Correlates of mother-to child-transmission of HIV infection in a tertiary hospital in Ebonyi state, Nigeria.

BACKGROUND: Nigeria has the largest global burden of HIV new infections in children despite global and national concerted efforts at the reduction of mother-to-child transmission of HIV. The goal of this study was to determine the associations between maternal characteristics, practices and mother-to-child transmission of HIV infection among mothers living with HIV. METHODS: This is a hospital-based descriptive cross-sectional study. Information was obtained using interviewer-administered questionnaire from the 240 participants. Data were analyzed with SPSS version 26, and P < 0.05 was considered statistically significant. RESULTS: Out of the 240 mothers recruited, 129 (53.8%) were within 25-35 years of age, with a mean age of 31.08 ± 5.65. A total of 35 (14.6%) of the participants had at least a child with HIV infection. Maternal ART status before childbirth (AOR = 0.02, 95%CI = 0.01-0.05, P = < 0 .001) was the singular determinant of having a child with HIV infection. Mothers who delivered outside the health facility were about four-fold at risk of having an infected child (AOR = 3.89, 95%CI = 1.82-8.50, P = 0.070). CONCLUSION: The prevalence rate of mother-to-child transmission of HIV is high. Routine HIV testing services and the provision of accessible and affordable reproductive health services are recommended for all women of childbearing age.

Review of four unusual cases of HIV-positive infants; cryptic pregnancy scam and mother-to-child transmission of HIV in Nigeria.

BACKGROUND: Cryptic pregnancy is defined as lack of awareness of pregnancy until the last weeks of gestation or during labour and delivery but in cryptic pregnancy scam, mothers feigned pregnancies that never existed. METHODS: We report a total of four cases of HIV infected infants said to have been delivered by HIV negative mothers. All the mothers are above 40 years of age with a range of 9 to 18 years of infertility in marriage. The cryptic pregnancy scam was neither confirmed by pregnancy test nor obstetric scan. Diagnosis of HIV infection was made at infancy following positive rapid test and HIV antigen test. CONCLUSION: The menace of cryptic pregnancy scam in Nigeria is setting back the gains of HIV prevention and control. Desperate infertile women are made to believe that they are pregnant while babies are bought and brought to them at said date of delivery. These mothers never had proper antenatal care and so were never screened for HIV. Cryptic pregnancy scam is real amongst desperate barren women who become easy prey to the perpetuators. Awareness creation and sensitization on its harm is advocated.

Cervical Cancer Screening Knowledge, Uptake and Barriers among Female Undergraduates in a Nigerian University.

Background: Cervical cancer is a highly preventable disease that disproportionally affects women in developing countries with an estimated incidence rate of 33 cases per 100,000 women in Nigeria. Over the year's awareness and uptake of cervical cancer screening services have remained poor in developing countries. Lack of knowledge and poor attitude towards the disease and its risk factors can affect screening practice and development of preventive behaviour for cervical cancer.Aim: This study assessed the level of knowledge and barriers towards cervical cancer screening among female undergraduate students. Methodology: Across-sectional study of 234 female students conducted at Ebonyi State University Abakaliki Nigeria from March 1st to July 30th, 2017. A pretested structured questionnaire was used to collect data on sociodemographic characteristics, knowledge and screening history of cervical cancer, including barriers to screening. We graded knowledge score into good (≥ 50%) and poor (< 50%). We analysed data with Epi info version 7.1.4. Results: Participants' median age was 21.0 years. The median age of sexual debut was 13.0 years. Overall, 130 (77.4%) respondents had poor knowledge of cervical cancer. Major sources of information were health workers 54(32.1%), friends 22 (13.1%) and Television10 (6.0%). One hundred and sixty-eight (72.1%) were aware of cervical cancer, but only 10(16.1%) have had Pap smear test. Common barriers to cervical cancer screening include not knowing the centres where such services are obtainable 84 (52.9%), unnecessary 29(18.6%), no time 26 (16.7%) and fear of discovering cancer 12 (7.7%). Conclusion: Comprehensive education and awareness creation on the importance/benefits of cervical cancer screening to university students, including centres where such services are provided is critical in improving uptake. Thus, leading to early detection and reduction in morbidity and mortality associated with cervical cancer in Nigeria.

An Epidemiological Investigation of Lassa Fever Outbreak in Ebonyi State South Eastern Nigeria Lessons Learnt (January to March 2018).

