Mpox in pregnancy: Management, risks and challenges in Africa and lessons from the COVID-19 pandemic.

Data on mpox in pregnancy are currently limited. Historically, only 65 cases in pregnancy have been reported globally since mpox was discovered in 1958. This includes 59 cases in the current outbreak. Vertical transmission was confirmed in one patient. Pregnant women are at high risk of severe disease owing to immunological and hormonal changes that increase susceptibility to infections in pregnancy. African women appear to be at higher risk of mpox infection and adverse outcomes in pregnancy for epidemiological and immunologic reasons, in addition to the background high rates of adverse feto-maternal outcomes in the region. This risk is potentially heightened during the COVID-19 pandemic due to the possibility of mpox virus exportation/importation as a result of the lifting of movement restrictions and trans-border travels between countries affected by the current outbreak. Furthermore, coinfection with mpox and COVID-19 in pregnancy is possible, and the clinical features of both conditions may overlap. Challenges of diagnosis and management of mpox in pregnancy in Africa include patients concealing their travel history from healthcare providers and absconding from/evading isolation after diagnosis, shortage of personal protective equipment and polymerase chain reaction testing facilities for diagnosis, vaccine hesitancy/resistance, and poor disease notification systems. There is a need for local, regional and global support to strengthen the capacity of African countries to address these challenges and potentially reduce the disease burden among pregnant women in the continent.

COVID-19: the implications and consequences of prolonged lockdown and COVID-19 vaccine cost in a low-middle income country.

Lockdowns and just recently, the COVID-19 vaccines, are amongst the disease containment measures instituted globally to check the spread of COVID-19. Prolonged lockdowns are however, not sustainable in low resource economies like Nigeria, where up to 70% of her population live on less than a dollar a day, with the majority, either unemployed, or working in the private/informal sector and depending on daily earnings for survival. If the lockdown remains sustained, it would not be long before the largely poor citizens starve to death. Also, spending over US $3.9 billion on COVID-19 vaccines for more than 200 million Nigerians, as intended by the Nigerian government, is not plausible, given that neglected tropical diseases (NTDs) like Lassa fever, and other more common causes of morbidity and mortality, continue to kill more Nigerians than COVID-19. Public enlightenment of the populace on the need to strictly adhere to non-pharmacologic preventive measures, including social distancing, use of face masks, good personal hygiene, covering of the mouth and nose when coughing and sneezing, frequent hand washing and sanitizing with alcohol-based hand-sanitizers and disinfection of surfaces, is what is sustainable, feasible and compatible with the economic reality in our setting. As Sir Robert Hutchison, the highly revered doyen of medicine, wrote in his petition over 85 years ago, "And from making the cure of the disease more grievous than the endurance of the same, Good Lord, deliver us", we must be careful not to make the cure of COVID-19 worse than COVID-19 itself.

Factors determining compliance to routine iron supplementation in pregnancy at the University of Portharcout Teaching Hospital.

BACKGROUND: Routine intake of iron supplements during pregnancy improves maternal health and pregnancy outcomes. This is observed in a background of increased availability and compliance to routine antenatal iron supplements. Poor compliance arises not only because of patient behavior but also from factors that may be out of patient's control. The aim of this study was to determine the proportion of patients who comply, the level of compliance with the iron prescription given at the antenatal clinic as well as propose interventions aimed at increasing compliance amongst the antenatal population. METHODS: A total of five hundred antenatal clients were recruited randomly (the 3rd of clients presenting to the clinic) during their antenatal visits between 1st May and 30th June, 2009 at the UPTH. Prescriptions for iron supplements and folic acid were given and they were interviewed using a standard structured questionnaire. Women with low or high compliance were asked to explain what influenced their adherence to iron supplementation. RESULTS: Overall compliance in this study was 88.0%. Women who complied fully were of the perception that good blood level and birth weight were beneficial effects of the routine iron supplement. Gastrointestinal side effects and forgetfulness were the main reasons for low compliance.