Effect of COVID-19 on sexual function and activities among reproductive-age women in Ibadan, South-West Nigeria.

Background: Since the outbreak of COVID-19 disease, the environment, families, individuals, and their ways of living have been affected. Social distancing was one of the strategies for the prevention of SARS-CoV-2 infection. It led to limited social interactions for fear of contracting the infection, which ultimately affected relationships, among which is sexual health. Aim: To determine the risk of female sexual dysfunction and the effect of the COVID-19 pandemic on sexual function and activities among women of reproductive age in Ibadan, South-West Nigeria. Methods: This cross-sectional study of 218 reproductive-age women evaluated the sexual function before, during, and after the COVID-19 disease pandemic and lockdown. Pretested semistructured self-administered questionnaires with the Female Sexual Function Index (FSFI) were used for data collection. Information collected included sociodemographic and gynecologic characteristics and COVID-19 experiences, as well as sexual history and function before, during, and after the COVID-19 pandemic lockdown. The level of significance was set at P < .05. Outcomes: Respondents were aged 20 to 50 years (95%) with a mean ± SD age of 34.82 ± 8.52 years; the majority were married (75.58%); one-fifth (21.9%) tested positive for COVID-19 infection; and participants who tested positive for COVID-19 infections were mostly health care workers. Results: An absence of sexual activity was reported in 9.18% of participants during lockdown, 7.73% before lockdown, and 4.18% after lockdown. The risk of female sexual dysfunction was prevalent among participants, especially those who tested positive for COVID-19 infection. The prevalence was worse during the pandemic lockdown (53.57%) than before (48.39%) or after (51.61%), and a similar pattern was seen among those who tested negative. There was no statistically significant difference in risk of developing sexual dysfunction during the COVID-19 pandemic between those who tested positive and negative to COVID-19. The arousal and desire domains contributed the highest proportion of low FSFI scores. Clinical Implications: Nationwide lockdowns, which may be a method of control for pandemics, may result in psychosocial complications such as female sexual dysfunction. Strength and Limitations: Most respondents had tertiary education and were able to respond to self-administered questionnaires, yet the risk of recall bias remains a concern whereas the pandemic met the world unprepared and baseline FSFI prior the pandemic was not available for participants. There are no local validation studies for the FSFI in Nigeria, which could have aided interpretation of results. Conclusion: A low FSFI score is prevalent in Ibadan, South-West Nigeria, with a higher incidence reported during the COVID-19 pandemic lockdown.

Attitude of postpartum women towards multiple postnatal clinic schedule in south-west Nigeria.

Background: The postnatal period is a critical in the lives of mothers and babies due to the risk of maternal and perinatal morbidity and mortality. According to the Nigeria Demographic Health Survey 2018, only 38 % of women and 42;% of newborns received a postnatal check in the first 2 days after birth. The World Health Organisation (WHO) recommends that postpartum women should have contact with healthcare providers within 24 h, at day 3, days 10-14 and 6 weeks post-delivery. Multiple postnatal clinic (PNC) visits will allow assessment and prompt treatment of complications arising from delivery. This study assessed the attitude of postpartum women towards multiple PNC schedule. Methods: This descriptive cross-sectional study assessed the attitude of postpartum women towards multiple PNC schedules. A total of 167 respondents participated in the study and data was collected using a semi-structured interviewer administered questionnaire. Information on awareness, knowledge and purpose of postnatal care, preference for multiple schedules and the timing of postnatal care visits were obtained. Data was analysed using IBM SPSS version 23; and the level of significance was set at p < 0.05. Results: Of the respondents, 71.9 % had poor or incorrect knowledge. About 87.4 % perceived PNC as beneficial; and that mothers and newborns should be seen at least three times (47.9 %) in the postnatal period. A high proportion of women were willing to come for PNC on day 3 (74.3 %), days 10-14 (86.2 %) and six weeks postpartum (91.6 %). Also, 69.5 % were willing to come for multiple PNC visits. Parity was significantly associated with willingness to attend multiple PNC visits. Conclusion: Despite suboptimal knowledge of the components of postnatal care services, postpartum women have a good attitude to postnatal care and are willing to attend scheduled and multiple PNC schedules. However, fewer women wanted the multiple PNC schedules. Health education and quality postnatal care will enhance postpartum surveillance with prompt detection and treatment of maternal and neonatal complications to forestall life-threatening complications or mortality.

