Serum leptin levels and relationship with maternal weight gain at term among obese and non-obese pregnant women in Enugu, Nigeria: a comparative cross-sectional study.

OBJECTIVE: To determine and compare the mean maternal serum leptin levels, the prevalence of high serum leptin levels and mean gestational weight gain at term among obese and non-obese pregnant women in Enugu, Nigeria. METHODS: This cross-sectional comparative study enrolled obese and non-obese pregnant women. The serum leptin levels of the women were determined using an enzyme-linked immunosorbent assay kit. Anthropometric and sociodemographic data were obtained and compared. Mean weight gain during pregnancy was determined. RESULTS: A total of 170 pregnant women were included in the study. The mean ± SD serum leptin level (99.39 ± 50.2 ng/ml) and the prevalence of hyperleptinaemia (81 of 85 patients; 95.3%) among the obese pregnant women at term were significantly higher than those of the non-obese pregnant women (48.98 ± 30.35 ng/ml/65 of 85 patients; 76.5%). The mean percentage weight gain was significantly higher in the non-obese women compared with the obese women at term. The predictors of high maternal serum leptin level at term among the participants were the employment status and levels of education of the participants. CONCLUSION: Maternal serum leptin level, maternal weight gain and prevalence of hyperleptinaemia at term were significantly higher in the obese compared with the non-obese pregnant women.

Association between maternal selenium levels and pregnancy outcome among human immunodeficiency virus-positive and human immunodeficiency virus-negative pregnant women in a tertiary health-care center in Owerri, Nigeria: A comparative cross-sectional study.

Background: Human immunodeficiency virus (HIV) infection constitutes a major medical complication of pregnancy and is associated with adverse feto-maternal outcomes. However, the relationship between maternal serum selenium levels and pregnancy outcomes has been inconsistent. Objective: This study aimed to determine the relationship between maternal serum selenium status and pregnancy outcome in HIV-positive and HIV-negative women in a tertiary health facility. Methodology: A.comparative cross-sectional study was carried out among HIV-positive and HIV-negative pregnant women at a tertiary health-care facility in Owerri. Participants were recruited from the labor ward and interviewed using a structured questionnaire. One hundred and ten HIV-positive pregnant women were compared with an equal number of HIV-negative pregnant women. They were matched for age, parity and gestational age. Selenium level was measured using atomic absorption spectrophotometer. Maternal packed cell volume (PCV) was also assessed at recruitment. At delivery, the birth weight was measured using a standard weighing scale and documented. Cases of preterm births, perinatal deaths, major congenital abnormalities, and neonatal admission were noted and also documented. Statistical analysis was performed using means and standard deviation. Chi-square test, Student's t-test, logistic regression, and Pearson correlation were also employed. Statistical significance was considered at P < 0.05. Results: HIV-positive pregnant women had significantly lower mean serum selenium concentration compared with HIV-negative pregnant women (64.3 ± 19.6 µg/L vs. 100.1 ± 30.9 µg/L; P < 0.001). There was a statistically significant association between serum selenium concentration and birth weight among both HIV-positive and HIV-negative pregnant women (P < 0.001). Similarly, a statistically significant association was seen between serum selenium and maternal PCV in HIV-positive and HIV-negative pregnant women (P = 0.024 and P < 0.001, respectively). However, there was no association found between serum selenium and other pregnancy outcomes. Conclusion: HIV-positive pregnant women had a lower mean serum selenium level compared to HIV-negative pregnant women. There was a significant association between low maternal serum selenium level and maternal anemia, as well as low birth weight, especially in HIV-positive pregnant women.

