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OBJECTIVE: Anemia in patients presenting for elective surgery is associated with increased morbidity, allogeneic blood transfusion, and delay of surgery. Extract of sorghum bicolor has been shown to have hemopoietic, immune-stimulating, and antioxidant effects in rats and in patients with HIV. The aim of this study was to determine the effect of the extract in patients with preoperative anemia booked for myomectomy. METHODS: Consenting patients (N = 66) were randomly assigned to two groups. The test group (n = 34) was given folic acid 5 mg/d, 200 mg iron tablet three times daily, and 500 mg/d of the extract. The control group (n = 32) was given the same doses of folic acid and iron for a period of 3 wk. Blood samples were taken at baseline and weekly for full blood cell count and liver and kidney function tests. Participants were screened for tuberculosis, HIV, hepatitis, and sickle cell anemia. RESULTS: Increases in red blood cell count, hematocrit, and hemoglobin concentration in participants in the test group were highly significant (P < 0.0002, P < 0.0001, and P < 0.0001, respectively). Participants in the control group had a significant increase in the hemoglobin concentration (P > 0.04). The changes in liver enzymes, urea, and creatinine for participants in the test group were within the normal ranges. CONCLUSION: The addition of the extract of sorghum bicolor to routine hematinics is superior to the use of routine hematinics alone. Although the difference is not statistically significant, the extract will correct preoperative anemia in an additional 15% of the patients.
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Anemia/tratamiento farmacológico , Hematínicos/uso terapéutico , Pruebas Hematológicas , Hemoglobinas/metabolismo , Fitoterapia , Cuidados Preoperatorios , Sorghum , Adulto , Anemia/complicaciones , Transfusión Sanguínea , Creatinina/metabolismo , Procedimientos Quirúrgicos Electivos , Recuento de Eritrocitos , Femenino , Ácido Fólico/farmacología , Ácido Fólico/uso terapéutico , Hematínicos/farmacología , Hematócrito , Humanos , Hierro/farmacología , Hierro/uso terapéutico , Hígado/efectos de los fármacos , Hígado/metabolismo , Persona de Mediana Edad , Extractos Vegetales/farmacología , Extractos Vegetales/uso terapéutico , Resultado del Tratamiento , Urea/metabolismo , Miomectomía Uterina , Adulto JovenRESUMEN
BACKGROUND: Several maternity units in the developing world lack facilities for caesarean section and often have to transfer patients in extremis. This case controlled study aimed to appraise predictive factors for caesarean section. METHODS: One hundred and fifty two consecutive women with singleton pregnancies who had caesarean section were studied. The next parturient with normal delivery served as control. Variables such as age, parity, marital status, booking status, past obstetric history, weight, height, infant birth weight were assessed. Data obtained were analysed using SPSS 16.0 Windows package. RESULTS: During the study period, there were 641 deliveries with 257 of them by caesarean section (40.1%).Logistic regression analysis showed that parity, booking status, maternal height; maternal weight, birth weight, previous caesarean section and ante-partum bleeding were significant predictive factors for caesarean section while maternal age was not. CONCLUSIONS: These predictive factors should be considered in antenatal counseling to facilitate acceptance by at risk women and early referral.
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Peso al Nacer , Cesárea/estadística & datos numéricos , Países en Desarrollo , Complicaciones del Embarazo/epidemiología , Hemorragia Uterina/epidemiología , Adulto , Estatura , Peso Corporal , Estudios de Casos y Controles , Cesárea Repetida , Femenino , Humanos , Nigeria , Paridad , Embarazo , Atención Prenatal/estadística & datos numéricos , Factores de Riesgo , Adulto JovenRESUMEN
BACKGROUND: Adoption as a treatment option for infertility amongst those that cannot access and/or afford assisted reproduction is not well accepted in developing countries. This study sets out to determine the willingness of infertile women in developing countries to adopt a child and factors that influence women's attitude to adoption. METHODS: We conducted a questionnaire survey of consecutive infertile patients who attended the gynecological clinic of a regional teaching hospital over a 2-month period. Information on demographics, fertility history, and attitude to adoption was obtained, and the data were analyzed using SPSS version 16.0. Tests of statistical significance were used where appropriate at the 95% confidence level. RESULTS: The majority of respondents were aware of child adoption, and the most common source of information was friends (47.8%), followed by the media (39.7%); 42.6% of respondents were willing to adopt if their infertility became intractable. The main reasons given by those unwilling to adopt were culture (78.3%) and family constraints (13.45%). On univariate analysis of factors associated with a favorable or unfavorable attitude to adoption, awareness of adoption (P = 0.002), duration of infertility > 5 years (P = 0.015), no living child (P = 0.007), tertiary education (P < 0.001), pressure from parents (P = 0.041), household yearly income ≥ $650 (P < 0.001), and belief that treatment will bring about the desired results (P < 0.001) were significant, and all except awareness of adoption turned out to be significant on multiple logistic regression analysis. CONCLUSION: There was a high level of awareness about child adoption among all respondents. However, the acceptability of adoption was significantly lower among poor women and those with limited education. Community advocacy and mobilization, especially through the media as well as via health care providers, will go a long way towards enlightening and enhancing the uptake of adoption among women in Nigeria.