Ecological analysis of demographic-, nutritional- and housing-related factors associated with anaemia among women of reproductive age group in Nigeria.

INTRODUCTION: Anaemia remains a major public health concern, particularly, in sub-Saharan Africa (SSA), where it is one of the causes of maternal death. The most common cause of maternal anaemia is iron deficiency or malnutrition. This study examined the prevalence of and risk factors for anaemia among women that participated in the Nigerian Demographic Health Survey. METHOD: We used data of 14,454 women that participated in the 2018 Nigeria Demographic and Health Survey (NDHS). We extracted information such as demographic, social and housing, dietary characteristics and haemoglobin concentration. The descriptive statistic results, prevalence and 95% confidence interval (CIs) of anaemia with the selected respondents background characteristics were presented. The Poisson regression model with robust variance was used to assess the risk of anaemia among women of reproductive age. All analyses were weighted and adjusted for the complex survey design. Statistical significance was interpreted at p value < 0.05. RESULTS: Maternal status, body mass index, education, residence, religion, ethnicity, region and type of cooking fuel were all important determinants of anaemia. The prevalence of anaemia was high among pregnant women (61.8%; 95% CI: 58.5-65.0), adolescents (60.4%; 95% CI: 58.1-62.6), underweight women (62.6%; 95% CI: 59.5-65.5), women who had no formal education (64.1%; 95% CI: 62.2-66.0) and those who belonged to the poorest wealth quintile (65.8%; 95% CI: 63.1-68.4). Similarly, anaemia was high among women residing in rural areas (61.5%; 95% CI: 60.0-63.0), Muslims (59.9%; 95% CI: 58.1-61.6) and women with six or more children (62.1%; 95% CI: 60.0-64.1). The risk of anaemia were 2% less likely among women who took minimum adequate diet compared to those who do not. CONCLUSION: To date, this is the largest data on maternal anaemia in Nigeria. The study highlighted the high burden of maternal anaemia in the country and different risk factors (medical and social) that are associated with this medical condition among women of reproductive age. We recommend future longitudinal studies to test hypothesis in order to assess whether there is any causal relationship between identified risk factors and anaemia in this group of women.

Assessment of anxiety and depression, and coping mechanisms during COVID-19 lockdown among pregnant women.

Background: COVID-19 lockdown was associated with disruption of daily life, economy, essential health services including maternal health service, and psychological reflexes such as panic, sleep disorders, fear, anxiety, and depression. Aim: To assess the perception of pregnant women on the COVID-19 pandemic lockdown and the prevalence of common mental health disorders (CMHD) among pregnant women. Methods: A cross-sectional study was conducted among 380 pregnant women at the University College Hospital (UCH) Ibadan; participants were enrolled using a simple random sampling technique. Data was collected using pretested interviewer-administered questionnaire. Information obtained - sociodemographic and obstetric characteristics, perception and reaction to the COVID-19 pandemic and lockdown, effect on ANC, coping mechanisms, and presence of CMHD (anxiety and depression) were measured using Hospital Anxiety and Depression Scale (HADS). Data were analysed using STATA 16.0 Software. Descriptive and bivariate statistics were performed. The level of significance was p-value < 0.05. Results: The mean age was 32 ± 4.78 years, most respondents were <35 years (75%), married (97.1%), had a higher education (89%) and multiparous (70%). About 43.9% were worried that COVID-19 would affect pregnancy care, 42.9% reported it affected care and 81.6% were not worried it would affect the delivery care. Among respondents, 96.6% were able to cope with the effects of the pandemic and 96.8% enjoyed good social support. Respondents did not have CMHD (88.16%), 7.9% had CMHD (4.74% had depression and 3.16% had anxiety) and 3.95% had co-morbid depression and anxiety. On multinomial regression analysis, relative to anxiety or depression only, respondents with combined depression and anxiety had higher odds of having no delivery plan and thought COVID-19 may affect their delivery. Conclusion: Only a few women reported anxiety and depression symptoms during the lockdown and those with anxiety or combined symptoms of anxiety and depression had no birth plan and believed that COVID-19 would affect their delivery.

Factors Associated with the Uptake of Antenatal Tetanus Toxoids Containing Vaccine by First-Time Mothers in Nigeria: Findings from the 2018 Nigerian Demographic Health Survey.

