Effects of Birth Preparedness and Complication Readiness on Pregnancy Outcome in Nigeria

Background: Birth preparedness and complication readiness (BPCR), a component of focused antenatal care, has a great potential to reducing maternal and newborn deaths in low‑income countries. However, the success of this strategy is not well known in most of sub‑Saharan Africa, and the effectiveness of the strategy has not been widely studied. Aims: This study aimed at evaluating the effects of BPCR on pregnancy outcome. Materials and Methods: This was an observational cohort study of eligible consecutive pregnant women presenting in labour at a tertiary hospital in Abakaliki, Nigeria. Maternal and neonatal outcomes of labour were compared between women who had a birth plan (n = 115) and a control group without a birth plan (n = 115). Results: The mean age of the parturients was 27.87 ± 5.20 years. Women who had a birth plan were less likely to have postpartum anaemia (P < 0.001), receive blood transfusion (P < 0.001), and have prolonged hospital stay (P = 0.03). Their neonates were at less risk of low birth weight (P = 0.02) and admission into newborn special care unit (P = 0.003). There was no association between BPCR and incidence of Caesarean section (P = 0.65) and maternal satisfaction (P = 0.20). Conclusion: The practice of BPCR in Abakaliki, Nigeria, is associated with some favourable maternal and neonatal outcomes. The study findings indicate the need for more advocacies for adequate implementation of BPCR during pregnancy in Nigeria.&nbsp

Coping Strategies of Infertility Clients Attending Gynecological Clinic in South-eastern Nigeria

Background: Infertility is the failure of a couple to achieve pregnancy after 12 months or more of regular unprotected sexual intercourse. It causes psychological and social consequences for couples. This study aimed to ascertain the “Coping strategies of infertility clients attending gynecological clinic in South-eastern Nigeria.” Subjects and Methods: A cross-sectional descriptive survey was used. One hundred and twenty participants were drawn from a population of one hundred and fifty clients, using the power analysis formula of sample size calculation. Participants were selected using a purposive sampling technique. One hundred and seventeen participants were analyzed using the Statistical Package for the Social Sciences version 25. Descriptive and inferential statistics were used at a 0.05 level of significance. P < 0.05 was considered statistically significant. Results: Majority of the participants use self-controlling, positive reappraisal coping strategy, and social seeking support strategy. There is no significant difference in the mean responses of male and female participants with infertility on their use of coping strategies. The respondents used more self-controlling (86.3%) strategies than they used positive reappraisal (62.4%), escape‐avoidance (59.8%), and other coping strategies (47.0%) and these showed statistical significance (P < 0.05). Even though they used social support seeking as much as they used self‐controlling strategies, this finding was not significant (P > 0.05). Furthermore, gender was found to have a significant influence on the coping strategies among the study participants (P < 0.05). Conclusion: The couple’s capacity to adapt to infertility-related stress depends on the coping strategies, which have different impacts on individuals’ mental health. Hence, this study suggested the need for health-care providers to integrate psychological counseling into the care of clients with infertility challenges

Impact of neoadjuvant chemotherapy in improving operative intervention in the management of cervical cancer in low resource setting: a preliminary report

There is paucity of data on interventions to improve cancer outcome in the low-resource setting. This study aims to determine the effect of Neoadjuvant Chemotherapy (NACT) in improving operative outcomes of cervical cancer. This was a longitudinal intervention study of patients diagnosed with FIGO stage IIB - IIIA cervical cancer that had NACT. Patients were re-evaluated after treatment with 4 cycles of chemotherapy for operability. McNemar test was used to determine changes in operability of the tumour. There was a significant difference in the number of patients that converted from inoperable to operable tumor post-chemotherapy. This study shows some promise for NACT for FIGO stage IIB - IIIA cancer of the cervix, especially in low-resource settings, where radiotherapy is scarce

Prevalence, outcome, and predictors of placenta migration among pregnant women with placenta praevia in Enugu Nigeria

Background: Placenta praevia is one of the leading causes of obstetric haemorrhages and a major contributor to maternal and fetal morbidity and mortality. Although low-lying placentae are common during routine midtrimester anomaly scans, the incidence of placenta praevia at term remains low, probably due to placenta migration. It is important to follow-up pregnant women with low-lying placentae to identify the few whose placenta will remain in the lower segment and hence at risk of major obstetric haemorrhage. Aim: The objectives of this study were to determine the prevalence, predictors, and pregnancy outcome of low-lying placenta diagnosed in the midtrimester. Materials and Methods: The study was a cohort study with longitudinal follow-up of 416 pregnant women from the University of Nigeria Teaching Hospital, Enugu State University Teaching Hospital, and Mother of Christ Specialist Hospital who had an ultrasound diagnosis of low-lying placentae between 16 weeks and 20 weeks of gestation. Data analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 22. P < 0.05 was considered statistically significant. Results: The prevalence of low-lying placenta at 20, 24, 28, 32, and 36 weeks of gestation was 51%, 41.3%, 22.3%, 12.7%, and 10.5%, respectively. 87.3% of those with low-lying placenta had normally situated placenta at term. Previous caesarean section and male gender were significant predictors of placenta praevia at delivery (P < 0.001 and P = 0.03, respectively). Conclusion: Despite the high prevalence of low-lying placenta before 20 weeks of gestation, only a few of these placentas remain low-lying at term. Previous caesarean section and male gender were significant predictors of placenta praevia at delivery. This study recommends a routine ultrasound scan in the second or third trimester for placenta localisation

An Assessment of Ovarian Cancer Histotypes Across the African Diaspora

ObjectiveOvarian cancer in Black women is common in many West African countries but is relatively rare in North America. Black women have worse survival outcomes when compared to White women. Ovarian cancer histotype, diagnosis, and age at presentation are known prognostic factors for outcome. We sought to conduct a preliminary comparative assessment of these factors across the African diaspora. MethodsPatients diagnosed with ovarian cancer (all histologies) between June 2016-December 2019 in Departments of Pathology at 25 participating sites in Nigeria were identified. Comparative population-based data, inclusive of Caribbean-born Blacks (CBB) and US-born Blacks (USB), were additionally captured from the International Agency for Research on Cancer and Florida Cancer Data Systems. Histology, country of birth, and age at diagnosis data were collected and evaluated across the three subgroups: USB, CBB and Nigerians. Statistical analyses were done using chi-square and student's t-test with significance set at pResultsNigerians had the highest proportion of germ cell tumor (GCT, 11.5%) and sex-cord stromal (SCST, 16.2%) ovarian cancers relative to CBB and USB (p=0.001). CBB (79.4%) and USB (77.3%) women were diagnosed with a larger proportion of serous ovarian cancer than Nigerians (60.4%) (p<0.0001). Nigerians were diagnosed with epithelial ovarian cancers at the youngest age (51.7 +/- 12.8 years) relative to USB (58.9 +/- 15.0) and CBB (59.0 +/- 13.0,p<0.001). Black women [CBB (25.2 +/- 15.0), Nigerians (29.5 +/- 15.1), and USB (33.9 +/- 17.9)] were diagnosed with GCT younger than White women (35.4 +/- 20.5, p=0.011). Black women [Nigerians (47.5 +/- 15.9), USB (50.9 +/- 18.3) and CBB (50.9 +/- 18.3)] were also diagnosed with SCST younger than White women (55.6 +/- 16.5, p<0.01). ConclusionThere is significant variation in age of diagnosis and distribution of ovarian cancer histotype/diagnosis across the African diaspora. The etiology of these findings requires further investigation