Zubairu Iliyasu

Maternal health in Northern Nigeria- : a far cry from ideal

Objective  To determine the level of maternal care in Northern Nigeria.

Prevalence and predictors of tuberculosis coinfection among HIV-seropositive patients attending the Aminu Kano Teaching Hospital, northern Nigeria.

Background The HIV/AIDS epidemic has been accompanied by a severe epidemic of tuberculosis (TB), although the prevalence of coinfection is largely unknown, especially in developing countries, including Nigeria. The aim of this study was to determine the prevalence and predictors of TB coinfection among HIV-seropositive Nigerians. Methods The case files of HIV/AIDS patients attending Aminu Kano Teaching Hospital, Nigeria from January to December 2006 were reviewed. Results A total of 1320 HIV/AIDS patients had complete records and were reviewed, among which 138 (10.5%) were coinfected with TB (95% CI, 8.9% to 12.2%). Pulmonary TB was diagnosed in 103 (74.6%) patients, among whom only 18 (17.5%) were sputum-positive. Fifty (36.2%) coinfected patients had some type of extrapulmonary TB (EPTB); 15 had both pulmonary TB and EPTB. Among the 35 patients with EPTB only, 20 (57.1%) had abdominal TB, 5 (14.3%) had TB adenitis, 5 (14.3%) had spinal TB, 3 (8.6%) were being monitored for tuberculous meningitis, and 1 (2.9%) each had renal TB and tuberculous adrenalitis. The highest prevalence of TB, 13.7% (n = 28), was seen among patients aged 41–50 years. TB coinfection was significantly associated with marital status, WHO clinical stage, and CD4 count. Marital status (OR, 2.1; 95% CI, 1.28–3.59; P = 0.04), WHO clinical stage at presentation (4.81; 1.42–8.34; P = 0.001), and baseline CD4 count (2.71; 1.51–6.21; P = 0.02) remained significant predictors after adjustment for confounding. Conclusions The moderately high prevalence of TB among HIV-seropositive patients underscores the urgent need for strategies that lead to rapid identification and treatment of coinfection with active or latent TB.

Determinants of utilization of antenatal care services in Kumbotso Village, northern Nigeria.

Women of childbearing age in a rural community in Kano state were interviewed to ascertain the determinants of utilization of antenatal care services in the village. Of the 200 women studied, 118 (59%) utilized antenatal care services during pregnancy. A majority (86%) of those who attained secondary school education, all of those with post-secondary education and 83% of those whose husbands had post-secondary education utilized antenatal care services.

A review of neonatal morbidity and mortality in Aminu Kano Teaching Hospital, northern Nigeria.

Neonatal morbidity and mortality still poses a serious challenge in developing countries. Low level of obstetric care, unsupervised home deliveries and late referrals lead to poor outcome even in special care baby units (SCBU). To identify the common causes of neonatal morbidity and mortality among babies admitted to the SCBU in Aminu Kano Teaching Hospital (AKTH) the case-notes of all admitted neonates from January 1998 to December 2004 were retrospectively reviewed. A total of 2963 (98.3%) babies had complete records. There were 1455 (49.1%) in-born (delivered in AKTH) and 1508 (50.9%) out-born (delivered elsewhere) babies. The sex ratio was1.25:1in favour of males. A total of1868 (63.0%) were of normal birth weight, while 951 (32.1%) and 134 (4.5%) were low birth weight and macrocosmic, respectively. The leading diagnoses were birth asphyxia (27%) (severe birth asphyxia 18.1%, moderate asphyxia 8.9%), neonatal sepsis (25.3%) and prematurity (16.0%). Out of the 2963 babies, 501 (16.9%) died. The risk of dying was significantly higher (20.5%) among out-born babies compared with those delivered in AKTH (6.4%) (odds ratio = 1.71, 95% confidence interval = 1.4-2.1). In conclusion, the causes of neonatal morbidity and mortality at this centre are similar to those reported from other units. They could be prevented through effective antenatal care, supervised delivery and appropriate care and early referral of sick neonates.

Cervical cancer risk perception and predictors of human papilloma virus vaccine acceptance among female university students in northern Nigeria

Cancer of the cervix is the most common cancer and the leading cause of cancer mortality among women in sub-Saharan Africa. Although a vaccine against human papilloma virus (HPV) is now available, its acceptance among vulnerable women in developing countries islargely unexplored. We studied cervical cancer awareness and HPV vaccine acceptance among 375 female university students in northern Nigeria. A total of 133 participants knew of HPV (35.5%), 202 (53.9%) had heard of cervical carcinoma and 277 (74.0%) were willing to accept HPV vaccination. After adjusting for potential confounders, age (adjusted odds ratio (AOR) = 2.3, 95% confidence interval (CI), 1.47–6.53); medical education (AOR = 3.4, 95% CI, 1.74–6.93); HPV knowledge (AOR = 1.8, 95% CI, 1.38–5.41) and awareness of cervical cancer (AOR = 2.3, 95% CI, 1.52–5.06) were significant predictors of readiness to accept HPV vaccine. Public health education and appropriate communication strategies should be implemented in advance of large scale vaccine introduction to increase awareness and prevent misconceptions about the HPV vaccine.

