Missed opportunities for HIV counselling and testing service delivery among pregnant women in Nigeria: Evidence from the 2018 National nutrition and health survey.

According to UNAIDS, the 90-90-90 strategy calls for 90% of HIV-infected individuals to be diagnosed by 2020, 90% of whom will be on anti-retroviral therapy (ART) and 90% of whom will achieve sustained virologic suppression. HIV counselling and testing (HCT) is an important entry point for effective prevention of mother-to-child transmission of HIV. However, evidence abounds that HCT is often missed by pregnant women during antenatal care in Nigeria. We used secondary data from the 2018 Nigerian National Nutrition and Health Survey (NNHS) to determine the pattern of missed opportunities within the HCT algorithm and the factors associated with the missed opportunities. Of the 8,329 eligible women, 2,327 (27.9%) missed HCT because of lack of antenatal care; 1,493 (24.9%) missed HIV pre-test counselling; 180 (4.0%) missed HIV testing after participating in pre-test counselling, while 793 (18.2%) missed collection of HIV result and post-test counselling. Generally, most of the women that missed HCT were from the North West (43.3%) and had their antenatal care with traditional birth attendants. The odds of missing ANC were higher in women in the Northern and Southern regions. Concerning pre-test HIV counselling, the odds of missing it were higher among women in the Northwest and Southeast while the odds of missing post-test counselling of HIV test were higher among women in the Northeast and Southeast relative to other regions. Using TBA as a care provider was associated with higher odds of women missing pre-test and post-test counselling of HIV during ANC compared to those that used doctors or midwives or CHEWs. Missed opportunities are common in different stages of HIV counselling and testing pathway in Nigeria, particularly in the Northern regions. Future studies would need to identify the specific reasons for these missed opportunities, enabling the targeting of more specific policy reform and interventions.

Prevalence and patterns of anthropometric failure among under-five children in Nigeria: Evidence from the National nutrition and health survey, 2018.

Globally, malnutrition among under-five children remains a public health concern. There is increasing concern at research and policy levels about anthropometric failure and the double burden of child malnutrition across different groups of children. The objective of this study was to describe the magnitude and distribution of various forms of anthropometric failure (AF) among children under age five in Nigeria. We used the 2018 National Nutrition and Health Survey data collected among 19,471 under-five children in Nigeria. The most prevalent AF was stunting only (17.7%) followed by stunting and underweight (13.9%). Wasting, stunting and underweight was found among 3.5% of the sample. Wasting, stunting and underweight was most common in age 6-11 months (7.0%) and 12-23 months (6.9%). Overall, about 1 out of 5 under-five children has multiple anthropometric failure. The peak age group for multiple AFs was between six months and 35 months. Multiple AF was less likely among females compared to males (RR=0.74, CI: 0.69, 0.80). The risk of multiple AF was higher in both North East (RR=2.15, CI: 1.78, 2.59) and North West (RR=2.98, CI: 2.51, 3.55) relative to the North Central. In contrast, the risk was lesser in the South East (RR=0.75, CI: 0.59, 0.95) and other southern regions. The study showed that multiple anthropometric failure is a common problem among children in Nigeria. Programmes that will support prevention and early identification of different types of malnutrition among under-five children across States in Nigeria are recommended.

Uptake of modern and traditional contraceptive methods in Nigeria: Lessons from a nationwide initiative on programming for results (2015-2018).

In general, family planning uptake promotes healthy living among couples and their children, in addition to aiding national development. This study was a secondary analysis of data collected from two nationally representative data - 2015 and 2018 National Nutrition and Health Surveys (NNHS) - aimed at measuring the uptake of modern and traditional contraceptive methods among women of reproductive age in Nigeria. The data were analysed by presenting differentials in prevalence of modern and traditional contraceptives between 2015 and 2018. The results showed that during the periods modern contraceptive uptake in Nigeria ranged between 10% and 17%. By contrast, the prevalence of the traditional methods was 8.3% and 10.0%. Within four years (2015-2018), the average national modern contraceptive uptake among women increased by 7%, while the traditional contraceptive uptake reduced by 2%. The uptake of both modern and traditional contraceptive methods varied by ages group of women, geo-political regions, and State of residence. We conclude that the uptake of modern contraception is below expectation in all regions in Nigeria. The uptake is worse in the northern regions as compared to the southern regions. Government needs to invest more to increase access to and utilization of modern contraceptive methods.

