Clinical predictors of Covid-19 mortality in a tertiary hospital in Lagos, Nigeria: A retrospective cohort study.

Background: The predictors of mortality among patients presenting with severe to critical disease in Nigeria are presently unknown. Aim: The aim of this study was to identify the predictors of mortality among patients with COVID-19 presenting for admission in a tertiary referral hospital in Lagos, Nigeria. Patients and Methods: The study was a retrospective study. Patients' sociodemographics, clinical characteristics, comorbidities, complications, treatment outcomes, and hospital duration were documented. Pearson's Chi-square, Fischer's Exact test, or Student's t-test were used to assess the relationship between the variables and mortality. To compare the survival experience across medical comorbidities, Kaplan Meir plots and life tables were used. Univariable and multivariable Cox-proportional hazard analyses were conducted. Results: A total of 734 patients were recruited. Participants' age ranged from five months to 92 years, with a mean ± SD of 47.4 ± 17.2 years, and a male preponderance (58.5% vs. 41.5%). The mortality rate was 9.07 per thousand person-days. About 73.9% (n = 51/69) of the deceased had one or more co-morbidities, compared to 41.6% (252/606) of those discharged. Patients who were older than 50 years, with diabetes mellitus, hypertension, chronic renal illness, and cancer had a statistically significant relationship with mortality. Conclusion: These findings call for a more comprehensive approach to the control of non-communicable diseases, the allocation of sufficient resources for ICU care during outbreaks, an improvement in the quality of health care available to Nigerians, and further research into the relationship between obesity and COVID-19 in Nigerians.

Seroprevalence of Hepatitis B, and C Viruses and HIV Infections among Antenatal Women in a Secondary Health Facility in Lagos, Nigeria.

BACKGROUND: Hepatitis B and C viruses and HIV infections contribute a significant proportion to maternal and perinatal morbidity and mortality in low and middle-income countries. While the burden of hepatitis B and C viruses is higher in low and middle-income countries, Nigeria also has the second largest burden of HIV. OBJECTIVES: To determine the seroprevalence of hepatitis B and C viruses and HIV infections among antenatal women who sought care at a secondary health facility in Lagos. METHODS: This was a retrospective review of patients managed in the antenatal clinic of 68 Nigerian Army Reference Hospital over one year. A study proforma was used to collect relevant data which were entered and analyzed using the IBM Statistical Package for Social Sciences (SPSS Statistics) Version 23. RESULTS: A total of 347 women attended prenatal care during the study period, however, only 329 cases with complete data were included in the final statistical analysis. The prevalence of HIV in our study was 6.4%, while HBV and HCV accounted for 6.2% and 1.8% respectively. Hepatitis B, and hepatitis C viruses and HIV Infections occurred in 3 (0.9%) of our patients, 6 (1.8%) of the women had HIV-HBV co-infection while 1 (0.3%) was infected with HIV-HCV. CONCLUSION: Our study re-emphasizes the public health importance of HBV, HCV and HIV screening in our antenatal clinics. This knowledge is very important for the implementation of effective prevention and control measures that will further decrease the mother-to-child transmission of these viruses.

CONTEXTE: Les virus de l'hépatite B et C et les infections par le VIH contribuent pour une part importante à la morbidité et à la mortalité maternelles et périnatales dans les pays à revenu faible et intermédiaire. Alors que le fardeau des virus de l'hépatite B et C est plus élevé dans les pays à revenu faible et moyen, le Nigeria a également le deuxième plus grand fardeau du VIH. OBJECTIFS: Déterminer la séroprévalence des virus de l'hépatite B et C et des infections par le VIH chez les femmes en période prénatale qui ont consulté dans un établissement de santé secondaire de Lagos. MÉTHODES: Il s'agit d'une étude rétrospective des patientes prises en charge dans la clinique prénatale de 68 références de l'armée nigériane sur une période d'un an. Un formulaire d'étude a été utilisé pour recueillir les données pertinentes qui ont été saisies et analysées à l'aide du progiciel statistique pour les sciences sociales IBM (SPSS Statistics) version 23. RÉSULTATS: Un total de 347 femmes ont suivi des soins prénataux pendant la période d'étude, cependant, seuls 329 cas avec des données complètes ont été inclus dans l'analyse statistique finale. La prévalence du VIH dans notre étude était de 6,4%, tandis que le VHB et le VHC représentaient respectivement 6,2% et 1,8%. Les virus de l'hépatite B et de l'hépatite C ainsi que le VIH étaient présents chez 3 (0,9%) de nos patientes, 6 (1,8%) des femmes avaient une co-infection VIHVHB tandis qu'une (0,3%) était infectée par le VIH-VHC. CONCLUSION: Notre étude souligne à nouveau l'importance pour la santé publique du dépistage du VHB, du VHC et du VIH dans nos cliniques prénatales. Ces connaissances sont très importantes pour la mise en œuvre de mesures de prévention et de contrôle efficaces qui permettront de diminuer davantage la transmission mère-enfant de ces virus. Mots clés: Hépatite B, VIH, Hépatite C, Séroprévalence, Coinfection, Lagos.