Background: Maternal and neonatal tetanus remains a public health problem in low-and-middle-income countries despite the increasing investment in tetanus toxoid containing vaccines (TTCV). Nigeria still records fatalities from tetanus, predominantly in women of reproductive age and in newborns. This is largely due to poor access to vaccinations and high rates of unsupervised labour and childbirth. We aim to investigate the antenatal uptake of TTCV and associated factors among first-time pregnant women in Nigeria. Methods: Data obtained from the 2018 Nigeria Demographic Health Survey (NDHS) was used to generate a list of eligible patients who in the last five years had undergone their first childbirth experience. Data was analysed using univariable and multivariable analyses and reported using a 95% confidence interval. Results: A total of 3640 participants were included in the analysis. 59.6% (95% CI, 57.6-61.8) of participants had received at least two doses of TTCV. Uptake of TTCV irrespective of current marital status was independently associated with number of and place of antenatal care. Other factors associated with receiving two doses of TTCV in all participants were ownership of mobile phones and region of residence. Among the currently married participants, wealth quintiles, region of residence, and having a polygamous family were additional associated factors. Conclusion: There was low uptake of the minimal required dosage of TTCV among first-time pregnant women with the lowest uptake in Northern regions relative to Southern regions. We recommend mixed methods studies to further explore the motivation behind TTCV uptake in pregnant women which can help guide future policies and interventions to improve uptake of tetanus immunization in Nigeria.

Utilization of Postnatal Care During the COVID-19 Pandemic: Perception and Intents of Postpartum Women at Tertiary Health Facility in Southwest, Nigeria.

Coronavirus disease (COVID-19) pandemic took the world unawares and disrupted maternal health care services. This study assessed postnatal care (PNC) utilization, perception, and intent of postpartum women to use PNC. This was a descriptive cross-sectional study conducted during the COVID-19 pandemic over a 2-months period. Inclusion criteria-consenting women, aged ≥18years, and delivery at the study site; 115 women were selected by simple random sampling technique. The information included sociodemographic, obstetric characteristics, perceived effects of COVID-19 on maternal healthcare, and willingness to return for PNC using pre-tested interviewer-administered questionnaires. The maternal healthcare register was also reviewed for the proportion of women accessing services before and during the pandemic. Data were analyzed using IBM Statistical Package and Service Solutions (SPSS) Version 23. The total No. of deliveries and PNC attendance/month was reduced. Respondents were multiparous women (61.7%), with no pregnancy complication (73.9%). About 93% were counseled on PNC; while only 47.8% of the respondents had good knowledge of PNC. The pandemic affected antenatal care in 25.2%, 7.8% perceived it would affect PNC, 62.6% perceived themselves at risk of COVID-19; 13.9% had fears of coming for PNC. Despite this, more than 75% were willing to come for PNC. COVID-19 affected the use of maternal healthcare. Counseling on the role and benefits of PNC can improve its use.

Outcomes of surgical treatments for acquired gynatresia in a tertiary institution in Ibadan, Nigeria.

A 16-year review of causes, clinical presentation and management outcomes of Acquired gynatresia (AG) at University College Hospital, Ibadan, Nigeria. Information was obtained using a proforma and data analysed using SPSS version 20.0. The mean age of the 31 women with AG was 35.6 ± 6.2 years. The majority (90.3%) were married and had a tertiary level of education. The mean parity was 0.74 ± 1.1 and 54.8% were nulliparous while 29.0% were primiparous women. The commonest cause of AG was the insertion of caustic substances into the vagina and this was mainly for the treatment of uterine fibroid (68.2%) and infertility (54.5%). Over three-quarters presented with dyspareunia while 54.8% had infertility. A majority (87.1%) had one-stage surgery with dissection/excision of fibrotic tissue being the commonest (45.2%) and sigmoid vaginoplasty the least performed. Postoperative complications were seen in 29.0% of cases. Acquired gynatresia remains a condition of public health interest despite an increase in female education and relatively improved health care in Nigeria.Impact statementWhat is already known on this subject? Acquired gynatresia (AG) could be of chemical and non-chemical origin and result from certain cultural beliefs and practices.What do the results of this study add? Irrespective of the women's level of education, there is inadequate awareness of the implications of inserting caustic materials into the vagina. However, there is a high success rate of treatment of AG.What the implications are of these findings for clinical practice and/or further research? There is a need to increase health education and awareness of the populace on the causes of AG and its associated complications.

Determinants of correct knowledge of coronavirus infection and COVID-19 disease pandemic among pregnant women in South-West Nigeria.

