Intravenous versus oral iron for anaemia among pregnant women in Nigeria (IVON): an open-label, randomised controlled trial.

BACKGROUND: Oral iron for anaemia in pregnancy is often not well tolerated, with poor adherence. Iron administered intravenously might address these tolerance and adherence issues. We investigated the effectiveness and safety of intravenous ferric carboxymaltose versus oral ferrous sulphate on anaemia and iron deficiency among pregnant women in Nigeria. METHODS: We did a multicentre, open-label, parallel, randomised controlled trial of pregnant women (aged 15-49 years) with haemoglobin (Hb) concentrations of less than 10 g/dL at 20-32 weeks' gestation from 11 primary, secondary, or tertiary health facilities in Nigeria (five in Lagos and six in Kano). Exclusion criteria included vaginal bleeding, blood transfusion or major surgery within the past 3 months, symptomatic anaemia, anaemia known to be unrelated to iron deficiency, clinically confirmed malabsorption syndrome, previous hypersensitivity to any form of iron, pre-existing maternal depression or other major psychiatric illness, immune-related diseases, such as systemic lupus erythematosus or rheumatoid arthritis, or severe allergic reactions. Participants were randomly assigned (1:1) by nurses and doctors using a web-based randomisation service to either receive a single dose of intravenous ferric carboxymaltose (20 mg/kg to a maximum of 1000 mg) or oral ferrous sulphate (200 mg; 65 mg elemental iron) three times daily until 6 weeks postpartum. The study was primarily unmasked. Primary outcomes were maternal anaemia (Hb <11 g/dL) at 36 weeks' gestation and preterm birth at before 37 weeks' gestation, with analysis by intention to treat in participants with available data. This study was registered at the ISRCTN registry on Dec 10, 2020 (ISRCTN63484804) and on ClinicalTrials.gov (NCT04976179) on April 7, 2021. FINDINGS: Between Aug 10, 2021, and Dec 15, 2022, 13 724 pregnant women were screened for eligibility. 12 668 were excluded due to ineligibility for inclusion, and 1056 provided consent to participate and were randomly assigned to either the intravenous or oral administration groups. 527 were assigned to the intravenous ferric carboxymaltose group and 529 were assigned to the oral ferrous sulphate group. 518 in the intravenous group were assessed at 36 weeks' gestational age and after 518 deliveries, and 511 completed the 6 weeks postpartum visit. 513 in the oral ferrous sulphate group were assessed at 36 weeks' gestational age and after 512 deliveries, and 501 completed the 6 weeks postpartum visit. No significant difference was found in anaemia at 36 weeks (299 [58%] of 517 in the intravenous group vs 305 [61%] of 503 in the oral group; risk ratio 0·95, 95% CI 0·85-1·06; p=0·36), nor in preterm birth (73 [14%] of 518 vs 77 [15%] of 513; 0·94, 0·70-1·26; p=0·66). There were no significant differences in adverse events. The most common adverse events were diarrhoea (in six participants) and vomiting (in three participants) in the oral group and fatigue (in two participants) and headache (in two participants) in the intravenous group. INTERPRETATION: Although the effect on overall anaemia did not differ, intravenous iron reduced the prevalence of iron deficiency to a greater extent than oral iron and was considered to be safe. We recommend that intravenous iron be considered for anaemic pregnant women in Nigeria and similar settings. FUNDING: Bill & Melinda Gates Foundation.

Caregiver burden and its sociodemographic determinants in family caregivers of patients with schizophrenia attending a psychiatric tertiary hospital in South Africa.

Background: Chronic mental illnesses such as schizophrenia affect patients' functioning, making caregiving necessary although burdensome. Aim: This study aimed to determine caregiver burden and its sociodemographic determinants in family caregivers of patients with schizophrenia attending a Psychiatric Outpatient Department (POD). Setting: Tertiary hospital in Northern Pretoria, South Africa. Methods: In this cross-sectional study conducted over 3 months, 300 consecutive family caregivers who attended the POD were administered a 22-item Zarit Burden Interview (ZBI-22), which has a score of 0-88, with higher values indicating more burden. Their sociodemographic characteristics were ascertained. Linear and ordinal logistic regression analyses were performed to identify determinants or predictors of total and severe burdens, respectively. Results: Most caregivers were aged 46.0 ± 14 years, females (62%), parents (39%), of low-income status (93.7%), had secondary education (70%), resided with the patient (87%), and helped with all troublesome activities (95.3%). The median ZBI-22 score was 19.0 (interquartile range: 13.0-30.5). The determinants of both total and severe burdens were: caregiver age ≥ 50 years adjusted odds ratio (aOR): 2.55, confidence interval (CI): 1.49-4.36; residential area farther away from the hospital aOR: 1.76, CI: 1.3-2.99; increasing months of caregiving aOR: 1.0, CI: 1.001-1.009, p = 0.006; and not having another family member that needs care aOR: 0.43, CI: 0.24-0.78. Conclusion: Having mental healthcare facilities close to residential areas and assisting caregivers aged ≥ 50 years who have multiple family members who need care may alleviate the burden. Contribution: Predicting total and severe caregiver burdens contemporaneously is effective for identifying potential burden interventions.

