Usmanu Danfodiyo University Teaching Hospital Research Articles

Ear, nose, and throat foreign bodies in a tertiary health institution in Sokoto, Nigeria

Background: Otorhinolaryngeal foreign bodies are common in ear, nose, and throat (ENT) practice. The objective of this study is to determine the pattern of otorhinolaryngeal foreign bodies in a Tertiary Health Institution in Sokoto, North-Western Nigeria. Materials and Methods: This is a 2 year retrospective study using the records of all cases of ENT foreign bodies at Usmanu Danfodiyo University Teaching Hospital, Sokoto, from January 2009 to December 2010. Data analysis was carried out using the SPSS for windows version 13.0. Results: A total of 90 cases were analysed. Ear foreign bodies 48 (53.3%) were commonest, followed by nasal foreign bodies 16 (17.8%), bronchial foreign bodies 15 (16.7%), and esophageal foreign bodies 11 (12.2%). Age range was 9 months to 64 years. High frequency of the foreign bodies was noted in the younger age group. The foreign bodies varied according to the site with plant seed being more common in the ear and the nose while meat bolus is more common in the esophagus. Bronchial foreign bodies were seen exclusively in children less than 14 years old with beads and valve of plastic toys being the most common. Conclusion: Otorhinolaryngeal foreign bodies remain frequent occurrence particularly in the younger age group 9 years old or less and high index of suspicion suggested and early intervention to prevent the morbidity and mortality from complications.

Breast Cancer and Mammography: Current Knowledge, Attitudes and Practices of Female Health Workers in a Tertiary Health Institution in Northern Nigeria

Breast cancer is one of the most common causes of cancer related deaths among women world wide, accounting for 31% of cancers among wo men and 19% of deaths among wo men are due to cancer. Early detection of breast cancer and early presentation for management has been shown to reduce mortality rates. This descriptive cross-sectional study involving 100 female health workers made up of 30 doctors and 70 nurses was carried out at the Usmanu Danfodiyo University Teaching hospital, So koto .The study is aimed at assessing the knowledge of female health workers about breast cancer and their attitude and practice o f mammography. A total of 67% of the study subjects had adequate knowledge of breast cancer and its risk factors with 80% of the female doctors having better knowledge co mpared to the nurses. Majority, (84%) of the respondents were aware of mammog raphy as a way of detecting early cancer o f the breast and only 9% of them had undergone the procedure in the last one year. The commonest reason for not undergoing the procedure was that they were not aware of the procedure being carried out in the study centre. The low mammographic screening rate recorded in the study portrays a bad omen for the fight against cancer of the breast and this reinforces the need for educational intervention to increase the awareness and uptake of mammog raphic screening among the study population.

Abdominal pregnancy in Usmanu Dan-Fodiyo university teaching hospital, Sokoto: A 10-year review

Background: Abdominal pregnancy, a rare condition with high maternal mortality (up to 50%), and even higher perinatal mortality (40 – 95%), is often associated with diagnostic difficulties. Objectives: To determine the mode of presentation and management of abdominal pregnancy, from cases in the Usmanu Dan-Fodiyo University Teaching Hospital (UDUTH), Sokoto. Materials and Methods: A retrospective review of the case records of all abdominal pregnancies managed in UDUTH, Sokoto, between January 2000 and December 2010. Results: During the 10-year study period, there were eight cases of abdominal pregnancies, 285 extrauterine pregnancies, and 25,506 total deliveries. All the patients were not booked for antenatal care and their ages ranged between 20 and 39 years (mean=28.1±3.4 years). The majority (88%) were grand multipara. The main presenting symptoms were persistent abdominal pain, vaginal bleeding, and prolonged pregnancy. Seven cases (87.5%) were diagnosed accurately by an ultrasound scan. There were seven perinatal deaths (87.5%) and one live birth. There was one maternal death (12.5%), which occurred in the patient whose placenta was left in-situ. Conclusion: Presence of persistent lower abdominal pain, vaginal bleeding, and prolonged pregnancy should raise the suspicion of abdominal pregnancy. Removal of the placenta, where feasible, improves the outcome of maternal health.

