Routine antenatal syphilis screening in South West Nigeria - a questionable practice

Background: Untreated maternal syphilis is strongly associated with adverse birth outcomes, especially in women with high titre syphilis. The WHO recommends routine serological screening in pregnancy. Some workers have advised a reappraisal of this practice, having demonstratedlow sero-prevalence in their antenatal population. In view of this, the aim of this study was to determine the seroprevalence of syphilis in the antenatal population presenting at a major hospital in south-west Nigeria.Methods: This was a cross sectional study of healthy pregnant Nigerian women attending Adeoyo Maternity Hospital in the capital of Oyo State. The case record of every pregnant woman presenting for their first antenatal clinic visit over a 4-month period (September 1st to December 31st 2006) was reviewed.Results: During the study period, two thousand six hundred and seventy-eight women sought antenatal care. Three hundred and sixty-nine women (369; 13.4%) had incomplete records and were excluded from analysis. The records of the 2,318(86.6%) women with adequate records were subsequently reviewed. The mean age of the women was 27.4years (± 5.34) and the mean gestational age 26.4 weeks (±6.36). The modal parity was 0. Only three patients were found to be reactive for syphilis giving a prevalence of 0.13%. Conclusion: The sero- prevalence value in this study is quite low and may justify the call to discontinue routine antenatal syphilis screening. However, a more rigorous screeningprogram using diagnostic tests with higher sensitivity maybe necessary before jettisoning this traditional aspect of antenatal care.Keywords - Pregnancy; syphilis; prevalence; serology; screenin

Demographic and epidemiological characteristics of HIV opportunistic infections among older adults in Nigeria

Background: In view of the maturing HIV epidemic in sub-Saharan Africa, better understanding of its epidemiology among older adults is necessary in order to design appropriate care and treatment programmes for them.Objectives: To describe the demographic and epidemiological characteristics of HIV opportunistic infections among newly enrolled patients aged 50 years and above in Ibadan, South-West Nigeria.Methods: Analysis of data extracted from electronic records of 17, 312 subjects enrolled for HIV/AIDS care and treatment between January 2006 and December 2014 at the ART clinic, University College Hospital, Ibadan.Results: Age of the patients ranged from 18 to 90 years with a mean of 36.4 years (SD= 10.3) with older adults constituting 12.0% (2075). Among older adults, about half (52.9%) were females. Majority (59.1%) were currently married while 25.9% were widowed. Prevalence of opportunistic infections was 46.6%. The commonest opportunistic infections (OIs) were: oral candidiasis (27.6%), chronic diarrhoea (23.5% and peripheral neuropathy (14.8%). Significant factors associated with opportunistic infections in older adults were: CD4 count less than 350 (OR=3.12, CI: 2.29-4.25) and hepatitis C virus co-infection (OR=2.17, CI: 1.14-4.13).Conclusion: There is need for prompt response to the peculiar challenges associated with the emerging shift in the epidemiology of HIV and associated infections in sub-Saharan Africa.Keywords: HIV/AIDS, older adults, epidemiological characteristics, opportunistic infections, Nigeri

Demographic and epidemiological characteristics of HIV opportunistic infections among older adults in Nigeria.

Background: In view of the maturing HIV epidemic in sub-Saharan Africa, better understanding of its epidemiology among older adults is necessary in order to design appropriate care and treatment programmes for them. Objectives: To describe the demographic and epidemiological characteristics of HIV opportunistic infections among newly enrolled patients aged 50 years and above in Ibadan, South-West Nigeria. Methods: Analysis of data extracted from electronic records of 17, 312 subjects enrolled for HIV/AIDS care and treatment between January 2006 and December 2014 at the ART clinic, University College Hospital, Ibadan. Results: Age of the patients ranged from 18 to 90 years with a mean of 36.4 years (SD= 10.3) with older adults constituting 12.0% (2075). Among older adults, about half (52.9%) were females. Majority (59.1%) were currently married while 25.9% were widowed. Prevalence of opportunistic infections was 46.6%. The commonest opportunistic infections (OIs) were: oral candidiasis (27.6%), chronic diarrhoea (23.5% and peripheral neuropathy (14.8%). Significant factors associated with opportunistic infections in older adults were: CD4 count less than 350 (OR=3.12, CI: 2.29-4.25) and hepatitis C virus co-infection (OR=2.17, CI: 1.14-4.13). Conclusion: There is need for prompt response to the peculiar challenges associated with the emerging shift in the epidemiology of HIV and associated infections in sub-Saharan Africa

Society of obstetrics and gynecology of Nigeria – Clinical practice guidelines: Guidelines for the prevention of cervical cancer

Clinical practice guidelines have been developed by professional societies globally. Each guideline although based on published scientific evidence reflected each country’s socioeconomic peculiarities and unique medical environment. The Society of Obstetrics and Gynaecology of Nigerian has published guidelines in other clinical areas; however, this is the first edition of practice guidelines for the prevention of cervical cancer. The Guidelines Committee was established in 2015 and decided to develop the first edition of this guideline following Delphi pool conducted among members which selected cervical cancer prevention as the subject that guideline is urgently needed. These guidelines cover strategies for cervical cancer prevention, screening, and management of test results. The committee developed the draft guideline during a 2‑day workshop with technical input from Cochrane Nigeria and Dr. Chris Maske, Lancet Laboratories, South Africa. The recommendations for each specific area were developed by the consensus, and they are summarized here, along with the details. The objective of these practice guidelines is to establish standard policies on issues in clinical practice related to the prevention of cervical cancer.Keywords: Cervical cancer; guideline; management; prevention; screening; Society of Obstetrics and Gynecology of Nigeria