Assessment of diagnostic accuracy and adherence to maternal and child health guidelines as a measure of clinical competence of frontline healthcare workers in Nigeria.

Clinical competence of primary healthcare (PHC) workers is important in the delivery of maternal and child health care and services. In this cross-sectional study, we investigated the diagnostic accuracy and adherence to clinical guidelines for the management of some clinical conditions such as malaria, diarrhea, pneumonia, neonatal asphyxia and postpartum hemorrhage, as a proxy to measure the clinical competence of frontline health workers in PHCs in selected states in Nigeria. Ninety PHC facilities were randomly selected in each State and the FCT. Of the 3330 health workers, only 36.0% were able to correctly diagnose the five selected medical conditions. There was a significant difference in the diagnostic accuracy of the health workers with the doctors having highest diagnostic accuracy (65.5%) compared to other health workers (p <0.001). Adherence to the management guidelines was generally poor across all cadres of health workers and this pattern appear similar across the geopolitical regions in the country. The highest adherence to guidelines was observed among medical doctors (38.2%). The diagnostic accuracy and adherence to national guidelines for managing patients was poor among health workers, particularly, among other cadres except doctors. PHC workers in Nigeria need continuous training to enhance their clinical competence to improve quality of maternal and child health care.

Individual and ecological analyses of antenatal care: Prospects for delivery assistance and use of modern family planning in Nigeria.

Despite the availability of healthcare centres for the provision of antenatal care (ANC) services in Nigeria, the services are still underutilized by pregnant women. ANC services not only reduce maternal mortality and birth defects, but also have a strong link to many causes of maternal deaths. This study explored the individual and ecological relationships between antenatal care, skilled birth assistance during delivery, and family planning use across states in Nigeria. This study was a secondary analysis of data from the 2018 National Nutrition and Health Survey (NNHS) carried out among 24,985 women aged 15-49 years in the 36 states and the Federal Capital Territory (FCT) in Nigeria. Analysis was carried out at the level of individual women and at the ecological level. Only 68.3% visited a health professional (doctors, nurses, midwives, community health extension workers, and community health officers) for ANC in the most recent pregnancy before the survey. At delivery, 44.9% were assisted by delivery attendants with about half (50.1%) assisted by non-professional (traditional birth attendants, relatives and friends) during delivery. There was a significant variation in use of modern family planning (FP) across types of ANC provider. There was a strong positive correlation between ANC utilisation and skilled birth attendance (SBA) (r=0.706, p <0.001), and between SBA and FP (r=0.730, p <0.001). These results have implications for the design of appropriate interventions for strengthening the role of healthcare providers to enhance ANC patronage, utilization of safe delivery services and sustained use of reproductive health services.

Hierarchical modelling of factors associated with anaemia among under-five children in Nigeria.

This study used a nationally representative cross-sectional data from 2018 Nigeria Demographic Health Survey (NDHS) to investigate the prevalence and factors associated with anaemia in children aged less than five years in Nigeria. Anaemia was defined as haemoglobin level <11.0g/dl, while explanatory variables included parental profile, social and environmental factors. Descriptive analyses and multivariable Poisson regression models were fitted using Stata 15 software. Associated factors were quantified using Prevalence Ratio (PR) with 95% confidence interval (CI). Of the 5834 children aged 6-59 months, 51.9% were male. The prevalence of anaemia among under-five children was 71.6% (95% CI: 69.9-73.2). Childhood anaemia was associated with history of maternal anaemia (PR 1.06; CI 1.05-1.08); having underweight mothers (PR 1.02; CI 1.00-1.05); being a Muslim (PR 1.05; CI 1.02-1.08), Igbo (PR 1.07; CI 1.01-1.14) and Hausa (PR 1.04; CI 1.01-1.07) ethnic group. Further, children from South-South (PR 1.09; CI 1.06-1.13) and South-West (PR 1.06; CI 1.02-1.10) and those currently breastfeeding (PR 1.06; CI 1.04-1.07) had higher risk of anaemia. However, children from middle (PR 0.94; CI 0.91-0.97), or higher wealth indices were less likely to have anaemia. Maternal socio-economic and nutritional characteristics were identified as key predictors of under-five anaemia. Strategies are needed to mitigate the effect of poverty and tweak new and existing nutritional intervention programs to make them responsive to socio-cultural peculiarities across the various geo-political regions of Nigeria.

