Association between C-Reactive Protein and low-grade Inflammation among Nigerian women with Polycystic Ovarian Syndrome.

BACKGROUND: There is evidence of a low-grade chronic inflammation reflected by minor but significant increases in circulating levels of inflammatory mediators in polycystic ovary syndrome (PCOS). There is uncertainty about the causal relationship whether it is obesity, insulin resistance, or PCOS. There is a paucity of studies from the West African subregion. OBJECTIVES: The study investigated C-reactive protein (CRP) concentration in Nigerian women with PCOS, and determined the factors that affect their concentration. METHODS: The study was conducted on 71 Nigerian women with PCOS and 76 normal ovulating women, recruited from the University of Benin Teaching Hospital and the Women's Health and Action Research Centre, in Nigeria. CRP levels were measured by the enzyme-linked immunosorbent assay (ELISA) method. Insulin resistance and insulin sensitivity were estimated using the Homeostatic Model Assessment Index and Quantitative Insulin-sensitivity Check Index respectively. RESULTS: The CRP levels were significantly elevated in Nigerian women with PCOS compared to controls (9.93 ± 8.38 vs 5.54 ± 5.93 mg/L; p=0.000). It positively correlated with age (r = 0.297, p = 0.012), Weight (r =0.313, p = 0.008) and BMI (r = 0.339, p = 0.004). Multiple linear regression analysis revealed that CRP values are positively associated with BMI (ß = 0.274, p = 0.001) and PCOS (ß = 0.382, p = 0.001). The CRP values were positively associated with BMI (ß = 0.372, p = 0.012) and negatively associated with QUICKI (ß = -0.644, p = 0.073). CONCLUSIONS: Among Nigerian women with PCOS, inflammation may be mediated through adiposity since the main predicting factor for increased CRP is BMI.

CONTEXTE: Il existe des preuves d'une inflammation chronique de faible intensité, se manifestant par des augmentations mineures mais significatives des taux circulants de médiateurs inflammatoires, dans le syndrome des ovaires polykystiques (SOPK). Il existe une incertitude quant à la relation causale, qu'il s'agisse de l'obésité, de la résistance à l'insuline ou du SOPK. Les études de cette région d'Afrique de l'Ouest sont rares. OBJECTIFS: L'étude a examiné la concentration de la protéine C-réactive (CRP) chez les femmes nigérianes atteintes du SOPK et a déterminé les facteurs qui influent sur leur concentration. MÉTHODES: L'étude a été menée auprès de 71 femmes nigérianes atteintes du SOPK et de 76 femmes à ovulation normale, recrutées à l'hôpital universitaire de Benin et au Centre de recherche sur la santé des femmes et l'action (Women's Health and Action Research Centre) au Nigéria. Les niveaux de CRP ont été mesurés à l'aide de laméthode ELISA (dosage immuno-enzymatique). La résistance à l'insuline et la sensibilité à l'insuline ont été estimées à l'aide de l'indice du modèle homéostatique d'évaluation et de l'indice de vérification quantitative de la sensibilité à l'insuline. RÉSULTATS: Les taux de CRP étaient significativement élevés chez les femmes nigérianes atteintes du SOPK par rapport aux témoins (9,93 ± 8,38 contre 5,54 ± 5,93 mg/L ; p = 0,000). Ils étaient positivement corrélés à l'âge (r = 0,297, p = 0,012), au poids (r = 0,313, p = 0,008) et à l'IMC (r = 0,339, p = 0,004). L'analyse de régression linéaire multiple a révélé que les valeurs de la CRP sont positivement associées à l'IMC (ß = 0,274, p = 0,001) et au SOPK (ß = 0,382, p = 0,001). Les valeurs de la CRP étaient positivement associées à l'IMC (ß = 0,372, p = 0,012) et négativement associées au QUICKI (ß = -0,644, p = 0,073). CONCLUSIONS: Chez les femmes nigérianes atteintes du SOPK, l'inflammation pourrait être médiée par l'adiposité, car le principal facteur prédictif d'une augmentation de la CRPest l'IMC. Mots-clés: Protéine C-réactive, inflammation chronique, syndrome des ovaires polykystiques, indice de vérification quantitative de la sensibilité à l'insuline, indice du modèle homéostatique d'évaluation.

