Can sugar taxes be used for financing surgical systems in Nigeria? A mixed-methods political economy analysis.

This study determined the feasibility of investing revenues raised through Nigeria's sugar-sweetened beverage (SSB) tax of 10 Naira/l to support the implementation of the National, Surgical, Obstetrics, Anaesthesia and Nursing Plan, which aims to strengthen access to surgical care in the country. We conducted a mixed-methods political economy analysis. This included a modelling exercise to predict the revenues from Nigeria's SSB tax based on its current tax rate over a period of 5 years, and for several scenarios such as a 20% ad valorem tax recommended by the World Health Organization. We performed a gap analysis to explore the differences between fiscal space provided by the tax and the implementation cost of the surgical plan. We conducted qualitative interviews with key stakeholders and performed thematic analyses to identify opportunities and barriers for financing surgery through tax revenues. At its current rate, the SSB tax policy has the potential to generate 35 914 111 USD in year 1, and 189 992 739 USD over 5 years. Compared with the 5-year adjusted surgical plan cost of 20 billion USD, the tax accounts for ∼1% of the investment required. There is a substantial scope for further increases in the tax rate in Nigeria, yielding potential revenues of up to 107 663 315 USD, annually. Despite an existing momentum to improve surgical care, there is no impetus to earmark sugar tax revenues for surgery. Primary healthcare and the prevention and treatment of non-communicable diseases present as the most favoured investment areas. Consensus within the medical community on importance of primary healthcare, along the recent government transition in Nigeria, offers a policy window for promoting a higher SSB tax rate and an adoption of other sin taxes to generate earmarked funds for the healthcare system. Evidence-based advocacy is necessary to promote the benefits from investing into surgery.

Comparative effectiveness of implementation strategies for Accelerating Cervical Cancer Elimination through the integration of Screen-and-treat Services (ACCESS study): protocol for a cluster randomized hybrid type III trial in Nigeria.

BACKGROUND: Despite the increased risk of cervical cancer (CC) among women living with HIV (WLHIV), CC screening and treatment (CCST) rates remain low in Africa. The integration of CCST services into established HIV programs in Africa can improve CC prevention and control. However, the paucity of evidence on effective implementation strategies (IS) has limited the success of integration in many countries. In this study, we seek to identify effective IS to enhance the integration of CCST services into existing HIV programs in Nigeria. METHODS: Our proposed study has formative and experimental activities across the four phases of the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework. Through an implementation mapping conducted with stakeholders in the exploration phase, we identified a core package of IS (Core) and an enhanced package of IS (Core+) mostly selected from the Expert Recommendations for Implementing Change. In the preparation phase, we refined and tailored the Core and Core+ IS with the implementation resource teams for local appropriateness. In the implementation phase, we will conduct a cluster-randomized hybrid type III trial to assess the comparative effectiveness of Core versus Core+. HIV comprehensive treatment sites (k = 12) will be matched by region and randomized to Core or Core+ in the ratio of 1:1 stratified by region. In the sustainment phase, we will assess the sustainment of CCST at each site. The study outcomes will be assessed using RE-AIM: reach (screening rate), adoption (uptake of IS by study sites), IS fidelity (degree to which the IS occurred according to protocol), clinical intervention fidelity (delivery of CC screening, onsite treatment, and referral according to protocol), clinical effectiveness (posttreatment screen negative), and sustainment (continued integrated CCST service delivery). Additionally, we will descriptively explore potential mechanisms, including organizational readiness, implementation climate, CCST self-efficacy, and implementation intentions. DISCUSSION: The assessment of IS to increase CCST rates is consistent with the global plan of eliminating CC as a public health threat by 2030. Our study will identify a set of evidence-based IS for low-income settings to integrate evidence-based CCST interventions into routine HIV care in order to improve the health and life expectancy of WLHIV. TRIAL REGISTRATION: Prospectively registered on November 7, 2023, at ClinicalTrials.gov no. NCT06128304. https://classic. CLINICALTRIALS: gov/ct2/show/study/NCT06128304.

Maternal antioxidant micronutrient deficiencies among pre-eclamptic women in Enugu, Nigeria: a cross-sectional analytical study.

