Evaluation of anxiety and depression among pregnant women in Enugu, Nigeria.

Background: Maternal depression and anxiety during pregnancy are public health concerns. They are commonly reported among pregnant women from all over the world. Maternal mental health has not been prioritized, especially in low- and middle-income countries. Aim: To evaluate depression and anxiety among pregnant women who receive antenatal care in four randomly selected hospitals in Enugu, Nigeria. Materials and Methods: A multicenter questionnaire-based cross-sectional survey of 434 pregnant women was conducted at four selected health institutions offering antenatal services in Enugu, Enugu State. The prevalence of anxiety and depression was assessed using the hospital anxiety and depression scale (HADS). Factors associated with anxiety and depression were determined using logistic regression. P <0.05 was taken as significant. Results: The mean age of study participants was 30.09 ± 5.12 years. The proportion of participants with depressive symptoms and borderline depressive symptoms was 9.7% and 11.1%, respectively. The proportion of participants with anxiety symptoms and borderline anxiety symptoms was 10.1% and 15.7%, respectively. Husband's employment status (P = 0.033, odds ratios (OR) =0.354, 95% confidence intervals (CI) =0.137-0.918) and gestational age (P = 0.042, OR = 2.066, 95% CI = 1.028-4.151) were the only factors associated with depressive symptoms, while only educational level (P = 0.001, OR = 3.552, 95% CI = 1.674-7.537) and husband's employment status (P = 0.013, OR = 0.295, 95% CI = 0.113-0.772) were the only factors associated with anxiety symptoms. Conclusions: Anxiety and depressive symptoms are relatively common in antenatal women in Enugu. The factors associated with depressive and anxiety symptoms were the respondent's educational level, gestational age, and the employment status of the husband.

Presence of chaperones during pelvic examinations in southeast Nigeria: women's opinions, attitude, and preferences.

OBJECTIVES: To assess the opinions, attitude, and preferences of Nigerian women to the presence of chaperones during pelvic examinations. MATERIALS AND METHODS: A cross-sectional survey of first time gynecology clinic attendees on their opinions, attitudes, and preferences with respect to the presence of chaperones during their pelvic examinations. The interview was conducted with the aid of semi-structured, researcher-administered questionnaires. RESULTS: One hundred and nineteen (51.7%) of the respondents preferred female physicians for pelvic examination, 23 (10%) preferred male physicians and 88 (38.3%) had no gender preference. When the examining physician is a male, 124 (53.9%) respondents would like to have chaperones during pelvic examinations while 106 (46.1%) would not. Eighty-three percent of respondents preferred nurse chaperones. Age, level of education, and parity did not have any significant relationship with the attitude of the respondents toward the presence of chaperones ( P = 0.503, 0.525, and 0.605 respectively). CONCLUSIONS: We conclude that most southeastern Nigerian women would prefer their pelvic examinations to be done by a female physician or to be attended by a nurse chaperone if the examining physician is a male. We recommend a routine offer of chaperones during such examinations while respecting the patients' right to refuse the offer.

Presence of Chaperones during Pelvic Examinations in Southeast Nigeria: Women's Opinions; Attitude; and Preferences

Objectives: To assess the opinions; attitude; and preferences of Nigerian women to the presence of chaperones during pelvic examinations.Materials and Methods: A cross-sectional survey of first time gynecology clinic attendees on their opinions; attitudes; and preferences with respect to the presence of chaperones during their pelvic examinations. The interview was conducted with the aid of semi-structured; researcher-administered questionnaires.Results: One hundred and nineteen (51.7) of the respondents preferred female physicians for pelvic examination; 23 (10) preferred male physicians and 88 (38.3) had no gender preference. When the examining physician is a male; 124 (53.9) respondents would like to have chaperones during pelvic examinations while 106 (46.1) would not. Eighty-three percent of respondents preferred nurse chaperones. Age; level of education; and parity did not have any significant relationship with the attitude of the respondents toward the presence of chaperones (P = 0.503; 0.525; and 0.605 respectively).Conclusions: We conclude that most southeastern Nigerian women would prefer their pelvic examinations to be done by a female physician or to be attended by a nurse chaperone if the examining physician is a male. We recommend a routine offer of chaperones during such examinations while respecting the patients' right to refuse the offer

Low-dose lisinopril in normotensive men with idiopathic oligospermia and infertility: a 5-year randomized, controlled, crossover pilot study.

The outcomes of drug treatment for male infertility remain conjectural, with controversial study results. Our pilot study employed a randomized, placebo-controlled, crossover methodology with intention-to-treat analysis. Thirty-three men with idiopathic oligospermia were randomized to start either daily oral lisinopril 2.5 mg (n = 17) or daily oral placebo (n = 16). Lisinopril was found to cause a normalization of seminal parameters in 53.6% of the participants. Although the mean ejaculate volume was unchanged (P ≥ 0.093), the total sperm cell count and the percentage of motile sperm cells increased (P ≤ 0.03 and P < 0.001, respectively), whereas the percentage of sperm cells with abnormal morphology decreased (P ≤ 0.04). The pregnancy rate was 48.5%, and there was no serious adverse drug event. It is concluded, albeit cautiously, that prolonged treatment with 2.5 mg/day of oral lisinopril may be well tolerated in normotensive men with idiopathic oligospermia, may improve sperm quantity and quality, and may enhance fertility in approximately half of those treated.

