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Biomedical subjects

J I Adinma

Publications and source records attributed to J I Adinma.

At least 19 recordsLinked to original sources

Headache following parturition.

The incidence of headache following childbirth in 226 Nigerian women is 24.3% (n=55) or one in four births. Headache was more prevalent among women aged between 21 and 30 years (n=44); those of social class 3-5 (n=50); and also increased incidence with increasing parity, although these relationships did not reach significance. There is a highly significant association between the incidence of postparturition headache and evidence of stress (P=0.004), but not with a history of migraine (p=0.102). A highly significant association also exists between the incidence of postparturition headache and anaemia (Hb value less than 10 g/dl (68%), (p=0.004). Headache started on the day of delivery in the majority of cases (36.4%; n=20) although the median number of days of onset after delivery was 2 days. Post-natal headache may be associated with some underlying sociomedical factors which may be influenced by the fall in pregnancy hormones following parturition.

Journal Article↗

Lipid and lipoprotein cardiovascular risk factor changes during normal pregnancy in Africans.

OBJECTIVES: The study was designed to determine how pregnancy affects lipid and lipoprotein profiles among women living in a typical suburban commercial community in Africa, and to highlight the consequences of such changes. STUDY DESIGN: Lipid and lipoprotein levels and coronary heart disease (CHD) risk predictor index [High density lipoprotein-cholesterol (HDLC)/Total cholesterol (TC)] were evaluated in 27 African pregnant and 17 non-pregnant women of the same age and demographic profiles. RESULTS: Total cholesterol and low density lipoprotein-cholesterol (LDLC) levels increased, while HDLC level and HDLC/TC ratio decreased in the pregnant women. CONCLUSIONS: These findings suggest that African women are more prone to hyperlipidemia during normal pregnancy. The consequences of the adverse lipid and lipoprotein changes as seen in the pregnant women, on the fetal development and welfare should be explored in further studies. In general, these results have added to our understanding and knowledge of the numerous factors that could cause abnormal lipid and lipoprotein levels in African women.

Adult↗

Contraception in teenage Nigerian school girls.

Contraception is reviewed in 314 teenage Nigerian school girls comprising 128 students at secondary and 186 at tertiary levels of institution. Out of all the teenagers, 26.8% were sexually exposed, among whom there was a total pregnancy rate of 19.05%. The rate of sexual exposure was higher in teenagers from tertiary institutions, 38.7% compared with 9.4% from secondary institutions. However, the pregnancy rate was higher among the sexually exposed secondary school girls, 33% vs. 16.7% for tertiary school girls. The mean level of contraceptive awareness for the various methods of contraception was 38.2% for the entire survey group: 22.6% for the secondary school girls and 54.4% for the tertiary school girls. Mean true contraceptive usage (TCU) among sexually active students, on the other hand, was 17.7%: 5% and 16.5% for the secondary school girls and tertiary school girls, respectively. The source of information on contraception for the study group was highest from 'a friend' (37.3%) and from the 'newsprint' (36.9%) and was lowest from routine 'lectures and sex instructions' (9.2%). Twenty-five point five per cent of the entire study group, 43% of the secondary school girls and 13.4% of the tertiary school girls, had never had any information on contraception. Instruction on contraception, as part of the academic curricula at the primary, secondary and tertiary levels of education, would improve contraceptive knowledge and forestall the emotional and social problems resulting from unwanted teenage pregnancies.

Adolescent↗

Practice and perceptions of female genital mutilation among Nigerian Igbo women.

Genital mutilation occurred in 296 (48.5%) of 610 pregnant Nigerian Igbo women attending antenatal clinics. The incidence was especially high in association with high maternal age, high parity and low social class. Female genital mutilation (FGM) class 1 occurred in 75 (25.3%) cases while FGM class 2 occurred in 221 (74.7%). There was no cases of FGM class 3 (infibulation). The majority, 322 (52.8%) of the women were positively aware of their true genital mutilation status, but 288 (47.2%) showed negative response being either unaware of their true genital mutilation status or had become confused. Female genital mutilation was no longer practised in the locality of 337 (55.3%) of the women, was occasionally practised in that of 55 (9.0%) and was still fully practised in that of 88 (14.4%) of the respondents. Most of the women, 324 (53.1%) had no knowledge of any advantages of female genital mutilation. However, 157 (25.7%) believed that it discourages infidelity while 56 (9.2%) believed that it facilitated delivery. Similarly, 336 (55.1%) of the women were not aware of any risks of female genital mutilation, although 164 (26.9%) believed that it would cause difficult labour. Eighty (13.1%) of the respondents would advocate FGM for their daughters, out of which 34 (42.5%) cited cultural reasons. Four hundred and sixty-six women (76.4%) would not wish their daughters to be circumcised. The eradication of female genital mutilation must involve the identification of issues sustaining the practice in different localities and subsequent action supported either by logical persuasion following aggressive health education and by legislation.

