Analysis of the genomic landscapes of Barbadian and Nigerian women with triple negative breast cancer.

PURPOSE: Triple negative breast cancer (TNBC) is an aggressive breast cancer subtype that disproportionately affects women of African ancestry (WAA) and is often associated with poor survival. Although there is a high prevalence of TNBC across West Africa and in women of the African diaspora, there has been no comprehensive genomics study to investigate the mutational profile of ancestrally related women across the Caribbean and West Africa. METHODS: This multisite cross-sectional study used 31 formalin-fixed paraffin-embedded (FFPE) samples from Barbadian and Nigerian TNBC participants. High-resolution whole exome sequencing (WES) was performed on the Barbadian and Nigerian TNBC samples to identify their mutational profiles and comparisons were made to African American, European American and Asian American sequencing data obtained from The Cancer Genome Atlas (TCGA). Whole exome sequencing was conducted on tumors with an average of 382 × coverage and 4335 × coverage for pooled germline non-tumor samples. RESULTS: Variants detected at high frequency in our WAA cohorts were found in the following genes NBPF12, PLIN4, TP53 and BRCA1. In the TCGA TNBC cases, these genes had a lower mutation rate, except for TP53 (32% in our cohort; 63% in TCGA-African American; 67% in TCGA-European American; 63% in TCGA-Asian). For all altered genes, there were no differences in frequency of mutations between WAA TNBC groups including the TCGA-African American cohort. For copy number variants, high frequency alterations were observed in PIK3CA, TP53, FGFR2 and HIF1AN genes. CONCLUSION: This study provides novel insights into the underlying genomic alterations in WAA TNBC samples and shines light on the importance of inclusion of under-represented populations in cancer genomics and biomarker studies.

Erratum to "Severe Life-Threatening Pregnancy Complications, "Near Miss" and Maternal Mortality in a Tertiary Hospital in Southern Nigeria: A Retrospective Study".

[This corrects the article DOI: 10.1155/2020/3697637.].

Severe Life-Threatening Pregnancy Complications, "Near Miss" and Maternal Mortality in a Tertiary Hospital in Southern Nigeria: A Retrospective Study.

BACKGROUND: Investigating severe life-threatening pregnancy complications that women encounter and the maternal morbidities (near miss) may help to evaluate the quality of care in health facility and recommend ways to improve maternal and infant survival especially in low-income countries. The aim of this review was to identify, classify, and determine the frequency and nature of maternal near miss events and the maternal and perinatal outcomes. METHODS: A retrospective facility-based review of cases of near miss and maternal mortality occurring between 1st January 2012 and 31st December 2016 at the University of Calabar Teaching Hospital was conducted. Near miss case definition was based on the WHO disease specific criteria. The main outcomes included the maternal mortality ratio (MMR), maternal near miss ratio (MNMR), mortality index, maternal morbidities, and perinatal outcome. RESULTS: There were 10,111 pregnancy-related admissions, 790 life-threatening pregnancy complications that resulted in 99 maternal deaths, and 691 near miss cases. The maternal mortality ratio was 979 maternal deaths per 100,000 live births, and the maternal near miss ratio was 6,834 per 100,000 maternities. The MMR to MNMR ratio was 1 : 8. Sepsis and severe anaemia had high case-specific mortality indices of 0.4 and 0.53, respectively. The perinatal outcome was poor compared to that of uncomplicated pregnancies: perinatal mortality rate (PMR) 266 per 1000 live births (OR 7.74); neonatal intensive care (NIC) admissions 11.6 percent (OR 1.83); and low birth weight (LBW) (<2.5 kg) 12.19 percent (OR 1.89). CONCLUSION: Antenatal care and early recognition of danger signs in pregnancy as well as prompt referral and early institution of essential obstetrics care are important for maternal and infant survival.

Trend and Causes of Maternal Mortality in a Nigerian Tertiary Hospital: A 5-year Retrospective Study (2010-2014) at the University of Calabar Teaching Hospital, Calabar, Nigeria.