Ectopic pregnancy at Usmanu Danfodiyo University Teaching Hospital Sokoto: A ten year review

Background: Ectopic pregnancy continues to be a life threatening gynaecological emergency. Objective: To determine the incidence, pattern of presentation and management of ectopic pregnancy in UDUTH Sokoto. Materials and Methods: This is a retrospective study of cases of ectopic pregnancy managed in the gynaecological unit of UDUTH from 1 st January 2002 to 31 st December 2011. Results: During the period, there was a total of 20,095 deliveries and 7,254 gynaecological admissions in the centre. Two hundred and ninety eight (298) patients had ectopic pregnancy accounting for 1.5% of all deliveries and 4.1% of all gynaecological admissions. Most of the affected patients were young nulliparous women. Abdominal pain, amenorrhoea, vaginal bleeding and cervical excitation tenderness were the most common clinical features amongst patients. The ampulla of the fallopian tube was the commonest site of implantation (59.7%) and majority of the cases (70.1%) were already ruptured at the time of presentation. The main mode of treatment was unilateral salpingectomy (76.3%) However, 3.8% of the patients benefited from medical treatment using methotrexate. The case fatality rate was 1.4%. Conclusion : The rate of ectopic pregnancy in the centre is relatively high. Majority of the patients presented late with the ruptured variety. Improvement in health seeking behaviour among our populace coupled with high index of suspicion and use of modern diagnostic techniques by the clinicians will assist in early diagnosis and treatment prior to tubal rupture which will ultimately lead to reduction in maternal morbidity and mortality associated with the condition.

Transabdominal ultrasonographic findings in children with sickle cell anemia in Sokoto, North-Western Nigeria

Background: Sickle cell anemia (SCA) is an inherited disease caused by production of abnormal hemoglobin chains within the red blood cell. In Nigeria, West Africa, the incidence of SCA is 3%. The most common abdominal manifestations include abdominal pain (mesenteric crisis), hepatomegaly, splenomegaly, autosplenomegaly, and cholelithiasis. Objective: To evaluate the abnormal transabdominal ultrasonographic (TAUS) findings in children with sickle cell anemia in Sokoto, Northwestern Nigeria. Materials and Methods: Pediatric patients with SCA attending the sickle cell clinic at the Department of Pediatrics, Usmanu Danfodiyo University Teaching Hospital Sokoto were scanned at the Radiology Department of the Hospital by transabdominal ultrasonography (TAUS) using Apogee 800 plus Ultrasound scanner with a variable frequency probes at 5-12 MHz. The patients were in their steady states. They were also screened for viral hepatitis B and C. Results: The commonest TAUS findings in this study was hepatomegaly in 70 (98.6%) patients followed by splenomegaly in 15 (21.1%), autosplenomegaly in 3 (4.2%), and gallbladder sludge in 2 (2.8%) patients. Conclusion: Transabdominal ultrasonographic imaging of patients with sickle cell anemia revealed a high prevalence of abdominal abnormalities, especially of the liver, spleen, and gallbladder.

The relationship between the weight of the placenta and birth weight of the neonate in a Nigerian Hospital

Background:There have been several publications from different countries on the relationship between the placental weight and birth weight of the neonate. However, such reports from Nigeria are lacking in literature. The objective of this study was to determine the relationship between the placental weight and birth weight of the neonate at term pregnancy in a Nigerian hospital.Materials and Methods:It was a cross-sectional study conducted at Usmanu Danfodiyo University Teaching Hospital Sokoto between 1st October 2008 and 31st March 2009. Data gestational age at delivery (in weeks), parity, mode of delivery, fetal birth weight, placental weight, fetal gender, presence or absence of maternal medical diseases were obtained from 1009 singleton term deliveries who met the inclusion criteria for the study. The data was processed using EPI-INFO version 2005 and statistical analysis performed using one-way analysis of variance. A probability of 0.05 was set for statistical significance.Results:The placental birth weight ranged from 300 to 890 g with a mean of 590±82 g while the birth weight of the neonate ranged from 2030 to 5020 g with an average of 3275±469 g. The mean gestational age at delivery was 38.8±1.1 weeks while the mean placental birth weight ratio was 18.2±2.4 Increase in birth weight of the neonate was associated with corresponding increase in placental weight. However, as the gestational age at term advances the proportion of increase in the former was greater than that of the latter.Conclusions:There is a positive correlation between placental weight and birth weight of the neonate. However, the ratio of the placental and neonatal birth weights at term decreases with advancing gestational age. Thus, prolongation of pregnancy at term may adversely affect the fetus.

