The effect of COVID-19 on maternal newborn and child health (MNCH) services in Bangladesh, Nigeria and South Africa: call for a contextualised pandemic response in LMICs.

Global response to COVID-19 pandemic has inadvertently undermined the achievement of existing public health priorities and laregely overlooked local context. Recent evidence suggests that this will cause additional maternal and childhood mortality and morbidity especially in low- and middle-income countries (LMICs). Here we have explored the contextual factors influencing maternal, neonatal and children health (MNCH) care in Bangladesh, Nigeria and South Africa amidst the pandemic. Our findings suggest that between March and May 2020, there was a reduction in utilisation of basic essential MNCH services such as antenatal care, family planning and immunization due to: a) the implementation of lockdown which triggered fear of contracting the COVID-19 and deterred people from accessing basic MNCH care, and b) a shift of focus towards pandemic, causing the detriment to other health services, and c) resource constraints. Taken together these issues have resulted in compromised provision of basic general healthcare. Given the likelihood of recurrent waves of the pandemic globally, COVID-19 mitigation plans therefore should be integrated with standard care provision to enhance system resilience to cope with all health needs. This commentary suggests a four-point contextualised mitigation plan to safeguard MNCH care during the pandemic using the observed countries as exemplars for LMIC health system adaptations to maintain the trajectory of progress regarding sustainable development goals (SDGs).

Prevalence, pattern and predictors of sexual abuse among young female hawkers in Kano metropolis, Nigeria.

CONTEXT: Sexual abuse of young female hawkers is a subject of public health importance with resultant long-lasting physical and mental consequences. AIMS: This study assessed the prevalence, pattern and predictors of sexual abuse among female hawkers in Kano State, Nigeria. SETTINGS AND DESIGN: Using a descriptive cross-sectional design and two-stage sampling technique, female hawkers in Kano metropolis were studied. SUBJECTS AND METHODS: An adapted and pre-tested semi-structured interviewer-administered questionnaire was used to obtain information from 236 female hawkers. Data were analysed with SPSS Statistics, version 24.0 software. Prevalence and pattern of sexual abuse was determined and adjusted odds ratios of predictors derived from binary logistic regression models. RESULTS: The prevalence of sexual abuse was 68.6%. Forms of sexual abuse reported included verbal abuse (38.1%), inappropriate touch (64.0%) and rape (25.8%). Predictors of sexual abuse included respondents' age (adjusted odds ratio [aOR] = 10.65, 95% confidence interval [CI] [2.92-38.84]), ethnicity (aOR = 4.26, 95% CI [1.30-14.00]), highest educational attainment (aOR = 0.38, 95% CI [0.15-0.99]), residence with parent (s) (aOR = 0.07, 95%CI [0.01-0.54]) and parents being alive (aOR = 6.79, 95%CI [1.41-32.62]). CONCLUSIONS: Sexual abuse is prevalent among female hawkers and the forms experienced ranged from verbal abuse to inappropriate touch and rape. Interventions that delay age at the commencement of hawking, ensure the education of the girl child and support parental care could foster more matured and smart female hawkers who can avoid sexual abuse.

Detection and management of postpartum haemorrhage: Qualitative evidence on healthcare providers' knowledge and practices in Kenya, Nigeria, and South Africa.

Background: Postpartum haemorrhage (PPH) is the leading cause of maternal death globally. Most PPH deaths can be avoided with timely detection and management; however, critical challenges persist. A multi-country cluster-randomised trial (E-MOTIVE) will introduce a clinical care bundle for early detection and first-response PPH management in hospital settings. This formative qualitative study aimed to explore healthcare providers' knowledge and practices of PPH detection and management after vaginal birth, to inform design and implementation of E-MOTIVE. Methods: Between July 2020-June 2021, semi-structured qualitative interviews were conducted with 45 maternity healthcare providers (midwives, nurses, doctors, managers) of nine hospitals in Kenya, Nigeria, and South Africa. A thematic analysis approach was used. Results: Four key themes were identified, which varied across contexts: in-service training on emergency obstetric care; limited knowledge about PPH; current approaches to PPH detection; and current PPH management and associated challenges. PPH was recognised as an emergency but understanding of PPH varied. Early PPH detection was limited by the subjective nature of visual estimation of blood loss. Lack of expertise on PPH detection and using visual estimation can result in delays in initiation of PPH management. Shortages of trained staff and essential resources, and late inter-hospital referrals were common barriers to PPH management. Conclusion: There are critical needs to address context-specific barriers to early and timely detection and management of PPH in hospital settings. These findings will be used to develop evidence-informed implementation strategies, such as improved in-service training, and objective measurement of blood loss, which are key components of the E-MOTIVE trial (Trial registration: ClinicalTrials.gov: NCT04341662).

