Incident HIV infection and perinatal transmission rates among HIV negative pregnant women who retested in labor in a tertiary health centre, South East Nigeria.

BACKGROUND: To reduce the number of new HIV infections among children, retesting of HIV negative pregnant women in labor to identify new infections and instituting appropriate modified obstetrics practices (MOP) has a huge role to play. AIMS AND OBJECTIVES: This study evaluated the HIV sero-positivity in labor among pregnant women who earlier tested negative in antenatal clinic, associated risk factors and the corresponding rate of mother-to-child transmission of HIV infection. METHODS: This was a prospective observational study where pregnant women in labor who had earlier tested HIV negative in the antenatal clinic at Imo State University Teaching Hospital Orlu, Imo state, Nigeria, were retested. The infants of the women who seroconverted were tested for HIV infection at 6 weeks using Deoxyribonucleic acid polymerase chain reaction (DNA PCR) by collecting Dried Blood Sample. This study was conducted from October 2015 to March 2016. RESULT: Out of the 163 patients studied, 6 demonstrated HIV seroconversion giving a seroconversion rate of 3.7%. Deliveries from the seroconverted patients were 5 live births and 1 intrauterine fetal death. All the 5 live babies tested HIV negative at 6 weeks of age. Predictors of seroconversion in late pregnancy include spouse's HIV status and number of other sexual partners. CONCLUSION: Retesting of HIV negative pregnant women in labor to identify new infections and instituting appropriate modified obstetrics practices has a huge role to play in the prevention of mother to child transmission of HIV infection.

Emergency Contraception: Awareness, Perception and Practice among Female Undergraduates in Imo State University, Southeastern Nigeria.

BACKGROUND: Limited knowledge and practice of contraception is a global public health problem. Unintended pregnancies are the primary cause of induced abortion. When safe abortions are not available, as in Nigeria with restricted abortion laws, abortion can contribute significantly to maternal mortality and morbidity. Adequate information on the awareness and the use of emergency contraception is necessary for planning interventions in groups vulnerable to unwanted pregnancy. AIM: The aim of the following study is to access the awareness, perception and practice of emergency contraception among female undergraduates in Imo State University, South Eastern Nigeria. SUBJECTS AND METHODS: A questionnaire based cross-sectional survey using female undergraduates selected randomly from Imo State University, Owerri. RESULTS: A total of 700 students participated in the study. Awareness of emergency contraception was very high (85.1%) (596/700). The awareness was significantly higher amongst students in health related faculties than in the non-health related faculties (P = 0.01). The main sources of information were through friends (43.1%) (317/700) and lectures (22.1%) (192/700). High dose progestogen (postinor-2) was the most commonly known type of emergency contraception (70.8%) (422/596). Only 58.1% (346/596) of those who were aware of emergency contraception approved of their use. The major reasons given by the 41.9% (250/596) who disapproved of their use were religious reasons (50.4%) (126/250) and that they were harmful to health (49.2%) (123/250). Two-third (67%) (46 9/700) of the students were sexually active and only 39.9% (187/469) of them used emergency contraception. High dose progestogen (postinor-2) was again the most commonly used method (70.8%) (422/596). The most common situation in which emergency contraception was used was following unprotected sexual intercourse (45.5%) (85/144). Only 34.6% (206/596) of those who were aware of emergency contraception identified correctly the appropriate time interval for its effectiveness. CONCLUSION: Although the awareness of emergency contraception was high amongst female undergraduates, the attitude and practice are still poor. The inclusion of reproductive health education as part of the undergraduate school curriculum might help to change students' attitude toward emergency contraceptives.

Asymptomatic bacteriuria among pregnant women with sickle cell trait in Enugu, South Eastern Nigeria.

CONTEXT: Asymptomatic bacteriuria (ASB) in pregnancy is a major risk factor for developing acute cystitis and pyelonephritis, especially, among women with sickle cell disease. This study compared the prevalence, pattern, and microbiological characteristics of ASB in pregnancy between sickle cell trait (HbAS) and normal hemoglobin AA (HbAA) genotype subjects. MATERIALS AND METHODS: Culture and sensitivity of mid-stream urine samples were collected from 300 HbAS women and 300 matched HbAA control at the antenatal clinic of University of Nigeria Teaching Hospital Enugu, Nigeria from August 2010 to December 2011. Analysis was both descriptive and inferential at 95% confidence levels. RESULTS: Prevalence of ASB in HbAS and HbAA women were 32.7% (98/300) and 32% (96/300) respectively (odd ratio (OR) =1.03 [95% confidence interval (CI) 0.73, 1.45]). Escherichia coli was the most common organism isolated in both the HbAS group (56.1%, 55/98) and control group (61.4%, 59/96), (OR = 0.80 [95% CI 0.45, 1.42]). The antibiotics with the highest microbial sensitivity were ciprofloxacin 90.8% (89/98) and gentamicin 100% (98/98) for HbAS and HbAA women respectively. CONCLUSIONS: The prevalence of ASB in pregnant women with HbAS in Enugu, Nigeria was high and did not vary significantly from that of woman with HbAA. Therefore, pregnant women irrespective of their sickle cell status would benefit from routine screening for ASB.