English

Serum bilirubin levels of 93 neonates aged between 0 and 14 days were estimated. The bilirubin levels were determined spectrophotometrically at 570 nm (Direct) and 540 nm (Total) at the pediatric unit, Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, Nigeria using continuous sampling techniques. It was established that the number of neonates with hyperbilirubinemia decreased with age.  The mean concentration of direct, indirect and total bilirubin of jaundiced neonates were significantly elevated (p<0.05) as compared to healthy neonates. There was, however, no significant different (p>0.05) in bilirubin levels between the age groups tested in this study. Neonatal Jaundice is a serious health problem concern with prolonged case that could be of grave or even fatal consequences. It is therefore pertinent from the result shown in this study that, close monitoring of bilirubin levels is essential during early infancy.   Key words: Bilirubin, neonates, jaundice, incidence age.

Awareness and the use of Insecticide Treated Net (ITN) among pregnant women attending ante-natal at Usmanu Danfodiyo University Teaching Hospital, Sokoto

Malaria remains a major public health problem, causing significant maternal and child morbidity and mortality annually in sub-Saharan Africa. The use of insecticide treated bed nets (ITN) is one of WHO recommended multipronged approach to combating malaria, but public awareness of the importance of this method vary from community to community. This study was therefore undertaken with the aim of assessing the current knowledge and use of ITN among pregnant women attending antenatal clinic at the Usmanu Danfodiyo University Teaching Hospital, Sokoto. Methodology used was a descriptive crosssectional study of randomly selected 111 pregnant women attending the ANC. A set of structured interviewer administered questionnaire was also used to extract information from the respondents. The result indicates that 101 (91%) of the respondentshad formal education and had heard of ITN, mainly through hospital sources (56.4%, x=57, n=101). However, only 59 (53.2%) of them own a net, supplied by government (21 or 35.6%) or purchased (32 or 54.2%) by the individual. 25 (42.4%) of the respondents used the net everyday but 31(52.5%, n=59) of them claimed to have used it the previous night. It was concluded from this study that although the knowledge of ITN was high (91%) amongANC attending women in study area, this did not(p>0.05) translate to ownership (53.2%) which in-turn did not (p>0.05) mean usage of net. There was a need to create more awareness of the anti-malarial significance of the ITN, through intensive health education in this and other such areas with endemic drug resistant malaria and insufficient health infrastructure, for the achievement of the objectives of theWHOGlobal Malaria Programme (GMP) and the United Nation Millenium Development Goal.

Antioxidant Vitamins and Trace Elements Status of Diabetics in Sokoto, Nigeria

Diabetes mellitus is associated with elevated oxidative stress via increased generation of reactive oxygen species (ROS), and decline in antioxidant defences. Increased oxidative stress is thought to play a role in the development of diabetic complications. In the current study, vitamins A, C, and E, chromium, manganese and zinc levels were estimated in 54 diabetics attending the outpatient clinic of the Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria and the results compared with those of apparently healthy non-diabetic volunteers of comparable age and social status. Serum levels of vitamin A,C, and E were 23.0 ± 6.5 ìg/dl, 15.1 ± 8.3 ìmol/l, 7.3 ± 4.0 ìmol/l and 51.7 ± 14.1 ìg/dl, 42.1 ± 20.3 ìmol/l and 30.5 ± 8.4 ìmol/l in diabetics and non - diabetic subjects respectively. There was significantly (P< 0.05) decreased levels of antioxidant vitamins in diabetics. The serum levels of Cr (2.6 ± 1.2mg/l), Mn (8.2 ± 2.8mg/l) and Zn(9.4 ± 6.9mg/l) were significantly (P< 0.05) low in diabetics. Most (82%) of the diabetics have deficient serum levels of the vitamins and minerals. The results suggest that diabetics in the study area have low serum levels of antioxidant vitamins and trace elements, an indication that the diabetics are predisposed to increased oxidative onslaught.

