Prevalence and risk factors for anaemia among pregnant women attending antenatal clinic at Benue State University Teaching Hospital, North-central Nigeria.

In developing countries such as Nigeria, anaemia in pregnancy is thought to be one of the most common complications of pregnancy accounting for a significant level of maternal morbidity and mortality. The aim of this study was to determine the prevalence of anaemia in pregnancy among women attending the booking Antenatal Clinic (ANC) in Benue State University Teaching Hospital (BSUTH), North-Central, Nigeria. A cross-sectional descriptive study was conducted from May 2019 to January, 2020 on 299 women. A structured interviewer administered questionnaire was used to obtain socio-demographic, clinical, and nutritional information from pregnant women attending the clinic who consented to participate in the study. Haematocrit levels were stratified according to the World Health Organisation's (WHO) classification as follows: <7mg/dL - severe, 7-8.99mg/dL - moderate, 9-10.99mg/dL - mild anaemia and ≧ 11mg/dL - non-anaemic. Data were analysed using SPSS version 25.0. Chi-square test was conducted to determine relationships. Multivariate logistic regression model was used to identify the risk factors for anaemia among pregnant women. P-value <0.05 and odds ratio with a 95% confidence interval were used to assess the association. The mean age of respondents was 29.9, ranging from 18 - 40 years. One hundred and twenty-three (41.1%) women were anaemic (haemoglobin [Hb] < 11.0 g/dL). The majority (95.1%) of these anaemic patients were mildly anaemic, whereas 4.9% were moderately anaemic. There was no case of severe anaemia (Hb < 7.0 g/dL). The prevalence of anaemia was significantly higher in those within the age group of 20-24 years and those with lower levels of education (P < 0.05). The patient's gestational age, number of miscarriages and birth interval had no significant relationship with the haemoglobin concentration among the pregnant women in this study (P > 0.05). However, parity, clinical features such as fever, and practices like use of haematinics and non-consumption of meat, poultry and fish were significantly related to anaemia (P < 0.05). The pregnant women who did not take haematinics were 5.8 times likely to develop anaemia (OR=5.8, 95%CI [2.3, 14.5]) while pregnant women who did not eat meat, poultry or fish were 9 times more likely to become anaemic than pregnant women who ate (OR=9.0, 95%CI [1.0, 79.5]). The prevalence of anaemia in pregnancy is high among women attending booking antenatal clinic at BSUTH, North-Central, Nigeria, and requires specific intervention that address the identified risk factors.

Awareness and perception of human papilloma virus vaccine among healthcare professionals in Nigeria.

Human papilloma virus (HPV) is a necessary cause of cervical cancer and cervical cancer is largely a vaccine-preventable disease. The aim of the study was to document the knowledge of healthcare professionals of the HPV vaccine and its acceptability. It was a cross-sectional study in three of the six geo-political zones of Nigeria, carried out between June 2010 and January 2011. The 602 adult Nigerian respondents were made up of 147 (24.4%) males and 455 (75.6%) females aged 20-57 years, with a mean of 34.3 ± 7.9 years; most were under 40 years (70.1%) and married (n = 394; 65.5%). In total, 548 (91%) were aware of HPV; 83.4% knew HPV as an STI; 78.2% knew HPV can cause cervical cancer but only 265 (44.0%) were aware of the HPV vaccine. Among the healthcare professionals studied, nurses were the least aware of the existence of the HPV vaccine (χ(2) = 1.54, p = 0.001). A total of 489 (81.0%) would approve HPV vaccine for their teenage daughters. The men were more likely to accept the vaccination of their daughters than the women (χ(2) = 14.76, p = 0.002). The unmarried were more favourably disposed to vaccination of teenagers than the married (χ(2) = 27.37, p = 0.001). Safety concerns were the commonest reasons expressed by the 7% who were reluctant to accept the vaccination of their teenage daughters. In conclusion, healthcare providers are the custodians of health in a community, yet have low knowledge of a vaccine that can prevent the commonest cancer in women in sub-Saharan Africa.

Female sterilization by tubal ligation at caesarean section in Makurdi, Nigeria.