Prevalence and predictive factors for early initiation of breastfeeding in Nigeria: Evidence from the Nigerian demographic and health survey (2003-2018).

Early initiation of breastfeeding (EIBF) is an essential first step in exclusive breastfeeding that is expected to commence within an hour after childbirth. This study examined the prevalence and the factors associated with EIBF among nursing mothers in Nigeria based on an analysis of the 2003, 2008, 2013, and 2018 Nigerian Demographic Health Survey (NDHS) data. The prevalence of early breastfeeding initiation by women's demographic, socio-economic and reproductive characteristics were computed for each of the survey rounds. The differences in the prevalence estimates for early breastfeeding initiation between the last two survey periods were calculated. A crude and adjusted model to examine association between explanatory variables and early breastfeeding initiation were fitted using Poisson regression model. The mean age of respondents was 29 years (SD=7.3). The prevalence of EIBF increased from 31.5% in 2003 (95% CI 28.4-34.5) to 43.8% in 2018 (95% CI 42.6-45.0), with a decline to 35.3% in 2013 (95% CI 34.0-36.7). The identified risk factors associated with EIBF were being 35-39 years, having at least a primary education, lower wealth quintiles, multiparity, and delivery in a public hospital. EIBF was lower among women that had skilled occupation, access to media, decided to delay pregnancy, history of previous caesarean section, small size baby at birth, and women who received antenatal care. The results indicate that the proportion of women with EIBF in Nigeria is low. Addressing the barriers identified in this paper will help promote EIBF practices in the country.

Prevalence of hypercholesterolemia in Nigeria: a systematic review and meta-analysis.

OBJECTIVES: Elevated blood cholesterol (hypercholesterolemia) is a significant cause of cardiovascular disease. We aimed to estimate national and zonal prevalence of hypercholesterolemia in Nigeria to help guide targeted public health programs. STUDY DESIGN: This is a systematic review and synthesis of publicly available epidemiologic data on hypercholesterolemia in Nigeria. METHODS: We systematically searched MEDLINE, EMBASE, Global Health, and Africa Journals Online for studies on the prevalence of hypercholesterolemia in Nigeria published between 1990 and 2018. We used a random-effects meta-analysis (Freeman-Tukey double arcsine transformation) and meta-regression model to estimate the prevalence of hypercholesterolemia in Nigeria in 1995 and 2015. RESULTS: In total, 13 studies (n = 16,981) were retrieved. The pooled crude prevalence of hypercholesterolemia in Nigeria was 38% (95% confidence interval: 26-51), with prevalence in women slightly higher (42%, 23-63) compared with men (38%, 20-58). The prevalence was highest in the South-south (53%, 38-68) and lowest in the South-west (3%, 2-4) and North-east (4%, 2-7). Urban dwellers had a significantly higher rate (52%, 24-79) compared with rural dwellers (10%, 6-15). We estimated over 8.2 million persons (age-adjusted prevalence 16.5%) aged 20 years or more had hypercholesterolemia in Nigeria in 1995, increasing to 21.9 million persons (age-adjusted prevalence 25.9%) in 2015. CONCLUSIONS: Our findings suggest a high prevalence of hypercholesterolemia in Nigeria. Urbanization, lifestyles, diets, and culture appear to be driving an increasing prevalence, especially among women. Population-wide awareness and education on reducing elevated cholesterol levels and associated risks should be prioritized.