Prevalence of uncomplicated malaria in a paediatrics outpatient department of a tertiary health institution in Sokoto, Nigeria

Background: Malaria remains one of the major tropical health challenges in the world today. It accounts for more than 80% of estimated 1.5 – 3 million deaths of children annually especially those aged 5 years and below. There is paucity of data on the prevalence of uncomplicated malaria in children in Sokoto.Objectives: To determine the prevalence of uncomplicated malaria in children aged 0 – 15 years. Methods: The health registers and outpatient cards of children aged 0 – 15 years that presented to the Paediatrics Outpatient Department/Clinic of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria, between 1st June 2007 and 31st May 2009 were studied retrospectively. Information of the patients with regards to their age, gender, presenting features, date of presentation at the clinic, and diagnosis of malaria (clinical and parasitological) were extracted from the registers and case records and analyzed.Results: During the study period, a total of 15,909 children aged 0 – 15 years were seen in our clinic. Of this number, 7,224 had clinical and parasitological diagnosis of uncomplicated malaria giving a prevalence rate of 45.4%.those aged 5 years and below were 5,782 (49.6%) while the remaining 1,442 (34.0%) were aged above 5 years. Males were 4,068 (56.3%) while the females were 3,156 (43.7%) with M: F ratio of 1.3:1. The main presenting symptoms were fever (100%), reduced appetite (80.5%), reduced activity (75%) and chills (74%). The main presenting signs were pyrexia (84.5%), splenomegaly (38%) and hepatomegaly (14%). Malaria was the leading cause of paediatrics outpatient clinicattendance followed by acute respiratory infection and diarrhoeal disease. Though malaria occurred throughout the year, majority of the cases were seen during the raining and early dry reasons.Conclusion: Malaria is partly meso-endemic and hyper endemic in the studied area and children aged 5-years and below are the most susceptible. It is therefore, recommended that more efforts should beput in place towards malaria control and prevention particularly in this age group.

Paediatrics hiv/aids: Clinical presentation and practical management Challenges in Sokoto, Nigeria

Background: Implications of continuing HIV/AIDS pandemic in Nigeria is very grave for children. Lack of financial resources means care of children with HIV/AIDS is exceedingly difficult to provide. We described the clinical pattern and highlight the problems in the management of HIV/AIDS in children seen in Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, Nigeria over a two-year period.Methods: This prospective study was carried out between 1st January 2001 and 31st December 2002. The clinical presentation of each patient satisfying the WHO diagnostic criteria for paediatrics HIV/AIDS,admitted consecutively into our Emergency Paediatrics Unit (EPU) was documented. Laboratory diagnosis was by Enzyme linked immunosorbent assay (ELISA) for HIV- I and HIV- II in affected children and their mothers while confirmatory test was by Western blot. Treatment of each patient wasindividualised.Results: A total of 41 children with HIV/AIDS were admitted into EPU over the study period. There were 22 males and 19 females with ratio of 1.2:1. Age ranged from 0.25 years to 14 years with mean (SD) of 1.5 (2.2) years. Forty - one (97.6%) patients were aged 5 years and below. Modes oftransmission were vertical in 40 (97.6%), while 1 (2.4%) was by homosexual abuse. The commonest clinical feature was weight loss in 41 (100%), followed by fever (>one month) 39 (95%), chronicdiarrhoea 39 (95%), recurrent cough 37 (90%) and oro-pharyngeal candidiasis 35 (85%) in that order. Thirty- six (87.8%) patients had protein – energy malnutrition (PEM), marasmus constituting 58%. Thirtytwo(78%) patients were in WHO clinical stage 3 while the remaining 9 (22%) patients were in stage 4. The main types of infections were oral candidiasis, pneumonia, malaria, septicaemia, urinary tractinfections, and tuberculosis. Case fatality rate was 91%. Highly active antiretroviral therapy (HAART) was not freely available to children during the period of our study.Conclusion: The mortality of these antiretroviral naive HIV/AIDS children was very high. It is anticipated that current availability of HAART to children free of charge would improve the outcome of HIV/AIDS in this group.