Résumé Contexte: L'infection par le virus de l'immunodéficience humaine (VIH) constitue une complication médicale majeure de la grossesse et est associée avec des issues fœto-maternelles défavorables. Cependant, la relation entre les niveaux de sélénium sérique maternel et les résultats de la grossesse aété incohérent. Objectif: Cette étude visait à déterminer la relation entre le statut maternel en sélénium sérique et la grossesse résultat chez les femmes séropositives et séronégatives dans un établissement de santé tertiaire Méthodologie: une étude transversale comparative a été menée auprès de femmes enceintes séropositives et séronégatives dans un établissement de soins de santé tertiaires à Owerri. Les participants étaient recrutés dans la salle de travail et interrogés à l'aide d'un questionnaire structuré. Cent dix femmes enceintes séropositives ont été comparativement à un nombre égal de femmes enceintes séronégatives. Elles ont été appariées pour l'âge, la parité et l'âge gestationnel. Le niveau de sélénium a été mesuré à l'aide d'un spectrophotomètre d'absorption atomique. L'hématocrite maternel (PCV) a également été évalué à recrutement. À l'accouchement, le poids à la naissance a été mesuré à l'aide d'une balance standard et documenté. Des cas de naissances prématurées, de décès périnataux, d'anomalies congénitales majeures et d'admissions néonatales ont été notés et également documentés. L'analyse statistique a été effectuée à l'aide des moyennes et des normes déviation. Le test du chi carré, le test t de Student, la régression logistique et la corrélation de Pearson ont également été utilisés. La signification statistique était considéré à P < 0,05. Résultats: Les femmes enceintes séropositives avaient une concentration sérique moyenne de sélénium significativement plus faible que avec des femmes enceintes séronégatives (64,3 ± 19,6 µg/L vs 100,1 ± 30,9 µg/L ; P < 0,001). Il y avait une association statistiquement significative entre la concentration sérique de sélénium et le poids à la naissance chez les femmes enceintes séropositives et séronégatives (P < 0,001). De la même manière, une association statistiquement significative a été observée entre le sélénium sérique et l'hématocrite maternel chez les femmes enceintes séropositives et séronégatives.femmes (P = 0,024 et P < 0,001, respectivement). Cependant, aucune association n'a été trouvée entre le sélénium sérique et d'autres grossesses. Résultats. Conclusion: les femmes enceintes séropositives avaient un taux sérique moyen de sélénium par rapport aux femmes enceintes séronégatives femmes. Il y avait une association significative entre la faible taux sérique de sélénium et anémie maternelle, ainsi que faible taux de naissance poids, en particulier chez les femmes enceintes séropositives. Mots-clés: enceinte séronégative pour le virus de l'immunodéficience humaine femmes, femmes enceintes séropositives pour le virus de l'immunodéficience humaine, taux de sélénium maternel, résultat de la grossesse.

Barriers and facilitators of access to maternal, newborn and child health services during the first wave of COVID-19 pandemic in Nigeria: findings from a qualitative study.

BACKGROUND: COVID-19 pandemic may have affected the utilization of maternal and newborn child health services in Nigeria but the extent, directions, contextual factors at all the levels of healthcare service delivery in Nigeria is yet to be fully explored. The objective of the study was to explore the barriers and facilitators of access to MNCH services during the first wave of COVID-19 pandemic in Nigeria. METHODS: A qualitative study was conducted among different stakeholder groups in 18 public health facilities in Nigeria between May and July,2020. In-depth interviews were conducted among 54 study participants (service users, service providers and policymakers) selected from across the three tiers of public health service delivery system in Nigeria (primary health centers, secondary health centers and tertiary health centers). Coding of the qualitative data and identification of themes from the transcripts were carried out and thematic approach was used for data analyses. RESULTS: Barriers to accessing MNCH services during the first wave of COVID-19-pandemic in Nigeria include fear of contracting COVID-19 infection at health facilities, transportation difficulties, stigmatization of sick persons, lack of personal protective equipment (PPE) /medical commodities, long waiting times at hospitals, shortage of manpower, lack of preparedness by health workers, and prioritization of essential services. Enablers to access include the COVID-19 non-pharmacological measures instituted at the health facilities, community sensitization on healthcare access during the pandemic, and alternative strategies for administering immunization service at the clinics. CONCLUSION: Access to MNCH services were negatively affected by lockdown during the first wave of COVID-19 pandemic in Nigeria particularly due to challenges resulting from restrictions in movements which affected patients/healthcare providers ability to reach the hospitals as well as patients' ability to pay for health care services. Additionally, there was fear of contracting COVID-19 infection at health facilities and the health systems inability to provide enabling conditions for sustained utilization of MNCH services. There is need for government to institute alternative measures to halt the spread of diseases instead of lockdowns so as to ensure unhindered access to MNCH services during future pandemics. This may include immediate sensitization of the general public on modes of transmission of any emergent infectious disease as well as training of health workers on emergency preparedness and alternative service delivery models.

