COVID-19 pandemic: the implications of the natural history, challenges of diagnosis and management for care in sub-Saharan Africa.

BACKGROUND: Coronavirus disease (COVID-19) is a severe acute respiratory infection which has afflicted virtually almost all nations of the earth. It is highly transmissible and represents one of the most serious pandemics in recent times, with the capacity to overwhelm any healthcare system and cause morbidity and fatality. MAIN CONTENT: The diagnosis of this disease is daunting and challenging as it is dependent on emerging clinical symptomatology that continues to increase and change very rapidly. The definitive test is the very expensive and scarce polymerase chain reaction (PCR) viral identification technique. The management has remained largely supportive and empirical, as there are no officially approved therapeutic agents, vaccines or antiviral medications for the management of the disease. Severe cases often require intensive care facilities and personnel. Yet there is paucity of facilities including the personnel required for diagnosis and treatment of COVID-19 in sub-Saharan Africa (SSA). It is against this backdrop that a review of key published reports on the pandemic in SSA and globally is made, as understanding the natural history of a disease and the documented responses to diagnosis and management is usually a key public health strategy for designing and improving as appropriate, relevant interventions. Lead findings were that responses by most nations of SSA were adhoc, paucity of public health awareness strategies and absence of legislations that would help enforce preventive measures, as well as limited facilities (including personal protective equipment) and institutional capacities to deliver needed interventions. CONCLUSION: COVID-19 is real and has overwhelmed global health care system especially low-income countries of the sub-Sahara such as Nigeria. Suggestions for improvement of healthcare policies and programs to contain the current pandemic and to respond more optimally in case of future pandemics are made herein.

Correlation of perinatal outcomes with amniotic fluid assessment techniques in high-risk pregnancies in a Tertiary Hospital in Southern Nigeria.

BACKGROUND: Oligohydramnios is a predictor of fetal compromise and a useful tool in pregnancy management. It has been assessed using various techniques, including two-diameter pocket (2-DP) and amniotic fluid index (AFI). OBJECTIVES: To determine which of these two techniques best diagnose oligohydramnios and predicts adverse perinatal outcomes. METHODS: This was a comparative cross-sectional study conducted at Delta State University Teaching Hospital, Oghara in southern region of Nigeria over eight months period. One hundred high-risk pregnant women were recruited and ultrasound determination of amniotic fluid was performed using AFI and 2-DP. The women were followed up till delivery to determine adverse perinatal outcomes. RESULTS: The indices of validity of AFI and the 2-DP were calculated and compared. The 2-DP had a higher sensitivity than AFI for adverse outcomes in high-risk pregnancies complicated by oligohydramnios. CONCLUSION: The 2-DP technique should preferably be used for the assessment of oligohydramnios in high-risk pregnancies.

Clinical and sociodemographic correlates of preterm deliveries in two tertiary hospitals in southern Nigeria.

BACKGROUND: To determine the prevalence of preterm delivery and identify the associated risk factors. DESIGN: This was a five - month prospective case control study of two cohorts of women who had preterm and term deliveries. SETTING: Central Hospital (CH), Warri, and Delta State University Teaching Hospital (DELSUTH), Oghara, respectively in southern Nigeria. PARTICIPANTS: 522 women which consisted of 174 who presented in preterm labour or with preterm prelabour rupture of membranes as cases and 348 parturient with term deliveries served as controls. INTERVENTIONS: The study was conducted from May 1st 2015 to September 30th 2015. Socio - demographic characteristics, past gynaecological/obstetric factors, maternal/obstetric factors, and fetal outcomes were compared, and associations between these variables and gestational age at delivery were determined. MAIN OUTCOME MEASURES: Prevalence of preterm delivery associated clinical and socio-demographic correlates and the fetal salvage rates. RESULTS: The incidence of preterm birth was 16%. Maternal age (p < 0.002), parity (p < 0.000), booking status (p < 0.000), and socio - economic class (p < 0.000) were significantly associated with preterm births. Others were multiple pregnancy (p < 0.000), pre - eclampsia/eclampsia (p < 0.000), anaemia (p < 0.000), malaria (p < 0.000), UTI (p < 0.012), premature rupture of membrane (p < 0.000) and antepartum haemorrhage (p < 0.000). Fetal salvage rate was zero for extreme preterm neonates and 100% at late preterm. CONCLUSION: Preterm birth was common, with well-defined correlates and predictors. The fetal salvage rates were significantly different across the categories of preterm neonates. FUNDING: The study was self-funded by the authors.

A survey of attitudes and practices of reproductive health and family planning services among private medical practitioners in four states of the Niger-Delta region of Nigeria.