BACKGROUND: Maternal mortality ratios (MMR) are still unacceptably high in many low-income countries especially in sub-Saharan Africa. MMR had been reported to have improved from an initial 3,026 per 100,000 live births in 1999 to 941 in 2009, at the University of Calabar Teaching Hospital (UCTH), Calabar, a tertiary health facility in Nigeria. Post-partum haemorrhage and hypertensive diseases of pregnancy have been the common causes of maternal deaths in the facility. AIM: This study was aimed at determining the trend in maternal mortality in the same facility, following institution of some facility-based intervention measures. METHODOLOGY: A retrospective study design was utilised with extraction and review of medical records of pregnancy-related deaths in UCTH, Calabar, from January 2010 to December 2014. The beginning of the review period coincided with the period the "Woman Intervention Trial" was set up to reduce maternal mortality in the facility. This trial consists of the use of Tranexamic acid for prevention of post-partum haemorrhage, as well as more proactive attendance to parturition. RESULTS: There were 13,605 live births and sixty-one (61) pregnancy-related deaths in UCTH during the study period. This yielded a facility Maternal Mortality Ratio of 448 per 100,000 live births. In the previous 11-year period of review, there was sustained the decline in MMR by 72.9% in the initial four years (from 793 in 2010 to 215 in 2013), with the onset of resurgence to 366 in the last year (2014). Mean age at maternal death was 27 ± 6.5 years, with most subjects (45, 73.8%) being within 20-34 years age group. Forty-eight (78.7%) were married, 26 (42.6%) were unemployed, and 33 (55.7%) had at least secondary level of education. Septic abortion (13, 21.3%) and hypertensive diseases of pregnancy (10, 16.4%) were the leading causes of death. Over three quarters (47, 77.0%) had not received care from any health facility. Most deaths (46, 75.5%) occurred between 24 and 97 hours of admission. CONCLUSION: Compared with previous trends, there has been a significant improvement in maternal mortality ratio in the study setting. There is also a significant change in the leading cause of maternal deaths, with septic abortion and hypertensive disease of pregnancy now replacing post-partum haemorrhage and puerperal sepsis that was previously reported. This success may be attributable to the institution of the Woman trial intervention which is still ongoing in other parts of the world. There is, however, need to sustain effort at a further reduction in MMR towards the attainment of set sustainable development goals (SDGs), through improvement in the provision of maternal health services in low-income countries.

Effect of Free Maternal Health Care Program on Health-seeking Behaviour of Women during Pregnancy, Intra-partum and Postpartum Periods in Cross River State of Nigeria: A Mixed Method Study.

BACKGROUND: Increasing the percentage of maternal health service utilization in health facilities, through cost-removal policy is important in reducing maternal deaths. The Cross River State Government of Nigeria introduced a cost-removal policy in 2009, under the umbrella of "PROJECT HOPE" where free maternal health services are provided. Since its inception, there has been no formal evaluation of its effectiveness. AIM: This study aims to evaluate the effect of the free maternal health care program on the health care-seeking behaviours of pregnant women in Cross River State, Nigeria. METHOD: A mixed method approach (quantitative and qualitative methods) was used to describe the effect of free maternal health care intervention. The quantitative component uses data on maternal health service utilisation obtained from PROJECT HOPE and Nigeria Demographic Health Survey. The qualitative part uses Focus Group Discussions to examine women's perception of the program. RESULTS: Results suggest weak evidence of change in maternal health care service utilization, as 95% Confidence Intervals overlap even though point estimate suggest increase in utilization. Results of quantitative data show increase in the percentage of women accessing maternal health services. This increase is greater than the population growth rate of Cross River State which is 2.9%, from 2010 to 2013. This increase is likely to be a genuine increase in maternal health care utilisation. Qualitative results showed that women perceived that there have been increases in the number of women who utilize Antenatal care, delivery and Post Partum Care at health facilities, following the removal of direct cost of maternal health services. There is urban and rural differences as well as between communities closer to health facility and those further off. Perceived barriers to utilization are indirect cost of service utilization, poor information dissemination especially in rural areas, perceived poor quality of care at facilities including drug and consumables stock-outs, geographical barriers, inadequate health work force, and poor attitude of skilled health workers and lack of trust in the health system. CONCLUSION: Reasons for Maternal health care utilisation even under a cost-removal policy is multi-factorial. Therefore, in addition to fee-removal, the government must be committed to addressing other deterrents so as to significantly increase maternal health care service utilisation.

