Prevalence and determinants of moderate-to-severe anaemia in the third trimester of pregnancy: a multicenter cross-sectional study in Lagos, Nigeria.

The high burden of anaemia during pregnancy underscores the urgent need to gain a comprehensive understanding of the factors contributing to its widespread occurrence. Our study assessed the prevalence and the trends of moderate-to-severe anaemia (MSA) in late pregnancy (28 to 36 weeks) and then investigated the key determinants driving this prevalence among women in Lagos, Nigeria. We conducted a secondary data analysis involving 1216 women enrolled in the Predict-PPH study between January and March 2023. We employed a multivariate binary logistic regression model with a backward stepwise selection approach to identify significant predictors of MSA. The study revealed a 14.5% prevalence of MSA during pregnancy. Independent predictors of MSA included having given birth to two or more children (adjusted odds ratio = 1.46, 95% confidence interval: 1.03-2.07), having a maternal body mass index (BMI) of 28 kg/m2 or higher (adjusted odds ratio = 1.84, 95% confidence interval: 1.29-2.61), having less than tertiary education (adjusted odds ratio = 1.51, 95% confidence interval: 1.08-2.11), and being unemployed (adjusted odds ratio = 1.97, 95% confidence interval: 1.19-3.26). It is crucial for pregnant women, particularly those with higher parities and elevated BMI, to be monitored regularly for anaemia and its consequences during their antenatal care. Additionally, addressing the link between low education, unemployment, and anaemia necessitates comprehensive strategies that empower women in terms of education and economic status to enhance the overall well-being of individuals and communities, ultimately reducing the prevalence of anaemia and associated health issues in pregnancy.

Prenatal anaemia and risk of postpartum haemorrhage: a cohort analysis of data from the Predict-PPH study.

BACKGROUND: Most previous clinical studies investigating the connection between prenatal anaemia and postpartum haemorrhage (PPH) have reported conflicting results. OBJECTIVES: We examined the association between maternal prenatal anaemia and the risk of PPH in a large cohort of healthy pregnant women in five health institutions in Lagos, Southwest Nigeria. METHODS: This was a prospective cohort analysis of data from the Predict-PPH study that was conducted between January and June 2023. The study enrolled n = 1222 healthy pregnant women giving birth in five hospitals in Lagos, Nigeria. The study outcome, WHO-defined PPH, is postpartum blood loss of at least 500 milliliters. We used a multivariable logistic regression model with a backward stepwise conditional approach to examine the association between prenatal anaemia of increasing severity and PPH while adjusting for confounding factors. RESULTS: Of the 1222 women recruited to the Predict-PPH study between January and June 2023, 1189 (97·3%) had complete outcome data. Up to 570 (46.6%) of the enrolled women had prenatal anaemia while 442 (37.2%) of those with complete follow-up data had WHO-defined PPH. After controlling for potential confounding factors, maternal prenatal anaemia was independently associated with PPH (adjusted odds ratio = 1.37, 95% confidence interval: 1.05-1.79). However, on the elimination of interaction effects of coexisting uterine fibroids and mode of delivery on this association, a sensitivity analysis yielded a lack of significant association between prenatal anaemia and PPH (adjusted odds ratio = 1.27, 95% confidence interval: 0.99-1.64). We also recorded no statistically significant difference in the median postpartum blood loss in women across the different categories of anaemia (P = 0.131). CONCLUSION: Our study revealed that prenatal anaemia was not significantly associated with PPH. These findings challenge the previously held belief of a suspected link between maternal anaemia and PPH. This unique evidence contrary to most previous studies suggests that other factors beyond prenatal anaemia may contribute more significantly to the occurrence of PPH. This highlights the importance of comprehensive assessment and consideration of various maternal health factors in predicting and preventing this life-threatening obstetric complication.

Development of antepartum risk prediction model for postpartum hemorrhage in Lagos, Nigeria: A prospective cohort study (Predict-PPH study).

