Effect of Age and Parity on Physiological Changes in the Eye During Pregnancy: A Prospective Longitudinal Study.

BACKGROUND: The hormonal and metabolic changes that occur during uncomplicated pregnancy affect the eye. The effects of maternal age and parity on the physiological eye changes in pregnancy have been scarcely documented. AIM: To determine these effects on some physiological eye changes that occur in pregnancy. METHODS: A longitudinal study involving consecutively recruited 140 pregnant women aged 18-48 years attending antenatal clinic at the University of Nigeria Teaching Hospital, Enugu. A structured questionnaire was administered to consenting women, after which the Schirmer test, tear break-up time (tBUT), corneal sensitivity, central corneal thickness (CCT), and intraocular pressure (IOP) was measured in the second and third trimesters, and six weeks after delivery. RESULTS: The mean CCT showed a significantly greater increase among the multiparous (≥para 2) women in both the second and third trimesters compared with the primigravida/primiparous women (P = 0.032 and 0.049, respectively). There was no difference in mean CCT between the two parity groups at six weeks postpartum. Women aged 18-35 years showed a significantly greater increase in the mean CCT in the second trimester compared to those aged less than 35 years (P = 0.04). However, there was no difference in the mean CCT between the different age groups in the third trimester and at six weeks postpartum. CONCLUSION: The age and parity of women affect their level of CCT changes in pregnancy. Consideration of this effect may guide clinicians on their approaches to eye care and treatment during pregnancy.

Atherogenic Index, Cardiovascular Risk Ratio, and Atherogenic Coefficient as Risk Factors for Cardiovascular Disease in Pre-eclampsia in Southeast Nigeria: A Cross-Sectional Study.

BACKGROUND: Pre-eclampsia is a key trigger for maternal and perinatal morbidity and mortality. Current evidence suggests an association between dyslipidemia and atherosclerosis. Thus, the importance of evaluating some indices of atherosclerosis during pregnancy cannot be over-emphasized. AIM: To evaluate the effect of some lipid profile indices as risk factors for developing cardiovascular disease (CVD) among women with pre-eclampsia in Enugu, Southeast Nigeria. MATERIALS AND METHODS: A cross-sectional study of two groups of eligible pregnant women between 20 and 40 weeks of gestation selected at three healthcare facilities in Enugu, Nigeria was carried out. The case group consisted of 160 women with pre-eclampsia, while the control group consisted of 160 normotensive pregnant women. Participants' fasting blood samples were analyzed for different fractions of lipids and their atherogenic indices were calculated. RESULTS: There were significantly higher mean levels of total cholesterol (TC), low-density lipoprotein (LDL), and triglyceride (TG) [P < 0.001] in pre-eclampsia than in normal pregnancy. The atherogenic index of plasma (AIP), cardiovascular risk ratio (CRR), and atherogenic coefficient (AC) were significantly higher in pre-eclampsia than in normal pregnancy (P < 0.001) and there was a significant positive correlation between mean arterial pressure (MAP) and AIP (r = 0.421), CRR (r = 0.416) and AC (r = 0.634) for women with pre-eclampsia. CONCLUSION: Pre-eclampsia is associated with an increased risk of CVDs. Determining the atherogenic indices and assessing the AIP level in pre-eclamptic women may predict disease risk and help in early management and measures for its prevention.

Incidence, Determinants, and Outcomes of Spontaneous Preterm Birth at Tertiary Hospitals in Enugu, Southeast, Nigeria: A Cross-Sectional Study.

BACKGROUND: In the past five years, observational evidence suggests that the rates and determinants of preterm birth may have changed due to the effect of the coronavirus disease 2019 (COVID-19) pandemic and other humanitarian crises in our environment. AIM: This study aimed to determine the incidence, associated factors, and outcomes of preterm birth in tertiary hospitals in Enugu, southeastern Nigeria. METHODS: This cross-sectional study included 238 pregnant women from the University of Nigeria Teaching Hospital (UNTH), Enugu State University of Science and Technology Teaching Hospital (ESUT-TH) Parklane, and Mother of Christ Specialist Hospital (MOCSH), Enugu, from April 2022 to March 2023. Eligible and consenting participants were recruited from 28-36 weeks +6 days of gestational age and followed up until delivery. Relevant outcome variables, such as sociodemographic characteristics, gestational age at delivery, and pregnancy outcomes, were recorded in a pro forma. These data were analyzed using IBM Statistical Package for the Social Sciences (SPSS) statistics for Windows, version 22.0, Armonk, NY: IBM Corp. RESULTS: The incidence of preterm birth was 16.6% (37/223), with spontaneous preterm birth constituting 24 of 37 (64.5%) cases. The mean age of participants was 30.3 ± 4.8 years. Advanced maternal age (>35 years) (P = 0.01, adjusted odds ratio (AOR) =0.01, confidence interval (CI): 0.00-0.144), low socioeconomic status (P = 0.04, AOR = 0.40, CI: 0.11-1.46), and history of miscarriage (P = 0.02, AOR = 0.06, CI: 0.01-0.59) were the factors associated with spontaneous preterm birth. Neonatal death occurred in 21.6% (8/37) of cases within the first 24 hours. Rates of cesarean section and low birth weight were 73% (27/37) each. CONCLUSIONS: The incidence of preterm birth is high in Enugu, and associated factors were advanced maternal age, low socioeconomic status, and a history of miscarriage.