Discordant rapid HIV tests: lessons from a low-resource community.

OBJECTIVES: HIV rapid antibody tests are widely used in Africa, but dual testing sometimes produces discordant results. It is not clear if discordant rapid HIV tests should always heighten suspicion by frontline health workers that early HIV infection is present. Some studies have reported that discordant rapid tests have value for identifying early HIV infection in high HIV prevalence populations. It is not known if rapid test performance influenced this conclusion, or if this observation will hold true for low HIV prevalence populations. We therefore explored the occurrence of discordant rapid HIV tests in a low-resource community. METHODS: A cross-sectional sample of HIV status-unaware adults with recent exposure to unsafe sex was assessed using a validated risk-based tool (University of North Carolina (UNC)-Malawi Risk Screening Score) for acute HIV infection. Participants received rapid testing with Determine™ HIV 1/2 and Uni-Gold™ HIV assays, plus plasma HIV-1 antigen testing with the COBAS® Ampliprep/COBAS® Taqman® HIV-1 assay, followed by western blot in those with detected HIV-1 antigen. RESULTS: Of 408 participants, 1.0% were confirmed to have established HIV infection. The discordance between rapid tests at initial screening was 2.45 and 2.94% when the two assays were used sequentially and simultaneously, respectively. Discordant rapid tests were strongly associated with risk scores > 2 [odds ratio (OR) 10.88; 95% confidence interval (CI) 2.35-50.43], and with detected HIV-1 RNA (OR 26.06; 95% CI 3.91-173.60). CONCLUSIONS: When the sample occurrence of discordance between the first and second tests is below 5%, discordant rapid tests in an adult with sexual risk behaviour should trigger strong suspicion of early HIV infection in low HIV prevalence populations.

HCV co-infection is associated with metabolic abnormalities among HAART naive HIV-infected persons.

OBJECTIVES: To determine the metabolic abnormalities among Hepatitis C Virus (HCV) co infected HAART naïve HIV infected persons within the adult ARV clinic of the University College Hospital/University of Ibadan, Ibadan, Nigeria Methods: This was a retrospective study involving the review of clinical records of newly recruited HIV-infected persons in the adult antiretroviral (ARV) clinic over a 12 month period (January - December 2006). Baseline results for fasting plasma glucose (FPG) and fasting lipid profile were retrieved. RESULTS: Out of the 1,260 HIV infected persons seen during the study period, HCV co-infection was found in 75 (6%) persons. The median values for total cholesterol, LDL-cholesterol and HDL-cholesterol were lower in the HCV co-infected persons. HIV-HCV co-infection was associated with a 0.31 mmol/L depression in Total Cholesterol (TC). The median FPG concentration was significantly higher in HIV-HCV co-infected than HIV only infected persons (5.33mmol/L vs. 5.00mmol/L, p = 0.047). However, regression analysis showed there was no relationship between the HIV-HCV co infected state and fasting glucose levels. CONCLUSION: HIV-HCV co-infection may be associated with a predictable decline in plasma cholesterol, but FPG may not be sufficient to demonstrate insulin resistance in these persons.

Is there any relationship between hearing threshold levels and CD4 cell count of human immunodeficiency virus infected adults?

Background The role of viral load level and/or CD4 (Cluster of differentiation 4) cell count in the aetiopathogenesis of hearing loss in HIV infection is unclear. Therefore, we investigated the relationship between CD4 cell counts, viral load and hearing threshold of HIV (Human immunodeficiency virus) infected adults. METHODS: This cohort audiometric study involved consecutive HIV-infected and HIV-uninfected adults as controls. Clinical data relating to hearing loss, HIV status, and highly -active antiretroviral therapy (HAART) were obtained. Audiornetric evaluation was performed. The most recent CD4 cell counts and RNA viral load-of HIV-infected participants were obtained from clinic records. RESULTS: There were 299(66.7%) HIV-infected adults and 149(33.3%) controls with mean age of 39.64± 12.45 years and 39.60±12.45 years respectively (p=0.98). In both groups, there were more participants with left hearing loss. Mild to profound hearing loss was found in 65.9% HIV- infected participants and 53.7% controls. Majority (86.3%) of the HIV-infected participants were on HAART. The mean CD4 cell count was 654.58±289.15 in 41 HIV-infected participants not on HAART and 523.95±300.17 in 258 participants on HAART (p=0.01). Majority,- 197 (62%) HIV- infected participants with hearing loss had CD4 cell count ≤200 cells/mm3. Higher viral load significantly correlated with low CD4 cell counts (p<0.0 1; r=0. 18) and low CD4 cell count significantly correlated with high hearing threshold (p