Sexual and Reproductive Health Communication Between Mothers and Their Adolescent Daughters in Northern Nigeria

We employed structured interviews and focus groups to investigate reproductive health (RH) communication practices among 184 mother–daughter pairs in Ungogo, northern Nigeria. Transcripts were analyzed using the grounded theory approach. A total of 136 mothers reported discussing RH issues with their daughters. The majority of daughters acquired RH education from their mothers. Parents were more likely to discuss marriage, menstruation, courtship, premarital sex, and sexually transmitted infections (STIs) than other sex education topics. Mothers in northern Nigeria need to be empowered with knowledge and skills to improve the scope and quality of home-based RH education.

Prevalence and Risk Factors for Domestic Violence Among Pregnant Women in Northern Nigeria

Many women experience domestic violence during pregnancy. The magnitude and risk factors for domestic violence during pregnancy are not well documented in many countries, including Nigeria. Using interviewer- administered questionnaires the authors investigated predictors of domestic violence during current pregnancy among women presenting for antenatal care at a tertiary care facility in northern Nigeria (n = 400). A total of 29 of 392 respondents (7.4%) experienced domestic violence during the current pregnancy. Of those who experienced violence, the majority (58.6%) reported being physically assaulted. Sexual violence was reported by only 4 respondents (13.8%). Financial and domestic issues were the major triggers of domestic violence. After adjusting for potential confounders, it was found that victims’ educational attainment and occupation remained significant predictors of domestic violence. Higher educational attainment of women and their engagement in economic activity outside the home were associated with a decreased risk for domestic violence. There is a need for preventive, protective, and redress mechanisms to guard against domestic violence in Nigeria.

Fistula Fortnight: Innovative partnership brings mass treatment and public awareness towards ending obstetric fistula

As part of the global Campaign to End Fistula, the Fistula Fortnight, a 2‐week mass obstetric fistula treatment project, was organized in northern Nigeria to contribute to reducing the backlog of untreated fistulas and raise awareness regarding obstetric fistulas and safe motherhood.

Postpartum beliefs and practices in Danbare village, Northern Nigeria

Summary Postpartum cultural beliefs and practices are widely prevalent in northern Nigeria. Using a cross-sectional survey, we set out to examine contemporary postpartum beliefs and practices among a cohort of 300 mothers in Danbare village, northern Nigeria. Common postpartum practices included sexual abstinence (100%), physical confinement (88%), hot ritual baths (86%), nursing in heated rooms (84%) and ingestion of gruel enriched with local salt (83%). The majority of mothers (93%) believed that these practices made them stronger and helped them regain their physiologic state. Most respondents believed that non-observance could lead to body swelling, foul-smelling lochia and perineal pain. Mothers with formal education were significantly more likely to believe that these practices were non-beneficial compared with those mothers without formal education (odds ratio (OR) = 9.9, 95% confidence interval (CI) = 3.6 – 28.8). Almost half of the respondents (49%) said they would continue with these practices. In conclusion, women are still holding on to postpartum cultural beliefs and practices in northern Nigeria. However, educated women could act as useful agents of change towards the elimination of practices harmful to the health of mothers and their children.

Survey of poliovirus antibodies in Kano, Northern Nigeria.

INTRODUCTION In 1988, the World Health Assembly resolved to eradicate poliomyelitis. Since then, much progress towards this goal has been made, but three countries including Nigeria remain polio-endemic as of end 2012. To assess the immunity level against poliomyelitis in young children in Northern Nigeria, we conducted a seroprevalence survey in the Kano Metropolitan Area (KMA) in May 2011. METHODS Parents or guardians of infants aged 6-9months or children aged 36-47months presenting to the outpatient department of Murtala Mohammad Specialist Hospital were approached for participation, screened for eligibility and were asked to provide informed consent. After that, a questionnaire was administered and blood was collected for neutralization assay. RESULTS A total of 327 subjects were enrolled. Of these, 313 (96%) met the study requirements and were analyzed (161 [51%] aged 6-9months and 152 [49%] aged 36-47months). Among subjects aged 6-9months, seroprevalence was 81% (95% confidence interval [CI] 75-87%) to poliovirus type 1, 76% (95% CI 68-81%) to poliovirus type 2, and 73% (95% CI 67-80%) to poliovirus type 3. Among subjects aged 36-47months, the seroprevalence was 91% (95% CI 86-95%) to poliovirus type 1, 87% (95% CI 82-92%) for poliovirus type 2, and 86% (95% CI 80-91%) to poliovirus type 3. Seroprevalence was associated with history of oral poliovirus vaccine (OPV) doses, maternal education and gender. CONCLUSIONS Seroprevalence is lower than required levels for poliovirus interruption in the KMA. Persistence of immunity gaps in the 36-47months group is a big concern. Since higher number of vaccine doses is associated with higher seroprevalence, it implies that failure-to-vaccinate and not vaccine failure accounts for the suboptimal seroprevalence. Intensified efforts are necessary to administer polio vaccines to all target children and surpass the threshold levels for herd immunity.