Join point trends of instrumental vaginal deliveries and cesarean sections at the Lagos University Teaching Hospital, Lagos, Nigeria (2002-2017).

OBJECTIVE: To determine the trends of instrumental vaginal delivery (IVD) and cesarean section (CS) at the Lagos University Teaching Hospital (LUTH), Nigeria, over 16 years, from 2002 to 2017. METHODS: A retrospective cross-sectional study. The case records of all women who had IVD and CS during the study period were reviewed. The trends in the IVD and CS rates were evaluated using join point regression modeling. The average annual percent change (AAPC) and annual percent change (APC) with associated 95% confidence interval of segmental trends were calculated. RESULTS: The overall IVD rate was 1.36%. Vacuum delivery rate was higher than forceps (0.79% vs 0.57%). The CS rate was 44.9 per 100 deliveries; the rate increased by about 3.7% per annum. CS rates were 7.1-89.9 times the IVD rates within the study period. The number of IVDs performed in the hospital declined by about 83.02%, from 53 cases in 2002 to nine cases in 2017. Forceps delivery declined at a faster rate than vacuum delivery between 2002 and 2017 (AAPC for forceps: -12.6% [-17.5 to -7.5], P < 0.001 vs AAPC for vacuum: -6.2% [-14.3 to 2.7], P = 0.200). The commonest indication for IVD was prolonged second stage of labor (47/162, 29.01%) and shortening of the second stage of labor for maternal conditions (47/162, 29.01%). CONCLUSION: IVD rates are low and declining at LUTH. There is need to train accoucheurs on the safe use of IVDs to potentially reduce the CS rate.

Serum Vitamin D Deficiency and Male Infertility: A Relationship?

Background Male infertility is one of the major reproductive health concerns, causing a lot of distress for couples globally. Others have looked into its connection to vitamin D deficiency, but their findings are conflicting. Aim This study aimed to determine the relationship between male infertility and vitamin D deficiency among Nigerians. Method This analytical cross-sectional study was conducted among 132 men. A purposive sampling technique was employed to recruit 66 participants in the study (men with infertility) and control groups (men with proven fertility). Descriptive statistics were conducted, while the association between vitamin D level and sperm parameters was assessed using bivariate and regression modeling. A two-tailed test of the hypothesis was assumed, and the level of statistical significance was set at a P-value < 0.05. Results None of the participants had a serum vitamin D deficiency. However, the overall serum vitamin D insufficiency rate was 15%. The median vitamin D level for the total study population (both fertile and infertile) was 37.52 ng/ml (IQR: 32.1 - 51.69). This study demonstrated no association between serum vitamin D levels and male infertility, as well as no association between serum vitamin D levels and the quality of semen parameters. Conclusion There was no significant association between vitamin D levels, male infertility, and seminal fluid parameters. However, larger multi-center studies are recommended to provide further insights into this conclusion.

Evaluation of serum adiponectin as a marker of insulin resistance in women with polycystic ovarian syndrome: a comparative cross-sectional study.

BACKGROUND: Insulin resistance (IR) is known to be prevalent amongst women with polycystic ovarian syndrome (PCOS). Its presence has been linked to chronic anovulation and marked long term complications in women. Hence, identification and treatment of IR in women with PCOS is required to prevent the metabolic and reproductive complications of the disease. The aim of this study is to determine if serum adiponectin could be used as a surrogate marker for insulin resistance among women with PCOS. MATERIALS AND METHODS: A total number of 148 consenting women with PCOS diagnosed using the Rotterdam criteria were recruited for this study. Fifty-two of these women had insulin resistance were compared with 96 of the women who did not have insulin resistance. The serum Adiponectin levels, fasting blood glucose and fasting insulin levels were assayed in all study participants. Insulin resistance was assessed in all the study participants using the Homeostasis Model Assessment for Insulin Resistance (HOMA-IR). Data were analyzed using relevant inferential statistics at 95% confidence interval and p value of < 0.05. RESULTS: The prevalence of insulin resistance among the study participants was 35.1%. Majority of the women (83.1%) had a high body mass index (BMI). More than half (68.2%) of the participants were in the age range of 21-30years and 76.4% (113) were nulliparous. There was no statistically significant difference in the median adiponectin level among insulin resistant (3.735 ug/ml) and non-insulin resistant participants vs. (3.705 ug/ml) (p = 0.6762). Both univariate and multivariate regression analysis did not show a statistically significant relationship between adiponectin and insulin resistance in PCOS. CONCLUSION: The prevalence of insulin resistance in women with PCOS is high and serum adiponectin is not a suitable surrogate marker of insulin resistance in women with PCOS.

Impact of training and case manager support for traditional birth attendants in the linkage of care among HIV-positive pregnant women in Southwest Nigeria: a 3-arm cluster randomized control trial.

