Knowledge and Utilization of PMTCT Services among Women accessing Antenatal Care in Private Health Facilities in Abakaliki, Nigeria.

Prevention of mother-to-child transmission (PMTCT) of HIV programme provides antiretroviral treatment to HIV-positive pregnant women to reduce the likelihood of transmission to their infants. Despite concerted efforts to scale-up PMTCT services in Nigeria, coverage and uptake of the services by Antenatal Care (ANC) attendees is below the acceptable. Private health facilities provide ANC services to large number of women, but they are sparingly involved in PMTCT capacity enhancement interventions. This study assessed the knowledge and utilization of PMTCT services among women accessing antenatal care in Private Health facilities in Abakaliki, Ebonyi State. It was a descriptive cross-sectional study in ANC clinics of the health facilities. Data was collected using interviewer administered questionnaire and analysed with Statistical Package for Social Sciences (SPSS) version 22.0 and test of association was by Chi square at P<0.05 level of significance. Results showed mean age of the respondents was 27± 4.6 years. Majority of the respondents (83.4%) had good knowledge of PMTCT but only 68.4% accessed HIV Counselling and Testing (HCT) in the index pregnancy, with fear of stigmatization given as the major reason for not doing HCT. Only 54.5% of sero-positive attendees took anti-retroviral drugs (ARVs) during pregnancy though they all used ARVs during labour/ delivery. Utilization of PMTCT services of HIV wassignificantly associated with educational status and occupation. CONCLUSION: There was good knowledge of PMTCT but utilization of the services was suboptimal. Training and mentoring of health care workers in private facilities on HIV testing programmes is important to improve uptake of PMTCT services and allay fears of stigmatization among the pregnant women.

Le programme de prévention de la transmission mère-enfant (PTME) du VIH fournit un traitement antirétroviral aux femmes enceintes séropositives pour réduire la probabilité de transmission à leurs nourrissons. Malgré les efforts concertés pour étendre les services de PTME au Nigeria, la couverture et l'utilisation des services par les personnes participant aux soins prénatals (ANC) sont inférieures à l'acceptable. Les établissements de santé privés fournissent des services de soins prénatals à un grand nombre de femmes, mais ils sont peu impliqués dans les interventions de renforcement des capacités de PTME. Cette étude a évalué la connaissance et l'utilisation des services de PTME chez les femmes ayant accès aux soins prénatals dans les établissements de santé privés à Abakaliki, dans l'État d'Ebonyi. Il s'agissait d'une étude transversale descriptive dans les cliniques de soins prénatals des établissements de santé. Les données ont été recueillies à l'aide d'un questionnaire administré par l'intervieweur et analysées avec le logiciel Statistical Package for Social Sciences (SPSS) version 22.0 et le test d'association a été effectué par le Chi carré au niveau de signification P<0,05. Les résultats ont montré que l'âge moyen des répondants était de 27 ± 4,6 ans. La majorité des personnes interrogées (83,4%) avaient une bonne connaissance de la PTME, mais seulement 68,4% ont eu accès au HCT lors de la grossesse de référence, la peur de la stigmatisation étant citée comme la principale raison de ne pas pratiquer le HCT. Seulement 54,5% des participantes séropositives ont pris des médicaments antirétroviraux (ARV) pendant la grossesse, bien qu'elles aient toutes utilisé des ARV pendant le travail/l'accouchement. L'utilisation des services de PTME du VIH était significativement associée au niveau d'instruction et à la profession. CONCLUSION: Il y avait une bonne connaissance de la PTME mais l'utilisation des services était sous-optimale. La formation et l'encadrement des agents de santé dans les établissements privés sur les programmes de dépistage du VIH sont importants pour améliorer l'utilisation des services de PTME et dissiper les craintes de stigmatisation parmi les femmes enceintes. Mots clés: Médicaments antirétroviraux, séropositifs, transmission mère-enfant, femmes enceintes, hôpitaux privés.

Cervical Cancer Screening: Assessment of Perception and Utilization of Services among Health Workers in Low Resource Setting.

