Kabiru Afolarin Rabiu

Seroprevalence of cytomegalovirus antibodies amongst normal pregnant women in Nigeria

Objective Cytomegalovirus (CMV), a ubiquitous virus belonging to the herpes family, is known to be transmitted frequently to developing fetuses in pregnancy. In an immunocompromised state like pregnancy, primary infection through blood transfusion or reactivation of a latent CMV infection can cause severe illness. The study was carried out to determine the seroprevalence of the immunoglobulin G (IgG) antibody to cytomegalovirus amongst pregnant women in correlation with previous exposure to blood transfusion. Methods A cross sectional study was carried out amongst 179 HIV negative pregnant women attending the antenatal clinic of Lagos State University Teaching Hospital (LASUTH), Ikeja, Nigeria. Five mL of blood was collected and stored in a plain bottle, centrifuged on the same day and the serum stored at −20°C. All samples were screened for anti-CMV IgG antibodies using the enzyme linked immunosorbent assay (ELISA). Consenting participants were instructed to fill a semi-structured questionnaire to obtain demographic and other related information. Statistical analysis of the results was done using Pearson’s chi squared test for analytical assessment. Results A total of 97.2% of the pregnant women recruited for this study were anti-CMV IgG positive. Out of the 179 recruited for the study 174 responded to the question on previous history of blood transfusion, 14.9% of the respondents (26 of 174) had a previous history of blood transfusion and all tested positive to the anti-CMVIgG antibody. However, past history of blood transfusion and educational level were found to be insignificant to the risk of acquiring CMV infection. Conclusion The seroprevalence of the CMV antibody amongst pregnant women in this environment is high in relation to findings in other developing countries. There is the need to assess anti-CMV immunoglobulin M antibodies in pregnant women, which is a determinant of active infection.

Risk factors for hepatitis B virus infection among pregnant women in Lagos, Nigeria

Objectives. To determine the risk factors for hepatitis B virus infection among pregnant women in Lagos, Nigeria, and the possible implications for hepatitis B prevention in the country. Design. Prospective case control study. Setting. Lagos Island Maternity Hospital. Methods. Between 1 August 2006 and 31 January 2007, risk factors for hepatitis B infection were determined amongst pregnant women using a structured questionnaire. The women were tested for hepatitis B surface antigen (HBsAg) as part of routine antenatal care. Univariate and multivariate analyses were carried out using logistic regression. Main outcome measures. Risk factors for hepatitis B virus infection among pregnant women. Results. Of the 1,052 women attending the antenatal clinic, 6.08% (n = 64) were positive for HBsAg. A total of 61 HBsAg positive and 183 negative controls were interviewed. The significant risk factors for HBV infection were an early age of sexual debut below 19 years (adjusted OR = 2.79; 95% CI = 1.44–5.40; p = 0.0023); history of multiple sexual partners (adjusted OR = 2.02; 95% CI = 1.02–3.98; p = 0.0427); and past history of sexually transmitted infection (adjusted OR = 2.61; 95% CI = 1.15–5.90; p = 0.0214). Of the HBsAg positive women, 45 (73.77%) had at least one of these risk factors while 91 (49.73%) of the controls had at least one risk factor. Conclusion. Screening pregnant for hepatitis B infection on the basis of risk factors may not be effective. Education on modification of lifestyle and sexual behavior as well as non‐selective screening of pregnant women for HBV infection is recommended.

Female reproductive tract infections: understandings and care seeking behaviour among women of reproductive age in Lagos, Nigeria

BackgroundReproductive tract infections (RTIs) are endemic in developing countries and entail a heavy toll on women. If untreated, RTIs can lead to adverse health outcomes such as infertility, ectopic pregnancy and increased vulnerability to transmission of the human immunodeficiency virus. It is also associated with adverse pregnancy outcomes. While RTIs and its sequelae abound in Nigeria, there is paucity of publications on the subject in the country. This study assessed the understandings and care seeking behavior with regards to RTIs among women of reproductive age in Lagos, Nigeria with the aim of improving awareness on the subject.MethodsA descriptive cross sectional survey of women attending the gynaecological outpatient and family planning clinics of the Lagos State University Teaching Hospital was carried out between 1st June 2008 and 31st August 2008 using a pre-tested questionnaire. Data was analysed using the Epi-Info 3.5 statistical software of the Centre for Disease Control and Prevention, Atlanta U.S.A.ResultsMost of the respondents (77.2%) had heard of RTIs. Toilet was the most perceived mode of contracting RTIs (44.6%), followed by sexual intercourse and poor hygiene. Vaginal discharge was the commonest symptom of RTIs named while inability to get pregnant was the commonest named complication. Majority of the respondents demonstrated poor overall knowledge of symptoms and complications of RTIs. 37.4% of the respondents had experienced symptoms of RTIs in the preceding six months. Vaginal discharge was the commonest symptom reported (21.8%) and the majority of those who reported symptoms sought medical treatment. Government health centres were the most visited health facilities for treatment.ConclusionEven though most of the respondents have heard of RTIs and sought treatment when symptomatic, they demonstrated poor overall understanding of the subject. There is need to educate women on preventive strategies, as RTIs are often assymptomatic.

