Prenatal Screening for Down Syndrome: How Acceptable is it among Pregnant Nigerian Women?

BACKGROUND AND OBJECTIVE: Down syndrome is the most common chromosomal anomaly found among newborns. Prenatal screening can inform pregnant women and their partners of the risk of their baby having Down syndrome. The study aimed to determine the awareness and attitude of Nigerian pregnant women towards prenatal screening for Down syndrome. METHODS: This was a prospective observational study among pregnant women who attended antenatal clinics at two teaching hospitals in Nigeria between January and June 2018. Data on their awareness and attitude towards Down syndrome screening were collected using a semi-structured questionnaire and analysed with SPSS version 23.0. Level of significance was set at p<0.05 and 95% confidence interval (CI). RESULTS: Four hundred and four women participated in the study and their mean age was 30.8±4.87 years. Overall, 65.1% were aware of Down syndrome and the media (54.4%) was their main source of information. Less than half (44.3%) of them had a positive attitude towards Down syndrome screening. Respondents with primary (AOR=0.20, 95% CI=1.175-21.687) and secondary education (AOR=0.34, 95% CI=1.494-5.867) were less likely to be aware of Down syndrome, while having a positive attitude towards Down syndrome screening (AOR=2.07, 95% CI=0.314-0.745) and being engaged in skilled occupation (AOR=3.26, 95% CI=0.135-0.697) predicted awareness. A positive attitude towards Down syndrome screening was predicted by being engaged in skilled (AOR=2.51, 95% CI=0.185-0.858) and semi-skilled (AOR=2.37, 95% CI=0.205-0.870) occupation. CONCLUSION: Though majority of pregnant women had good awareness of Down syndrome; however, less than half of them had a positive attitude towards the screening test. The awareness and positive attitude exhibited by the women in this study were influenced by their level of education and occupation.

CONTEXTE ET OBJECTIF: Le syndrome de Down est l'anomalie chromosomique la plus fréquente chez les nouveau-nés. Le dépistage prénatal peut informer les femmes enceintes et leurs partenaires du risque que leur bébé soit atteint du syndrome de Down. L'étude visait à déterminer la sensibilisation et l'attitude des femmes enceintes nigérianes à l'égard du dépistage prénatal du syndrome de Down. MÉTHODES: Il s'agissait d'une étude observationnelle prospective parmi les femmes enceintes qui ont fréquenté les cliniques prénatales de deux hôpitaux universitaires au Nigéria entre janvier et juin 2018. Les données sur leur sensibilisation et leur attitude à l'égard du dépistage du syndrome de Down ont été recueillies à l'aide d'un questionnaire semi-structuré et analysées avec SPSS version 23.0. Le niveau de signification a été fixé à p<0,05 et à un intervalle de confiance (IC) de 95%. RÉSULTATS: Quatre cent quatre femmes ont participé à l'étude et leur âge moyen était de 30,8±4,87 ans. Dans l'ensemble, 65,1 % d'entre elles connaissaient le syndrome de Down et les médias (54,4%) étaient leur principale source d'information. Moins de la moitié (44,3%) d'entre eux avaient une attitude positive à l'égard du dépistage du syndrome de Down. Les répondants ayant suivi un enseignement primaire (AOR=0,20, IC 95 %=1,175-21,687) et secondaire (AOR=0,34, IC 95 %=1,494-5,867) étaient moins susceptibles de connaître le syndrome de Down, tandis qu'une attitude positive à l'égard du dépistage du syndrome de Down (AOR=2,07, IC 95 %=0,314-0,745) et l'exercice d'une activité professionnelle qualifiée (AOR=3,26, IC 95 %=0,135-0,697) étaient des facteurs prédictifs de la connaissance du syndrome de Down. Une attitude positive à l'égard du dépistage du syndrome de Down était prédite par l'exercice d'une profession qualifiée (AOR=2,51, IC à 95 %=0,185-0,858) et semiqualifiée (AOR=2,37, IC à 95 %=0,205-0,870). CONCLUSION: Bien que la majorité des femmes enceintes aient une bonne connaissance du syndrome de Down, moins de la moitié d'entre elles ont une attitude positive à l'égard du test de dépistage. La connaissance et l'attitude positive des femmes de cette étude ont été influencées par leur niveau d'éducation et leur profession. Mots-clés: Syndrome de Down ; Connaissance, Attitude, Test de dépistage, Femmes enceintes.

ASYMPTOMATIC BACTERIURIA AS A PREDICTOR OF PRE-ECLAMPSIA: A CASECONTROLLED STUDY.