OBJECTIVES: To determine the prevalence of antioxidant micronutrient deficiencies in pregnant women with pre-eclampsia and healthy pregnant women, and to assess the relationships between trace element deficiency in pregnancy and the severity of pre-eclampsia in Enugu, Nigeria. METHODS: We performed a secondary analysis of a cross-sectional analytical study of serum concentrations of copper, selenium, zinc, magnesium, and manganese in 81 pregnant women with pre-eclampsia and healthy pregnant women (controls) who were matched for age, gestational age, body mass index, and parity. This study was performed at the University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu. Participants' sera were analyzed with an atomic absorption spectrophotometer. RESULTS: Trace element deficiencies were common and similar between women with pre-eclampsia and controls. However, women with pre-eclampsia were more likely to be deficient in manganese than controls (odds ratio = 2.28, 95% confidence interval: 1.90-2.75). Among the micronutrients studied, only manganese concentrations were significantly lower in women without severe symptoms of pre-eclampsia than in those with severe symptoms of pre-eclampsia. CONCLUSIONS: Micronutrient deficiency is common in pregnant women with pre-eclampsia and in healthy pregnant women in Enugu, Nigeria. Only manganese deficiency is higher in women with pre-eclampsia than in healthy pregnant women.

Urinary and anal incontinence in pregnancy in a Nigerian population: A prospective longitudinal study.

Objectives: There are several studies from sub-Saharan Africa on postpartum urinary incontinence and anal incontinence, but very rare in pregnancy. Such data will guide obstetric caregivers in providing appropriate counseling to the women as well as in minimizing the risk factors. This study aimed to determine the comparative effects of different trimesters of pregnancy on urinary incontinence and anal incontinence, and their possible risk factors. Methods: The study was longitudinal in design, and the study population consisted of 223 pregnant women receiving care at the two largest tertiary health institutions in Enugu, South-East Nigeria. The recruitment was in the first trimester and the women were followed up to term. Interviews were conducted at specific times in the three trimesters and data regarding urinary incontinence and anal incontinence symptoms were obtained using validated questionnaires. Results: The incidence of urinary incontinence increased across the trimesters: 22%, 30.5%, and 48% in the first trimester, second, and third trimesters, respectively, with a cumulative incidence rate of 50.2%. The incidence of anal incontinence also increased across the trimesters but not as high as urinary incontinence: 1.7%, 3.6%, and 5.8%, respectively, with a cumulative incidence rate of 6.7%. The risk factors for urinary incontinence were maternal age >35 years, multiparity, previous prolonged second-stage labor, and previous history of neonatal macrosomia, while that of anal incontinence were previous instrumental vaginal delivery and previous prolonged second stage of labor. Conclusion: Our study demonstrated an increase in the incidence of urinary incontinence and anal incontinence as pregnancy advances. Obstetricians are therefore encouraged to discuss these pelvic floor issues during antenatal care services and make more efforts toward reducing the modifying obstetric risk factors.

A randomised control trial on oral dydrogesterone versus micronized vaginal progesterone pessary for luteal phase support in in vitro fertilization cycles.

This study aimed to evaluate the pregnancy rates, adverse reactions, and medication costs of two luteal phase support regimens: oral dydrogesterone and micronized vaginal progesterone (MVP) pessary in in vitro fertilization cycles. A randomized open-label trial with participants randomly assigned to either 400 mg MVP twice daily or 10 mg dydrogesterone three times daily. The primary endpoints were pregnancy rates, and the secondary endpoints included tolerance, miscarriage rates, and medication cost. Per-protocol principle analysis was performed. The baseline characteristics of the 162 participants were similar. Dydrogesterone had statistically similar (p>0.05) positive pregnancy test rates fifteen days post embryo transfer (35.8% vs. 32.7%), clinical pregnancy rates at the gestational age of 6 weeks (32.1% vs. 28.8%), ongoing pregnancy rates (26.4% vs. 23.1%) and miscarriage rates at 14 weeks of gestation (9.2% vs. 9.4%) and safety profile to MVP. Dydrogesterone was better tolerated as vaginal itching was significantly more prevalent in the MVP arm (p=0.008). Dydrogesterone is significantly less expensive than MVP pessary. Oral dydrogesterone and MVP pessary had similar pregnancy rates and adverse effects. Dydrogesterone appears more user-friendly and less expensive in cases of luteal-phase support in in vitro fertilization cycles.

Postnatal care services use by mothers: A comparative study of defaulters versus attendees of postnatal clinics in Enugu.