Journal Article↗

Contraceptive choices among Nigerian women attending an antenatal clinic.

The factors determining the choice of contraception were studied among 230 pregnant women attending the antenatal clinic at Nnewi, Nigeria. There were 174 (52.1%) choices for the natural methods of contraception, 86 (25.7%) for the traditional methods, and 74 (22.2%) for the artificial methods. The most commonly chosen contraceptive methods were rhythm, 95 (28.4%) and Billings, 79 (23.5%), while the least was surgical contraception, 4 (1.2%). The barrier method was not chosen at all. The most common reason given for choice of contraception was safety, 28.7%, followed by dislike of artificial methods, 25.2%; the no-response rate was 29.1%. Other reasons given were ease of use, 10%; husband's decision, 1.3%; fear of the complications of the artificial methods, 13%; dislike of foreign body, 2.6%; the method most understood, 24.8%; need for further counselling, 7%; and long-lasting, 2.6%. The most common reason given against the use of the artificial methods of contraception was fear of its complications, 31.9%, followed by preference for the natural methods, 22.3%. Condom use decreased with increasing age, being highest at 16-20 years, 37.5%, and lowest at 31-35 years, 5.9%. When compared with other parity groups, the grandmultipara group (> or = 5) used the IUD, 14.3%; injectable contraception, 4.8%; and other traditional methods (breastfeeding and abstinence), 28.5%, and did not use the rhythm method. Women of the lowest social class most commonly chose other traditional methods, 57.1%, and never chose the Billings method. Women who desired 1 to 3 children most commonly chose the pill, 23.5%, or withdrawal method, 23.5%, while women who desired 4 to 10 children most commonly chose the rhythm and Billings methods. There was no difference in choice of method of contraception for the various religious denominations, although the artificial methods were less commonly chosen by Catholics, 14.1%, compared with Anglicans, 33%, and other Christian denominations, 33.3%. The physician was the most common source of information for the choosers of the condom, 18.9%; surgical contraception, 2.7%; and the pill, 8.1%; the nurse for injectable contraception, 4.9%, while the commonest source of information among choosers of the rhythm method was the electronic media, 40.5%; print media, 34.9%; and peer group, 34.4%. Lecture/sex instruction was the commonest source of information among choosers of the Billings, 35.5%, and withdrawal, 22.6%, methods, while the no-response rate on source of information on contraception was highest among choosers of the Billings method. There is a need to bridge the gap in contraceptive information by redirecting counselling strategies and restructuring family planning programs to dispel negative perceptions and encourage informed choice of effective family planning methods.

Adolescent↗

Multiple births in Nigerian Igbo women: incidence and outcomes.

The rate of multiple births varies amongst races and ethnic groups. This study shows that the incidence of multiple births among the Nigerian Igbo women is one in 35.5 or 28.2 per 1000 births. A significant difference in Apgar scores at 1 minute between the first and second twins suggests a greater risk for the second twin following the delivery of the first twin. Significantly lower Apgar scores and higher perinatal mortality rate in the twins compared with the singleton controls also indicate greater hazard for the multiple births in general. Successful management of multiple pregnancy can occur following early diagnosis and confirmation of fetal presentations, adequate antepartum fetal surveillance and prompt management of pregnancy complications; appropriate referrals to specialised centres when indicated; and prompt decisions as to timing and mode of delivery.

Journal Article↗

Treatment of Gardnerella vaginalis infection.

This review of the antibiotic sensitivity pattern of Gardnerella vaginalis culture isolates shows that the drugs found sensitive to G. vaginalis cultures include the new antimicrobial agents- ciprofloxacin, cefuroxine and ceftazidine, and some older antibiotics- ceftriaxone, cloxacillin, erythromycin, chloramphenicol and metranidazole. Streptomycin and augmentin showed intermediate sensitivity while penicillin, ampicillin, tetracycline and gentamycin exhibited resistance to G. vaginalis isolates. Metronidazole is currently the first-line drug of choice for the treatment of G. vaginalis and its related infections because of its effectiveness not just against G. vaginalis but also against anaerobes. It can be administered orally, parenterally and intravaginally as gel or sponge. The advantages and drawbacks to the use of these G. vaginalis - sensitive drugs, and the place of alternative drugs in the management of G. vaginalis - associated infections are discussed.

Journal Article↗

Umbilical cord encirclement in twins.