Obstetrics violence among parturient women in Kano State, north-west Nigeria.

OBJECTIVES: Women endure physical and psychological abuse from carers during delivery. This form of human-right violation has not been well investigated, especially, in low-income countries. This study determined the prevalence and predictors of obstetric violence among women who gave birth in urban Kano, Nigeria. STUDY DESIGN: Descriptive cross sectional study. MAIN OUTCOME MEASURES: Three hundred and sixty (360) postnatal attendees were interviewed using validated structured questionnaires. Forms of obstetric violence were ascertained and predictors generated using a logistic regression model in SPSS. RESULTS: The overall prevalence of obstetric violence was 32.3% (n = 115). The proportion among women who gave birth at home and in the hospital were 15.8% (n = 28) and 48.6% (n = 87), respectively (p < 0.05). Of the respondents that have experienced at least one form of OV, the most reported form was due to failure to meet professional standards of care (61.7%), of which neglect and abandonment (38.3%) was the commonest form. The least reported form was physical abuse (22.6%). Obstetric violence was predicted by place of delivery (hospital versus home) (Adjusted Odds ratio (AOR) = 3.52, 95% Confidence Interval (CI) = (2.07-5.99), parity (0 versus ≥ 1) (AOR = 2.94, 95%CI (1.62-5.35), and labour/delivery complication (present versus absent) (AOR = 2.22, 95%CI (1.17-4.24). CONCLUSIONS: Obstetric violence was prevalent, especially, among hospital births. Health workers require training on respectful maternity care.

Rapid, Cheap, and Effective COVID-19 Diagnostics for Africa.

BACKGROUND: Although comprehensive public health measures such as mass quarantine have been taken internationally, this has generally been ineffective, leading to a high infection and mortality rate. Despite the fact that the COVID-19 pandemic has been downgraded to epidemic status in many countries, the real number of infections is unknown, particularly in low-income countries. However, precision shielding is used in COVID-19 management, and requires estimates of mass infection in key groups. As a result, rapid tests for the virus could be a useful screening tool for asymptomatic virus shedders who are about to come into contact with sensitive groups. In Africa and other low- and middle-income countries there is high rate of COVID-19 under-diagnosis, due to the high cost of molecular assays. Exploring alternate assays to the reverse transcriptase polymerase chain reaction (RT-PCR) for COVID-19 diagnosis is highly warranted. AIM: This review explored the feasibility of using alternate molecular, rapid antigen, and serological diagnostic assays to accurately and precisely diagnose COVID-19 in African populations, and to mitigate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RT-PCR diagnostic challenges in Africa. METHOD: We reviewed publications from internet sources and searched for appropriate documents available in English. This included Medline, Google Scholar, and Ajol. We included primary literature and some review articles that presented knowledge on the current trends on SARS-CoV-2 diagnostics in Africa and globally. RESULTS: Based on our analysis, we highlight the utility of four different alternatives to RT-PCR. These include two isothermal nucleic acid amplification assays (loop-mediated isothermal amplification (LAMP) and recombinase polymerase amplification (RPA)), rapid antigen testing, and antibody testing for tackling difficulties posed by SARS-CoV-2 RT-PCR testing in Africa. CONCLUSION: The economic burden associated COVID-19 mass testing by RT-PCR will be difficult for low-income nations to meet. We provide evidence for the utility and deployment of these alternate testing methods in Africa and other LMICs.

