Evaluation of serum adiponectin as a marker of insulin resistance in women with polycystic ovarian syndrome: a comparative cross-sectional study.

BACKGROUND: Insulin resistance (IR) is known to be prevalent amongst women with polycystic ovarian syndrome (PCOS). Its presence has been linked to chronic anovulation and marked long term complications in women. Hence, identification and treatment of IR in women with PCOS is required to prevent the metabolic and reproductive complications of the disease. The aim of this study is to determine if serum adiponectin could be used as a surrogate marker for insulin resistance among women with PCOS. MATERIALS AND METHODS: A total number of 148 consenting women with PCOS diagnosed using the Rotterdam criteria were recruited for this study. Fifty-two of these women had insulin resistance were compared with 96 of the women who did not have insulin resistance. The serum Adiponectin levels, fasting blood glucose and fasting insulin levels were assayed in all study participants. Insulin resistance was assessed in all the study participants using the Homeostasis Model Assessment for Insulin Resistance (HOMA-IR). Data were analyzed using relevant inferential statistics at 95% confidence interval and p value of < 0.05. RESULTS: The prevalence of insulin resistance among the study participants was 35.1%. Majority of the women (83.1%) had a high body mass index (BMI). More than half (68.2%) of the participants were in the age range of 21-30years and 76.4% (113) were nulliparous. There was no statistically significant difference in the median adiponectin level among insulin resistant (3.735 ug/ml) and non-insulin resistant participants vs. (3.705 ug/ml) (p = 0.6762). Both univariate and multivariate regression analysis did not show a statistically significant relationship between adiponectin and insulin resistance in PCOS. CONCLUSION: The prevalence of insulin resistance in women with PCOS is high and serum adiponectin is not a suitable surrogate marker of insulin resistance in women with PCOS.

Impact of training and case manager support for traditional birth attendants in the linkage of care among HIV-positive pregnant women in Southwest Nigeria: a 3-arm cluster randomized control trial.

BACKGROUND: Mother-to-child transmission (MTCT) accounts for 90% of all new paediatric HIV infections in Nigeria and for approximately 30% of the global burden. This study aimed to determine the effectiveness of a training model that incorporated case managers working closely with traditional birth attendants (TBAs) to ensure linkage to care for HIV-positive pregnant women. METHODS: This study was a 3-arm parallel design cluster randomized controlled trial in Ifo and Ado-Odo Ota, Ogun State, Nigeria. The study employed a random sampling technique to allocate three distinct TBA associations as clusters. Cluster 1 received training exclusively; Cluster 2 underwent training in addition to the utilization of case managers, and Cluster 3 served as a control group. In total, 240 TBAs were enrolled in the study, with 80 participants in each of the intervention and control groups. and were followed up for a duration of 6 months. We employed a one-way analysis of variance (ANOVA) statistical test to evaluate the differences between baseline and endline HIV knowledge scores and PMTCT practices. Additionally, bivariate analysis using the chi-square test was used to investigate linkage to care. Furthermore, logistic regression analysis was utilized to identify TBA characteristics associated with various PMTCT interventions, including the receipt of HIV test results and repeat testing at term for HIV-negative pregnant women. The data analysis was performed using Stata version 16.1.877, and we considered results statistically significant when p values were less than 0.05. RESULTS: At the end of this study, there were improvements in the TBAs' HIV and PMTCT-related knowledge within the intervention groups, however, it did not reach statistical significance (p > 0.05). The referral of pregnant clients for HIV testing was highest (93.5%) within cluster 2 TBAs, who received both PMTCT training and case manager support (p ≤ 0.001). The likelihood of HIV-negative pregnant women at term repeating an HIV test was approximately 4.1 times higher when referred by TBAs in cluster 1 (AOR = 4.14; 95% CI [2.82-5.99]) compared to those in the control group and 1.9 times in cluster 2 (AOR = 1.93; 95% CI [1.3-2.89]) compared to the control group. Additionally, older TBAs (OR = 1.62; 95% CI [1.26-2.1]) and TBAs with more years of experience in their practice (OR = 1.45; 95% CI [1.09-1.93]) were more likely to encourage retesting among HIV-negative women at term. CONCLUSIONS: The combination of case managers and PMTCT training was more effective than training alone for TBAs in facilitating the linkage to care of HIV-positive pregnant women, although this effect did not reach statistical significance. Larger-scale studies to further investigate the benefits of case manager support in facilitating the linkage to care for PMTCT of HIV are recommended. TRIAL REGISTRATION: The study was retrospectively registered in the Pan African Clinical Trial Registry, and it was assigned the unique identification number PACTR202206622552114.

Caregiver burden and its sociodemographic determinants in family caregivers of patients with schizophrenia attending a psychiatric tertiary hospital in South Africa.