A Multicenter Retrospective Cohort Study of the Profile of Seminal Fluid Analyses of Men Seeking Fertility Care at Different Hospitals.

BACKGROUND: Male infertility contributes 40 % of couple infertility. The prevalence of abnormal semen parameters has been on the increase. Age among other factors affects the fertility potential of males. This study analysed the pattern of seminal fluid parameters of males, seeking fertility treatment in hospitals and the relationship between age, volume and liquefaction time on these other semen parameters. METHODS: This is a multicentre retrospective cohort study conducted in eight secondary and tertiary hospitals in Nigeria. The case notes of couples that sort fertility care at the Gynaecology and Urology clinics of these hospitals from January 1st 2022 to December 31st 2022 were retrieved after receiving ethical approval. A purposeddesigned proforma based on the WHO manual for the examination of human semen was used for data collection. Outcome measures were time of semen collection and examination, volume of semen, sperm number, sperm concentration, PH, agglutination, liquefaction, motility,morphology, vitality, and white blood cell count. Data was analysed using SPSS version 23. Data were presented as means and proportions. P-value of < 0.05 was used as the level of significance. RESULTS: Overall, 1063 couples attended gynaecology and urology clinics with fertility-related concerns within the study period with a retrieval rate of 98.3%. The mean age of participants was 38.24 ± 8 years, while the mean semen volume and sperm concentrations were 2.62 ± 1.6 mls and 34.32 ± 7.4 million respectively. The age of participants significantly affected motility, volume and morphology (p-values of 0.001, 0.001 and 0.004 respectively). The total motility and sperm concentration have an inverse relationship with the age of the participants. CONCLUSION: This study shows that sperm motility decreases with the age of participants. It was also observed that the most common combined abnormality was oligoasthenozoospermia.

CONTEXTE: L'infertilité masculine représente 40 % de l'infertilité des couples. La prévalence des paramètres anormaux du sperme est en augmentation. L'âge, entre autres facteurs, affecte le potentiel de fertilité des hommes. Cette étude a analysé le profil des paramètres du liquide séminal des hommes cherchant un traitement de fertilité dans les hôpitaux et la relation entre l'âge, le volume et le temps de liquéfaction sur ces autres paramètres du sperme. MÉTHODES: Il s'agit d'une étude de cohorte rétrospective multicentrique menée dans huit hôpitaux secondaires et tertiaires au Nigeria. Les notes de cas des couples qui ont eu recours à des soins de fertilité dans les cliniques de gynécologie et d'urologie de ces hôpitaux entre le 1er janvier et le 31 décembre 2022 ont été récupérées après avoir reçu une approbation éthique. Un proforma conçu à dessein et basé sur le manuel de l'OMS pour l'examen du sperme humain a été utilisé pour la collecte des données. Les mesures des résultats étaient le temps de collecte et d'examen du sperme, le volume de sperme, le nombre de spermatozoïdes, la concentration en spermatozoïdes, le PH, l'agglutination, la liquéfaction, la motilité, la morphologie, la vitalité et la numération des globules blancs. Les données ont été analysées à l'aide de SPSS version 23. Les données ont été présentées sous forme de moyennes et de proportions. Une valeur P < 0,05 a été utilisée comme niveau de signification. RÉSULTATS: Dans l'ensemble, 1 063 couples ont fréquenté les cliniques de gynécologie et d'urologie pour des problèmes de fertilité au cours de la période d'étude, avec un taux de récupération de 98,3 %. L'âge moyen des participants était de 38,24 ± 8 ans, tandis que le volume moyen de sperme et les concentrations de spermatozoïdes étaient respectivement de 2,62 ± 1,6 ml et 34,32 ±7,4 millions. L'âge des participants a affecté de manière significative la motilité, le volume et la morphologie (valeurs p de 0,001, 0,001 et 0,004 respectivement). La motilité totale et la concentration en spermatozoïdes ont une relation inverse avec l'âge des participants. CONCLUSION: Cette étude montre que la mobilité des spermatozoïdes diminue avec l'âge des participants. Il a également été observé que l'anomalie combinée la plus fréquente était l'oligoasthénozoospermie. Mots-clés: Infertilité Masculine, Anomalies du Liquide séminal, Nigeria.