Background: We investigated an outbreak of Lassa fever that occurred in Ebonyi state, Southeast Nigeria from January to March 2018. Methodology: The Emergency operational centre (EOC) model was used for the outbreak coordination. Cases and deaths were identified through the routine surveillance system. Blood specimens collected from suspected cases were sent for confirmation at the Virology Centre, Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA). Active case search was instituted, and identified contacts of confirmed cases were followed up for the maximum incubation period of the disease. Other public health responses included infection prevention and control, communication and advocacy as well as case management. Data collected were analysed using the Epi info statistical software package. Results: We identified 89 suspected Lassa Fever (LF) cases out of which 61 were confirmed. The mean age was 35±16.2 and the age group mostly affected was 30-39 years. More than half (59.7%) of the confirmed cases were females. The Case Fatality Rate (CFR) was 26.2% among the laboratory confirmed cases. Five of the deaths occurred among health care workers. Out of 325 contacts of the confirmed cases, 304(99.7%) completed the follow-up and only 1(0.3%) of them developed symptoms consistent with LF and was confirmed by the laboratory. Conclusions: The high CFR in those presenting late to the hospital underscores the need for intensive public enlightenment that encourages early presentation to hospital. Majority of the confirmed cases were primary cases, hence efforts should be intensified in breaking the chain of transmission in the animal-man interphase. Death of healthcare workers involved in management of Lassa fever raises the importance of providing life insurance for concerned healthcare workers.

Lassa fever in pregnancy with a positive maternal and fetal outcome: A case report.

BACKGROUND: The signs and symptoms of Lassa fever are initially indistinguishable from other febrile illnesses common in the tropics and complications of pregnancy. Surviving Lassa fever during pregnancy is rare. Only few cases have been documented. The antiviral drug of choice is ribavirin. CASE DESCRIPTION: A 25-year-old multigravida farmer with fever who was initially thought to have malaria in pregnancy at 29 weeks gestation. Further changes in her clinical state and laboratory tests led to a confirmation of Lassa fever. The Liver enzymes were markedly deranged and the packed cell volume was 27%. She commenced on ribavirin and subsequently was delivered of a live male neonate who was RT PCR negative for Lassa fever virus. Her clinical state improved, repeat RT PCR on day 15 was negative and she made full recovery. DISCUSSION: The case reported had similar clinical features of fever and abdominal pain and resulted in the initial diagnoses of Malaria in pregnancy. When she failed to respond to antimalarial and antibiotics treatments, a strong suspicion of viral hemorrhagic fever was made. At this time the patient was in advanced stage of the disease with bleeding from vagina and puncture sites. On the third day of admission she was delivered of a live male neonate who remained negative after 2 consecutive RT PCR tests for Lassa fever virus. Lassa fever carries a high risk of death to the fetus throughout pregnancy and to the mother in the third trimester. Mothers with Lassa fever improved rapidly after evacuation of the uterus by spontaneous abortion, or normal delivery. She was clinically stable following delivery. Her laboratory investigations were essentially normal. Throughout her management transmission based precautions were observed. None of the six close contacts developed symptoms after been followed up for 21 days. CONCLUSION: This report adds to the body of literature that individuals can survive Lassa fever during pregnancy with good maternal and fetal outcome.

Low Serum Vitamin C Status Among Pregnant Women Attending Antenatal Care at General Hospital Dawakin Kudu, Northwest Nigeria.

BACKGROUND: Vitamin C levels are low in pregnancy. The purpose of this study was to determine serum Vitamins C levels among pregnant women attending antenatal care at a General Hospital in Dawakin Kudu, Kano, and this can help further research to determine the place of Vitamin C supplementation in pregnancy. METHODS: This was a prospective study of 400 pregnant women who presented for antenatal care in General Hospital Dawakin Kudu, Kano, Nigeria. Research structured questionnaire was administered to 400 respondents. Determination of serum Vitamin C was done using appropriate biochemical methods. RESULTS: Vitamin C deficiency was found in 79.5% of the participants. The values for Vitamin C were 0.20 ± 0.18 mg/dl during the first trimester, 0.50 ± 0.99 mg/dl in the second trimester, and 0.35 ± 0.36 mg/dl in the third trimester and P = 0.001. CONCLUSIONS: There is a significant reduction in the serum Vitamins C concentration throughout the period of pregnancy with the highest levels in the second trimester. Therefore, Vitamin C supplementation is suggested during pregnancy, especially for those whose fruit and vegetable consumption is inadequate.