BACKGROUND: Female sterilization is an important tool in reducing unplanned pregnancy and maternal mortality in our environment. The aim of this study was to determine the incidence, sociodemographic characteristics, technique, effectiveness and complications associated with female sterilization by bilateral tubal ligation at caesarean section. METHOD: This was a retrospective analysis of the clinical records of 78 clients who had female sterilization out of 1,346 acceptors of contraceptive methods at the Federal Medical Centre, Makurdi, over a 5-year period between November 2002 and October 2007. RESULTS: Of the 1,346 acceptors of family planning methods, 78 clients had bilateral tubal ligation. The majority of the clients (37 [47.4%]) had sterilization at caesarean section, representing 2.7% of all acceptors of family planning methods. The mean age and parity of the clients were 34.3 years and 5.5, respectively. The majority of the clients (36 [97.3%]) had sterilization using the modified Pomeroy's technique. Contraceptive effectiveness was 100%. No complication specific to tubal ligation was noticed. CONCLUSION: Majority of female sterilization were performed at caesarean section. The procedure was found to be safe and effective.

HIV prevalence amongst clients attending antenatal clinic at the Federal Medical Centre, Makurdi.

BACKGROUND: Evidence from the 2005 National HIV Seroprevalence Sentinel Survey showed that Benue state has the highest seroprevalence rate of HIV infection in the country. Seroprevalence rate amongst antenatal women is a reflection of what is happening in the larger society. Knowledge of seroprevalence rate amongst pregnant women would help in targeting intervention strategies for prevention of mother to child transmission (PMTCT) of HIV. OBJECTIVE: The objective of the study is to determine the seroprevalence rate of HIV infection amongst clients attending antenatal clinic at the Federal Medical Centre Makurdi. METHODS: Cross-sectional study of 262 randomly selected women that booked for antenatal care at the Federal Medical Centre Makurdi between 1st January 2007 to 30th April, 2007 was carried out. Information regarding age, parity, gestational age at booking, educational status and HIV sero-status of the clients were looked into. RESULTS: A total of 50 women out of the 262 women studied were positive, giving a seroprevalence rate of 19.1%. The highest seroprevalence rate was amongst 25-29 years age group (40.8%). Women of parity 1-4 constituted the highest group (53.4%). Majority of them (45.5%) had secondary school education while 60 (22.9%) had tertiary education. One hundred and ten (42%) booked in the 3rd trimester while only 34 (13%) booked in the 1st trimester. CONCLUSION: HIV seroprevalence is high amongst antenatal women in Makurdi and intervention strategies should be scaled up for prevention of vertical transmission of the virus.

HIV prevalence amongst clients attending antenatal clinic at the Federal Medical Centre, Makurdi

Background: Evidence from the 2005 National HIV Seroprevalence Sentinel Survey showed that Benue state has the highest seroprevalence rate of HIV infection in the country. Seroprevalence rate amongst antenatal women is a reflection of what is happening in the larger society. Knowledge of seroprevalence rate amongst pregnant women would help in targeting intervention strategies for prevention of mother to child transmission (PMTCT) of HIV. Methods:The objective of the study is to determine the seroprevalence rate of HIV infection amongst clients attending antenatal clinic at the Federal Medical Centre Makurdi. Methods:Cross-sectional study of 262 randomly selected women that booked for antenatal care at the Federal Medical Centre Makurdi between 1 January 2007 to 30 April; 2007 was carried out. Information regarding age; parity; gestational age at booking; educational status and HIV sero-status of the clients were looked into. Results:A total of 50 women out of the 262 women studied were positive; giving a seroprevalence rate of 19.1. The highest seroprevalence rate was amongst 25-29 years age group (40.8). Women of parity 1-4 constituted the highest group (53.4). Majority of them (45.5) had secondary school education while 60 (22.9) had tertiary education. One hundred and ten (42) booked in the 3 trimester while only 34 (13) booked in the 1 trimester. Conclusion:HIV seroprevalence is high amongst antenatal women in Makurdi and intervention strategies should be scaled up for prevention of vertical transmission of the virus

Reversible blindness in fulminating preeclampsia.