Factors Influencing Antenatal Haematinics Prescription Behaviour of Physicians in Calabar, Nigeria.

BACKGROUND: Routine iron and folic acid supplementation in pregnancy have been proved to be effective in reducing the prevalence and morbidities of anaemia. However, there is limited data regarding the prescription habits of physician obstetric care givers. AIM: This study set to investigate the attitudes and factors which influence the practice among physicians in University of Calabar Teaching Hospital (UCTH). MATERIAL AND METHODS: A questionnaire based cross-sectional survey was conducted among randomly recruited physician offering antenatal services between August and September 2015. Systemic sampling was used to select 70 doctors in the departmental duty roster. Data were presented in percentages and proportion. Chi-square test was used to test the association between variables. Statistical significance was set at p < 0.05. RESULTS: The response rate was 100%. The mean age of the respondents was 30.26 ± 6.67 years. All the respondents routinely prescribed haematinics to pregnant women but 34.3% of them did not prescribe to apparently healthy clients in their first trimester. Only 30% and 11.4% of them prescribed it in the postnatal and preconception periods respectively. Brands that contained iron, folate and vitamins as a single capsule were mostly favoured, and information about brands of drugs was mostly provided by the pharmaceutical sales representatives. Younger doctors were more likely to offer haematinics with nutritional counselling compared to older respondents. However, there was no significant relationship between haematinics prescription and sex (p = 0.3560), Age (p = 0.839), current professional status (p = 0.783), and client complaint of side effect of medication (p = 0.23). Oral medication was mostly utilised. CONCLUSION: Effort to effectively control anaemia in pregnancy should involve re-orientation of physician obstetric care providers especially about prenatal and postnatal medication and counselling.

Syndromic anorectal malformation associated with Holt-Oram syndrome, microcephaly, and bilateral corneal opacity: a case report.

BACKGROUND: The occurrence of an anorectal malformation with Holt-Oram syndrome, microcephaly, and bilateral corneal opacity is rare and to the best of our knowledge has not previously been reported in the literature. Hence, there is a need to document our experience in this case and learn as much as possible from it. CASE PRESENTATION: We present the case of a Nigerian female neonate with a postnatal diagnosis of syndromic anorectal malformation associated with Holt-Oram syndrome, microcephaly, and bilateral corneal opacity. The infant had successful staged correction of her anorectal malformation but developed a metastatic Wilms' tumor and died before other corrective procedures could be instituted. CONCLUSIONS: An anorectal malformation is here reported to occur with Holt-Oram syndrome, an association that has not been reported previously. To enhance the prognosis and quality of life of children with syndromic anorectal malformation, prenatal ultrasound monitoring of high-risk pregnancies and expertise in prenatal detection of congenital anomalies are invaluable in antenatal care.

Predictors of Poor Pregnancy Outcomes Among Antenatal Care Attendees in Primary Health Care Facilities in Cross River State, Nigeria: A Multilevel Model.