BACKGROUND: Mother-to-child transmission (MTCT) accounts for 90% of all new paediatric HIV infections in Nigeria and for approximately 30% of the global burden. This study aimed to determine the effectiveness of a training model that incorporated case managers working closely with traditional birth attendants (TBAs) to ensure linkage to care for HIV-positive pregnant women. METHODS: This study was a 3-arm parallel design cluster randomized controlled trial in Ifo and Ado-Odo Ota, Ogun State, Nigeria. The study employed a random sampling technique to allocate three distinct TBA associations as clusters. Cluster 1 received training exclusively; Cluster 2 underwent training in addition to the utilization of case managers, and Cluster 3 served as a control group. In total, 240 TBAs were enrolled in the study, with 80 participants in each of the intervention and control groups. and were followed up for a duration of 6 months. We employed a one-way analysis of variance (ANOVA) statistical test to evaluate the differences between baseline and endline HIV knowledge scores and PMTCT practices. Additionally, bivariate analysis using the chi-square test was used to investigate linkage to care. Furthermore, logistic regression analysis was utilized to identify TBA characteristics associated with various PMTCT interventions, including the receipt of HIV test results and repeat testing at term for HIV-negative pregnant women. The data analysis was performed using Stata version 16.1.877, and we considered results statistically significant when p values were less than 0.05. RESULTS: At the end of this study, there were improvements in the TBAs' HIV and PMTCT-related knowledge within the intervention groups, however, it did not reach statistical significance (p > 0.05). The referral of pregnant clients for HIV testing was highest (93.5%) within cluster 2 TBAs, who received both PMTCT training and case manager support (p ≤ 0.001). The likelihood of HIV-negative pregnant women at term repeating an HIV test was approximately 4.1 times higher when referred by TBAs in cluster 1 (AOR = 4.14; 95% CI [2.82-5.99]) compared to those in the control group and 1.9 times in cluster 2 (AOR = 1.93; 95% CI [1.3-2.89]) compared to the control group. Additionally, older TBAs (OR = 1.62; 95% CI [1.26-2.1]) and TBAs with more years of experience in their practice (OR = 1.45; 95% CI [1.09-1.93]) were more likely to encourage retesting among HIV-negative women at term. CONCLUSIONS: The combination of case managers and PMTCT training was more effective than training alone for TBAs in facilitating the linkage to care of HIV-positive pregnant women, although this effect did not reach statistical significance. Larger-scale studies to further investigate the benefits of case manager support in facilitating the linkage to care for PMTCT of HIV are recommended. TRIAL REGISTRATION: The study was retrospectively registered in the Pan African Clinical Trial Registry, and it was assigned the unique identification number PACTR202206622552114.

Prevalence and factors associated with female sterilization in Rwanda: evidence from the demographic and health survey data (2019-2020).

BACKGROUND: Female sterilization is a safe and effective surgical procedure of achieving contraception. There is disparity in the prevalence of female sterilization globally, with high income countries having higher rates than low- and middle-income countries. However, current evidence of the uptake of female sterilization in Rwanda is not known. We therefore evaluated the prevalence and factors associated with female sterilization among women of reproductive age in Rwanda. METHODOLOGY: This was a secondary data analysis of 14,634 women of reproductive age (15-49) in Rwanda. The data utilized was from the Rwanda Demographic Health and Survey (RDHS) 2019/2020. The predictors of female sterilization were determined using multivariable binary logistic regression analysis. RESULTS: We found that the prevalence of female sterilization was 1.1% among women of reproductive age in Rwanda. Women older than 35 years had about 8 times higher chance of being sterilized as compared to younger women (aOR: 7.87, 95% CI: 4.77-12.99). Women living with their partners had higher odds of being sterilized as compared to never married women (aOR: 19.23, 95% CI: 4.57-80.82), while women from minority religion are more likely to be sterilized as compared to those of the catholic religion (aOR: 2.12, 95% CI: 1.03-4.37). Women from rich household had a higher chance to be sterilized as compared to their counterparts from poor households (aOR: 3.13, 95% CI: 1.94-5.03). Women from the Western region were more likely to accept sterilization compared to women from Kigali (aOR: 2.025, 95% CI: 1.17-3.49) and women who had more than 5 children had higher odds when compared to women who had 5 or less children (aOR: 1.49, 95% CI: 1.06-2.10). CONCLUSION: The overall prevalence of sterilization among Rwandan women of reproductive age was 1.1%, which was very low as compared to India (29%), China (14.1%) and United States of America (13.7%). The age, marital status, religion, household wealth quintile, region and children ever born were associated with the uptake of female sterilization among Rwandan women. Public awareness campaign on the advantages of female sterilization should be done to improve uptake.

Urinary Nephrin Levels Among Pregnant Women With Preeclampsia in Lagos, Southwest Nigeria: An Analytical Cross-Sectional Study.