The incidence of umbilical cord encirclement in twins in this study was 10.1%. Twins with tight cord entanglement (TCE) had a 1-minute Apgar score predominantly at the range of 0-6, (3 of 4), unlike those with loose cord entanglement (LCE) whose Apgar scores at 1 minute occurred evenly in the 0-6 (15 of 29) and 7-10 (14 of 29) score range. The perinatal mortality rate was significantly higher for tight cord-entangled twins (750 per 1,000) compared to noncord-entangled (NCE) (58 per 1,000) and all twins (61 per 1,000). All the perinatal deaths occurred in the tight cord-entangled (TCE) twins, 2 of the 3 being in second twins with gestational age less than 30 weeks. The umbilical cord was significantly longer in cord-entangled twins compared to all twins (p < 0.0005) by 11.7 cm for twin 1 and 10.4 cm for twin 2. No difference occurred in birth-weight between cord-entangled twins 1 and 2 and between them and non-cord entangled twins. There was no difference in the overall mode of delivery for the cord entangled, nonentangled and all twins, although cord entanglement was more prevalent in spontaneous vertex vaginal deliveries compared to other modes of delivery for the first twin only.

Birth Weight↗

Sexual activity during and after pregnancy.

The factors related to sexual behavior during pregnancy and after childbirth were studied in 352 Nigerian women. Sexual frequency was higher during the postnatal period (1.7 times per week) compared to the pregnancy period (1.5 times per week). Coital frequency also showed no difference for the various social class and age groups but was more prevalent among the primigravidas compared to the higher parity groups (p < 0.05). Vulval itching was experienced in 246 (69.9%) women although this had no effect on sexual activity in 114 (46.5%) of them. The earliest date of resumption of sexual intercourse following childbirth was 3 days while the latest was 84 weeks. However, sexual activity was resumed between 6 and 12 weeks after delivery in 114 respondents (48.7%). The overall mean resumption time for sexual activity postpartum was 16.5 weeks. The longest mean resumption time occurred for breastfeeding/cultural reasons (41 weeks) and family planning reasons (23.9 weeks) while the shortest resumption time occurred for pleasure reasons (3.2 weeks). The attitude toward sexuality among African women during pregnancy and after childbirth can be said to be positive and purposeful, and this should be taken into account in the overall management of sexuality in the pregnant African woman.

Attitude↗

Karman's cannula and vacuum aspirator in gynecological practice.

The charts of 340 patients who underwent an endometrial suction procedure using Karman's cannula and syringe were reviewed. The therapeutic uses of this instrument were for the treatment of chronic endometritis (18.6%), the evacuation of incomplete or missed abortion (14.6%) and hydatidiform mole (0.8%), and the retrieval of the missing tail of an intrauterine contraceptive device (1.2%). Its diagnostic indications include: the investigation of infertility (55.3%), dysfunctional uterine bleeding (8.7%), and postcoital bleeding (0.8%). The diagnostic yield of the instrument was 96.6%. Transient postoperative abdominal pain occurred in 65.9% of the cases while cervical dilatation preceded aspiration in 12.9% of the cases with cervical stenosis. The advantages of the instrument are discussed and its usefulness in everyday gynecological practice highlighted.

Abortion, Incomplete↗

Influence of mode of delivery on twin births.

The mode of delivery and outcome in 158 twin births in a Nigerian sub-urban hospital are reviewed. Apgar scores at one minute were significantly higher for twin 1 compared to twin 2 in vertex deliveries only. There was no significant difference in Apgar scores at 5 minutes between the twins for the various modes of delivery. Apgar scores were generally higher for the controls (a set of singleton births) compared to twin births for all the modes of delivery except breech births. Birth weights were also significantly higher for controls compared to twin births although no significant difference occurred between the twins. Perinatal mortality rates were generally higher for twin 2 compared to twin 1, and for the twins compared to controls irrespective of mode of delivery. Better outcome could not be ascribed to any particular mode of delivery in twin births and would depend on the judgement and expertise of the labour attendant.

Apgar Score↗

Family planning knowledge and practice among Nigerian women attending an antenatal clinic.

This study investigates family planning activity in 308 Nigerian women attending an antenatal clinic. Family planning awareness was present in 234 women (76%) and practice occurred in 168 (54.5%). Proposal to practice family planning occurred in 66 of 137 women who had never used contraception while 69 (22.4%) had no intention to practice family planning. The best-known type of contraception was the condom, 182 (59.1%); the most common used, the safe period (rhythm), 73 women (23.7%); while Billings' contraception was the most commonly proposed type, 72 women (23.4%). Knowledge of the beneficial effects of the chosen method of contraception was claimed by 102 women (43.6%) while 33 (14.2%) conceded ignorance of this. Similarly, 81 women (34.6%) claimed to know the adverse effects of their chosen method of contraception, while 119 (50.9%) admitted ignorance of it. The most common source of information on contraception was the printed media, 112 (47.9%), while the least common was lecture/sex instruction, 27 (11.5%). Lack of adequate information and ignorance are key factors militating against family planning practice in Nigeria. Family planning activity in Nigeria would be improved by wider dissemination of information on family planning through public lectures and the electronic media; training of family planning counselors to facilitate grass-roots coverage; universal entrenchment of family planning counseling into routine antenatal clinic activities; and integration of private medical centers into the national family planning service.