BACKGROUND: Cervical cancer is a preventable disease and the most common cancer among women in Nigeria. OBJECTIVES: To appraise the perception and utilization of cervical cancer screening services among female nurses in Federal Teaching hospital, Abakaliki. MATERIALS AND METHODS: A cross-sectional study was done using semi-structured questionnaires on 408 consenting female nurses. Data was represented using simple percentages, charts, and Chi-square. RESULTS: Of the 408 questionnaires shared, 388 were correctly and completely filled and analyzed. The respondents in this study showed good knowledge of cervical cancer as all (388) were aware that cervical cancer is a preventable disease of public health concern. Majority of them, 179 (46.1%) were between 21 and 30 years of age. The most common symptom of cervical cancer identified was postcoital bleeding (57%). Nursing training was the most common (73.5%) source of cervical cancer information. Utilization of cervical cancer screening was poor in this study as only 20.6% of the respondents had ever undergone screening. The most common reason for nonscreening was that they have not thought of it (28.4%). CONCLUSION: Despite the high level of awareness of cervical cancer screening, utilization remains low. There is, therefore, the need for cervical cancer education for the nurses to help improve utilization.

Ruptured ectopic in heterotopic pregnancy: Management and spontaneous vertex delivery of a live baby at term.

Spontaneous heterotopic pregnancy is an uncommon clinical condition in which there is a simultaneous development of intrauterine and extrauterine pregnancies. It is a life-threatening emergency when the ectopic ruptures. We present Mrs. EC, a 27-year-old G1P0 + 0 with a family history of multiple gestations who had a heterotopic pregnancy at a gestational age of 7 weeks. She presented with features of threatened miscarriage at early pregnancy with an ultrasound confirmation of intrauterine pregnancy. The diagnosis of ruptured ectopic pregnancy coexisting with intrauterine gestation was made with ultrasound findings as well as clinical features necessitating emergency exploratory laparotomy. Thereafter, pregnancy was carried to term, and she delivered a live male baby that weighed 3.0 kg. Heterotopic pregnancy should be sort for in all pregnancies during the early scan, especially in those with predisposing factors for multiple gestations and risk factors for ectopic gestation. A high index of suspicion is necessary for making a diagnosis in women with intrauterine pregnancy, with or without symptoms of ectopic gestation, and irrespective of the existence of risk factors for ectopic pregnancy.

Prevalence of CKD-MBD in pre-dialysis patients using biochemical markers in Enugu, South-East Nigeria.

BACKGROUND: As kidney function declines, there is a progressive deterioration in mineral homeostasis with disruption of normal serum and tissue concentration of phosphorus and calcium, and changes in circulating levels of hormones-parathyroid hormone (PTH), calcitriol (1,25(OH)2 D), and Fibroblast growth factor-23 (FGF-23). OBJECTIVE: This study was aimed at determining the prevalence of markers of CKD-MBD in pre-dialysis patients. METHODS: We evaluated consecutively 168 subjects made up of 85 CKD patients and 83 healthy controls, who were attending the renal clinics and medical outpatient of University of Nigeria Teaching Hospital, Enugu. GFR was estimated and serum calcium, phosphorus, alkaline phosphatase, PTH, and 25(OH) D levels assayed. RESULTS: The prevalence of various mineral bone disease abnormalities were 70% hyper-phosphatemia, 85% hyper-parathyroidism, and 100% low levels of 25 (OH) D among the patients. Estimated GFR correlated negatively with both serum phosphorus, and PTH. Age of the patients ranged from18-76 years with a male to female ratio of 1.7:1. Chronic Glomerulonephritis (CGN), hypertension and diabetes mellitus caused CKD in 75% of the patients. There was no significant decrease in serum calcium levels of patients compared to controls. The patients did not have pathologically raised alkaline phosphatase, although their mean level was significantly higher than that of the control group. CONCLUSION: Low 25 (OH) D levels (insufficiency/deficiency), hyperparathyroidism, and hyper-phosphatemia were the obvious markers of CKD-MBD in our pre-dialysis patients. These should be evaluated at presentation in these patients.

High population frequencies of APOL1 risk variants are associated with increased prevalence of non-diabetic chronic kidney disease in the Igbo people from south-eastern Nigeria.

