A Guide to Obstetric Risk Assessment and Referral Cascade in the Primary and Secondary Healthcare Settings in Nigeria

Obstetric risk assessment and referral cascade are two interdependent and indispensable aspects of obstetric practice used to identify high risk pregnancies with subsequent referral to a higher level of care. The aim of the study was to formulate a practice guideline for obstetric risk assessment and referral cascade from primary and secondary healthcare settings to tertiary care facilities for specialised care. It was of mixed design – observational descriptive and a systematic review carried out at the Rivers State University Teaching Hospital (RSUTH). Four groups of obstetric risk factors on which obstetric referral cascade depend were clearly defined, namely intra-partum risk factors necessitating referral to tertiary centres, medical conditions indicating increased risk suggesting antenatal care and planned birth in tertiary centres, factors and medical conditions indicating increased risk suggesting referral for booking and planned delivery in tertiary centres but for joint antenatal care at all settings of obstetric care and lastly, risk factors with known timing of occurrence and outcome necessitating referral to tertiary centres when complications occur. The urgent need for structured retraining of obstetric Practitioners and equipping primary and secondary healthcare facilities with medical instruments was also emphasised. In conclusion, four obstetric risk groups necessitating referral to tertiary health facilities were identified and the need for structured retraining of antenatal/birth Attendants and adequate equipment of healthcare facilities was highlighted

Human bite and HIV transmission

The concentration of human immune-deficiency virus (HIV) in the saliva of a carrier is low. As a result, human bite is not considered to be a likely route of HIV infection transmission, and this is even less likely because of the presence of HIV inhibitor in the saliva. There has been no well documented HIV transmission through human bite. The few reported cases of HIV sero-conversion following human bite suggest that there must be blood in the mouth of the biter and a discontinuity in the body part of the bitten for transmission to occur

Human bite and HIV transmission

The concentration of human immune-deficiency virus (HIV) in the saliva of a carrier is low. As a result, human bite is not considered to be a likely route of HIV infection transmission, and this is even less likely because of the presence of HIV inhibitor in the saliva. There has been no well documented HIV transmission through human bite. The few reported cases of HIV sero-conversion following human bite suggest that there must be blood in the mouth of the biter and a discontinuity in the body part of the bitten for transmission to occur

Prevalence and determinants of utero-vaginal prolase in southern Nigeria

Background: Utero-vaginal (u-v) prolapse is primarily a disease of the parous and often elderly post-menopausal women. The number of ageing women appears to be increasing in proportion due to the increasing life expectancy. Methods: This was a retrospective review of the service delivery records (case notes, ward and Theater records) of 21 women who presented with u-v prolapse at the gynaecological unit of University of Port Harcourt Teaching Hospital over a 5-year period. Results: The incidence of u-v prolapse is 1.6% per total number of patients who underwent major gynecological surgeries. The leading determinants of u-v prolapse were – multiparity, difficult delivery, menopause, ageing and physically exerting occupations. Others were no formal education or low levels of education and diet. Conclusion: We recommend that there is a need for public health education geared towards enlightening the populace on the need for antenatal care and supervised hospital delivery, reduced family size, improved nutrition, and the need for hormone replacement therapy for post-menopausal women particularly high parity individuals. Finally, female education should be given priority attention.Key words: Determinants, utero-vaginal prolapse, SouthernNigeri

Practical Approach to Sub-specialty Training in Maternal Foetal Medicine (MFM) in Nigeria