Sexual Function in Pregnancy in a Nigerian Population: A Prospective Longitudinal Study.

Background: Studies are abound from low- and middle-income countries (LMICs) on postpartum sexual dysfunction but very limited in pregnancy. The data will help clinicians in providing women with evidence-based information and counseling in these regards. Aim: To determine the effects of different trimesters of pregnancy on sexual functions and the possible risk factors for sexual dysfunction in pregnancy. Patients and Methods: The study was longitudinal in design, and study population consisted of 270 pregnant women attending antenatal care at the two largest tertiary hospitals in Enugu, Nigeria. The recruitment was in the first trimester, and each recruited participant served as her own control. Interviews were conducted at specific times in the three trimesters, and data regarding sexual functions were obtained using validated questionnaires. Analysis of variance (ANOVA) was performed to compare the mean total and domain female sexual function index (FSFI) scores between the three trimesters, and Bonferroni's test for significant association between any two trimesters as may be applicable. The risk factors were determined via multivariate logistic regression analysis. A P value ≤0.05 was considered statistically significant. Results: The FSFI means total score decreased as pregnancy advanced. It was significantly lower in second trimester (T2) than in first trimester (T1) (P < 0.001), and significantly lower in third trimester (T3) than T1 (P < 0.001), but no difference between T3 and T2 (P = 0.759). Similarly, the mean frequency of coitus per week declined across the trimesters; lower in T2 than T1 (2.2 ± 0.7 vs. 2.4 ± 0.6; P < 0.01), and lower in T3 than T1, but no difference between T3 and T2. The overall rate of sexual dysfunction was 50.7% and the risk factors age ≥35 years (AdjOR: 1.4; 95%CI: 1.1-1.9; P: 0.01), multiparity (AdjOR: 1.7; 95%CI: 1.2-2.5; P: 0.013) and a previous history of cesarean section (AdjOR: 2.1; 95%CI: 1.7-2.6; P: 0.004). Conclusion: Sexual function declines as pregnancy advances and the rate of sexual dysfunction is high in Enugu, Nigeria. Obstetricians are encouraged to discuss sexual health issues during antenatal care services and make more efforts towards reducing the modifying obstetric risk factors.

Antichlamydia antibodies and sperm quality among male partners of infertile couples ins Nigeria.

Background: The impact of Chlamydia trachomatis on semen quality has been studied with varied results. Aim: To determine the prevalence of antichlamydial antibodies and their relationship with sperm quality among male partners of infertile couples in Enugu, South-East Nigeria. Materials and Methods: It was a cross-sectional study of infertile male partners of couples attending infertility clinics at the University of Nigeria Teaching Hospital (UNTH) Ituku-Ozalla, Enugu, Nigeria. Their sera were assayed for antichlamydial antibodies, and semen analysis and culture were done for each participant. Results: Two hundred and eighty-two (282) male partners of infertile couples were studied. Infertility was commoner among participants aged 40 years or more (45.1%) and was mainly of the "primary type" (62.1%). Antichlamydia antibody was detected in 156 (55.3%) participants and was significantly associated with sperm quality (P = 002; OR = 2.294; 95% CI = 1.36-3.88). Overall, 81 (28.7%) had abnormal sperm quality. The sperm count, progressive motility, and vitality were significantly lower in participants with abnormal sperm quality than those with normal sperm quality (P < 0.001) while morphology, volume, and liquefaction time did not differ significantly (P > 0.05). Staphylococcus aureus was the predominant organism isolated from culture (122/282, 43.3%) while Streptococcus species were the least (4/262, 1.4%). There was significantly more Staphylococcus aureus isolated from the semen of participants that were seropositive to antichlamydial antibodies than those that were seronegative (80/156, 51.3% vs. 42/126, 33.3%; OR = 2.105; 95% CI = 1.30-3.42; P = 0.003). Conclusion: The prevalence of antichlamydial antibodies among male partners of infertile couples in Enugu, Nigeria is high and there is a significant association with sperm quality, sperm count, and bacterial isolates in seminal culture. Male partners of infertile couples in Enugu should be screened for antichlamydial antibodies and appropriate treatment offered wherever indicated. There is a need for increased public awareness and advocacy campaigns on the impact of Chlamydia infection on male factor infertility. This primary preventive measure may help in reducing the burden of Chlamydia infection and male factor infertility.

