Emmanuel O. Otolorin

Sexual Behavior Contraceptive Practice and Reproductive Health Among Liberian Adolescents

This paper reports on a survey that was aimed at obtaining information for use in designing programs to reduce the incidence of adolescent pregnancy in Liberia. The sample of 1,488 never-married adolescents aged 14-21 was divided into subgroups based on age, sex, student status, and (for non-students) level of education. Although 57-93 percent of respondents claimed to have received information on reproductive health, only 2-21 percent could identify the monthly fertile period. Thirty to 49 percent of females ages 14-17 years have sexual relations at least once a month; over 80 percent of female non-students ages 18-21 years are sexually active. Highest levels of current contraceptive use were reported for 18-21-year-old female students (51 percent). Never-use of contraception among sexually active respondents was 97 percent for 14-17-year-old non-student females with a low educational level. Insufficient information about family planning methods and inaccessibility were the main reasons cited for non-use. Half of females ages 14-21 years who are currently attending school have been pregnant, as have 67 percent of those not in school. These results indicate a substantial unmet need on the part of Liberian adolescents with respect to reproductive health knowledge, information, and access to contraceptive methods.

The effect of continuous subdermal levonorgestrel (Norplant) on carbohydrate metabolism

Blood glucose and plasma insulin levels during an oral glucose tolerance test were measured in 20 women using continuous subdermal levonorgestrel (Norplant) for contraception over a 12-month period. Changes in carbohydrate metabolism occurred as early as 1 month but were most marked after 6 months. After 1 month the area under the glucose and insulin curves increased by 12.3% and 37.7%, respectively. This increase was more marked by 6 months, but by 12 months it was significantly less marked. Although changes in the blood glucose and plasma insulin levels at different times during the oral glucose tolerance test occurred, they were all within normal limits for normal women. The peak blood glucose and insulin levels after insertion of the implant occurred 60 minutes after the glucose load, as opposed to 30 minutes before insertion. Apart from this, there was a significant delay in the return of these levels to fasting values. We conclude that this product, like any other progesterone-containing contraceptive, alters carbohydrate metabolism, but these alterations are not clinically significant in normal women. It is, however, possible that in potential cases of diabetes it may predispose to frank diabetes.

Laparoscopic evaluation of the tuboperitoneal factor in infertile Nigerian women

Laparoscopy has become the most important investigative tool for the evaluation of tubal disease in developed countries of the world. In this report of 218 diagnostic laparoscopies performed on infertile Nigerian women, bilateral tubal occlusion was found in 35.3% and unilateral occlusion in 9.6%. Pelvic adhesions were present in 55.0% out of which 25.2% and 21.1% were moderate or severe, respectively. Endometriosis and uterine fibroids were present in 1.4% and 26.6% of patients, respectively. The implications of these findings for management of tubal disease in Nigerian women is discussed.

CARBOHYDRATE METABOLISM BEFORE AND AFTER NORPLANTR REMOVAL

Changes in carbohydrate metabolism, measured by oral glucose tolerance test, were studied in Norplant users before and after removal. The mean area under the glucose curve rose from 24.7 min mmol/L before Norplant insertion to 35.1 min mmol/L before removal and decreased to 26.1 min mmol/L four weeks after Norplant removal. The areas before insertion and after removal were not statistically different (95% confidence interval -3.3 to 0.56, P = 0.16). The mean areas under the insulin curves before insertion (53.14 min uU/L) and after removal (59.46 min uU/L), however, were significantly different (95% confidence interval -7.64 to -5.0, P less than 0.0001). We conclude that changes in carbohydrate metabolism induced by Norplant are reversible once the implants are removed. While the changes in glucose induced by Norplant returned to pre-insertion levels within 4 weeks after removal, insulin changes were slower to return to pre-insertion values.

Changes in carbohydrate metabolism during 30 months on NorplantR

During a 30-month period, changes in carbohydrate metabolism (measured by oral glucose tolerance test) were studied in 20 Norplant acceptors. Changes were first observed one month after Norplant insertion and peaked between 12-18 months. The area under the glucose curve rose by 12.3% and 40.5% one and 12 months post insertion, respectively. At 18, 24 and 30 months the rise was, respectively, 41.9%, 40% and 38.6%. Although the changes under the insulin curves were similar, the increase at one month was doubled (25.7%). Only fasting insulin values showed very slight and insignificant changes during the 30-month period. All the changes were, however, within the normal limits for healthy women. We conclude that although Norplant induces changes in carbohydrate metabolism, these changes remain within normal limits, peak at 12 months and either remain the same or decrease with time.

Physician Attitudes and Family Planning in Nigeria

This study examines family planning attitudes and practices of 681 Nigerian physicians selected from cities in which large university teaching hospitals are located. About half of the physicians were practicing family planning; the method of choice was the IUD. Obstetrician/gynecologists and general practitioners were more likely to provide methods to their patients than were other types of physicians. The physicians were concerned about population growth and favored family planning, yet a substantial minority believed that family planning is foreign to the culture and that it promotes promiscuity. Physicians were reluctant to promote family planning on a wide scale; many disapproved of non-physicians providing oral contraceptives or IUDs.

Pituitary and placental hormone levels in pseudocyesis

Twelve patients with clinical features of pseudocyesis were divided into two groups according to the presence or absence of galactorrhea. The mean serum prolactin level of patients with galactorrhea was significantly higher than the normal values of the patients without galactorrhea. The mean serum levels of luteinizing hormone and follicle‐stimulating hormone were markedly elevated in patients without galactorrhea. This was especially true of luteinizing hormone. Serum levels of human chorionic gonadotropin were undetectable in all patients. The significance of these observations is discussed.

Maternity care monitoring: A contrast at two levels of health care delivery in Ibadan, Nigeria

The obstetric performance of women delivering at two hospitals in Ibadan is compared in this study. The prevalence of high‐risk pregnancies at the tertiary level hospital (University College Hospital) was higher than that of the secondary level hospital (Oluyoro Catholic Hospital). Consequently, the cesarean section rate of the UCH (21.8%) was higher than that at the OCH (2.3%). Similarly, the maternal mortality (3.5 per 1000) and perinatal mortality (60.2 per 1000) at the UCH were significantly higher than at the OCH, 2.0 per 1000 and 9.8 per 1000, respectively. The need for a national birth survey based on a representative sample of all the different types of health establishments in Nigeria was stressed.

Plasma immunoglobulin, total protein and albumin levels during Norplant use by Nigerian women

Objective. To determine the effect of Norplant on plasma immunoglobulins, albumin and total proteins.

Advanced extrauterine pregnancies--further observations.

Advanced extrauterine pregnancy is a rare condition that is difficult to diagnose. Stewart (15) states that it is more common in the tropics than elsewhere and that the ratio of advanced to early extrauterine pregnancies is approximately 1 to 30 in Hong Kong and Jamaica. Other studies report various incidences of the condition in other parts of the world (1, 4, 5, 12). Doubts have been expressed that advanced extrauterine pregnancy is primarily abdominal. Many authorities believe that most cases of abdominal pregnancy are secondary and that the zygote was first implanted in the Fallopian tube or ovary (8). This report presents case histories of three Nigerian women with advanced extrauterine pregnancy who were treated in one of the gynecologic units at the University College Hospital in Ibadan during 2 months in 1976. Our purpose is to highlight the difficulties involved in diagnosing advanced extrauterine pregnancy and to discuss possible etiologic factors involved in each case.