Neurocysticercosis in a Nigerian woman -missed diagnosis of a neglected disease and surgical management

Neurocysticercosis is a rarely diagnosed but significant clinical problem from infestation with taenia solium. It occurs as a result of ingestion of infested pork and the mode of transmission is usually feco-oral. It is commonly associated with non-specific neurologic manifestations expected of intracranial space-occupying lesions with its most common neurological presentation being seizures. However, its diagnosis without seizure is rarely reported. We report a recent experience in this regard and outcome of this disease which was inadvertently managed surgically. A good history and high index of suspicion especially in developing and low socioeconomic region is helpful for diagnosis in the presence of appropriate radiological findings. Prognosis is good when treatment is tailored to well selected cases. Treatment options include medical with or without surgical removal of encapsulated cyst. A high index of suspicion will be helpful in making appropriate diagnosis and proper management of this disease.

Surgical management of Aneurysmal Subarachnoid Haemorrhage in a resource-constrained region: A Nigerian regional experience

Background

Aneurysmal Subarachnoid Haemorrhage (aSAH) is a vascular injury with significantly high mortality, especially when poorly managed. This study seeks to outline the experiences in setting up a neurovascular service in Lagos, Nigeria.

Methods

A series of 45 patients were operated after aSAH over a period of 10 years. Patients consecutively were recruited following computed tomography angiography (CTA) diagnosis of aSAH. Clinical data were recorded on a predesigned form after obtaining informed consent; aSAH was classified using the WFNS classification, intraoperative findings were documented. Challenges in the management were analysed in a post-operative root cause analysis (RCA) review. Outcomes and factors responsible for the observed outcomes and actions taken were recorded.

Results

Forty-five patients were operated after aSAH was confirmed; there were 29 females and 16 males. (M:F 1:1.8), the age ranged from 14 to 76 years (mean 49.1±13.58). All the aneurysms were on the anterior circle of Willis, mainly on Anterior Communicating Artery aneurysm (18/48).Thirty-eight patients (84.4%) survived and were discharged within an average of 10 days after surgery. Lower GCS at presentation was associated with poor prognosis (p = 0.026); however, data analysis demonstrated that other factors (financial issues, lack of appropriate instrumentation and equipment, experience of the surgeon) played a significant role in determining the outcome.

Conclusions

Aneurysmal Subarachnoid Haemorrhage (aSAH) is a challenging pathology and its management may be further burdened in resource constrained countries, as shown by the data analysed in this study from Lagos, Nigeria. Specialized and well-funded Neurovascular centres are needed to overcome the challenges faced and to improve care for aSAH patients in Nigeria.

Women in Neurosurgery: Historical Path to Self-Segregation and Proposal for an Integrated Future

Despite the rising percentage of women accessing the medical profession over the last few decades, surgical specialties are still largely male-dominated; in particular, a remarkable gender disparity is evident in neurosurgery, where only 19% of practitioners are females. Although women may be reluctant to choose a challenging specialty like neurosurgery due to concerns around how to balance family and career, it must be admitted that prejudices against female neurosurgeons have been deeply rooted for long, prompting many to give up and switch track to less demanding subspecialties. Among those who have persisted, many, if not most, have experienced difficulties in career progression and received unequal treatment in comparison with their male counterparts. In 1989, a group of 8 female neurosurgeons founded Women in Neurosurgery (WINS), an organization that aimed to guarantee inclusivity in neurosurgery, encouraging a better and more egalitarian working environment. Thereafter, WINS sessions were regularly promoted at international conferences, offering female neurosurgeons a platform to report issues related to gender discrimination. Over recent years, the mission of WINS sessions in national and international conferences has taken an unexpected deviation; they have progressively become supplementary scientific sessions with only women neurosurgeons as speakers, thus paving the road to a form of self-segregation. This tendency has also resulted in the establishment of sections of only female neurosurgeons within some national societies. Although there remains a faction that fiercely supports the WINS mindset of reserved spaces for women, such segregation is an upsetting prospect for those who believe that science and professionalism have no gender; a growing part of the global neurosurgical community believes that the conception of a “female neurosurgery” and a “male neurosurgery” is misguided and counterproductive and consider the existence of the WINS as anachronistic and no longer necessary.