Women's perceptions of reasons for maternal deaths: Implications for policies and programs for preventing maternal deaths in low-income countries.

We investigated perceptions of the causes of maternal mortality by women attending referral hospitals in Nigeria. Focus group discussions were conducted with various categories of women. Our results showed that women were aware of the medical causes of mortality, although a few listed divine reasons. Delays in reaching hospitals or after women arrive in hospitals featured prominently as lead causes mentioned by women. Listening to women as end-users is an important approach to identify points of remediation in the provision of maternal health care. This should be taken into cognizance when policymakers or international agencies plan the prevention of maternal deaths in developing countries.

Case report of an unusual finding of intrauterine contraceptive device in the rectum.

INTRODUCTION: Intrauterine contraceptive device (IUCD) is a safe and effective method of contraception. It is however rarely associated with complications. Migration of this device to the rectum is very rare. We report a case of IUCD migrating to the rectum with the history of missing IUCD strings. PRESENTATION OF CASE: A 32-year-old multipara presented 8 weeks following IUCD insertion with missing thread, ultrasound scan done showed a viable pregnancy with IUCD in-situ. Following vaginal examination, IUCD could not be retrieved. Pregnancy was allowed to continue for IUCD to be retrieved at delivery. She presented again about 6 weeks later with IUCD strings protruding through the rectum and was subsequently removed. DISCUSSION: Uterine perforation and migration of IUCD into the pelvic organs is an uncommon but major complication following insertion of the device. The risk of perforation appears to depend on type of device, skill of the operator and position of the uterus. Postpartum insertion, lactation and atrophic uterus also increase risk of perforation. CONCLUSION: perforation and migration of IUCD to the rectum is a rare but possible complication of following insertion of the device. Family planning providers should continue to undergo training and retraining to minimize complications associated with the use of IUCD.

Understanding birthing preferences of women in Benin City, Nigeria: a qualitative study.

OBJECTIVE: The aim of this study was to explore women's birthing preferences and the motivational and contextual factors that influence their preferences in Benin City, Nigeria, so as to better understand the low rates of healthcare facility usage during childbirth. SETTING: Two primary care centres, a community health centre and a church within Benin City, Nigeria. PARTICIPANTS: We conducted one-on-one in-depth interviews with 23 women, and six focus groups (FGDs) with 37 husbands of women who delivered, skilled birth attendants (SBAs), and traditional birth attendants (TBAs) in a semi-rural region of Benin City, Nigeria. RESULTS: Three themes emerged in the data: (1) women reported frequently experiencing maltreatment from SBAs in clinic settings and hearing stories of maltreatment dissuaded women from giving birth in clinics, (2) women reported that the decision of where to deliver is impacted by how they sort through a range of social, economic, cultural and environmental factors; (3) women and SBAs offered systemic and individual level solutions for increasing usage of healthcare facilities delivery, which included decreasing costs, increasing the ratio of SBAs to patients and SBAs adopting some practices of TBAs, such as providing psychosocial support to women during the perinatal period. CONCLUSION: Women in Benin City, Nigeria indicated that they want a birthing experience that is emotionally supportive, results in a healthy baby and is within their cultural scope. Adopting a woman-centred care approach may encourage more women to transition from prenatal care to childbirth with SBAs. Efforts should be placed on training SBAs as well as investigating how non-harmful cultural practices can be integrated into local healthcare systems.

Spousal disclosure of HIV serostatus among women attending antenatal care in urban Nigeria.

About 80% of HIV-positive pregnant women in our unit have a seronegative spouse. The prevalence, pattern and determinants of spousal disclosure of HIV serostatus was evaluated among 166 HIV-positive pregnant women receiving antiretroviral treatment. Although 146 women (88%) disclosed their HIV serostatus, 20 women (12%) did not disclose their status to their spouse. Non-disclosure was significantly associated with nulliparous (p=0.024) and unmarried women (p=0.026). Fear, regarding spread of the information (57.8%), stigmatisation (53%) and deterioration in the relationship with the spouse (47%) were the three commonest reasons for non-disclosure. Disclosure of HIV-positive status remains a sensitive issue among infected pregnant women. Strategies to reduce the stigma associated with HIV infection, appropriate management of the information following disclosure of seropositive status by HIV-infected persons are necessary to encourage disclosure to sexual partners and ultimately prevent new HIV infections.

