Pattern and risk factors for partner infection with hepatitis B virus in a prevention of mother-to-child transmission programme.

BACKGROUND: Hepatitis B virus (HBV) infection is horizontally and vertically transmitted. It is associated with high morbidity and mortality but is preventable with vaccine. There is paucity of data on pattern and risk factors for partner infection in prevention of mother-to-child transmission (PMTCT) programmes. OBJECTIVE: To determine the pattern and risk factors for partner infection with HBV in a PMTCT Programme. METHODS: This cross-sectional study evaluated the hepatitis B surface antigen (HBsAg) serostatus of partners of HBV-infected pregnant women in a PMTCT programme using rapid, third generation immunochromatographic test. Repeatedly reactive samples were confirmed using enzyme-linked immunosorbent assay. Patients' sociodemographic characteristics and behavioral risk factors were evaluated against their HBsAg-serostatus. The seropositive and seronegative subjects had liver function tests HBV vaccination respectively. RESULTS: Out of 3,907 pregnant women seen, 3,762(96.3%) and 73 (45.3%) partners of 161 HBV-infected women were screened. The HBsAg seroprevalence among the women and partners were 161(4.3%) and 5(6.8%) respectively; p<0.43. The sero-concordance and discordance were 6.8% and 93.2% respectively. Nulliparity (60.9%) associated with non-protective pre-marital sex and induced abortions (58.4%), history of blood transfusion (6.7%) and lack of vaccination (93.6%) were risk factors for HBV-infection. CONCLUSION: This study has revealed high prevalence of HBV infection among the couples and high serodiscordance rate. The risk factors for HBV infection were preventable. We recommend integration of couple counseling and testing backed with vaccination into antennal care services nationwide. Further study is required to assess the serostatus of female partners' of HBV-infected males to determine HBV feminization.

Neonatal jaundice and its management: knowledge, attitude, and practice among expectant mothers attending antenatal clinic at University of Benin Teaching Hospital, Benin City, Nigeria.

INTRODUCTION: Neonatal Jaundice (NNJ) is a common disorder worldwide and one of the important contributors to the high neonatal morbidity and mortality in Sub-Saharan Africa. Severe neonatal jaundice leads to brain damage or even death in otherwise healthy newborns. The objective of the study was to assess the knowledge, attitude and practice of expectant mothers about neonatal jaundice and its management. MATERIALS AND METHODS: The study was descriptive cross-sectional, carried out among 389 expectant mothers who were attending the antenatal clinic at the University of Benin Teaching Hospital. A structured, Pre-tested, researcher administered questionnaire was used to interview the respondents. Data was analysed using SPSS version 15. RESULTS: The mean age of the expectant mothers was 30.5 (SD 4.9) years. Fifty-five (14.1%) of respondents had previous experience with NNJ, 8 (2.1%) lost babies due to NNJ. 334 (85.9%) were aware of the condition, 381 (77.4%) knew how to recognize the symptoms of NNJ, 279 (71.7%) knew a correct method of treatment of NNJ. A large proportion of the expectant mothers 261 (67%) knew some complications of NNJ. Two hundred and five (52.7%) did not know any danger sign of complications of NNJ. Three hundred and fifty five (91.3%) had good attitude towards its management. Majority of expectant mothers whose previous babies had NNJ took the babies to the hospital for treatment. A large proportion also expressed their willingness to seek medical attention if their babies were to develop the condition. Their knowledge of neonatal jaundice was significantly influenced by their level of education and the number of their previous babies who had NNJ. CONCLUSION: This study revealed that expectant mothers attending antenatal clinic at UBTH had good knowledge of the treatment and complications of NNJ but inadequate knowledge of the causes and danger signs of the condition. Their attitude and practice towards the management of NNJ was good. It is therefore recommended that Health care providers should give more health education on NNJ to the expectant mothers during antenatal visits.