Background: Pre-eclampsia, an important cause of maternal and perinatal morbidity and mortality world-wide has been linked to subclinical infections, with maternal infection and inflammation postulated in its aetio-pathogenesis including asymptomatic bacteriuria which is common in pregnancy. The Obejctive of the study is to determine the relationship of asymptomatic bacteriuria as a risk factor for pre-eclampsia. Methodology: A hospital-based case-control study among 28 pre-eclamptic pregnant women (cases) and 56 healthy pregnant women (controls) at gestational age of at least 28 weeks at the University College Hospital, Ibadan, between January 2019 and August 2019. Controls were matched with cases in age, parity and gestational age. Asymptomatic bacteriuria was determined with mid-stream urine analysis for microscopy and culture and data collected using an interviewer administered questionnaire with other details from medical records extracts. Chi- square, and multivariate regression analysis were used to assess statistical significance, odds ratio and adjusted odds ratio respectively, with P-value <0.05 and 95% confidence interval (CI). Results: There was a significant association between asymptomatic bacteriuria and pre-eclampsia. The rate of asymptomatic bacteriuria was about three times higher in women with pre-eclampsia compared to those without pre-eclampsia and 1.23 times higher after adjusting for confounders (OR: 2.9, AOR:1.23). There was no significant relationship between sterile pyuria and pre-eclampsia (p-value: 0.92). Conclusion: This study supports the proposition that asymptomatic bacteriuria is a risk factor for pre-eclampsia. It has not however shown whether the association is causal or casual. Further studies will be needed to explain this.

PUERPERAL SEPSIS AT UNIVERSITY COLLEGE HOSPITAL, IBADAN: A 10-YEAR REVIEW.

Background: Puerperal sepsis is one of the leading causes of pregnancy-related maternal morbidity and mortality in developing countries. This study explored the complications, treatment modalities, and management outcomes of puerperal sepsis. Methods: A 10-year retrospective review of women managed for puerperal sepsis at University College Hospital, Ibadan, Nigeria between January 2009 and December 2018. Information on their socio-demographic and obstetrics characteristics, presenting complaints, treatment modalities, complications, and outcomes were obtained from the medical records. Data was analyzed with SPSS version 20. Descriptive statistics was done and results were presented in tables and chart. Results: The prevalence of puerperal sepsis during the period reviewed was 0.83%. The mean age of the women was 29.0±6.7 years. The primiparous women 53(33.5%) were mostly affected. Klebsiella spp 25(15.8%) was the most common organism isolated and most sensitive to the third generation of Cephalosporin and Quinolones. Anaemia 90(56.8%) was the most common complication and all the women had intravenous antibiotics while about half (46.5%) of those with abdominopelvic collections were managed surgically via laparotomy. The case fatality rate was 16.5%. Conclusion: Despite the low prevalence of puerperal sepsis within the period reviewed, a high case fatality was recorded. Cephalosporin and Quinolones should be considered in managing puerperal sepsis in our facility but more importantly prevention of maternal sepsis is essential.

MANAGEMENT OUTCOME OF PREMATURE RUPTURE OF MEMBRANES IN A TERTIARY HEALTH FACILITY IN SOUTH WESTERN NIGERIA.

Background: Pre-labour Rupture of Membranes (PROM) contributes immensely to the potential risk of maternal morbidity and mortality. Objective: To explore the incidence and management outcome of PROM at Ladoke Akintola University of Technology Teaching Hospital (LTH), Ogbomoso, Nigeria. Methods: A retrospective study of 61 cases of PROM managed at LTH, Ogbomoso over a 3-year period. Information on the socio-demographics and obstetrics characteristics, management instituted, and outcomes were obtained using a structured proforma. Data were analysed using SPSS version 20. Level of statistical significance was set at <0.05 and 95% confidence interval. Results: The incidence of PROM was 4.1% with a perinatal mortality rate of 0.18 per 1000 deliveries. Twenty (33%) were pre-term while 41 (67%) were term PROM with 10% of the perinatal death occurring among those with preterm PROM. The mean age of the women was 36.9 (SD=2.1) years and median parity of 1(range 1-5) children. There was a significant association between the women's gestational age at which PROM occurred with the latency period (p< 0.001). Fetal birth weight, APGAR score and Neonatal Intensive Care Unit (NICU) admission were all significantly associated with the gestational age at which PROM occurred (p<0.05). There was a significant difference between the intervention instituted and mode of delivery (p=0.009). Conclusion: The incidence of PROM at term was high and conservative/ expectant management was effective. The latency period and fetal outcomes such as birth weight, apgar score and NICU admission were determined by the gestational age at which PROM occurred.

The Assessment of Copeptin and Brain Natriuretic Peptide Levels as Biomarkers in Hypertensive Disorders of Pregnancy.

