HIV and malaria co-infection in pregnancy in a teaching hospital in sub-Saharan Africa

Background: The high prevalence of Human immunodeficiency virus (HIV) and malaria infection in sub Saharan Africa, makes co-infection a burden in this region, as together, they are responsible for 4 million deathsannually. A study of the health implications of this interaction in our pregnant women is important.Objective: To determine the incidence and recurrence, incidence of febrile malaria infection in different stages of HIV infection among pregnant women, at Aminu Kano Teaching Hospital, Kano, Nigeria.Method: A retrospective analysis of 95 HIV-infected and 95 HIV-uninfected pregnant women, who met the recruitment criteria between January 2005 and December 2007. The study variables of interest were age and parity; occurrence and recurrence of febrile malaria infection in both groups; the incidence of febrile malaria infection in different stages of HIV-infection. The data was prospectively obtained and retrospectively analysed using Z and Chi-square tests. Odds ratio (OR) and confidence interval (CI) were determined where appropriate.Results: The incidence of febrile malaria co-infection among HIV-infected women was 22.1%. The occurrence of febrile malaria infection was three times higher (OR = 3.09, CI=1.21 – 8.11, P < 0.05), and recurrence was nine times higher (OR = 9.33, CI=0.83 – 241.31, P < 0.05) among HIV-infected pregnant women. Febrile malaria coinfection was significantly higher among those in the symptomatic stages compared to asymptomatic stage.Conclusion: There is increased frequency of febrile malaria parasitaemia among HIV-infected pregnant women. Effective Highly Active Antiretroviral Therapy (HAART) and antimalarial interventions through structured antenatal programs are needed.Keywords: HIV/AIDS, malaria fever, incidence, clinical cours

Preconception Care and Sickle Cell Anemia in Pregnancy

Background: Pregnancy in women with sickle cell anemia is associated with adverse outcome for mother and child, but with improvements in medical care, the outcome has greatly improved in developed countries. Despite being the most prevalent genetic disease in Africa, sickle‑cell disease, along with its serious health problems in pregnancy, is largely neglected.Objective: To determine the effects of preconceptual care on pregnancy outcome among booked patients with homozygous sickle cell disease at Aminu Kano Teaching Hospital, Kano, Nigeria.Materials and Methods: A cohort study of the pregnancy outcome, among booked 39 pregnant women with homozygous sickle cell disease (Hbss), who had preconception care, and an equal number of booked pregnant women with homozygous sickle cell disease (Hbss), who did not have preconception care (controls), at Aminu Kano Teaching Hospital, between January 2000 and December 2006.Results: There was no statistically significant difference in the occurrence of complications between the two groups, but complications occurred with less frequency among the cases compared to the controls.Conclusion: This study suggest that preconception care and effective prenatal care by a multidisciplinary team, and delivery in a hospital which is accustomed to management of sickle cell disease and its complications, is associated with good pregnancy outcome in women with sickle cell anemia in pregnancy. Keywords: Multidisciplinary team management, preconception care, pregnancy outcome, sickle cell anemi

Ectopic pregnancy at Aminu Kano Teaching Hospital, Kano, Nigeria

Background: Ectopic pregnancy is an important cause of maternal morbidity and mortality in developing countries like Nigeria. The incidence of ectopic pregnancy is on the increase worldwide.Objective: To determine the influence of age and parity on the incidence of ectopic pregnancy, findings at operation and pattern of treatment of ectopic pregnancy at Aminu Kano Teaching Hospital (AKTH), Kano,Nigeria.Methods: It was a descriptive retrospective study of 178 patients that were admitted with ectopic pregnancy at Aminu Kano Teaching Hospital between January 2006 and December 2009.Results: The incidence of ectopic pregnancy was 11.7 per 1000 deliveries, 14.7% of all gynaecological operations and 74.8% of all gynaecological emergency operations. Modal age and parity were 25-29 years age group, and para 1. Ruptured ectopic pregnancy ( 75%), right tubal ectopic pregnancy (58%) and ampullary implantation (66.9%) were the most common presentations. Hemoperitoneum of greater than 1 litre occurred in 62.7% of the cases, but only 11.8% had autotransfusion of blood. There was a rising trend in the incidence of ectopic pregnancy during the study period.Conclusion: Ectopic pregnancy is the commonest gynaecological emergency at AKTH. Early girl marriage made ectopic pregnancy to be more associated with older parous women. Ruptured ectopic pregnancy was the commonest presentation, which calls for community campaign to encourage early presentation in the hospital. Autotransfusion where not contraindicated should be used more in the management of ruptured ectopic pregnancy.  Key words: Ectopic pregnancy, incidence, operative findings, pattern of treatmen

Appraisal of the efficacy of SP-IPTP in Aminu Kano teaching hospital – impact on maternal anaemia, malaria parasitaemia and clinical malaria in pregnancy.