The magnitude and predictors of cervical squamous intraepithelial lesions among women in Enugu, Nigeria: a cross-sectional study of women in a low-resource setting.

Introduction: the prevalence of cervical squamous intraepithelial lesion is not well appreciated in most low-income countries. The study aimed to determine the level of awareness, prevalence and the pattern of squamous intraepithelial lesions and predictors for abnormal Pap smear reports (development of pre-malignant lesions of the cervix) among women attending various clinics in a tertiary health facility in Enugu, Nigeria. Methods: a cross-sectional study of 207 female patients attending various clinics of Enugu State University Teaching Hospital, Parklane, Enugu between June and August 2017 was undertaken. Structured interviewer-administered questionnaires were used for data collection while cervical smears were collected from the patients and sent for cytology. Data analysis was done using the Statistical Package for the Social Sciences (SPSS) version 22.0. The results were presented as means, standard deviations, frequencies and proportions. Pearson´s Chi-square test was used to test for associations between categorical variables and statistical significance was set at a p-value of < 0.05. Results: the levels of awareness of cervical cancer and the screening methods among the respondents were 76.8% and 36.7% respectively. The overall knowledge of cervical cancer and its screening was poor (6.8% and 29.0% respectively). The prevalence of pre-malignant lesions of the cervix among the respondents was 15.0% with low grade squamous intraepithelial lesion (LGSIL) having the highest frequency (38.7%). Among all the other risk factors for the development of premalignant lesions of the cervix among the respondents, a report of abnormal pap (positive) smear report was significantly associated with only age ≥35 years (χ2=5.723; p=0.017). The same age of 35 years and above also correctly predicted abnormal Pap smear reports among other factors (AOR = 3.02, 95% CI = 1.16 - 7.89, p = 0.024). Conclusion: the awareness of cervical cancer and cervical cancer screening was high but the overall knowledge on cervical cancer and its screening was very poor among the respondents. The prevalence of pre-malignant lesions of the cervix was high, and the commonest abnormal smear was LGSIL. Only age 35 years and above correctly predicted the occurrence of abnormal Pap smear reports among the respondents.

Association between serum chlamydial antibody levels and tubal infertility in tertiary health facility in South-East Nigeria: a case-control study.

Objectives: This study evaluates the association between genital Chlamydial infection and tubal factor infertility in a tertiary health facility in South-East Nigeria. Design: This was a case-control analytical study. Setting: Gynaecology Clinic and Maternity Unit of the Department of Obstetrics and Gynaecology of the Federal Medical Centre (FMC), Owerri, Imo State, Nigeria. Participants: Ninety-six (96) women with confirmed tubal factor infertility served as the cases, and 96 women with normal intra-uterine pregnancy matched in age served as the control. Data Collection/Intervention: A structured questionnaire was used to extract information on the sociodemographic data and the sexual history of the participants. About 2mls of blood was collected, the blood was allowed to clot, and the sera were used for the test. Statistical analysis/Main outcome measure: Pearson Chi-square, Fisher's exact test, likelihood ratio and multivariate logistic regression were used to determine risk associations and identify factors independently related to tubal factor infertility. P-value < 0.05 was considered significant. Results: The sociodemographic characteristics of both cases and control did not differ (P = 0.975). The Chlamydial antibody seropositivity was significantly higher in the cases than the control 78(81.2%) versus 13(13.5%) respectively {(P < 0.001; OR (95% CI) = 27.7(12.7-60.2)}. Only lower abdominal pain {(P = 0.011); OR (95% CI) = 4.3(1.4-13.3)}; was independently associated with tubal factor infertility. Conclusion: Tubal factor infertility is strongly associated with chlamydial IgG antibodies, and a history of lower abdominal pain significantly predicted tubal factor infertility. Funding: The authors paid the cost of procuring the anti-chlamydial ELIZA test kits, plain sample bottles, syringes, gloves and other consumables and stationaries.

