Archive 2007 - No 2

AKUYAM SA* BAMIDELE AS* AMINU SM** ALIYU IS* MUKTAR HM**

Correspondence to: Dr. S. A. Akuyam Department of Chemical Pathology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

Background: Several reports across the world suggest that liver and biliary tract dysfunctions are common complications of sickle cell anaemia (SCA). However, there is paucity of data on the pattern of liver function tests profile in SCA patients in Zaria. Most of the reported studies were carried out elsewhere. Objective: The overall objective of this study was therefore to evaluate the liver function status in patients with SCA in Zaria, northern Nigeria with a view to recommend or otherwise the inclusion of liver function tests in the routine investigation of SCA in Nigerian hospitals. Subjects and methods: The study was conducted in the Departments of Chemical Pathology and Haematology of Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, northern Nigeria. Serum levels of total bilirubin (TB), alanine amino transferase (ALT), aspartate amino transferase (AST), alkaline phosphatase (ALP), total protein (TP), albumin (ALB) and AST/ALT (De Ritis) ratio were determined in sixty (60) each of SCA patients and age- and sex-matched control individuals. These consisted of thirty (30) each of male and female patients and controls, respectively. The mean age of these patients was 21 years (ranged 13-40 years). Both the patients and controls were partitioned according to age groups, as groups I (13-20 years), II (21-30 years) and III (31-40 years) with thirty three (33), fifteen (15) and twelve (12) subjects, respectively. The data obtained were analysed using Microsoft Office Excel 2003. Two-tailed student's t- test for matched samples and one way analysis of variance (ANOVA) statistical methods were employed for the analyses. A p-value of equal to or less than 0.05 (p = 0.05) was considered as statistically significant. Results: The results of serum TB, ALT, AST, ALP, TP, ALB and AST/ALT ratio in SCA patients were 24.33±0.21 μmol/L, 47.17±1.51, 27.85±0.63, 145.05±6.45 IU/L, 75.35±0.97, 43.40±0.98 g/L and 0.7±0.06 respectively, while those in controls were respectively 16.09±0.79 μmol/L, 27.78±1.48, 15.78±0.90, 72.32±3.57 IU/L, 72.58±0.87, 50.48±2.26 g/L and 0.6±0.03. These results show that the levels of serum TB, ALT, AST and ALP were significantly higher in patients than in controls (p < 0.001), while serum ALB concentrations were significantly lower (p < 0.002) in patients than in control individuals. The results of serum TP and AST/ALT ratio in patients and controls were not statistically different (p>0.05). These results therefore, demonstrate that LFTs are mildly deranged in SCA patients. There were no gender variations in LFTs profile in both patients and controls. Serum TB and ALP in patients decrease significantly with advancing age, while serum ALT, AST, TP, ALB and AST/ALT ratio levels at different age groups were statistically similar. All the components of LFTs at different age groups in controls were statistically similar. Conclusion: It can be concluded from the findings of this study that there is a minor derangement in LFTs profile in SCA patients and that the extent of the abnormalities decreases with advancing age. This therefore, suggests that liver functions are impaired in SCA patients, most especially below twenty years of age. Therefore, it can be recommended from this study that routine evaluation of liver function status be considered in the management of SCA patients in Nigerian hospitals. This could assist in early detection of liver dysfunction and hence reduce morbidity and mortality from SCA in Nigeria.

LAWAN UM* ABUBAKAR IS* GREMA BA*** NASIR NA**
Correspondence to: Dr Muhammad Lawan Umar Department of Community Medicine, Bayero University Kano, Kano State. E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

Background: Malaria is a leading cause of morbidity and mortality in the tropics. Objectives:To determine the knowledge of Malaria and combination therapy for its treatment among PMVs; and to investigate the use of combination therapy for treatment of Malaria, using a structured questionnaire. Methods: A cross sectional descriptive study was conducted among 162 randomly selected Patent Medicine Vendors (PMVs) Results: The results show that majority of the subjects knew about malaria but, only 31.5% of them have heard of combination therapy for treatment of malaria. The current recommended combinations for effective malaria treatment are not known to most of them. Only 14.2% of the PMVs had good knowledge of malaria and combination therapy for treatment of malaria. Up to 72.5% of those who were aware of the combination therapy have used one or more of the drugs on their patients. However, 64.9% of them used the drugs irrationally. Sulphadoxinepyramethamine and artesunate combination or amodiaquine and artemether were the common drugs prescribed. Conclusion: It was concluded that registration of PMVs should often the primary source of drugs used in the home, the potential role of this group as partners for effective malaria treatment and control had been recognized. The PMVs in Nigeria are therefore expected to be knowledgeable on malaria and combination therapy for its treatment. This study was therefore planned to assess the knowledge of PMVs on malaria and combination therapy for its treatment; and to investigate the use of combination therapy for treatment of malaria amongst PMVs in Kano State. Information from this research could be useful to policy makers.