BACKGROUND: Continental Africa is facing an epidemic of chronic kidney disease (CKD). APOL1 risk variants have been shown to be strongly associated with an increased risk for non-diabetic kidney disease including HIV nephropathy, primary non-monogenic focal and segmental glomerulosclerosis, and hypertension-attributed nephropathy among African ancestry populations in the USA. The world's highest frequencies of APOL1 risk alleles have been reported in West African nations, overlapping regions with a high incidence of CKD and hypertension. One such region is south-eastern Nigeria, and therefore we sought to quantify the association of APOL1 risk alleles with CKD in this region. METHODS: APOL1 risk variants were genotyped in a case-control sample set consisting of non-diabetic, CKD patients (n = 44) and control individuals (n = 43) from Enugu and Abakaliki, Nigeria. RESULTS: We found a high frequency of two APOL1 risk alleles in the general population of Igbo people of south-eastern Nigeria (23.3%). The two APOL1 risk allele frequency in the CKD patient group was 66%. Logistic regression analysis under a recessive inheritance model showed a strong and significant association of APOL1 two-risk alleles with CKD, yielding an odds ratio of 6.4 (unadjusted p = 1.2E-4); following correction for age, gender, HIV and BMI, the odds ratio was 4.8 (adjusted p = 5.1E-03). CONCLUSION: APOL1 risk variants are common in the Igbo population of south-eastern Nigeria, and are also highly associated with non-diabetic CKD in this area. APOL1 may explain the increased prevalence of CKD in this region.

Vaginal myomectomy of a prolapsed gangrenous cervical leiomyoma.

We report a challenging case of a huge gangrenous prolapsed cervical leiomyoma in a multiparous HIV positive lady. A 37-year-old para 3 lady presented with a progressively increasing irreducible mass protruding out per vaginam, 3 months duration of heavy menses, and symptoms of a urinary tract infection. We performed a vaginal myomectomy and she did well postoperatively. A prolapsed gangrenous cervical leiomyoma is a rare condition with only a few cases reported in the literature. Vaginal myomectomy for this condition can be performed in experienced hands without difficulties.

Perception of intimate pelvic examination by gynaecological clinic attendees in rural Southeast Nigeria.

CONTEXT: Intimate gynaecological examinations are part of the necessary retinue in gynaecological consultation and management. OBJECTIVE: To evaluate women's perception of digital and speculum vaginal examinations in rural Southeast Nigeria. METHODS: This was a prospective descriptive study. Gynaecologic clinic attendees in a Mission hospital in rural Nigeria were interviewed using a pre-tested questionnaire over a 3-year period. RESULTS: Four hundred and eighty-six women with a mean age of 35.2 ± 8.1 years were interviewed. They presented mainly for infertility (36.8%), menstrual abnormalities (31.1%) and early pregnancy complications (10.7%). Over a quarter of the women felt embarrassed at vaginal examination and 37.2% found it a bit painful or felt discomfort. In spite of the discomfort, 73.7% believed vaginal examination was necessary and over 95% indicated readiness to undergo such examination in future if necessary. CONCLUSION: Performing intimate gynaecological examination should be a carefully planned procedure with patient's consent, and performed conscientiously taking patient's feelings and emotions into consideration, to engender confidence.

Impacts of elevated prenatal blood lead on trace element status and pregnancy outcomes in occupationally non-exposed women.

BACKGROUND: Lead toxicity has been reported to affect hematopoietic, nervous, reproductive, cardiovascular and urinary tract systems. Many investigators have so far studied the effects of high blood lead levels on pregnancy outcomes. OBJECTIVE: To investigate the effects of elevated maternal blood lead during pregnancy on some trace elements and pregnancy outcomes. METHODS: Blood lead and plasma copper, iron and zinc were measured in 349 pregnant women with a mean ± SD age of 27.0 ± 4.8 years, and gestational age of 21.8 ± 3.1 weeks, at recruitment using atomic absorption spectrophotometer. Maternal and fetal outcomes were recorded during follow-up and at delivery, respectively. A blood lead level of ≥ 10 µg/dL was considered high. RESULTS: Women with elevated blood lead had significantly higher plasma copper and iron and lower plasma zinc than women with low blood lead level (<10 µg/dL). Blood lead level correlated with maternal hemoglobin concentration (r = -0.1054, p = 0.051) and total white blood cell count (r = 0.1045, p = 0.053). Hypertension, malaria and low birth weight were significantly higher (p<0.05) in women with elevated blood lead than in those with low blood lead level. CONCLUSION: Complications of pregnancy may be induced by a high blood lead level possibly through the alterations in trace element metabolism.

The incidence, pattern and management outcomes of early pregnancy losses at the Ebonyi State University Teaching Hospital, Abakaliki.