Background: Chronic mental illnesses such as schizophrenia affect patients' functioning, making caregiving necessary although burdensome. Aim: This study aimed to determine caregiver burden and its sociodemographic determinants in family caregivers of patients with schizophrenia attending a Psychiatric Outpatient Department (POD). Setting: Tertiary hospital in Northern Pretoria, South Africa. Methods: In this cross-sectional study conducted over 3 months, 300 consecutive family caregivers who attended the POD were administered a 22-item Zarit Burden Interview (ZBI-22), which has a score of 0-88, with higher values indicating more burden. Their sociodemographic characteristics were ascertained. Linear and ordinal logistic regression analyses were performed to identify determinants or predictors of total and severe burdens, respectively. Results: Most caregivers were aged 46.0 ± 14 years, females (62%), parents (39%), of low-income status (93.7%), had secondary education (70%), resided with the patient (87%), and helped with all troublesome activities (95.3%). The median ZBI-22 score was 19.0 (interquartile range: 13.0-30.5). The determinants of both total and severe burdens were: caregiver age ≥ 50 years adjusted odds ratio (aOR): 2.55, confidence interval (CI): 1.49-4.36; residential area farther away from the hospital aOR: 1.76, CI: 1.3-2.99; increasing months of caregiving aOR: 1.0, CI: 1.001-1.009, p = 0.006; and not having another family member that needs care aOR: 0.43, CI: 0.24-0.78. Conclusion: Having mental healthcare facilities close to residential areas and assisting caregivers aged ≥ 50 years who have multiple family members who need care may alleviate the burden. Contribution: Predicting total and severe caregiver burdens contemporaneously is effective for identifying potential burden interventions.

Prevalence and factors associated with female sterilization in Rwanda: evidence from the demographic and health survey data (2019-2020).

BACKGROUND: Female sterilization is a safe and effective surgical procedure of achieving contraception. There is disparity in the prevalence of female sterilization globally, with high income countries having higher rates than low- and middle-income countries. However, current evidence of the uptake of female sterilization in Rwanda is not known. We therefore evaluated the prevalence and factors associated with female sterilization among women of reproductive age in Rwanda. METHODOLOGY: This was a secondary data analysis of 14,634 women of reproductive age (15-49) in Rwanda. The data utilized was from the Rwanda Demographic Health and Survey (RDHS) 2019/2020. The predictors of female sterilization were determined using multivariable binary logistic regression analysis. RESULTS: We found that the prevalence of female sterilization was 1.1% among women of reproductive age in Rwanda. Women older than 35 years had about 8 times higher chance of being sterilized as compared to younger women (aOR: 7.87, 95% CI: 4.77-12.99). Women living with their partners had higher odds of being sterilized as compared to never married women (aOR: 19.23, 95% CI: 4.57-80.82), while women from minority religion are more likely to be sterilized as compared to those of the catholic religion (aOR: 2.12, 95% CI: 1.03-4.37). Women from rich household had a higher chance to be sterilized as compared to their counterparts from poor households (aOR: 3.13, 95% CI: 1.94-5.03). Women from the Western region were more likely to accept sterilization compared to women from Kigali (aOR: 2.025, 95% CI: 1.17-3.49) and women who had more than 5 children had higher odds when compared to women who had 5 or less children (aOR: 1.49, 95% CI: 1.06-2.10). CONCLUSION: The overall prevalence of sterilization among Rwandan women of reproductive age was 1.1%, which was very low as compared to India (29%), China (14.1%) and United States of America (13.7%). The age, marital status, religion, household wealth quintile, region and children ever born were associated with the uptake of female sterilization among Rwandan women. Public awareness campaign on the advantages of female sterilization should be done to improve uptake.

Trends and causes of maternal death at the Lagos University teaching hospital, Lagos, Nigeria (2007-2019).

BACKGROUND: Nigeria has one of the worst global maternal mortality ratios (MMR). Institutional audit is invaluable in providing useful information for formulating preventive interventions. OBJECTIVE: To evaluate the trends, causes and socio-demographic characteristics of maternal mortality at a tertiary institution in South-western Nigeria over a period of 13 years (2007-2019). METHODOLOGY: Cross sectional and temporal trend analysis of maternal deaths were conducted using chart reviews from 2007 to 2019. Socio-biological characteristics, booking status and ranking of clinical causes of maternal deaths were derived from patients' chart review (2007-2019). Bivariate analysis and Annual percent change (APC) of the observed trends was respectively conducted using Stata version 17 and Joinpoint version 4.5.0.1 software respectively. RESULTS: In the period 2007-2019, the mean age at maternal death was 30.8 ± 5.9 years and 88.8% of mortalities occurred among the "unbooked" women. The leading causes of direct maternal mortality were Hypertension (27.0%), Sepsis (20.6%) and haemorrhage (18.7%), while anaemia in pregnancy (3.2%), Human Immunodeficiency Virus (3.2%) and Sickle Cell Disease (2.4%) were the leading indirect causes of maternal mortality Joinpoint estimates showed a statistically significant increase in MMR of about 3.4% per annum from 2211 per 100,000 live births in 2007 to 3555.6 per 100,000 live births in 2019 (APC: +3.4%, P-value < 0.001). CONCLUSION: Contrary to some other reports, there was an increase in the institutional MMR between 2007 and 2019 even though the leading causes of death remained similar. Targeted interventions based on accurate data are urgently required in order to achieve the Sustainable Development Goal (SDG) 3.1.

