Maternal side effects of efavirenz‑containing highly active antiretroviral therapy (HAART): A comparative study of HIV‑positive pregnant and nonpregnant women in a tertiary hospital

Background: Efavirenz is now a first‑line non‑nucleoside reverse transcriptase inhibitor used as highly active antiretroviral therapy (HAART) though its use is fraught with maternal side effects, usually of the central nervous system (CNS) and fetal complications.Objective: The study aims to comparatively document the maternal side‑effect profile of an efavirenz‑containing fixed‑dosage HAART and compliance with its use in HIV‑positive pregnant and nonpregnant women at the Lagos University Teaching Hospital (LUTH), Idi‑Araba.Methodology: A prospective study among HIV‑positive pregnant (40) and nonpregnant women (40) on efavirenz‑containing fixed‑dose HAART (Atripla®) who were recruited purposively at the antenatal clinic and AIDS Prevention Initiative Nigeria (APIN) clinics of LUTH. Data analysis was done with EPI Info 2014, and the results are presented in frequencies.Results: The mean age of respondents was 31 ± 5.7 years. Atripla® was the only fixed‑dose combination used. Fifty‑three percent and 62.5% of pregnant and nonpregnant HIV‑positive women, respectively, reported CNS side effects of Atripla® [odds ratio: 0.66, 95% confidence interval 0.27–1.62]. Adherence to the use of Atripla® was 100% among HIV‑positive pregnant women. Women with baseline viral load values greater than 400 copies/mL reported more side effects to Atripla®.Conclusion: There are similar side‑effect profiles of Atripla® in HIV‑positive women irrespective of pregnancy. Education and counselling can help foster adherence, resulting in improved immunological and virological outcome.Keywords: Efavirenz; HAART; maternal; side-effect

Effect of training on the knowledge and use of the partograph for low risk pregnancies among health workers in a tertiary hospital in Lagos State, Nigeria

Background: Partogram use is important for early recognition of deviations in labour. This study assessed the effect of training on the knowledge and use of the partogram in low-risk pregnancy (LRP).Methods: This is an analytical before and after study at the Lagos University Teaching Hospital. Fifty-two health personnel who conduct deliveries in the labour ward were assessed before and after a training on the proper utilization of the partogram which used WHO recommendations on the integrated management of pregnancy and child birth. Comparison of knowledge and utilization of the partogram before and after the training was estimated using the chi square test. The level of significance was p<0.05.Results: Thirty-two (61.5%) of the respondents were resident doctors while 38.5% were midwives. Only 27% of them had had any formal training on partogram use in the three years preceding the intervention. Training significantly improved knowledge of the partogram by improving standard records for cervical dilatation, uterine contraction and fetal descent; reducing substandard records for uterine contraction and fetal descent and no records, (p=0.0001). Training only significantly affected the utilization of the partogram in reference to blood pressure readings. There was a significant increase in substandard records and a reduction in standard records, (p=0.001)Conclusion: Training improved knowledge, but not the use of the partogram by health workers. Greater emphasis should be placed on the use of the partogram in monitoring labour progress in women with low risk pregnancies.Keywords: Partogram; Training; Labour management; Intrapartum car

Enhanced urinalysis in the detection of asymptomatic bacteriuria in pregnancy

Background: Detection and treatment of asymptomatic bacteriuria (ASB) in pregnancy is important to avert the attendant maternal and fetal morbidity. Other than urine culture, no other screening test is unequivocal.Objective: The use of enhanced urinalysis test to detect ASB in pregnancy was investigated.Methods: This was a prospective observational study which compared enhanced urinalysis with dipstick tests and urine culture. Clean catch midstream urine specimen was collected from 150 consecutive asymptomatic pregnant women. Tests of validity were used for comparison.Results: Enhanced urinalysis detected bacteriuria as much as urine culture (4% vs. 4.7%). It was 57.1% sensitive and 98.6% specific. It had a false negative rate of 42.9% and was 96.7% accurate when compared to urine culture. Enhanced urinalysis took 1-2 hours to be done and required skills to use the microscope and was more expensive than dipstick urinalysis.Conclusion: The accuracy of enhanced urinalysis and its ability to detect ASB as much as urine culture connotes that it can be used to detect asymptomatic bacteriuria in pregnancy albeit only in secondary and tertiary health centres because of the cost and technicality involved.Keywords: Asymptomatic bacteriuria, UTI in pregnanc