Seroprevalence of Hepatitis B, and C Viruses and HIV Infections among Antenatal Women in a Secondary Health Facility in Lagos, Nigeria.

BACKGROUND: Hepatitis B and C viruses and HIV infections contribute a significant proportion to maternal and perinatal morbidity and mortality in low and middle-income countries. While the burden of hepatitis B and C viruses is higher in low and middle-income countries, Nigeria also has the second largest burden of HIV. OBJECTIVES: To determine the seroprevalence of hepatitis B and C viruses and HIV infections among antenatal women who sought care at a secondary health facility in Lagos. METHODS: This was a retrospective review of patients managed in the antenatal clinic of 68 Nigerian Army Reference Hospital over one year. A study proforma was used to collect relevant data which were entered and analyzed using the IBM Statistical Package for Social Sciences (SPSS Statistics) Version 23. RESULTS: A total of 347 women attended prenatal care during the study period, however, only 329 cases with complete data were included in the final statistical analysis. The prevalence of HIV in our study was 6.4%, while HBV and HCV accounted for 6.2% and 1.8% respectively. Hepatitis B, and hepatitis C viruses and HIV Infections occurred in 3 (0.9%) of our patients, 6 (1.8%) of the women had HIV-HBV co-infection while 1 (0.3%) was infected with HIV-HCV. CONCLUSION: Our study re-emphasizes the public health importance of HBV, HCV and HIV screening in our antenatal clinics. This knowledge is very important for the implementation of effective prevention and control measures that will further decrease the mother-to-child transmission of these viruses.

CONTEXTE: Les virus de l'hépatite B et C et les infections par le VIH contribuent pour une part importante à la morbidité et à la mortalité maternelles et périnatales dans les pays à revenu faible et intermédiaire. Alors que le fardeau des virus de l'hépatite B et C est plus élevé dans les pays à revenu faible et moyen, le Nigeria a également le deuxième plus grand fardeau du VIH. OBJECTIFS: Déterminer la séroprévalence des virus de l'hépatite B et C et des infections par le VIH chez les femmes en période prénatale qui ont consulté dans un établissement de santé secondaire de Lagos. MÉTHODES: Il s'agit d'une étude rétrospective des patientes prises en charge dans la clinique prénatale de 68 références de l'armée nigériane sur une période d'un an. Un formulaire d'étude a été utilisé pour recueillir les données pertinentes qui ont été saisies et analysées à l'aide du progiciel statistique pour les sciences sociales IBM (SPSS Statistics) version 23. RÉSULTATS: Un total de 347 femmes ont suivi des soins prénataux pendant la période d'étude, cependant, seuls 329 cas avec des données complètes ont été inclus dans l'analyse statistique finale. La prévalence du VIH dans notre étude était de 6,4%, tandis que le VHB et le VHC représentaient respectivement 6,2% et 1,8%. Les virus de l'hépatite B et de l'hépatite C ainsi que le VIH étaient présents chez 3 (0,9%) de nos patientes, 6 (1,8%) des femmes avaient une co-infection VIHVHB tandis qu'une (0,3%) était infectée par le VIH-VHC. CONCLUSION: Notre étude souligne à nouveau l'importance pour la santé publique du dépistage du VHB, du VHC et du VIH dans nos cliniques prénatales. Ces connaissances sont très importantes pour la mise en œuvre de mesures de prévention et de contrôle efficaces qui permettront de diminuer davantage la transmission mère-enfant de ces virus. Mots clés: Hépatite B, VIH, Hépatite C, Séroprévalence, Coinfection, Lagos.

Prevalence and risk factors associated with musculoskeletal disorders among pregnant women in Enugu Nigeria.

BACKGROUND: Pregnancy usually triggers a wide range of changes that result in a variety of musculoskeletal disorders (MSDs). The scope and burden of these disorders in Nigeria are not known. AIM: The study aimed to determine the prevalence and risk factors of pregnancy-related MSDs in Enugu. PATIENTS AND METHODS: A cross-sectional study of pregnant women attending antenatal clinics at three tertiary hospitals in Enugu, Nigeria, was done using an observer-administered questionnaire. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 22. RESULTS: A total of 317 participants were studied. A majority of the participants (93.1%) had one or more MSDs. Low back pain (LBP) and muscle cramps were the two most common pregnancy-related MSDs with prevalence rates of 56.8 and 54.8%, respectively. Increasing gestational age (P = 0.001), previous pregnancies (P = 0.027), and occupation (P = 0.018) were associated with increased risk of MSDs. A majority of the MSDs were of mild and moderate severity and 10.4% of the participants had significant impairment of their daily activities. CONCLUSION: MSDs are common in pregnancy with LBP and muscle cramps as the most prevalent conditions. Increasing gestational age, multigravidity, and occupation increased the risk of MSDs among our cohorts. Preventive and therapeutic measures should be instituted when necessary to ensure optimal maternal health during pregnancy.