Predictors of successful vaginal delivery after previous caesarean section in a Nigerian tertiary hospital.

Achieving a successful vaginal birth after a previous caesarean section (VBAC) is an important strategy in reducing the rising rate of caesarean section and its associated morbidities. Records of 188 women attempting trial of vaginal delivery after a previous lower segment caesarean section were reviewed to predict factors favouring successful vaginal delivery. Of the 188 women, 64 had recurrent indications for caesarean section, while 124 had non-recurrent indications. The group with recurrent indications for previous caesarean section had less vaginal delivery and more repeat caesarean sections as compared with the group with non-recurrent indications (21.9% and 78.1% vs 46.8% and 53.2%, respectively, p = 0.01). Cephalopelvic disproportion was more frequent in the group with recurrent indications (65.6% vs 27.4%, p < 0.0001). Significant predictors of successful VBAC in this cohort of women were non-recurrent indications for the previous caesarean section (p < 0.001, odds ratio (95% CI) 0.32 (0.2-0.6)) and a previous vaginal delivery (p < 0.0001, odds ratio (95% CI) 3.90 (2.1-7.4)). A previous vaginal delivery and a non-recurrent indication for the previous caesarean section are important predictors of VBAC in this cohort of women.

The prevalence of dual human immunodeficiency virus/hepatitis C virus (HIV/HCV) infection in asymptomatic pregnant women in Benin City, Nigeria.

Concerted efforts have been made to combat HIV infection in Nigerian. By contrast, much less attention has been paid to hepatitis C viral (HCV) infection. These viruses have similar immuno-epidemiology. The objective of this study was to determine the prevalence of HCV/HIV dual infection among 269 antenatal attendees at the University of Benin Teaching Hospital in southern Nigeria. The study was prospective and cross-sectional and consisted of the analysis of the sera of the participants for anti-HCV and HIV antibodies using ELISA. The result showed that 1.86% samples were HCV antibodies positive while 8.30% were seropositive for HIV-1 antibodies. There were no cases of dual infections. The HIV positive women and their babies had antiretroviral therapy. We conclude that dual HCV/HIV infection in pregnancy in Nigeria may be uncommon but suggest multicenter studies to determine the national prevalence while initiating strategies for their prevention.

Coitally Related Traumatic Injury of the Female Genital Tract in a Nigerian Urban Setting: A-5 year review.

BACKGROUND: Available evidence suggests that most female lower genital tract injuries are primarily of coital origin and may result in death where prompt diagnosis and treatment is not obtained. Yet there is paucity of recent reports on this clinical entity from our setting. METHODS: This was a retrospective study of the service delivery records of patients with coital trauma seen at the University of Benin Teaching Hospital over 5 years. RESULTS: The incidence of coital trauma was 0.7% of the total gynaecological patients (3,300) seen within the study period. Majority (52.2%) of the patients were nulliparous. A significant proportion (73.9%) of the patients were single and 82.2% had primary or no formal education. Coital laceration occurred in sexual intercourse with boyfriends in 39.1% of patients and casual sex partners in 30.4% of cases. Non-consensual sex was reported in 47.8% of the patients and 39.1% had consensual sex. Sex was pre-marital in 65.2% of the cases. Inadequate or lack of foreplay was a significant predisposing circumstance to coital trauma (56.5%). Pain was a presenting symptom in 60.9% of cases, and same proportion of patients had laceration > 4cm. CONCLUSION: The incidence of coitally associated trauma was low. Nulliparity, low levels of education, non-consensual and premarital sex with little or no foreplay were strongly correlated with the risk of coital trauma. Severe forms of intra-peritoneal complications were not documented in this series. Management strategies were quite adequate.