Sociodemographic predictors of endometrial cancer mortality in South Africa (1997 to 2015): a case-control study.

South Africa is currently undergoing epidemiological and health transition that may impact on the risk factors of endometrial cancer mortality. We evaluated the sociodemographic characteristics of women that died from endometrial cancer in South Africa from 1997 to 2015.An unmatched case control study was conducted to compare the sociodemographic characteristic of women that died from endometrial cancer cases (n = 3,955) with the characteristics of women that died from other cancers (controls, n = 66,202) using the population-based mortality data from Statistics South Africa. Unconditional binary logistic regression modelling was conducted.The Mean age of women that died from endometrial cancer was 66.7 ± 11.9 years. The odds of death from endometrial cancer among women aged ≥50 years was about 4-fold as compared to women younger than 50 years (AOR = 3.98 95% CI: 3.14 - 5.03; p value: <.001). Conversely, high school leavers (AOR = 0.79 95% CI: 0.66 - 0.94; p value: .009), smokers (AOR= 0.53 95% CI: 0.43 - 0.65; p value: <.001), and divorced women (AOR= 0.73 95% CI: 0.59 - 0.89; p value: .002) had lesser odds of endometrial cancer mortality.This study provides information to guide Public Health control program on endometrial cancer in South Africa.Impact statementWhat is already known on this subject? The prevalence of endometrial cancer is increasing in low and middle income countries. After the abolition of Apartheid in South Africa, the country commenced a multi-racial government that provided socio-economic empowerment to the majority of the country. Thus, South Africa is currently undergoing epidemiological and health transition that may impact on the risks of endometrial cancer in the country.What do the result of the study add? This study is the first in South Africa to evaluate the sociodemographic characteristics of women that died from endometrial cancer using a large population-based data. Age, educational status, smoking status are some identified risk factors of mortality from endometrial cancer in South AfricaWhat are the implications of these findings for clinical practice and/or further research? The highlighted risk factors that are associated with endometrial mortality will help in guiding health policies that will help reduce the prevalence of endometrial cancer. The study recommends a targeted national prevention program for endometrial cancer as the burden appears to be worsening with each passing year.

Predictors and causes of in-hospital maternal deaths within 120 h of admission at a tertiary hospital in South-Western, Nigeria: A retrospective cohort study.

Background: An efficient, comprehensive emergency obstetrics care (CEMOC) can considerably reduce the burden of maternal mortality (MM) in Nigeria. Information about the risk of maternal death within 120 h of admission can reflect the quality of CEMOC offered. Aim: This study aims to determine the predictors and causes of maternal death within 120 h of admission at the Lagos University Teaching Hospital, LUTH, Lagos South-Western, Nigeria. Methods: We conducted a retrospective cohort study amongst consecutive maternal deaths at a hospital in South-Western Nigeria, from 1 January 2007 to 31 December 2017, using data from patients' medical records. We compared participants that died within 120 h to participants that survived beyond 120 h. Survival life table analysis, Kaplan-Meier plots and multivariable Cox proportional hazard regression were conducted to evaluate the factors affecting survival within 120 h of admission. Stata version 16 statistical software (StatCorp USA) was used for analysis. Results: Of the 430 maternal deaths, 326 had complete records. The mean age of the deceased was 30.7± (5.9) years and median time to death was 24 (5-96) h. Two hundred and sixty-eight (82.2%) women out of 326 died within 120 h of admission. Almost all maternal deaths from uterine rupture (95.2%) and most deaths from obstetric haemorrhage (87.3%), induced miscarriage (88.9%), sepsis (82.9%) and hypertensive disorders of pregnancy (77.9%) occurred within 120 h of admission. Admission to the intensive care unit (P = 0.007), cadre of admitting doctor (P < 0.001), cause of death (P = 0.036) and mode of delivery (P = 0.012) were independent predictors of hazard of death within 120 h. Conclusion: The majority (82.2%) of maternal deaths occurred within 120 h of admission. Investment in the prevention and acute management of uterine rupture, obstetric haemorrhage, sepsis and hypertensive disorders of pregnancy can help to reduce MM within 120 h in our environment.

Assessment of the utility of a screening tool for COVID-19 diagnosis in an accident and emergency department in Lagos, Nigeria: A pilot study.