Contemporary Management of Intracranial Subdural Empyema: An Institutional Experience

BACKGROUND

Intracranial subdural empyema (SDE) is a seemingly uncommon life-threatening ailment with varying presentations and outcomes. A variety of risk factors have been associated with predisposition to intracranial SDEs; however, they may be cryptogenic. There is an increased predilection for intracranial SDE in children and teenagers with paranasal sinusitis or middle ear infections. The clinical presentation is non-specific and thus a high index of suspicion is required. Neuroimaging is an invaluable diagnostic tool for early diagnosis and surgical intervention. There have been multiple proponents for either burr hole or craniotomy to treat intracranial SDEs; however, despite surgical intervention, adverse neurologic sequelae and even mortality still occur. Extended antibiotic therapy is mandatory and impacts significantly on patients' outcomes.

OBJECTIVES

This study describes the demographics, clinical presentation, and surgical outcomes in patients with intracranial SDEs over the study period.

DESIGN

This is a retrospective single-centre case series.

SETTING

This study takes place in a tertiary referral centre, university hospital.

MATERIALS AND METHODS

This was a retrospective review of patients presenting with intracranial SDEs over a 10-year period in a tertiary neurosurgical unit serving south-western Nigeria. Demographic, clinical, and radiologic data were retrieved from patient records.

RESULTS

Forty-nine patients presented with intracranial SDEs during the review period. These patients aged between 16 months and 75 years, most of whom were 20 years of age and below. The mean age was 21.37 ± 19.29 years with a median age of 15 years. There were 35 males and 14 females giving a male-to-female ratio of 2.5:1. The most common presentations were headache (73.5%), altered sensorium (55.1%), and seizures (38.8%). Forty patients (81.6%) had evacuation of SDE by burr hole and subdural washout. There was a significant post-op residual SDE in six patients. There were eight (16.3%) mortalities in this series. Forty-seven (95.9%) patients had sterile cultures of the subdural pus collection.

CONCLUSION

Intracranial SDE affects mostly children and teenagers. Early diagnosis, emergent surgery, extended antibiotic therapy, and concurrent source control employing a multidisciplinary approach are essential in managing this condition. Burr hole and subdural washout help control the disease process, reduce operation time, and may yield outcomes similar to craniotomies, which are more invasive.

Early Outcome of Endoscopic Third Ventriculostomy With Choroid Plexus Cauterization Versus Ventriculoperitoneal Shunt as Primary Treatment of Hydrocephalus in Children With Myelomeningocele: A Prospective Cohort Study

BACKGROUND

Myelomeningocele is associated with hydrocephalus in 35% to 90% of cases. Hydrocephalus is usually treated with insertion of ventriculoperitoneal shunt; however, there is growing evidence that endoscopic third ventriculostomy (ETV) with choroid plexus cauterization (CPC) is an alternative.

OBJECTIVE

To compare the success rate and morbidity of ETV with CPC and ventriculoperitoneal shunt (VPS) as the primary treatment of hydrocephalus in patients with myelomeningocele.

METHODS

A prospective study from January 2016 to February 2019, involving 46 patients with myelomeningocele who developed hydrocephalus after repair in a tertiary hospital in southwestern Nigeria. Biodata and preoperative features of hydrocephalus were documented. ETV + CPC or VPS was done using standard operative techniques. Patients were followed up monthly for 6 mo.

RESULTS

There were 23 patients in the ETV + CPC arm and 22 patients in the VPS arm. Morbidities were cerebrospinal fluid leak, 8.3% in the ETV + CPC arm and 4.5% in the VPS arm, wound dehiscence, 13.6% in the VPS arm, none in the ETV + CPC arm. At 6-mo follow-up, success rate for ETV + CPC was 60.9% and 59.1% for VPS, P = .9.

CONCLUSION

ETV + CPC had similar success rate with VPS at 6 mo with lower morbidity. ETV + CPC should be considered a viable alternative when treating patients with myelomeningocele and hydrocephalus.

Pattern of Self-care practices among type 2 diabetes patients in Southwest, Nigeria

Background

Self-care practices in individuals with diabetes are important skills required to effectively prevent, manage, and limit complications associated with diabetes since patients spend considerably less time with health care providers than spend alone to manage their diabetes condition.

Aims

The aim of the study was to assess self-cate practices and their determinants among patients with type 2 diabetes. Hence, this study aimed at assessing self-care practices and their determinants among patients with type 2 diabetes.