Household survey on Human Papilloma Virus vaccine awareness among women of reproductive age in Ibadan, Nigeria.

BACKGROUND: Cervical cancer is the commonest female genital tract malignancy associated with high mortality in sub-Saharan Africa due to poor prevention plan. Human Papilloma Virus (HPV) is a necessary cause of cervical cancer, and the infection is vaccine preventable. Since the introduction of HPV vaccine, robust community surveys on awareness of the vaccine that capture end-users perspective is scarce. The aim of this study is to determine HPV vaccine awareness among women of reproductive age group. METHODS: This was a household survey that used multi-stage random sampling conducted amongst 1002 women aged 18-49 years from August to September 2012 in Mokola area, Ibadan, south western Nigeria. A self-administered pre-tested questionnaire was used for data collection. Descriptive, bivariate and multivariable analyses were performed, and statistical significance was set at 95% confidence level. RESULTS: The mean age was 29.8 +/- 8.2 years and 49.9% had female children. Only 4.6% had heard of HPV vaccine. A significantly higher odds of HPV vaccine awareness was found among highly skilled women, those initiating sexual intercourse at older ages; women with multiple sexual partners and those aware that cervical cancer is preventable. CONCLUSION: The awareness of HPV vaccine is low. Policies and programs that will improve awareness utilising culturally sensitive messages are imperative.

ASSESSMENT OF THE LIVING CONDITIONS OF RURAL BASED PEOPLE LIVING WITH HIV/AIDS WITH CLINICAL PRESENTATIONS IN NIGERIA.

OBJECTIVE: To describe the living conditions of rural based people living with HIV/AIDS (PLWHA) and their clinical presentations DESIGN: descriptive cross-sectional study, SETTING: University College Hospital, Ibadan. SUBJECTS: PLWHA on anti-retroviral therapy. RESULTS: One hundred and fifty PLWHA participated. The mean age of the respondents was 28.7 ± 8.9 years. Majority of the respondents visited had advanced disease (97%), were poor (75%) and presented with opportunistic infections such as oral candidiasis (92%), chronic diarrhoea (70%) and pulmonary tuberculosis (46%). Majority were treated for malaria (72%) and anaemia (61%). All respondents lived in homes predisposed to these opportunistic infections. They drink unsafe water and had poor disposal of their domestic wastes. CONCLUSION: PLWHA visited lived in homes that predispose them to various opportunistic infections. Improved living conditions and economic empowerment will improve the health conditions of PLWHA.

Socio-demographic characteristics and challenges experienced by disabled patients living with HIV/AIDS in a tertiary hospital in Ibadan, Nigeria.

BACKGROUND: HIV/AIDS is highly prevalent in sub-Saharan Africa and few studies had looked at physically and mentally challenged people living with HIV/AIDS (PLHIV) in this environment. This study aimed to describe the socio-demographic characteristics and challenges faced by these patients attending University College Hospital, Ibadan. METHODS: A descriptive cross-sectional study design was done. A semi-structured interviewer administered questionnaire was administered to consecutive disabled PLHIV over a period of six months. Data obtained were analyzed using descriptive and inferential statistics. RESULTS: A total of ninety-nine patients were seen during the study period. The mean age of these patients was 39.9 +/- 9.4 years (range 23-60 years). There were 30 (30.3%) males and 69 (69.7%) females. Twenty-four percent had no formal education while 12% had tertiary education. All respondents had suffered stigmatization/discrimination while most were poor. Eighty-seven percent had AIDS at presentation. Musculoskeletal impairments (46.5%), hearing loss (16.2%) and visual impairment (31.3%) were the commonest disability. Over twenty-three percent had prior history of road traffic accident as the cause of disability. CONCLUSION: Physically and mentally challenged people living with HIV/AIDS are poor and highly stigmatized. They require special assistance to cope and need economic empowerment to reduce their poverty level.