Elective caesarean section in a tertiary hospital in Sokoto, north western Nigeria.

Background:Elective caesarean sections have been considered safer for both mother and the fetus compared to their emergency counterpart. However, emergency caesarean sections have continued to form bulk of caesarean deliveries in our facility.Objective:The objective of this study was to determine the caesarean section rate together with the trend, indications, and maternal mortality associated with elective caesarean operation.Materials and Methods:A retrospective analysis of clinical records of all the patients that had caesarean section between January 2002 and December 2010 (9 years) at Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto, Nigeria was conducted.Results:During the 9 year study period, 2284 caesarean sections were performed out of 22,985 total deliveries at UDUTH Sokoto, thus giving a caesarean section rate of 9.9%. Emergency and elective operations accounted for 1784 (78.2%) and 498 (21.8%) of the cases respectively. The rate of elective caesarean section increased from 1.7% in 2002 to 3.2% in 2007. Thereafter it declined gradually to 1.8% in 2010. Repeat caesarean section (30.7%) and malpresentation (17.1%) were the most common indications for elective caesarean operation. There were 18 maternal deaths from caesarean section and only one from the elective caesarean procedure.Conclusion:The rising trend in the elective caesarean section rate in this study underscores the need for better and improved patient selection together with counseling on its benefits and risks. This is because despite the fact that it is safer than emergency caesarean operation, it is not entirely devoid of complications. Routine use of spinal anesthesia in performing the procedure should be encouraged.

Knowledge, Attitude and Practice of Child Adoption among Infertile Female Patients in Sokoto North-West Nigeria

To determine the knowledge, attitude and practice of child adoption among infertile female patients at Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto. Semi structured interview questionnaire was administered to 250 consecutive infertile female patients (between January 2008 and November 2009) at UDUTH Sokoto who agreed to participate in the study after counseling. The data was analysed by simple percentages, descriptive statistics, chi-square tests and regression equations at 95% confidence level. Knowledge of child adoption was high (74.8%). However only 1.2% of the respondents had adopted a child while 27.2% were willing to adopt. Willingness for child adoption was significantly higher in patients whose duration of infertility was greater than 5 years (OR=6.0, P<0.001), those with secondary/tertiary education (OR=4.1, P<0.001) and in those with no living child (OR=24.9, P<0.001) compared to their reverse counterpart. Majority of the respondents (71.6%) were not willing to adopt a child and their main reason was that child adoption would not allow them fulfill their conception role as women. Knowledge of child adoption was high among the respondents but the willingness to adopt a child was low due to the fact that it would not allow them fulfill their conception role as women. There is need to educate and encourage our infertile patients to utilise this cheaper and available option of managing infertility.

Histo-pathological features of primary ovarian Tumours managed in a tertiary hospital, Sokoto.