BACKGROUND: As the spread of COVID-19 continues, the disease and its sequels affect antenatal, intrapartum and post-partum care, thus making pregnant women and their babies vulnerable. This study assessed the knowledge of COVID-19 disease and determinants of correct knowledge among pregnant women at the University College Hospital, Ibadan, Nigeria. METHODS: A cross-sectional study was conducted among pregnant women. Data collected were analysed with STATA 16.0 software. Descriptive, bivariate and multinomial regression analyses were performed. The primary outcomes were awareness of COVID-19 (yes/no), correct knowledge, and determinants. RESULTS: Three hundred and eighty participants were interviewed. The mean age was 32 years (±4.78). A little over a third (37%) were aged 30-34 years, married (97.1%), Yoruba (86.6%), had tertiary education (89.0), in skilled occupation (54.6%) and not well-exposed to media (56.7%). The knowledge of COVID-19 was good (15%), fair (79%), and poor (6%). About 19.6%, 66.7% and 13.7% of participants who had poor, fair and good knowledge, respectively, believed that COVID-19 exists (P = 0.007). The factors associated with good knowledge include occupation, income, level of education and exposure to media (P value <0.05). On multinomial logistic regression, occupation was significantly associated with good knowledge, while being less exposed to media was significantly associated with having poor knowledge. CONCLUSION: Pregnant women had fair knowledge of COVID-19 disease; occupation, level of education, exposure to media and income are associated with having correct knowledge. Misinformation and misconception about COVID-19 disease may affect maternal health utilization and pregnancy outcomes. Antenatal care presents an opportunity to provide health education and increase the knowledge of COVID-19 among pregnant women.

Reducing anxiety and depression in infertility among Nigerian women: an exploratory psycho-educational intervention trial (RADIANT) study protocol.

RATIONALE: high premium is placed on infertility in Nigerian culture. Data is limited on its association with emotional problems in Nigeria. AIMS: to develop content for a culturally relevant and cost-effective psychoeducational intervention package and to evaluate its effectiveness for reducing symptoms of anxiety and depression. Sample size estimate: Methods and design: a multi-method study design including development and validation (which includes focus group discussions) of an audio-visual tool which will serve as the intervention in a randomized controlled trial. Data will be analyzed with interim and survival analyses. POPULATION STUDIED: one hundred and 138 (68 per group) infertile women attending infertility clinic in Ibadan. STUDY OUTCOMES: anxiety and depressions scores assessed with the hospital depression and anxiety scale (HADS) at 0, 3 and 6 weeks. DISCUSSION: it is hoped that the use of the audio-visual tool will improve participants depression and anxiety scores and that the tool will be used for education in routine clinic use and community awareness on psychosocial effects of infertility.

Factors associated with the awareness of vaginal fistula among women of reproductive age: findings from the 2018 Nigerian demographic health cross-sectional survey.

INTRODUCTION: Involuntary leakage of urine and or stool per vaginam (vaginal fistula) after childbirth remains a public health challenge in Africa and South East Asia. To the best of our knowledge, there is no previous national data that examined the awareness of vaginal fistula among women in Nigeria. AIM: To determine the prevalence of awareness of urinary/faecal incontinence due to vaginal fistula, and the associated risk factors among women with no previous experience of incontinence. METHODS: We used a cross-sectional study, the 2018 Nigerian Demographic Health Survey, to analyse awareness of vaginal fistula among women with no previous leakage of urine or stool. The primary outcome was childbirth experience, and other variables were demographics, access to information and reproductive or sexual history. The descriptive, univariate and multivariable models were presented. RESULTS: Of 26 585 women interviewed, 50 (0.2%) who had experienced fistula were excluded from the risk factor analysis. The mean age of women with childbirth experience was 32.8±8.6 years, while that of women without childbirth experience was 20.3±6.2 years. The prevalence of vaginal fistula awareness was 52.0%. Factors associated with the awareness include the following: childbirth experience (adjusted OR (AOR)=1.14; 95% CI, 1.01 to 1.30); age of 20-24 years (AOR=1.36; 95% CI, 1.18 to 1.56) and older; currently working (AOR=1.35; 95% CI, 1.22 to 1.49) and ownership of a mobile phone (AOR=1.16; 95% CI, 1.05 to 1.27). Other associated factors include the following: having at least secondary education; wealth quintiles, ethnicity, regional location, religion, access to radio, newspaper and internet; age up to 17 years at first sex; history of previous termination of pregnancy and use of contraception. CONCLUSION: A significant number of young women with no childbirth experience had low level of awareness. We recommend vaginal fistula awareness programmes that will target women at risk of vaginal fistula and the inclusion of other useful questions to improve the quality of information in future surveys.