Human papilloma virus vaccination for control of cervical cancer: a challenge for developing countries.

Primary HPV prevention may be the key to reducing incidence and burden of cervical cancer particularly in resource-poor countries. Vaccination programmes are already established in several developed regions, but several grey areas stand in the path of similar success in developing countries. This review sought to identify challenges of HPV vaccination in developing countries and discuss vaccine use, pitfalls and controversies; areas requiring collaborative efforts were identified. A Pub Med search was done; key words included Human papilloma virus, HPV vaccine and sub-Saharan Africa. Other resources included locally-published articles and additional internet resources. The potential benefit of mass HPV vaccination appears enormous. However, the challenges of competing health demands, poverty, ignorance, religion, culture, weak health system, establishment of an effective intersectoral collaboration and underfunding must be overcome to make maximal vaccine uptake a reality. Education and effective communication is crucial in achieving successful immunization programmes.

Risk of anaemia in HIV positive pregnant women in Ibadan, south west Nigeria.

UNLABELLED: Anaemia in pregnancy is an important cause of maternal and neonatal mortality. It is a recognized co-morbidity of HIV infection. This study aimed to determine the risk of anaemia in HIV positive pregnant women. METHODOLOGY: This is a cross sectional study of healthy pregnant women attending Adeoyo Hospital, a secondary health centre in South-western Nigeria over a 1-month period (January 2007). During the study period, 2737 eligible women presented for antenatal care. About 98% (2682) of these women consented to HIV testing. Over all, their mean (+ S.D) packed cell volume was 30.96% (+/- 4.13). The prevalence of HIV infection was 2.9% (95% CI 2.3% - 3.6%) and the overall prevalence of anaemia was 33.1%. Frequency of anaemia was significantly higher in HIV +ve women (57.3% vs. 42.7%, p = 0.00. OR = 2.81., CI = 1.72-4.58). HIV +ve women presented more frequently with moderate or severe anaemia. In the logistic regression analysis only HIV infection (OR = 2.4, 95% CI = 1.37-4.21) and primigravidity (OR = 1.25, 95% CI = 1.04-15.2) remained independently associated with anemia. Anaemia is common in HIV positive pregnant women in this environment. Care providers must endeavor to determine the HIV status of every pregnant woman especially if she presents with anaemia with a view to providing appropriate interventions.

The learning curve of radical hysterectomy for early cervical carcinoma.

Cervical cancer remains a public health concern in developing countries that lack the wherewithal to cope with the associated challenges. Screening for premalignant cervical lesions and offering definitive care for early disease is the key to preventing the scourge. We conducted an audit of the radical hysterectomies performed on account of early cervical carcinoma at our centre between September 2006 and August 2008, following capacity-building by Operation Stop Cervical Cancer. Ten women aged 35 to 60 years were managed. All had type III radical hysterectomy. Three patients had adjuvant teletherapy (one was stage IIb, diagnosed intra-operatively). There was a linear reduction in the surgical blood loss and duration of surgery. Average blood loss was 1500 mls; four had blood transfusions. One case was complicated with rectovaginal fistula (the woman with stage IIb disease) and another had bilateral lymphoedema and left lower limb sensory neuropathy. There was no tumour recurrence on follow-up. Definitive surgery for early cervical cancer is feasible in developing countries despite limited resources. Audit of surgical care of cervical cancer will assist in strengthening the scarce skill. Determination of suitable cases during preoperative evaluation is crucial to the success of the surgery.

Human immuno-deficiency virus and hepatitis B virus coinfection in pregnancy at the University College Hospital, Ibadan.