Neonatal Jaundice and its Management: Knowledge; Attitude; and Practice among Expectant Mothers Attending Antenatal Clinic at University of Benin Teaching Hospital; Benin City; Nigeria

Introduction: Neonatal Jaundice (NNJ) is a common disorder worldwide and one of the important contributors to the high neonatal morbidity and mortality in Sub-Saharan Africa. Severe neonatal jaundice leads to brain damage or even death in otherwise healthy newborns. The objective of the study was to assess the knowledge; attitude and practice of expectant mothers about neonatal jaundice and its management. Materials and Methods: The study was descriptive cross-sectional; carried out among 389 expectant mothers who were attending the antenatal clinic at the University of Benin Teaching Hospital. A structured; Pre-tested; researcher administered questionnaire was used to interview the respondents. Data was analysed using SPSS version 15. Results: The mean age of the expectant mothers was 30.5 (SD 4.9) years. Fifty-five (14.1) of respondents had previous experience with NNJ; 8 (2.1) lost babies due to NNJ. 334 (85.9) were aware of the condition; 381 (77.4) knew how to recognize the symptoms of NNJ; 279 (71.7) knew a correct method of treatment of NNJ. A large proportion of the expectant mothers 261 (67) knew some complications of NNJ. Two hundred and five (52.7) did not know any danger sign of complications of NNJ. Three hundred and fifty five (91.3) had good attitude towards its management. Majority of expectant mothers whose previous babies had NNJ took the babies to the hospital for treatment. A large proportion also expressed their willingness to seek medical attention if their babies were to develop the condition. Their knowledge of neonatal jaundice was significantly influenced by their level of education and the number of their previous babies who had NNJ. Conclusion: This study revealed that expectant mothers attending antenatal clinic at UBTH had good knowledge of the treatment and complications of NNJ but inadequate knowledge of the causes and danger signs of the condition. Their attitude and practice towards the management of NNJ was good. It is therefore recommended that Health care providers should give more health education on NNJ to the expectant mothers during antenatal visits

HIV-AIDS related maternal mortality in Benin City, Nigeria.

OBJECTIVE: To determine the causes and characteristics of maternal deaths in HIV-infected women. DESIGN: A retrospective study of maternal deaths in a cohort of HIV-infected women. SETTING: A facility-based maternal death review using case records and mortality summaries. METHODS: Thirty seven maternal deaths which occurred in HIV-infected women were reviewed in a university teaching hospital in southern Nigeria over a 4-year period. Causes and circumstances surrounding each maternal death were identified. RESULT: One in every four maternal deaths occur in women with HIV infection. Majority (64.9%) of the women presented in advanced stage (WHO stage III/IV) of HIV syndrome while 86.5% had missed opportunities for antiretroviral programme. Pregnancy-related sepsis was the commonest cause of maternal death. Other common causes were death from tuberculosis and pneumonia. CONCLUSION: HIV-related maternal death is emerging as a leading cause of pregnancy related death in Nigeria. There is need to scale-up preconception care and ensure comprehensive and sustainable prevention of mother -to-child transmission service for all pregnant women throughout Nigeria to reduce the burden of HIV/AIDS infection and minimize avoidable deaths from opportunistic infections.

Seroprevalence survey of rubella infection in pregnancy at the University of Benin Teaching Hospital, Benin City, Nigeria.

OBJECTIVE: To determine the serosusceptibility of rubella infection in pregnancy and the feasibility of establishing an organized prevention program in a tertiary hospital in Nigeria. MATERIALS AND METHODS: This prospective, cross-sectional, laboratory-based study involved 300 consecutive pregnant women who gave informed consent and were screened for rubella immunoglobulins G (IgG) and M (IgM), using the ELISA-based quantitative assay at the University of Benin Teaching Hospital, Nigeria. Of the cohort, 30 women later withdrew. IgG seropositive samples were screened for IgM antibodies. RESULTS: The mean age and parity of the women were 30.0 ± 4.8 years, 95% CI 29.727-30.873 and 2.0 ± 1.4; 95% CI 1.317-1.661, respectively. IgG seroprevalence was 53%, while 10.0% of all IgG seropositive women were IgM seropositive. Most infections were acquired before the age of 35. None of the women ever had previous rubella vaccination. Rubella vaccine is scarce in Nigeria. CONCLUSIONS: Prevalence of rubella seromarkers for previous and current infection is high. Facilities for routine diagnosis and vaccination are lacking. Initiation of organized screening and vaccination programs is limited by lack of vaccine. We recommend immunization of children and women of child-bearing age as a cost-effective public health intervention strategy for managing the sequelae of the congenital rubella syndrome.