A randomized controlled trial of azithromycin and sulphadoxine-pyrimethamine as prophylaxis against malaria in pregnancy among human immunodeficiency virus-positive women.

BACKGROUND: Malaria and human immunodeficiency virus (HIV) infections in pregnancy are important and major contributing factors to maternal morbidity and mortality in sub-Saharan Africa. Prevention of malaria in HIV-positive pregnant woman will reduce the burden of malaria-HIV comorbidity. The objective of this study was to compare effects and safety of azithromycin (AZ) with sulphadoxine-pyrimethamine (SP) for intermittent preventive therapy for malaria in HIV-positive pregnant women. METHODS: We performed a randomized, controlled, open-label pregnancy trial of 140 HIV-positive pregnant patients attending antenatal clinics at the University College Hospital and Adeoyo Maternity Teaching Hospital, Ibadan, Nigeria. Participants were enrolled from a gestational age of 16 weeks and randomized to receive AZ or SP. The primary outcome was peripheral parasitaemia at delivery. Secondary outcomes were drug tolerability, foetal outcome and birthweight. The χ2 test (or Fisher's exact test, as appropriate) and Student's t test were used in the per-protocol analysis. The level of statistical significance was p<0.05. RESULTS: A total of 123 participants (87.9%) completed the study: 60 participants received AZ and 63 received SP. The incidence of malaria parasitaemia at delivery in the AZ group was 6 (10.0%), compared with 7 (11.1%) in the SP group (relative risk 0.89 [95% confidence interval 0.28 to 2.82], p=0.84). Placental parasitization was demonstrated in 1 (1.6%) participant in the SP group compared with 3 (5.0%) in the AZ group (p=0.36). CONCLUSIONS: The findings suggest that AZ is comparable to SP in malaria prevention and safety in HIV-positive pregnant women.

Assessing the knowledge and skills on emergency obstetric care among health providers: Implications for health systems strengthening in Nigeria.

OBJECTIVE: To assess the existing knowledge and skills relating to Emergency Obstetrics Care (EMOC) among health providers in eight referral maternity hospitals in Nigeria. STUDY DESIGN: A cross-sectional study of skilled health providers (doctors, nurses and midwives) working in the hospitals during the period. SETTING: Six general hospitals (4 in the south and 2 in the north), and two teaching hospitals (both in the Northern part) of the country. POPULATION: All skilled providers offering EMOC services in the hospitals during the study. METHODS: A pre-tested self-administered questionnaire was used to obtain information relating to socio-demographic characteristics, the respondents' knowledge and skills in offering specific EMOC services (as compared to standard World Health Organization recommendations), and their confidence in transferring the skills to mid-level providers. Data were analyzed with univariate, bivariate, binary and multinomial logistic regression analyses. Main outcome measures: knowledge and skills in EMOC services by hospital and overall. RESULTS: A total of 341 health providers (148 doctors and 193 nurses/midwives) participated in the study. Averagely, the providers scored less than 46% in a composite EMOC knowledge score, with doctors scoring considerable higher than the nurses/midwives. Similarly, doctors scored higher than nurses/midwives in the self-reporting of confidence in carrying out specific EMOC functions. Health providers that scored higher in knowledge were significantly more likely to report confidence in performing specific EMOC functions as compared to those with lower scores. The self-reporting of confidence in transferring clinical skills was also higher in those with higher EMOC knowledge scores. CONCLUSION: The knowledge and reported skills on EMOC by health providers in referral facilities in Nigeria was lower than average. We conclude that the in-service training and re-training of health providers should be included in national policy and programs that address maternal mortality prevention in referral facilities in the country. TRIAL REGISTRATION: Nigeria Clinical Trials Registry 91540209.

Our Experience with Iatrogenic Ureteric Injuries among Women Presenting to University College Hospital, Ibadan: A Call to Action on Trigger Factors.

