Maternal anaemia care in Kano state, Nigeria: an exploratory qualitative study of experiences of uptake and provision

Background: Maternal anaemia (anaemia in pregnancy, childbirth, and the postpartum period) remains a persistent challenge, particularly in Kano State, Nigeria, which has the highest prevalence of maternal anaemia globally, at 72%. Methods: We conducted a qualitative study in Murtala Muhammad Specialist Hospital in Kano State, Nigeria. We aimed to identify factors constraining uptake and provision of maternal anaemia care, exploring perspectives across different stakeholders. We carried out 10 key informant interviews with policymakers and hospital managers, 28 in-depth interviews with healthcare providers and pregnant women using antenatal services and four focus group discussions with pregnant women’s husbands and mothers-in-law. Data were analysed thematically. Results: Issues with provision include a lack of provider training and guidelines specific to maternal anaemia and blood transfusion, insufficient staff to meet increasing demand, and inadequate resources. Issues with uptake include the inability to afford informal user fees, distrust in health services and the blood transfusion process, and a lack of understanding of the causes, consequences, and treatment for anaemia, resulting in poor uptake of care and adherence to treatment. Conclusions: This study recommends the implementation of standardized guidelines and training sessions to better support healthcare providers in offering quality services and increasing funding allocated to supporting maternal anaemia care. Education initiatives for service users and the public are also recommended to build public trust in health services and to improve understanding of maternal anaemia

Changes in iron status markers in pregnant women in Kano, north-western Nigeria Asian Journal of Medical and Clinical Sciences Short Communication

Objective: The objective of this study was to assess the iron status markers in pregnant women in Kano North-western Nigeria. Methods: The study was conducted on 59 apparently healthy pregnant women at their first bookings in the antenatal clinic of Aminu Kano Teaching Hospital, Kano in addition to 32 healthy non-pregnant women from Kano metropolis between January and June, 2011. The serum iron and total ironbinding capacity (TIBC) were analysed using Giesse Diagnostics kits manufactured in Italy while packed cell volume (PCV) was determined using micro-haematocrit method. Results: There were no significant differences observed between pregnant and non-pregnant women with regard to serum iron, latent iron-binding capacity (LIBC), transferrin saturation index (TSI) and TIBC (P>0.05) while pregnant women had significant lower value of PCV of 33.1 ± 2.8% compared to 34.5 ± 2.8% in non-pregnant women (P<0.05). There were no influences of age and gestational period on serum, TIBC, LIBC, TSI and PCV during pregnancy (P>0.05). Conclusion: The study of iron status markers in pregnant women in Kano is associated with mild anaemia and reduction in iron stores as the pregnancy progresses especially in the second and third trimester periods. It is therefore recommended to determine the level of iron stores of pregnant women before the prescription of supplemental iron dose is made. folic acid and ascorbic acid as the deficiency of these nutrients [1,2] could affect pregnancy, delivery and its outcome . The absorption of iron in normal women is 15-30% but can increase to 50% during pregnancy and therefore, the amount of iron that can be absorbed from an optimal diet is less than the iron requirement in later part of pregnancy which makes the iron [3,4] stores of =300 mg necessary to meet the requirements fully . Increase in the demand for Iron during pregnancy results from increased utilization by the growing foetus, placenta as well as the increasing maternal blood volume and red cell mass which makes iron supplementation to be necessary since maternal iron [5,6] stores cannot meet all these demands . A daily dose of 60 mg ferrous iron which is equivalent to 2g/L rise in haemoglobin is recommended from the second half of the pregnancy to combat iron-deficiency which is common in most of the developing [7, Previous studies have shown significant reduction in packed cell volume (PCV) values during pregnancy compared to However, raised total iron binding capacity (TIBC) in The study of the changes in iron status markers (serum iron, TIBC, Latent iron-binding capacity, PCV and TSI) in pregnant women was necessitated due to paucity of information on these parameters in Northern Nigeria as variations in these values can be associated with nutrition, dietary habits , socio- MATERIALS AND METHODS A total of ninety-one apparently healthy subjects (59 pregnant and 32 non-pregnant women), aged 18-38 years were recruited for this study in Aminu Kano Teaching Hospital (AKTH), Kano between January and June, 2011. Ethical approval and consent were obtained from the ethical committee of AKTH, Kano and the subjects respectively. 5ml of blood was drawn from antecubital vein by clean venepuncture from each subject with sterile syringe and 2.5ml of blood was put into Ethylene Diamine Tetra-acetic Acid (EDTA) bottle for the determination of PCV while the remaining 2.5ml of blood was put into plain container for the determination of serum iron and TIBC. Momodu Imoru * ,Aisha Kuliya-Gwarz