The heavy burden of maternal and perinatal morbidities and mortalities in Nigeria, most of which are MFM-related has stimulated the introduction of subspecialty training in MFM. Unfortunately in the available curriculum, less attention was paid to the ultrasound-related aspect of the training and also there was less clarity on the order of navigation through the various modules of the training. The objective of the present study therefore was to design a sub-specialty training curriculum in MFM with practical approach to its execution, taking into consideration the Nigerian ethno- cultural peculiarities, its disease topography and the level of its economic development. It was of mixed design study, with both observational and review components. A literature search and telephone communication with MFM specialists in tertiary health institutions in Nigeria on the subject were carried out. There was no structured training program in MFM in Nigeria. A competency-based modular training framework whereby acquisition of ultrasound-based competencies intertwined with the maternal medicine components of the training was proposed. The ultrasound modules to be covered were as following: first trimester scan at 11+0 to 13+6 weeks, the 20 + 0 to 23 + 6 weeks scan, growth and doppler ultrasound, cervical assessment, foetal echocardiography, application of ultrasound in the management of labour, screening for and diagnosis of placenta accrete spectrum and invasive procedures. Successful completion of the training modules, including rural posting, rotation in allied disciplines will earn the trainee an exemption from the dissertation component of the part II fellowship examination and award of fellowship or diploma in MFM, depending on whether the trainee completed the invasive module or not

High prevalence of hepatitis B virus among female sex workers in Nigeria Alta prevalência de hepatite pelo vírus B entre trabalhadoras do sexo feminino na Nigéria

Hepatitis B virus (HBV) infection is endemic in Nigeria and constitutes a public health menace. The prevalence of HBV infection in many professional groups has been described in Nigeria. However, literature on HBV infection among female sex workers (FSW) in Nigeria is scanty. FSW in Nigeria are not subjected to a preventive control of HBV infection. This study assesses the extent of spread of HBV among FSW in Nigeria. Seven hundred and twenty (n = 720) FSW (mean age = 26.7 years) were tested for hepatitis B surface antigen (HBsAg) by a double antibody sandwich ELISA method. The overall HBV prevalence among the FSW was 17.1%. FSWs between the ages of 31-35 year (20.5%) and those with 'age-at-first-sex' below 10 years of age (28%) were most affected. This high prevalence of a vaccine preventable disease is unacceptable, therefore, vaccination of this high risk HBV reservoir group should be considered worthwhile.<br>A hepatite pelo vírus B (HBV) é infecção endêmica na Nigéria e constitui problema de saúde pública. A prevalência da infecção HBV em muitos grupos profissionais foi descrito na Nigéria. No entanto, a literatura da infecção HBV entre trabalhadoras do sexo feminino (FSW) na Nigéria é escasso. FSW na Nigéria não são submetidas a um controle preventivo de infecção de HBV. Este estudo avalia a extensão da disseminação de HBV entre FSW na Nigéria. Setecentos e vinte (n = 720) FSW (média de idade = 26,7 anos) foram testadas para antígeno de superfície da hepatite B (HBsAg) pelo método ELISA usando sandwich de duplos anticorpos. A prevalência total de HBV entre o FSW foi 17,1%. FSWs entre as idades de 31-35 anos (20,5%) e abaixo de 10 anos de idade (28%) foram mais afetadas. Esta alta prevalência de doença evitável pela vacinação é inaceitável, portanto, vacinação deste grupo de alto risco de HBV deve ser considerada fundamental

Emergency Contraceptive Knowledge and Use among Urban Women in Nigeria and Kenya

Rates of emergency contraception (EC) use in sub-Saharan Africa are highest in Kenya and Nigeria, although little is understood about user characteristics and use dynamics in these countries. In order to better meet the emergency contraceptive needs of women, and contribute to the limited knowledge base on EC in Africa, this study examines a large, representative sample of EC users. It draws on data collected from household surveys that included 7,785 sexually experienced women in urban Kenya and 12,653 sexually experienced women in urban Nigeria. Bivariate and multivariate analyses found that among these urban women, knowledge of EC was higher than reported in other nationally representative surveys (58% in Kenya and 31% in Nigeria). About 12% of sexually-experienced women in Kenya and 6% in Nigeria ever used EC, although fewer women (less than 5%) reported using EC in the past one year. Recent users of EC were more likely to be in their twenties, unmarried, and more highly educated than never users or ever users of EC in both countries. Results contradict public perceptions of EC users as younger adolescents, and indicate the importance of strengthening EC provision in Africa, including targeting information and services to unmarried women and supporting private pharmacies in delivering quality EC services