Risk Factors for Hepatitis B Virus Infection during Pregnancy in South Eastern Nigeria

Objective: To determine the seroprevalence of hepatitis B surface antigen (HBsAg) and possible risk factors in pregnant women.Design: A cross –sectional serological survey of women attending antenatal clinics.Setting: Five antenatal clinics in Aba, South Eastern Nigeria.Subjects: Eight hundred and ten consecutive and consenting antenatal clinic attendees over the period 15 June- 15 November 2010.Main Outcome measures: For each pregnant woman, the medical and sociodemographic data were documented. Hepatitis B surface antigen seropositivity determined.Results: Twenty two (2.7%) of the 810 subjects were found to be HBsAg seropositive and asymptomatic. Maternal age, parity, educational level attained, marital status, history of blood transfusion, intravenous drug use, tattooing, jaundice in the past and Human Immunodeficiency Virus seropositivity did not show any association with HBsAg sseropositivity.Conclusion: HBsAg seropositive women in the study were asymptomatic and showed no association with the medical and sociodemographic characteristics examined. These findings affirm the recommendation for universal HBsAg screening in pregnancy and imply that screening on the basis of the presence of risk factors alone may be insufficient

Women's preference for cesarean delivery and differences between Taiwanese women undergoing different modes of delivery

<p>Abstract</p> <p>Background</p> <p>The rate of cesarean delivery was 35% in 2007 in Taiwan. It is unclear how many of the cesarean deliveries were without medical indications. Women's preference for cesarean delivery during their course of pregnancy has rarely been studied and therefore our objectives were to examine rate of cesarean deliveries without medical indications, to explore women's preference for cesarean delivery as their gestation advances, and to compare background and perinatal factors among women who underwent different modes of delivery in Taiwan.</p> <p>Methods</p> <p>This prospective study applied a longitudinal design. The study participants were 473 women who received prenatal care at four hospitals in Taipei and answered structured questionnaires at 20 to 24 weeks of pregnancy, 34 to 36 weeks of pregnancy, and 5 to 7 weeks after delivery.</p> <p>Results</p> <p>Of the 151 women (31.9%) who had cesarean deliveries, 19.9% were without medical indication. Three indications: malpresentation, prior cesarean section, and dysfunctional labor together accounted for 82.6% of cesarean section with medical indications. The prevalence of maternal preference for cesarean delivery was found to be 12.5% and 17.5% during the second and third trimester, respectively. Of the women who preferred cesarean delivery during the second trimester, 93.2% eventually had a cesarean delivery. Women who were older, with older spouses, and who had health problems before or during pregnancy were more likely to have cesarean deliveries.</p> <p>Conclusions</p> <p>About 20% of cesarean deliveries were without medical indications. Women's preference for cesarean delivery during the second trimester predicts subsequent cesarean delivery. Counseling regarding mode of delivery should be offered early in pregnancy, especially for women who are older or with older spouses, have health problems, or had a prior cesarean section.</p

Refugee and Migrant Women's Views of Antenatal Ultrasound on the Thai Burmese Border: A Mixed Methods Study

Antenatal ultrasound suits developing countries by virtue of its versatility, relatively low cost and safety, but little is known about women's or local provider's perspectives of this upcoming technology in such settings. This study was undertaken to better understand how routine obstetric ultrasound is experienced in a displaced Burmese population and identify barriers to its acceptance by local patients and providers.Qualitative (30 observations, 19 interviews, seven focus group discussions) and quantitative methods (questionnaire survey with 644 pregnant women) were used to provide a comprehensive understanding along four major themes: safety, emotions, information and communication, and unintended consequences of antenatal ultrasound in refugee and migrant clinics on the Thai Burmese border. One of the main concerns expressed by women was the danger of childbirth which they mainly attributed to fetal malposition. Both providers and patients recognized ultrasound as a technology improving the safety of pregnancy and delivery. A minority of patients experienced transitory shyness or anxiety before the ultrasound, but reported that these feelings could be ameliorated with improved patient information and staff communication. Unintended consequences of overuse and gender selective abortions in this population were not common.The results of this study are being used to improve local practice and allow development of explanatory materials for this population with low literacy. We strongly encourage facilities introducing new technology in resource poor settings to assess acceptability through similar inquiry

