact test for continuous and categorical variables. Multivariate analysis was by Cox hazard regression
Results:  In the study population, the incidence of gestational hypertension and pre-eclampsia were 28.93% and 4.13% respectively, 29.64% had previous abortions and same paternity abortion rate was 25.92%. Length of sexual cohabitation before index pregnancy was protective against hypertension in pregnancy but not for pre-eclampsia; there was a 4% decrease in the risk of developing hypertension for every month increase in cohabitation (hazard ratio, HR 0.96 (95% CI 0.93 – 0.99)). Also protective in this model was same paternity abortion with a HR of 0.71 (95% CI 0.55–0.93). A previous abortion was not protective (HR 1.05 (95% CI 0.82–1.35)).
Conclusion:  It was concluded that increased length of sexual cohabitation prior to conception reduces the risk of gestational hypertension.     

Stressors and psychological symptoms in students of medicine and allied health professions in Nigeria

Background Studies suggest that high levels of stress and psychological morbidity occur in health care profession students. This study investigates stressors and psychological morbidity in students of medicine, dentistry, physiotherapy and nursing at the University of Ibadan. Methods The students completed a questionnaire about their socio-demographic characteristics, perceived stressors and the 12-item General Health Questionnaire. Qualitative methods were used initially to categorise stressors. Data was then analysed using univariate and logistic regression to determine odds ratios and 95% confidence intervals. Results Medical and dental students were more likely to cite as stressors, overcrowding, strikes, excessive school work and lack of holidays while physiotherapy and nursing students focused on noisy environments, security and transportation. Medical and dental students (1.66; SD: 2.22) had significantly higher GHQ scores than the physiotherapy and nursing students (1.22; SD: 1.87) (t = 2.3; P = 0.022). Socio-demographic factors associated with psychological morbidity after logistic regression include being in a transition year of study, reporting financial distress and not being a ‘Pentecostal Christian’. Although males were more likely to perceive financial and lecturer problems as stressors and females to perceive faculty strikes and overcrowding as source of stress, gender did not have any significant effect on psychological morbidity. Stressors associated with psychological distress in the students include excessive school work, congested classrooms, strikes by faculty, lack of laboratory equipment, family problems, insecurity, financial and health problems. Conclusion Several identified stressors such as financial problems, academic pressures and their consequent effect on social life have an adverse effect on the mental health of students in this environment especially for students of medicine and dentistry. While stressors outside the reach of the school authorities are difficult to control, academic support including providing a conducive learning environment, advice on means for sustenance, added support during periods of transition are key areas for interventions.     

Significant bacteriuria among asymptomatic antenatal clinic attendees in ibadan, Nigeria

Untreated asymptomatic bacteriuria can lead to urinary tract infection (UTI) in pregnancy with devastating maternal and neonatal effects such as prematurity and low birth weight, higher fetal mortality rates and significant maternal morbidity. We carried out a two year (April 2007 to March 2009) cross-sectional epidemiological study to determine the prevalence of significant bacteriuria among asymptomatic antenatal clinic attendees at two antenatal clinics (ANCs) in University College Hospital and Adeoyo Maternity Hospital, both in Ibadan, Nigeria.All consenting ANC attendees without UTI were enrolled in the study. Urine specimens of 5 to 10 ml collected from each subject were examined microscopically for white blood cells, red blood cells and bacteria. The specimens were further cultured on MacConkey agar using a sterile bacteriological loop that delivered 0.002 ml of urine. Colony counts yielding bacterial growth of more than 10(5)/ml of pure isolates were considered significant.Of the 473 subjects studied, 136 had significant bacteriuria, giving a prevalence rate of 28.8%. The highest age specific prevalence (47.8%) was found in the 25-29 year olds while only one (0.7%) was found in the teenage group. A large percentage (64.0%) of subjects with significant bacteriuria had tertiary education, compared with 4.4% who had no formal education but the association was not statistically significant (X(2) = 0.47, p = 0.79). The majority (75.8%) of subjects with significant bacteriuria had no previous history of abortion, while 20 (14.7%) had one previous abortion and only three (2.1%) admitted to three previous abortions (X(2) = 5.16, p = 0.16). The majority (69.8%) of those with significant bacteriuria presented at second trimester while 38 (28.0%) presented at third trimester (X(2) = 6.5, p = 37).Only 22 (4.6%) of the studied subjects presented at first trimester, and 3 (13.7%) of these had significant bacteriuria.The prevalence of asymptomatic bacteriuria is high among this study population. Hence we suggest that advocacy programs be initiated to urge pregnant women to access ANC services early in pregnancy.