Seroprevalence of Hepatitis C viral antibodies in pregnancy in a tertiary health facility in Nigeria.

BACKGROUND: Liver disease due to Hepatitis C viral (HCV) infection is the most common indication for liver transplant. It is a viral pandemic that is five times as widespread as the human immunodeficiency virus type 1 infection. In spite of this, vaccines were yet unavailable for protection of the human race due to the morphology and fastidious nature of the organism. While the scanty data available on this infection in our environment are limited to blood donors, people continue to be screened for and deprived of renal dialysis if any patient is found to have HCV infection. Also in this environment, data on HCV infection in pregnancy is virtually nonexistent even though the infection can have a deleterious effect on materno-fetal outcome. OBJECTIVE OF THE STUDY: To determine the seroprevalence of hepatitis C viral antibodies among antenatal women attending a tertiary health facility in Nigeria. METHODOLOGY: This was a prospective cross-sectional study whose subjects were booked consecutive antenatal women volunteers attending the University of Benin Teaching Hospital, Benin City, Nigeria between June 1 and December 31, 2005. Hepatitis C viral antibodies were determined and confirmed using a second and a third generation Enzyme Linked immunosorbent assay respectively. Both HCV sero-positive and seronegative women had both pre-and post-test counseling. RESULTS: Of the 269 samples screened for HCV antibodies, 5 (1.86%) samples were confirmed seropositive. None of the HCV seropositive women had liver enzyme derangement. CONCLUSION: Hepatitis C viral infection in pregnancy is not uncommon in Nigeria. It's prevalence in pregnant women South-South of Nigerian is similar to that of their Cameroonian counterparts, an immediate neighbouring country. A multi-centre study to determine the national prevalence of HCV and in addition to elevation of public awareness is suggested. Hepatitis C viral-induced liver disease remains the major indication for liver transplant for which our present levels of economy and health infrastructures can least support. With no vaccines and no cure, the time to act is now.

The prevalence of dual human immunodeficiency virus/hepatitis C virus (HIV/HCV) infection in asymptomatic pregnant women in Benin City, Nigeria.

Concerted efforts have been made to combat HIV infection in Nigerian. By contrast, much less attention has been paid to hepatitis C viral (HCV) infection. These viruses have similar immuno-epidemiology. The objective of this study was to determine the prevalence of HCV/HIV dual infection among 269 antenatal attendees at the University of Benin Teaching Hospital in southern Nigeria. The study was prospective and cross-sectional and consisted of the analysis of the sera of the participants for anti-HCV and HIV antibodies using ELISA. The result showed that 1.86% samples were HCV antibodies positive while 8.30% were seropositive for HIV-1 antibodies. There were no cases of dual infections. The HIV positive women and their babies had antiretroviral therapy. We conclude that dual HCV/HIV infection in pregnancy in Nigeria may be uncommon but suggest multicenter studies to determine the national prevalence while initiating strategies for their prevention.

The prevalence of dual Human Immunodeficiency Virus/Hepatitis C Virus (HIV/HCV) Infection in asymptomatic pregnant women in Benin City, Nigeria

Concerted efforts have been made to combat HIV infection in Nigerian. By contrast, much less attention has been paid to hepatitis C viral (HCV) infection. These viruses have similar immuno-epidemiology. The objective of this study was to determine the prevalence of HCV/HIV dual infection among 269 antenatal attendees at the University of Benin Teaching Hospital in southern Nigeria. The study was prospective and cross-sectional and consisted of the analysis of the sera of the participants for anti-HCV and HIV antibodies using ELISA. The result showed that 1.86% samples were HCV antibodies positive while 8.30% were seropositive for HIV-1 antibodies. There were no cases of dual infections. The HIV positive women and their babies had antiretroviral therapy. We conclude that dual HCV/HIV infection in pregnancy in Nigeria may be uncommon but suggest multicenter studies to determine the national prevalence while initiating strategies for their prevention (Afr J Reprod Health 2009; 13[2]:97-108)

Changing trends in maternal mortality in a developing country.