BACKGROUND: Hypertensive disorders in pregnancy are one of the leading causes of maternal and perinatal morbidity and mortality worldwide. The clinical utility of urinary nephrin as a diagnostic biomarker of preeclampsia is currently of research interest. However, this is yet to gain significant traction within clinical settings. OBJECTIVES: We evaluated the association between maternal urinary nephrin levels and the occurrence and severity of preeclampsia among pregnant women in Lagos, Nigeria. DESIGN: We conducted an analytical cross-sectional study involving pregnant women diagnosed with preeclampsia as well as their age- and gestational-age-matched normotensive counterparts. We tested the association between high maternal urinary nephrin levels and the occurrence of preeclampsia without and with severe features. P < 0.05 was reported as statistically significant. RESULTS: The study showed that for every unit increase in urinary nephrin levels, the odds of preeclampsia increased by about ninefold (adjusted Odds ratio = 8.9, 95% confidence interval: 2.8-29.2, P < 0.001). The levels of urinary nephrin increased steadily with increasing severity of the disease: 1.9 ± 0.8 ng/mL in preeclampsia without severe features, 2.7 ± 0.7 ng/mL in preeclampsia with at least one severe feature, and 3.3 ±1.1 ng/mL in eclampsia. CONCLUSION: There was an association between elevated levels of urinary nephrin and preeclampsia and its severe variant. However, there is a need for more robust studies with a longitudinal characterization of urinary nephrin levels to establish causal relationships with preeclampsia, explore other potential risk factors of preeclampsia, and define the clinical usefulness of urinary nephrin as a potentially reliable and accurate predictive marker of preeclampsia among women in low- and middle-income countries (LMIC) settings.

Serum Calcium and Magnesium Levels in Women with Uterine Fibroids in Southwest Nigeria: a Cross-sectional Study.

Studies have suggested the potential roles of serum macronutrients such as calcium and magnesium in the development of uterine fibroids. The primary objective was to assess the association between serum magnesium and calcium levels and the prevalence of uterine fibroids in women of reproductive age. A cross-sectional study of 194 parity-matched women with or without a sonographic diagnosis of uterine fibroids enrolled at a university teaching hospital in Lagos, Southwest Nigeria. Participants' sociodemographic, ultrasound, and anthropometric information as well as the estimated serum levels of calcium and magnesium were collected for statistical analyses. This study found significant negative associations between low serum calcium levels and uterine fibroids (adjusted odds ratio = 0.06), uterine size, and the number of fibroid nodules. However, no significant association was observed between serum magnesium levels and uterine fibroids. This study found significant inverse associations between low serum calcium levels and uterine fibroids, uterine size, and the number of fibroid nodules.

Socio-demographic and reproductive characteristics of clients that accepted contraceptives at abortion center at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), Johannesburg, South Africa: a cross-sectional study (January-July 2021).

Introduction: access to family planning services is an important preventive strategy against maternal mortality as it can considerably reduce unintended pregnancies and prevent sequelae of unsafe abortion. We aimed to describe the socio-demographic and reproductive characteristics of abortion seekers and investigate factors associated with uptake of contraceptives following induced abortion at Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa. Methods: this study was a cross-sectional study among women who had legal termination of unwanted pregnancy at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), from 1st January 2021 to July 2021. Questionnaires were administered to 80 consenting consecutive clients after undergoing induced abortion. Information on socio-demographic and reproductive characteristics and pattern of contraceptive uptake of the respondents were obtained. Descriptive and bivariate analysis were conducted to determine the pattern and relationship of socio-demographic and reproductive characteristics and contraceptive uptake. Results: the mean age of the 80 respondents was 25.6 ± 6.6 years. Majority of the participants were of the Black race (96.25%, n= 77/80), single (90.00%, n= 72/80), of the Christian faith (80.00%, n= 64/80) and unemployed. The median number of children alive among the clients was 1(0-2), with about 37.5% of the participants being nulliparous. About 16.25% of the participants had had at least one previous termination of pregnancy. The prevalence of post-abortion contraceptive uptake was 97.5% (95%CI: 90.36% - 99.39%, N=78/80). More than half chose injectable contraceptive (53.85%, 95%CI: 42.60% - 64.71%, N= 42/78), followed by oral contraceptive pills (21.79%, 95%CI: 13.90% - 32.49% N= 17/78). We found no association between socio-demographic and reproductive characteristics, and contraceptive uptake among the abortion clients (p values >0.05). Conclusion: the immediate post-abortion contraceptive uptake in our facility is very high. Majority of the clients accepted injectable contraceptives. The demographic and reproductive characteristics of our clients did not affect uptake of post-abortion contraception. More education is needed to improve uptake of other long-acting contraceptives that may not require frequent contact with the health facility.

Serum Calcium and Magnesium Levels in Women with Uterine Fibroids at a University Teaching Hospital in Southwest Nigeria: A Comparative Cross-Sectional Study.

Background: Studies have suggested the potential roles of serum trace elements such as calcium and magnesium in the development of uterine fibroids. Aims: This study compared magnesium and calcium serum levels in reproductive-age women with and without uterine fibroids in Lagos, Southwest Nigeria. Methods: A comparative cross-sectional study of 194 parity-matched women with or without a sonographic diagnosis of uterine fibroids enrolled at a university teaching hospital in Lagos, Southwest Nigeria. Participants' sociodemographic, ultrasound, and anthropometric information as well as the estimated serum levels of calcium and magnesium were collected for statistical analyses. Results: This study found significant negative associations between low serum calcium levels and uterine fibroids (adjusted odds ratio= 0.06; 95% CI: 0.004, 0.958; p=0.047), uterine size (p=0.004), and the number of fibroid nodules (p=0.030). However, no significant association was observed between serum magnesium levels and uterine fibroids (p=0.341). Conclusion: The findings of this study suggest the promising role of calcium-rich diets and supplements in the prevention of uterine fibroids among Nigerian women. However, future longitudinal studies are required to further evaluate the potential role of these trace mineral elements in the development of uterine fibroids.