Adult↗

Sexuality in Nigerian pregnant women: perceptions and practice.

The sexual behaviour and beliefs of 440 pregnant women from South-eastern Nigeria were investigated. The mean frequency of sexual intercourse during pregnancy (1.5 times per week) was less than that before pregnancy (2.3 times per week). The husband was the main initiator of sexual activity (41.6%), while the wife only rarely did so (2.7%). 44.3% of the respondents believed that sexual intercourse during pregnancy widens the vagina and facilitates labour; 34.8% that it improves fetal well-being; 30.2% that it caused abortion in early pregnancy while 21.1% had no knowledge of any repercussions of sexual intercourse in pregnancy. Coitus during pregnancy was always painful in 22.7% of the respondents; was always gratifying in 46.1%; was functional in 49.3% and helped to keep the husband around, also in 49.3% of the respondents. The majority of the respondents (83.4%) considered that coitus should not be stopped during pregnancy. Whereas 19.3% of the respondents believed that sexual frequency should be increased during pregnancy, 73.9% considered otherwise, and 63.6% actually felt it should be reduced. Findings from this study suggest a 'mixed-feeling' effect with a tilt towards a positive attitude to sexuality in pregnancy. Restriction should not be imposed on sexual activity during a normal pregnancy to enhance marital harmony.

Adolescent↗

The second twin: retained and unretained.

In this comparative review of retained and unretained second twins, the commonest causes of retention of the second twins, were found to be uterine inertia (48.4%) and obstruction from malpresentation and malposition (32.3%). The pair-presentation most likely to be retained was vertex/transverse. Apgar scores were lower for retained than unretained second twins. The perinatal mortality rate was significantly higher for the retained second twins (258/1000) compared to the unretained second twins (60.2/1000) (P < 0.002). Early recognition of twin pregnancies in which the 2nd twin is more likely to be retained, and prompt application of appropriate remedial measures would reduce the incidence of retention of the second twin.

Delivery, Obstetric↗

Sexual behavior and pregnancy among Nigerian students.

The sexual behavior of 539 Nigerian female students comprising 387 adults and 152 teenagers was studied. The overall incidence of sexual activity among the students was 51.2%. The incidence of sexual intercourse was significantly higher among adult students (61.0%) compared with teenagers (26.3%) (p < 0.0005). There was no significant difference in the mean age at sexual debut for the adult students (18.7 +/- 3.2) compared with the teenage population (16.1 +/- 1.7). The frequency of sexual exposure was also not significantly different in the two groups (4.1 +/- 6.1 times per month for the adult students and 3.6 +/- 5.9 times per month for the teenage students). However, pregnancy occurred more often among the adult students (38.1%) than among the teenagers (15.0%) (p < 0.005). This article looks at the psychosocial implications of adolescent sexuality and the overall relevance of adequate reproductive health education in encouraging responsible attitudes regarding sexuality among teenagers.

Adolescent↗

Acute puerperal coital headache and hypertension.

An unusual case of acute headache and hypertension occurring at the height of sexual excitement during the puerperium is presented. The patho-mechanism of this phenomenom is discussed and the literature reviewed.

Acute Disease↗

The pill: perceptions and usage among Nigerian students.

The knowledge and use of oral contraception were investigated in 498 students from 5 tertiary institutions in south-eastern Nigeria. Awareness of the pill was high (92.2%) but usage was comparatively low (17.5%). Post-coital oral contraception was more often used (11.5%) than the other types. Perceptions about the risks of the pill were variable: 46.4% of the students believed that it could damage the uterus, and 41% said it could cause infertility; 31.7% believed that it caused amenorrhea, while only 14.9% of the students admitted ignorance of the risks of the pill. There was a lack of desire to use the pill in 72.3% of the respondents. Only 18.7% desired to do so, including students already using the pill. The most common source of information on contraception was peer groups (43.6%), while lectures and sex instructions constituted the least common source (11.2%). Poor information on the pill and ignorance were identified as the major factors militating against pill usage. Accordingly, the role of early and adequate sex and contraceptive education in improving pill usage in this population and developing countries in general is highlighted.

Adolescent↗