INTRODUCTION: Despite much emphasis on the reproductive health of women, maternal mortality is still high, especially in postnatal period. OBJECTIVE: To assess the prevalence of postnatal care use and reasons for defaults among mothers attending the child immunization clinics in Enugu, Nigeria. METHODS: This was a cross-sectional comparative study of 400 consecutive nursing mothers who presented at the Institute of Child Health of UNTH and ESUTH, Enugu for Second dose of the Oral Polio Vaccine (OPV2) for their babies at 10 weeks postpartum. Data was collected using Interviewer-administered questionnaire and subsequently analyzed with version 22.0 IBM SPSS software, Chicago, Illinois. A p-value of less than 0.05 was considered as statistically significant. RESULT: The prevalence of the 6th week postnatal clinic attendance among the mothers was 59%. The majority of the women (60.6%) who had antenatal care by skilled birth attendants attended postnatal clinic. Unawareness and being healthy were the main reasons for not attending postnatal clinic. Following multivariate analysis, place of antenatal (OR = 2.870, 95% C.I = 1.590-5.180, p < 0.001) and mode of delivery (OR = 0.452, 95% C.I = 0.280-0.728, p = 0.001) were the only significant predictors of postnatal clinic attendance (p < 0.05). CONCLUSION: Postnatal clinic attendance by women in Enugu is still suboptimal. The main reason for non-attendance of the 6th week postnatal clinic was lack of awareness. There is need for healthcare professionals to create awareness about the importance of postnatal care and encourage mothers to attend.

Identifying Hot Spots of Tuberculosis in Nigeria Using an Early Warning Outbreak Recognition System: Retrospective Analysis of Implications for Active Case Finding Interventions.

BACKGROUND: Undiagnosed tuberculosis (TB) cases are the major challenge to TB control in Nigeria. An early warning outbreak recognition system (EWORS) is a system that is primarily used to detect infectious disease outbreaks; this system can be used as a case-based geospatial tool for the real-time identification of hot spot areas with clusters of TB patients. TB screening targeted at such hot spots should yield more TB cases than screening targeted at non-hot spots. OBJECTIVE: We aimed to demonstrate the effectiveness of an EWORS for TB hot spot mapping as a tool for detecting areas with increased TB case yields in high TB-burden states of Nigeria. METHODS: KNCV Tuberculosis Foundation Nigeria deployed an EWORS to 14 high-burden states in Nigeria. The system used an advanced surveillance mechanism to identify TB patients' residences in clusters, enabling it to predict areas with elevated disease spread (ie, hot spots) at the ward level. TB screening outreach using the World Health Organization 4-symptom screening method was conducted in 121 hot spot wards and 213 non-hot spot wards selected from the same communities. Presumptive cases identified were evaluated for TB using the GeneXpert instrument or chest X-ray. Confirmed TB cases from both areas were linked to treatment. Data from the hot spot and non-hot spot wards were analyzed retrospectively for this study. RESULTS: During the 16-month intervention, a total of 1,962,042 persons (n=734,384, 37.4% male, n=1,227,658, 62.6% female) and 2,025,286 persons (n=701,103, 34.6% male, n=1,324,183, 65.4% female) participated in the community TB screening outreaches in the hot spot and non-hot spot areas, respectively. Presumptive cases among all patients screened were 268,264 (N=3,987,328, 6.7%) and confirmed TB cases were 22,618 (N=222,270, 10.1%). The number needed to screen to diagnose a TB case in the hot spot and non-hot spot areas was 146 and 193 per 10,000 people, respectively. CONCLUSIONS: Active TB case finding in EWORS-mapped hot spot areas yielded higher TB cases than the non-hot spot areas in the 14 high-burden states of Nigeria. With the application of EWORS, the precision of diagnosing TB among presumptive cases increased from 0.077 to 0.103, and the number of presumptive cases needed to diagnose a TB case decreased from 14.047 to 10.255 per 10,000 people.

Comparison of Pregnancy Outcomes of History-Indicated and Ultrasound-Indicated Cervical Cerclage: A Retrospective Cohort Study.

