Charles Ikechukwu Okafor

Prevalence, correlates and pattern of hepatitis B surface antigen in a low resource setting

BackgroundHepatitis B virus (HBV) infection in Nigeria has remained a Public Health issue. It is a major cause of mortality, especially in developing countries. Vertical transmission of hepatitis B virus infection is thought to be a major route of transmission in low resource areas. In spite of this, routine antenatal screening for hepatitis B infection is not yet practiced in many Nigerian hospitals. This paper present the findings of a study conducted among antenatal women in Nnewi, Nigeria.MethodsIt was a cross-sectional study carried out over a 3-month period (August - October, 2009). Recruitment of 480 women attending antenatal clinics in Nnewi, Nigeria was done by simple random sampling using computer generated random numbers. HBsAg screening was done using rapid ELISA Kits. Statistical analysis was computed using STATA 11 package. The results were subjected to analysis using cross tabulations to explore statistical relationships between variables. Chi square test was used to explore proportional relationship between groups. The level of statistical significance was set at p < 0.05 (providing 95% confidence interval).ResultsFour hundred and eighty pregnant women were recruited into the study. Of these, 40 tested positive to HBsAg, accounting for 8.3% of the sample population. The age of the subjects studied varied from 14 to 45 years (mean age - 24.3 years) while the mean parity was 2.18. The HIV/HBV co-infection rate was 4.2%. The vertical transmission rate was 51.6%. There were statistically significant relationships between HBV infection and previous history of tribal marks/tattoos (χ2 = 27.39, P = 0.001, df = 1), history of contact with previously infected HBV patients (χ2 = 23.11, P = 0.001, df = 1) and occupation of the women (χ2 = 51.22, P = 0.001, df = 1). Multiple sexual partners, blood transfusion, dental manipulations, sharing of sharps/needles, and circumcision were not significant modes of transmission. There was no statistically significant relationship between maternal age, educational level and HBV infection.ConclusionThe authors argued that hepatitis B screening in pregnancy should be made routine practice in Nigeria because of the low pick up rate of the infection based only on risk factors for the disease.

Presentation and Outcome of Eclampsia at a Tertiary Center in South East Nigeria – A 6-Year Review

Objective. To determine the maternal and fetal outcomes of eclamptic patients treated in Nnamdi Azikiwe University Teaching Hospital, Nnewi, over a 6-year period (2004–2009). Materials and Methods. It was a retrospective study. The case notes of 212 patients with eclampsia were analyzed with respect to age, parity, type of eclampsia, gestational age, booking status, mode of delivery, and outcome of the babies and mothers. Results. There were 212 cases of eclampsia out of a total of 13,536 deliveries, giving a prevalence of 1.57%. One hundred and sixty (24.5%) of the women were unbooked. Antepartum eclampsia constituted 160 (75.5%) of all types of eclampsia. Nulliparous teenagers were the most commonly affected women – 128 (60.4%). Cesarean delivery was higher than vaginal delivery, accounting for 160 (75.5%) of all deliveries. There was a statistically significant relationship between the route of delivery and the parity of the women (χ2 = 3.60; d = 5; p = 0.035). There were 16 maternal deaths, giving a case fatality rate of 7.5%. There were 12 neonatal and 8 perinatal deaths. Puerperal sepsis occurred in 9.4% of the patients. Conclusion. Eclampsia is a major cause of maternal mortality in Nnewi, rural South East Nigeria. Teenage nulliparous women are most susceptible.

Male infertility management in a Nigerian tertiary hospital.

routine use of near-miss mortality reviews as tools for monitoring the quality of obstetric care. Hospital data on near-miss cases provide information on what happens in the local community, especially among women at high risk of morbidity (such as the emergency referrals in the present study), and particularly in extremely severe near-miss cases, in which women are unlikely to survive without effective tertiary care. Optimal management requires that pregnant women, women in labor, and newborns have access to life-saving interventions for managing obstetric and newborn complications. If such care is unavailable at peripheral facilities, women are referred to tertiary facilities, often leading to delays in receiving the appropriate care. Thismay be due to a failure to recognize the importance of timely referral or unavailability of transport/failure to meet transport costs, or may be a result of a delay at the tertiary unit. In accordance with other studies [4,5], the present study showed that many women were admitted to emergency care with existing life-threatening complications, indicating that the quality of prenatal care at peripheral units (where some complications may have been identified early), the quality of obstetric care at referral units, and the efficiency of the referral system may be inadequate. In the present study, difficulty gaining access to the hospital (the Kabale district is hilly and many homesteads are inaccessible with motorized transport) may have caused delays in receiving care. The finding that many of the women were in a critical condition at admission indicates possible delays by healthcare workers in making referral decisions (possibly owing to difficulties in making diagnoses), delays in reaching the referral hospital, or poor quality of care at the referral facility.