Background: Sulphadoxine-pyrimethamine (SP) intermittent preventive treatment in pregnancy (IPTp), is the malaria prophylaxis that is recommended in malaria endemic areas. Increasing reports of resistance to SP across the globe, make appraisal of its efficacy to be necessary in health facilities that use it.Objective: To determine the efficacy of SP – IPTp in the prevention of malaria in pregnancy using Proguanil chemoprophylaxis as the gold standard, in Aminu Kano Teaching Hospital, Kano, Nigeria.Methods: In this prospective study, 300 primigravid women were enrolled and assigned by block randomization to SP – IPTp (cases) or proguanil chemoprophylaxis (control) group. Each group consisted of 150 women. Study variables of interest were packed cell volume (PCV) at recruitment and at 34 weeks gestation, peripheral malaria parasitaemia, severe anaemia at 34 weeks gestation, and the frequency of clinical malaria during the study period in the two groups. The data obtained were recorded using tables. Students't-test, Z-test and chi-square test were used to compare means and proportions respectively for statistically significant differences, setting the level of significance at P < 0.05.Results: There was statistically significant increase in the PCV between recruitment and at 34 weeks in each group (P < 0.05), but there was no statistically significant difference in the PCV, peripheral malaria parasitaemia and frequency of clinical malaria between the two groups at 34 weeks gestation (P > 0.05).Conclusion: SP-IPTp has similar effectiveness as proguanil chemoprophlaxis. SP-IPTp is still effective in the prevention of malaria in pregnancy at Aminu Kano Teaching Hospital.Keywords ; Sulphadoxine-pyrimethamine, proguanil, malaria, pregnancy

Risk factors for peripartum hysterectomy among women with postpartum haemorrhage: analysis of data from the WOMAN trial.

BACKGROUND: Peripartum hysterectomy can cause significant morbidity and mortality. Most studies of peripartum hysterectomy are from high income countries. This cohort study examined risk factors for peripartum hysterectomy using data from Africa, Asia, Europe and the Americas. METHODS: We used data from the World Maternal Antifibrinolytic (WOMAN) trial carried out in 193 hospitals in 21 countries. Peripartum hysterectomy was defined as hysterectomy within 6 weeks of delivery as a complication of postpartum haemorrhage. Univariable and multivariable random effects logistic regression models were used to analyse risk factors. A hierarchical conceptual framework guided our multivariable analysis. RESULTS: Five percent of women had a hysterectomy (1020/20,017). Haemorrhage from placenta praevia/accreta carried a higher risk of hysterectomy (17%) than surgical trauma/tears (5%) and uterine atony (3%). The adjusted odds ratio (AOR) for hysterectomy in women with placenta praevia/accreta was 3.2 (95% CI: 2.7-3.8), compared to uterine atony. The risk of hysterectomy increased with maternal age. Caesarean section was associated with fourfold higher odds of hysterectomy than vaginal delivery (AOR 4.3, 95% CI: 3.6-5.0). Mothers in Asia had a higher hysterectomy incidence (7%) than mothers in Africa (5%) (AOR: 1.2, 95% CI: 0.9-1.7). CONCLUSIONS: Placenta praevia/accreta is associated with a higher risk of peripartum hysterectomy. Other risk factors for hysterectomy are advanced maternal age, caesarean section and giving birth in Asia

Maternal death and obstetric care audits in Nigeria: A systematic review of barriers and enabling factors in the provision of emergency care.

Acknowledgements We would like to thank Yutaka Osakabe for co-ordinating the retrieval of full text articles. The John D. and Catherine T. MacArthur Foundation supported this study, grant number 12-100074-000-INPPeer reviewedPublisher PD

Grand multiparity: Obstetric performance in Aminu Kano Teaching Hospital, Kano, Nigeria

No Abstract

Diagnostic laparoscopy in chronic pelvic pain: What are the issues in a resource poor country?