Background: Cervical cerclage is the procedure of choice for preventing preterm delivery due to cervical insufficiency. The indication for its application may be based on the woman's reproductive history, findings at ultrasound, or clinical findings on vaginal examination. Pregnancy outcomes from these indications are variable according to the available literature. Objective: To compare the effectiveness and reproductive outcomes (miscarriage, preterm birth rates, and birth weights) of McDonald's cervical cerclage after history-indicated and ultrasound-indicated cervical cerclage in pregnant women. Methods: The retrospective cohort study was conducted at Life International Hospital Awka, Nigeria and Life Specialist Hospital Nnewi, Nigeria. Pregnant women, who had a McDonald's cervical cerclage performed due to either history or ultrasound indication between January 1, 2011, and December 31, 2020, were included in the study. Women with multiple pregnancies and those with physical examination-indicated or emergency cerclages were excluded. The main outcome measures included the prevalence of cervical cerclage, miscarriage, and preterm delivery rates. Outcomes were compared between groups with the chi-square test, Fisher's exact test, or Student's t test. p value of < 0.5 was set as significant value. Results: Overall, during the study period, 5392 deliveries occurred in the study sites, of which 103 women had a history-indicated or ultrasound-indicated cervical cerclage. This resulted in a 1.91% prevalence rate for history-indicated and ultrasound-indicated cervical cerclage. Of these, 68 (66%) had history indicated, while 35 (34%) had ultrasound-indicated cerclage. There was no difference in the sociodemographic characteristics of both groups. Both groups had similar miscarriage rates: 1.18 in 1000 and 1.04 in 1000 deliveries, respectively (RR 1.160, 95% CI: 0.3824 to 3.5186, p = 0.793). There was more preterm delivery in history-indicated cerclage than ultrasound-indicated cervical cerclage (26.50% vs. 17.10%; p = 0.292), though the difference was not statistically significant. The ultrasound group had a higher average birthweight than the history group (2.67 ± 0.99 vs. 2.53 ± 0.74). However, this difference was not statistically significant. Conclusion: The effectiveness and reproductive outcomes (miscarriage, preterm birth rates, and birth weights) of pregnant women with cervical cerclage due to history-indicated and ultrasound-indicated cervical cerclage appear similar. When needed, cervical cerclage should be freely applied for cervical insufficiency, irrespective of the type of indication.

Sublingual misoprostol versus manual vacuum aspiration for treatment of incomplete abortion in Nigeria: a randomized control study.

Introduction: single-dose of sublingual misoprostol 400mcg with the participant followed-up at the gynecology clinic one week after with an ultrasound scan for the completeness of the uterine evacuation. Objective: to compare the effectiveness of single-dose sublingual misoprostol to manual vacuum aspiration in the treatment of incomplete spontaneous abortion in Enugu, Nigeria. Methods: the primary outcome measure was the incidence of complete uterine evacuation (complete abortion) after one week of treatment while the secondary outcome measures included incidence, types, and tolerability of treatment side effects as well as participants' satisfaction with the treatment received. Results: two hundred and three participants who met the study criteria and completed the study were randomised into the intervention group (n=102) received single-dose sublingual misoprostol 400mcg and the control group (n= 101) received manual vacuum aspiration. Incidence of complete abortion was 86.3% for the misoprostol group and 100.0% for the control group, RR = 0.86, (CI 95%: 0.80 - 0.93), p <0.001. The most common side effect was abdominal pain with an incidence of 27.5% versus 48.55 for the misoprostol and control groups respectively (p = 0.002). Most participants in each group (81.1% versus 77.6% for the misoprostol and control groups respectively) considered the side effects as tolerable. The mean visual analogue scale score for maternal satisfaction was higher in the misoprostol group (86.7 ± 14.11) than the control group (81.36 ± 11.10), p < 0.001. Conclusion: the treatment of incomplete spontaneous abortion with single-dose sublingual misoprostol 400mcg produced a high rate of complete abortion among women in Enugu, Nigeria. Despite having a lower complete abortion rate, maternal satisfaction was higher when compared with women that had manual vacuum aspiration of the uterus. Trial registration: trial registration number - PACTR202009857889210, date of registration - September 23rd, 2020. Retrospectively registered.

The outcome of complementary and alternative medicine use among pregnant women in South-East Nigeria: a multi-centre prospective study.