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BACKGROUND: Maternal mental illness is likely to have a profound impact in less developed parts of the world. A mother experiencing mental illness in a low income setting is at risk of providing sub-optimal care for her offspring which can have grave consequences in an environment where poverty, overcrowding, poor sanitation, malnutrition, tropical diseases and a lack of appropriate medical services may be pronounced. Given the profound consequences of antenatal and postnatal mental illness on maternal mental health, foetal wellbeing and childhood growth and development the factors associated with mental illness in a Sub-Saharan setting merit clarification and investigation. METHODS: A prospective survey design was conducted in Lagos. Self reporting questionnaire 20 items - SRQ20 - assessed the presence of mental illness. The WHO Multi-country Study on Women's Health and Domestic Violence Questions assessed women's exposure to violence. Numerous variables potentially associated with mental illness including maternal socio-economic factors, maternal characteristics, obstetric variables and the characteristics of previous children were recorded. Direct logistic regression was performed to assess the impact of a number of variables on the likelihood of presence of mental disorder in the population. RESULTS: 189 women were surveyed. 7% met the criteria for experiencing a common mental disorder according to their score on the SRQ-20. Of variables examined only the number of female children and the presence of inter personal violence predicted being a case of mental illness (OR = 3.400; 95%CI = 1.374 - 8.414 and OR = 5.676; 95%CI = 1.251 - 25.757 respectively). CONCLUSIONS: Rates of mental disorder found in our study were lower than those previously observed internationally and in Africa, perhaps reflecting stigma about disclosing symptoms. The predictive nature of violence on mental disorder is in keeping with international evidence. Our study demonstrated that exposure to inter personal violence within the last 12 months and increasing numbers of female children predict the presence of mental illness in a sample of pregnant Nigerian women. Training and education for primary health care and obstetric health workers should highlight these areas.
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Trastornos Mentales/epidemiología , Complicaciones del Embarazo/epidemiología , Adulto , Estudios Transversales , Violencia Doméstica , Femenino , Humanos , Trastornos Mentales/etiología , Nigeria/epidemiología , Embarazo , Complicaciones del Embarazo/etiología , Atención Prenatal , Estudios Prospectivos , Psicometría , Análisis de Regresión , Factores de Riesgo , Encuestas y CuestionariosRESUMEN
BACKGROUND: Haemorrhage from obstetric causes is the most common cause of maternal mortality in the developing world. Prevention of mortality from haemorrhage will necessarily involve prompt blood transfusions among other life saving measures. There are however limited stocks of fresh or stored blood in many health care facilities in Sub Saharan Africa. Caesarean section has been identified as a common indication for blood transfusion in obstetrics practice and its performance is often delayed by non availability of blood in our centre. An evaluation of blood reservation and use at caesarean sections in a tertiary maternity unit in Lagos, south western Nigeria should therefore assist in formulating the most rational blood transfusion policies. METHODS: Case records of 327 patients who had elective and emergency caesarian sections at the Lagos State University Teaching Hospital between 1st October and 31st December 2007 were reviewed. Data pertaining to age, parity, booking status, type and indication for Caesarean section, pre- and post-operative packed cell volume, blood loss at surgery, units of blood reserved in the blood bank, unit(s) of blood transfused and duration of hospital stay was extracted and the data analysed. RESULTS: There were 1056 deliveries out of which 327 (31%) were by Caesarean section. During the study period, a total of 654 units of blood were reserved in the blood bank and subsequently made available in theatre. Out of this number, only 89 (13.6%) were transfused to 41 patients. Amongst those transfused, twenty-six (54%) were booked and 31 (75.6%) had primary caesarian section. About 81% of those transfused had emergency caesarean section. The most common indication for surgery among those transfused were placenta praevia (9 patients with 21 units of blood) and cephalo-pelvic disproportion (8 patients with 13 units). CONCLUSION: Even though a large number of units of blood was reserved and made available in the theatre at the time of operation, majority of the patients operated did not need blood transfusion. Provision of a mini- blood bank within the obstetric unit and careful patient categorization will ensure timely availability of blood for surgery without necessarily tying down stock in the central blood bank.
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Bancos de Sangre/estadística & datos numéricos , Pérdida de Sangre Quirúrgica/prevención & control , Transfusión Sanguínea/estadística & datos numéricos , Cesárea , Unidades Hospitalarias/estadística & datos numéricos , Hemorragia Uterina/terapia , Adulto , Femenino , Hospitales Universitarios , Humanos , Nigeria , Complicaciones del Trabajo de Parto/terapia , Servicio de Ginecología y Obstetricia en Hospital/estadística & datos numéricos , EmbarazoRESUMEN
BACKGROUND: A primipara with multiple pregnancy who booked for antenatal care at 21 weeks presented with vaginal bleeding and pedal oedema at the 27th week. She had had five previous ultrasound scans that gave conflicting results. MATERIALS AND METHODS: The patient was therefore sent for a confirmatory scan, which was performed using a linear 3.5 MHz transducer of a dynamic imaging dedicated, concept MC ultrasound scan machine. RESULTS: A diagnosis of conjoint twins was made. The twin was joined from the mandible to the abdomen. Although they cried at birth, they died a few minutes after. The pregnancy was terminated by caesarian section at the patient's request. The patient did well postpartum and was discharged on the 5th postoperative day. Records confirm that this is the first case seen in this hospital, which has been in existence for 18 years. CONCLUSION: To diagnose conjoint twins by ultrasound, one needs the expertise and careful scanning techniques, as the diagnosis may be easily missed, especially if the union is extensive.