Hematological profile of normal pregnant women in Lagos, Nigeria

Background Hematological profile is considered one of the factors affecting pregnancy and its outcome. Anemia is the most common hematological problem in pregnancy, followed by thrombocytopenia. Leukocytosis is almost always associated with pregnancy. The study reported here was designed to evaluate the overall mean values of seven major hematological parameters and their mean values at different trimesters of pregnancy. Subjects and methods This examination was a cross-sectional study of 274 pregnant women who registered to attend the Lagos University Teaching Hospital or Lagos State University Teaching Hospital antenatal clinics between their first and third trimester. Blood (4.5 mL) was collected from each participant into a tube containing the anticoagulant ethylenediaminetetraacetic acid (EDTA). A full blood count was performed on each sample and the results were analyzed. Results Overall, the values obtained were (mean ± standard deviation [SD]): hematocrit level, 30.16% ± 5.55%; hemoglobin concentration, 10.94 ± 1.86 g/dL; white blood cells, 7.81 ± 2.34 × 109; platelets, 228.29 ± 65.6 × 109; cell volume 78.30 ± 5.70 fL, corpuscular hemoglobin, 28.57 ± 2.48 pg; and corpuscular hemoglobin concentration, 36.45 ± 1.10 g/dL. When grouped by trimester, the mean ± SD value of packed cell volume at first trimester was 32.07% ± 6.80%; of second trimester, 29.76% ± 5.21%; and of third, 33.04% ± 3.88%. The mean ± SD hemoglobin concentration values were 11.59 ± 2.35 g/dL, 10.81 ± 1.72 g/dL, and 10.38 ± 1.27 g/dL for women in their first, second, and third trimester, respectively. Mean ± SD white blood cell concentration for first, second, and third trimesters were 7.31 ± 2.38 × 109, 7.88 ± 2.33 × 109, and 8.37 ± 2.15 × 109, respectively, while the mean ± SD platelet values for first, second, and third trimesters were 231.50 ± 79.10 × 109, 227.57 ± 63 × 109, and 200.82 ± 94.42 × 109, respectively. A statistically significant relationship was found to exist between packed cell volume and white blood cell count with increase in gestational age (P = 0.010 and 0.001, respectively). However, there was no statistically significant association between platelet count and increase in gestational age (P = 0.296). Conclusion These findings reinforce the need for supplementation and provide additional information on hematological reference values in pregnancy in Nigeria.

Emergency peripartum hysterectomy in a tertiary hospital in Lagos, Nigeria: a five-year review

This was a retrospective descriptive study of all the patients who underwent emergency peripartum hysterectomy from January 1st 2003 to December 31st 2007 at the Lagos State University Teaching Hospital. Of the 15,067 deliveries during the study period, 57 patients had emergency peripartum hysterectomy (3.78/1000 deliveries). 19.3% of these patients were booked for antenatal care in the hospital, while 80.7% were unbooked. The mean age of patients was 32.7 years (SD = 5.5) and the mean parity was 3.08 (SD = 1.9). The major indications for emergency peripartum hysterectomy were ruptured uterus (77.2%), uterine atony (10.5%), abruptio placentae (3.5%) and sepsis (3.5%). Subtotal hysterectomy was performed in 96.5% of the cases. The maternal mortality was 19.3% and the perinatal mortality was 75.4%. The incidence of emergency peripartum hysterectomy in this study is high and the major indication is ruptured uterus. It is associated with high maternal and perinatal morbidity and mortality.

Caesarean section – an appraisal of some predictive factors in Lagos Nigeria

BackgroundSeveral maternity units in the developing world lack facilities for caesarean section and often have to transfer patients in extremis. This case controlled study aimed to appraise predictive factors for caesarean section.MethodsOne hundred and fifty two consecutive women with singleton pregnancies who had caesarean section were studied. The next parturient with normal delivery served as control. Variables such as age, parity, marital status, booking status, past obstetric history, weight, height, infant birth weight were assessed. Data obtained were analysed using SPSS 16.0 Windows package.ResultsDuring the study period, there were 641 deliveries with 257 of them by caesarean section (40.1%).Logistic regression analysis showed that parity, booking status, maternal height; maternal weight, birth weight, previous caesarean section and ante-partum bleeding were significant predictive factors for caesarean section while maternal age was not.ConclusionsThese predictive factors should be considered in antenatal counseling to facilitate acceptance by at risk women and early referral.

