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Objective: Menstrual disorders are common in young women, and heavy menstrual blood losses (MBL) are an important cause of anaemia. Menstrual morbidity normally goes untreated in developing countries where cultural barriers also serve to mask the problems. We investigated the prevalence of menstrual morbidity, and measured MBL and its relationship to iron deficiency in a rural adolescent population. The rationale was to assess whether or not reducing heavy MBL could be part of a strategy to reduce iron deficiency anaemia. Setting: Rural village in south-east Nigeria. Design: Cross-sectional survey. Subjects:The study included all non-pregnant, unmarried nulliparous girls (< 20 years) who had menstruated, and who lived in K'Dere village. Methods: A field worker allocated to each girl completed a questionnaire, and supervised recovery and collection of soiled pads and ensured blood sampling. MBL was measured using the standard alkaline haematin method. Haemoglobin (Hb), serum iron, transferrin saturation and protoporphyrin levels (ZPP) were also measured. Results 307 girls completed MBL measurements; 11.9?! refused to participate. 12.1% had menorrhagia (> 80ml); median MBL was 33.1 ml. Menorrhagia was more frequent in girls who had menstruated for > 2 years ( P = 0.0481, and had longer duration of menses ( P < 0.001). Iron status as measured by haematocrit, serum iron, transferrin saturation and ZPP values was inversely related to MBL. Neither height nor body mass index for age was associated with current iron status. Conclusions: The level of menorrhagia detected (12%) may be an 'expected' level for a condition which often has no underlying pathology. Heavy MBL is one of the most important factors contributing to iron deficiency anaemia. Measures are needed to alleviate menstrual disorders, and improve iron status. Oral contraceptives can be part of a strategy to reduce anaemia, particularly for adolescents at high risk of unwanted pregnancies.

Objective To review what is known about COVID‐19 and highlight gaps in the context of Nigerian obstetric practice. Research data on COVID‐19 are understandably sparse in Africa. Nigeria, like most African countries, is battling a disease she is poorly equipped to fight. Methods The current available literature on COVID‐19 was reviewed in relation to obstetric practice in the Nigerian context, gaps were identified, and recommendations were made to improve the handling of the COVID‐19 pandemic in Nigerian obstetric practice. Results In and out of hospital, both the obstetrician and the obstetric patient are constantly being put at risk of exposure to the coronavirus because testing and preventive measures are either ineffective or non‐existent. Conclusion The pandemic has exposed the gross inadequacies in Nigeria’s healthcare system and is therefore a wake‐up call to the need for a complete overhaul of infrastructure and services. The government will do well to increase the budget allocation for health from the current paltry 4.14% to the recommended 15% of the total budget. The Nigerian obstetrician stands a high risk of exposure due to inadequate preventive measures, and testing and diagnostic challenges.

Background The COVID-19 pandemic has drastically impacted postgraduate training programmes worldwide. This study aims to evaluate the Nigerian situation with respect to surgical training, with a view to identifying gaps and proffering solutions. Methods A cross-sectional survey of surgical residents in Nigeria was conducted between 27 July 2020 and 14 August 2020. A structured questionnaire designed using the free software Google Forms ® was utilised for the study. The questionnaire was electronically distributed randomly to 250 surgical residents via emails and social media platforms including WhatsApp and Telegram. The data obtained was analysed by Google Forms ® . Ethical approval for the study was obtained from the ethics and research unit of the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Osun State, Nigeria. Results At the end of the study period, 207 surgical residents completed and submitted the questionnaire, giving a response rate of 82.8%. The majority of respondents reported a reduction (164, 79.2%) or cancellation (11, 5.3%) of postgraduate programmes in their institutions. Of those who had academic programmes, meetings were done using virtual technology in all instances. The majority of respondents reported seeing fewer patients in the outpatient clinics (173, 83.6%), as well as a reduction in the number of emergency and elective operations (58.5% and 90.8%, respectively). About a third of the respondents (70, 33.8%) were contemplating emigrating from the country. Conclusion The COVID-19 pandemic has significantly affected the clinical, research and teaching components of surgical training in Nigeria. It has, however, led to increased adoption of digital technology which should be further explored in the face of current realities.

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