Cluster of differentiation 4+ cell count mean value, reference range and its influencing factors in Human Immunodeficiency Virus-seronegative pregnant women in Lagos.

BACKGROUND: Immunity in pregnancy is physiologically compromised and this may affect cluster of differentiation four (CD4) count levels. It is well established that several factors affect CD4 count level in pregnancy. This study aims to determine the effects of maternal age, gestational age, parity and level of education as they influence CD4 count in pregnancy and also to determine the mean and reference range of CD4 count in pregnancy in Lagos, Nigeria. MATERIALS AND METHODS: A descriptive cross-sectional study was carried out at Ante-natal clinics in Lagos State, Nigeria. About 5 mls of blood was collected into Ethylene Diamine Tetracetic Acid (EDTA) bottles from HIV-negative pregnant women in various gestational ages of pregnancy. CD4+ cell count and full blood count of all samples were done within 3 hours of collection. The descriptive data was given as means ± standard deviation (SD). Pearson's chi-squared test and correlation were used for analytical assessment. RESULTS: A total of 74 pregnant women were recruited. The age range was 19-41 years and a mean age of 30.42 ± 5.34 years. The CD4+ cell count was not statistically significant when compared with participants ages P = 0.417, neither with gestational ages P = 0.323, nor with parity P = 0.247 nor level of education P = 0.96. An overall mean CD4+ cell count was 771.96 ± 250 cells/µl and the range was 193-1370 cells/µl. CONCLUSION: Maternal age, gestational age, parity and level of education had no significant effects on CD4+ cell count levels in pregnancy. The mean CD4+ cell count of HIV-negative pregnant women in Lagos is 771.96 ± 250 cells/µl.

Decision-Delivery Interval and Perinatal Outcome in Emergency Caesarean Section:A University Teaching Hospital Experience.

BACKGROUND: The recommended time for decision-delivery-interval (DDI) in emergency caesarean section is 30 minutes, though this is rarely achieved in practice. Good perinatal outcome has been achieved with DDI up to 240 minutes. OBJECTIVES: To evaluate the average time it took to deliver the baby by emergency caesarean section after the decision had been taken and determine the effect on perinatal outcomes when this time exceeded 240 minutes. MATERIALS AND METHODS: This prospective observational study was undertaken in Lagos State University Teaching Hospital between January and May 2009. Data was collected from the case notes of the mothers and the neonates admitted to Special care baby unit(SBCU) using a proforma. The main outcome measures were DDI, 5-minute Apgar score, newborn admission to special care baby unit(SCBU) and perinatal outcome.Odds ratio (OR) with 95% Confidence interval (CI) for factors affecting DDI and perianatal outcomes in different DDI categories were calculated by logistic regression and multivariate analysis with p<0.05 considered statistically significant. All data were analyzed with SPSS17.0 statistical software. RESULTS: A total of 359 emergency caesarean sections were performed within the study period. None was done within the recommended 30-minute period. The average DDI was 401 + 315 min, with a range of 45-1393 min.Univariate analysis of factors affecting DDl showed that DDI >240 minutes was significantly more likely in urgent as opposed to crash surgery (OR 4.52[95% CI: 2.78-7.35]), in spinal as opposed to general anaesthesia(OR 2.16[95% CI: 1.40-3.30]) and in junior as opposed to senior surgeon (OR 2.52[95% CI: 1.64-3.89]). Concerning foetal out-comes, DDI> 240 minutes was associated with significantly higher incidence of low Apgar scores at 5-minutes(OR 2.09 [95%CI: 1.33-3.29]) and admission to SCBU(OR 1.66[95% CI: 1.07-2.57]) but did not significantly affect perinatal deaths(OR 1.01[ 95%CI: 0.51.2.01]). Multiple logistic regression analysis showed that DDI >240 minutes was significantly influenced by degree of urgency of the surgery (a OR 3.76[95%CI: 2.17-6.53], p=0.005) and rank of surgeon(aOR 0.55[95%CI: 0.48-1.34],p=0.017) but not by type of anaesthesia(a OR 0.80[95% CI: 0.48-1.34],p=0.397). Multiple logistic regression analysis of perinatal outcomes showed that DDI>240 minutes was significantly associated with 5-minute Apgar score (aOR 0.29[95%CI: 0.11-0.79],p=0.015) and admission into SCBU(aOR 2.59[95%CI: 1.01-6.63],p=0.048) but not with perinatal deaths (aOR 1.54[95%CI: 0.66-3.80],p=0.302). CONCLUSION: The average DDI in this study was 401 + 315mins. Whilst perinatal deaths were not significantly affected when the time exceeded 240 minutes, 5-minute Apgar scores and SCBU admissions were significantly higher. The 30-minute recommendation may remain the target if these outcomes are to be improved.