Severe preeclampsia and eclampsia are major causes of maternal and perinatal morbidity and mortality in many parts of the world. One of the uncommon effects of severe preeclampsia on the eye is sudden loss of vision. This blindness can be due to involvement of the occipital cortex or the retina. Although very alarming, this type of blindness is usually reversible following appropriate management of such patients. Here we present the case of a woman in whom fulminating preeclampsia was complicated by blindness. Fundoscopic findings were bilateral papillo edema and macular edema. She responded well to therapy, which included antihypertensives, seizure prophylaxis and operative delivery. Vision was restored by the third day.

Relative birth weights in twins.

BACKGROUND: To determine if the first twin (Twin I) weighs more than the second twin (Twin II). METHODS: One hundred and seventeen sets of twins delivered at the Federal Medical Centre Makurdi, Nigeria over a three year period between 1st January, 2005 and 31st December2007 were reviewed. RESULTS: Of the 117 sets of twins in the study, 9 (7.7%) were of equal weights while in 57 (48.7%) sets Twin I were heavier than Twin II. In 51 (43.6%) sets Twin II were heavier than Twin I. The mean birth weight of Twin I was 2.460 +/- 0.436 Kg while that of Twin II was 2.390 +/- 0.451 Kg, (P< 0.05). CONCLUSION: Twin I was often heavier than twin II. The difference in the mean birth weight of twin I and Twin II was statistically significant in favour of Twin I.

Clinical rabies in pregnancy with delivery of a live fetus: a case report.

We report a rare case of a 22 year old G2P1+0 at 35 weeks gestation in whom clinical rabies developed seven weeks after a bite from a rabid dog. Treatment was palliative with emergency caesarean delivery of a live male baby. She died 8 hours after delivery. The baby was not given the rabies vaccine and was well until he was lost to follow up 5 months later.

Forgotten intrauterine contraceptive device: a rare cause of infertility.

Worldwide, Intra Uterine Devices (IUDs) are among the most commonly used reversible methods of contraception. This is particularly true in developing countries. Insertion of IUD may be interval or postpartum. The concept of early postpartum IUD insertion has been investigated since the 1960s and has become accepted worldwide, even though IUDs inserted in the immediate postpartum appear to have a higher expulsion rate. Several complications associated with IUD use have been documented, for instance, the association between IUD use and pelvic inflammatory disease or salpingitis has been demonstrated in several studies. Contamination at the time of insertion has been suggested to be responsible for this risk of infection. We report here an unusual case of early postpartum IUD insertion without the patient's knowledge or adequate counselling sixteen years prior to presentation with secondary infertility.

Emergency caesarean section in a Nigerian tertiary health centre.

BACKGROUND: Caesarean delivery is an important aspect of emergency obstetric care and a major tool in the reduction of maternal and perinatal morbidity and mortality This study was done to determine the caesarean section rate, ascertain the trend of emergency caesarean section, indications for emergency caesarean section and emergency caesarean morbidity and mortality at the Federal Medical Centre Makurdi. METHOD: A retrospective analysis of the clinical records of all patients delivered by caesarean section between January 2004 and December 2006 at the Federal Medical Centre Makurdi in north central Nigeria was conducted. RESULTS: There were 4011 deliveries with 420 caesarean sections during the review period giving a caesarean section rate of 10.5%. Emergency caesarean sections accounted for 351 (83.6%) caesarean deliveries. The rate of emergency caesarean section decreased from 89.7% in 2004 to 77.2% in 2006. The leading indication for emergency caesarean section was cephalopelvic disproportion, accounting for 138 (39.3%) cases, while antepartum haemorrhage and foetal distress followed in that order. There were 9 maternal deaths associated with emergency caesarean section giving a caesarean mortality rate ofs 2.1% CONCLUSION: Emergency caesarean sections account for 5 out of every 6 caesarean deliveries in our centre with a decreasing trend relative to elective caesarean sections. The emergency caesarean mortality is high.

Globalization and health: a critical appraisal.