There is a global increasing trend of complementary and alternative medicine (CAM) use among pregnant women. This study aimed at determining the maternal and perinatal outcome of CAM use among the pregnant women in South-East Nigeria. This was a prospective study in which self-administered semi-structured questionnaires were used to collate information from the consenting pregnant women who use CAM and those who did not use CAM from the gestational age of 36 weeks at four hospitals in South-East Nigeria. Both groups were matched for age, parity and address. Every participant was followed up until delivery. Data were analysed using SPSS version 23 (SPSS Inc., Chicago, IL). This study's ethical clearance number was NHREC/05/01/2008B-FWA00002458-1RB00002323 and it was obtained at UNTH and on February 15 2019. CAM use in pregnancy was associated with low haemoglobin concentration, maternal complications, high caesarean section rate, low birth weight, low APGAR score, large placental weight and high hospital admission of babies when compared with non-CAM users (p value= <.05). In conclusion, CAM use in pregnancy was associated with poor maternal and perinatal health indices, hence the need to implement policies aimed at reversing them.Impact StatementWhat is already known on this subject? There is an increasing trend of CAM use among pregnant women in the world. Pregnancy is associated with certain conditions that predispose women to CAM use. The clinical indications for CAM use by the pregnant women are nausea and vomiting, labour pain, induction of labour, pedal oedema and waist pain.What the results of this study add? CAM use in pregnancy was associated with low haemoglobin concentration, maternal complications, high caesarean section rate, low birth weight, low APGAR score, large placental weight and high hospital admission of the babies when compared with non-CAM users.What the implications are of these findings for clinical practice and/or further research? CAM use in pregnancy was associated with poor maternal and perinatal health indices, hence the need to implement policies aimed at reversing them.

Magnitude and predictors of female domestic abuse in pregnancy in a patriarchal African society: a cross-sectional study of pregnant women in Enugu, South East Nigeria.

INTRODUCTION: domestic abuse against women is very common globally and has far-reaching consequences on the society. Therefore, it is essential to deeply study the seriousness of this public health issue among our pregnant women. The objectives were to determine the prevalence, pattern, and predictors of domestic abuse among pregnant women in Enugu, Nigeria. METHODS: a cross-sectional study of 400 consenting pregnant women at the antenatal clinics of the University of Nigeria Teaching Hospital Ituku-Ozalla, Nigeria. Each woman completed a modified abuse assessment screen structured questionnaire. Data analysis was descriptive and inferential with Chi-square and multivariate binary logistic regression using SPSS version 21. A p-value of <0.05 was considered statistically significant. RESULTS: a total of 172 out of 400 respondents (43.0%) had ever experienced domestic abuse in their pregnancies. One hundred and ten (37.2%; 110/296) of the multigravid women were abused in previous pregnancies while 137 (34.3%; 137/400) of all respondents were being abused in the current pregnancy. For all pregnancies, the most common type of abuse experienced by the respondents was verbal abuse (85.5%; 147/172), while the commonest perpetrators of abuse were the respondents´ spouses for both the index pregnancy (82.5%; 113/137) and previous pregnancies (84.5%; 93/110). The most common women perceived cause of abuse was financial constraints (68.6%; 118/172). Age less than 25 years (AOR=1.9, 95% CI=1.01-3.76, p=0.048), not having tertiary education (AOR=2.0, 95% CI=1.17 - 3.25, p=0.01), having at least a male child (AOR=3.3, 95% CI=1.71 - 6.40, p=<0.001), and maternal unemployed status (AOR=2.0, 95% CI=1.27 - 3.19, p=0.003) were the identified predictors among women abused in pregnancy. CONCLUSION: the prevalence of domestic abuse was high among pregnant women in the University of Nigeria Teaching Hospital Ituku-Ozalla, Enugu, Nigeria. The predominant women perceived cause of domestic abuse was financial constraints while age less than 25 years, not having tertiary education, having at least a male child, and maternal unemployed status were the predictors in abused women. Domestic abuse poses a great threat to women´s reproductive health, and so, its screening should be incorporated into antenatal care in our environment.

Population seroprevalence of SARS-CoV-2 antibodies in Anambra State, South-East, Nigeria.

OBJECTIVE: The objective of this study was to determine the proportion of the Anambra State population that had been infected by the SARS-CoV-2 virus and developed antibodies before the second wave. METHODS: The WHO-recommended health facility-based cross-sectional approach was adapted for this survey. Between 8th and 15th December 2020, 3142 participants across the 21 local government areas (LGAs) of the State, aged one year and over, attending randomly selected health facilities, were recruited. Demographic and symptom-related information were collected from the participants as well as whole peripheral blood, which was tested for SARS-CoV-2 IgG and IgM with rapid test kits. RESULTS: 425 participants tested positive for IgG only, 74 for IgM only, while 54 were positive for both IgG and IgM. Overall, 553 positives were recorded, giving a crude seroprevalence of 17.6% (95% CI = 16.26 - 18.98). It ranged widely from 31.9% (95% CI = 24.43 - 40.22) in Onitsha North LGA to 5.4% (95% CI = 2.19 - 10.78) in Awka north. Bayesian Adjustments yielded a state seroprevalence of 16.1%. CONCLUSION: One in six state residents had been infected by SARS-CoV-2 and developed antibodies before the second wave. All LGAs, age groups, sexes, and settlement types were affected by COVID-19. A large proportion of the population remained susceptible to SARS-CoV-2.