OBJECTIVE: To have a 5-year review of the maternal mortality ratio in the largest centrally located Mission hospital in Benin City where a large proportion of women deliver yearly. METHOD: This was a 5-year (January 1, 1996 through December 31, 2000) review of the causes of maternal mortality at the Saint Philomena Catholic Hospital, Benin City. The case notes of those that suffered maternal mortality were retrieved and thoroughly perused. Information on all cases of maternal mortality were extracted from the patients' case-notes; the labour ward Registers; the antenatal, postnatal, the female ward and the theatre registers. The midwifery/nurses' reports were also examined. The duplicate copies of the death certificates were examined and the necessary information was also extracted. The total deliveries for the period were extracted from the delivery registers. RESULTS: There were 7055 women who gave birth during the 5-year period. There were 32 maternal deaths; Maternal Mortality Ratio (MMR) of 454/ 100,000 live births. Unbooked emergencies accounted for 68.7% of all deaths, and were more than doubled the booked women. The MMR increased progressively from 325 in 1996 to peak at 765 in 1999 (P < 0.0001) with an insignificant drop in 1998 (P > 0.06). It was lowest in 2000 (241) (P < 0.0001). Paradoxically, as the number of deliveries decreased progressively from 1530 in 1996 to 1247 in 2000, the MMR increased progressively from 327 in 1996 to 675 in 1999. There were no postmortem examinations and no coroner's inquests. More than 76% of the women spent 48 hours or less from time of admission to death and majority of them were of low parity. Nulliparity was 37.5%. The mean parity was one. Young women 20-39 years old accounted for 81.3% with 9.4% teenage deaths due to illegally induced abortions. Eclampsia (34.4%), hemorrhage (25.0%), Infections (18.8%) and abortions 12.5%) were the four leading causes of death. Puerperal deaths were 56.3%. Five short case scenarios were presented to highlight the tortuous pathway the women passed to end in maternal mortality. CONCLUSION: The MMR ratio was still unacceptably high. The causative factors were largely preventable. The puerperium was the most dangerous period. Women empowerment, free or highly subsidized universal antenatal care services, and provision of adequate emergency obstetric services with effective contraceptive backup is suggested. Re-orientation of care givers and community leaders to enhance awareness and early recognition of the danger signs and risk factors associated with pre-eclampsia and eclampsia with prompt and adequate management or referral is emphasized.

Salvaging twin 2 after abortion of twin 1: a case report.

We present intentional delayed delivery of twin 2 after a spontaneous membrane rupture and abortion oftwin1 in a dichorionic twin pregnancy at 14 weeks. As signs of infection were missing, we adopted a conservative (not expectant) management. The pregnancy was prolonged to 35 weeks' gestation. In the absence of additional risk factors, the role of conservative management of multiple pregnancies after loss of one fetus in prolonging the pregnancy to fetal viability in resource-poor setting is highlighted. The gained gestational age of 20 weeks and 4 days (144 days in all), for the remaining fetus and the healthy mother and child pair after delivery at 35 weeks are discussed. The perinatal, economic and psychological implications are highlighted. The importance of good clinical assessment in the diagnosis of cervical incompetence and using ultrasound scan as a complimentary instrument is emphasized.

Caring for the terminally ill: what do the doctors think?

Patients' perception of end-of-life events varies with cultural norms and values, and expectations may differ from clinicians practice and actions. In contemporary practice, conflict of ideas often results in patients discharging themselves against medical advice. Clinicians (67) that have been in medical practice for at least five years at the main tertiary hospital in Benin City were interviewed with a semi-structured questionnaire. The main outcome measured was clinicians' attitude towards caring for the terminally ill patients and physician assisted suicide (PAS). The mean age of the clinicians was 36.89 +/- 7.57, 11 females and 56 males. Twenty-six clinicians (40%) do not routinely record in the case notes details of their discussion on prognosis with their patients. Forty one (62.1%) clinicians will not support life while patients are on palliative care, while 49/66 (74.2%) will transfuse their patients with blood. Thirteen (31.7%) will not support life, and will not transfuse blood. Fifty seven (85.1%) clinicians will not support euthanasia, 8 of the 9 physicians who will support PAS are males, while 6 of the 9 clinicians that will grant patient's request for PAS are gynaecologists. All (17) clinicians in Internal Medicine specialty will not support PAS, while 51/67 (77.3%) clinicians are of the opinion that patients should be routinely informed of the prognosis of their disease. Documentation of physician-patients interactions is poor amongst clinicians. Most will not support life and physician-assisted suicide for the terminally ill patients. However, in clinical practice most will transfuse their patients on palliative care with blood and give other life support treatment; an apparent dissociation between what clinicians think and what is practised.

