Seroprevalence of Hepatitis C viral antibodies in pregnancy in a tertiary health facility in Nigeria.

BACKGROUND: Liver disease due to Hepatitis C viral (HCV) infection is the most common indication for liver transplant. It is a viral pandemic that is five times as widespread as the human immunodeficiency virus type 1 infection. In spite of this, vaccines were yet unavailable for protection of the human race due to the morphology and fastidious nature of the organism. While the scanty data available on this infection in our environment are limited to blood donors, people continue to be screened for and deprived of renal dialysis if any patient is found to have HCV infection. Also in this environment, data on HCV infection in pregnancy is virtually nonexistent even though the infection can have a deleterious effect on materno-fetal outcome. OBJECTIVE OF THE STUDY: To determine the seroprevalence of hepatitis C viral antibodies among antenatal women attending a tertiary health facility in Nigeria. METHODOLOGY: This was a prospective cross-sectional study whose subjects were booked consecutive antenatal women volunteers attending the University of Benin Teaching Hospital, Benin City, Nigeria between June 1 and December 31, 2005. Hepatitis C viral antibodies were determined and confirmed using a second and a third generation Enzyme Linked immunosorbent assay respectively. Both HCV sero-positive and seronegative women had both pre-and post-test counseling. RESULTS: Of the 269 samples screened for HCV antibodies, 5 (1.86%) samples were confirmed seropositive. None of the HCV seropositive women had liver enzyme derangement. CONCLUSION: Hepatitis C viral infection in pregnancy is not uncommon in Nigeria. It's prevalence in pregnant women South-South of Nigerian is similar to that of their Cameroonian counterparts, an immediate neighbouring country. A multi-centre study to determine the national prevalence of HCV and in addition to elevation of public awareness is suggested. Hepatitis C viral-induced liver disease remains the major indication for liver transplant for which our present levels of economy and health infrastructures can least support. With no vaccines and no cure, the time to act is now.

The prevalence of dual human immunodeficiency virus/hepatitis C virus (HIV/HCV) infection in asymptomatic pregnant women in Benin City, Nigeria.

Concerted efforts have been made to combat HIV infection in Nigerian. By contrast, much less attention has been paid to hepatitis C viral (HCV) infection. These viruses have similar immuno-epidemiology. The objective of this study was to determine the prevalence of HCV/HIV dual infection among 269 antenatal attendees at the University of Benin Teaching Hospital in southern Nigeria. The study was prospective and cross-sectional and consisted of the analysis of the sera of the participants for anti-HCV and HIV antibodies using ELISA. The result showed that 1.86% samples were HCV antibodies positive while 8.30% were seropositive for HIV-1 antibodies. There were no cases of dual infections. The HIV positive women and their babies had antiretroviral therapy. We conclude that dual HCV/HIV infection in pregnancy in Nigeria may be uncommon but suggest multicenter studies to determine the national prevalence while initiating strategies for their prevention.

The prevalence of dual Human Immunodeficiency Virus/Hepatitis C Virus (HIV/HCV) Infection in asymptomatic pregnant women in Benin City, Nigeria

Concerted efforts have been made to combat HIV infection in Nigerian. By contrast, much less attention has been paid to hepatitis C viral (HCV) infection. These viruses have similar immuno-epidemiology. The objective of this study was to determine the prevalence of HCV/HIV dual infection among 269 antenatal attendees at the University of Benin Teaching Hospital in southern Nigeria. The study was prospective and cross-sectional and consisted of the analysis of the sera of the participants for anti-HCV and HIV antibodies using ELISA. The result showed that 1.86% samples were HCV antibodies positive while 8.30% were seropositive for HIV-1 antibodies. There were no cases of dual infections. The HIV positive women and their babies had antiretroviral therapy. We conclude that dual HCV/HIV infection in pregnancy in Nigeria may be uncommon but suggest multicenter studies to determine the national prevalence while initiating strategies for their prevention (Afr J Reprod Health 2009; 13[2]:97-108)

Changing trends in maternal mortality in a developing country.