Maternal and neonatal factors associated with mode of delivery under a universal newborn hearing screening programme in Lagos, Nigeria

<p>Abstract</p> <p>Background</p> <p>Emerging evidence from a recent pilot universal newborn hearing screening (UNHS) programme suggests that the burden of obstetric complications associated with mode of delivery is not limited to maternal and perinatal mortality but may also include outcomes that undermine optimal early childhood development of the surviving newborns. However, the potential pathways for this association have not been reported particularly in the context of a resource-poor setting. This study therefore set out to establish the pattern of delivery and the associated neonatal outcomes under a UNHS programme.</p> <p>Methods</p> <p>A cross-sectional study in which all consenting mothers who delivered in an inner-city tertiary maternity hospital in Lagos, Nigeria from May 2005 to December 2007 were enrolled during the UNHS programme. Socio-demographic, obstetric and neonatal factors independently associated with vaginal, elective and emergency caesarean deliveries were determined using multinomial logistic regression analyses.</p> <p>Results</p> <p>Of the 4615 mothers enrolled, 2584 (56.0%) deliveries were vaginal, 1590 (34.4%) emergency caesarean and 441 (9.6%) elective caesarean section. Maternal age, parity, social class and all obstetric factors including lack of antenatal care, maternal HIV and multiple gestations were associated with increased risk of emergency caesarean delivery compared with vaginal delivery. Only parity, lack of antenatal care and prolonged/obstructed labour were associated with increased risk of emergency compared with elective caesarean delivery. Infants delivered by vaginal method or by emergency caesarean section were more likely to be associated with the risk of sensorineural hearing loss but less likely to be associated with hyperbilirubinaemia compared with infants delivered by elective caesarean section. Emergency caesarean delivery was also associated with male gender, low five-minute Apgar scores and admission into special care baby unit compared with vaginal or elective caesarean delivery.</p> <p>Conclusions</p> <p>The vast majority of caesarean delivery in this population occur as emergencies and are associated with socio-demographic factors as well as several obstetric complications. Mode of delivery is also associated with the risk of sensorineural hearing loss and other adverse birth outcomes that lie on the causal pathways for potential developmental deficits.</p

Social differentiation and embodied dispositions: a qualitative study of maternal care-seeking behaviour for near-miss morbidity in Bolivia

<p>Abstract</p> <p>Background</p> <p>Use of maternal health care in low-income countries has been associated with several socioeconomic and demographic factors, although contextual analyses of the latter have been few. A previous study showed that 75% of women with severe obstetric morbidity (near-miss) identified at hospitals in La Paz, Bolivia were in critical conditions upon arrival, underscoring the significance of pre-hospital barriers also in this setting with free and accessible maternal health care. The present study explores how health care-seeking behaviour for near-miss morbidity is conditioned in La Paz, Bolivia.</p> <p>Methods</p> <p>Thematic interviews with 30 women with a near-miss event upon arrival at hospital. Near-miss was defined based on clinical and management criteria. Modified analytic induction was applied in the analysis that was further influenced by theoretical views that care-seeking behaviour is formed by predisposing characteristics, enabling factors, and perceived need, as well as by socially shaped habitual behaviours.</p> <p>Results</p> <p>The self-perception of being fundamentally separated from "others", meaning those who utilise health care, was typical for women who customarily delivered at home and who delayed seeking medical assistance for obstetric emergencies. Other explanations given by these women were distrust of authority, mistreatment by staff, such as not being kept informed about their condition or the course of their treatment, all of which reinforced their dissociation from the health-care system.</p> <p>Conclusion</p> <p>The findings illustrate health care-seeking behaviour as a practise that is substantially conditioned by social differentiation. Social marginalization and the role health institutions play in shaping care-seeking behaviour have been de-emphasised by focusing solely on endogenous cultural factors in Bolivia.</p

Presence of chaperones during pelvic examinations in southeast Nigeria: Women’s opinions, attitude, and preferences