Delays in presentation and management of ovarian cancer in Lagos, Nigeria.

This study highlights the extent of delays in the presentation and management of ovarian cancer at the Lagos State University Teaching Hospital. A total of 37 histologically confirmed epithelial ovarian cancer cases managed from January 2004 to December 2008 were analysed. The time interval between onset of symptoms and seeking healthcare, was 36.1 ± 40.8 weeks; between seeking healthcare and referral to tertiary hospital, was 22.7 ± 30.4 weeks; and the overall time interval from onset of symptoms to presentation for definitive care, was 52.0 ± 51.8 weeks. Private hospitals (35.1%) and herbal homes (21.6%) were the commonest facilities first visited. A total of 32 (86.5%) of the patients presented in stages III and IV. The overall compliance rate for recommended chemotherapy was 11.1%. Ovarian cancer in Lagos, Nigeria is characterised by patient-related delays in presentation, provider-related delays in referrals and poor compliance with recommended chemotherapy.

Orofacial injuries associated with eclampsia in patients presenting at a Nigerian Tertiary Hospital.

A prospective study was conducted to determine the incidence and pattern of orofacial injuries among eclamptic patients at the Lagos State University Teaching Hospital between December 2008 and November 2009. The incidence of orofacial injuries was 42%. Most injuries were due to bite and forceful insertion of hard objects into the patient's mouth by relatives during convulsive episodes. The type of antenatal care received had an influence on the incidence of orofacial injuries and there was a correlation between the number of convulsions and orofacial injuries. The mortality rate from eclampsia was 20.6%, and presence of orofacial injuries was a risk factor for mortality. Obstetricians and other healthcare providers should be familiar with the ways of preventing these injuries and seek early maxillofacial consultation when they occur. There is need for community education on the dangers of forceful insertion of hard objects into the mouth of eclamptics during fits.

Comparison of maternal and neonatal outcomes following caesarean section in second versus first stage of labour in a Tertiary Hospital in Nigeria.

AIMS AND OBJECTIVES: To compare maternal and neonatal outcomes between caesarean section performed in the first and second stages of labour at the maternity unit of the Lagos State University Teaching Hospital, Lagos, Nigeria. MATERIALS AND METHODS: Patients hospital records from 1st January 2008 to 31st December 2009 were examined. Data were extracted using a structured proforma. Information on demographics, intrapartum and intraoperative characteristics as well as selected maternal and neonatal outcomes were obtained. Comparative analysis was done using the student t test for continuous variables and the chi- square with Yates correction or the Fisher exact test for categorical variables. RESULTS: Of the 347 caesarean deliveries available for analysis, 245 (70.6%) were performed in the first stage while 102 (29.4%) were performed in the second stage of labour. Women who had caesarean deliveries performed in the second stage were more likely to be referred rather than institutional patients (p< 0.001), to have longer operative time, higher blood loss, more cases of intraoperative trauma, primary post partum haemorrhage, blood transfusion, re-look laparotomy, hysterectomy, post op pyrexia, wound infection and longer hospital stay (all with p value <0.05). Infants born to women who had caesarean section in the second stage of labour, had higher incidence of birth asphyxia, admission to neonatal intensive care unit, sepsis, seizure, need for ventilation and neonatal death (all with p value <0.05). CONCLUSION: Caesarean section in the second stage of labour is associated with significantly increased maternal and neonatal morbidity as well as increased neonatal mortality.