Seroprevalence of Hepatitis C viral antibodies in pregnancy in a tertiary health facility in Nigeria.

BACKGROUND: Liver disease due to Hepatitis C viral (HCV) infection is the most common indication for liver transplant. It is a viral pandemic that is five times as widespread as the human immunodeficiency virus type 1 infection. In spite of this, vaccines were yet unavailable for protection of the human race due to the morphology and fastidious nature of the organism. While the scanty data available on this infection in our environment are limited to blood donors, people continue to be screened for and deprived of renal dialysis if any patient is found to have HCV infection. Also in this environment, data on HCV infection in pregnancy is virtually nonexistent even though the infection can have a deleterious effect on materno-fetal outcome. OBJECTIVE OF THE STUDY: To determine the seroprevalence of hepatitis C viral antibodies among antenatal women attending a tertiary health facility in Nigeria. METHODOLOGY: This was a prospective cross-sectional study whose subjects were booked consecutive antenatal women volunteers attending the University of Benin Teaching Hospital, Benin City, Nigeria between June 1 and December 31, 2005. Hepatitis C viral antibodies were determined and confirmed using a second and a third generation Enzyme Linked immunosorbent assay respectively. Both HCV sero-positive and seronegative women had both pre-and post-test counseling. RESULTS: Of the 269 samples screened for HCV antibodies, 5 (1.86%) samples were confirmed seropositive. None of the HCV seropositive women had liver enzyme derangement. CONCLUSION: Hepatitis C viral infection in pregnancy is not uncommon in Nigeria. It's prevalence in pregnant women South-South of Nigerian is similar to that of their Cameroonian counterparts, an immediate neighbouring country. A multi-centre study to determine the national prevalence of HCV and in addition to elevation of public awareness is suggested. Hepatitis C viral-induced liver disease remains the major indication for liver transplant for which our present levels of economy and health infrastructures can least support. With no vaccines and no cure, the time to act is now.

Perceptions and attitudes of a rural community to abortion in the Niger-delta region of Nigeria.

OBJECTIVE: To determine the perceptions and beliefs relating to unwanted pregnancy, family planning and abortion, and identify issues that can be leveraged to initiate positive attitudes towards family planning and abortion in the area. MATERIALS AND METHODS: Focus group discussions (FGDs) and in-depth interviews (IDIs) were conducted in Amukpe, Delta State, Nigeria. A highly motivated and well-trained team versed in the local language and culture conducted the FGDs and IDIs. RESULTS: There was unanimity that unwanted pregnancies was quite common amongst women of reproductive age group and constitute a significant problem in the community. Abortion, particularly in the hands of quacks was a major option to handling an unwanted pregnancy. Almost all agreed that their culture and religion abhors abortion, yet widely practiced because of the odium associated with an unwanted pregnancy in the community. The knowledge of the Nigeria National abortion law even amongst the health workers and teachers was generally poor. The participants agreed that there were problems and complications (often severe) including death associated with abortion in the community. It was largely agreed that contraceptive knowledge and usage was poor. The reasons adduced for this include lack of knowledge, lack of spousal consent, socio-cultural taboos and misconceptions, as well as economic reasons. It was suggested that imbibing positive family values by parents in their wards and government leveraging the socio-economic status of the community will go a long way to stemming the tide. CONCLUSION: Unwanted pregnancy, unsafe abortion and abortion complications are reported to be common amongst women of reproductive age group in Amukpe community, whilst contraceptive awareness and usage is poor.

Pregnancy outcome in women with sickle cell - a five year review.