Local risk factors in genital human papilloma virus infection in cervical smears.

BACKGROUND: Infection with human papilloma virus (HPV) is the main cause of cervical cancer, but the local risk factors have not been sufficiently assessed. AIM: The study is aimed at determining the prevalence and to evaluate the local risk factors of HPV infection in cervical smears at the Imo State University Teaching Hospital, Orlu, Nigeria. SUBJECTS AND METHODS: The participants involved 445 randomly selected sexually active women attending the antenatal, postnatal, gynecology and family planning clinics in the Department of Obstetrics and Gynecology of the university between April 2004 and May 2012. A questionnaire assessing various socio-demographic characteristics of the participants was administered. The pap smears of the participants were examined microscopically for evidence of HPV infection. The SPSS version 17.0 (Chicago, Illinois, USA) was used to compute and analyze the results. The results were presented in tables as simple percentages. Tests of significance using the Chi-square and fisher exact tests were applied where appropriate. RESULTS: The prevalence rate of HPV was 10.3%. The peak age-specific prevalence of 11.7% occurred in the 15-19 years age group. There were significant associations between the occurrence of HPV and multiple sexual partners, coital frequency, multiparity, contraceptive use, marital status, low socio-economic status, abnormal vaginal discharge, irregular menstruation, post-coital and post-menopausal bleeding, (P < 0.05). CONCLUSION: All sexually active women including teenagers should be screened for cervical HPV infection in an organized systematic program equipped with a good call and recall system. There is, therefore, a need to move emphasis from the current practice of opportunistic screening to a systematic screening of the whole population at risk despite cost implications.

Stillbirth rate in a teaching hospital in South-eastern Nigeria: a silent tragedy.

BACKGROUND: Stillbirths often are not seen as a major public health problem, for despite increasing attention and investment on maternal, neonatal, and child health, stillbirths remain invisible. AIM: The objective of this study was to determine the stillbirth rate at the Imo State University Teaching Hospital, Orlu. SUBJECTS AND METHODS: Analysis of the case records of stillbirths that occurred in the institution over a 5-year period from 1(st) July 2005 to 30(th) June 2010 was made. Data retrieved was analyzed for age of the women, parity, presumptive risk factor for the stillbirth, and booking status of the women. Also, the total births during the period of study were obtained. A P-value of <0.05 is said to be significant at confidence level of 95% (95/100). RESULTS: There were a total of 1,142 deliveries within the study period, out of which 206 resulted in stillbirths. This gave an institutional stillbirth rate of 18% (180/1000 deliveries). One-hundred and fifty-five 75.2% (155/206) of the stillbirths were macerated stillbirth. The age range of the women was 15-44 years. The modal age was 31 years. The age group of 26-30 years had the highest prevalence rate of stillbirths of 79 (38.3%, 79/206), while age group of more than 40 years contributed the least with four stillbirths 4 (1.9%, 4/206). CONCLUSION: The stillbirth rate at the institution is too high and efforts must be made to reduce it.

Human immuno-deficiency virus antibody seroprevalence among pregnant women at booking at a university teaching hospital in South-Eastern Nigeria.

BACKGROUND: In Africa, human immuno-deficiency virus (HIV) infection continues to be progressively feminized. This has led to an increase in the number of paediatric HIV infections reported due to increased risk of mother-to-child transmission (MTCT) of HIV during pregnancy, labour and breastfeeding. OBJECTIVE: The objective of the study was to determine the HIV positive sero-prevalence at booking among pregnant women at the Imo State University Teaching Hospital, Orlu. METHODS: A retrospective analysis of the case records of women who booked and were screened for Human Immune-deficiency Virus at the Imo State University Teaching Hospital (IMSUTH), Orlu from 1st March 2008 to 28th February 2010 was done. Data on age, parity, educational status, gestational age at booking, and retroviral status were collected and analysed using spss version 13. RESULTS: Nine hundred and twenty one pregnant women were screened for the presence of HIV 1 & 2 antibodies in their serum. One hundred and six of them were positive, giving a sero-prevalence rate at booking of 11.5%. The highest sero prevalence rate of 45.2% occurred in the age group of 26-30 years. Petty traders contributed 97 (91.5%) of the HIV positive women, while multiparous (para 2-4) women contributed 50% of the positive pregnant women. Only 32 (30.2%) of the HIV positive women booked within the first trimester for antenatal care. Majority 53 (59.4%) of the HIV positive women had secondary education, while those that had no formal education contributed only 6 (5.7%) of the HIV positive women. CONCLUSION: There was a high HIV seroprevalence at booking among pregnant women at IMSUTH, Orlu. A lot more needs to be done in order to reduce vertical transmission of HIV in our environment.