Materials and Methods

This cross-sectional, descriptive, multi-center study was conducted among 348 type 2 diabetes patients selected from six tertiary hospitals in Southwest Nigeria. Descriptive statistical analysis was employed for categorical and continuous variables and multivariable logistic regression assessed association between determinant factors and adherence to self-monitoring of blood glucose (SMBG).

Results

Of the study participants, 83.1%, 66.9%, 28.4%, and 27.9% adhered to prescribed medications, physical exercise, had meal plans incorporated into their diabetes management and SMBG, respectively. There was a statistically significant association between male gender, duration of diabetes, and previous episode of hypoglycemia with adherence to SMBG practices while lower educational level and use of insulin were associated with less likelihood of adherence to prescribed medications.

Conclusion

The degree to which individuals with diabetes adhered to recommended self-care practice components were less than satisfactory especially SMBG, physical activity, and having meal plans.

Aqueous extract of Solanum macrocarpon Linn leaves abates hyperglycaemia and expression of glucose transporters gene in alloxan-induced diabetic rats

PURPOSE

In this study, antihyperglycaemic and level of gene expression of glucose transporters in alloxan-induced diabetic rats administered aqueous extract of S. macrocarpon leaves were assessed.

METHOD AND RESULTS

Diabetes was induced by a single intraperitoneal (I.P) injection of freshly prepared alloxan. The animals were divided into six groups, euthanized on the fourteenth day of the experiment and different hyperglycaemic parameters were evaluated. Administration of different doses of the plant extract significantly (p < 0.05) reduced the fasting blood glucose level, glycated haemoglobin, serum lipid profiles, lipid peroxidation, and glucose-6-phosphatase. There was a significant (p < 0.05) increase in liver glycogen content, antioxidant enzyme activities, hexokinase activity, and expression of glucose transporter genes (GLUT-2 and GLUT-4) in diabetic rats administered different doses of S. macrocarpon.

CONCLUSION

It can be concluded that the aqueous extract of S. macrocarpon leaves could be helpful in the management of diabetes mellitus and its metabolic complications.

Prevalence and Determinants of Complementary and Alternative Medicine (CAM) Use among Diabetes Patients in Southwestern Nigeria

INTRODUCTION

The epidemic of diabetes mellitus (DM) in African countries demands a critical assessment and review of patients' management protocols and their self-care habits. The objective of this research was to evaluate the pattern of usage of CAM, its role in the management of diabetes and possible determinants of its use in patients with diabetes.

METHODS

Subjects were recruited from six selected hospitals from four of the six States in South western, Nigeria. Participants were consecutively recruited from the diabetes clinics of the selected hospitals. Participants completed a multicomponent questionnaire which comprised three sections.

RESULTS

The majority of the subjects were females (57.7%) and of Yoruba extraction (89.7%). Their mean age was 62.58±11.80 years and their mean duration of diabetes was 7.95±6.41 years (range 1-36 years). Two hundred and forty one (62.1%) of the subjects reported the use of at least one type of CAM of which 213(88.4%) indicated using CAM as complementary to regular conventional anti-diabetic medications, while in the remaining 28 (11.6%) CAM users, it served as alternative medicine. The predictors of CAM use included male gender, and patients with at least secondary level education .

CONCLUSION

The prevalence of the use of CAM therapies is high in this study among people living with diabetes in Southwest, Nigeria. CAM is used mainly as complementary rather than as an alternative therapy. The most commonly used CAM therapy was biological therapy-Vernonia amygdalina (bitter leaf), garlic and Moringa oleifera. Orientation about CAM should be included in diabetes education at diagnosis and regularly re-enforced at subsequent clinic visits.

Improvised external ventricular drain in neurosurgery: A Nigerian tertiary hospital experience

Background:

The most common type of hydrocephalus in developing countries is post infective hydrocephalus. Infected cerebrospinal fluid (CSF) however cannot be shunted for the reason that it will block the chamber of the ventriculo-peritoneal (VP) shunt due to its high protein content. In centers where standard external ventricular drain (EVD) sets are not available, improvised feeding tube can be used.

Aim:

The main focus of this study is to encourage the use of improvised feeding tube catheters for EVD when standard sets are not available to improve patients’ survival.