Effects of mode of delivery on sexual functions of parturients in Nigeria: a prospective cohort study.

INTRODUCTION AND HYPOTHESIS: Female sexual function disorders (FSFDs) have received less attention than male sexual function disorders, despite being more prevalent. Furthermore, most available literature is on the effect of vaginal delivery (VD) on sexual function, and studies on the effect of caesarean section (CS) are generally lacking. This study determined the comparative effect of CS and VD on FSFDs. METHODS: A prospective cohort of postnatal mothers at two hospitals in Nigeria was studied. In the intervention group women delivered via CS whereas women in the control group had a VD. Both groups were followed up to 3 months to determine the time to first coitus and other FSFs using a validated questionnaire. RESULTS: At 6 weeks postpartum, mean time (days) to first coitus was shorter in the CS than in the VD group (29.2 ± 4.3 vs 32.1 ± 4.9; t = 2.38; p = 0.02). However, no difference was observed at 3 months (37.3 ± 8.7 vs 40.9 ± 9.9; t = 1.83; p = 0.07). Also, there were no differences in mean Female Sexual Function Index (FSFI) total scores at 6 weeks and 3 months (p > 0.05). Mean FSFI domain scores at 6 weeks for orgasm, satisfaction, and pain were significantly higher in the CS group (p < 0.05). However, there were no differences in any of the domain scores at 3 months (p > 0.05). CONCLUSION: Mode of delivery does not affect time to resumption of coitus after childbirth, and FSF disorders by 3 months postpartum. Caesarean section should therefore not be recommended to women merely for early resumption of coital activity or preservation/maintenance of sexual function after childbirth.

Serum antioxidant micronutrient levels in pre-eclamptic pregnant women in Enugu, south-East Nigeria: a comparative cross-sectional analytical study.

BACKGROUND: Pre-eclampsia is a common obstetric complication of pregnancy in Nigeria, and oxidative stress has been implicated in its aetiopathogenesis. Despite this fact, there is a paucity of information regarding the serum antioxidant micronutrient status of pre-eclamptic Nigerian women. The objective of the was to determine the mean serum levels of some antioxidant trace elements (copper, zinc, selenium, magnesium, manganese) in pre-eclamptic pregnant women and compare with that of healthy pregnant women in Enugu, South-Eastern, Nigeria. METHODS: A cross-sectional analytical study was carried out at the Obstetrics and Gynaecology department of the University of Nigeria, Teaching Hospital Ituku-Ozalla, Enugu. Using atomic absorption spectrophotometry, the sera of 81 pregnant pre-eclamptic and 81 matched healthy pregnant controls were analyzed for the antioxidant micronutrients. Both descriptive and inferential analysis was performed using the statistical package for social sciences (SPSS) version 21.0 and a P value of < 0.05 was considered to be statistically significant. RESULTS: The mean serum levels of copper, selenium, and magnesium were found to be significantly lower in the pre-eclamptic pregnant group when compared to the healthy pregnant controls (p < 0.05). The mean serum levels of zinc and manganese did not differ between the two groups (p > 0.05). All the mean serum levels of micro-nutrients studied did not vary by category of pre-eclampsia (with or without severity findings) except manganese which was significantly lower in pre-eclamptic women without severity findings when compared to those with severity findings (p = 0.043). CONCLUSIONS: The serum levels of copper, selenium, and magnesium were significantly lower among pre-eclamptics when compared to their normal healthy controls. Low levels of selenium, copper, and magnesium may have contributed to the incidence of pre-eclampsia in our environment.

Effects of peer health education on perception and practice of screening for cervical cancer among urban residential women in south-east Nigeria: a before and after study.