OBJECTIVES: There is currently a limited ability to accurately identify women at risk of postpartum hemorrhage (PPH). We conducted the "Predict-PPH" study to develop and evaluate an antepartum prediction model and its derived risk-scoring system. METHODS: This was a prospective cohort study of healthy pregnant women who registered and gave birth in five hospitals in Lagos, Nigeria, from January to June 2023. Maternal antepartum characteristics were compared between women with and without PPH. A predictive multivariable model was estimated using binary logistic regression with a backward stepwise approach eliminating variables when P was greater than 0.10. Statistically significant associations in the final model were reported when P was less than 0.05. RESULTS: The prevalence of PPH in the enrolled cohort was 37.1%. Independent predictors of PPH such as maternal obesity (adjusted odds ratio [aOR] 3.25, 95% confidence interval [CI] 2.47-4.26), maternal anemia (aOR 1.32, 95% CI 1.02-1.72), previous history of cesarean delivery (aOR 4.24, 95% CI 3.13-5.73), and previous PPH (aOR 2.65, 95% CI 1.07-6.56) were incorporated to develop a risk-scoring system. The area under the receiver operating characteristic curve (AUROC) for the prediction model and risk scoring system was 0.72 (95% CI 0.69-0.75). CONCLUSION: We recorded a relatively high prevalence of PPH. Our model performance was satisfactory in identifying women at risk of PPH. Therefore, the derived risk-scoring system could be a useful tool to screen and identify pregnant women at risk of PPH during their routine antenatal assessment for birth preparedness and complication readiness.

Predictors of Pap smear testing uptake among women in Lagos, Nigeria.

We assessed the predictors of Pap smear testing uptake within 6 months after cervical cancer prevention education among women in Lagos, Nigeria. This was a prospective follow-up study conducted as part of the 'mHealth-Cervix trial' in the two teaching hospitals in Lagos, Nigeria, between August 2020 and April 2021. Participants were followed up for 6 months after pre-enrolment cervical cancer prevention education. The potential socio-demographic and clinical predictors of Pap smear testing uptake during the 6-month follow-up were tested using the predictive model in a binary logistic regression analysis. Statistical significance was reported as p < 0.05. The rate of Pap smear testing uptake during the 6-month follow-up was 35.7%. Following the adjustments in the final multivariate analysis, participants' previous awareness of Pap smearing (RR = 6.92, 95% CI: 8.37-56.68, p = 0.001) and attendance at the general outpatient clinic during the period of follow-up (RR = 11.22, 95% CI: 1.54-81.51, p = 0.017) independently predict Pap smear testing uptake. We will, therefore, explore the impact of continuous provision of health promotion on cervical cancer prevention and its effect in the context of routine clinical care in our next implementation research agenda. We recommend, in the meantime, that regular health education of women on cervical cancer prevention by healthcare providers should be further reinforced as an integral part of health promotion in clinics to reduce the burden of cervical cancer in most low- and middle-income settings.

Pattern of Gynaecological Malignancies at a University Teaching Hospital in Southwest Nigeria: A 5-Year Review.

Background: The study determined the pattern and distribution of gynaecological cancer cases seen at a university teaching hospital in southwest Nigeria over a 5-year period. Methodology: It was a 5-year retrospective review of all gynaecological cancer cases seen and managed at the hospital from 1 September 2013 to 31 August 2018. Results: A total of 6247 gynaecological admissions and 902 gynaecological cancers were seen in the hospital during the study period accounting for a proportion of 14.4%. Of these 902 cases, 835 (92.6%) women had their detailed records available for data extraction and analyses. Cervical cancer was the most commonly seen malignancy (61.7%). The mean age of the patients was 52.5 ± 12.4 years with the largest proportion of the women being in the age group of 50-59 years (26.9%). A large proportion (35.6%) of the patients had a parity of 5 or more with an overall median parity of 4 (IQR, 1-5) while the largest proportion (59.1%) were postmenopausal women. The highest mean age was seen in women with vulvar cancer (67.2 ± 0.6 years) while the lowest was in those with sarcoma botryoides (12.3±1.01 years). Conclusion: There was a steady annual increase in the number of gynaecological cancer cases at the hospital during the period under review. The most common cancers seen in this study are associated with advanced age, increased parity and postmenopausal status. There is a need for improved public enlightenment on the importance of routine screening and for consistent government policy on the institution of an effective organised screening programme for cervical cancer.

Posterior classical caesarean section in a myomatous gravid uterus at term: a case report.

We present a case of a 30-year-old primigravida, at 38-week gestation, who had a posterior classical uterine incision due to a huge anterior wall leiomyoma associated with uterine torsion and breech presentation. The rarity of this type of uterine incision, the size of the uterine myoma and the uterine torsion prompted this case report. During caesarean section, the diagnoses of uterine torsion and a huge anterior wall leiomyoma were made. She had safe delivery of the fetus through a posterior classical caesarean section. The patient had an uneventful post-operative period and was discharged home with her baby on the fourth post-operative day.