BACKGROUND: Abortion is widespread in the Niger-Delta region of Nigeria, with resulting high rates of morbidity and mortality. It is thought that the private sector provides the majority of abortion services in Nigeria as a result of the restrictive abortion law in the country. The oil-rich Niger-Delta region accounts for 90% of the country's resource, is economically active and has increased opportunities for sexual networking. METHOD: This study assays the attitudes of staff at family planning (FP) services and practices of reproductive health and FP services among private practitioners in four states of Niger-Delta of Nigeria (the states of Edo, Delta, Bayelsa and Rivers). RESULTS: Women who had unwanted pregnancies were attended by 119 (87.5%) respondents. However, only 33 (24.0%) provided services for termination of pregnancy. Indeed, just over half (72; 53.4%) counselled women to continue the pregnancy while fewer (35; 25.9%) referred women to other clinics. However, there was no evidence to suggest that doctors followed up on those women counselled to continue their pregnancies. Most private sector service providers of abortion services in Nigeria (69.7%) are non-specialist doctors. CONCLUSION: Education of private practitioners in the principles of abortion, post-abortion care and FP is recommended to alleviate abortion-related morbidity and mortality in Nigeria.

Rate of negative appendectomy in pregnant women in Benin City, Nigeria.

AIM: This study was an analysis of women diagnosed with acute appendicitis in pregnancy, to appraise the maternal and fetal outcomes and explore the correlations with negative appendectomy. MATERIAL AND METHODS: A retrospective study was undertaken at the University of Benin Teaching Hospital, Nigeria. The service delivery records of all pregnant women who underwent appendectomy for acute appendicitis from January 2000 to December 2009 were analyzed. RESULTS: Among 16,173 deliveries, 23 pregnant women were diagnosed with acute appendicitis. The age of the women ranged between 15 and 34 years (median = 26 years), while the majority (65.2%) were nulliparous. The mean gestational age at presentation was 21.1 ± 6.9 weeks with up to 15 (65.2%) patients presenting in the second trimester. Eighteen (78.3%) patients had histopathologically proven appendicitis giving a negative appendectomy rate of 21.7%. Postoperative complications were noted in eight (34.8%) patients. Half of these occurred within the negative appendectomy group. The negative appendectomy group also contributed significantly to the adverse obstetric outcome: preterm labor, 8.7% of 21.7%, preterm delivery, 4.5% of 13.6% and a fetal loss rate of 4.3% of 13%. One maternal death occurred in the group with diseased appendix giving a maternal mortality rate of 4.3%. CONCLUSIONS: While a higher index of suspicion among clinicians will ensure earlier diagnosis and improve the associated maternal and fetal prognosis, the need to reduce the negative laparotomy rate is highlighted by the high rate of adverse obstetric outcomes amongst the negative appendectomy group.

Self-reporting of induced abortion by women attending prenatal clinics in urban Nigeria.

OBJECTIVE: To determine the proportion of all clinically confirmed pregnancies that end as induced abortion in a cohort of pregnant women in Nigeria. METHODS: A total of 490 women who attended prenatal clinics at the University of Benin Teaching Hospital were interviewed with the preceding birth technique (PBT) on the outcomes of their previous pregnancies, including abortions. RESULTS: Of the 490 women, 384 women (78.4%) reported previous abortions. A total of 1883 previous pregnancies were reported by the women, of which 914 ended in abortion, 545 in live births, and 421 in stillbirths, with 3 unclassified. The total abortion ratio was 914/1842 (49.6%), when 41 women who reported no previous pregnancies were excluded. Of the 914 abortions, 751 (82.25) were induced abortions, 146 (16.0%) were spontaneous abortions, 9 (0.98%) were missed abortions, and 8 were unclassified. Results of logistic regression analysis showed that women aged 25-29 years were 4 times more likely to report induced abortion compared with older women. CONCLUSION: Induced abortion was found to be highly prevalent in this region of Nigeria, according to self-reports of women who were asked questions on abortion in the context of medical care.

Pregnancy in a noncommunicating rudimentary horn of a unicornuate uterus: a case report.

Pregnancy in the rudimentary horn is rare and carries grave consequences for the mother and fetus. A case report is presented of a 26 year old single gravida 3 para 0(+2) lady with rupture of a rudimentary horn pregnancy at a gestational age of 20 weeks. Laparotomy was done and the rudimentary horn excised. Post-operative recovery was uneventful. The need for a high index of suspicion and the role of ultrasonography in the accurate diagnosis is highlighted.

The challenges of diagnosis and treatment of malaria in pregnancy in low resource settings.

Malarial infestation in pregnancy is a major public health concern in endemic countries and ranks high amongst the commonest complications of pregnancy, especially in large areas of Africa and Asia. It is an important preventable cause of significant maternal morbidity and mortality with associated fetal as well as perinatal wastage. The burden of malaria is greatest in sub-Saharan Africa where it contributes directly or indirectly to maternal and perinatal morbidity and mortality. The need for prompt and accurate diagnosis as well as prevention and treatment of malaria during pregnancy cannot, therefore, be overemphasized. This commentary focuses on the challenges of diagnosis and treatment of malaria in pregnancy.