OBJECTIVE: To have a 5-year review of the maternal mortality ratio in the largest centrally located Mission hospital in Benin City where a large proportion of women deliver yearly. METHOD: This was a 5-year (January 1, 1996 through December 31, 2000) review of the causes of maternal mortality at the Saint Philomena Catholic Hospital, Benin City. The case notes of those that suffered maternal mortality were retrieved and thoroughly perused. Information on all cases of maternal mortality were extracted from the patients' case-notes; the labour ward Registers; the antenatal, postnatal, the female ward and the theatre registers. The midwifery/nurses' reports were also examined. The duplicate copies of the death certificates were examined and the necessary information was also extracted. The total deliveries for the period were extracted from the delivery registers. RESULTS: There were 7055 women who gave birth during the 5-year period. There were 32 maternal deaths; Maternal Mortality Ratio (MMR) of 454/ 100,000 live births. Unbooked emergencies accounted for 68.7% of all deaths, and were more than doubled the booked women. The MMR increased progressively from 325 in 1996 to peak at 765 in 1999 (P < 0.0001) with an insignificant drop in 1998 (P > 0.06). It was lowest in 2000 (241) (P < 0.0001). Paradoxically, as the number of deliveries decreased progressively from 1530 in 1996 to 1247 in 2000, the MMR increased progressively from 327 in 1996 to 675 in 1999. There were no postmortem examinations and no coroner's inquests. More than 76% of the women spent 48 hours or less from time of admission to death and majority of them were of low parity. Nulliparity was 37.5%. The mean parity was one. Young women 20-39 years old accounted for 81.3% with 9.4% teenage deaths due to illegally induced abortions. Eclampsia (34.4%), hemorrhage (25.0%), Infections (18.8%) and abortions 12.5%) were the four leading causes of death. Puerperal deaths were 56.3%. Five short case scenarios were presented to highlight the tortuous pathway the women passed to end in maternal mortality. CONCLUSION: The MMR ratio was still unacceptably high. The causative factors were largely preventable. The puerperium was the most dangerous period. Women empowerment, free or highly subsidized universal antenatal care services, and provision of adequate emergency obstetric services with effective contraceptive backup is suggested. Re-orientation of care givers and community leaders to enhance awareness and early recognition of the danger signs and risk factors associated with pre-eclampsia and eclampsia with prompt and adequate management or referral is emphasized.

Salvaging twin 2 after abortion of twin 1: a case report.

We present intentional delayed delivery of twin 2 after a spontaneous membrane rupture and abortion oftwin1 in a dichorionic twin pregnancy at 14 weeks. As signs of infection were missing, we adopted a conservative (not expectant) management. The pregnancy was prolonged to 35 weeks' gestation. In the absence of additional risk factors, the role of conservative management of multiple pregnancies after loss of one fetus in prolonging the pregnancy to fetal viability in resource-poor setting is highlighted. The gained gestational age of 20 weeks and 4 days (144 days in all), for the remaining fetus and the healthy mother and child pair after delivery at 35 weeks are discussed. The perinatal, economic and psychological implications are highlighted. The importance of good clinical assessment in the diagnosis of cervical incompetence and using ultrasound scan as a complimentary instrument is emphasized.

Caring for the terminally ill: what do the doctors think?

Patients' perception of end-of-life events varies with cultural norms and values, and expectations may differ from clinicians practice and actions. In contemporary practice, conflict of ideas often results in patients discharging themselves against medical advice. Clinicians (67) that have been in medical practice for at least five years at the main tertiary hospital in Benin City were interviewed with a semi-structured questionnaire. The main outcome measured was clinicians' attitude towards caring for the terminally ill patients and physician assisted suicide (PAS). The mean age of the clinicians was 36.89 +/- 7.57, 11 females and 56 males. Twenty-six clinicians (40%) do not routinely record in the case notes details of their discussion on prognosis with their patients. Forty one (62.1%) clinicians will not support life while patients are on palliative care, while 49/66 (74.2%) will transfuse their patients with blood. Thirteen (31.7%) will not support life, and will not transfuse blood. Fifty seven (85.1%) clinicians will not support euthanasia, 8 of the 9 physicians who will support PAS are males, while 6 of the 9 clinicians that will grant patient's request for PAS are gynaecologists. All (17) clinicians in Internal Medicine specialty will not support PAS, while 51/67 (77.3%) clinicians are of the opinion that patients should be routinely informed of the prognosis of their disease. Documentation of physician-patients interactions is poor amongst clinicians. Most will not support life and physician-assisted suicide for the terminally ill patients. However, in clinical practice most will transfuse their patients on palliative care with blood and give other life support treatment; an apparent dissociation between what clinicians think and what is practised.