Evaluating laboratory request forms submitted to haematology and blood transfusion departments at a hospital in Northwest Nigeria

Background: The laboratory request form (LRF) is a communication link between laboratories, requesting physicians and users of laboratory services. Inadequate information or errors arising from the process of filling out LRFs can significantly impact the quality of laboratory results and, ultimately, patient outcomes. Objective: We assessed routinely-submitted LRFs to determine the degree of correctness, completeness and consistency. Methods: LRFs submitted to the Department of Haematology (DH) and Blood Transfusion Services (BTS) of Aminu Kano Teaching Hospital in Kano, Nigeria, between October 2014 and December 2014, were evaluated for completion of all items on the forms. Performance in four quality indicator domains, including patient identifiers, test request details, laboratory details and physician details, was derived as a composite percentage. Results: Of the 2084 LRFs evaluated, 999 were from DH and 1085 from BTS. Overall, LRF completeness was 89.5% for DH and 81.2% for BTS. Information on patient name, patient location and laboratory number were 100% complete for DH, whereas only patient name was 100% complete for BTS. Incomplete information was mostly encountered on BTS forms for physician’s signature (60.8%) and signature of laboratory receiver (63.5%). None of the DH and only 9.4% of BTS LRFs met all quality indicator indices. Conclusion: The level of completion of LRFs from these two departments was suboptimal. This underscores the need to review and redesign the LRF, improve on training and communication between laboratory and clinical staff and review specimen rejection practices

Hematological parameters of human immunodeficiency virus positive pregnant women on antiretroviral therapy in Aminu Kano Teaching Hospital Kano, North Western Nigeria

CONTEXT: Human immunodeficiency virus (HIV) scourge continues to affect young women within the reproductive age group and pregnancy is a recognized indication for the use antiretroviral (ARV) drugs among HIV-positive women. AIMS: The aim is to determine the combined effect of pregnancy, HIV and ARV drugs on the hematological parameters of the pregnant women. SETTINGS AND DESIGN: This was a comparative cross-sectional study conducted among 70 each of HIV-positive and negative pregnant women. SUBJECTS AND METHODS: Bio-demographic and clinical data were extracted from the client folder and 4 ml of blood sample was obtained from each participant. Full blood count was generated using Swelab automatic hematology analyzer while reticulocyte count and erythrocyte sedimentation rate (ESR) were conducted manually. STATISTICAL ANALYSIS USED: Data analysis was performed using SPSS version software 16 while P < 0.05 was considered statistically significant. RESULTS: Pregnant women with HIV had statistically significant lower hematocrit and white blood cell (WBC) and higher ESR than pregnant women without HIV (P 0.05). However, among HIV positive pregnant women, those with CD4 count 0.050) between women on first- and second-line ARV regimens. CONCLUSIONS: There is a significant difference in terms of hematological parameters between HIV-positive and HIV-negative pregnant women in this environment

Hematological parameters of human immunodeficiency virus positive pregnant women on antiretroviral therapy in aminu kano teaching hospital Kano, North Western Nigeria

CONTEXT: Human immunodeficiency virus (HIV) scourge continues to affect young women within the reproductive age group and pregnancy is a recognized indication for the use antiretroviral (ARV) drugs among HIV-positive women. AIMS: The aim is to determine the combined effect of pregnancy, HIV and ARV drugs on the hematological parameters of the pregnant women. SETTINGS AND DESIGN: This was a comparative cross-sectional study conducted among 70 each of HIV-positive and negative pregnant women. SUBJECTS AND METHODS: Bio-demographic and clinical data were extracted from the client folder and 4 ml of blood sample was obtained from each participant. Full blood count was generated using Swelab automatic hematology analyzer while reticulocyte count and erythrocyte sedimentation rate (ESR) were conducted manually. STATISTICAL ANALYSIS USED: Data analysis was performed using SPSS version software 16 while P < 0.05 was considered statistically significant. RESULTS: Pregnant women with HIV had statistically significant lower hematocrit and white blood cell (WBC) and higher ESR than pregnant women without HIV (P < 0.000). There was no statistically significant difference between the two groups in terms of platelet and reticulocyte (P > 0.05). However, among HIV positive pregnant women, those with CD4 count <350/μL had statistically significant lower WBC and lymphocyte count than those with CD4 count ≥350/μL (P < 0.05), whereas, those on zidovudine (AZT)-containing treatment had statistically significant lower hematocrit and higher mean cell volume than those on non-AZT-containing treatment (P < 0.05), but there was no statistically significant difference in any of the hematological parameters (P > 0.050) between women on first- and second-line ARV regimens. CONCLUSIONS: There is a significant difference in terms of hematological parameters between HIV-positive and HIV-negative pregnant women in this environment