Background: Ovarian tumours are the 2nd most common female genital tract tumour in Sokoto, northwestern, Nigeria. We determined the histo-pathological features of surgically removed ovarian tumours. Methods: A 12-year retrospective study of all surgically removed ovarian tumours at the Gynaecological department of Usmanu Danfodiyo University Teaching Hospital UDUTH) Sokoto, North- Western Nigeria.Results: The highest incidence of ovarian tumours was within the age range of 20-45 years. Of the 125 cases of surgically removed neoplastic ovarian tumours seen during the study period, 83(66.4 %)were benign, 40(22.4%) were malignant and 2(1.6%) were of borderline malignancy. Epithelial tumours were the commonest neoplasms 54(43.2%), while germ cell tumours were present in 47(37.6%) cases.Mucinous cystadenocarcinoma was the commonest malignant ovarian tumour 14(35%) and was closely followed by granulosa cell tumour 10(25%), dysgerminoma 17.5%), serous cystadenocarcinoma(12.5%), malignant teratoma 2(5%) and endodermal sinus tumour (5%). There were 2 cases of metastatic tumours: one from Burkitts lymphoma, and the other from gestational choriocarcinoma. Conclusion: The high frequency of malignant ovarian tumours in the young age group type in this study underscores the need for histology of all surgically removed tumours irrespective of age.

Waiting time among acute abdominal emergencies in a Nigerian teaching hospital: causes of delay and consequences

Background-In many patients presenting with an acute surgical abdomen, the outcome of management is determined by the promptness of the appropriate surgical intervention. The average interval the patienthas to spent waiting for treatment at first presentation to hospital with an acute abdominal emergency is unknown in our center. This study was designed to evaluate the waiting time between hospital presentation and operation,to highlight causes of the delay and outcome of treatment among patients admitted with emergency abdominal events in a Nigerian tertiary health Centre.Method- This is a prospective study of all consecutive patients with the clinical diagnosis of acute surgical abdomen admitted over an 8- month period [March to October 2005] into the surgical services of Usmanu Danfodiyo University Teaching Hospital [UDUTH], Sokoto.Results- One hundred and thirty six patients were studied. There were 95 males and 41 females aged between 3-days and 75 years [median age 25 years]. The waiting time ranged between 4 to 180 hours [>7 days]; with a mean of 44 hours. Only 13(9.6%) of the patients were operated within 6-hours of hospital admission, considered prompttreatment. Operations after six hours in 123 others was due to several reasons but the commonest reason in [65.4%] was financial constraint. The commonest complication responsible for significant morbiditywas wound infection in 31 (22.8%) patients, the majority of whom had delayed surgical operation (n=23/31). Twenty-eight (20.6%) patients died in this study. All but one were from the group operatedbeyond 6-hours of hospital presentation.Conclusion: The adverse consequences of prolonged waiting time in our center among patients admitted with acute surgical abdomen are most commonly due to financial difficulties. A hospital-basedcredit scheme available to emergency aptients will rapidly improve the quality of care we give our patients.

Pregnancy outcome in women involved in road traffic accidents in Sokoto

Background: Road traffic accidents (RTA) are common in Nigeria. Pregnant mothers could be involved in such accidents and this might affect pregnancy outcome.Method: A retrospective analysis of pregnant mothers admitted at Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria because of road traffic accidents between January 1998 and December, 2002, was undertaken to determine the incidence, type of injury and pregnancy outcome.Results: One hundred and forty nine women admitted because of major injuries sustained after road traffic accidents. Twelve (8%) of these women were pregnant at the time of the accident. Gestational age ranged from 16 to 38 weeks. Fall from commercial motorcycles was the most common accident with deep lacerations and long bone fractures. Obstetric complication included abruptio placentae and premature uterine contractions. There was normal delivery in 9 patients, 2 stillbirths and one moth with head injury died undelivered.Conclusion: Early consult with appropriate obstetric intervention was associated with good foetal and maternal outcome. The emergency duty doctor should always think of the possibility of a co-existing pregnancy whenever managing any woman within the reproductive age group involved in RTAs.

