A study of anemia in women with asymptomatic malaria parasitaemia at their first antenatal care visit at the General Hospital,Ikot Ekpene,Akwa Ibom State,Nigeria

Objective:To assess the prevalence of anemia and asymptomatia malaria parasitemia and the effect of prior antimalarials therapy on the parasite density in pregnant women at their first antenatal visit at the secondary level health care facility in Nigeria.Methods:This cross sectional observational study was carried out in the antenatal clinic of General Hospital,Ikot Ekpene,Akwa Ibom State,Nigeria for 3 months period(1st June to 31st August,2009).Five hundred and fourteen women attending their first antenatal registration visits in the hospital were recruited in the study.Socio-demographic information was obtained using pre-tested questionnaires.The malaria parasite was obtained by examining thick and thin blood films prepared on 2 glass slides while the hematocrit was obtained through 2 capillary tubes read by a Hawksleys microhematocrit reader.Results:A total of 514 pregnant women participated in the study with a mean maternal age of 21.4 years and a mean gestational age at booking of 18.3 weeks.The primigravid women booked at significantly lower gestational age than multigravidae （16.2 weeks vs 21.6 weeks）.Most of the women（59.3%） were anemic,out of which 60.4%were primigravida.More than half of the women had moderate to high parasite density and only 6.8% had no malaria parasitemia.All patients with severe anemia were parasitemic.Out of the 479 （93.2%） women with parasitemia,a third had taken antimalarial drugs.A majority（60.3%） of those without prior antimalarial drugs had moderate to high density parasitemia.Conclusions: This study shows high prevalence of anemia in women with asymptomatic malarial parasitemia, particularly the primigravida.The severity of anemia is directly related to the density of malaria parasitemia.Those with effective antimalarial therapy appear to have low density parasitemia and therefore mild anemia.Routine screening for anemia and malaria parasites at booking,prompt parasite clearance and correction of anemia would reduce the associated maternal and perinatal complications.

Study of sexual behaviour in relation to sexually transmitted infections(STIs) among Nigerian undergraduates

Objective:To determine their reproductive health behaviour concerning fidelity and psychosocial intimacy in the face of current trends in sexually transmitted infections(STIs) and human immunodeficiency virus(HIV)/ acquired immune deficiency syndromes(AIDS) pandemic.Methods:A cross-sectional comparative male/female cohort study using a semi-structured questionnaire to interview sexually activity of undergraduates in University of Calabar(UNICAL) was conducted over a three(3) month period in 2007.Markers used were number of sexual partners,frequency of sexual intercourse in the 6 months preceding,knowledge of last menstrual period(LMP),methods of self-protection against STIs,number of unwanted pregnancies terminated,and contraceptive use.Results:Of the 1 337 respondents,648 out of 684 males(94.7%) and 543 out of 653 females (83.2%) had multiple sex partners.The gender difference was statistically significant(P 【0.01).Only 36 (5.3%) of males and 110(16.9%) of females maintained single mates in the past six months.About half of females(320,49.0%) and 314(45.9%) of males exhibited spontaneous sexual contact habits.The difference in frequency of intercourse between both groups was not statistically significant(P 】0.05).While 275(42.0%) of the females could state the exact last menstrual period(LMP),only 14(2.1%) males could remember their mates LMP,and 496(72.5%) of males did not know anything about mates’menstrual habits.There was no statistical significance difference(P 】0.05 ) between both groups in their safe sex practices. One hundred and sixty three(23.8%) male and one hundred and forty one(22.8%) females used condoms,while 347(50.7%) of male and 337(51.6%) of females did nothing.Two hundred and seventy six(40.0%) of males’mates had terminated pregnancies and three hundred and forty eight(53.3%) of female respondents admitted doing so.Thirty(4.60%) females terminated pregnancy more than six times.Females had more knowledge of contraceptives but males used condoms more.Respondents expressed need for sexuality education.Conclusion:Sexual behaviour of UNICAL undergraduates does not conform to current trends of safe-sex.There is need for more information,education and communication.

Prevalence of asymptomatic malaria parasitaemia

Objective:To evaluate factors associated with prevalence of malaria parasitaemia at first antenatal care visit.Methods:The study was conducted at the University of Calabar Teaching Hospital from 1st June,2007 to 31st July,2007.A structured questionnaire was administered to a total of 545 pregnant women that were recruited in this study after obtaining informed consent and two slides of thin and thick films were prepared for each participant.Results:Five hundred and twenty(95.4%) out of the 545 participants suffered from malaria parasitaemia,the rest 4.6%of those who had no parasitaemia had experienced symptomatic malaria before and were treated in private hospitals prior to their recruitment into the study.All participants(100%) who did not have antimalarials had parasitaemia compared with 91.1%among those that had antimalarials.The proportion of moderate to severe parasitaemia was also significantly higher among the former.Besides,the difference in parasitaemia between primigravidae and multigravidae was statistically significant(P=0.000) too. Among the methods used for vector control,only insecticide treated nets(ITNS) was associated with significant reduction in the level of parasitaemia(RR=0.83).Conclusion:Malaria parasitaemia at first booking is significandy higher in primigravidae and women who have no anti-malaria treatment. The use of safe and effective antimalarial treatment along with ITNs will significandy reduce the level of parasitaemia in pregnant women.