Staphylococcal infections and infertility: mechanisms and management.

Infertility is a subject of worldwide concern as it affects approximately 15% of couples. Among the prime contributors of infertility, urogenital bacterial infections have lately gained much clinical importance. Staphylococcal species are commensal bacteria and major human pathogens mediating an array of reproductive tract infections. Emerging evidences are 'bit by bit' revealing the mechanisms by which Staphylococci strategically disrupt normal reproductive functions. Staphylococcal species can directly or through hematogenous routes can invade the reproductive tissues. In the testicular cells, epididymis as well as in various compartments of female reproductive tracts, the pathogen recognition receptors, toll-like receptors (TLRs), can recognize the pathogen-associated molecular patterns on the Staphylococci and thereby activate inflammatory signalling pathways. These elicit pro-inflammatory mediators trigger other immune cells to infiltrate and release further inflammatory agents and reactive oxygen species (ROS). Adaptive immune responses may intensify the inflammation-induced reproductive tissue damage, particularly via activation of T-helper (Th) cells, Th1 and Th17 by the innate components or by staphylococcal exotoxins. Staphylococcal surface factors binding with sperm membrane proteins can directly impair sperm functions. Although Staphylococci, being one of the most virulent bacterial species, are major contributors in infection-induced infertility in both males and females, the mechanisms of their operations remain under-discussed. The present review aims to provide a comprehensive perception of the possible mechanisms of staphylococcal infection-induced male and female infertility and aid potential interventions to address the lack of competent therapeutic measures for staphylococcal infection-induced infertility.

Impact of COVID-19 on utilization of maternal, newborn and child health services in Nigeria: protocol for a country-level mixed-methods study.

Background: Battling with COVID-19 and providing essential services along the continuum of care could be challenging. This study will evaluate the impact of COVID-19 on utilization of maternal, newborn and child health (MNCH) services in Nigeria and explore the barriers being experienced by women and their families in getting access to MNCH services, as well as other contextual factors that may have shaped the utilization of MNCH services during the COVID-19 pandemic. Methods and analysis: The study will adopt an observational mixed-methods study design involving 18 health care facilities delivering MNCH services in six selected states across six geopolitical zones of Nigeria. We will retrieve longitudinal data on MNCH services from all selected hospitals six months before and after the first recorded case of COVID-19 in Nigeria. Qualitative data will be collected using in-depth interviews conducted via mobile phones or ZOOM meeting platforms among stakeholder participants (users of MNCH services, health workers and policymakers) to ascertain their perceptions on how COVID-19 has shaped the utilization of MNCH services. We will triangulate quantitative and qualitative data to better understand the impact of COVID-19 on the utilization of MNCH services in Nigeria. Ethics and dissemination: Ethics approvals have been obtained from the Health Research Ethics Committee of the tertiary hospitals involved in the study. Our findings will provide the first evidence from an African setting on the impact of COVID-19 on the utilization of MNCH services using a mixed-methods study design for policy formulation towards sustained MNCH service delivery.

Evidence for decreasing sperm count in African population from 1965 to 2015.

PURPOSE: This meta-analysis, following our previous reports those documented an overall 57% diminution in mean sperm concentration around the globe over past 35 years and 32.5% decline in past 50 years in European population, attempts to report the declining trend of sperm concentrations in African population between 1965 and 2015. METHODS: In the course of retrieval of data following MOOSE guidelines and PRISMA checklist, we found a total of fourteen studies that have been conducted during that period on altering sperm concentration in the African male. RESULTS: Following analysis of the data, a time-dependent decline of sperm concentration (r = -0.597, p = 0.02) and an overall 72.6% decrease in mean sperm concentration was noted in the past 50 years. The major matter of concern is the present mean concentration (20.38×106/ml) is very near to WHO cut-off value of 2010 of 15×106/ml. Several epidemic diseases, genital tract infection, pesticides and heavy metal toxicity, regular consumption of tobacco and alcohol are reported as predominant causative factors. CONCLUSION: This comprehensive, evidence-based meta-analysis and systematic review concisely presents the evidence of decreased sperm concentration in the African male over past 50 years with possible causative factors to serve the scientific research zone related to male reproductive health.