Evaluation of the medically necessary, time sensitive triage score during and beyond the local COVID-19 pandemic in the Gynaecologic Oncology Unit of a tertiary hospital in South Africa.

OBJECTIVE: The main objective of this study was to evaluate the Medically Necessary Time Sensitive (MeNTS) scoring system in triaging gynaecologic oncologic surgery during and beyond the COVID-19 pandemic. MATERIAL AND METHODS: This was a retrospective cross-sectional study including 209 patients who either had surgery (151) or surgery postponed (58) between the 26th March and 30th September 2020 in an academic hospital in South Africa. The MeNTS score was used to independently score each patient three times by two observers. RESULTS: The mean age of the participants was 46.6 ± 15 years and the cumulative mean MeNTS score was 51.0 ± 5.1. Over two-thirds of the cases had surgery. There was no significant difference between the first and second observers' cumulative scores, 51.0 vs 51.1 (p 0.77). The cumulative score among those who had surgery was significantly lower than that for those whose surgeries were postponed, 49.8 vs 54.1 (p <0.0001). The intra-observer and inter-observer reliability were 0.78 and 0.74 respectively. After adjusting for confounding variables, those with low cumulative MeNTS scores were about 5 times more likely to have surgery than those with high scores (Adj. OR = 4.67, 95% CI: 1.92-11.4, p <0.001. Patients with malignant diagnosis were also 5 times more likely to be operated than those with benign diagnosis (Adj. OR = 5.03, 95% CI: 1.73-14.6, p <0.001. The area under the curve (AUC) was 0.85 suggesting an excellent discriminatory power between those who were operated and those who were postponed. CONCLUSION: The study provided some insight into the potential usefulness of MeNTS score in prioritizing patients for surgery in gynaecologic oncologic sub-specialty. The score performed well across a range of gynaecologic conditions and procedures with good intra-observer and inter-observer consistency and reliability. This is a prioritization tool that is dynamically adaptable to accommodate changes in resources availability and operating theatre capacity.

Population-based temporal trends and ethnic disparity in breast cancer mortality in South Africa (1999-2018): Joinpoint and age-period-cohort regression analyses.

Globally, breast cancer is the leading cause of cancer deaths, accounting for 15.5% of female cancer deaths in 2020. Breast cancer is also the leading cause of female cancers in South Africa. The rapid epidemiological transition in South Africa may have an impact on the trends in breast cancer mortality in the country. We therefore evaluated the trends in the breast cancer mortality in SA over 20 years (1999-2020). Methods: Joinpoint regression analyses of the trends in crude and age-standardized mortality rates (ASMR) of breast cancer among South African women were conducted from 1999 to 2018 using mortality data from Statistics South Africa. Age-period-cohort regression analysis was then conducted to evaluate the independent effect of age, period, and cohort on breast cancer mortality, and analysis was stratified by ethnicity. Results: The mortality rate of breast cancer (from 9.82 to 13.27 per 100,000 women) increased at around 1.4% per annum (Average Annual Percent Change (AAPC): 1.4%, 95% CI:0.8-2.0, P-value< 0.001). Young women aged 30-49 years (1.1%-1.8%, P-value< 0.001) had increased breast cancer mortality. The risk of breast cancer mortality increased among successive birth cohorts from 1924 to 1928 but decreased among recent cohorts born from 1989 to 1993. In 2018, the breast cancer mortality rate among Blacks (9.49/100,000 women) was around half of the rates among the non-Blacks. (Coloreds: 18.11 per 100,000 women; Whites: 17.77/100,000 women; Indian/Asian: 13.24 per 100,000 women). Conclusions: Contrary to the trends in high- and middle-income countries, breast cancer mortality increased in South Africa especially among young women. Breast cancer prevention programs should be intensified and should also target young women. The marked disparity in ethnic burden of breast cancer should be considered during planning and implementation of interventions.

Trends of cleft surgeries and predictors of late primary surgery among children with cleft lip and palate at the University College Hospital, Nigeria: A retrospective cohort study.