Impact of Mobile Technologies on Cervical Cancer Screening Practices in Lagos, Nigeria (mHealth-Cervix): A Randomized Controlled Trial.

PURPOSE: We assessed the impact of mHealth on Pap test screening uptake and also determined the factors that affect screening uptake among women in Lagos, Nigeria. MATERIALS AND METHODS: A randomized controlled trial was carried out among women in two tertiary health institutions in Lagos, Nigeria, between July 2020 and March 2021. Participants were randomly assigned to either a text message (mHealth) intervention or usual care arm. The main study outcome was the uptake of Pap smear testing within 6 months of enrollment in the study. We tested the associations between two groups of continuous variables using the unpooled independent-sample t-test (normal distribution) and that of two groups of categorical variables with the chi-square (χ2) test. Using a multinomial logistic regression model, we adjusted for relevant sociodemographic and clinical predictors of uptake of Pap smear screening. Statistical significance was defined as P < .05. RESULTS: There was a significantly higher rate of uptake of Pap smear screening among women in the mHealth arm compared with those in the usual care arm (51.0% v 35.7%, P = .031). Following adjustment in the final multivariate model, level of income (odds ratio [OR] = 5.13, 95% CI, 1.55 to 16.95), awareness of Pap smear (OR = 16.26; 95% CI, 2.49 to 76.64), General Outpatient clinic attendance, and introduction of mHealth intervention during follow-up (OR = 4.36; 95% CI, 1.44 to 13.22) were the independent predictors of Pap smear uptake. CONCLUSION: The use of mHealth technologies intervention via short-text message services is a feasible solution for cervical cancer prevention in low- and middle-income countries, and thus, the widespread use of mHealth services by health care providers and policymakers could contribute to the implementation of cervical cancer prevention services in Nigeria and in the settings of other low- and middle-income countries.

Predictors of Survival Outcomes After Primary Treatment of Epithelial Ovarian Cancer in Lagos, Nigeria.

PURPOSE: This study was designed to investigate the clinicopathologic predictors of progression-free survival (PFS) and overall survival (OS) in patients with epithelial ovarian cancer (EOC) following primary treatment in Lagos, Nigeria. MATERIALS AND METHODS: Using data from a retrospective cohort of 126 patients who received treatment for EOC between 2010 and 2018, we identified 83 patients with a complete clinical record for subsequent data analysis. Patients' demographics and updated 2-year follow-up status were abstracted from medical records. Kaplan-Meier survival curves were compared using the log-rank test, and Cox proportional hazard models were used for multivariate analysis to identify independent predictors of survivals following treatment in EOC patients. RESULTS: The median PFS and OS were 12 and 24 months, respectively. After adjusting for covariates in the multivariate analysis, younger age ≤ 55 years (hazard ratio [HR] = 0.40; 95% CI, 0.22 to 0.74; P = .01) and International Federation of Gynecology and Obstetrics (FIGO) stage I/II (HR = 0.02; 95% CI, 0.01 to 0.08; P = .01) were independent predictors of improved PFS, whereas being premenopausal (HR = 2.34; 95% CI, 1.16 to 4.75; P = .02) was an independent predictor of reduced OS after 2-year follow-up. CONCLUSION: PFS could be predicted by the age and FIGO stage of the disease, whereas menopausal status was predictive of OS in patients with EOC. This knowledge should form the basis for counseling patients with ovarian cancer during their primary treatment and lend support to the importance of aggressive follow-up and monitoring for the older, premenopausal patients and those with an advanced stage of epithelial ovarian cancer. However, robust longitudinal research should be carried out to provide additional reliable insight to this information.

Predictors, barriers and motivating factors for human papillomavirus vaccination and testing as preventive measures for cervical cancer: A study of urban women in Lagos, Nigeria.