A systematic review and meta-analysis of progestogen use for maintenance tocolysis after preterm labor in women with intact membranes

The use of progestogens for maintenance tocolysis remains controversial, with randomized controlled trials having conflicting results on their efficacy.

Antibiotic susceptibility pattern of genital tract bacteria in pregnant women with preterm premature rupture of membranes in a resource‐limited setting

To identify microbes prevalent in the genital tract of pregnant women with preterm premature rupture of membranes (PPROM) and to assess the susceptibility of the microbial isolates to a range of antibiotics to determine appropriate antibiotics for treating cases of PPROM in resource‐limited settings.

Accuracy of a combined insulin-like growth factor-binding protein-1/interleukin-6 test (Premaquick) in predicting delivery in women with threatened preterm labor

Abstract Purpose: To determine values of combinations of interleukin-6 (IL-6)/cervical native insulin-like growth factor-binding protein-1 (IGFBP-1)/total IGFBP-1 (Premaquick©) in predicting spontaneous deliveries and spontaneous exclusive preterm deliveries in women with threatened preterm labor. Methods: Women with singleton pregnancies between gestation age (GA) of 24 weeks and 36 weeks and 6 days with preterm labor were recruited during a prospective multicenter study. Premaquick© was positive when at least two of three biomarkers were positive. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were estimated for both prediction of spontaneous deliveries and spontaneous exclusive preterm deliveries. Results: Ninety-seven (99.0%) out of 98 women enrolled were analyzed. Based on delivery status 7/14 days post-enrollment of general study population, Premaquick© had a sensitivity of 87.1/85.7%, a specificity of 92.4/96.8%, a PPV of 84.4/93.8% and a NPV of 93.9/92.3% for prediction of spontaneous delivery. Predictive accuracy of Premaquick© test in relation to days of enrollment were: 90.7% (≤7 days) and 92.8% (≤14 days). For women enrolled at GA <35 weeks, Premaquick© had a sensitivity of 100.0/87.5%, a specificity of 94.1/96.9%, a PPV of 70.5/87.5%, a NPV of 100.0/96.9% and an accuracy of 95.0/95.0% for prediction of preterm delivery within 7/14 days of enrollment, respectively. PPV was most significantly different in both groups when outcomes were compared between 2 days and 14 days post-enrollment (P<0.001). Conclusion: This novel triple biomarker model of native and total IGFBP-1 and IL-6 appears to be an accurate test in predicting spontaneous deliveries and spontaneous exclusive preterm deliveries in threatened preterm labor in singleton pregnancies.

Comparison of the duo of insulin-like growth factor binding protein-1/alpha fetoprotein (Amnioquick duo+®) and traditional clinical assessment for diagnosing premature rupture of fetal membranes

Abstract Purpose: To determine the diagnostic accuracy of insulin-like growth factor binding protein-1/alpha fetoprotein (Amnioquick duo+®) compared with traditional clinical assessment (TCA) of nitrazine, ferning and pooling for the diagnosis of prelabor rupture of membranes (PROM). Methods: A double-blinded, multicenter clinical study was conducted between February 2015 and August 2015 among pregnant women presenting with symptoms or features suggestive of PROM between 24 and 42 weeks gestation. Confirmation of PROM was done after delivery based on the presence of any two of these criteria: delivery within 48 h to 7 days, evidence of chorioamnionitis, membranes explicitly ruptured at delivery and adverse perinatal outcomes strongly correlated with prolonged PROM. Sensitivity, specificity and accuracy were outcome measures assessed. Results: Two hundred and thirty-six women were recruited. Three women were excluded from the final analysis due to lack of follow-up data and failure to meet inclusion criteria. Two hundred and thirty-three women had complete data for analysis. The specificity and sensitivity values for TCA were 76.2% and 85.2%, which were lower than those of Amnioquick duo+, which were 97.6% and 97.9%, respectively. The accuracy of Amnioquick duo+ was statistically higher (97.9% vs. 83.7%; RR=1.17; 95%CI=1.10–1.24; P<0.001). In equivocal cases (pooling=negative), the accuracy of Amnioquick duo+ vs. TCA was 98.4% vs. 69.4% (RR=1.42; 95%CI=1.20–1.68; P<0.001) at ≥34 weeks gestation and 100.0% vs. 71.4% (RR=1.40; 95%CI=1.07–1.83; P=0.021) at <34 weeks gestation. Conclusion: The performance matrix of Amnioquick duo+® was superior to that of TCA for diagnosing PROM even in equivocal cases.