BACKGROUND: Cleft of the lip and palate is the most common craniofacial birth defect with a worldwide incidence of one in 700 live births. Early surgical repairs are aimed at improving appearance, speech, hearing, psychosocial development and avoiding impediments to social integration. Many interventions including the Smile Train partner model have been introduced to identify and perform prompt surgical procedures for the affected babies. However, little is known about the trends of the incidence and surgical procedures performed at our hospital. Nothing is also known about the relationship between the clinical characteristics of the patients and the timing of primary repairs. OBJECTIVE: To determine the trends in cleft surgeries, patterns of cleft surgeries and identify factors related to late primary repair at the University College Hospital, UCH, Ibadan, Nigeria. METHODS: A retrospective cohort study and trends analysis of babies managed for cleft lip and palate from January 2007 to January 2019 at the UCH, Ibadan was conducted. The demographic and clinical characteristics were extracted from the Smile Train enabled cleft database of the hospital. The annual trends in rate of cleft surgeries (number of cleft surgeries per 100,000 live births) was represented graphically. Chi square test, Student's t-test and Mann Whitney U were utilised to assess the association between categorical and continuous variables and delay in cleft surgery (≥12 months for lip repair, ≥18months for palatal repair). Kaplan-Meier graphs with log-rank test was used to examine the association between sociodemographic variables and the outcome (late surgery). Univariable and multivariable Cox proportional hazard regression was conducted to obtain the hazard or predictors of delayed cleft lip surgery. Stata version 17 (Statacorp, USA) statistical software was utilised for analysis. RESULTS: There were 314 cleft surgeries performed over the thirteen-year period of study. The male to female ratio was 1.2:1. The mean age of the patients was 58.08 ± 99.65 months. The median age and weight of the patients were 11 (IQR:5-65) months and 8 (IQR: 5.5-16) kg respectively. Over half (n = 184, 58.6%) of the cleft surgeries were for primary repairs of the lip and a third (n = 94, 29.9%) were surgeries for primary repairs of the palate. Millard's rotation advancement flap was the commonest lip repair technique with Fishers repair introduced within two years into the end of the study. Bardachs two flap palatoplasty has replaced Von Langenbeck palatoplasty as the commonest method of palatal repair. The prevalence of late primary cleft lip repair was about a third of the patients having primary cleft lip surgery while the prevalence of late palatal repair was more than two thirds of those who received primary palatoplasty. Compared with children who had bilateral cleft lip, children with unilateral cleft lip had a significantly increased risk of late primary repair (Adj HR: 22.4, 955 CI: 2.59-193.70, P-value = 0.005). CONCLUSION: There has been a change from Von Langenbeck palatoplasty to Bardachs two-flap palatoplasty. Intra-velar veloplasty and Fisher's method of lip repair were introduced in later years. There was a higher risk of late primary repair in children with unilateral cleft lip.

Comparative Assessment of p16/Ki-67 Dual Staining Technology for cervical cancer screening in women living with HIV (COMPASS-DUST)-Study protocol.

The risk of progression of low-grade (CIN1) to high-grade cervical intraepithelial neoplasia (CIN2/3) is 3-5 times higher for women living with HIV (WLHIV) than for HIV-negative women. Evidence suggests that the current cervical cancer screening methods perform less effectively in WLHIV. An emerging screening method-p16/Ki-67 dual staining technology (DUST) is a safe and rapid assay that could be used to detect CIN2/3 with higher sensitivity and specificity. The study in this protocol will evaluate the performance of DUST in cervical cancer screening among WLHIV. We will conduct an intra-participant comparative study (Phase 1) to enrol n = 1,123 sexually active WLHIV aged 25-65 years at two accredited adult HIV treatment centres in Lagos, Nigeria to compare the performance of DUST to the currently used screening methods (Pap smear, hr-HPV DNA, or VIA testing) in detecting high-grade CIN and cancer (CIN2+). Subsequently, a prospective cohort study (Phase 2) will be conducted by enrolling all the WLHIV who are diagnosed as having low-grade CIN (CIN1) in Phase 1 for a 6-monthly follow-up for 2 years to detect the persistence and progression of CIN1 to CIN2+. The findings of this study may provide evidence of the existence of a better performance screening method for the primary and triage detection of CIN2+ in WLHIV. It may also demonstrate that this high-performance test can improve the long-term predictive accuracy of screening by extending the intervals between evaluations and thus decrease the overall cost and increase screening uptake and follow-up compliance in WLHIV.

Population-Based Temporal Trends and Ethnic Disparity in Cervical Cancer Mortality in South Africa (1999-2018): A Join Point and Age-Period-Cohort Regression Analyses.

Cervical cancer is one of the leading causes of cancer deaths among women in low- and middle-income countries such as South Africa. The current impact of national cervical cancer control and sexual and reproductive health interventions in South Africa reduce its burden. The aim of this study was to assess the trends in cervical cancer mortality and its relation to breast and gynaecological cancers in South Africa from 1999 to 2018. We conducted joinpoint regression analyses of the trends in crude and age-standardised mortality rates (ASMR) for cervical cancer mortality in South Africa from 1999 to 2018. An age−period−cohort regression analysis was also conducted to determine the impact of age, period, and cohort on cervical cancer mortality trends. Analyses were stratified by ethnicity. Cervical cancer (n = 59,190, 43.92%, 95% CI: 43.65−44.18%) was responsible for about 43.9% of breast and gynecological cancer deaths. The mortality rate of cervical cancer (from 11.7 to 14.08 per 100,000) increased at about 0.9% per annum (Average Annual Percent Change (AAPC): 0.9% (AAPC: 0.9%, p-value < 0.001)), and young women aged 25 to 49 years (AAPC: 1.2−3.5%, p-value < 0.001) had increased rates. The risk of cervical cancer mortality increased among successive birth cohorts. In 2018, cervical cancer mortality rate among Blacks (16.74 per 100,000 women) was about twice the rates among Coloureds (8.53 deaths per 100,000 women) and approximately four-fold among Indians/Asians (4.16 deaths per 100,000 women), and Whites (3.06 deaths per 100,000 women). Cervical cancer control efforts should be enhanced in South Africa and targeted at ethnic difference, age, period, and cohort effects.

