Seroepidemiology of Lassa virus in pregnant women in Southern Nigeria: A prospective hospital-based cohort study.

BACKGROUND: There is limited epidemiological evidence on Lassa fever in pregnant women with acute gaps on prevalence, infection incidence, and risk factors. Such evidence would facilitate the design of therapeutic and vaccine trials and the design of control programs. Our study sought to address some of these gaps by estimating the seroprevalence and seroconversion risk of Lassa fever in pregnant women. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a prospective hospital-based cohort between February and December 2019 in Edo State, Southern Nigeria, enrolling pregnant women at antenatal clinic and following them up at delivery. Samples were evaluated for IgG antibodies against Lassa virus. The study demonstrates a seroprevalence of Lassa IgG antibodies of 49.6% and a seroconversion risk of 20.8%. Seropositivity was strongly correlated with rodent exposure around homes with an attributable risk proportion of 35%. Seroreversion was also seen with a seroreversion risk of 13.4%. CONCLUSIONS/SIGNIFICANCE: Our study suggests that 50% of pregnant women were at risk of Lassa infection and that 35.0% of infections might be preventable by avoiding rodent exposure and conditions which facilitate infestation and the risk of human-rodent contact. While the evidence on rodent exposure is subjective and further studies are needed to provide a better understanding of the avenues of human-rodent interaction; public health measures to decrease the risk of rodent infestation and the risk of spill over events may be beneficial. With an estimated seroconversion risk of 20.8%, our study suggests an appreciable risk of contracting Lassa fever during pregnancy and while most of these seroconversions may not be new infections, given the high risk of adverse outcomes in pregnancy, it supports the need for preventative and therapeutic options against Lassa fever in pregnancy. The occurrence of seroreversion in our study suggests that the prevalence obtained in this, and other cohorts may be an underestimate of the actual proportion of women of childbearing age who present at pregnancy with prior LASV exposure. Additionally, the occurrence of both seroconversion and seroreversion in this cohort suggests that these parameters would need to be considered for the development of Lassa vaccine efficacy, effectiveness, and utility models.

Prevalence and pattern of intimate partner violence among men and women in Edo State, Southern Nigeria.

BACKGROUND:  Intimate partner violence (IPV) is a growing concern in Nigeria and globally. Although women are at greater risk of IPV, men are also affected, but this is less reported. AIM:  This study sought to determine the prevalence and pattern of IPV among the respondents and to compare the pattern of IPV among the male and female respondents. SETTING:  The study was conducted in six towns (local government headquarters) across the three senatorial districts in Edo State, Southern Nigeria. METHODS:  The study was a descriptive, cross-sectional, community-based study. A multistage sampling technique was used in selecting 1227 respondents from Edo State, Southern Nigeria. A semistructured, interviewer-administered questionnaire and the Extended Hurt, Insult, Threaten, Scream (E-HITS) tool were used to collect data, which were analysed with Epi Info version 7.1.2.0. RESULTS:  The study found an IPV prevalence of 37.7% among the respondents (confidence interval [CI]: 95%, odds ratio [OR]: 0.169-0.294). The mean age was 38 ± 12 and respondents were mostly female (725, 59.1%), married (770, 62.8%) and unemployed (406, S33.1%), with a tertiary level of education (766, 62.4%). Intimate partner violence was significantly higher among women compared with men (95% CI: 4.474, OR: 3.425-5.846). The pattern of IPV showed a lower OR between sexual and physical IPV (95% CI: 0.276, OR: 0.157-0.485). There was a higher likelihood of IPV among married women (95% CI: 1.737, OR: 1.279-2.358). CONCLUSION:  There is a need to improve the socio-economic status of the Nigerian populace, especially women. Healthy, nonviolent and safe relationships should be promoted in communities by signalling what is socially unacceptable and strengthening sanctions against perpetrators.

Corrigendum: Caseload and Case Fatality of Lassa Fever in Nigeria, 2001-2018: A Specialist Center's Experience and Its Implications.

[This corrects the article DOI: 10.3389/fpubh.2019.00170.].

Caseload and Case Fatality of Lassa Fever in Nigeria, 2001-2018: A Specialist Center's Experience and Its Implications.