OBJECTIVES: To evaluate the cases of sickle cell anaemia in obstetric practice, and to highlight their problems in pregnancy as well as their contribution to maternal and foetal outcome in Nigeria. We believe that the findings would be useful for designing interventions to reduce the obstetric burden of sickle cell disease. PATIENTS AND MATERIALS: The service delivery record of 42 pregnancies in 39 patients with sickle cell disease was retrospectively reviewed at the University of Benin Teaching Hospital (UBTH) between January 2000 and December 2004. RESULTS: The incidence of sickle cell disease in the study was 8.7/1000 deliveries. Nearly 62% of the patients were aged 25-34 years, while 76.2% were either nulliparous (Para O) or primiparous (Para 1). There was one grandmultipara (2.38%). Anaemia (95.25%), Malaria (33.33%), Bone pain crisis (23.81%), and pneumonia (19.05%) in that order of frequency were the most common complications of pregnancy. The perinatal mortality rate was 250 per 1000 births while the maternal mortality rate was 47.6 per 1000 pregnancies. At delivery, 20% of cases had caesarean section (5% elective and 15% emergency) and the instrumental interventions include 12.5% vacuum and 27.5% forceps respectively. CONCLUSION: Early booking, good antenatal care and supervised hospital delivery produced a better obstetric outcome.

Perceptions of women on workloads in health facilities and its effect on maternal health care: A multi-site qualitative study in Nigeria.

OBJECTIVE: of the study was to explore women's perception of maternal health care providers' workload and its effects on the delivery of maternal healthcare in secondary and tertiary hospitals in Nigeria. RESEARCH DESIGN, SETTING, PARTICIPANTS: five focus groups discussions (FGDs) were conducted with women in each of eight secondary and tertiary hospitals in 8 States in four geo-political zones of the country. In all, 40 FGDs were held with women attending antenatal and post-natal clinics in the hospitals. We elicited information on women's perceptions of workloads of maternal health providers and the effects of the workloads on maternity care. The discussions were audio-taped and transcribed while thematic analysis was carried out using Atlas.ti computer software. FINDINGS: the majority of the participants submitted that the health providers are burdened with heavy workloads in the provision of maternal health care. Examples of heavy workload cited included complaints from health providers, evidence of stress and strain in care provision by providers and the sheer numbers of patients that are left unattended to in health facilities. Poor quality care, insufficient time to carry out necessary investigations on patients, and prolonged waiting time experienced by women in accessing care featured as consequences of heavy workload, with the secondary result that women are reluctant to seek care in the health facilities because of the belief that they would spend a long time in receiving care. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: we conclude that women are concerned about heavy workloads experienced by healthcare providers and may partly account for the low utilization of referral health facilities for maternal health care in Nigeria. Efforts to address this problem should include purposeful human resource policy development, the development of incentives for health providers, and the proper re-organization of the health system.

Achieving accountability through maternal death reviews in Nigeria: a process analysis.

Maternal death reviews (MDRs) are part of the drive to increase accountability for maternal deaths and reduce their occurrence by identifying barriers to effective, quality care. However, conducting MDRs well is difficult; staff commitment and establishing a blame free environment are key challenges. By examining the communication strategies used in MDRs this study sought to understand how MDR members implement policy imperatives (e.g. 'no blame, no name') and manage the inevitable sensitivities of discussing a client's death in a multidisciplinary team. We observed and recorded four MDRs in Nigerian teaching hospitals and used conversation and discourse analysis to identify patterns in verbal and non-verbal interactions. MDRs were conducted in a structured way and had multidisciplinary representation. We grouped discursive strategies observed into three overlapping clusters: 'doing' no-name no-blame; fostering participation; and managing personal accountability. Within these clusters, explicit reminders, gentle enquiries and instilling a sense of togetherness were used in doing no-name, no-blame. Strategies such as questioning and invoking protocol were only partially successful in fostering participation. Regarding managing accountability, forms of communication which limit personal responsibility ('pass the buck') and resist passing the buck were observed. Detailed, lengthy eye witness accounts of dramatic events appeared to reduce staff's personal accountability. We conclude that interactional processes affect the meaningfulness of MDRs. In-depth, critical analysis depends on resisting 'passing the buck' by practitioners and chairs especially, who are also key to fostering participation and extracting value from multidisciplinary representation. Our innovative methods provide detailed insights into MDRs as an interactional process, which can inform design of training aimed at enhancing MDR members' skills. However, given the multitude of systemic challenges we should also adjust our expectations of MDRs and the individual practitioners tasked to perform them in the name of enhancing accountability for maternal death reduction.