Sero-prevalence of Hepatitis B virus infection: A cross-sectional study of a large population of health care workers in Nigeria.

BACKGROUND: Hepatitis B virus (HBV) infection has been recognized globally as a major public health challenge necessitating a global call for increased awareness, patients' identification, and development of activities for prevention and control of the disease. Consequently, massive health education campaigns and screening exercises have been mounted globally to mark the World Hepatitis Day (WHD). AIMS: As part of WHD 2016 activities, we undertook a survey and screening of health care workers in order to raise awareness, identify patients and contribute to the Global Health Strategy goal of eliminating HBV infection by the year 2030. METHOD: This was a cross-sectional analytical study done at the University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria. Hospital workers voluntarily presented themselves to be screened using a rapid test kit and completing a semi-structured investigator-administered questionnaire. RESULTS: A total of 3123 participants were studied. The mean age of the participants was 39.4 ± 9.6 years. The seroprevalence of HBV infection was 2.3%. Most (97.0%) of the participants had previously heard about HBV infection and over two thirds (68.1%) could correctly identify risk factors and modes of transmission of HBV. Twenty-eight and a half percent of the participants knew their hepatitis B virus status prior to the study. CONCLUSION: The seroprevalence of HBV among healthcare workers in Enugu, Nigeria is relatively low compared to figures from other African countries. The healthcare workers have considerable knowledge of the disease. However, the observed knowledge gaps in awareness and screening need to be addressed.

ABO blood group as a biomarker of preeclampsia among antenatal clinic attendees in Nigeria.

BACKGROUND: The clinical application of the ABO blood group is not limited to transfusion medicine but extends to other aspects of medicine. Its impact on preeclampsia is controversial. AIM: To determine the association of ABO blood group type with preeclampsia. SUBJECTS AND METHODS: This was a cross-sectional analytical study of 66 women with preeclampsia and 81 apparently healthy women controls carried out in a tertiary health institution. The case and control groups were consecutively recruited during antenatal clinic visits and matched for age, parity, and gestational age. Data on demographics and the ABO blood group of the two groups of individuals were obtained. The analysis was both descriptive and inferential using the statistical package for social sciences (SPSS) version 21 (Chicago Il, USA). A P value of <0.05 was considered statistically significant. RESULTS: The mean age of the participants was 30.6 (4.9), 95% CI: 27.76-33.95. The majority of the women were ≤40 years (98.5%) and multigravidae constituted 81.8%. Forty-six (69.7%) women with preeclampsia had blood group O and 20 (30.3%) had a non-O blood group. Forty-nine (60.5%) of the controls had blood group O and 32 (39.5%) had a non-O blood group. The observed difference was not statistically significant (OR 1.50; 95% CI: 0.75-3.0; P = 0.26). The odds ratio for developing preeclampsia was 0.83 (95% CI: 0.37-1.91; P = 0.67) for the primigravidae. The non-O blood groups were more likely to present with symptoms than the O group (P < 0.01). Twenty-six (39.4%) women with preeclampsia had a mild disease while 40 (60.6%) had severe disease. CONCLUSION: Women with non-O blood groups are not at increased risk of developing preeclampsia but are more likely to be symptomatic than the O group.

Effects of short inter-pregnancy interval on maternal and perinatal outcomes: A cohort study of pregnant women in a low-income country.

BACKGROUND: Short inter-pregnancy interval (IPI) is a potential risk factor for adverse pregnancy outcomes. Previous reports from sub-Sahara Africa documented increasing incidence of short IPI but evidence is lacking in its effect on pregnancy outcome. AIM: The study aimed to determine the effect of short IPI on pregnancy outcome in Nigeria. SUBJECTS AND METHODS: It was a prospective cohort study of 271 pregnant women receiving antenatal care in a tertiary hospital in Nigeria. For every eligible woman with short IPI (<18 months) recruited; a suitable control with IPI ≥18 months was selected. Statistical analysis was both inferential and descriptive using the statistical package for social sciences version 24 (SPSS Inc. Chicago, Illinois, USA) for windows. A P value of less than 0.05 was considered statistically significant. RESULTS: Incidence of maternal anemia was higher in women with short IPI than control (RR: 2.091; 95% CI: 1.4433.031; P < 0.001). Other maternal and perinatal outcome measures including premature rupture of membranes, preterm labor/delivery, pregnancy induced hypertension, third trimester bleeding, postpartum hemorrhage, and inadequate gestational weight gain did not show any significant association with short IPI (P > 0.05). CONCLUSION: Short IPI is associated with anemia in pregnancy in Nigeria. Public health campaigns for improvement in uptake of family planning services and breastfeeding may help reduce the incidence of short IPI and anemia in low income countries.