Maternal Outcomes of Eclampsia at the Lagos University Teaching Hospital: A Six-Year Retrospective Review.

BACKGROUND: Eclampsia is one of the leading causes of maternal morbidity and mortality. OBJECTIVES: To determine the incidence as well as the maternal outcomes of eclampsia at the Lagos University Teaching Hospital (LUTH). METHODS: This was a retrospective review. RESULTS: During the six-year review period, 4182 women gave birth at our facility, out of which 67 cases of eclampsia were diagnosed (16 per 1000 deliveries). Four women died constituting a case fatality rate of 5.9%. Fifteen women were admitted to the intensive care unit, 6 women had acute kidney injury while 5 had abruptio placentae. Further comparison of our data with previous studies from our institution decades ago showed a continuous decrease in total number of eclamptic cases presenting to our facility (572 eclamptics in 1977 - 1986, 299 ECLAMPTICS IN 1986 - 1995, 165 IN 1996-2005 AND 67 IN 2015-2020). CONCLUSION: The case fatality rate from eclampsia is still high in our hospital. Increased utilisation of antenatal care may play an important role in improving the maternal outcomes from this life-threatening obstetric condition. There is need for maternal education and increase awareness on the importance of antenatal care and early referral to tertiary level of care in order to reverse this trend.

CONTEXTE: L'éclampsie est l'une des principales causes de morbidité et de mortalité maternelles. OBJECTIFS: Déterminer l'incidence ainsi que les issues maternelles de l'éclampsie à l'hôpital universitaire de Lagos (LUTH). METHODES: Il s'agissait d'une revue rétrospective. RESULTATS: Au cours de la période d'examen de six ans, 4182 femmes ont accouché dans notre établissement, dont 67 cas d'éclampsie ont été diagnostiqués (9,5 pour 1 000 accouchements). Quatre femmes sont décédées, soit un taux de létalité de 5,9 %. Quinze femmes ont été admises à l'unité de soins intensifs, 6 femmes avaient une lésion rénale aiguë tandis que 5 avaient un décollement placentaire. Une comparaison plus poussée de nos données avec des études antérieures de notre institution il y a des décennies a montré une diminution continue du nombre total de cas d'éclampsie se présentant à notre établissement (572 éclamptiques en 1977­1986, 299 éclamptiques en 1986-1995, 165 en 1996-2005 et 67 en 2015­2020). CONCLUSION: Le taux de létalité de l'éclampsie est encore élevé dans notre hôpital. L'utilisation accrue des soins prénatals peut jouer un rôle important dans l'amélioration des résultats maternels de cette affection obstétricale potentiellement mortelle. Il est nécessaire d'éduquer les mères et d'accroître la sensibilisation à l'importance des soins prénatals et de l'orientation précoce vers le niveau de soins tertiaires afin d'inverser cette tendance. MOTS CLÉS: Éclampsie, issues maternelles, Grossesse, hypertension, Lagos.

Management of covid-19: a practical guideline for maternal and newborn health care providers in Sub-Saharan Africa.

COVID-19 is a pandemic that is currently ravaging the world. Infection rate is steadily increasing in Sub-Saharan Africa. Pregnant women and their infants may suffer severe illnesses due to their lower immunity. This guideline prepares and equips clinicians working in the maternal and newborn sections in the sub-region to manage COVID-19 during pregnancy and childbirth.

Association between Serum Homocysteine Levels in Preeclampsia and its Severity among Women in Lagos, South-West Nigeria.