Objectives Pregnancy carries a high risk for millions of women and varies by urban-rural location in Nigeria, a country with the second highest maternal deaths in the world. Addressing multilevel predictors of poor pregnancy outcomes among antenatal care (ANC) attendees in primary health care (PHC) facilities could reduce the high maternal mortality rate in Nigeria. This study utilised the "Risk Approach" strategy to (1) compare the risks of poor pregnancy outcomes among ANC attendees by urban-rural location; and (2) determine predictors of poor pregnancy outcomes among ANC attendees in urban-rural PHC facilities in Cross River State, Nigeria. Methods A cross-sectional survey was conducted in 2011 among 400 ANC attendees aged 15-49 years recruited through multistage sampling. Data on risk factors of poor pregnancy outcomes were collected using interviewer-administered questionnaires and clinic records. Respondents were categorised into low, medium or high risk of poor pregnancy outcomes, based on their overall risk scores. Predictors of poor pregnancy outcomes were determined by multilevel ordinal logistic regression. Results A greater proportion of the women in the rural areas were below the middle socio-economic quintile (75 vs. 4 %, p < 0.001), had no education (12 vs. 2 %, p < 0.001), and were in the 15-24 age group (58 vs. 35 %, p < 0.001) whereas women in the urban areas were older than 35 years (10 vs. 5 %, p < 0.001). The women attending antenatal care in the urban PHC facilities had a low overall risk of poor pregnancy outcomes than those in the rural facilities (64 vs. 50 %, p = 0.034). Pregnant women in the urban areas had decreased odds of being at high risk of poor pregnancy outcomes versus the combined medium and low risks compared with those in the rural areas (OR 0.55, 95 % CI 0.09-0.65). Conclusions for Practice Pregnant women attending antenatal care in rural PHC facilities are more at risk of poor pregnancy outcomes than those receiving care in the urban facilities. Health programmes that promote safe pregnancy should target pregnant women in rural settings.

The use of the partograph in labor monitoring: a cross-sectional study among obstetric caregivers in General Hospital, Calabar, Cross River State, Nigeria.

BACKGROUND: Prolonged and obstructed labor is a significant cause of maternal morbidity and mortality in Nigeria, one of the six countries contributing significantly to the global maternal mortality crisis. The use of the partograph would engender a remarkable reduction in the number of these deaths since abnormal markers in the progress of labor would be identified early on. OBJECTIVE: This study aimed to evaluate the non-physician obstetric caregivers' (OCGs) knowledge of partograph use, assess the extent of its use, determine the factors that impede its usage, and unravel the relationship between years of experience and partograph use among the respondents (OCGs) in General Hospital, Calabar, Nigeria. METHODOLOGY: Using a self-administered semi-structured questionnaire, a cross-sectional descriptive study was conducted among 130 purposely selected and consenting OCGs working in the General Hospital, Calabar, Nigeria. RESULTS: The majority of the respondents (70.8%) had good general knowledge of the partograph but lacked detailed and in-depth knowledge of the component parts of the partograph. Knowledge of partograph (χ(2) =12.05, P=0.0001) and partograph availability (χ(2) =56.5, P=0.0001) had a significant relationship with its utilization. Previous training (χ(2) =9.43, P=0.002) was significantly related to knowledge of partograph. Factors affecting utilization were: little or no knowledge of the partograph (85.4%), nonavailability (70%), shortage of staff (61.5%), and the fact that it is time-consuming to use (30%). CONCLUSION: Lack of detailed knowledge of the partograph, nonavailability of the partograph, poor staff numbers, and inadequate training are factors that work against the effective utilization of the partograph in the study facility. Usage of this tool for labor monitoring can be enhanced by periodic training, making partographs available in labor wards, provision of reasonable staff numbers, and mandatory institutional policy.

An evaluation of the knowledge and utilization of the partogragh in primary, secondary, and tertiary care settings in calabar, South-South Nigeria.

The challenge to maternal well-being with associated maternal wastages especially in labor has remained unsurmountable across the three tiers of health care delivery in Nigeria. This study aimed to determine and compare the factors that influence utilization of the partograph in primary, secondary, and tertiary health care delivery levels in Calabar, Nigeria. This was a descriptive study, using a self-administered semistructured questionnaire on 290 consenting nonphysician obstetric care workers, purposively recruited. The mean age of the respondents was 40.25 ± 8.68 with a preponderance of females (92.4%). Knowledge of the partograph and previous partograph training had statistically significant relationship with its utilization among respondents from the tertiary and general hospitals. The level of knowledge was higher among workers in the general hospital than those working in the university teaching hospital. Nurses/midwives in the three levels of care were significantly more knowledgeable in partograph use than other nonphysician obstetric care workers. Lack of detailed knowledge of the partograph, its nonavailability and poor staff strength in the study centers were factors militating against its ease of utilization. The authors recommend periodic in-service training and provision of partograph in labor rooms in all maternity wards in our environment.