Serum levels of antioxidant vitamins and mineral elements of human immunodeficiency virus positive subjects in Sokoto, Nigeria

Undernourishment and micronutrient deficiencies exacerbate immunosuppression, oxidative stress, acceleration of human immunodeficiency virus (HIV) replication and CD4 T-cell depletion in HIV-infected individuals. The current work reports the serum levels of antioxidant vitamins (vitamins A, C and E) and minerals (Zn, Fe, Cu) in 90 HIV positive subjects attending the Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, Nigeria. The serum levels of the micronutrients were correlated with the CD4 count of the subjects. The results showed that the HIV positive subjects have significantly lower (P < 0.05) levels of vitamins A, C and E. Also, serum Zn, Fe, Cu and CD4 count were also significantly (P < 0.05) lower compared with the HIV negative subjects. Micronutrient deficiencies were more pronounced in HIV positive subjects with CD4 counts less than 200 cell/μl. The results based on age and sex showed no significant (P > 0.05) difference. Vitamins A, E and C and Zn and Fe showed positive correlation with CD4 count of the HIV positive subjects. The results suggest that the HIV subjects in the study area have lowered serum levels of antioxidant micronutrients and that the levels decrease with increase in the severity of the infection. These may increase the chances of the symptomatic and asymptomatic subjects progressing into full-blown Acquired Immunodeficiency Syndrome.

Proceedings and abstract of the 2 nd annual scientific conference of nigerian medical association sokoto state branch held in Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria

Proceedings and abstract of the 2 ^nd annual scientific conference of nigerian medical association sokoto state branch held in Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria

Awareness and utilization of insecticides treated mosquito nets among pregnant mothers at tertiary health institution in North-Western Nigeria

Malaria in pregnancy is a formidable misery in Africa and contributes significantly to maternal death in Nigeria. The use of insecticide treated mosquito bed nets is one of the strategies of the Roll Back Malaria initiative. It is a form of vector control measure but there exists discordance between awareness and utilization of insecticide treated nets in Nigeria. This study set out to assess the level of awareness and utilization of insecticide treated nets among pregnant mothers attending antenatal clinic. Using a structured questionnaire, a cross sectional study of 250 consecutive pregnant mothers attending antenatal booking clinic in Usmanu Danfodiyo University Teaching Hospital Sokoto between January and March 2008 was conducted. Seventy four percent of the clients were aware of Insecticide treated nets. Awareness of insecticide treated nets was significantly higher in clients with post primary education (66.8%) compared to those with at most primary education (33.2%); p < 0.05. Thirteen percent of the clients were using insecticide treated nets while 67.6% were not. The main reason for non-utilization of insecticide treated nets were non availability of the nets (58.8%) and inconvenience of the barrier to the clients (29.4%). There is high level of awareness of insecticide treated nets among the study population but very low utilization largely due to non availability. For Nigeria to achieve the millennium development goal target in combating the menace of malaria in pregnancy, more effort is required to increase the availability of insecticide treated nets. In addition, proper education on the benefits of insecticide treated nets may increase its utilization.

Fetal Outcome Following Cesarean Section in a University Teaching Hospital

ObjectiveTo evaluate fetal outcome for the various indications for cesarean section.Methodology: A review of all cases of cesarean section that were done in the maternity unit at Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria, between January 2006 and April 2007, with emphasis on indications and perinatal outcome. ResultsThere were 2562 total deliveries within the study period and 112 perinatal deaths giving a perinatal mortality rate of 43.7 per 1000 live births. Cesarean section accounted for 216 of the deliveries (8.4%) with 24 perinatal deaths (11.1%). Perinatal mortality from Cesarean sections accounted for 21.4% of the total deaths with severe birth asphyxia responsible for most perinatal deaths, 17 of 24 (70.8%). There were 174 emergency sections with 22 perinatal deaths, while 42 elective sections had 2 perinatal deaths. The main indications for cesarean section were cephalopelvic disproportion, 86 (39.8%); previous section plus an obstetric abnormality, 39 (18.1%); and prolonged obstructed labor, (10.2%), with perinatal deaths of 3, 2 and 11, respectively. ConclusionsThe perinatal mortality among the cesarean deliveries were 11.1%, and the main cause of death was severe birth asphyxia. Emergency cesarean section was more likely than elective to result in a perinatal loss. The indication with the poorest fetal outcome was prolonged obstructed labor.