Evaluation of postgraduate educational environment in a Nigerian teaching hospital.

BACKGROUND: Congenial educational environment (EE) is paramount to effective impartation of knowledge as required in residency training. In this study EE for residency training is evaluated using Postgraduate Hospital Educational Environment Measure (PHEEM). OBJECTIVES: To assess the postgraduate educational environment at the University of Nigeria Teaching Hospital (UNTH), South-East Nigeria, using PHEEM and to determine if there are significant differences in PHEEM scores amongst various sub-groups of resident doctors. METHODS: A cross-sectional study, employing a census survey, involving the administration of validated PHEEM questionnaires to residents in the Departments of Internal Medicine, Obstetrics/Gynaecology, Pediatrics and Surgery in the year 2018. Data entry and analysis were done using SPSS. ANOVA assessed significance of total scores and sub-scale scores. Cronbach's alpha was calculated. RESULTS: A total of 114 Males and 46 females; 93 registrars and 67 senior registrars responded giving 71% response rate. Overall PHEEM score was 85.82; Role autonomy (29.27), Perception of teaching (34.80), Perception of social support (21.55). Males scored more than females in total PHEEM score (p = 0.000, F = 148.235), perception of teaching (P = 0.000, F = 420), and perception of social support (p = 0.000, F = 162.95), but not in role autonomy (p = 0.748, F = 0.104). Registrars scored more than senior registrars in total PHEEM (p = 0.000, F = 67.159), role autonomy (p = 0.000, F = 25.123), Perception of teaching (p = 0.000, F = 18.042) but not in perception of social support (p = 0.31, F = 1.045). There were significant differences in total and subscale scores amongst the specialties. Cronbach's alpha was 0.915. CONCLUSIONS: Postgraduate educational environment in UNTH has more positives than negatives but with room for improvement. There are significant differences in PHEEM scores among various groups of resident doctors.

Uptake of hepatitis B vaccination and its determinants among health care workers in a tertiary health facility in Enugu, South-East, Nigeria.

BACKGROUND: Hepatitis B vaccination is the most effective method of prevention for hepatitis B virus infection. It is a major public health problem in Nigeria, and health workers are at increased risk. This study determined the uptake of hepatitis B vaccination and assessed its determinants among health care workers (HCWs). METHODS: A hospital-based cross-sectional study was conducted between July and August, 2016 using self-administered structured questionnaires among 3132 HCWs in University of Nigeria Teaching Hospital, Enugu, South-East, Nigeria. Data was analysed using SPSS version 22. Binary logistic regression analysis was used to identify factors that influenced uptake of vaccination. Ethical clearance was obtained from the Research Ethics Committee of the health facility. RESULTS: The uptake of hepatitis B vaccination was 14.2% (n = 445). The number of doses received were: 3 doses (218/3132, 48.9%), 2 doses (71/3132, 16.0%), and one dose (156/3132, 35.1%). The reasons for non-uptake of vaccination included: cost of vaccine 48 (10.8%), 'did not believe they could be infected' 28 (6.6%), long vaccination schedule, and lack of time 150 (35.1%). The Odds for uptake of hepatitis B vaccination were 22% lower among nurses compared to doctors (AOR = 0.78, 95% CI = 0.54-0.98, P = 0.037). It increased with increasing age (AOR = 1.30, 95% CI = 1.08-1.59, P <  0.001), increasing duration of work in the hospital (AOR = 1.19, 95% CI = 1.09-1.32, P = 0.032), and was about twice higher among those that had tertiary education than others that had less education (AOR = 1.96, 95 CI = 0.76-5.07, P = 0.164). CONCLUSIONS: The uptake of hepatitis B vaccination was low among HCWs in Enugu, Nigeria. Age, staff category, and duration of work in the hospital, were independently associated with hepatitis B vaccination. Provision of adequate hepatitis B surface antigen screening facilities and vaccination sites where the cost of vaccination is subsidized for all HCWs is recommended.

Predictors of autonomic dysfunction among predialysis chronic kidney disease patients in Nigeria.