BACKGROUND: Early pregnancy losses are a source of deep emotional trauma to any woman, her family and the attttending Gynaecologist. This study evaluated the prelence, pattern and management outcomes of such losses at a tertiary Health Institution. METHODS: Data of all women who suffered early pregnancy losses between 1st January, 2002 and 31st December, 2004, were reviewed in a descriptive study. Information obtained from their case notes which related to the early pregnancy event, their socio demographics, obstetric history and management outcomes were collated. Univariate analysis was performed and frequency tables and figures were constructed where appropriate. RESULTS: Early pregnancy losses comprised miscarriages, molar pregnancy and ectopic gestations accounted for 32.1% of all gynaecological admissions during the period. Miscarriages were the commonest diagnosis and incomplete abortion constituted the bulk of this. Women of all parities were involved but rate of loss increased down the socio economic class strata. Majority were unbooked. A maternal mortality rate of 1.8% attended all forms of early pregnancy losses during the period. CONCLUSION: Early pregnancy loss constitutes a major gynaecological problem in our centre. Health care providers must institute prompt and appropriate clinical management for a good clinical outcome.

The Incidence; Pattern and Management Outcomes of Early Pregnancy Losses at the Ebony State University Teaching Hospital; Abakaliki

Background: Early pregnancy losses are a source of deep emotional trauma to any woman; her family and the attending Gynaecologist. This study evaluated the prevalence; pattern and management outcomes of such losses at a tertiary Health Institution. Methods: Data of all women who suffered early pregnancy losses between 1st January; 2002 and 31st December; 2004; were reviewed in a descriptive study. Information obtained from their case notes which related to the early pregnancy event; their socio demographics; obstetric history and management outcomes were collated. Univariate analysis was performed and frequency tables and figures were constructed where appropriate. Results: Early pregnancy losses comprised miscarriages; molar pregnancy and ectopic gestations accounted for 32.1of all gynaecological admissions during the period. Miscarriages were the commonest diagnosis and incomplete abortion constituted the bulk of this. Women of all parities were involved but rate of loss increased down the socio economic class strata. Majority were unbooked. A maternal mortality rate of 1.8attended all forms of early pregnancy losses during the period. Conclusion: Early pregnancy loss constitutes a major gynaecological problem in our centre. Health care providers must institute prompt and appropriate clinical management for a good clinical outcome

Pattern and determinants of domestic violence among prenatal clinic attendees in a referral centre, South-east Nigeria.

Gender-based violence, though deeply entrenched in some cultures and religions, has remained a neglected area in health research in South-east Nigeria. This study assessed the prevalence, pattern and background factors precipitating domestic violence in a population of prenatal clinic attendees. This was a cross-sectional questionnaire-based study. Booked antenatal women were recruited into the study after informed consent. Trained research assistants administered the questionnaires in the local dialects of the women. Analysis was by the Epi Info Statistical Software package version 3.2.2 of 2005. A total of 500 women were involved in the study that spanned 3 months. Of these, 68 were exposed to gender-based violence. Verbal abuse/insult was the commonest form of male engendered violence. Others were sexual abuse, financial deprivation, threats and physical harm. Financial and domestic issues were the major sources of disagreements. Some 17.6% sustained physical injury, while all admitted to some degree of psychological trauma. Routine assessment in a non-judgemental way of antenatal population for gender-based violence is advocated. This will determine the true prevalence and pattern of domestic violence, and form a rational basis for the formulation of interventional strategies.

Uterine fibroids in a tertiary health centre South East Nigeria.

BACKGROUND: Uterine fibroids are common benign tumours of the female reproductive tract. This study evaluated the clinical presentations and the treatment of fibroids at Ebonyi State University Teaching Hospital over the 5-year period (2001-2005). METHODS: A retrospective analysis of all cases of uterine fibroids admitted into the gynaecological ward of the Ebonyi State University Teaching Hospital (EBSUTH) over the five-year period (2001-2005). RESULTS: Uterine fibroids accounted for 13.6% of all gynaecological admissions during the period. It was found predominantly during the third and fourth decades of life in nulliparas and women of the higher socio economic class. Primary infertility (22.9%), lower abdominal mass (21. 6%), menstrual abnormalities (15.9%), lower abdominal pain (15.9%) and anaemia (11.8%) were the common clinical presentations while abdominal myomectomy was the commonest modality of treatment employed (90%). CONCLUSION: Uterine fibroid is common among gynaecological admissions in Igbo women of Southeastern Nigeria. Infertility is a common presentation necessitating abdominal myomectomy in majority of the cases.

Retained placenta aspect of clinical management in a tertiary health institution in Nigeria.