Diagnostic performance of placental alpha-microglobulin-1 test in women with prolonged pre-labour rupture of membranes

Abstract Objectives: To determine diagnostic performance of placental alpha-microglobulin-1 (PAMG-1) test compared to conventional clinical assessment (CCA) in women with prolonged pre-labour rupture of membranes (PROM). Methods: A double-blind study of women with symptoms and signs of PROM in Nnamdi Azikiwe University Teaching Hospital, Nnewi and University of Nigeria Teaching Hospital, Enugu, in south-east Nigeria using CCA for PROM and PAMG-1 test was done. Women were included if their symptoms, signs or complaints suggestive of PROM was more than 24 h duration. PROM was diagnosed if two out of three methods from CCA (pooling, positive nitrazine test or ferning) were present. Confirmation of PROM was done after delivery using any two of these clinical criteria: delivery in 48 h to 7 days, evidence of chorioamnionitis, membranes obviously ruptured at delivery and adverse perinatal outcomes strongly correlated with prolonged PROM. Results: Accuracy, specificity and sensitivity value for CCA were 72.5, 36.8 and 86.0% lower than for PAMG-1 test which were 95.7, 94.1 and 96.2%. In equivocal cases, PAMG-1 was significantly more accurate than CCA (92.3% versus 38.5%; p < 0.001). Conclusions: This study in women with prolonged PROM, confirms that PAMG-1 test has high diagnostic accuracy irrespective of the duration of PROM before clinical evaluation.

Genital tract microbial isolate in women with preterm pre-labour rupture of membranes in resource-constrained community setting

Abstract This study determined patterns of microbial isolates in genital tract of women with preterm pre-labour rupture of membranes (PPROM) compared with cases without PPROM. Endocervical swabs of women with confirmed diagnosis of PPROM were examined microbiologically and compared in blinded pattern with gestational-age-matched controls. One hundred and five microbiological results each for cases and controls were analysed. Positive microbial cultures were seen in 79.05% of cases versus 6.67% of controls. Streptococcus spp. (31.43%) was the commonest organism isolated in cases (p < 0.001), while Candida albicans was significantly more in controls (p < 0.001). The highest incidence of PPROM (82.86%) occurred in gestational ages of 28–30 and 34–36 weeks. No fewer than 75.24% cases occurred in low parity (0–2). Majority occurred in extremes of viable preterm gestation and in women of low parity.

Placental Peripartum Pathologies in Women with Preeclampsia and Eclampsia

Objective To determine the pattern of pathological changes in placentas of preeclamptic/eclamptic parturients and its correlation with the clinical severity as well as the perinatal outcome. Methods A cross-sectional analytical study of placental pathologies in preeclamptic/eclamptic patients was performed in a blinded pattern and compared with matched normal controls. Data were analyzed using Epi-Info 2008 version 3.5.1. Results Placental pathologies were evaluated in 61 preeclamptic/eclamptic patients and in 122 controls. Of the 61 placentas, 53 (4.7%) were of preeclampsia while 8 (0.71%) were of eclampsia. Of the preeclamptic group, 14 (23%) had mild preeclampsia while 39 (63.9%) had severe preeclampsia. Infarction, haematoma, and some histological changes increased with the severity of preeclampsia (p < 0.001). When comparing placentas in eclampsia, severe preeclampsia, mild preeclampsia, and normal controls, there was respective increase in the presence of any infarction (75%, 66.7%, 35.7% vs. 12.3%) or any haematoma (100%, 100%, 71.4% vs. 35.2%), decidual arteriopathy (87.5%, 76.9%, 64.3% vs. 35.2%), cytotrophoblastic proliferation (75%, 71.8%, 42.9% vs. 25.4%), and accelerated villous maturation (75%, 69.2%, 57.1% vs. 31.1%). There was no statistically significant difference in placental calcifications, stromal oedema, stromal fibrosis, and syncytial knots. Degree of placental infarction was correlated with the fetal birth weight. The fetal birth weight with placental involvement of >10% was significant (p=0.01). Conclusion In mild or severe preeclampsia/eclampsia, placentas had significant histological signs of ischaemia and degree of placental involvement by infarction is inversely proportional to fetal birth weight. While feto-placental ratio was higher with increased severity of the disease, the mean weight was less. This trial is registered with researchregistry3503.