BACKGROUND: Ureteric injuries leading to ureterovaginal fistula (UVF) is less common than vesicovaginal fistula, as a cause of urinary incontinence. Recently, there is a surge in the number of UVF cases presenting to University College Hospital (UCH) following a caesarean delivery. The urogynaecology unit at UCH is at the forefront of providing surgical repair for women with all forms of genitourinary fistulas. We describe our experience with managing UVF arising from ureteric injury. METHODS: A retrospective data collection of UVF cases managed from January 2012-December 2017 at UCH is presented. Information on sociodemographic and obstetric characteristics, presenting complaints, antecedent surgery, treatment received, findings at surgery, and postoperative complications were obtained with a structured proforma. RESULTS: Eighteen cases of UVFs due to iatrogenic ureteric injury were managed. Majority (N=11; 61.1%) of the women suffered the injury following the emergency caesarean section (EMCS). Abdominal hysterectomy operation accounted for four (22.2%) cases, and one case each (5.6%) was due to vaginal hysterectomy and destructive operations. Prolonged obstructed labour (POL) (81.8%) was the most common indication for the EMCS, while 18.2% had surgery on account of lower uterine segment fibroid. Most of the ureteric injuries were on the left side. Postoperative complications documented were haemorrhage, urinary tract infection, wound infection, and injury to the neighbouring structure. CONCLUSION: Caesarean section being one of the most performed surgical operations in Nigeria was surprisingly found to be the most common cause of ureteric injury ahead of hysterectomy. It is a pointer that the surgeons might not have properly learnt the art of the caesarean delivery well. We recommend adequate surgical training of medical officers/surgeons that are involved.

Prevalence and determinants of stillbirth in Nigerian referral hospitals: a multicentre study.

BACKGROUND: In 2015, Nigeria's estimated 317,700 stillbirths accounted for 12.2% of the 2.6 million estimated global stillbirths. This suggests that Nigeria still makes substantial contribution to the global burden of stillbirths. This study was conducted to determine the prevalence and identify the causes and factors associated with stillbirth in eight referral hospitals in Nigeria. METHODS: This was a cross-sectional study of all deliveries over a period of 6 months in six general hospitals (4 in the south and 2 in the north), and two teaching hospitals (both in the north) in Nigeria. The study population was women delivering in the hospitals during the study period. A pre-tested study protocol was used to obtain clinical data on pregnancies, live births and stillbirths in the hospitals over a 6 months period. Data were analyzed centrally using univariate, bivariate and multivariate logistic regression analyses. The main outcome measure was stillbirth rate in the hospitals (individually and overall). RESULTS: There were 4416 single births and 175 stillbirths, and a mean stillbirth rate of 39.6 per 1000 births (range: 12.7 to 67.3/1000 births) in the hospitals. Antepartum (macerated) constituted 22.3% of the stillbirths; 47.4% were intrapartum (fresh stillbirths); while 30.3% was unclassified. Acute hypoxia accounted for 32.6% of the stillbirths. Other causes were maternal hypertensive disease (6.9%), and intrapartum unexplained (5.7%) among others. After adjusting for confounding variables, significant predictors of stillbirth were referral status, parity, past experience of stillbirth, birth weight, gestational age at delivery and mode of delivery. CONCLUSION: We conclude that the rate of stillbirth is high in Nigeria's referral hospitals largely because of patients' related factors and the high rates of pregnancy complications. Efforts to address these factors through improved patients' education and emergency obstetric care would reduce the rate of stillbirth in the country. TRIAL REGISTRATION: Trial Registration Number NCTR91540209. Nigeria Clinical Trials Registry. http://www.nctr.nhrec.net/ Registered April 14th 2016.

Pregnancy-induced periodontal inflammation: Influence of salivary cytokines and antimicrobial proteins.

The aim of this study was to evaluate the association between pregnancy-induced periodontal inflammation and levels of some salivary cytokines and antimicrobial proteins (AMPs). The study was a cohort longitudinal study that included pregnant women attending a secondary health facility. Consented participants had oral examination and saliva sampling during pregnancy and post-partum (three months after pregnancy). Saliva samples were used for the analysis of cytokines (TNF-α, IFN-gamma and IL-1ß) and AMPs (Lactoferin, Lysozyme, and ß defensin-1) using ELISA. Data are presented as median with interquartile range and compared using related sample Wilcoxon signed rank test. Correlations between levels of the salivary factors and indices of periodontal inflammation were determined using Spearman's correlation test. Salivary flow rate, pH, levels of salivary IL-1ß and IFN-gamma were significantly lower; while gingival index, periodontal index and level of salivary TNF-α were significantly higher during pregnancy compared with postpartum period. However, salivary lactoferin, lysozyme and ß defensin-1 did not show significant difference comparing during pregnancy and postpartum period. Level of salivary IFN-gamma showed negative correlation with gingival index while level of salivary TNF-α showed positive correlation with gingival and periodontal indices. Lower levels of salivary IL-1ß and IFN-gamma along with higher TNF-α concentration during pregnancy suggest their contributions to the pathophysiology of pregnancy-induced periodontal inflammation.