BACKGROUND: Retained placenta is a significant cause of postpartum haemorrhage, maternal morbidity and occasionally mortality. This study assessed the clinical presentation, management and outcomes of retained placenta at the Ebonyi State University teaching Hospital. METHOD: Analysis of records relating to retained placenta managed in the hospital over a three year period (August 2003 to July 2006. RESULTS: The incidence of retained placenta was 0.22% (1 in 456 vaginal deliveries). Eleven (32.4%) patients were admitted with retained placenta following home delivery. Two (5.6%) delivery in a peripheral hospital, 6 (17.7%) delivered in a. Health center and 2 (5.9%) delivered in a maternity home. Preterm deliveries accounted for 17.7% of the cases. Eighteen parturient were admitted in shock. One patient had hysterectomy for adherent placenta. CONCLUSION: Improved peripatum services, education on the dangers of unsupervised home deliveries, women empowernment and prompt referral for emergency obstetrics care will reduce the associated mortality and morbidity.

Sociocultural impediments to male factor infertility evaluation in rural South-east Nigeria.

This study evaluated the rate and factors influencing male uptake of infertility investigations. Infertility constituted 11.2% of all new gynaecological consultations in the centre during the study period. A total of 61 (70.1%) males consented to seminal fluid studies without much hesitation, 12.4% after much persuasion, while the remainder (17.5%) refused. Obliging doctor's recommendation was the primary motivation for those who willingly had seminal fluid studies while the claim to be healthy and not being responsible for infertility were the commonest barriers for reluctance or refusal to be investigated. Fears of exposure of semen so obtained to witchcraft and rituals were also contributory. Gynaecologists working in rural South-east Nigeria should through systematic public enlightenment dispel misconceptions of necessary medical intervention.

Patterns of menopausal symptoms and adaptive ability in a rural population in South-east Nigeria.

We set out to assess menopausal symptoms and the adaptability to them in a Nigerian population. This was a cross-sectional survey using a self-administered questionnaire and supplemented with focus group discussion carried out on a rural postmenopausal population in South-east Nigeria. Data were analysed using the epi Info version 3.3.2. Data from 186 were analysed. The mean age of women at the time of interview was 49.6+/-6.3 years. Mean and median ages at menopause were 45.47+/-5.5 years and 47 years, respectively. The major symptoms at menopause were: hot flushes 36 (58.1%), sweating 25 (40.3%), urinary frequency 24 (38.7%), vaginal dryness, discomfort or discharge 22 (35.5%), lack of concentration 17 (27.4%) and irritability 15 (24.2%). Widowhood and the empty nest syndrome but not educational attainment imparted negatively on the ability of the women to cope with the menopausal symptoms. Menopausal symptoms are a health concern to the Christian population in South-east Nigeria. Doctors working in this environment should utilise the opportunity of clinical consultation to raise and discuss these symptoms with postmenopausal women.

Implementing the new WHO antenatal care model: voices from end users in a rural Nigerian community.

CONTEXT: The recommended WHO antenatal focused visits with reduced number of visits and tests is yet to be implemented in many communities in rural Nigeria. AIM: This paper evaluated the attitude of antenatal clients in a rural mission hospital to the new antenatal model. STUDY DESIGN: Focus group discussions were carried out bi-weekly for 12 weeks with consenting booked antenatal clients. The topic guide was developed following interactions with prenatal clients at a referral tertiary center. RESULTS: One hundred and forty-four clients were interviewed. Prior to discussion, none had heard of the new antenatal care model. More than half of them will prefer the traditional policy with multiple visits to the new model. The traditional visit was said to be more reassuring and provides the clients time away from their routine chores/occupations and afford them the opportunity to interact with other expectant mothers and get acquainted with the health care providers. CONCLUSION: To realize the goals of the new WHO recommended antenatal model in rural Nigeria, mass enlightenment and education must precede its gradual and cautious introduction.

Prevalence of low sperm count and abnormal semen parameters in male partners of women consulting at infertility clinic in Abakaliki, Nigeria.

In order to provide an insight to the prevalence of low sperm count and abnormal semen parameters in suspected subfertile/infertile men in our environment, semen samples collected from one hundred and seventy (170) men aged 21-50 years, whose wives were seen at a private fertility clinic in Abakaliki, Nigeria with diagnosis of primary and secondary infertility (78 and 92 respectively) were analysed in accordance with World Health Organization guidelines. Significantly high proportion (70%) of the study population had low sperm count (p < 0.05) with significantly high defective parameters (64%). Asthenozoospermia and teratozoospermia were the major abnormal parameters recorded. Higher prevalence of oligospermia was found in the civil servants and age-group 31-40 years (74% and 75% respectively). Using 10(5) cfu/ml as a significant level of bacteria growth, the prevalence of bacteria growth was found to be 56% of which 18% were from normospermic semen d 38% from oligospermic semen.