BACKGROUND: Effective female education on cervical cancer prevention has been shown to increase awareness and uptake of screening. However, sustaining increase in uptake poses a challenge to control efforts. Peer health education has been used as an effective tool for ensuring sustained behavior change. This study was undertaken to assess the effectiveness of peer health education on perception, willingness to screen and uptake of cervical cancer screening by women. METHODS: A before and after intervention study was undertaken in 2 urban cities in Enugu state, Nigeria among women of reproductive age attending women's meeting in Anglican churches. Multistage sampling was used to select 300 women. Peer health education was provided once monthly for 3 consecutive sessions over a period of 3 months. Data was collected at baseline and after the intervention using pre-tested questionnaires. Descriptive statistics and tests of significance of observed differences and associations were done at p-value of <0.05. RESULTS: Statistical significant difference was observed in participants' individual risk perception for cervical cancer and perception of benefits of early detection through screening. Practice of screening for cervical cancer increased by 6.8% and the observed difference was statistically significant (p = 0.02). This was significantly associated with marital status, level of education, employment status and parity (p < 0.05). CONCLUSION: Peer health education is an effective strategy for increasing women's perception of benefits of early detection of cervical cancer through screening. It is also effective for increasing their practice of screening for cervical cancer.

The impact of community health educators on uptake of cervical and breast cancer prevention services in Nigeria.

OBJECTIVE: To determine the impact of trained community health educators on the uptake of cervical and breast cancer screening, and HPV vaccination in rural communities in southeast Nigeria. METHODS: A prospective population-based intervention study, with a before-and-after design, involved four randomly selected communities in southeast Nigeria from February 2014 to February 2016. Before the intervention, baseline data were collected on the uptake of cervical and breast cancer prevention services. The intervention was house-to-house education on cervical cancer and breast cancer prevention. Postintervention outcome measures included the uptake of cervical and breast cancer screening, and HPV vaccination within 6 months of intervention. RESULTS: In total, 1327 women were enrolled. Before the intervention, 42 (3.2%) women had undergone cervical cancer screening; afterwards, 897 (67.6%) women had received screening (P<0.001). Clinical breast examination was performed for 59 (4.4%) women before and 897 (67.6%) after the intervention (P<0.001). Only 2 (0.9%) of 214 children eligible for HPV vaccination had received the vaccine before versus 71 (33.2%) after the intervention (P<0.001). CONCLUSION: The use of community health educators for house-to-house cervical and breast cancer prevention education was associated with significant increases in the uptake of cervical cancer screening, clinical breast examination, and HPV vaccination.

Prevalence and Predictors of Alcohol Consumption during Pregnancy in South-Eastern Nigeria.

INTRODUCTION: Alcohol consumption during pregnancy is a major public health problem because of the enormous deleterious effects on a developing fetus. Sub-Saharan Africa (SSA) is among the highest per capita rates of alcohol consumption in the world, thus suggesting a high burden of Fetal Alcohol Syndrome Disorder (FASD) in the sub-region. Despite this, there is limited data on alcohol exposed pregnancies for most SSA countries including Nigeria. AIM: To determine the prevalence and predictors of alcohol consumption during pregnancy in Enugu, South-Eastern Nigeria. MATERIALS AND METHODS: It was a cross-sectional study of 380 consecutive consenting parturients accessing antenatal care at the University of Nigeria Teaching Hospital, Enugu, Nigeria. The information sought for, included the women's socio-demographic characteristics, alcohol use in pregnancy, awareness of the harmful effects of alcohol on the babies including FASD, sources of initial information on awareness, type and quantity of alcohol ingested, reasons for taking alcohol and willingness to stop alcohol ingestion in pregnancy after counseling on the risk of alcohol use in pregnancy. Statistical analysis was both descriptive and inferential at 95% confidence level. A p-value of less than 0.05 was considered statistically significant. RESULTS: The prevalence of alcohol consumption in pregnancy was 22.6%. The most common brand of alcoholic beverage consumed was stout beer (62.8%, 54/86). A total of 135 (35.5%) respondents were aware that alcohol is harmful to the fetus. Maternal age 30 years or less, nulliparity, less than tertiary education, pre-pregnancy alcohol consumption and lack of awareness of the harmful effect of alcohol on the fetus, were associated with alcohol consumption during pregnancy (p< 0.05). CONCLUSION: The prevalence of alcohol consumption during pregnancy among women in Enugu, South-Eastern Nigeria is high and lack of awareness of harmful effect of alcohol on fetus was a major predictor. There is need for a concerted public health campaign to improve the awareness of harmful effects of alcohol on the fetus.

Effect of Low CD4 Cell Count on Cervical Squamous Intraepithelial Lesions among HIV-Positive Women in Enugu, Southeastern Nigeria.