COVID 19: Evaluating the Knowledge, Attitude and Preventive Practices of Healthcare Workers in Northern Nigeria.

BACKGROUND: Although much is known about the rapidly spreading COVID-19 disease, a lot of knowledge is still evolving. The knowledge, attitude and practice (KAP) of healthcare workers (HCWs) towards COVID-19 remain key in protecting themselves and in fighting the "war" against the disease. This study assessed the KAP of HCWs in Kano, northern Nigeria. METHODOLOGY: A cross-section of different cadre of healthcare workers was recruited online via google forms. Using a link, the participants completed an adapted from a similar study, pre-tested questionnaire on KAP regarding COVID-19. Predictors of KAP were assessed using logistic regression modelling. RESULTS: Among the 651 HCWs invited to participate, 233 respondents responded giving a response rate of 35.8%. Of these, 195 (83.7%) had good knowledge, 183 (78.9%) had a positive attitude and 180 (77.6%) had good practice towards prevention of COVID-19. The odds of having good knowledge were significantly lower among Community Health Officers/Community Health Extension workers (aOR=0.2, 95% CI: 0.1-0.6;p<0.001) and other health workers compared to doctors. Positive attitude was predicted by good knowledge (aOR=4.8, 95% CI:1.7-010.2;p=0.003), being in the fifth decade of life (aOR=5.5, 95% CI: 1.1-29.3, p=0.04), female gender (aOR=3.0, 95% CI: 1.1-8.3;p=0.04), Christian faith (aOR=7.0, 95% CI: 1.3-40.4; p=0.03), and having a bachelors' or medical degree (aOR=4.6, 95% CI: 1.3-16.5).The only predictor of good practice was good knowledge on COVID-19 (aOR=7.8, 95% CI 2.8-12.4;p<0.001). CONCLUSION AND GLOBAL HEALTH IMPLICATIONS: Majority of the HCWs at the study site have good knowledge, attitude and practice regarding COVID-19. Continuous dissemination of information on prevention of spread of COVID-19 to all HCWs will strengthen the health workforce in the fight against it.

Prevention of Mother-to-child HIV Transmission in Nigeria: Six Years' Experience from a Tertiary Institution.

BACKGROUND: In line with global standards and progress made in Prevention of Motherto- Child Transmission (PMTCT), an assessment of the outcome of Early Infant Diagnosis in northern Nigeria is necessary to evaluate progress towards zero Human immunodeficiency Virus (HIV) infection among children. OBJECTIVES: This study assessed the infection rate and risk factors for mother-to-child HIV transmission among HIV-exposed children in Kano, northwest Nigeria. METHODS: Using a retrospective cohort design, pregnant HIV-positive women and their exposed infants were recruited over a period of six years (2010 to 2016). Participants were enrolled during pregnancy or at delivery in the PMTCT clinic of a tertiary health facility in Kano, Nigeria. The main outcomes for the study were Early infant diagnosis positivity for HIV at 6 weeks and risk factors for positivity. RESULTS: Of the 1,514 infants studied, early infant diagnosis was positive for HIV among 13 infants (0.86%). Infants whose mothers did not have antiretroviral therapy (adjusted Prevalence Ratio aPR = 2.58, 95%CI (1.85- 3.57)), who had mixed feeding (aPR = 12.06, 95%CI (9.86- 14.70)), and those not on antiretroviral prophylaxis (aPR = 20.39, 95%CI (16.04- 25.71)) were more likely to be infected with HIV. HIV-exposed infants on nevirapine and zidovudine prophylaxis were 95% and 74%, respectively, less likely to be infected with HIV. CONCLUSION: HIV infection rate remains high among HIV-exposed infants whose mothers did not receive PMTCT services. Scaling up proven interventions of early commencement of antiretroviral treatment for mothers, adherence to antiretroviral prophylaxis, and avoidance of mixed feeding among HIV-exposed infants would protect future generations from HIV infection.

Quality of life of patients surgically treated for ameloblastoma.