Maternal and neonatal seroprevalence of hepatitis B surface antigen (HBsAg) in Benin City, Nigeria.

The seroprevalence of maternal and neonatal hepatitis B surface antigen (HBsAg) was determined prospectively through unlinked anonymous testing of volunteers at delivery at the University of Benin Teaching Hospital, Benin City, Nigeria. Six hundred and forty (320 mother-cord blood pairs) samples were assayed for HBsAg using hepatitis B latex test kit (Biotech Laboratory Ltd, UK). Repeatedly reactive samples were confirmed by the use of ELISA kit (Wellcome Laboratory, UK). None of these women had had a blood transfusion or hepatitis B vaccination in the past, and none was an intravenous drug abuser. The maternal seroprevalence was 2.19%. This means one of every 45 pregnant women was a carrier of the antigen. The neonatal seroprevalence and the vertical transmission rate were 0.96% and 42.86%, respectively. The endemicity of this occasionally fatal disease is thus being propagated. We advocate universal free screening and immunisation of our pregnant women and their infants as part of the antenatal and childhood immunization programmes. Healthcare providers should be vaccinated routinely.

Maternal and neonatal seroprevalence of human immunodeficiency virus antibodies in Benin City, Nigeria.

The prevalence of human immunodeficiency virus antibodies in mothers and their neonates was determined through unlinked anonymous HIV testing at delivery. Two hundred and forty-six apparently healthy volunteer anonymous parturients at the University of Benin Teaching Hospital, Nigeria, and their neonates were recruited for the study. Blood samples were collected from the mothers and cord blood from their neonates at delivery. The blood samples were coded and assayed for HIV antibodies using ImmunoComb HIV 1 and 2 bispot test and ImmunoComb II HIV-1 and 2 CombFirm, both from PBS Orgenics, France. The results for maternal and neonatal blood sample pairs were matched. The maternal seroprevalence for HIV antibodies was 2.4% (6/246) while only two infants had HIV antibodies. The mother-to-child transmission of HIV antibodies was 33.3%. The study highlights the increasing HIV infection among pregnant women in this hospital. The risk of vertical transmission is therefore high. Universal antenatal HIV testing with an opt-out system is suggested. The need for our maternity centres and special care baby units to establish management protocols and anti-retroviral therapy for HIV infected women and their neonates is recommended.

Comparative maternal lactate-pyruvate ratios in singleton and twin pregnancies and in babies delivered at term.

The lactate-pyruvate (L/P) ratio was used for assessment of anaerobic metabolism, hypoxia or oxygen debt in uterine contractile muscle during labour and immediately after parturition. The mean blood lactate level was significantly higher in mothers with twin pregnancies (P<0.001) than in singleton pregnancies at term. L/P ratios were markedly elevated in established labour both in mothers of singleton as well as in mothers of twin pregnancies and were also higher in cord blood of the twins than those of singleton babies (P<0.001). The twins delivered second had higher L/P ratios (P<0.05) than the leading twins.

Fructose concentration in seminal fluids and the deoxyribonucleic acid content of spermatozoa from infertile human males.

Seminal fructose concentration and deoxyribonucleic acid (DNA) content of spermatoza from a group of 35 infertile male patients were measured. While six patients were azoospermic, 29 (83%) had oligospermia whose seminal fluid analysis showed (1) higher fructose levels and (2) higher DNA content per spermatozoon compared with normospermic age-matched 24 male controls who were similarly investigated within the same period. There was no significant quantitative correlation between sperm density, plasma testosterone, and seminal fructose concentration among the normospermic and oligospermic subjects. The oligospermia was probably caused by spermatic arrest which could explain the higher spermatic DNA content in the oligospermic than in normospermic subjects.