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Early pregnancy body mass index and obstetric outcomes in Ibadan

Introduction: Obesity in pregnancy has been associated with adverse pregnancy outcomes. In this study, we estimate the prevalence of early pregnancy obesity and the impact on materno-fetal outcomes. Materials and Methods: A cohort of 176 pregnant women were purposively recruited before 20 weeks. Women <18 years, with multiple pregnancies or chronic medical conditions, were excluded from the study. Body mass index (BMI) grouping was done at the first clinic. Data were presented as means (standard deviation) and proportions and differences compared using Chi-square or ANOVA. Results: Early pregnancy weight of 173 women followed up from booking to delivery showed 41.2%, 24.3%, and 32.2% were normal weight, overweight, and obese, respectively. At recruitment, the mean age, mean BMI, and mean gestational age were 31.7 ± 4.4 years, 27.1 ± 5.3 kg/m2, and 14.4 ± 3.2 weeks, respectively. Compared to normal weight women, the obese were older (31.1 ± 4.0 vs. 32.8 ± 4.1, P = 0.06) and of higher parity >2 (19.2% vs. 36.9%, P = 0.17). Compared to those with normal BMI, occurrence of gestational diabetes mellitus (1.3% vs. 10.53%) and preeclampsia (6.9% vs. 14.0%) were more in obese women whereas overweight women had higher occurrence of pregnancy-induced hypertension (6.9% vs. 16.3%) and preeclampsia (6.9% vs. 13.95%). At delivery, compared to normal weight, obese women had more cesareans (57.5% vs. 69.7%), more deliveries <37 weeks (20.6% vs. 41.07%), more babies <2.5 kg (13.7% vs. 25.0%), acrosomic (9.6% vs. 12.5%), and more special care baby unit admissions (4.1% vs. 10.7%). Conclusion: Even in low-resource setting, obesity in pregnancy is not uncommon. Affected women would benefit from prepregnancy interventions

Mobilising Human and Financial Resources for Maternal Health

Effective mobilisation of human and financial resources in healthcare is critical for Africa’s development. In the last two decades, Africa has witnessed a dramatic increase in life expectancy at birth. This progress was possible because of improvements in healthcare delivery systems that have been implemented by governments in the continent. Human and financial capital management, including a deep understanding and commitment to their development and smart mobilisation, are at the heart of effective healthcare delivery. However, there remains a significant gap in the capacity of health systems to deliver quality healthcare to all of their citizens due to weaknesses in the mobilisation of scarce human and financial resources. In this chapter, we provide a general overview of the practice of human and money management in healthcare systems with a specific focus on the organisation of resources within the Nigerian healthcare system. The chapter also considers local and foreign sources of funding and presents a critical discussion of the implications of the diminishing role of international donor organisations. This is followed by a robust analysis of the role of technology in monitoring human resources in public health programmes, improving access to services and forecasting the demand and supply of resources. The chapter concludes by articulating new paradigms for consensus building and ensuring long-term sustainability of human and financial resources

Blood donation and transfusion: Perception of pregnant women at the University College Hospital, Ibadan

Background: At the University College Hospital (UCH), Ibadan, there is a policy of compulsory blood donation by relatives of pregnant women registered for care. This study assesses the perception of these women about blood donation and transfusion and compliance with the policy. Materials and Methods: This cross-sectional study was among women registered for antenatal care at UCH. By nonprobability purposive sampling, 300 pregnant women >18 years were recruited from July 1, 2017, to September 30, 2017. Women presenting for emergency care and Jehovah's Witnesses were excluded from the study. Information was obtained using pretested questionnaires. Data are presented as means (standard deviation), simple frequency, and percentages. Results: Among the 300 participants, the mean age was 31.0 (±3.7) years, 194 (64.6%) were multiparous, 94.4% had postsecondary education, and 263 (87.7%) were Yoruba by ethnicity. Concerning perception about blood donation, 221 (73.7%) agreed that blood can be donated and stored for the future use, 279 (93.0%) thought that blood donation is good, 214 (71.3%) agreed that voluntary blood donation is best, and both men and women could donate (269, 89.7%). Concerning the effect of blood donation, 229 (74.6%) agreed/strongly agreed that donation could cause weakness. However, 195 (65.0%) and 194 (64.0%) disagreed/strongly disagreed with donation causing loss of sexual drive or death. Concerning transfusion, 273 (90.7%) and 253 (84.3%), respectively, agreed that women may need blood during pregnancy/delivery, and hemorrhage during labor/delivery may lead to death. Finally, 266 (88.7%) were aware of the hospital policy although only 133 (44.3%) had complied. Conclusion: The positive perception was unmatched with compliance suggesting unidentified factors for further research