Acceptability of counselling and testing for HIV infection in women in labour at the University College Hospital, Ibadan, Nigeria.

BACKGROUND: Many patients are referred to labour ward as emergencies, and therefore do not benefit from the antenatal HIV counselling and testing and treatment offered to registered patients. OBJECTIVE: To assess the acceptability and suitability of offering HIV counselling and testing to women of unknown HIV status presenting in labour. METHODS: A cross-sectional study comprising counselling and obtaining consent for HIV testing among 104 unregistered patients who presented in labour over a 3-month period. Rapid and enzyme-linked immunosorbent assay screening was performed for 90 consenting respondents. Reactive results were confirmed by Western blot. Appropriate therapy was instituted. RESULTS: Acceptance rate for HIV testing was 86.5%, prevalence of HIV was 6.7%. Women of lower educational status were more likely to accept testing in labour (OR: 0.3; 95% CI: 0.1-0.7; p=0.01); age, parity, occupation and knowledge of HIV had no influence. Most women (66.3%) had satisfactory knowledge of HIV. No one admitted to feeling coerced to test in fear of being denied care. Most refusals for screening were to avoid needle pricks (28.6%). Compared to ELISA screening test, specificity of the rapid test was 100%, sensitivity 85.7%, positive predictive value 100% and negative predictive value 98.8%. Attitude to testing was maintained on post-partum re-evaluation. CONCLUSION: The prevalence of HIV amongst unregistered parturients showed the importance of offering point-of-care HIV testing and intervention, especially in an environment where antenatal clinic attendance is poor. Rapid testing appeared to be acceptable and feasible in labour to prevent the mother-to-child transmission of HIV.

Asymptomatic bacteriuria in pregnancy: evaluation of reagent strips in comparison to microbiological culture.

Screening for asymptomatic bacteriuria during pregnancy, the major risk factor for symptomatic urinary tract infection during pregnancy have been recommended. This cross sectional study was conducted to determine prevalence of asymptomatic bacteriuria in Ibadan and evaluate the diagnostic accuracy and relative cost effectiveness of dipstick tests for nitrite and leucocyte esterase in comparison to laboratory culture. Two hundred and five patients, presenting for their first antenatal visit at the University College Hospital, Ibadan, participated in the study. Urine samples obtained from the participants were subjected to two tests; reagent dipstick test for nitrite and leucocyte esterase and routine laboratory culture, which is the gold standard for diagnosis. Main outcome measures were sensitivity, specificity, positive and negative predictive values of the reagent dipstick tests as well as likelihood ratios. The prevalence of asymptomatic bacteriuria in pregnancy with routine laboratory culture and using combined leucocyte esterase and nitrite strip tests were 10.7% and 11.7% respectively. Compared with laboratory culture, combined strip tests had sensitivity, specificity and negative predictive values of 50%, 92.9% and 93.9% respectively, indicating a statistically significant lower level of accuracy (P < 0.05). The corresponding likelihood ratios for positive and negative strip tests (LR+ and LR-) were 7 and 0.5 respectively. The study concludes that combined Leucocyte esterase-nitrite dipstick test is not sufficiently sensitive and specific to be used for routine screening of bacteriuria in pregnancy in place of laboratory culture, though may be more cost effective in low resource settings.

Predictors of asymptomatic bacteriuria among obstetric population in Ibadan.

BACKGROUND: Asymptomatic bacteriuria in pregnancy is the major risk factor for symptomatic urinary tract infection during pregnancy. Screening and identification of bacteriuria during pregnancy have been recommended. The general objective of the study was to determine the pattern as well as possible predictors of asymptomatic bacteriuria at the University College Hospital, Ibadan. METHODS: The study was a descriptive, cross sectional, exploratory survey of the pattern of asymptomatic bacteriuria among all consecutive patients presenting for the first antenatal visit at the University College Hospital, Ibadan during the study period. RESULTS: The prevalence of asymptomatic bacteriuria was 10.7%. Although no statistically significant association was found, the prevalence was higher among women aged between 26 - 35 years (11.5%) and those with only secondary education (14.6%). Other demographic parameters characterized by high rates of bacteriuria were Christian women (12.7% compared to 4.3% among Muslims) and genotypes AS and AC (16.4% and 16.7% respectively). Low parity (para 1-2), 2nd and 3rd trimesters of pregnancy were the identified possible obstetric predictors of bacteriuria in pregnancy. Staphylococcus species constitute the predominant isolates in 3rd trimester and among Muslim pregnant women. CONCLUSION: Since no statistically significant predictors for bacteriuria in pregnancy were found, routine screening of all our pregnant women for this condition in 2nd trimester is recommended.

Predictors of Asymptomatic Bacteriuria among Obstetric Population in Ibadan

Asymptomatic bacteriuria in pregnancy is the major risk factor for symptomatic urinary tract infection during pregnancy. Screening and identification of bacteriuria during pregnancy have been recommended.The general objective of the study was to determine the pattern as well as possible predictors of asymptomatic bacteriuria at the University College Hospital; Ibadan. The study was a descriptive; cross sectional; exploratory survey of the pattern of asymptomatic bacteriuria among all consecutive patients presenting for the first antenatal visit at the University College Hospital; Ibadan during the study period. The prevalence of asymptomatic bacteriuria was 10.7. Although no statistically significant association was found; the prevalence was higher among women aged between 26 - 35 years (11.5) and those with only secondary education (14.6). Other demographic parameters characterized by high rates of bacteriuria were Christian women (12.7compared to 4.3among Muslims) and genotypes AS andAC (16.4and 16.7respectively). Low parity (para 1-2); 2 and 3 trimesters of pregnancy were the identified possible obstetric predictors of bacteriuria in pregnancy. Staphylococcus species constitute the predominant isolates in 3 trimester and among Muslim pregnant women. Since no statistically significant predictors for bacteriuria in pregnancy were found; routine screening of all our pregnant women for this condition in 2 trimester is recommended