Methodology:

This was a prospective study. Consecutive patients with hydrocephalus that cannot be shunted immediately for high chances of shunt failure or signs of increasing intracranial pressure were recruited into the study. Other inclusion criteria were preoperative brain tumor with possibility of blocked CSF pathway and massive intraventricular hemorrhage necessitating ventricular drainage as a salvage procedure. Standard EVD set is not readily available and too expensive for most of the parents to afford. Improvised feeding tube is used to drain/divert CSF using the standard documented procedure for EVD insertion. Outcome is measured and recorded.

Results:

A total of 28 patients were recruited into the study over a time frame of 2 years. There were 19 (67.9%) male and 9 (32.1%) females with a ratio of about 2:1. Age ranges varied from as low as 7 days to 66 years. The median age of the study sample was 6.5 months while the mean was 173.8 months. Duration of EVD varied from 2 days to 11 days with a median of 7 while the average was 6 days. Eventual outcome following the procedure of EVD showed that 19 (67.9%) survived and were discharged either to go home or to have VP shunt afterwards while 8 (28.6%) of the patients died.

Conclusions:

External ventricular drain can and should be done when it is necessary. Potential mortalities could be reduced by the improvised drainage using a standard feeding tube as described.

Early decompressive craniectomy for traumatic brain injury in resource poor centres:a tertiary institution experience

Decompressive craniectomy (DC) is the surgical management of increasing intracranial pressure (ICP) following a severe traumatic brain injury (TBI) as well as severe cerebrovascular insult. Established protocols for the use of DC include monitoring ICP and going through non-surgical methods to reduce ICP before DC which is the last resort. ICP monitors and facilities to render patients hypothermic and for inducing barbiturate coma are not readily available in resource depleted facilities, hence the need for a timely DC. DC when timely done saves lives and improves chances of survival following severe brain injury.

AIMS AND OBJECTIVES

This study intends to justify early and appropriate DC in selected patients with radiological and clinical increasing ICP in resource poor centres.

PATIENTS AND METHOD

A one-year prospective study of patients with severe brain injury with CT and clinical evidence of increasing ICP who had DC as the main modality of management.

RESULTS

Ten patients were recruited into the study on the basis of deterioration in level of consciousness and CT evidence of raised intracranial pressure. Males were 8 (80%) and females were 2 (20%) with a ratio of 4:1. RTA accounted for 80% of aetiology of TBI. Out of the ten patients, 4 (40%) died after DC. Six (60%) of the patients survived and had cranioplasty with bone flap replacement (3), titanium (2) and acrylic (1). Two (20%) were discharged with GOS of 5, another 2 (20%) with 4 and last 2 (20%) with GOS of 3.

CONCLUSION

Early decompressive craniectomy is beneficial for selected groups of patients most especially in settings where facilities for ICP monitoring and other medical options are not available.

Prophylactic effect of aqueous extract of Sesamum indicum seeds on ethanol-induced toxicity in male rats

The liver is vulnerable to alcohol-related injury because it is the primary site of alcohol metabolism. Additionally, a number of potentially dangerous by-products are generated as alcohol is broken down in the liver. However, dietary supplements may prevent or relieve some of alcohol's deleterious effects. Therefore, this study was conducted to evaluate the prophylactic effect of aqueous extract of Sesamum indicum (SI) on ethanol induced toxicity in rats. Male Wistar albino rats were divided into control, ethanol, pre-treatment, simultaneous and post-treatment groups. In the prophylactic experiment, Sesamum indicum, (200 mg/kg body weight) was administered by oral gavage for 28 days; two hours before, simultaneously with or two hours after ethanol exposure. Toxicity was induced by administering 45% ethanol (4.8 g/kg bw) by oral gavage. Lipid peroxidation (TBARS) and reduced glutathione (GSH) levels and catalase (CAT), glutathione peroxidase (GPx), superoxide dismutase (SOD) and gluthathione-S-transferase (GST) activities were then determined in the liver, serum triglyceride (TG) levels, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) activities were monitored and histological examination was carried out. The results revealed that ethanol administration led to significant elevation of TBARS level while depleting in the level of GSH as well as CAT, GPx, SOD and GST activities. Similarly, TG level and ALT and AST activities were elevated. The SI pre-treated group significantly inhibited TBARS, restored GSH level, enhanced CAT, GPx, SOD and GST activities and significantly decreased the elevated level of serum TG, ALT and AST activities. SI treatment (simultaneously with ethanol) exhibited similar effects to those of the SI pre-treated groups, while the SI post-treated group did not show the same protection as the Pre-treated group. S. indicum possesses antioxidant and hepatoprotective properties, that eliminate the deleterious effects of toxic metabolites of ethanol.