AD GEIDAM* BM AUDU* AA KULLIMA** MB KAWUWA**

Correspondence to: Dr AD GEIDAM Department of Obstetrics and Gynaecology University of Maiduguri Teaching Hospital PMB 1414, Maiduguri Borno State, Nigeria. E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

Background: Contraceptive use is poor among women in northern Nigeria, but it is agreed that regulating fertility goes along with socioeconomic development. It is therefore important to identify the determinants of contraceptive use in Borno state and utilise this for planning and advocacy. Method: The subjects were women of reproductive age living in urban as well as rural settings in Borno State, northeastern Nigeria. Questionnaires were administered enquiring about their socio-demographic characteristics and contraceptive practices. Logistic regression analysis was use to construct a model for
significant determinants of contraceptive use. Results: There were 532 respondents, with a mean age of 29.5+7.9 years and a mean parity of 3.4+3.0. Although 77.6% were educated, 68.4% were unemployed. One hundred and seventy five participants (32.9%) had 4 or more living children while 15.4% had no living child. In 15% of the cases, the husbands have no formal education. Eighty (33.8%) of the respondent were married into polygamous setting out of which 36 (20%) have 3 co-wives. The prevalence of current contraceptive use was 29.1% and majority of the clients (38.7%) used pills.
Previous contraceptives counselling and education were found to be the strongest determinants of contraceptives use. Conclusion: Making contraceptives counselling routine in all our gynaecological consultation and women empowerment through girl child education may help in the improvement of contraception utilisation. Further research is needed to address the men and co-wives issue with regard to family planning in our environment.

B. Bako, B. M. Audu, C. M. Chama, O. Kyari, A. Idrissa

Correspondence to: Dr.Babagana Bako Department of Obstetrics and Gynaecology University of Maiduguri Teaching Hospital P.M.B 1414, Maiduguri, Borno State. Nigeria E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

Background: Antepartum haemorrhage is one of the obstetric emergencies associated with increased maternal and perinatal morbidity and mortality. Objective: To determine the incidence, types, predisposing factors, complications and outcome of antepartum haemorrhage. Methodology: A retrospective study of cases of antepartum haemorrhage over an 8 year period from January 1999 to December 2006 at the University of Maiduguri Teaching Hospital was carried out. Results: The incidence of antepartum haemorrhage was 1.6% (248/15512), while that of placenta praevia and placental abruption were 0.8% and 0.7% respectively. Typically, placenta praevia was detected early in the pregnancy as low lying placenta in 42(36.8%) of cases, while lower abdominal pain, uterine tenderness and woody hard uterus was found in 88(89.8%), 88(85.4%) and 68(69.4%) of cases of placental abruption respectively. The predisposing factors for antepartum haemorrhage were; increasing maternal age, multiparity, previous abortion, previous uterine instrumentation and uterine scar. Threatened abortion in the index pregnancy was associated with placenta praevia while maternal hypertension was associated with placental abruption. The first bleeding episode occurred intrapartum in 74(34.9%) of patients with APH and the majority of them (57 out of 74) had placental abruption. The commonest mode of delivery was caesarean section, which accounted for 135(63.7%) deliveries and 73.3% of these were patients with placenta praevia. Seventy seven women delivered vaginally and 80.5% of them were patients with placental abruption. Preterm labour and post partum haemorrhage were the most common maternal complications while prematurity and increased perinatal mortality were the most common fetal complications. The perinatal mortality was 85(40.1%). There was no maternal mortality from this series. Conclusion: Antepartum haemorrhage is an obstetric emergency associated with increased maternal and perinatal morbidity and mortality unless prompt resuscitative measures and appropriate treatment are offered. Early booking, appropriate referral of high risk patients and routine ultrasound scanning for placental localization are advocated for early diagnosis and optimum maternal and fetal outcomes..