Background: The general lack of comprehensive data on the trends of Lassa fever (LF) outbreaks contrasts with its widespread occurrence in West Africa and is an important constraint in the design of effective control measures. We reviewed the contribution of LF to admissions and mortality among hospitalized patients from 2001 to 2018 in the bid to address this gap. Methods: Observational study of LF caseload and mortality from 2001 to 18 in terms of the contribution of confirmed LF to admissions and deaths, and case fatality (CF) among patients with confirmed LF at a specialist center in Nigeria. The diagnosis of LF was confirmed using reverse transcription polymerase chain reaction (RT-PCR) test, and medians and frequencies were compared using Kruskal-Wallis, Mann-Whitney and χ2 tests, with p-values <0.05 taken as significant. Results: The contribution of confirmed LF to deaths (362/9057, 4.0%) was significantly higher than to admissions (1,298/185,707, 0.7%; OR [95% CI] = 5.9 [5.3, 6.7], p < 0.001). The average CF among patients with confirmed LF declined from 154/355 (43%) in 2001-09 to 183/867 (21.1%) (OR [95% CI] = 2.9 [2.2, 3.7], p < 0.001) in 2011-18. The annual CF declined from 94% in 2001 to 15% in 2018 whereas the caseload increased from 0.3 to 3.4%. The outbreaks were characterized by irregular cycles of high caseload in 2005-2007, 2012-2014, and 2016-2018, and progressive blurring of the seasonality. Conclusion: LF outbreaks in Nigeria have upgraded spatially and temporally, with the potential for cycles of increasing severity. The strategic establishment of LF surveillance and clinical case management centers could be a pragmatic and cost-effective approach to mitigating the outbreaks, particularly in reducing the associated CF. Urgent efforts are needed in reinvigorating extant control measures while the search for sustainable solutions continues.

Molecular diagnostics for lassa fever at Irrua specialist teaching hospital, Nigeria: lessons learnt from two years of laboratory operation.

BACKGROUND: Lassa fever is a viral hemorrhagic fever endemic in West Africa. However, none of the hospitals in the endemic areas of Nigeria has the capacity to perform Lassa virus diagnostics. Case identification and management solely relies on non-specific clinical criteria. The Irrua Specialist Teaching Hospital (ISTH) in the central senatorial district of Edo State struggled with this challenge for many years. METHODOLOGY/PRINCIPAL FINDINGS: A laboratory for molecular diagnosis of Lassa fever, complying with basic standards of diagnostic PCR facilities, was established at ISTH in 2008. During 2009 through 2010, samples of 1,650 suspected cases were processed, of which 198 (12%) tested positive by Lassa virus RT-PCR. No remarkable demographic differences were observed between PCR-positive and negative patients. The case fatality rate for Lassa fever was 31%. Nearly two thirds of confirmed cases attended the emergency departments of ISTH. The time window for therapeutic intervention was extremely short, as 50% of the fatal cases died within 2 days of hospitalization--often before ribavirin treatment could be commenced. Fatal Lassa fever cases were older (p = 0.005), had lower body temperature (p<0.0001), and had higher creatinine (p<0.0001) and blood urea levels (p<0.0001) than survivors. Lassa fever incidence in the hospital followed a seasonal pattern with a peak between November and March. Lassa virus sequences obtained from the patients originating from Edo State formed--within lineage II--a separate clade that could be further subdivided into three clusters. CONCLUSIONS/SIGNIFICANCE: Lassa fever case management was improved at a tertiary health institution in Nigeria through establishment of a laboratory for routine diagnostics of Lassa virus. Data collected in two years of operation demonstrate that Lassa fever is a serious public health problem in Edo State and reveal new insights into the disease in hospitalized patients.

Ipsilateral ectopic pregnancy occurring in the stump of a previous ectopic site: a case report.

BACKGROUND: Ectopic pregnancy continues to be a significant cause of maternal morbidity, mortality and reproductive failure in Nigeria. Ipsilateral ectopic pregnancy occurs rarely and may be difficult to diagnose in low resource settings where there are no diagnostic tools. Few cases have been reported in the literature but none in our region. CASE PRESENTATION: We present an unusual case of a 22 year old female undergraduate, from the Urhobo tribe in the Niger Delta region of Nigeria who had a recurrent left ectopic pregnancy at the stump of a previous cornual resection done five years earlier. She had a left salpingo-oophorectomy done and did well postoperatively. CONCLUSION: Ectopic pregnancy could pose a diagnostic dilemma where diagnostic facilities are not available. Every woman with a previous ectopic pregnancy would be at high risk for recurrence and that would be the condition to be ruled out if a pregnant woman presented at early gestation with abdominal pain.