The need to incorporate routine cervical cancer counselling and screening in the management of HIV positive women in Nigeria.

OBJECTIVE: The study aimed to assess the awareness and utilization of the Pap smear among HIV positive women in Lagos, Nigeria. MATERIALS AND METHODS: A descriptive cross sectional survey of women attending the anti-retroviral clinic of the Lagos State University Teaching Hospital, Ikeja, Lagos State, Nigeria was carried out between 1st September and 30th November 2009 using a pre-tested questionnaire. Data were analysed using the Epi-info 3.5 statistical software of the Centre for Disease Control and Prevention, Atlanta USA. RESULTS: None of the 300 respondents reported having received any form of counselling about cervical cancer and screening during the post HIV test counseling. Seventy six (25.3%) of them had heard of cervical cancer; Forty eight (16%) were aware of the Pap smear and only 15 (31.3%) of these (5% of the total number of respondents) have ever done the test before. The majority (69.7%) of those who had not been screened despite knowledge of the Pap smear, gave non- recommendation by their doctor as the main reason for not doing the test. CONCLUSION: Cervical cancer counseling and screening is not part of the routine management of HIV positive women in Lagos, Nigeria. There is need to address this deficiency with appropriate guidelines.

Seroprevalence of Toxoplasma gondii antibodies amongst pregnant women at the Lagos State University Teaching Hospital, Nigeria.

BACKGROUND: Toxoplasma gondii (T.gondii), an obligate intracellular parasite found in many species throughout the world, causes a variety of clinical syndromes in humans and animals. It is also associated with morbidity and mortality in pregnancy. Hence the need to determine the seroprevalence of antibody to toxoplasmosis gondii amongst pregnant women. SUBJECTS AND METHODS: A cross- sectional study was carried out using patients attending the ante-natal clinic of Lagos State University Teaching Hospital Ikeja. All consenting newly registered ante-natal patients were recruited consecutively into the study within a time frame of six weeks during which a total of 179 pregnant participants were recruited. Literate participants filled self administered questionnaires whilst the non-literate participants were interviewed by research assistants. Five milliliters of blood was collected from each participant after obtaining patient's consent. Sera were assayed for antitoxoplasmosis IgG antibody by enzyme linked immunosorbent assay. (ELISA.) RESULTS: A total of 179 pregnant women were studied. Almost 50.8% were between the ages of 25-30 years, 70.8% of the patients studied, had tertiary education. An assessment of the patients' status to anti-toxoplasmosis IgG showed 40.8% were positive while 59.2% were negative. Pet-keeping was a practice amongst only 6.1% of patients whilst 90.5% did not keep pets. Out of those who kept pets, 63.6% were positive while 39.5% were negative. Amongst those who did not keep pets, 39.5% were positive while 60.5% were negative. This difference was not statistically significant. (P=0.261) CONCLUSION: It appears that seroprevalence of toxoplasmosis IgG antibody amongst the pregnant women in this study population is high. Therefore, it is valuable to follow up the IgMantibody status of their off springs as its presence indicates recent exposure.

Emergency peripartum hysterectomy in a tertiary hospital in Lagos, Nigeria: a five-year review.

This was a retrospective descriptive study of all the patients who underwent emergency peripartum hysterectomy from January 1st 2003 to December 31st 2007 at the Lagos State University Teaching Hospital. Of the 15,067 deliveries during the study period, 57 patients had emergency peripartum hysterectomy (3.78/1000 deliveries). 19.3% of these patients were booked for antenatal care in the hospital, while 80.7% were unbooked. The mean age of patients was 32.7 years (SD = 5.5) and the mean parity was 3.08 (SD = 1.9). The major indications for emergency peripartum hysterectomy were ruptured uterus (77.2%), uterine atony (10.5%), abruptio placentae (3.5%) and sepsis (3.5%). Subtotal hysterectomy was performed in 96.5% of the cases. The maternal mortality was 19.3% and the perinatal mortality was 75.4%. The incidence of emergency peripartum hysterectomy in this study is high and the major indication is ruptured uterus. It is associated with high maternal and perinatal morbidity and mortality.