Human Immuno-deficiency virus (HIV) and Hepatitis B Virus (HBV) share common modes of transmission which include blood borne and the vertical routes. Although, the natural course of HIV does not appear altered by HBV, the rate of liver-related deaths is several times higher among HIV/HBV co-infected persons. Clinicians providing care for HIV positive individuals, including pregnant women, need to be aware of this problem. This is a 2-year cross-sectional study that commenced in January 2006, among HIV positive pregnant women seen at the University College Hospital, Ibadan. During the study period, 721 HIV positive pregnant women were screened for hepatitis B virus infection. Sixty-four women (8.9%) were positive for HBsAg, 14(1.9%) were HCV positive and 642 (89.2%) were negative for both HBV and HCV. One patient was positive forboth HBV and HCV. There were no remarkable differences between HIV infected and HIV-HBV coinfected patients in terms of the hematological, albumin and bilirubin measurements. Alanine transaminase was however higher in the HIV-HBV co-infected patients than HIV patients and this was statistically significant (17.5 iu/ ml vs. 15.0 iu/ml, p value--0.009). In addition, the CD4 cell count was lower and the viral load marginally higher in the hepatitis B virus positive patients. The differences were however not statistically significant (p value--0.114 and 0.644 respectively). HIV-HBV co-infection in HIV positive pregnant women is not of negligible proportions as demonstrated in this study. Thus, HIV positive pregnant women should be screened for HBV and assisted to access care targeted at preventing morbidity and vertical transmission.

Service uptake and performance of the prevention of mother-to-child transmission (PMTCT) programme in Ibadan, Nigeria.

The Prevention of Mother to Child Transmission (PMTCT) programme in the University College Hospital (UCH), Ibadan has been in existence for more than five years and has scaled up to other sites. The study evaluated the service uptake and performance of the programme using national key indicators. Antenatal and delivery records of women enrolled between July 2002 and June 2007 were reviewed. A total of 51952 women attended first antenatal visits and received HIV pre-test counselling. Of these, 51614 (99.5%) accepted HIV test and 49134 (95.2%) returned for their results. Out of the tested patients, 2152 (4.2%) were identified to be HIV positive. Partners of positive patients accepting HIV testing were 361 (16.7%) with 87 (18.6%) testing positive. There were a total of 942 deliveries out of which 39.2% of the mothers and 95.2% of the babies respectively received ARV prophylaxis. In all, 85.8% (788/918) of the mothers opted for formula as the method of infant feeding. Out of the 303 babies eligible for ELISA testing, 68.3% reported for the test and 17 (8.7%) tested positive. There has been progress in the programme, reflected in the increase in the number of new clients accessing the PMTCT service. However, partner testing and follow up of mother-infant pairs remain formidable challenges that deserve special attention.

Emergency obstetric patients in developing countries and prevalence of HIV infection.

The availability of VCT for HIV for booked antenatal patients offers a unique opportunity for best obstetrics practice but not for patients presenting with emergencies and unknown HIV status. Health workers who attend to such patients are at higher risk of acquiring HIV infections. Between 1st March 2005 and 30th September 2007, unbooked emergency obstetric patients in the labour ward of a teaching hospital who consented were tested using double rapid immunodiagnostic technique and confirmed by Western Blot. HIV positive patients were post-test counselled and offered single dose nevirapine tablet (200 mg) in labour with syrup given to the baby at birth at 2 mg/kg followed by syrup zidovudine for 6 weeks. The results showed that 275 (89.0%) of the 309 women pre-test counselled agreed to testing. The mean age of clients was 27.7 years (+/- 4.4 SD). The mean gestational age at presentation was 36.4 weeks (+/- 4.2 weeks). Primigravidae constituted 37.5% of the patients. Twenty-one (7.6%) of these consenting patients were HIV positive. In conclusion, the HIV prevalence of 7.6% among these unbooked obstetric patients is higher than the 4.7% among our booked antenatal patients and National prevalence of 4.4%. This poses substantial risk of transmission of HIV to attending health workers considering the readiness with which needle prick accident can occur in emergency situations.