Pre- and intra -COVID-19 trends of contraceptive use among women who had termination of pregnancy at Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg South Africa (2010-2020).

BACKGROUND: Contraception is a key prevention strategy for maternal morbidity and mortality and is an important component of postabortion care. The trend of contraceptive uptake can guide interventions among vulnerable individuals. The aim of the study was to determine the trends of immediate post-abortion contraceptive uptake among women who had induced abortion at a dedicated abortion centre in Johannesburg, South Africa. METHOD: This study was a retrospective cross-sectional and trend analysis of the contraceptive uptake among women who had legal termination of unwanted pregnancy at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), from 1 January 2010 to 31 December 2020. We reviewed the nursing records and summaries of the induced abortion cases that were performed for the past eleven years from 1 January 2010 to 31 December 2020. The trends in the annual number of abortion seeking clients, annual contraceptive uptake rate (stratified by types), age of clients and gestational age at presentation were extracted into a spreadsheet for analysis. Join point regression modelling and Pearson's chi square were utilized to assess the trends and association between categorical variables. The trends before and during the Corona Virus disease(COVID-19) era were also compared. RESULTS: In all, 12,006 clients had induced abortion over the study period. Nearly half (n = 5915, 49.26%) of the clients were aged 26-40 years, one tenth (n = 1157, 9.64%) being teenagers and one third (n = 4619, 38.47%) between age 19-25 years. There was a 16.3% annual increase in the number of abortion clients performed at the facility from 2010 to 2014 and a gradual declining trend of about 9.2% per annum from 2014 to 2019. The overall postabortion contraceptive uptake rate was 74.5%. There was an initial 15.1% annual decline in contraceptive uptake per 100 clients from 2010 to 2014 and a subsequent increasing trend of about 11.1% per annum from 53.45 per 100 clients in 2014 to 98 per 100 clients in 2019. About 66.43% of the clients opted for injectable contraceptives. There was a reduction in the number of abortion seeking clients by 32.2% from 985 in 2019 to 668 in 2020 during the COVID-19 era. However, the contraceptive uptake was still high in 2020 (90.72%). There was no statistically significant relationship between the age group and the time periods. Thus, the distribution of the age group accessing the abortion services did not significantly change over the two time periods of 2010-2014 and 2015-2019. (P-value = 0.076). CONCLUSION: There was increased trends in postabortion contraceptive uptake among our clients from 2010 to 2020. Although there was reduced number of performed induced abortion during the COVID -19 era, the contraception uptake rate was still high during the COVID-19 era. About 6 out of every 10 clients accepted injectable contraceptives. More education is needed to improve uptake of other long-acting contraception that may not require frequent contact with the health facility.

Trends and Determinants of Operative Vaginal Delivery at Two Academic Hospitals in Johannesburg, South Africa 2005-2019.

Operative Vaginal delivery (OVD) can reduce perinatal and maternal morbidity and mortality especially in low resource setting such as South Africa. We evaluated the trends and determinants of OVD rates using join point regression at Charlotte Maxeke Johannesburg (CMJAH) and Chris Hani Baragwaneth (CHBAH) Academic Hospitals from 1 January 2005−31 December 2019 and conducted a comparative study of OVD (n = 179) and normal delivery (n = 179). Over the 15-year study period (2005−2019), 323,617 deliveries and 4391 OVDs were conducted at CHBAH giving an OVD rate of 1.36 per 100 births. In CMJAH, 74,485 deliveries and 1191 OVDs were conducted over an eleven-year period (2009−2019) with OVD rate of 1.60 per 100 births. OVD rate at CHBAH increased from 2005−2014 at 9.1% per annum and declined by 13.6% from 2014−2019, while OVD rates fluctuates at CMJAH. Of the 179 patients who had OVD, majority (n = 166,92.74%) had vacuum. Women who had OVDs were younger than those who vaginal delivery (p-value < 0.001). The prevalence of OVDs was higher among nulliparous women (p-value < 0.001), HIV negative women (p-value = 0.021), underweight (p-value < 0.001) as compared to normal delivery. The OVD rates has dramatically reduced over the study period This study heightens the need to further evaluate barriers to OVD use in our environment

Maternal tumour necrosis factor-alpha levels in preeclamptic pregnancies in Lagos, South-West Nigeria.

OBJECTIVE: This study aimed to assess the association between maternal serum levels of TNF-α and preeclampsia. METHODS: An analytical cross-sectional study involving 45 women diagnosed with preeclampsia and 45 healthy normotensive pregnant women matched for age, and gestational age at enrolment. Venous samples were collected from each participant after informed consent was obtained. Serum TNF-α level was determined using the human TNF-α competitive enzyme-linked immunosorbent assay (ELISA) technique with ELISA Kit. Hypothesis testing was done using the Chi-square test for categorical variables, the independent samples t-test and the Kruskal-Wallis test for numerical variables. All significances were reported at P < 0.05. RESULTS: The median concentrations of TNF-α in women with preeclampsia of varying severity were significantly higher than those with normotensive pregnancies (P = 0.001). The median level of TNF-α was also significantly higher in patients with severe features of preeclampsia than in those without. The estimated cut-off levels of serum TNF-α were 15.6 ng/mL and 26.4 ng/mL respectively for the development and severity of preeclampsia. Maternal serum TNF-α level in preeclamptic patients is strongly correlated with systolic and diastolic BP, serum uric acid and alkaline phosphatase levels, proteinuria, and platelet count (P < 0.05). CONCLUSION: We can infer from this study that increased maternal serum levels of TNF-α may play a significant role in the pathogenesis of preeclampsia. We recommend further validation of these findings with a more robust longitudinal characterization of maternal serum TNF-α profiles in pregnancy through a well-designed prospective cohort study.