The use of reverse transcription-polymerase chain reaction (RT-PCR) is the gold standard laboratory test for diagnosing SARS-CoV-2 infection. However, it has the disadvantage of a long turnaround time and cost. The Nigeria Centre for Disease Control (NCDC) formulated a case definition for COVID-19. We sought to determine the utility of a 14-item, point-weighted clinical screening questionnaire adapted from the NCDC case definition in identifying patients more likely to have the disease. This was to aid prompt clinical decision-making. Methods: We retrospectively reviewed the data of 113 non-surgical patients presenting to the Accident and Emergency Department (A and E) of Lagos University Teaching Hospital, Lagos, Nigeria. Patients were stratified based on screening scores into low (0-2), moderate (3-5) and high (6) pre-test categories. Patients with low and high scores ≥6 were admitted to the A and E and the COVID-19 holding ward, respectively, while the moderate group had chest computed tomography scans to aid further decision-making, pending the outcome of their RT-PCR results. The validity of the triage score as compared to the RT-PCR test result was calculated and the kappa score of agreement was utilised to evaluate the concordance between two triage scores. The optimum cut-off score was also obtained based on the maximal Younden's index. Results: The frequencies of low, moderate and high pre-test scores were 34 (30%), 43 (38.1%) and 36 (31.9%), respectively. Overall, 38.1% (43/113) were RT-PCR positive. RT-PCR was positive in 26.5% (9/34) with low screening scores, 55.8% (24/43) with moderate scores and 27.8% (10/36) with high scores. The sensitivity and specificity of a high score of 6 were 25% and 92.86%, while the lower score of 3 had sensitivity and specificity of 62.5% and 58.6%, respectively. Conclusion: The screening tool showed a high specificity in its initial design, which suggests that anyone with a low score using this tool has a high probability of testing negative. We recommend a cut-off score of 4 (score A) or 6 (score B) of the current screening tool be used to increase the chances of identifying persons with COVID-19 for RT-PCR testing.

Impact of Erythropoietin in the management of Hypoxic Ischaemic Encephalopathy in resource-constrained settings: protocol for a randomized control trial.

BACKGROUND: Perinatal asphyxia, more appropriately known as hypoxic-ischemic encephalopathy (HIE), is a condition characterized by clinical and laboratory evidence of acute or sub-acute brain injury resulting from systemic hypoxemia and/or reduced cerebral blood flow. HIE is a common and devastating clinical condition in resource-poor countries with poor treatment outcome. This paper describes the protocol for an ongoing study that aims to evaluate the neuroprotective effects of Erythropoietin (EPO) as compared to routine care in the management of moderate to severe HIE among term infants. METHODS: This study is a double-blind randomized controlled trial that will be conducted in the neonatal wards of the Lagos University Teaching Hospital (LUTH), Lagos, Nigeria, over a two-year period after ethical approvals and consents. One hundred and twenty-eight term newborns (≥ 37 weeks gestation) diagnosed with moderate/ severe HIE at admission will be allocated by randomization to receive either EPO or normal saline. All the participants will be offered standard care according to the unit protocol for HIE. Baseline investigations and close monitoring of the babies are done until discharge. Participants are followed up for 2 years to monitor their outcome (death or neurological development) using standard instruments. DISCUSSION: Previous trials had shown that EPO confers neuroprotective benefits and improve neurological and behavioral outcome in infants with HIE both singly or as an adjuvant to therapeutic hypothermia. This study hypothesized that administering EPO to newborns with moderate /severe HIE can positively influence their clinical and neurological outcomes and will provide evidence to either support or disprove the usefulness of Erythropoietin as a sole agent in the treatment of HIE, especially in resource-limited environment with the highest burden of the disease. TRIAL REGISTRATION: The study has been registered with the Pan African Clinical trials registry on the 2nd of December 2018, with registration number PACTR201812814507775.

Hepcidin and GDF-15 are potential biomarkers of iron deficiency anaemia in chronic kidney disease patients in South Africa.

BACKGROUND: Anaemia is a common presenting feature among patients with chronic kidney disease (CKD) and it is associated with poor clinical outcomes and quality of life. It is not clear if growth differentiation factor-15 (GDF-15) or hepcidin are useful as early markers of iron deficiency anaemia (IDA) among non-dialysis CKD patients. We therefore evaluated the diagnostic validity of GDF-15 and hepcidin as biomarkers of IDA among non-dialysis CKD patients in Johannesburg, South Africa. METHOD: An analytic cross-sectional study was conducted among non-dialysis CKD patients (n = 312) and apparently healthy controls (n = 184) from June to December 2016 at an Academic Hospital, in Johannesburg, South Africa. An interviewer administered proforma was used to obtain the socio-biological and clinical characteristics of the participants. Serum levels of GDF-15 and hepcidin were determined. Predictive logistic regression models were built and post estimation receiver operator characteristics were determined to evaluate diagnostic validity of hepcidin and GDF-15 for absolute and functional iron deficiency anaemia. RESULTS: About half (50.6%) of the participants were female while the participants' mean age was 49.7 ± 15.8 years. The predictive value of diagnosing absolute IDA among CKD patients using GDF-15 was 74.02% (95% CI: 67.62-80.42%) while the predictive value of diagnosing functional IDA among CKD patients using hepcidin was 70.1% (95% CI: 62.79-77.49%).There was a weak negative correlation between hepcidin levels and GFR (r = - 0.19, p = 0.04) in anaemic CKD patients, and between serum GDF-15 and haemoglobin (r = - 0.34, p = 0.001). Serum ferritin (ß = 0.00389, P-value< 0.001), was a predictor of log hepcidin. MCHC (ß = - 0.0220, P-value 0.005) and CKD stage (ß = 0.4761, P-value < 0.001), race (ß = 0.3429, P-value = 0.018) were predictors of log GDF-15. Both GDF-15 (adj OR: 1.0003, 95%CI: 1.0001-1.0005, P = 0.017) and hepcidin (adj OR: 1.003, 95%CI: 1.0004-1.0055, P = 0.023) were associated with iron deficiency anaemia after multiple linear regression modelling. CONCLUSION: Serum GDF-15 is a potential biomarker of absolute IDA, while hepcidin levels can predict functional IDA among CKD patients.