Unsafe abortion in lagos, Nigeria: a continuing tragedy.

OBJECTIVES: To assess the incidence, pattern of presentation and management of complications resulting from unsafe abortion as well as the associated demographic variables at the Lagos Island Maternity Hospital. PATIENTS AND METHODS: A cross sectional survey of all cases with complicated induced abortion was carried out between 1st August 2005 and 31st January 2007. RESULTS: The majority of the patients were young 21.7% were teenagers between 14 and 19 years while 32.6% were in the 20-24 year age group. The majority (64.0%) were single while 30.9% were married, 1.7% were divorced, while 3.4% were separated. Teenagers and single women were more likely to obtain their abortion late (above 12 weeks gestation). 81.2% of the patients knew about modern methods of contraception but only 34.5% had ever used contraception and only 8.6% were using contraception when they became pregnant. Medical doctors were the abortionists in 46.9% of the cases, followed by nurses (17.7%) and traditional practitioners. Retained products of conception was the commonest complication (77.1%) followed by anaemia (48.6%) and sepsis (44.6%). Evacuation of the uterus was the commonest surgical procedure done. There were 16 maternal deaths giving a case fatality rate of 9.14%. Sepsis was the commonest cause of death. CONCLUSION: Unsafe abortion remains a serious concern to the health of women. Efforts need to be maximised at preventing unwanted pregnancy by making contraceptive services easily accessible to women. Effective post abortion care services need to be put in place.

Malaria in the first 6 months of life in urban African infants with anemia.

A total of 446 infants in the first 6 months of life who presented at an urban children's hospital with complaints of any illness whatsoever were recruited into a study with the aim of determining the contribution of malaria to infant morbidity in a malaria-endemic urban area in Nigeria. Sixty-eight of the infants were in their first month of life and 79, 77, 61, 97, and 64 were in their second, third, fourth, fifth and sixth month of life, respectively. Overall, 107 (24.0%) infants were clinically diagnosed as having malaria. This included 3 who were in the first month of life, 12 in the second, 15 in the third, 17 in the fourth, 33 in the fifth, and 27 in the sixth months of life (4.4, 15.2, 19.5, 27.9, 34.0, and 42.1%, respectively). Laboratory investigations confirmed 35 (32.7%) of those clinically diagnosed and 86 (25.4%) of those not clinically diagnosed (n = 339) as having malaria parasitemia, giving an overall malaria parasite rate of 27.1% among the infants. Acute respiratory infection was the major diagnosis (41.3%) among those that were not initially diagnosed as malaria but turned out to have malaria parasitemia followed by gastroenteritis (11.8%) and failure to growth (1.5%). Overall geometric mean parasite density was 202.5 parasites/microL of blood (range, 12-65,317 parasites/microL of blood). The mean hematocrit of infants with parasites (33.0%) was significantly lower (P < 0.005) than that of infants without parasites (35.1%). The mean hematocrit of infants with malaria parasites in each age group was lower than that of infants without malaria parasites in the corresponding age group. Among the infants with malaria parasites, those aged 2 to 2.9 months recorded the lowest mean hematocrit (30.1%), and those aged < 1 month recorded the highest mean hematocrit (42.7%). Axillary temperature increased and hematocrit decreased with increase in parasite density. The percentage of infants with anemia likewise increased as the parasite density increased. Plasmodium falciparum was present in all infected infants, but mixed infection with P. malariae was present in only 2.5% of infections. Analysis of our data suggests an urgent need for health education of caretakers and for training of clinicians for increased awareness of malaria as an important cause of illness and anemia in infants aged < 6 months so as to reduce children's wasting due to an easily preventable and treatable disease.