Adjuncts to case assessment of vaginal discharge syndrome in pregnant women

Objective:To investigate the aetiology of abnormal vaginal discharge,using a non-culture based method,among pregnant women presenting at the University of Calabar Teaching Hospital, Calabar,Nigeria.Methods:Two hundred consecutive antenatal patients,aged 18 to 38 years,with complaints of abnormal vaginal discharge between 1st April and 31st July 2004 were investigated clinically for the characteristics of the vaginal discharge.High vaginal swabs taken from the vaginal fornices were examined using a non-culture based method to determine the possible aetiology of the discharge.The possibility of integrating non-culture based laboratory methods in the syndromic case management of abnormal vaginal discharge in an antenatal clinic setting is discussed.Results: The commonest form of abnormal discharge was curdy white in 66%of cases.Ten(5%) women had malodourous vaginal discharged,92%had vulval itching;and superficial dyspareunia was seen in 29%of cases.Microscopic studies of vaginal discharge revealed the following findings: lactobacilli(96%),polymorphs(96%),’clue’ cells(4%);positive Whiff test(5%),and pH 】 4.5 (7%).The clinical and laboratory assessment of each patient lasted between 35 and 45 minutes.The procedures used were acceptable to 78%of women.Conclusion:The use of non-culture based laboratory methods in the initial assessment of abnormal vaginal discharge can be a useful adjunct in the syndromic case management of abnormal vaginal discharge in pregnant women.

Cervical cancer in Calabar,Nigeria

Objective: To assess the prevalence of cervical cancer and histologic variants as seen in Calabar,Cross River state.Methods: This is a retrospective study involving histologically verified uterine cervix carcinoma between January,1997 and December,2006.Results: There were 1,207 malignancies diagnosed during the study period;175(14.5%) were malignancies of the genital tract while 113(9.4.0%) were carcinoma of the cervix constituting 64.6% of female genital malignancies.Cervical cancer was commonest between the ages of 40-59 years.There was no patient with carcinoma of the cervix below the age of 20 years.Squamous cell carcinoma(87.6%) of the uterine cervix was the main histological type.Conclusion:Cervical cancer is still the most common female genital tract malignancy in Calabar with most of these patients in their middle age.The use of PAS/Alcian blue stain as was used in this study eliminates most false-positive squamous cell carcinomas compared with Haematoxylin and Eosin stains used in most reports from most centres in this part of the world.Epithelial malignancies continue to be the predominant histological variant with squamous cell variety the commonest.There is also an urgent need for introduction of efficient and affordable population based cervical screening programme for early detection,use of vaccines against Human Papilloma Virus(HPV) and treatment of pre-malignant cervical lesions.

Risk of adverse maternal outcome following macrosomic birth in Nigeria.

Objective: To determine the risk of adverse maternal outcome associated with obstetric intervention in labour.Methods:All cases of macrosomic births conducted at the University of Calabar Teaching Hospital,Calabar,between January 1st 1994 and December 31st 2000 were reviewed.Measure of treatment/intervention effect was calculated as relative risk for adverse maternal outcome,using spontaneous vaginal births as control.Results:Frequency of mode of delivery was as follow: vaginal births,139(60.7%);instrumental vaginal deliveries,16(7%);and abdominal deliveries,74(32.3%).Obstetric intervention occurred in 90(39.3%) cases.Sixty-four(28%) cases did not book for antenatal care,with 42 cases(18.3%) requiring obstetric intervention.About one in every two parturients(1: 2.1) in this study,requiring obstetric intervention at delivery had been interfered with at unorthodox health facilities.Relative risks for postpartum haemorrhage,wound sepsis and paralytic ileus were significantly high in parturients with abdominal delivery;while in parturients with instrumental vaginal delivery relative risks were significantly high for puerperal sepsis,paralytic ileus and obstetric palsy.There were no maternal deaths.Conclusion:Obstetric intervention in parturients with macrosomic births was high due to labour complications;and was associated with significant risk for adverse maternal outcome,especially in parturients with unskilled interference.