Predictors of Discontinuation of Subdermal Levonorgestrel Implants (Jadelle) at the Lagos University Teaching Hospital, Lagos, Nigeria: An Analytic Cohort Study.

Uptake and continuation of long acting reversible contraceptives (LARC) such as subdermal levonorgestrel implants are pivotal to the achievement of some sustainable development goals (SDG). We evaluated Jadelle uptake and factors affecting its discontinuation in the first three years of initiation at the Family Planning Clinic of the College of Medicine, University of Lagos (CMUL), Nigeria. A retrospective cohort study was conducted among 517 consecutive new Jadelle acceptors, at the family planning clinic of CMUL, between 1 October 2007 and 30 September 2010, who were followed up till 30 September 2011. Survival life table analysis, Kaplan-Meier plots and multivariable Cox proportional hazard regression were conducted to evaluate factors affecting time to Jadelle discontinuation. Stata version 13 statistical software (StataCorp USA) was used for analysis. The mean age of Jadelle acceptors was 32.9 (S.D: ±5.4) years and uptake rate of Jadelle was 61.8%. The overall discontinuation rate was 19 per 100 women-years while the 1-year, 2-year and 3-year Jadelle discontinuation rates were 7.1%; 27.0% and 58.1% respectively. Increased age, (P=0.047) and previous contraceptive use (P <0.001) were independent predictors of Jadelle discontinuation. Menstrual irregularity (51.4%) and intention to get pregnant (40.3%) were the commonest reasons for discontinuation. The failure rate was low at 0.27 per 100 women-years. This study showed that Jadelle had a high uptake rate complimented by a low failure rate; and is quite suitable for postpartum childbirth spacing as well as ongoing long term contraception.

Ectopic pregnancy at the Lagos University Teaching Hospital, Lagos, South-Western Nigeria: Temporal trends, clinical presentation and management outcomes from 2005 to 2014.

BACKGROUND: There is uncertainty in the trend of ectopic pregnancy incidence in the Southwest region, though the region has a lower fertility rate and a higher contraceptive use than some other regions of Nigeria. The study objective was to determine the temporal trends, presentation and management outcome of ectopic pregnancy at the Lagos University Teaching Hospital (LUTH), Lagos, South-Western Nigeria over a decade. SUBJECTS AND METHODS: This is a retrospective study of ectopic pregnancies at LUTH, Lagos, Nigeria, from January 2005 to December 2014. Participants' medical records were used to extract socio-demographic, clinical characteristics, management and outcome data. Joinpoint regression modelling (version 4.7.1) was used to evaluate the trends while descriptive statistics were conducted using Stata version 14 software. RESULTS: There were 434 cases of ectopic pregnancies giving an overall incidence of 2.2/100 deliveries and 3.50/100 gynaecological admissions. Overall, there was a 59.7% increase in the ectopic pregnancy rate from 1.81/100 deliveries in 2005 to 2.89/100 deliveries in 2014. Join point regression revealed two trends. There was an initial non-significant decrease in incidence of ectopic pregnancy from 2005 to 2010 (annual percent change [APC] = -1.5%, 95% confidence interval [CI]: -8.1% to 5.6%, P = 0.6). However, there was a statistically significant increase in incidence of ectopic pregnancy at an average of 11.6% per annum from 8.6/100 deliveries in 2011 to 25.4/100 deliveries in 2014 (APC = 11.6%, 95% CI: 1.2% to 23.1% P < 0.001). About one-third (33.9%) of the patients with ectopic pregnancy were within the age range 25-29 years while the majority (68.0%) presented at 9-10 weeks of gestational age. The most common identifiable risk factor was previous pelvic infection (35.71%). Majority (96.5%) had tubal pregnancy and all the cases had laparotomy. There were six maternal deaths giving a case fatality rate of 1.4%. CONCLUSION: The hospital had an increased trend in the incidence of ectopic pregnancy from 2005 to 2014. Frontline health workers need high index of suspicion in the prompt diagnosis and intervention of ectopic pregnancy among women in the reproductive age.

Temporal trends in the epidemiology of cervical cancer in South Africa (1994-2012).