Obstetric outcomes of booked teenage pregnancies at University of Calabar Teaching Hospital, Nigeria.

BACKGROUND: Teenage pregnancy is high-risk and associated with complications due to adverse physiological, anatomical, and socioeconomic factors. The purpose of this study was to determine the patterns and obstetric outcomes of booked teenage pregnancies at the University of Calabar Teaching Hospital (UCTH) in Nigeria. METHODS: A retrospective comparative analysis of teenage pregnancies and mature mothers at UCTH was carried out from January 2011 to December 2011. A total of 82 teenage pregnancies and 72 mature pregnancies were compared. RESULTS: There were 145 teenage deliveries from a total of 2313 deliveries, ie, 6.3% of total deliveries. There was no statistically significant difference in the mode of delivery (cesarean section, spontaneous vaginal delivery, instrumental delivery) between the groups of mothers. There was also no difference in risk of complications, including obstructed labor, retained placenta, uterine atony, pre-eclampsia/eclampsia, and antepartum hemorrhage. However, teenage mothers had more perineal lacerations (P = 0.02) and more preterm labor (P = 0.05), and delivered more low-birth-weight babies (P = 0.02). CONCLUSION: Supervised teenage pregnancy may not be as hazardous as previously thought.

Awareness of birth preparedness and complication readiness in southeastern Nigeria.

The aims of this study are to assess the awareness and intention to use maternity services. This was a multicentric study involving 800 women. Educational status was the best predictor of awareness of birth preparedness (P = 0.0029), but not a good predictor of intention to attend four antenatal clinic sessions (P = 0.449). Parity was a better predictor of knowledge of severe vaginal bleeding as a key danger sign during pregnancy than educational level (P = 0.0009 and P = 0.3849, resp.). Plan to identify a means of transport to the place of childbirth was related to greater awareness of birth preparedness (χ(2) = 0.3255; P = 0.5683). Parity was a highly significant predictor (P = 0.0089) of planning to save money. Planning to save money for childbirth was associated with greater awareness of community financial support system (χ(2) = 0.8602; P = 0.3536). Access to skilled birth attendance should be promoted.

The role of prophylactic antimalarial in the reduction of placental parasitemia among pregnant women in Calabar, Nigeria.

INTRODUCTION: Intermittent preventive treatment of malaria with sulfadoxine-pyrimethamine is a recommendation of the World Health Organization as part of the malaria control strategy in pregnancy in areas with malaria burden. AIM: This study set out to appraise the effectiveness of this regimen in the prevention of placental parasitemia among parturients in Calabar, Nigeria. MATERIALS AND METHODS: Pretested, precoded questionnaires were administered to eligible women at the antenatal clinic and later updated at the labor ward. Intermittent preventive treatment was administered under direct observation at the clinic, while packed cell volume, placental parasitemia, and other laboratory tests were measured at the labor ward. RESULTS: The gross presence of placental malaria in the intermittent preventive treatment (IPT)-treated and the control groups was 10.6% and 11.3% respectively (P=0.76). Anemia occurred in 3.1% of the IPT-treated group compared to 11.7% among the control group (P=0.000). Only 7.9% of the IPT-treated women had moderate to severe placental parsitemia whereas as many as 53.2% of women in the control group had moderate to severe parasitemia (P=0.000). CONCLUSION: Intermittent preventive treatment of malaria with sulfadoxine-pyrimethamine was associated with significant reduction in the degree of placental parasitemia among women in the IPT-treated group, although it did not completely eradicate placental malaria in the treatment group.