The antimicrobial activities of processed Nigerian and South African black tea

The antibacterial activity of processed Nigerian Lipton Tea and South African 5 Roses Tea, extracted using distilled water, chloroform and 70% ethanol were determined against nine (9) enteropathogenic bacteria which includes; Bacillus subtilis, Proteus sp, Enterobacter sp., Klebsiella pneumoniae, Escherichia coli, Salmonella typhi, Salmonella paratyphi A, Salmonella arizona and Staphylococcus aureus. The 2 tea bags, Nigerian Lipton tea bag and the South African 5 Roses tea bag were extracted through Solvent extraction method using 3 extraction solvents; Distilled water, Chloroform and 70% Ethanol and then inoculated onto the Mueller-Hinton agar plates containing the standard isolates at 6 different points on each plate. The zones of inhibition of the bacterial isolates produced by each of these tea - extracts were determined while meaningful antibacterial activities against five (5) of the standard isolates; Enterobacter sp., K. pneumoniae, S. paratyphi A, B. subtilis and S. aureus were observed. Lipton tea water-extract was a more effective antibacterial agent than water-extract of 5 Roses tea. While the 70% ethanol-extract of 5 Roses tea had the greatest antibacterial activity of all the different tea-extract used for the study, the chloroform-extracts of the tea bags had no antimicrobial effect on all the test organisms used.

Choroid plexus papilloma in a Nigerian child: a case report

Choroid plexus papilloma is a rare but known cause of hydrocephalus among children. We report the case of an 8 month old girl who clinically was thought to have post-infective Hydrocephalus. Cranial CT however showed an associated intra-ventricular tumour which after surgical resection was reported as a Choroid plexus papilloma. This is the first time such a case is being diagnosed at our hospital and very few cases have been documented in literature from sub-Saharan Africa. This case highlights the available treatment and good prognosis that is possible with Choroid plexus papilloma. It also highlights the need for a high index of suspicion for less common causes of an enlarging head especially when the clinical picture is not typical as demonstrated in our patient. The seeming rarity of this disease in our environment may be partly due to the limited availability of CT scanners in many centres and the paucity of Neuroradiologist and Neurosurgeons in sub-Saharan Africa.

Outpatient interval female sterilization at the University College Hospital, Ibadan, Nigeria

Between September 1975 and April 1981, 258 patients were sterilized at the University College Hospital (UCH), Ibadan, using minilaparotomy and laparoscopy. Selected sociodemographic data as well as the technical and surgical difficulties encountered have been reviewed in this article. The mean age at sterilization was 38.3 years whilst the mean parity was 7.2. In all, there were 215 minilaparotomy sterilizations and forty-three laparoscopic sterilizations. Surgical difficulties were reported for 12.1% of minilaparotomy and 11.6% for laparoscopic procedures. The most frequently reported difficulties were obesity and pelvic adhesions. The failure rates were 1.4% for minilaparotomy and 2.3% for laparoscopy.

Plasma high-density-lipoprotein cholesterol levels during long-term use of an oral contraceptive in Nigerian women

Total and high-density lipoprotein (HDL) cholesterol were estimated in 131 blood samples obtained from women who had been taking the oral contraceptive Noriday 1 + 50Fe (one packet contains 21 tablets of 1 mg of norethindrone + 0.05 mg of mestranol, and 7 of 75 mg of ferrous fumarate) for 1-60 months. Thirty five women who had never used oral contraception (OC) formed the control group. There was a significantly higher mean HDL cholesterol level, and HDL cholesterol/total cholesterol ratio but not total cholesterol level in the women who had been using OC for 19-60 months. The values in women who had been using OC for 1-18 months were not significantly different from those in the control group. The increase in the HDL cholesterol level may not depend on the oestrogen content of the oral contraceptive but on the duration of its intake.

Serum vitamin A, carotene and cholesterol levels in Nigerian women using various types of contraceptives

The diet in southern Nigeria is unusually high in carotenoids and low in preformed vitamin A. We studied the changes in serum vitamin A carotene and cholesterol induced in women in this region by the use of 3 types of contraceptives: IUD, injectable progestogen (INJ), and oral combination estrogen-progestogen (OC). The mean serum vitamin A and carotene levels were high in all groups. As expected, the serum vitamin A level in OC users was higher than in the other groups, but unexpectedly, the serum vitamin A was lower in IUD users. Serum carotene was lower in OC users than in other groups. Serum cholesterol was lower in the IUD and INJ groups than in the control and OC groups. A more detailed study of plasma transport forms of vitamin A is needed to determine if the very high serum vitamin A levels seen in some OC users in this population are potentially harmful.