Factors associated with acceptability of child adoption as a management option for infertility among women in a developing country

Background Adoption as a treatment option for infertility amongst those that cannot access and/or afford assisted reproduction is not well accepted in developing countries. This study sets out to determine the willingness of infertile women in developing countries to adopt a child and factors that influence women’s attitude to adoption. Methods We conducted a questionnaire survey of consecutive infertile patients who attended the gynecological clinic of a regional teaching hospital over a 2-month period. Information on demographics, fertility history, and attitude to adoption was obtained, and the data were analyzed using SPSS version 16.0. Tests of statistical significance were used where appropriate at the 95% confidence level. Results The majority of respondents were aware of child adoption, and the most common source of information was friends (47.8%), followed by the media (39.7%); 42.6% of respondents were willing to adopt if their infertility became intractable. The main reasons given by those unwilling to adopt were culture (78.3%) and family constraints (13.45%). On univariate analysis of factors associated with a favorable or unfavorable attitude to adoption, awareness of adoption (P = 0.002), duration of infertility > 5 years (P = 0.015), no living child (P = 0.007), tertiary education (P < 0.001), pressure from parents (P = 0.041), household yearly income ≥

Evaluation of blood reservation and use for caesarean sections in a tertiary maternity unit in south western Nigeria

650 (P < 0.001), and belief that treatment will bring about the desired results (P < 0.001) were significant, and all except awareness of adoption turned out to be significant on multiple logistic regression analysis. Conclusion There was a high level of awareness about child adoption among all respondents. However, the acceptability of adoption was significantly lower among poor women and those with limited education. Community advocacy and mobilization, especially through the media as well as via health care providers, will go a long way towards enlightening and enhancing the uptake of adoption among women in Nigeria.

Sexual assault in Lagos, Nigeria: a five year retrospective review

BackgroundHaemorrhage from obstetric causes is the most common cause of maternal mortality in the developing world. Prevention of mortality from haemorrhage will necessarily involve prompt blood transfusions among other life saving measures. There are however limited stocks of fresh or stored blood in many health care facilities in Sub Saharan Africa. Caesarean section has been identified as a common indication for blood transfusion in obstetrics practice and its performance is often delayed by non availability of blood in our centre. An evaluation of blood reservation and use at caesarean sections in a tertiary maternity unit in Lagos, south western Nigeria should therefore assist in formulating the most rational blood transfusion policies.MethodsCase records of 327 patients who had elective and emergency caesarian sections at the Lagos State University Teaching Hospital between 1st October and 31st December 2007 were reviewed. Data pertaining to age, parity, booking status, type and indication for Caesarean section, pre- and post-operative packed cell volume, blood loss at surgery, units of blood reserved in the blood bank, unit(s) of blood transfused and duration of hospital stay was extracted and the data analysed.ResultsThere were 1056 deliveries out of which 327 (31%) were by Caesarean section. During the study period, a total of 654 units of blood were reserved in the blood bank and subsequently made available in theatre. Out of this number, only 89 (13.6%) were transfused to 41 patients. Amongst those transfused, twenty-six (54%) were booked and 31 (75.6%) had primary caesarian section. About 81% of those transfused had emergency caesarean section. The most common indication for surgery among those transfused were placenta praevia (9 patients with 21 units of blood) and cephalo-pelvic disproportion (8 patients with 13 units).ConclusionEven though a large number of units of blood was reserved and made available in the theatre at the time of operation, majority of the patients operated did not need blood transfusion. Provision of a mini- blood bank within the obstetric unit and careful patient categorization will ensure timely availability of blood for surgery without necessarily tying down stock in the central blood bank.

Malaria prevention and treatment in pregnancy: Survey of current practice among private medical practitioners in Lagos, Nigeria

BackgroundCases of sexual assault are increasingly reported. However, Nigerian researchers have not given adequate attention to this subject despite its attendant social, physical and psychological consequences.This study assessed survivors’ characteristics, circumstances of assault and treatment offered with a view to reducing the incidence as well as improving evaluation and management.MethodsA retrospective review of survivors’ case records at Lagos State University Teaching Hospital, Ikeja, between January 2008 and December 2012. Data was analysed using the Epi-info 3.5 statistical software of the Centre for Disease Control and Prevention, Atlanta U S A.ResultsOf the 39,770 new gynaecological cases during this period, 304 were alleged sexual assault giving an incidence of 0.76% among hospital gynaecological consultations. Only 287 case notes had sufficient information for statistical analysis. Of these, 83.6% were below 19xa0years, 73.1% knew their assailants (majority were neighbours), most assaults (54.6%) occurred in the neighbours’ homes and over 60% of victims presented after 24xa0hours of assault.Although 77.3% were assaulted at daytime, teenagers were likely to be raped during the day and non-teenagers at night (Pu2009<u20090.001). Threat and physical violence were mostly used to overcome victims. Seventy three point six percent had Human Immunodeficiency Virus (HIV) screening with one positive at onset. Post Exposure Prophylaxis for HIV was given in 29.4% of those eligible and emergency contraception in 22.4% of post-menarcheal victims (nu2009=u2009125).There were neither referrals for psychotherapy nor forensic specimen collected. No record of post-assault conception or HIV infection was found during follow-up.ConclusionsAdolescents remain the most vulnerable requiring life skills training for protection. Survivors delay in presenting for care. Therefore, public enlightenment on the benefits of early interventions and comprehensive care of survivors with the use of standardized protocols are recommended.