Adebiyi Gbadebo Adesiyun

Female sterilization by tubal ligation: a re-appraisal of factors influencing decision making in a tropical setting

BackgroundFemale sterilization by tubal ligation is the most commonly used method of fertility regulation. However, in some lesser-developed country like Nigeria, it has not been accepted as a popular method of contraception.ObjectiveTo assess the pattern of female sterilization and determine factors that may influence its acceptability.MethodA retrospective study of 102 cases of tubal ligation (TL) performed between January 1999 and December 2004.ResultOf the 102 patients/clients, 60 (58.8%) had TL at caesarean section, 28 (27.5%) had TL with repair of ruptured uterus and 14 (13.7%) clients had TL alone on request. In the reproductive age group, the rate of TL increased with age. In the group that had TL at caesarean section, the highest incidence of TL (65%) was recorded against parity 4. However, in the groups that had TL with repair of ruptured uterus and TL alone, the highest proportion of TL was recorded against parity 6, with rates of 46.3 and 57.1%, respectively. The rates of TL increased with the level of literacy. In the group that had TL alone, 92.9% of the clients were in a monogamous union. On the contrary, 89.3% of patients that had TL with repair of uterine rupture were in a polygamous union. There was relative distribution of patients/clients amongst the two religions and five ethnic grouping. In 55 of the 102 patients/clients, the indication for TL was completion of family size, though 41 of the 55 patients had TL at caesarean section.ConclusionDemand for TL alone was low. A greater percentage of the patients had TL in conjunction with another surgical procedure.

Reproductive health in Nigeria.

BACKGROUND Adolescents have special reproductive health needs, but these peculiar needs are often unmet in many cultures and countries. METHODS A cross-sectional study involving adolescents in three secondary schools in a northern Nigerian setting. Demographic characteristics as well as reproductive health issues (adolescent sex, abortion, sexual experience) among the students were surveyed. RESULTS Of the 1070 students that fully participated in the survey, 539 (50.4%) were girls and 531 (49.6%) boys. They were aged 10 - 27 years (median 16 Years). Five hundred forty three (50.7%) were Christians and 499 (46.6%) Muslims. Nine hundred and four (84.5%) of the students knew about abortion. On their view about reasons why adolescents indulge in premarital sex, 574 (53.6%) felt it was to please boyfriend/girlfriend, 391 (36.5%) to experiment with sex, 312 (29.6%) to test fertility and 239 (22.3%) felt it was to stop painful menstruation. One hundred thirty five (12.6%) have had sex and 15 - 19 years age group were more likely to be sexually active. Twelve (1.1%) of the girls had been pregnant once - four times before and all had an abortion. Children of civil servants were significantly more likely to be sexually active compared to other groups of children (p <0.05). All the respondents knew one or more complication of abortion to include inability to get pregnant in future 682 (63.7%), abdominal pain 589 (55%) and painful menstruation 427 (39.9%). CONCLUSION Adolescents are unique in every way including issues of reproductive health. The age at sexual debut in this setting is early. There is a need to include reproductive health education in the curriculum of secondary schools. This should help the adolescents to obtain the correct information from the right source.

Term extrauterine pregnancy in a Nigerian mother: a complication of uterine dehiscence.

Abdominal pregnancy is an uncommon but life-threatening form of ectopic pregnancy. It is associated with high maternal/fetal morbidity and mortality. We present a rare case of term abdominal pregnancy resulting from anterior uterine wall dehiscence, in a 36-year-old woman with three previous caesarean sections. The diagnosis was made at laparotomy for the fourth “caesarean section”.

Postpartum Ovarian Vein Thrombosis: Incidental Diagnosis at Surgery

Ovarian vein thrombosis is a rare clinical entity that may present in the puerperium. We report the clinical outcomes of two cases of postpartum ovarian vein thrombosis, incidentally diagnosed at laparotomy in 16-year-old and 23-year-old females. They had preoperative diagnosis of torsion tuboovarian mass and twisted pedunculated uterine fibroid, respectively. Both patients had transection and ligation of right thrombosed ovarian vein. Postoperative management included a week course of anticoagulant, antibiotics and analgesia. Postpartum ovarian vein thrombosis is a diagnosis of exclusion in the puerperium and a high index of suspicion will reduce associated morbidity and mortality.

Cutaneous umbilical metastases in post-menopausal females with gynaecological malignancies.

Gynaecological malignancies frequently metastasize to contiguous structures, internal organs and bones. Cutaneous metastasis as a primary or recurrent presentation of these malignancies is rare and only a few cases have been reported in the literature. A twenty year (1991-2010) retrospective search for umbilical metastasis from gynaecological malignancies in our departmental case records showed only four cases. Four post-menopausal females presented with painful cutaneous umbilical (Sister Josephs) nodules. The clinical examinations of all four patients revealed well delineated nodules of varying sizes and degrees of ulceration. Other findings were matted axillary and inguinal lymph node enlargement, intra-abdominal and pelvic masses, vaginal discharge and vaginal bleeding. Incisional tissue biopsies from the nodules were processed in paraffin wax and stained with haematoxylin and eosin. Histology of the sections showed pigmented skin overlying metastatic malignant tumours consistent with adenocarcinoma from the endometrium and ovary in three cases, and squamous cell carcinoma, large cell keratinizing from the cervix uteri in the fourth case. Gynaecological cancers have a global spread and varied geographic distribution. Cervical cancer is the commonest in our setting and patients often present to hospital with advanced stage disease. Ovarian and endometrial cancers are infrequent and their diagnosis may be delayed by non- specificity of presenting clinical symptoms from other benign tumours at these sites. Although umbilical metastasis is commonly associated with gastro-intestinal malignancies, its presence may be the first harbinger of occult gynaecologic cancer.