Plasmodium falciparum parasitaemia among booked parturients who received two doses of sulfadoxine-pyrimethamine (SP) for intermittent preventive treatment in pregnancy (IPTp) in a tertiary health facility Southeast Nigeria.

BACKGROUND: Malaria is preventable but has contributed significantly to maternal morbidity and mortality in our environment. Malaria parasitaemia during pregnancy is mostly asymptomatic, untreated but with complications. AIM: A follow-up study aimed at determining plasmodium falciparum parasitaemia and associated complications among booked parturient who had intermittent preventive treatment with sulfadoxine-pyrimethamine (SP) compared with another study among unbooked parturients who did not take SP for intermittent preventive treatment in pregnancy (IPTp). MATERIALS AND METHODS: This study was conducted in the labour ward complex of Federal Teaching Hospital, Abakaliki from March to May 2012. Five hundred booked parturients at term that received two doses of SP were consecutively recruited. A structured data collection sheet was administered to each parturient. Thick and thin blood films were prepared for quantification and speciation of parasitaemia, respectively. The haemoglobin concentration and birth weights were determined. Analysis was done with the Statistical Package for the Social Sciences (SPSS) software with level of significance at P value < 0.05. RESULTS: The prevalence of malaria parasitaemia in the study was 59.6%. The mean age of parturients was 28.7 (5.5). The highest prevalence of malaria parasitaemia, 92% was found among the parturients aged ≤19 years. The association between age and parasitaemia was significant (x(2) = 16.496, P = 0.000). The median parity was 1.0 (3.0). The highest prevalence of asymptomatic parasitaemia, 65.5% was noted among the nulliparous parturients. The association between parity and parasitaemia was significant (x(2) = 11.551, P = 0.003). Majority of the parturients were of high social class. Those of the lowest social class (class 5) had the highest prevalence (80%) of parasitaemia. The association between social class and parasitaemia was significant (x(2) = 9.131, P = 0.003). Prevalence of anaemia in the study was 14%. The non-parasitaemic and parasitaemic parturients had mean haemoglobin concentrations of 12.7 g/dl and 10.4 g/dl, respectively. There was significant association between haemoglobin concentration and parasitaemia (x(2) = 39.143, P = 0.000). The prevalence of low birth weight was 3.0%. The relationship between birth weight and parasitaemia was significant (x(2) = 2.535, P = 0.000). CONCLUSION: The was reduction in asymptomatic malaria parasitaemia compared to parturients who had no SP though the prevalence was still high showing possibly increasing resistance to SP but the treatment was still very effective in reducing anaemia and low birth weight associated with malaria in pregnancy.

Outcomes of asymptomatic malaria parasitaemia in neonates in a tertiary hospital, southeast Nigeria.

BACKGROUND: Malaria infestation during pregnancy is mostly asymptomatic and untreated especially in unbooked pregnancies. It presents with almost all the fetal complications of overt malaria in pregnancy. The aim of this study was to determine the effect of asymptomatic malaria parasitaemia on the neonates of unbooked parturients delivered at term at the Federal Teaching Hospital, Abakaliki. MATERIALS AND METHODS: This study was conducted in the labour ward complex of the Federal Teaching Hospital, Abakaliki from March to May 2012. Unbooked pregnant women who fulfilled the inclusion criteria and gave consent were consecutively recruited. Cord blood and placenta tissue were collected for haemoglobin concentration determination and histology, respectively. Birth weights were determined with an electronic weighing machine. Statistical Analysis was done with 2008 Epi Info™ software and level of significant was set at P-value <0.05. RESULTS: A total of 250 unbooked parturients were recruited, of which 194 (77.6%) had asymptomatic malaria parasitaemia while 227 (90.8%) had placental parasitisation. The prevalence of low birth weight in the study was 16.4%. There was significant relationship between asymptomatic malaria parasitemia and birth weight (X(2) = 43.70, P-value < 0.001). There were no low-birth-weight deliveries among paturients without placental parasitemia. No neonate, however, had anaemia in the study. CONCLUSION: Asymptomatic malaria parasitemia and placental parasitisation by malaria parasites contribute to the outcome of the foetal birth weight. Asymptomatic malaria parasitaemia and placental parasitaemia did not result in a corresponding foetal anaemia on babies delivered.