The magnitude and determinants of depressive symptoms amongst women in early pregnancy in Southern Nigeria: A cross-sectional study.

Background: Antenatal depression (AD) is prevalent and associated with adverse pregnancy, maternal and child outcomes, yet no study has addressed its magnitude and predictors in early pregnancy in Nigeria. Aim: To determine the prevalence and factors associated with AD in first half of pregnancy. Setting: Multicentric health facilities in Southern Nigeria. Methods: A multicentric health-facilities-based cross-sectional study was conducted from January to July 2018. Using pretested structure interviewer-administered questionnaires, antenatal depressive symptoms were assessed amongst 511 pregnant mothers with the Edinburg Postnatal Depressive Scale tool. Socio-demographic, socio-economic, clinical, family and social factors were also measured. Descriptive statistics, bivariate and multivariable logistic regression analyses were employed to describe and identify factors associated with AD. Results: The prevalence of antenatal depressive symptoms in early pregnancy in this study was 29.4% (95% confidence interval [CI] 26.6-32.9). Factors independently associated with AD were intimate partner violence (adjusted odds ratios [AOR] = 8.10, 95% CI 5.00-13.14), marital dissatisfaction (AOR 5.48, 95% CI 3.48-8.38), poor social support (AOR 4.70; 95% CI 2.99-7.38), past history of depression (AOR 4.67; 95% CI 2.47-8.80), previous pregnancy complication (AOR 2.50, 95% CI 1.57-3.89), low socio-economic status (AOR 2.41, 95% CI 1.61-3.66) and unplanned pregnancy (AOR 2.35, 95% CI 1.47-3.64). Conclusions: The prevalence of antenatal depression is high with modifiable risk factors requiring context-specific policies such as provision of family, social and economic support for mothers at the earliest possible contact in the antenatal period.

Obstetric and perinatal outcome in HIV positive women receiving HAART in urban Nigeria.

PURPOSE: To compare the outcome of pregnancy between HIV positive pregnant women on highly active antiretroviral therapy (HAART) and HIV negative controls. METHODS: A prospective matched case-control study. RESULTS: HIV positive women were significantly more likely to have anaemia in pregnancy [p < 0.001, odds ratio (95% CI) 5.66 (3.0-10.5)], intrauterine growth restriction [p = 0.002, odds ratio (95%CI) 13.82 (1.8-106.7)], preterm labour [p = 0.03, odds ratio (95% CI) 2.89 (1.2-7.0)] and birth weight less than 2,500 g [p < 0.0001, odds ratio (95% CI) 5.43 (2.4-12.0)]. The 5-min apgar score less than 7, admission into neonatal unit, stillbirth and perinatal mortality were comparable between the two groups. CONCLUSION: Anaemia in pregnancy, intrauterine growth restriction, preterm labour and birth weight less than 2,500 g are important complications among HIV positive pregnant women. This information is vital for strategic antenatal care planning to improve obstetric and perinatal outcome in these women.

Attitudes of Nigerian women toward the presence of their husband or partner as a support person during labor.

OBJECTIVE: To assess the attitudes of Nigerian women regarding the presence of a husband/partner during labor. METHODS: Women who were invited to participate in a randomized trial regarding companionship in labor at the Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria, were interviewed in a qualitative cross-sectional survey. Demographic characteristics and opinions regarding the presence of a partner/husband as a support person during labor were assessed. RESULTS: Of the 197 women interviewed, 69 declined all forms of social companionship during labor; of the remaining 128 participants--who did not object to having a social companion--71 declined to have their husband/partner present during labor because of: personal embarrassment (28 [39.4%]); fear of loss of sexual attractiveness (19 [26.8%]); concern for their husband/partner (17 [23.9%]); and lack of privacy (15 [21.1%]). Of the 57 women whose husband/partner accompanied them during labor, 38 (66.7%) said that they would repeat the experience in subsequent labor, and 34 (59.6%) would recommend it. However, 15 (26.3%) expressed dissatisfaction. CONCLUSION: The issue of husband/partner companionship during labor is viewed with concern by Nigerian women, who should be allowed to make an informed decision.

Outpatient misoprostol cervical ripening without subsequent induction of labor to prevent post-term pregnancy.

BACKGROUND: Interventions that may help shorten the duration of pregnancy in an African setting where facilities for fetal monitoring in post-term pregnancy are limited, and induction is not without its hazards, are needed. AIM: To determine whether outpatient administration of intravaginal misoprostol safely decreases the interval to delivery in postdate pregnancies. DESIGN: Open randomized controlled trial. SETTING: Zonal district hospitals, Kwale, Southern Nigeria (August 2000 to October 2001). METHODS: Seventy-seven women were randomized at 40 weeks gestation to receive either 25 microg misoprostol intravaginally (38) or gentle cervical assessment only (39) on an outpatient basis. Subjects were then allowed to go into spontaneous labor unless an indication for induction developed. MAIN OUTCOME MEASURES: Interval to delivery, duration of labor, and incidence of side-effects. RESULTS: Misoprostol was associated with significant decrease in mean time to delivery (4.5 +/- 4.1 versus 7.4 +/- 5.2 days; P = 0.008), earlier gestational age at delivery (40.6 +/- 0.6 versus 41.4 +/- 0.05 weeks; P < 0.001) and shorter duration of active labor (6.1 +/- 4.0 versus 8.2 +/- 5.3 h; P = 0.028), without any significant increase in fetal distress, low Apgar score at delivery or other side-effects. CONCLUSION: Outpatient administration of low-dose misoprostol can safely shorten the length of gestation in postdate pregnancies.