Human papillomavirus (HPV) vaccination and HPV based cervical screening are scientifically proven ways to prevent and eliminate cervical cancer (CC). Unfortunately, these measures are yet to be widely accepted or utilized. Our study aimed to explore the individual-related factors that predict HPV vaccination and testing, its motivating factors and barriers among urban women in Lagos, Nigeria. This was a descriptive cross-sectional study among 208 consenting women who attended a community health awareness program in Surulere, Lagos, Nigeria, in September 2019. Structured questionnaires were interviewer administered and analysis was done using SPSS version 23. The uptake of HPV vaccination and testing was 29.0% and 3.0% respectively. Being employed [adjusted odds ratio (AOR) = 60.45, CI = 10.64-343.46, P < 0.001] and unmarried (AOR = 33.33, CI = 12.5-100.0, P < 0.001) predicted HPV vaccination uptake while being unmarried was the only predictor of uptake of HPV testing [crude odds ratio (COR) = 7.69, CI = 1.01-100.00, P = 0.039]. Knowing someone with CC (AOR = 21.64, CI = 4.87-96.16, P < 0.001) and being unmarried (AOR = 5.56, CI = 1.45-20.00, P = 0.012) predicted increased willingness to be vaccinated. Being unmarried (AOR = 5.26, CI = 1.89-14.29, P = 0.002) and knowing someone with CC (AOR = 6.41, CI = 2.68-15.33, P < 0.001) predicted willingness to do HPV testing. Recommendation by healthcare provider (HCP), friends/relatives and media were major motivators for HPV vaccination & testing while fear, cost, no recommendation by HCP, inaccessibility & lack of awareness were major barriers. There is need to urgently address these identified factors that affect HPV vaccination and testing in order to improve its acceptability and uptake rate in our environment.

Effects of selenium supplementation on pregnancy outcomes and disease progression in HIV-infected pregnant women in Lagos: A randomized controlled trial.

OBJECTIVE: To examine the effects of selenium supplementation on pregnancy outcomes and disease progression among HIV-infected pregnant women in Lagos. METHODS: A randomized, placebo-controlled trial conducted among HIV-positive pregnant women between September 2018 and August 2019. At enrollment, 90 women were randomly assigned into each treatment arm to receive either a daily tablet of 200 µg elemental selenium or a placebo. Relevant participants' sociodemographic and clinical data were collected at enrollment and delivery. RESULTS: Women in the selenium arm had a significantly lower risk of preterm delivery (relative risk [RR] 0.32, 95% confidence interval [CI] 0.11-0.96) and a non-significant reduction in the risk of delivering term neonates with a low delivery weight (RR 0.24, 95% CI 0.05-1.19). Supplemental selenium does not increase the risk of perinatal death and adverse drug events. CONCLUSION: The study reported a beneficial effect of prenatal selenium supplements on the risk of preterm delivery with no further reduction in risk among HIV-infected women who used the supplements for more than 14 weeks. TRIAL REGISTRATION: Pan African Clinical Trial Registry (PACTR201809756724274).

Primary vaginal leiomyosarcoma: case report of a rare gynaecological malignancy and diagnostic challenge in a resource-constraint setting.

Primary vaginal leiomyosarcoma (VLMS) is an extremely rare variant of primary vaginal cancers with very poor prognosis irrespective of the stage at presentation and the type of treatment received. It is easily recurrent and has a high propensity for haematogenous spread especially to the lungs. We present the case of a 34-year-old Para 1 + 1 (1 alive) woman with recurrent vaginal mass of 8 years duration after two surgical excisions without histological evaluation. She had examination under anaesthesia and a wide local excision of the vaginal mass. Histological examination of the mass revealed poorly differentiated VLMS with positive surgical margins and she was commenced on adjuvant chemo-radiation. Histological evaluation remains the hallmark for diagnosing rare malignancies like VLMS, which unfortunately is not a standard practice in some resource-constraint settings.

Primary vaginal adenocarcinoma of intestinal-type: case report of a rare gynaecological tumour.

Vaginal cancer is rare and accounts for only 1 to 2% of all gynaecological malignancies. They arise as primary squamous cell cancers or are the result of extension from the cervix or vulva. Primary mucinous vaginal adenocarcinoma of intestinal-type is an extremely rare malignancy of unknown histogenesis with a diagnostic dilemma for the clinician and histopathologist. We presented the case of a 40-year-old Para 0+2 woman with the complaint of a mass in the vagina and recurrent vaginal bleeding who was evaluated and worked-up for examination under anaesthesia and biopsy of the vaginal mass. The histological examination revealed the unusual intestinal-type variant of adenocarcinoma of the vagina. Recognition of this rare entity is important, particularly to avoid the pitfall of misdiagnosing metastatic disease as primary vaginal cancer.