BACKGROUND: Health has long been recognized as a central feature of development. Globalization tends to be understood as a process of economic integration, but it implies more. It entails openness to trade, ideas, investment, people and culture all of which impact health. METHOD: Review of relevant literature on globalization and health obtained from texts and Pubmed search. RESULTS: Globalization affects health positively and negatively simultaneously, depending on such factors as geographical location, sex, age, ethnic origin, educational level and socioeconomic status. CONCLUSION: The challenge remains how to make globalization work for health and to use health to foster better forms of globalization. The health community must brace up to the challenge of engaging in the globalization debate with a view to promoting better health for us all.

Ruptured tubal pregnancy in Makurdi, north central Nigeria.

BACKGROUND: Ruptured tubal pregnancy remains a major cause of early foetal wastage and maternal mortality in Nigeria and other developing countries. This study was done to determine the incidence, predisposing factors, clinical presentation and management options of ruptured tubal pregnancy at the Federal Medical Centre Makurdi. METHODOLOGY: A retrospective descriptive study of 35 cases of ruptured tubal pregnancy managed at the Federal Medical Centre, Makurdi, between January 2004 and December 2006 was conducted. RESULTS: The incidence of ruptured tubal pregnancy was 0.87% of total births (1 in 114 deliveries) and accounted for 94.6% of all ectopic pregnancies. There was a rising trend in the incidence of ruptured tubal pregnancy from 0.65% in 2004 to 1.09% in 2006. Identified risk factors include previous pelvic infection and previous induced abortions. Abdominal pain (100%), vaginal bleeding (65.7%), dizziness (62.9%) and amenorrhoea (57.1%) were the commonest symptoms. The ampulla was the site of rupture in 27(77.1%) patients. All patients had laparotomy. Unilateral total salpingectomy was done in 31(88.5%) patients. There was no maternal death in the cases managed. CONCLUSION: The incidence of ruptured tubal pregnancy is relatively low at the Federal Medical Centre Makurdi. Health education of women in the reproductive age on safe sex and eradication of unsafe abortion and early treatment of pelvic infections will prove useful preventive measures.

Caesarean Morbidity in a Northern Nigeria Tertiary Health Centre

Background: The popularity of caesarean section in developed countries is anchored on the increasing safety of the procedure. In Nigeria; there is a general aversion to the procedure. Regular auditing of morbidity trends following the procedure with a view to improving safety remains central to the acceptability of the procedure in our environment. The aim of this study is to determine the incidence and nature of morbidities complicating caesarean section at the Federal Medical Centre Makurdi. Method: A three-year retrospective study from January 2004 to December 2006 involving all mothers who had caesarean delivery at the Federal Medical Centre Makurdi was conducted. Results: There were 4011 deliveries during the study period of which 420 were caesarean deliveries giving a caesarean section rate of 10.5. Caesarean section related complications occurred in 87 patients giving a caesarean morbidity rate of 20.7. Seventy one (81.6) patients developed caesarean morbidity following emergency caesarean section. The commonest complications were infections (42.1); postpartum anaemia (34.3) and postpartum haemorrhage (17.9). Conclusion: Though the caesarean morbidity in our centre there is much room for improvement

Ruptured Tubal Pregnancy in Makurdi; North Central Nigeria

BACKGROUND: Ruptured tubal pregnancy remains a major cause of early foetal wastage and maternal mortality in Nigeria and other developing countries. This study was done to determine the incidence; predisposing factors; clinical presentation and management options of ruptured tubal pregnancy at the Federal Medical Centre Makurdi. METHODOLOGY: A retrospective descriptive study of 35 cases of ruptured tubal pregnancy managed at the Federal Medical Centre; Makurdi; between January 2004 and December 2006 was conducted. RESULTS: The incidence of ruptured tubal pregnancy was 0.87of total births (1 in 114 deliveries) and accounted for 94.6of all ectopic pregnancies. There was a rising trend in the incidence of ruptured tubal pregnancy from 0.65in 2004 to 1.09in 2006. Identified risk factors include previous pelvic infection and previous induced abortions. Abdominal pain (100); vaginal bleeding (65.7); dizziness (62.9) and amenorrhoea (57.1) were the commonest symptoms. The ampulla was the site of rupture in 27(77.1) patients. All patients had laparotomy. Unilateral total salpingectomy was done in 31(88.5) patients. There was no maternal death in the cases managed