BACKGROUND: The surgical management of ameloblastoma can have a profound functional and psychological effect on a patient's quality of life (QoL). The aim of this study was to compare the pre- and post-operative QoL outcomes of patients requiring surgical treatment for ameloblastoma. PATIENTS AND METHODS: A total number of 30 patients were identified as fulfilling the criteria for this study. They included 18 males and 12 females, aged between 14 and 47 years with a mean of 27.3 years (standard deviation 10.2). Each patient completed a modified version of the University of Washington QoL questionnaire version 4, a day to surgery and postoperatively on the 7(th) day, 3 months, and 6 months. RESULTS: Following surgical treatment of patients for ameloblastoma, the QoL decreased immediately after surgery. It then gradually improved over time and exceeded the preoperative value at 6 months postoperatively. When analyzed with respect to location, posteriorly placed tumors had the best postoperative QoL outcome. Patients expressed concern more about their appearance preoperatively while postoperative concerns were mostly focused on their ability to chew. CONCLUSION: Significant improvement occurred in QoL scores following surgical management of ameloblastoma. The small sample size utilized in this study limits a definitive conclusion. A larger multicenter study is therefore recommended.

Prevalence, reasons and predictors for home births among pregnant women attending antenatal care in Birnin Kudu, North-west Nigeria.

OBJECTIVE: To determine the prevalence, reasons and predictors for home birth in a rural community. METHOD: Descriptive cross sectional study which utilised a pretested interviewer administered semi-structured questionnaire to assess the place of delivery in their last childbirth among 410 pregnant women attending antenatal care in Birnin Kudu, Nigeria. Logistic regression analysis was used to assess the relative effect of determinants. PREVALENCE: Of the 410 women, 248 (60.5%) delivered at home in their last childbirth. Self reported reasons: Home birth was opted for because of: lack of transportation 113 (45.6%), onset of labour was at night 104 (41.9 %), preferred birthing position 72 (29.0%), tradition 60 (24.2%), fear of surgery 42 (16.9%) and poor attitude of health workers 32 (12.9%). PREDICTORS: The odds of giving birth at home was 3.88 times higher in women with informal education (adjusted OR 3.88; 95% CI: 2.51, 6.00) and the odds of giving birth at home was 0.27 for women with less than 5 deliveries compared with women with 5 or more deliveries (adjusted OR 0.27; 95% CI: 0.15, 0.49) after controlling for confounders. CONCLUSION: The prevalence of home birth is high in Birnin Kudu and according to our respondents the main reasons for this practice are onset of labour late at night with lack of transportation and a limited choice of birthing positions. Provision of training and retraining of skilled birth attendants to assist women birthing in squatting positions would encourage women to deliver in the hospitals.

A prospective surveillance of ruptured uterus in a rural tertiary health facility in northwest Nigeria.

OBJECTIVE: To determine the frequency, cause and management outcome of ruptured uterus at a rural tertiary hospital. METHODS: Cross sectional study which utilized a prospective surveillance of all cases of ruptured uterus that presented to the hospital from 1 April 2010 to 31 March 2013. RESULTS: Frequency: Over the study period there were 3001 deliveries and 44 cases of ruptured uterus; however, three died before surgery and 41 cases had exploratory laparatomy giving a prevalence of 14.7/1000 deliveries or 1 in 68 deliveries. Their ages ranged from 18 to 45 with a mean of 28.3 ± 6.6 years and parity varied between 1 and 13 with majority (62.7%) being grand multiparous. Twenty-five (61.0%) lived over 50 km away from the hospital. Causes: Prolonged/obstructed labour accounted for 33 (80.5%) cases, 23 (56.1%) had previous caesarean sections, while injudicious use of oxytocin was observed in 17 (41.5%). Management outcome: All the women who had surgery survived but 16 (39.0%) had anaemia, 10 (24.4%) had wound infection, three (7.3%) developed burst abdomen and 11 (26.8%) had prolonged hospital stay. There were 40 (97.5%) stillbirths of which 25 (61.0%) were fresh. CONCLUSION: The prevalence of ruptured uterus is high especially among women with prolonged/obstructed labour and previous caesarean section with associated high perinatal mortality.