Cervical cancer (CC) is the leading cause of cancer death among female South Africans (SA). Improved access to reproductive health services following multi-ethnic democracy in 1994, HIV epidemic, and the initiation of CC population-based screening in early 2000s have influenced the epidemiology of CC in SA. We therefore evaluated the trends in CC age-standardised incidence (ASIR) (1994-2009) and mortality rates (ASMR) (2004-2012) using data from the South African National Cancer Registry and the Statistics South Africa, respectively. Five-year relative survival rates and average per cent change (AAPC) stratified by ethnicity and age-groups was determined. The average annual CC cases and mortalities were 4,694 (75,099 cases/16 years) and 2,789 (25,101 deaths/9 years), respectively. The ASIR was 22.1/100,000 in 1994 and 23.3/100,000 in 2009, with an average annual decline in incidence of 0.9% per annum (AAPC = -0.9%, p-value < 0.001). The ASMR decreased slightly by 0.6% per annum from 13.9/100,000 in 2004 to 13.1/100,000 in 2012 (AAPC = -0.6%, p-value < 0.001). In 2012, ASMR was 5.8-fold higher in Blacks than in Whites. The 5-year survival rates were higher in Whites and Indians/Asians (60-80%) than in Blacks and Coloureds (40-50%). The incidence rate increased (AAPC range: 1.1-3.1%, p-value < 0.001) among young women (25-34 years) from 2000 to 2009. Despite interventions, there were minimal changes in overall epidemiology of CC in SA but there were increased CC rates among young women and ethnic disparities in CC burden. A review of the CC national policy and directed CC prevention and treatment are required to positively impact the burden of CC in SA.

Join point trends of instrumental vaginal deliveries and cesarean sections at the Lagos University Teaching Hospital, Lagos, Nigeria (2002-2017).

OBJECTIVE: To determine the trends of instrumental vaginal delivery (IVD) and cesarean section (CS) at the Lagos University Teaching Hospital (LUTH), Nigeria, over 16 years, from 2002 to 2017. METHODS: A retrospective cross-sectional study. The case records of all women who had IVD and CS during the study period were reviewed. The trends in the IVD and CS rates were evaluated using join point regression modeling. The average annual percent change (AAPC) and annual percent change (APC) with associated 95% confidence interval of segmental trends were calculated. RESULTS: The overall IVD rate was 1.36%. Vacuum delivery rate was higher than forceps (0.79% vs 0.57%). The CS rate was 44.9 per 100 deliveries; the rate increased by about 3.7% per annum. CS rates were 7.1-89.9 times the IVD rates within the study period. The number of IVDs performed in the hospital declined by about 83.02%, from 53 cases in 2002 to nine cases in 2017. Forceps delivery declined at a faster rate than vacuum delivery between 2002 and 2017 (AAPC for forceps: -12.6% [-17.5 to -7.5], P < 0.001 vs AAPC for vacuum: -6.2% [-14.3 to 2.7], P = 0.200). The commonest indication for IVD was prolonged second stage of labor (47/162, 29.01%) and shortening of the second stage of labor for maternal conditions (47/162, 29.01%). CONCLUSION: IVD rates are low and declining at LUTH. There is need to train accoucheurs on the safe use of IVDs to potentially reduce the CS rate.

Serum Vitamin D Deficiency and Male Infertility: A Relationship?

Background Male infertility is one of the major reproductive health concerns, causing a lot of distress for couples globally. Others have looked into its connection to vitamin D deficiency, but their findings are conflicting. Aim This study aimed to determine the relationship between male infertility and vitamin D deficiency among Nigerians. Method This analytical cross-sectional study was conducted among 132 men. A purposive sampling technique was employed to recruit 66 participants in the study (men with infertility) and control groups (men with proven fertility). Descriptive statistics were conducted, while the association between vitamin D level and sperm parameters was assessed using bivariate and regression modeling. A two-tailed test of the hypothesis was assumed, and the level of statistical significance was set at a P-value < 0.05. Results None of the participants had a serum vitamin D deficiency. However, the overall serum vitamin D insufficiency rate was 15%. The median vitamin D level for the total study population (both fertile and infertile) was 37.52 ng/ml (IQR: 32.1 - 51.69). This study demonstrated no association between serum vitamin D levels and male infertility, as well as no association between serum vitamin D levels and the quality of semen parameters. Conclusion There was no significant association between vitamin D levels, male infertility, and seminal fluid parameters. However, larger multi-center studies are recommended to provide further insights into this conclusion.

Intravenous versus oral iron for anaemia among pregnant women in Nigeria (IVON): an open-label, randomised controlled trial.