BACKGROUND: Chronic kidney disease (CKD) is a global public health problem with increasing incidence and mortality in Africa. Autonomic dysfunction (AD) has been implicated as a major contributor to the disease morbidity and mortality, but little is known about the predictors of this dysfunction in African populations. Understanding the predictors of this condition is necessary for early detection and management of CKDs. Objectives: This study was designed to determine the predictors of AD in CKD patients in Nigeria. MATERIALS AND METHODS: It was a cross-sectional study of CKD patients at University of Nigeria Teaching Hospital, Enugu, Nigeria. The CKD patients with AD were compared with those without AD and a normal control group. Autonomic function was assessed through noninvasive cardiovascular tests: measurement of resting tachycardia, orthostatic hypotension, heart rate response (HRR) to standing, HRR to Valsalva maneuvre, and HRR to respiration. Data on symptoms of CKD and AD were obtained using a validated questionnaire. RESULTS: The mean age of the CKD patients was 41.3 ± 1.5 (range: 21-69) years. Early hospital presentation is associated with significantly less risk of the development of AD (P < 0.001). Dizziness, nocturnal diarrhea, and impotence are the major markers/predictors of AD in CKD patients (P < 0.05). CONCLUSION: AD is common among predialysis CKD patients in Nigeria, and best predicted by the presence of postural dizziness, nocturnal diarrhea, and impotence in men. Physicians should, therefore, be on the lookout for these features for prompt and adequate management of cases.

Prevalence and predictors of placental malaria in human immunodeficiency virus-positive women in Nigeria.

BACKGROUND: Human immunodeficiency virus (HIV)-infected pregnant women have alterations in cellular and humoral immunity that increase the risks to placental malaria infection. AIM: This study aimed at determining the prevalence and predictors of placental malaria among HIV-positive women in Nigeria. MATERIALS AND METHODS: It was a longitudinal cohort study of pregnant women receiving antenatal care at a tertiary hospital in Nigeria. Peripheral blood sample for packed cell volume estimation and placental blood sample for malaria parasite estimation were collected from each participant at a presentation in labor and upon delivery, respectively. RESULTS: The Prevalence of placenta malaria (68.6%) and anemia (66.7%) in HIV-positive women were significantly higher than the prevalence of placental malaria (35.3%) and anemia (44.1%) in HIV-negative control (P < 0.001 and P = 0.001 respectively). The employment status was the only sociodemographic factor significantly associated with the development of placental malaria in HIV-positive women (odds ratio: 21.60; 95% confidence interval: 7.1-66.2; P< 0.001). CONCLUSION: The prevalence of placental malaria is very high among HIV-positive women in Nigeria. Scaling up free distribution of insecticide treated nets in the short term and employment opportunities of HIV-positive women, in the long run, may reduce the prevalence of placental malaria in our population.

Patterns of gestational weight gain and its association with birthweight in Nigeria.

BACKGROUND: Despite the increasing global importance of gestational weight gain (GWG) and its impact on birthweight, little is known about the patterns of GWG in African populations. OBJECTIVES: To determine the pattern of GWG and its association with birthweight in Nigeria. METHODS: It was a longitudinal study of 200 pregnant women receiving antenatal care at two tertiary hospitals in Enugu, south eastern Nigeria. The women were consecutively recruited at <14 weeks gestation and their body mass indexes recorded upon recruitment. Thereafter, weight measurements were taken at each visit until 38-39 weeks. RESULTS: Mean total GWG was 10.7 ± 3.4 kg, while mean birthweight was 3.3 ± 0.6 kg. GWG in second trimester had positive correlation with birthweight (r = 0.164, P = 0.02). Obese women gained above the recommended limits by the "institute of medicine" while underweight women gained below the limits. Excessive total GWG was associated with higher risk of macrosomia [8/21 (38.1%) vs. 7/179; RR: 9.74; 95% CI: 3.9-24.2; P < 0.001] while inadequate total GWG was associated with higher risk of low birth weight [7/72 (9.7%) vs. 3/128 (2.3%; RR: 4.15; 95% CI: 1.1-15.4; P = 0.03]. Maternal age of <35 years, high social class, nulliparity, and regular antenatal care were associated with normal GWG while maternal age <35 years and regular antenatal care were associated with normal birthweight (P < 0.05). CONCLUSIONS: Women should be counseled on the factors that influence GWG and birthweight. Interventions to assist women achieve appropriate GWG may need to include components related to improved dietary intake for the underweight and increased physical activity for the obese.

Male partner involvement in female contraceptive choices in Nigeria.

Opposition by male partners is one of the barriers to contraceptive use in sub-Saharan Africa. The study aimed at determining the extent of male partner involvement in female contraceptive (FP) choices in Enugu, south-east Nigeria. Questionnaires were administered to 243 consecutive women attendee of family planning clinic, University of Nigeria Teaching Hospital (UNTH), Enugu from January to June, 2012. A total of 137 women made contraceptive decisions jointly with their partners, which gave a male involvement rate of 56.4%. Only respondents' higher age (≥ 35 years) had significant association with male partner involvement in FP choices (odds ratio (OR) = 2.1; 95% confidence interval: 1.22, 3.51; p = 0.008). Covert contraceptive use rate was 4.9% (12/243). A majority of women attending the FP clinic of UNTH, Enugu involved their partners when making contraceptive choices. Male-partner-targeted family planning programme has the potential to increase uptake of contraception in our environment.