INTRODUCTION: HIV-positive women are more likely to develop cervical neoplasm. HIV-positive women with low CD4 T-lymphocyte cell count may be more predisposed to cervical squamous intraepithelial lesions (SILs). This study aimed to determine the association between low cellular immunity of HIV positive women, and the prevalence and grade of cervical squamous intraepithelial lesions. MATERIALS AND METHODS: Pap smear was carried out on two cohorts of Highly Active Anti Retroviral Therapy (HAART) experienced HIV-positive women (178 per group) at the AIDS Prevention Initiative in Nigeria-Centre for Disease Control Adult Anti-Retroviral clinic of the University of Nigeria Teaching Hospital, Enugu, Nigeria from June to November, 2012. The study group had CD4 cell count of < 200 cells/µl while the control group had CD4 cell count of ≥200 cells/µl. RESULTS: The mean CD4 cell counts of participants in the study (low CD4) group was 127.9 ± 47.49 cells/ml while that of the control (high CD4) group was 489.2 ± 186.36 cells/ml (p < 0.001). The prevalence of SIL was 10.2% (18/176) for the low CD4 group, and 5.7% (10/176) for the high CD4 group [OR = 1.9 (95% CI: 0.85, 4.22)]. The commonest category of SILs identified was Low-grade Squamous Intraepithelial Lesion (LSIL), thus 11 (6.3%) in the study versus 7 (4.0%) in the control group (p = 0.703). CONCLUSION: Prevalence of cervical SILs among HIV positive women on HAART in Enugu, Nigeria is low and has no significant relationship with their CD4 cell count.

Prevalence and predictors of urinary/anal incontinence after vaginal delivery: prospective study of Nigerian women.

INTRODUCTION AND HYPOTHESIS: Urinary and anal incontinence are major public health problems impacting on the quality of life of affected women, with resultant loss of self-esteem. Despite the anticipated magnitude of this public health problem in sub-Saharan Africa, there is paucity of data on the prevalence of urinary and/or anal incontinence after childbirth in the region. This study determined the prevalence and predictors of urinary and anal incontinence after vaginal delivery among women in Enugu, southeastern Nigeria. METHODS: This was a longitudinal study of 230 consecutive parturients at the University of Nigeria Teaching Hospital, Enugu, Nigeria. Eligible women were followed up immediately, 6 weeks, and 3 months postpartum to assess the development of urinary and/or anal incontinence using validated questionnaires. RESULTS: Overall, 28 women had urinary incontinence, giving a cumulative prevalence rate of 12.2 %. The cumulative prevalence rate was 13.5 % for anal incontinence and 3 % for combined urinary and anal incontinence. Age, social class, parity, prolonged second stage of labor, and neonatal birth weight were significantly associated with postpartum urinary incontinence (P < 0.05). On the other hand, age, parity, prolonged second stage of labor, episiotomy, and instrumental vaginal delivery were significantly associated with postpartum anal incontinence (P < 0.05). CONCLUSION: Urinary and anal incontinence are common after vaginal delivery in Enugu, Nigeria. Modification of obstetric care and discouraging preventable predisposing factors for incontinence, such as prolonged second stage of labor and vaginal delivery of macrosomic babies, are measures that may reduce the prevalence of postpartum incontinence in our population.

Effect of early amniotomy on the outcome of spontaneous labour: a randomized controlled trial of pregnant women in Enugu, South-east Nigeria.

BACKGROUND: Early amniotomy is common in obstetric practice but, its effectiveness has not been proven. OBJECTIVES: To determine the effects of early amniotomy on the duration of labour, and other maternal / neonatal outcomes of uncomplicated pregnancies in Enugu, South-east Nigeria. METHODS: A randomized controlled study of 214 consenting term pregnant women at the University of Nigeria Teaching Hospital Enugu, Nigeria. Intervention group received amniotomy early in active labour while the control group had their membranes conserved. RESULTS: Mean duration of labour for the amniotomy group (279.4 ± 53.7 minutes) was significantly lower than that of control group (354.4 ± 67.5 minutes), (t = -8.988, p <0.001). Three (3.8%) women in amniotomy group needed oxytocin augmentation as against 21 (19.6%) women in the control group RR = 0.14, (CI 95%: 0.04 - 0.46), NNT = 16. The two groups did not vary with respect to cesarean section rate, newborn Apgar scores, and need for new born special care unit admission. CONCLUSION: Early amniotomy when compared to fetal membrane conservation reduced the duration of labour and need for oxytocin augmentation among term singleton pregnant women in Enugu, Nigeria. Its routine use in well selected cases may reduce prolonged labour and its complications.