BACKGROUND: Oral iron for anaemia in pregnancy is often not well tolerated, with poor adherence. Iron administered intravenously might address these tolerance and adherence issues. We investigated the effectiveness and safety of intravenous ferric carboxymaltose versus oral ferrous sulphate on anaemia and iron deficiency among pregnant women in Nigeria. METHODS: We did a multicentre, open-label, parallel, randomised controlled trial of pregnant women (aged 15-49 years) with haemoglobin (Hb) concentrations of less than 10 g/dL at 20-32 weeks' gestation from 11 primary, secondary, or tertiary health facilities in Nigeria (five in Lagos and six in Kano). Exclusion criteria included vaginal bleeding, blood transfusion or major surgery within the past 3 months, symptomatic anaemia, anaemia known to be unrelated to iron deficiency, clinically confirmed malabsorption syndrome, previous hypersensitivity to any form of iron, pre-existing maternal depression or other major psychiatric illness, immune-related diseases, such as systemic lupus erythematosus or rheumatoid arthritis, or severe allergic reactions. Participants were randomly assigned (1:1) by nurses and doctors using a web-based randomisation service to either receive a single dose of intravenous ferric carboxymaltose (20 mg/kg to a maximum of 1000 mg) or oral ferrous sulphate (200 mg; 65 mg elemental iron) three times daily until 6 weeks postpartum. The study was primarily unmasked. Primary outcomes were maternal anaemia (Hb <11 g/dL) at 36 weeks' gestation and preterm birth at before 37 weeks' gestation, with analysis by intention to treat in participants with available data. This study was registered at the ISRCTN registry on Dec 10, 2020 (ISRCTN63484804) and on ClinicalTrials.gov (NCT04976179) on April 7, 2021. FINDINGS: Between Aug 10, 2021, and Dec 15, 2022, 13 724 pregnant women were screened for eligibility. 12 668 were excluded due to ineligibility for inclusion, and 1056 provided consent to participate and were randomly assigned to either the intravenous or oral administration groups. 527 were assigned to the intravenous ferric carboxymaltose group and 529 were assigned to the oral ferrous sulphate group. 518 in the intravenous group were assessed at 36 weeks' gestational age and after 518 deliveries, and 511 completed the 6 weeks postpartum visit. 513 in the oral ferrous sulphate group were assessed at 36 weeks' gestational age and after 512 deliveries, and 501 completed the 6 weeks postpartum visit. No significant difference was found in anaemia at 36 weeks (299 [58%] of 517 in the intravenous group vs 305 [61%] of 503 in the oral group; risk ratio 0·95, 95% CI 0·85-1·06; p=0·36), nor in preterm birth (73 [14%] of 518 vs 77 [15%] of 513; 0·94, 0·70-1·26; p=0·66). There were no significant differences in adverse events. The most common adverse events were diarrhoea (in six participants) and vomiting (in three participants) in the oral group and fatigue (in two participants) and headache (in two participants) in the intravenous group. INTERPRETATION: Although the effect on overall anaemia did not differ, intravenous iron reduced the prevalence of iron deficiency to a greater extent than oral iron and was considered to be safe. We recommend that intravenous iron be considered for anaemic pregnant women in Nigeria and similar settings. FUNDING: Bill & Melinda Gates Foundation.

Trends of cleft surgeries and predictors of late primary surgery among children with cleft lip and palate at the University College Hospital, Nigeria: A retrospective cohort study.

BACKGROUND: Cleft of the lip and palate is the most common craniofacial birth defect with a worldwide incidence of one in 700 live births. Early surgical repairs are aimed at improving appearance, speech, hearing, psychosocial development and avoiding impediments to social integration. Many interventions including the Smile Train partner model have been introduced to identify and perform prompt surgical procedures for the affected babies. However, little is known about the trends of the incidence and surgical procedures performed at our hospital. Nothing is also known about the relationship between the clinical characteristics of the patients and the timing of primary repairs. OBJECTIVE: To determine the trends in cleft surgeries, patterns of cleft surgeries and identify factors related to late primary repair at the University College Hospital, UCH, Ibadan, Nigeria. METHODS: A retrospective cohort study and trends analysis of babies managed for cleft lip and palate from January 2007 to January 2019 at the UCH, Ibadan was conducted. The demographic and clinical characteristics were extracted from the Smile Train enabled cleft database of the hospital. The annual trends in rate of cleft surgeries (number of cleft surgeries per 100,000 live births) was represented graphically. Chi square test, Student's t-test and Mann Whitney U were utilised to assess the association between categorical and continuous variables and delay in cleft surgery (≥12 months for lip repair, ≥18months for palatal repair). Kaplan-Meier graphs with log-rank test was used to examine the association between sociodemographic variables and the outcome (late surgery). Univariable and multivariable Cox proportional hazard regression was conducted to obtain the hazard or predictors of delayed cleft lip surgery. Stata version 17 (Statacorp, USA) statistical software was utilised for analysis. RESULTS: There were 314 cleft surgeries performed over the thirteen-year period of study. The male to female ratio was 1.2:1. The mean age of the patients was 58.08 ± 99.65 months. The median age and weight of the patients were 11 (IQR:5-65) months and 8 (IQR: 5.5-16) kg respectively. Over half (n = 184, 58.6%) of the cleft surgeries were for primary repairs of the lip and a third (n = 94, 29.9%) were surgeries for primary repairs of the palate. Millard's rotation advancement flap was the commonest lip repair technique with Fishers repair introduced within two years into the end of the study. Bardachs two flap palatoplasty has replaced Von Langenbeck palatoplasty as the commonest method of palatal repair. The prevalence of late primary cleft lip repair was about a third of the patients having primary cleft lip surgery while the prevalence of late palatal repair was more than two thirds of those who received primary palatoplasty. Compared with children who had bilateral cleft lip, children with unilateral cleft lip had a significantly increased risk of late primary repair (Adj HR: 22.4, 955 CI: 2.59-193.70, P-value = 0.005). CONCLUSION: There has been a change from Von Langenbeck palatoplasty to Bardachs two-flap palatoplasty. Intra-velar veloplasty and Fisher's method of lip repair were introduced in later years. There was a higher risk of late primary repair in children with unilateral cleft lip.

Population-based temporal trends and ethnic disparity in breast cancer mortality in South Africa (1999-2018): Joinpoint and age-period-cohort regression analyses.