BACKGROUND: Clinical evidence had suggested that hyperhomocysteinaemia features in hypertensive disorders of pregnancy. However, there is still conflicting evidence on the extent to which elevated maternal homocysteine contributes to this deadly complication of pregnancy. OBJECTIVES: This study investigated the impact of elevated maternal homocysteine levels in early pregnancy on preeclampsia and its severity among Nigerian women in Lagos. METHODS: This was a prospective cohort study conducted at the Lagos University Teaching Hospital. Participants were enrolled in the first trimester of pregnancy following which their sociodemographic data were obtained by interview. Venous blood samples were collected for measurement of homocysteine concentration using the ELISA method. Data on the occurrence of preeclampsia was obtained from the delivery records. Binary logistic regression model was used to study the effects of the major baseline characteristics on the development of preeclampsia. RESULTS: The final analysis included 167 patients; hyperhomocysteinaemia was recorded in 24 (24.6%) patients. Women with hyperhomocysteinaemia had no statistically significant risk of developing preeclampsia or severe preeclampsia, compared with women with a normal homocysteine concentration. CONCLUSION: The prevalence of hyperhomocysteinaemia in the study was relatively low. The absence of a significant association between maternal hyperhomocysteinaemia and preeclampsia reported in this study could create room for the conduct of a more robust, adequately powered longitudinal research needed to answer some of the major reservations that remain from the present study.

Seroprevalence of hepatitis B virus infection among pregnant women at the antenatal booking clinic of a Tertiary Hospital in Lagos Nigeria.

OBJECTIVES: The objectives were to determine the seroprevalence of hepatitis B virus (HBV) infection and assess the major risk factors among Nigerian pregnant women. SUBJECTS AND METHODS: This was a cross-sectional descriptive study carried out among pregnant women at the antenatal clinic of a Tertiary Hospital in Lagos, Nigeria. A total number of 150 consenting pregnant women were selected for the study. A structured pretested interviewer-administered questionnaire was used for the data collection. Sera were collected and tested for hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg). RESULTS: Of the 150 women screened during the study, 11 (7.3%) were seropositive for HBsAg. Of these 11 women, 4 (36.4%) were also positive for HBeAg. There was no statistically significant difference in the mean ages of participants who were seropositive for HBsAg and those who were negative for the virus (P=0.888). There were statistically significant differences in the seroprevalence of HBsAg recorded among respondents with previous surgery (odd ratio [OR]-2.97; 95% confidence interval [CI]-1.08-16.67; P=0.046), previously affected sibling or spouse (OR-5.03; 95% CI-1.11-25.27; P=0.001) and those with two or more lifetime sexual partners (OR-4.11; 95% CI-2.85-9.22; P=0.024). CONCLUSION: The sero-prevalence rate of HBV infection and also its infectivity is high in Lagos, Nigeria. These findings thus support the need for a nationwide policy of routine and widespread HBV screening among pregnant women.

FEMALE GENITAL TRACT CANCERS IN SAGAMU, SOUTHWEST, NIGERIA.

OBJECTIVE: To describe pattern of female genital tract cancers seen at Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu, Nigeria. DESIGN: This is a retrospective review of all cases of female genital tract cancers managed at the Gynaecology department of OOUTH, Sagamu, Nigeria. SETTING: OOUTH is a tertiary health institution of the State's university and it takes referrals from within and outside the State. SUBJECTS: Case records of all female genital tract cancers managed between January 2004 and December 2013 were retrieved and analysed using SPSS version 16.0. RESULTS: There were 2059 women treated forvarious gynaecologic conditions, 179 (8.7%) were cases of female genital tract cancers and 161 records were available for analysis. Cervical cancer constituted the commonest (51.6%), followed by ovarian (35.4%), endometrial (9.9%), and choriocarcinoma (1.9%). There were no cases of vaginal and fallopian tube cancers. The lowest mean age was found in choriocarcinoma (36.60 ± 4.50 years) and highest in vulvar cancer (70.00 ± 2.82 years). The mean ages for cervical, endometrial and ovarian cancers were (51.98 ± 12.39), (65.38 ± 7.24), and (54.42 ± 10.51) years respectively. Similarly the least mean parity was found in choriocarcinoma (2.33 ± 1.52), and the highest in vulvar cancer (6.00 ± 1.44). The mean parity for cervical, endometrial, and ovarian were (4.10 ± 1.49),(3.06 ± 1.48), and (3.72 ± 1.68) respectively. These differences are statistically significant, age; F = 7.61, p < 0.0001, and parity; F = 3.27, p= 0.013. CONCLUSION: Incidence of cervical, endometrial, and ovarian cancers remain high and presentations are at late stages. There is a need to improve on cervical cancer screening, and for the attending physicians to improve on their indices of suspicions as regards endometrial and ovarian cancers.