Emergency Caesarean Section in a Nigerian Tertiary Health Centre

Background: Caesarean delivery is an important aspect of emergency obstetric care and a major tool in the reduction of maternal and perinatal morbidity and mortality. This study was done to determine the caesarean section rate; ascertain the trend of emergency caesarean section; indications for emergency caesarean section and emergency caesarean morbidity and mortality at the Federal Medical Centre Makurdi. Method: A retrospective analysis of the clinical records of all patients delivered by caesarean section between January 2004 and December 2006 at the Federal Medical Centre Makurdi in north central Nigeria was conducted. Results: There were 4011 deliveries with 420 caesarean sections during the review period giving a caesarean section rate of 10.5. Emergency caesarean sections accounted for 351 (83.6) caesarean deliveries. The rate of emergency caesarean section decreased from 89.7in 2004 to 77.2in 2006. The leading indication for emergency caesarean section was cephalopelvic disproportion; accounting for 138 (39.3) cases; while antepartum haemorrhage and foetal distress followed in that order. There were 9 maternal deaths associated with emergency caesarean section giving a caesarean mortality rate of s 2.1Conclusion: Emergency caesarean sections account for 5 out of every 6 caesarean deliveries in our centre with a decreasing trend relative to elective caesarean sections. The emergency caesarean mortality is high

Globalization and Health: A Critical Appraisal

Background: Health has long been recognized as a central feature of development. Globalization tends to be understood as a process of economic integration; but it implies more. It entails openness to trade; ideas; investment; people and culture all of which impact health.Method: Review of relevant literature on globalization and health obtained from texts and Pubmed search.Results: Globalization affects health positively and negatively simultaneously; depending on such factors as geographical location; sex; age; ethnic origin; educational level and socioeconomic status. Conclusion: The challenge remains how to make globalization work for health and to use health to foster better forms of globalization. The health community must brace up to the challenge of engaging in the globalization debate with a view to promoting better health for us all

Globalization and Health: A Critical Appraisal

Background: Health has long been recognized as a central feature of development. Globalization tends to be understood as a process of economic integration; but it implies more. It entails openness to trade; ideas; investment; people and culture all of which impact health.Method: Review of relevant literature on globalization and health obtained from texts and Pubmed search.Results: Globalization affects health positively and negatively simultaneously; depending on such factors as geographical location; sex; age; ethnic origin; educational level and socioeconomic status. Conclusion: The challenge remains how to make globalization work for health and to use health to foster better forms of globalization. The health community must brace up to the challenge of engaging in the globalization debate with a view to promoting better health for us all

Elective caesarean section at the Federal Medical Centre Makurdi, north central Nigeria.

BACKGROUND: Elective caesarean section is associated with less risk of adverse events compared to emergency caesarean section. Paradoxically, emergency caesarean deliveries continue to form the bulk of caesarean deliveries in our facility. The aim of this study is to determine the caesarean section rate, ascertain the trend of elective caesarean section, indications for elective caesarean section and elective caesarean mortality. METHODS: A retrospective analysis of the clinical records of all patients that had caesarean section between January 2004 and December 2006 at the Federal Medical Centre Makurdi was conducted. RESULTS: There were 4011 deliveries with 420 caesarean sections during the review period giving a caesarean section rate of 10.5%. The elective caesarean sections accounted for 69(16.4%) while emergency caesarean sections accounted for 351(83.6%) of all caesarean sections. The rate of elective caesarean section increased from 10.3% in 2004 to 22.8% in 2006 of all caesarean sections. Two or more previous caesarean sections were the commonest indication for elective caesarean section accounting for 23.2% of cases, followed by HIV infection in pregnancy accounting for 21.7% of cases. No maternal death occurred with elective caesarean section. CONCLUSION: There is a rising trend of elective caesarean section presently accounting for 1 out of every 6 caesarean sections in the centre. The commonest indication for elective caesarean section was two or more caesarean sections, followed by retroviral disease in pregnancy. Elective caesarean section remains safer than emergency caesarean section in our facility.