Globally, breast cancer is the leading cause of cancer deaths, accounting for 15.5% of female cancer deaths in 2020. Breast cancer is also the leading cause of female cancers in South Africa. The rapid epidemiological transition in South Africa may have an impact on the trends in breast cancer mortality in the country. We therefore evaluated the trends in the breast cancer mortality in SA over 20 years (1999-2020). Methods: Joinpoint regression analyses of the trends in crude and age-standardized mortality rates (ASMR) of breast cancer among South African women were conducted from 1999 to 2018 using mortality data from Statistics South Africa. Age-period-cohort regression analysis was then conducted to evaluate the independent effect of age, period, and cohort on breast cancer mortality, and analysis was stratified by ethnicity. Results: The mortality rate of breast cancer (from 9.82 to 13.27 per 100,000 women) increased at around 1.4% per annum (Average Annual Percent Change (AAPC): 1.4%, 95% CI:0.8-2.0, P-value< 0.001). Young women aged 30-49 years (1.1%-1.8%, P-value< 0.001) had increased breast cancer mortality. The risk of breast cancer mortality increased among successive birth cohorts from 1924 to 1928 but decreased among recent cohorts born from 1989 to 1993. In 2018, the breast cancer mortality rate among Blacks (9.49/100,000 women) was around half of the rates among the non-Blacks. (Coloreds: 18.11 per 100,000 women; Whites: 17.77/100,000 women; Indian/Asian: 13.24 per 100,000 women). Conclusions: Contrary to the trends in high- and middle-income countries, breast cancer mortality increased in South Africa especially among young women. Breast cancer prevention programs should be intensified and should also target young women. The marked disparity in ethnic burden of breast cancer should be considered during planning and implementation of interventions.

Socio-demographic and reproductive characteristics of clients that accepted contraceptives at abortion center at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), Johannesburg, South Africa: a cross-sectional study (January-July 2021).

Introduction: access to family planning services is an important preventive strategy against maternal mortality as it can considerably reduce unintended pregnancies and prevent sequelae of unsafe abortion. We aimed to describe the socio-demographic and reproductive characteristics of abortion seekers and investigate factors associated with uptake of contraceptives following induced abortion at Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa. Methods: this study was a cross-sectional study among women who had legal termination of unwanted pregnancy at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), from 1st January 2021 to July 2021. Questionnaires were administered to 80 consenting consecutive clients after undergoing induced abortion. Information on socio-demographic and reproductive characteristics and pattern of contraceptive uptake of the respondents were obtained. Descriptive and bivariate analysis were conducted to determine the pattern and relationship of socio-demographic and reproductive characteristics and contraceptive uptake. Results: the mean age of the 80 respondents was 25.6 ± 6.6 years. Majority of the participants were of the Black race (96.25%, n= 77/80), single (90.00%, n= 72/80), of the Christian faith (80.00%, n= 64/80) and unemployed. The median number of children alive among the clients was 1(0-2), with about 37.5% of the participants being nulliparous. About 16.25% of the participants had had at least one previous termination of pregnancy. The prevalence of post-abortion contraceptive uptake was 97.5% (95%CI: 90.36% - 99.39%, N=78/80). More than half chose injectable contraceptive (53.85%, 95%CI: 42.60% - 64.71%, N= 42/78), followed by oral contraceptive pills (21.79%, 95%CI: 13.90% - 32.49% N= 17/78). We found no association between socio-demographic and reproductive characteristics, and contraceptive uptake among the abortion clients (p values >0.05). Conclusion: the immediate post-abortion contraceptive uptake in our facility is very high. Majority of the clients accepted injectable contraceptives. The demographic and reproductive characteristics of our clients did not affect uptake of post-abortion contraception. More education is needed to improve uptake of other long-acting contraceptives that may not require frequent contact with the health facility.

Serum Calcium and Magnesium Levels in Women with Uterine Fibroids at a University Teaching Hospital in Southwest Nigeria: A Comparative Cross-Sectional Study.

Background: Studies have suggested the potential roles of serum trace elements such as calcium and magnesium in the development of uterine fibroids. Aims: This study compared magnesium and calcium serum levels in reproductive-age women with and without uterine fibroids in Lagos, Southwest Nigeria. Methods: A comparative cross-sectional study of 194 parity-matched women with or without a sonographic diagnosis of uterine fibroids enrolled at a university teaching hospital in Lagos, Southwest Nigeria. Participants' sociodemographic, ultrasound, and anthropometric information as well as the estimated serum levels of calcium and magnesium were collected for statistical analyses. Results: This study found significant negative associations between low serum calcium levels and uterine fibroids (adjusted odds ratio= 0.06; 95% CI: 0.004, 0.958; p=0.047), uterine size (p=0.004), and the number of fibroid nodules (p=0.030). However, no significant association was observed between serum magnesium levels and uterine fibroids (p=0.341). Conclusion: The findings of this study suggest the promising role of calcium-rich diets and supplements in the prevention of uterine fibroids among Nigerian women. However, future longitudinal studies are required to further evaluate the potential role of these trace mineral elements in the development of uterine fibroids.