ATTITUDES AND ACCEPTANCE OF NIGERIANS TOWARDS VASECTOMY--A COMPARISON OF MARRIED MEN AND WOMEN IN LAGOS.

BACKGROUND: Nigeria with a growth rate of 28%, accounts for over two thirds of the West African population. It also has one of the highest maternal mortality rates in the world with contraceptive prevalence among married couples less than 10%. Despite its safety and efficacy vasectomy appears to be unpopular in our environment. OBJECTIVE: To assess the perception and acceptance of married men and women towards vasectomy and the influence of the spouse on the man's decision to accept or reject vasectomy. DESIGN: A cross sectional questionnaire based study. SETTING: With an estimated population of 20 million, Lagos is the most cosmopolitan and urbanised city in Nigeria and accounts for 65% of all commercial activities in the country. Virtually all the tribes in Nigeria are represented in the city. SUBJECTS: Literate pregnant women recruited from the antenatal clinics and literate new fathers. All subjects were recruited from three health facilities in the Lagos metropolis. RESULTS: Twenty seven point five and twenty one percent of the men and women respectively had a good Knowledge of vasectomy while 49.1% and 19% of all men and women respectively with good knowledge would accept vasectomy (or agree for their spouses to have the procedure). Overall acceptance rates for men and women were 26 and 13.5% respectively while 92% of men who can opt for vasectomy will only do so if their spouses agree. Knowledge about vasectomy was the strongest single factor influencing the acceptance of vasectomy (p= 0.013) with stronger correlation among men than women (p=0.005 vrs p=.0.023). CONCLUSION: Knowledge and acceptance of vasectomy is significantly better in males than female Nigerians living in Lagos.

The role of manix in the management of idiopathic oligospermia. A pilot study at the Lagos University Teaching Hospital.

OBJECTIVES: To assess the usefulness of Manix in the management of men with idiopathic oligospermia. PATIENTS AND METHODS: The study involved 55 infertile men with idiopathic oligospermia. Thirty-five patients were administered oral 600 mg of manix for 13 weeks and 20 were put on oral 1000 IU of vitamin E for 13 weeks. Semen analysis and the sex hormone profiles were done as baseline and then repeated at 3 and 6 months. RESULTS: There were statistically significant improvements in semen parameters in the patients on Manix . No improvement was noted in the other group on vit E. There was however no significant difference in pregnancy rates in the two groups. CONCLUSION: Manix may play a role in the management of patients with idiopathic olligospermia. However, large scale double blind controlled trials are needed to confirm the findings in this preliminary study.

Sociodemographic factors in anaemia in pregnancy at booking in Lagos, Nigeria.

Anaemia in pregnancy is a common problem in many developing countries. In Nigeria, it is responsible for 11.0% of maternal deaths. This study examined the sociodemographic factors associated with anaemia in pregnancy. Anaemia was defined as a haemoglobin (Hb) level <11 g/dl. Proportions were compared using the chi2 test. A total of 35.3% of the 374 women studied were anaemic. Anaemia was more common in primigravidae than in parous women of parity 2 - 4 (chi2 = 6.87; p = 0.0087). Low socioeconomic status, (chi2 = 24.67, p = 0.00090), short interval between pregnancies (chi2 = 20.34, p = 0.000144), booking in the third trimester (chi2 = 15.4, p = 0.00045) and recent febrile illness (chi2 = 6.80; p = 0.0091) were associated with anaemia. Women who only used haematenics were more anaemic than those who also used anti-malarial chemo-prophylaxis (chi2 = 57.32, p = 0.00001). Anaemia in pregnancy is associated with several social and demographic factors. To reduce the prevalence of anaemia women need to have a good formal education, be economically empowered and good antenatal care must be made available, accessible and affordable to all women.