Prevalence of Trichomonas vaginalis and HIV co‑infection among asymptomatic pregnant women in Zaria, northern Nigeria

Background: Trichomonas vaginalis infection is the most common curable, sexually transmitted infection worldwide. Serious adverse reproductive health outcomes including pregnancy complications, pelvic inflammatory disease, and an increased risk of human immunodeficiency virus (HIV) acquisition have been linked to T. vaginalis infection. Objective: To determine the prevalence of T. vaginalis in asymptomatic pregnant women and their HIV status in Ahmadu Bello University Teaching Hospital, Zaria, northern Nigeria. Materials and Methods: This was a prospective cross‑sectional descriptive study conducted using a proforma to obtain demographic and reproductive health information from consenting pregnant women attending the antenatal clinic. Vaginal swab and blood samples were taken and analyzed for T. vaginalis and HIV, respectively. Data were analyzed using Statistical Package for Social Science (SPSS) V17, with the level of significance set at 5% . Results: The overall prevalence of T. vaginalis was 19.2%. There was an inverse relationship between the level of education and acquisition of T. vaginalis infection in pregnancy; women having no formal education had a higher prevalence of the T. vaginalis infection (7.5%) as against those who had tertiary education (1.7%). The 26–30 years age group had the highest prevalence of both HIV infection (5.0%) and T. vaginalis infection (5.8%), strongly suggesting the possibility of co‑infection between the two agents. There was a statistically significant association between T. vaginalis infection and HIV infection with a P value of 0.0003. The relative risk (RR) of acquiring HIV in the presence of T. vaginalis infection was 4 (RR: 4.193; Confidence Interval: 1.756–10.01). Conclusion: Improvement of the socioeconomic status and education of women, especially sexual health; will reduce the prevalence of T. vaginalis and HIV co‑infection.

Knowledge and attitude towards child adoption among women in Zaria, northern Nigeria

Background: The success of marriages has largely been premeditated on child bearing in most African society and oftentimes women are at the receiving end of childlessness with possible psychological and physical torture. Objective: To assess the knowledge and attitude of women of reproductive age towards child adoption in Zaria, Northern Nigeria. Methodology: A cross-sectional descriptive study, structured closed and open ended questionnaires was administered to 200 consenting consecutive women aged 15–49years to obtain information on socio-demographic characteristics, reproductive profile, knowledge and attitude towards child adoption. Data was analysed using SPSS V17 with p value set at 0.05. Results: The majority 89.4% of respondents have heard and are aware of child adoption and 77% agreed it is a good practice. The most prevalent source of information is the Mass media in 35.0% of respondents. The female gender is preferred by majority 64.2% of respondent if they will adopt. There is a strong association between numbers of living children and willingness to consider child adoption with P value < 0.05. Conclusion: There is a high level of knowledge and acceptability of child adoption practices in our environment. Child adoption institutions should therefore be supported to meet the need of the infertile couples.

Age at menarche and prevalence of menstrual abnormalities among adolescents in Zaria, northern Nigeria

Background: Nigerian adolescents constitute about 20% of the total population. Problems associated with menstruation affect 75% of adolescent females in both the developing and the developed world. Objectives: The objective of this study is to establish the age at menarche and menstrual abnormalities among adolescents in secondary schools in Zaria. Materials and Methods: A descriptive cross sectional study in which a self-administered pretested, semi-structured questionnaire in english was administered to 535 female secondary school students in Zaria, northern Nigeria. The students were selected from five schools that were chosen by simple random sampling from a list of schools in Zaria metropolis. Information obtained included age at menarche and menstruation related issues. Results: Of the 535 female secondary school students interviewed, 448 (83.7%) were in senior secondary school. The mean age of the respondents was 15.35 ± 1.48 years. The average age at menarche was 12.53 ± 1.33 years. Most respondents, 369 (69.0%) experienced regular menses. The average duration of menstruation was 5.45 ± 1.81 days in 354 (66.2%) of the respondents. Three hundred and forty-four (64.3%) of the respondents had dysmenorrhea, and it was severe in 229 (66.6%) of them. Only, 137 (25.6%) experienced premenstrual symptoms, the most common symptom being breast tenderness in 62 respondents (45.2%). Conclusion: The age at menarche and the menstrual pattern amongst adolescents in Zaria, northern Nigeria is similar to findings from other parts of Nigeria as well as from other parts of the world. Further studies are however needed to explore the full range of menstrual abnormalities that can occur in the adolescent age group.

Referral for assisted reproductive technology: indications and treatment outcome.

Dear Sir, Africa has the highest rate of infertility, mostly due to tubal occlusion. Paradoxically, however, it records the lowest rate of assisted reproductive technology (ART) treatment.[1] ART services are unaffordable to the majority of patients in Africa.[2] I conducted a prospective review of 23 consenting infertile patients/couples referred for ART following counseling that a treatment cycle would cost an estimated US

Foetal chondrodysplasia: intrauterine diagnosis.

4000. The patients were seen and referred for treatment between years 2000 and 2007. In this study, successful ART treatment was measured by number of clinical pregnancies.