Stillbirth Rate in a Teaching Hospital in South-Eastern Nigeria: A Silent Tragedy

Background: Stillbirths often are not seen as a major public health problem; for despite increasing attention and investment on maternal; neonatal; and child health; stillbirths remain invisible. Aim: The objective of this study was to determine the stillbirth rate at the Imo State University Teaching Hospital; Orlu. Subjects and Methods : Analysis of the case records of stillbirths that occurred in the institution over a 5-year period from 1 st July 2005 to 30 th June 2010 was made. Data retrieved was analyzed for age of the women; parity; presumptive risk factor for the stillbirth; and booking status of the women. Also; the total births during the period of study were obtained. A P-value of 0.05 is said to be significant at confidence level of 95 (95/100). Results : There were a total of 1;142 deliveries within the study period; out of which 206 resulted in stillbirths. This gave an institutional stillbirth rate of 18 (180/1000 deliveries). One-hundred and fifty-five 75.2 (155/206) of the stillbirths were macerated stillbirth. The age range of the women was 15-44 years. The modal age was 31 years. The age group of 26-30 years had the highest prevalence rate of stillbirths of 79 (38.3 ;79/206); while age group of more than 40 years contributed the least with four stillbirths 4 (1.9 ; 4/206). Conclusion : The stillbirth rate at the institution is too high and efforts must be made to reduce it

Stillbirth Rate in a Teaching Hospital in South-eastern Nigeria: A Silent Tragedy

Stillbirths often are not seen as a major public health problem; for despite increasing attention and investment on maternal; neonatal; and child health; stillbirths remain invisible. Aim: The objective of this study was to determine the stillbirth rate at the Imo State University Teaching Hospital; Orlu. Subjects and Methods : Analysis of the case records of stillbirths that occurred in the institution over a 5-year period from 1 st July 2005 to 30 th June 2010 was made. Data retrieved was analyzed for age of the women; parity; presumptive risk factor for the stillbirth; and booking status of the women. Also; the total births during the period of study were obtained. A P-value of 0.05 is said to be significant at confidence level of 95 (95/100). Results : There were a total of 1;142 deliveries within the study period; out of which 206 resulted in stillbirths. This gave an institutional stillbirth rate of 18 (180/1000 deliveries). One-hundred and fifty-five 75.2 (155/206) of the stillbirths were macerated stillbirth. The age range of the women was 15-44 years. The modal age was 31 years. The age group of 26-30 years had the highest prevalence rate of stillbirths of 79 (38.3; 79/206); while age group of more than 40 years contributed the least with four stillbirths 4 (1.9; 4/206). Conclusion : The stillbirth rate at the institution is too high and efforts must be made to reduce it

Preliminary Outcome of the Management of Eclampsia at the Imo State University Teaching Hospital

Background: Eclampsia continues to be a major cause of maternal and perinatal mortality in developing countries. Early identification and management of pre-eclampsia will help reduce the mortality due to eclampsia. Aim: This study aims at determining the prevalence and management outcome of eclampsia in our centre with a view to proffering solutions for an optimal or near optimal care.Methods: A retrospective review of the case records of patients managed for eclampsia at the Imo State University Teaching Hospital (IMSUTH); Orlu from 1st October 2004 to 30th September 2009 was carried out. Data on socio-demographic characteristics as well as clinical management and outcome were extracted and analyzed.Results: The prevalence of eclampsia was 2.7of all the deliveries. The prevalence was significantly higher in the unbooked than the booked patients (p0.05). The prevalence was also significantly higher in primigravidae than in multiparae (p0.05). Twenty-eight (93.3) of the eclampsia occurred antepartum. Twenty-eight (93.3) had severe hypertension on presentation. Twenty nine (95.8) of the patients had 2-5 episodes of convulsions prior to presentation to the hospital. Twenty-six (86.7) of the patients had emergency Caesarean section was carried out; mostly for unfavourable cervix. The perinatal mortality was 6.7while maternal mortality was 3.3. Complications included acute renal failure; aspiration pneumonitis and abruptio placentae. Conclusion: The prevalence of eclampsia is unacceptably high in our centre. Early antenatal booking; antenatal care follow-up to identify the imminent signs and prompt treatment of cases of pre-eclampsia will reduce the burden of eclampsia in this environment

Maternal HIV positive sero-prevalence at delivery at a tertiary hospital in South-Eastern Nigeria.

BACKGROUND: The duo of HIV/AIDS infection has become a Global public health problem. This study was conducted to determine the maternal HIV positive seroprevalence at delivery at the Imo State University Teaching Hospital, Orlu. METHODS: A retrospective analysis of the case records of women (both booked and unbooked) who tested positive to Human Immune-deficiency Virus at delivery at the Imo State University Teaching Hospital (IMSUTH), Orlu from 1st May 2005 to 30th April 2010 was made. The biosocial, obstetric and fetal sex data were extracted and analysed. RESULTS: The maternal HIV positive sero-prevalence at delivery was 6.9%. The highest sero prevalence rate of 42.4% occurred in the age group of 31-35 years. Sixty three (68.5%) of the women were multiparous (para 1-4). The male: female birth ratio was 1:1.42. Forty one (44.6%) of the women were unbooked. None of the women were symptomatic of Acquired Immunodeficiency Syndrome (AIDS) on presentation. CONCLUSION: There is high maternal HIV seroprevalence at delivery at IMSUTH, Orlu. There should be improvement on interventions to reduce this ugly trend. There should also be early booking and adequate antenatal care services.