Comparative study of mefloquine and sulphadoxine-pyrimethamine for malaria prevention among pregnant women with HIV in southwest Nigeria.

OBJECTIVE: To compare the effectiveness of mefloquine and sulphadoxine-pyrimethamine as intermittent preventive therapy for malaria among pregnant women with HIV. METHODS: The present randomized, controlled, prospective, open-label study enrolled women with HIV who had reached at least 16 weeks of pregnancy attending prenatal clinics at secondary and tertiary health facilities in South West Nigeria between January 1 and August 31, 2016. Block randomization was used to assign patients to treatment with mefloquine or sulphadoxine-pyrimethamine for malaria prophylaxis. The primary outcome was malaria parasitemia at delivery. Data were compared with the χ2 and t tests on a per-protocol basis. RESULTS: Of 142 women enrolled and randomized equally to each group, 131 (92.3%) completed the study (64 in the mefloquine group and 67 in the sulphadoxine-pyrimethamine group). Blood-sample malaria parasites were isolated from 6 (9%) and 5 (7%) patients in the mefloquine and sulphadoxine-pyrimethamine groups, respectively, at enrolment, and 6 (9%) and 9 (13%) patients in the mefloquine and sulphadoxine-pyrimethamine groups, respectively, at delivery; the differences between the groups was not significant at enrolment (P=0.693) or delivery (P=0.466). CONCLUSION: Outcomes following prophylactic use of mefloquine for intermittent preventive therapy for malaria among pregnant women with HIV were comparable to sulphadoxine-pyrimethamine treatment; mefloquine is a feasible alternative therapy. ClinicalTrials.gov: NCT02524444.

Prevalence and risk factors for maternal mortality in referral hospitals in Nigeria: a multicenter study.

INTRODUCTION: While reports from individual hospitals have helped to provide insights into the causes of maternal mortality in low-income countries, they are often limited for policymaking at national and subnational levels. This multisite study was designed to determine maternal mortality ratios (MMRs) and identify the risk factors for maternal deaths in referral health facilities in Nigeria. METHODS: A pretested study protocol was used over a 6-month period (January 1-June 30, 2014) to obtain clinical data on pregnancies, births, and maternal deaths in eight referral hospitals across eight states and four geopolitical zones of Nigeria. Data were analyzed centrally using univariate, bivariate, and multivariate statistics. RESULTS: The results show an MMR of 2,085 per 100,000 live births in the hospitals (range: 877-4,210 per 100,000 births). Several covariates were identified as increasing the odds for maternal mortality; however, after adjustment for confounding, five factors remained significant in the logistic regression model. These include delivery in a secondary health facility as opposed to delivery in a tertiary hospital, non-booking for antenatal and delivery care, referral as obstetric emergency from nonhospital sources of care, previous experience by women of early pregnancy complications, and grandmultiparity. CONCLUSION: MMR remains high in referral health facilities in Nigeria due to institutional and patient-related factors. Efforts to reduce MMR in these health facilities should include the improvement of emergency obstetric care, public health education so that women can seek appropriate and immediate evidence-based pregnancy care, the socioeconomic empowerment of women, and the strengthening of the health care system.

Association of the client-provider ratio with the risk of maternal mortality in referral hospitals: a multi-site study in Nigeria.