BACKGROUND: Hypertensive disorders of pregnancy associated with potentially fatal outcomes are common obstetrics occurrences. Early diagnosis, management and prediction of outcomes are challenges to be surmounted especially in developing countries. Biomarkers are emerging as useful tools for diagnosis and prognostication in varying health conditions. Elevated levels of serum copeptin and Brain Natriuretic Peptide (BNP) are associated with adverse perinatal outcomes and may serve as potential biomarkers utilized during routine antenatal care. OBJECTIVE: To determine the level and clinical value of copeptin and BNP as biomarkers of hypertensive disorders of pregnancy among Nigerian pregnant women. METHODS: This case-control study comprised 156 consenting pregnant women equally grouped into those with chronic hypertension (CH), gestational hypertension (GH), and preeclampsia (PE) as cases and normotensives as controls. Pregnant women were recruited from the antenatal clinic, University College Hospital, Nigeria. Blood pressures were measured and blood (10ml) was drawn from patients, serum and plasma obtained accordingly while other data were collected using interviewer administered questionnaire and medical records. Serum copeptin and plasma BNP levels were measured using enzyme-linked immunosorbent assay. Data was analysed with SPSS version 20.0 and statistical significance was set at p < 0.05. RESULTS: The mean levels of SBP and DBP were significantly higher in CH (155.41±2.14; 102.36±2.0 mmHg), GH (150.49±0.82; 98.67±0.56 mmHg), and PE (153.92±1.47; 98.92±0.61 mmHg), compared to controls (101.85±1.9; 66.77±1.24 mmHg). Mean serum copeptin and plasma BNP were significantly higher in women with GH (21.25±1.31pmol/L; 223.05±14.95pg/mL) and PE (22.47±1.01pmol/L; 253.99±17.69pg/mL) compared with controls (9.05±1.01pmol/L; 48.63±2.50pg/mL) (p<0.05). There was no significant difference in the mean levels of copeptin and BNP in CH compared with controls (p>0.05). The ROC curve for copeptin gave an AUC of 0.829 (p= 0.000) with a cut off value of 10.15pmol/ L while the AUC for BNP was 0.902 (p= 0.000) with a cut off value of 50.81pg/mL. CONCLUSION: Serum copeptin and plasma BNP levels were significantly higher in GH and PE and may be used as markers of hypertensive disorders of pregnancy among Nigerian pregnant women.

CASE REPORT: RETRIEVAL OF AN INTRA-UTERINE CONTRACEPTIVE DEVICE PENETRATING THROUGH THE WALL OF THE RECTUM.

A Copper T intrauterine contraceptive device (IUCD) is a commonly employed method of reversible contraception for women. Its use has been associated with complications such as bleeding, perforation and migration to adjacent organs or peritoneum. Uterine wall erosion and subsequent perforation by an IUCD is not unusual; however the subsequent intraperitoneal migration, to and perforation of the rectum is uncommon. We present a case of 31-year-old female with an IUCD migrating through the uterus possibly into the peritoneal cavity and subsequently eroding into the posterior rectal wall. It was removed easily without complications through the rectum during an examination under anesthesia.

Lassa Fever in Pregnancy: Report of 2 Cases Seen at the University College Hospital, Ibadan.

Lassa fever (LF), an acute viral haemorrhagic fever, is an endemic zoonotic viral infection in West Africa countries with up to 15% case fatality rate. Though a rodent-borne infection, it can also be transmitted from person to person during the care of sick relations or more commonly in health care settings as a nosocomial infection. Vertical transmission from mother to child has been documented. We report 2 cases of LF among pregnant women which were managed at the University College Hospital, Ibadan, between September and October 2014. Both patients were in their early 20s with only one surviving the disease. Both had supportive therapy but none had antiviral therapy. This report emphasized the importance of early presentation, high index of suspicion, prompt diagnosis, and early commencement of supportive therapy in the management of patients suspected with LF especially in the era of other viral haemorrhagic infections.

Awareness and attitude towards HPV and its vaccines among market women in Bodija Market, Ibadan.

Background: Cervical cancer, commonest among cancers of the female genital tract continued to pose major challenge to women of reproductive age in developing countries though infection by its causative agent, human papilloma virus (HPV) is preventable.This study aimed to assess awareness and attitude of market women concerning HPV and its vaccines in prevention of cervical cancer. Materials and Methods: A cross sectional study involving 329 market women, using multistage sampling technique. Instrument was an Interviewer--administered questionnaire on socio-demographic characteristics, knowledge and awareness of HPV and its vaccine, sexual history and attitude towards HPV vaccines. Data analysis was done using SPSS version 20.0 with statistical significance level set at p<0.05. Results: Mean age of respondents was 29.49 ± 3.65 years. All respondents were sexually active with majority (94.8%) having multiple sexual partners. Awareness of HPV vaccine and Pap smear test was among 1.2% and 9.4% respectively. Attitude towards HPV vaccination was good in 304 (92.4%) with 302 (91.8%) willing to take the HPV vaccines. There was significant association between attitude towards HPV vaccine and willingness to take HPV vaccine x2=111.8, p<0.01). Conclusions: Awareness of HPV and its vaccines is low among market women in our community. Policies and actions to step up information dissemination are urgently needed in order to stem the scourge of cervical cancer in our society.