Background: In resource poor countries, the underlying diagnosis of the cause of chronic pelvic pain are unclear in many of the cases, because of the poor sophistication of the non-invasive investigation tools that are employed in making the diagnosis, and laparoscope is not available in many health facilities that manage gynaecological emergencies. A study of the role of diagnostic laparoscopy is necessary.Aim: To determine the role of diagnostic laparoscopy in management of chronic pelvic pain in a resource poor country.Method: A two year prospective, comparative study of 44 patients with chronic pelvic pain, who had initial diagnosis following non-invasive investigations (clinical/laboratory/ultrasound evaluation) and final diagnosis following laparoscopy, at Aminu Kano Teaching Hospital, Kano, Nigeria. The correlation of the initial diagnosis with final diagnosis (accuracy of initial diagnosis) was done using tests of validity.Results: The period incidence was 27.9% of all gynaecological diagnostic laparoscopy. The sensitivity of initial diagnosis for ectopic pregnancy was 60.0%, specificity 89.5%, positive predictive value (PPV) 81.8%, negativepredictive value (NPV) 51.5%, and accuracy 59.1%. For chronic pelvic inflammatory disease, the sensitivity was 23.3%, specificity 70.3%, PPV 21.4%, NPV 86.7%, and accuracy 61.4%. For pelvic adhesions, sensitivity was 0.0%, specificity 100.0%, PPV 0.0%, NPV 84.1% and accuracy 84.1%, and for uterine fibroids, the sensitivity was 100%, specificity 100%, PPV 100%, NPV 100% and accuracy 100%.Conclusion: Diagnostic laparoscopy should be strongly considered as a primary evaluation tool in the management of chronic pelvic pain in resource poor countries.Keywords: Chronic pelvic pain, resource poor countries, initial diagnosis, final diagnosis, tests of validit

A Study of Serum Testosterone and Luteinizing Hormone Levels in Patients with Low Libido at Aminu Kano Teaching Hospital, Kano, Nigeria.

Background: Low libido is considered to be the most prominent symptomatic reflection of low serum testosterone and it is unclear how frequent an individual who reported to the clinic with low libido indicates low serum testosterone levels. Objective: This study seeks to know how many of the self reported patients with low libido, have low serum testosterone or luteinizing hormone (LH) levels and whether there is an association between serum testosterone and self reported low libido in Nigerian males. Subjects and Methods: Testosterone and LH were measured in 50 middle aged male patients with low libido and 50 apparently healthy males using ELECSYS 1010 auto-analyzer. Results: Some 23.5% of the patients had abnormal hormone levels and significant decreases (p<0.001; p<0.05) were observed for testosterone and LH respectively. Low libido was associated with low testosterone levels (p<0.05) in these patients. Conclusion: Abnormal sex hormone levels were observed in about 24% of the patients and serum testosterone was associated with low libido. Male hypogonadism is under diagnosed at present, because not many of the affected patients can afford to pay for hormonal evaluations. Longitudinal community base study may highlight the true burden of the abnormalities. Keywords: Low libido, Testosterone, luteinizing hormone

Placenta praevia: prevalence and risk factors at aminu kano teaching hospital, kano, Nigeria.

In an attempt to reduce maternal mortality from obstetric haemorrhage worldwide, obstetrician now offer routine ultrasound scan for placental localization in the mid trimester more readily to pregnant women, especially those who have risk factor(s). Knowledge of the risk factors of placenta praevia in our hospital will be necessary. Hospital, Kano, Nigeria. Methods: This is a case control study of fifty-two women who were confirmed to have placenta praevia (cases) and were compared with the next four women who delivered after without placenta previa (control) from January 2007 to December 2008. The study variables of interest were prevalence, age, and parity of the patients, gestational age, and risk factors of placenta praevia. Chi-square test was used to determine significant association between categorical variables, Results: The prevalence of placenta praevia was found to be 0.7%. Women in the 30-34 years age group (OR- 2.03, CI= 1.02-4.02, P= 0.042), Multiparae (OR= 2.81, CI= 1.42 -5.61, P= 0.002), early pregnancy bleeding (OR= 8.66, CI= 3.73 -20.33, P<0.001), previous uterine/caesarean section scar (OR= 4.21, CI= 1.97 - 9.02, P<0.001) and previous placenta praevia (OR= 4.32, CI= 1.03 -18.11, P= 0.030) all conferred increased risk placenta praevia Conclusion: Maternal age 30-34 years, multiparity, early pregnancy bleeding, previous uterine/caesarean section scar and previous placenta praevia were found to have significant association with placenta praevia in this study