BACKGROUND: The paucity of human resources for health buoyed by excessive workloads has been identified as being responsible for poor quality obstetric care, which leads to high maternal mortality in Nigeria. While there is anecdotal and qualitative research to support this observation, limited quantitative studies have been conducted to test the association between the number and density of human resources and risk of maternal mortality. This study aims to investigate the association between client-provider ratios for antenatal and delivery care and the risk of maternal mortality in 8 referral hospitals in Nigeria. METHODS: Client-provider ratios were calculated for antenatal and delivery care attendees during a 3-year period (2011-2013). The maternal mortality ratio (MMR) was calculated per 100,000 live births for the hospitals, while unadjusted Poisson regression analysis was used to examine the association between the number of maternal deaths and density of healthcare providers. RESULTS: A total of 334,425 antenatal care attendees and 26,479 births were recorded during this period. The client-provider ratio in the maternity department for antenatal care attendees was 1343:1 for doctors and 222:1 for midwives. The ratio of births to one doctor in the maternity department was 106:1 and 18:1 for midwives. On average, there were 441 births per specialist obstetrician. The results of the regression analysis showed a significant negative association between the number of maternal deaths and client-provider ratios in all categories. CONCLUSION: We conclude that the maternal mortality ratios in Nigeria's referral hospitals are worsened by high client-provider ratios, with few providers attending a large number of pregnant women. Efforts to improve the density and quality of maternal healthcare providers, especially at the first referral level, would be a critical intervention for reducing the currently high rate of maternal mortality in Nigeria. TRIAL REGISTRATION: Trial Registration Number: NCTR91540209 . Nigeria Clinical Trials Registry. Registered 14 April 2016.

Qualitative assessment of women's satisfaction with maternal health care in referral hospitals in Nigeria.

BACKGROUND: Available evidence suggests that the low use of antenatal, delivery, and post-natal services by Nigerian women may be due to their perceptions of low quality of care in health facilities. This study investigated the perceptions of women regarding their satisfaction with the maternity services offered in secondary and tertiary hospitals in Nigeria. METHODS: Five focus group discussions (FGDs) were held with women in eight secondary and tertiary hospitals in four of the six geo-political zones of the country. In all, 40 FGDs were held with women attending antenatal and post-natal clinics in the hospitals. The questions assessed women's level of satisfaction with the care they received in the hospitals, their views on what needed to be done to improve patients' satisfaction, and the overall quality of maternity services in the hospitals. The discussions were audio-taped, transcribed, and analyzed by themes using Atlas ti computer software. RESULTS: Few of the participants expressed satisfaction with the quality of care they received during antenatal, intrapartum, and postnatal care. Many had areas of dissatisfaction, or were not satisfied at all with the quality of care. Reasons for dissatisfaction included poor staff attitude, long waiting time, poor attention to women in labour, high cost of services, and sub-standard facilities. These sources of dissatisfaction were given as the reasons why women often preferred traditional rather than modern facility based maternity care. The recommendations they made for improving maternity care were also consistent with their perceptions of the gaps and inadequacies. These included the improvement of hospital facilities, re-organization of services to eliminate delays, the training and re-training of health workers, and feedback/counseling and education of women. CONCLUSION: A women-friendly approach to delivery of maternal health care based on adequate response to women's concerns and experiences of health care will be critical to curbing women's dissatisfaction with modern facility based health care, improving access to maternal health, and reducing maternal morbidity and mortality in Nigeria. TRIAL REGISTRATION: Trial Registration Number NCTR No: 91540209. Nigeria Clinical Trials Registry. http://www.nctr.nhrec.net/ . Registered April 14th 2016.

A comparative study of azithromycin and sulphadoxine-pyrimethamine as prophylaxis against malaria in pregnancy.

CONTEXT: The benefit of malaria prophylaxis in pregnancy is threatened by emergence of Plasmodium falciparum resistance to antimalarial agents for chemoprophylaxis and treatment. AIM: This study aimed to compare the effectiveness of azithromycin (AZ) with sulphadoxine-pyrimethamine (SP) for malaria prevention. SETTINGS AND DESIGN: A prospective comparative study of antenatal clinic attendees at the University College Hospital, Ibadan, Nigeria. Participants were randomised to receive SP or AZ. SUBJECTS AND METHODS: The subjects were antenatal attendees and Samples for malaria parasitaemia were collected and repeated at follow-up visits; maternal peripheral blood film, placental and cord blood samples were collected at delivery. STATISTICAL ANALYSIS USED: Chi-square test and t-test in a per-protocol analysis. RESULTS: Of 200 participants (100 in each group), 166 (83.0%) completed the study: 86 (86.0%) of SP and 80 (80.0%) of AZ groups, respectively (P = 0.26). Four (4.7%) participants who had SP compared to five (6.2%) in AZ group developed malaria at mean gestational ages of 30.3 ± 1.56 and 33.0 ± 8.6, respectively (P = 0.56). Positive peripheral, placental and cord blood parasitaemia were found in ≤2% of the participants. Drug tolerability and foetal outcomes were comparable for both groups. CONCLUSION: AZ was comparable to SP for prevention of malaria in pregnancy and may be used in patients who do not tolerate SP.