Uterine packing in the management of complete placenta praeuvia.

BACKGROUND: Complete (type 4) placenta praevia is a major cause of haemorrhage in Obstetrics. Uterine packing is an effective but underutilized life-saving intervention in situation of uncontrolled haemorrahage due to major placenta praevia. OBJECTIVES: To reappraise the effectiveness of uterine packing in the management of complete placenta praevia in order to popularize the practice. METHODS: Seven case series of complete placenta praevia were managed with uterine packing in Enugu, Nigeria between January 2, 2012 and February 28, 2013. RESULTS AND INTERPRETATION: Previous Caesarean delivery (85.71%) was the commonest identified risk factor for complete placenta praevia. Uterine packing was effective in preventing blood transfusion in 57.14% of the cases, and further post-operative intervention in 85.71%.Peripartum hysterectomy and maternal death were 100% avoidable. CONCLUSIONS: Uterine packing is an effective life-saving intervention in management of complete placenta praevia. The technique should be considered whenever there is uncontrollable haemorrage following complete placenta praevia.

Determinants of compliance to iron supplementation among pregnant women in Enugu, Southeastern Nigeria.

BACKGROUND: Anemia in pregnancy is highly prevalent among antenatal clinic attendees in Enugu, Nigeria despite the practice of routine iron supplementation in pregnancy. The major problem with iron supplementation in pregnancy is compliance, and this may be a potential driver to the persistent high prevalence of anemia in this population. OBJECTIVES: To find out the compliance rate and determinants of compliance to iron supplementation among pregnant women in Enugu, southeastern Nigeria. MATERIALS AND METHODS: This was a questionnaire-based cross-sectional study of eligible pregnant women receiving antenatal care at the University of Nigeria Teaching Hospital (UNTH), Ituku/Ozalla, Enugu, Nigeria between April 1, 2012 and January 31, 2013. RESULTS: The knowledge of iron supplementation was 76.3% ( n = 302), however, the compliance rate was 65.9% ( n = 261). Tertiary level of education and high social class were factors significantly associated with compliance to iron supplementation after adjusting for other factors in the binary logistic regression analysis ( P < 0.05). The major barriers to compliance to iron supplementation included gastrointestinal side effects of iron supplements (41.7%), non-affordability of iron supplements (28.3%), and forgetfulness (15.0%) among the antenatal mothers. CONCLUSION: The compliance rate of 65.9% for iron supplementation by pregnant mothers in Enugu can further be improved by providing the drug free of charge in the short term and improvement in education and socioeconomic class of the populace in the long run.

Accuracy of clinical and ultrasound estimation of fetal weight in predicting actual birth weight in Enugu, Southeastern Nigeria.

BACKGROUND: Estimation of fetal weight is important for antenatal and intrapartum management of pregnant women. Sonographic methods are not readily accessible in under-resourced settings, it is therefore necessary to study the accuracy of a clinical method of estimating fetal weight where this limitation (unavailability of ultrasound) exists. OBJECTIVE: To compare the accuracy of clinical and ultrasound methods of fetal weight estimation at term. MATERIALS AND METHODS: Clinical and ultrasound fetal weights were estimated on 200 consecutive term pregnancies (37 completed weeks of gestation - 41 weeks and 6 days) at the University of Nigeria Teaching Hospital, Enugu, Nigeria from 1 st April to 30 th November 2012. Accuracy was determined using percentage error, absolute percentage error, and proportion of estimates within 10% of actual birth weight. RESULTS: Actual birth weight had strong positive correlation with both clinical and ultrasound estimated fetal weights (r = 0.71, P < 0.001 and r = 0.69, P < 0.001, respectively). Overall, both the clinical and ultrasound methods systematically overestimated the actual birth weight. The proportion of the clinical estimated weights that were within 10% of the actual birth weight was significantly lower than that of ultrasound method for babies of all birth weights (35.0 vs. 67.5%; P < 0.001) and for macrosomic babies (76 vs 100%, P = 0.009). For babies with normal birth weights (2.5-3.9 kg), ultrasound method error values were significantly lower than those of clinical method for both the mean % error (5.4 vs 19.6%; P < 0.001) and the mean absolute % error (9.97 vs 20.6%; P < 0.001). CONCLUSION: The ultrasound method is generally a better predictor of the actual birth weight than the clinical method, and thus should be used in estimating the actual birth weight when accessible.