Maternity care monitoring in Ibadan, Nigeria

During this hospital stay, 993 women delivered 1008 infants at University College Hospital in Ibadan, Nigeria from January through June 1977. The stillbirth rate was 45.4 per 1000 deliveries; the neonatal mortality rate was 20.2 per 1000 deliveries. Significant differences occurred in patient characteristics, antenatal care, and complications of labour/delivery between those patients with favourable and unfavourable birth outcomes. As expected from all previous reports, the rate of multiple births was very high: 37 sets of twins and 3 sets of triplets. Contraceptive acceptance rose after delivery from 17.1% to 63.5% accepting some method. Orals were the most popular choice both antepartum and postpartum.

Obstetric neuropraxia in the Nigerian African

The results of a prospective study of 34 Nigerian women with obstetric neuropraxia (puerperal paresis of the lower limbs) seen at the University College Hospital, Ibadan, are presented. The height of 29 (84%) was under 62 in (1.58 m). All were younger than 45, and 41% (14) were primiparous. Lumbosacral plexus injury with a foot-drop was the most frequent presenting feature (88%), bilateral involvement was observed in 13 patients (38%), femoral neuropathy was observed in nine (26%) and the ankle tendon jerks were absent in 35%. Spastic paraparesis was not uncommon (15%). Results of electromyographic examination and determinations of conduction velocities were consistent with proximal neuropraxia of the lumbasacral trunk in many of them (88%). The presentation of the fetus was cephalic in 97% of the women. The major predisposing factor was prolonged labor. Among the complications associated with the neuropraxia were hydroureters above the pelvic brim and vesico- and rectovaginal fistulae. Perinatal mortality was high particularly with labor of more than 18 hours. Recovery from the neuropraxia was complete for 76% of the patients. It is concluded that direct pressure on the lumbosacral plexus and nerve trunks by the presenting fetal part is the major factor in the pathogenesis of obstetric neuropraxia encountered in Nigerians.

Experience with PGF2 alpha in mid-trimester pregnancy termination in Ibadan

Twenty-five cases of mid-trimester pregnancy termination using intra-amniotic PGF2 alpha are described. The dose of PGF2 alpha used ranged between 40 and 80 mgs. Eighty-eight percent of all patients received 66mg or less of PGF2 alpha. Complete abortion without surgical intervention occurred in 13 (52%) of the women. The mean instillation abortion interval was 22 h. Surgical intervention was required in twelve patients. Side effects, mainly gastrointestinal symptoms, occurred in 72% of our patients. No epileptic seizure or cervical laceration was reported. It is suggested that the use of prostaglandin for pregnancy termination should be restricted to large medical centres with adequate facilities for coping with complications. Introduction of mid-trimester abortion with prostaglandin offers a back up method for failed contraception and obviates the need for surgical dilation of the cervix with its attendant risks.

Menstrual regulation in Ibadan, Nigeria

Menstrual regulation (MR) (i.e., vacuum aspiration of the uterus with a small diameter, flexible cannula before pregnancy can be determined by a conventional pregnancy test) has been proven safe and effective in many clinics around the world. The present study, which we believe is the first such study of MR in Subsaharan Africa, shows that, for women in an urban African setting, MR is an acceptable backup for other contraceptive methods. Data on 507 MR patients treated at the University College Hospital in Ibadan, Nigeria, between January 1974 and April 1976, showed that the procedure was both safe and effective for 93.4% of the study subjects: there was an overall complication rate of 3.4% and MR failed in seven cases (3.2%). Data also showed that MR is an effective method of recruiting new contraceptive acceptors, as well as an effective back-up procedure in case of contraceptive failure.

Arterial pressures in rural and urban populations in Nigeria

Surveys of arterial pressure carried out in rural and urban communities in Western Nigeria showed a steady rise in systolic values with age, this trend being less marked with diastolic pressures. Blood pressure levels were similar in women from rural and urban areas, but seemed much higher in urban than in rural men. The incidence of proteinuria was lowest in the female urban group. In general, the incidence of proteinuria or glycosuria was low and did not appear to be related to the blood pressure.