Placenta percreta in a booked multiparous woman with minimal risk factors and challenges of management in a low resource setting.

Retained placenta membranes and tissue are responsible for 5% to 10% of postpartum hemorrhage. Placenta accreta occurs in approximately 1 in 2500 pregnancies of which placenta percreta constitutes about 5% of placenta accreta. This portends the rarity of placenta percreta especially in a 32 year old woman with minimal risk factors. Our patient was a G4P3(+0) woman with 2 living male children who presented at 39 weeks plus 2 days gestation in latent phase of labour and transverse lie. She had emergency caesarean hysterectomy due to primary postpartum haemorrhage secondary to placenta percreta. There should be a high index of suspicion of placenta percreta in women with the risk factors and whoever does caesarean section should have the skills for hysterectomy in case of any encounter with placenta percreta not amenable to conservative management.

Prevention of Mother to Child Transmission of Human Immunodeficiency Virus: The Nigerian Perspective

Despite the proven effectiveness of the prevention of mother to child transmission (PMTCT) of human immunodeficiency virus (HIV) program; Nigeria currently has the highest burden of vertical transmission of HIV in the world due to poor coverage of the PMTCT program partly as a result of poor knowledge of PMTCT interventions amongst healthcare providers in the country. This paper aims at making information on PMTCT interventions more readily available to healthcare providers in developing countries. The internet was searched using Google and Google scholar. In addition; relevant electronic journals from the Universities library including PubMed and Scirus; Medline; Cochrane library; and World Health Organization (WHO)'s Hinari were used. There was paucity of published work on PMCT from Nigeria. Most of the information concerning PMCT in Nigeria was obtained from technical reports from the Federal Ministry of Health and WHO. It is expected that this article will help in improving healthcare providers' knowledge of PMTCT interventions and thus help in the urgently needed rapid scale-up of PMTCT services in Nigeria

Voluntary counselling and testing (VCT) uptake, nevirapine use and infant feeding options at the University of Nigeria Teaching Hospital.

This study assessed voluntary counselling and testing (VCT) uptake, nevirapine use and infant feeding options among the pregnant women seen in a tertiary care centre in Enugu, South-east Nigeria, with the aim of identifying gaps (if any) in the prevention of mother-to-child transmission (PMTCT) implementation in the hospital. It was a prospective study of all antenatal clinic attendees and those who delivered at the University of Nigeria Teaching Hospital, Enugu, within a 7-month period (1 March to 30 September 2005). During the 7-month period, 635 pregnant women accessed the PMTCT services in the hospital. With respect to VCT, 25 (3.9%) of the antenatal clinic attendees had only group counselling, while 610 (96.1%) others had both group and individual pre-test counselling. A total of 87 (13.7%) of the 635 women tested were HIV positive. Some 426 (67.1%) women had post-test counselling carried out. Twenty (23.0%) of the 87 HIV-positive women had their infection diagnosed prior to the current pregnancy, while 67 (77.0%) had the disease diagnosed during the index pregnancy. Eight (9.2%) of them had previously had anti-retroviral therapy with nevirapine. Twelve (13.8%) of the women were on antiretroviral therapy in the index pregnancy - two on highly active antiretroviral therapy (HAART) and 10 on nevirapine. A total of 41 (47.1%) of the 87 HIV-positive women had delivered as at 30 September 2005. Ten of them had antiretrovirals administered to them during the antenatal period. The remaining 31 had antiretrovirals administered to them on arrival at the labour ward for delivery. Of the 41 women who delivered, 39 had intra-partum nevirapine, while the 2 women on HAART took their usual daily dosage. Regarding mode of delivery, one-third of the women had a caesarean section and two-thirds had vaginal delivery. Ten (24.4%) of the 41 women had episiotomy, while seven of the remaining 31 women who did not receive episiotomy sustained varying degrees of perineal tear. There was no maternal death. All the 41 live born babies received nevirapine syrup at birth. A total of 86 (98.9%) out of the 87 HIV-positive women had infant feeding counselling. All chose exclusive breast-milk substitutes for their babies. There was one twin delivery, giving a total of 42 babies delivered. One of the babies was a stillbirth. The rest survived the neonatal period. It was concluded that the VCT uptake at the University of Nigeria Teaching Hospital, Enugu, is high. The majority of the women and their babies received peripartum nevirapine and at delivery all the women chose to do exclusive formula-feeding. The main gaps identified by the study were that most of the women delivered vaginally and there were delays in obtaining HIV test results. It remains to be seen how these variables will affect the vertical transmission rate.

Correlation between intrapartum fundal height and birth weight.

In a prospective cross-sectional study, the correlation between symphysiofundal height (SFH) and birth weight was evaluated in 2646 consecutive parturients at the University of Nigeria Teaching Hospital, Enugu, over a 19-month period. The standard deviations of the observed birth weight were least when the SFH measured 33-39 cm, which corresponded to the birth weight range 2500-3999 g. The overall standard deviation was 275 g. A second order polynomial fitted the data best, giving the equation y +/- 258.1-62.9x -3.8x2, where y represents the observed birth weight in grams and x the SFH in centimetres. The R2 statistic for the model was 0.82. This and other assessment showed a good model fit. The birth weight centiles for the various SFH measurements were derived and their usefulness discussed. It was concluded that the SFH-derived birth weight centiles are useful alternatives to ultrasonography especially in the birth weight range 2500-3999 g.