Maternal mortality at the Central Hospital, Benin City Nigeria: a ten year review.

Maternal mortality remains a major challenge in Nigeria. This retrospective study was conceptualized to document the number and pattern of obstetric deaths at the Central Hospital, Benin City, over a ten year period, to identify common causes of maternal deaths and proffer relevant interventions. The overall maternal mortality ratio (MMR) was 518/100,000. MMR was 30 times higher in unbooked as compared to the booked patients, while 60% of maternal deaths occurred within 24 hours of admission. The leading direct causes of maternal deaths were sepsis, hemorrhage, obstructed labor and preeclampsia/eclampsia, while the major indirect causes are institutional difficulties and anaemia. Low literacy, high poverty levels, extremes of parity and non-utilization of maternity services were associated with maternal mortality. Recommendations are made for public enlightenment campaign and advocacy activities aimed at mobilizing resources for reducing maternal mortality. Also, female education and poverty alleviation programmes will contribute to the reduction of the burden of maternal mortality.

Maternal mortality at the central hospital, Benin City Nigeria: a ten year review

Maternal mortality remains a major challenge in Nigeria. This retrospective study was conceptualized to document the number and pattern of obstetric deaths at the Central Hospital, Benin City, over a ten year period, to identify common causes of maternal deaths and proffer relevant interventions. The overall maternal mortality ratio (MMR) was 518/100,000. MMR was 30 times higher in unbooked as compared to the booked patients, while 60% of maternal deaths occurred within 24 hours of admission. The leading direct causes of maternal deaths were sepsis, hemorrhage, obstructed labor and preeclampsia/eclampsia, while the major indirect causes are institutional difficulties and anaemia. Low literacy, high poverty levels, extremes of parity and non-utilization of maternity services were associated with maternal mortality. Recommendations are made for public enlightenment campaign and advocacy activities aimed at mobilizing resources for reducing maternal mortality. Also, female education and poverty alleviation programmes will contribute to the reduction of the burden of maternal mortality (Afr J Reprod Health 2008; 12[3]:17-26)

Association of Chlamydia trachomatis serology with tubal infertility in Nigerian women.

AIM: To determine the association between tubal infertility and Chlamydia trachomatis in Nigerian women. METHODS: This case-control study is from the Departments of Obstetrics and Gynecology of two tertiary hospitals in Nigeria. One hundred and sixty-two infertile patients with tubal occlusion had 162 pregnant women matched for age as controls. Information on sociodemographic variables, sexual and reproductive risk factors, and history of previous pelvic infections were elicited using a study protocol. The prevalence of Chlamydia Trachomatis antibody was determined for cases and controls. RESULTS: The prevalence of serum Chlamydia antibody was significantly higher in cases (65.8%) compared with controls (17.3%; P < 001). The effects of Chlamydia antibodies on infertility were strengthened in the multivariate model controlling for Chlamydia antibodies and gynecologic symptoms, compared to the univariate model. However, the association was attenuated and non-significant when the effects of gynecologic symptoms, sociodemographic characteristics, contraceptive and sexual history were controlled in the conditional logistic regression model. The strongest independent predictors of infertility in the model were vaginal discharge, education less than tertiary and more than three lifetime sexual partners (proxies of sexually transmitted infections). CONCLUSIONS: There was no strong independent association between Chlamydia antibodies and the risk of being infertile in Nigerian women. By contrast, the proxies of sexually transmitted infections were significant predictors of infertility in the women. Efforts to address these factors, which are proxies of sexually transmissible infections, Chlamydia infection, and health-seeking behavior for these infections, will likely contribute to reducing the burden of infertility in Nigerian women.

Perceptions and attitudes of pregnant women towards caesarean section in urban Nigeria.

OBJECTIVES: To determine the perceptions and attitudes towards caesarean section [CS] among women attending maternity care at the University of Benin Teaching Hospital in Nigeria. METHODS. Some 413 consecutive women, attending antenatal care in the hospital, were interviewed with a structured questionnaire that solicited information on their socio-demographic characteristics, their previous pregnancy and delivery history, and their knowledge and attitudes towards CS. Additional focus group discussions and in-depth interviews were held with women who recently underwent CS in the hospital, to gain further insights into attitudes and perception about CS in the women. RESULTS: The women had good knowledge of CS; however, only 6.1% were willing to accept CS as a method of delivery, while 81% would accept CS if needed to save their lives and that of their babies. Up to 12.1% of women would not accept CS under any circumstances. Logistic regression showed that women's low level of education, and past successful vaginal and instrumental deliveries, were most likely to be associated with women's non-acceptance of indicated caesarean section. Further analysis showed that this was mainly due to inaccurate cultural perceptions of labour and caesarean section in the cohort of women. CONCLUSION: There is a need for programs to increase women's and community understanding and perceptions of CS as a method of delivery in Nigeria.