Prevalence of Low Sperm Count and Abnormal Semen Parameters in Male Partners of Women Consulting at Infertility Clinic in Abakaliki; Nigeria

In order to provide an insight to the prevalence of low sperm count and abnormal semen parameters in suspected subfertile/ infertile men in our environment; semen samples collected from one hundred and seventy (170) men aged 21-50 years; whose wives were seen at a private fertility clinic in Abakaliki; Nigeria with diagnosis of primary and secondary infertility (78 and 92 respectively) were analysed in accordance with World Health Organization guidelines. Significantly high proportion (70) of the study population had low sperm count (p 0.05) with significantly high defective parameters (64). Asthenozoospermia and teratozoospermia were the major abnormal parameters recorded. Higher prevalence of oligospermia was found in the civil servants and age-group 31-40 years (74and 75respectively). Using 105 cfu/ml as a significant level of bacteria growth; the prevalence of bacteria growth was found to be 56of which 18were from normospermic semen d 38 from oligospermic semen

Retained placenta aspect of clinical management in a tertiary health institution in Nigeria

Background: Retained placenta is a significant cause of postpartum haemorrhage; maternal morbidity and occasionally mortality. This study assessed the clinical presentation; management and outcomes of retained placenta at the Ebonyi State University teaching Hospital.Method: Analysis of records relating to retained placenta managed in the hospital over a three year period (August 2003 to July 20060. Results: The incidence of retained placenta was 0.22(1 in 456 vaginal deliveries). Eleven (32.4) patients were admitted with retained placenta following home delivery. Two (5.6) delivery in a peripheral hospital; 6(17.7) delivered in a Health center and 2(5.9)delivered in a maternity home. Preterm deliveries accounted for 17.7of the cases. Eighteen parturient were admitted in shock. One patient had hysterectomy for adherent placenta. Conclusion: Improved peripatum services; education on the dangers of unsupervised home deliveries; women empowernment and prompt referral for emergency obstetrics care will reduce the associated mortality and morbidity

Left ventricular hypertrophy in African Black patients with chronic renal failure at first evaluation.

OBJECTIVE: Chronic kidney disease (CKD) is a major cause of cardiovascular morbidity and mortality all over the world. The combined effect of volume and pressure overload seen in patients with CKD is the primary cause of left ventricular hypertrophy (LVH). Though it accounts for a significant proportion of patients dying in hospitals in Nigeria, information on CKD in African Blacks is lacking. This study evaluates the prevalence of LVH and factors affecting it in pre-dialysis patients by using echocardiography. DESIGN, SETTING AND PATIENTS: One hundred consecutive patients with CKD who were attending the medical outpatient and renal clinics of University of Nigeria Teaching Hospital, Enugu, who satisfied the inclusion criteria were screened for the study. Eighty-eight patients completed the study. Forty-five age- and sex-matched subjects were selected as controls. Clinical and laboratory parameters and echocardiographic indices were measured. RESULTS: Left ventricular hypertrophy (LVH), defined in absolute terms as left ventricular mass index >134 g/m2 in men and >110 g/m2 in women was present in 95.5% of patients and 6.7% of controls. The most prevalent type of LVH was eccentric hypertrophy, which was found in 54.6%, while concentric was seen in 40.9%. Hypertension was present in 85.2% of the patients. The predominant causes of CKD were chronic glomerulonephritis (43.2%), hypertension (25%), and diabetes mellitus (14.8%). All the patients studied had advanced CKD, either stage 4 or 5 of the Kidney Disease Outcome Quality Initiative classification of CKD. Stepwise method of multiple linear regressions identified mean arterial pressure (32%), hemoglobin concentration (22%), male sex (17%), and creatinine clearance (24%) as predictors of LVH in CKD. CONCLUSION: This study showed a strong association between CKD and LVH in patients in developing countries at the time of first evaluation by a nephrologist. It demonstrated a high prevalence of LVH in patients at first evaluation. The patients were often anemic and had severe hypertension even at first presentation. Early detection and treatment of causes of CKD should be pursued aggressively at the primary prevention level, as has been advocated by the International Society of Nephrology to reduce the effects of CKD and its attendant complications in the society.