Prevalence of hypertension and determinants of poor blood pressure control in patients with Type 2 diabetes mellitus attending a Tertiary Clinic in Lagos, Nigeria.

Objective: The objective is to determine the prevalence of comorbid hypertension and blood pressure (BP) control among patients with Type-2-diabetes-mellitus attending a tertiary-hospital in Lagos, and identify the determinants of poor BP control. Materials and Methods: A cross-sectional study of 238 consecutive patients with Type-2-diabetes Mellitus (DM) at the adult diabetes-clinic of a tertiary health-facility in Lagos, Nigeria over a 5-month period. Data were retrieved with the aid of structured-investigator-administered-questionnaire, physical examination, and review of hospital record. Hypertension was defined as BP ≥140/90 mmHg and target BP control was defined as <130/80 mmHg. Logistic regression analysis was used to identify the independent determinants of poor BP control. Results: Comorbid hypertension was present in 187 (78.6%) of study participants with males (68/87 [78.8%]) and females (119/151 [78.2%]) similarly affected, P = 0.907. Older age (62.9 ± 10.1 vs. 54.9 ± 9.6 years) and obesity (35.3% vs. 17.6%) were associated with comorbid hypertension, P < 0.05. Awareness, treatment, and medication adherence rates were 96.3%, 100%, and 46%, respectively. Only 17.1% (n = 32/187) had BP controlled to target. Waist circumference (WC) (adjusted odd ratio: 1.04, 95% confidence interval [CI]: 1.01-1.06) and poor glycemic control (adjusted odd ratio: 5.39, 95% CI: 2.07-13.99) were the predictors of poor BP control. Conclusion: The prevalence of co-morbid hypertension in Type 2 DM patients in our setting is high and the BP control rate is low. Increasing WC and poor glycemic control are the independent determinants of poor BP control. Individualized weight reduction and glycemic control strategies may help achieve target BP control.

Résumé Objectif: L'objectif est de déterminer la prévalence de l'hypertension comorbide et du contrôle de la pression artérielle (PA) chez les patients atteints de diabète sucré de type 2 fréquentant un hôpital tertiaire à Lagos et d'identifier les déterminants d'un mauvais contrôle de la pression artérielle. Matériaux et méthodes: Une étude transversale de 238 patients consécutifs atteints de diabète sucré (DM) de type 2 à la clinique de diabète pour adultes d'un établissement de santé tertiaire à Lagos, au Nigéria, sur une période de 5 mois. Les données ont été récupérées à l'aide d'un questionnaire structuré administré par l'investigateur, d'un examen physique et d'un examen des dossiers hospitaliers. L'hypertension a été définie comme une pression artérielle ≥140/90 mmHg et le contrôle de la PA cible a été défini comme une pression artérielle inférieure à 130/80 mmHg. L'analyse de régression logistique a été utilisée pour identifier les déterminants indépendants d'un mauvais contrôle de la PA. Résultats: L'hypertension comorbide était présente chez 187 (78,6 %) des participants à l'étude, les hommes (68/87 [78,8 %]) et les femmes (119/151 [78,2 %]) ayant été touchés de la même manière, P = 0,907. L'âge plus avancé (62,9 ± 10,1 contre 54,9 ± 9,6 ans) et l'obésité (35,3 % contre 17,6 %) étaient associés à une hypertension comorbide, P était inférieur à 0,05. Les taux de sensibilisation, de traitement et d'observance thérapeutique étaient de 96,3 %, 100 % et 46 %, respectivement. Seulement 17,1 % (n = 32/187) ont vu leur tension artérielle contrôlée pour cibler. Le tour de taille (WC) (rapport impair ajusté: 1,04, intervalle de confiance à 95%[IC]: 1,01-1,06) et mauvais contrôle glycémique (rapport impair ajusté: 5,39, IC à 95%: 2,07-13,99) étaient les prédicteurs d'un mauvais contrôle de la PA. Conclusion: La prévalence de l'hypertension comorbide chez les patients atteints de DM de type 2 dans notre milieu est élevée et le taux de contrôle de la PA est faible. L'augmentation de la WC et un mauvais contrôle glycémique sont les déterminants indépendants d'un mauvais contrôle de la PA. Des stratégies individualisées de réduction de poids et de contrôle glycémique peuvent aider à atteindre le contrôle de la PA cible. Mots-clés: Contrôle de la pression artérielle, hypertension comorbide, contrôle glycémique, Nigeria, diabète sucré de type 2.