Objectives: To assess the opinions, attitude, and preferences of Nigerian women to the presence of chaperones during pelvic examinations.Materials and Methods: A cross‑sectional survey of first time gynecology clinic attendees on their opinions, attitudes, and preferences with respect to the presence of chaperones during their pelvic examinations. The interview was conducted with the aid of semi‑structured, researcher‑administered questionnaires. Results: One hundred and nineteen (51.7%) of the respondents preferred female physicians for pelvic examination, 23 (10%) preferred male physicians and 88 (38.3%) had no gender preference. When the examining physician is a male, 124 (53.9%) respondents would like to have chaperones during pelvic examinations while 106 (46.1%) would not. Eighty‑three percent of respondents preferred nurse chaperones. Age, level of education, and parity did not have any significant relationship with the attitude of the respondents toward the presence of chaperones (P = 0.503, 0.525, and 0.605 respectively).Conclusions: We conclude that most southeastern Nigerian women would prefer their pelvic examinations to be done by a female physician or to be attended by a nurse chaperone if the examining physician is a male. We recommend a routine offer of chaperones during such examinations while respecting the patients’ right to refuse the offer.Keywords: Attitudes, chaperone, pelvic examination, preferences, southeast NigeriaNigerian Journal of Clinical Practice • Oct-Dec 2013 • Vol 16 • Issue

Insecticidal net distribution channel that is rural women-friendly, in abia south, Nigeria

Background: Government channel for distributing free insecticidal nets stop at the health centers. About 70% of rural women who do not access this health facility fail to collect the free nets. Alternative channel for reaching these women is hereby advocated. Materials and Methods: An interventional study was carried out in eight randomly selected villages of Abia South. Experimental and control groups were assigned four villages each. Sample size for each group was 200 households systematically selected. Questionnaire and interview guide were instruments for data collection. Data were analyzed quantitatively.  Chi-square statistic was used in testing for statistical significance.Results: Before intervention, ownership and utilization of treated nets inexperimental group were 36.5% and 28.8%, respectively, while in the control group, it was 38% and 30.0%, respectively. Ownership and  utilization of treated nets in experimental group increased by 54.5% and 46.5%, respectively, after intervention. In the control group, where there were no interventional activities carried out, ownership and utilization of treated nets showed no significant increase.Conclusion: Health promotion intervention, fixed-install mental  payment-basis for net cost, and home-based net distribution channel scaled up net ownership and utilization by 54.5% and 46.5%, respectively, in the study area.Key words: Abia South, Net distribution channel, Nigeria, Rural women-friendl

Impact of visual inspection with acetic acid plus cryotherapy “see and treat” approach on the reduction of the population burden of cervical preinvasive lesions in Southeast Nigeria

Objective: The aim of this study is to determine the impact of visual inspection with acetic acid (VIA) plus immediate cryotherapy on the prevalence of VIA‑detected cervical squamous intraepithelial lesion (SIL).Methods: Women in four rural communities in Southeast Nigeria were screened with VIA. Women who tested positive to VIA were offered either immediate cryotherapy or large loop excision of the transformation zone based on predetermined eligibility criteria. Cervical biopsies were taken before cryotherapy and examined by consultant histopathologists. All participants were rescreened 1 year later. The main outcome measures were population prevalence of cervical precancers before and after intervention, cure rates, and over‑treatment rates.Results: A total of 653 women participated in the study. The prevalence of cervical SIL before the intervention was 8.9% (58/653). The prevalence 1 year later was 1.4% (9/649). This gave an 84.3% reduction in the population prevalence of SIL. The reduction in cervical SIL prevalence was statistically significant (P = 0.0001). The prevalence of high‑grade SIL reduced significantly from 4.1% (27/653) preintervention to 0.5% (3/649) 1 year postintervention (P = 0.0001). This gave an 87.8% reduction in the population prevalence of high‑grade SIL. Cryotherapy provided a cure rate of 87.9% (95% confidence interval: 76.82–94.33).Conclusion: Population cervical cancer prevention using VIA plus immediate cryotherapy leads to significant reduction in the population prevalence of cervical SIL. This has the potential of being an acceptable supplement to cervical cytology for cervical cancer prevention in low‑income populations.Key words: Cervical cancer, cryotherapy, impact, see and treat, visual inspection with acetic aci

Is there any association between hormonal contraceptives and cervical neoplasia in a poor Nigerian setting?

Leonard Ogbonna Ajah,1,2 Chibuike Ogwuegbu Chigbu,2 Benjamin Chukwuma Ozumba,2 Theophilus Chimezie Oguanuo,2 Paul Olisaemeka Ezeonu1 1Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Abakaliki, Nigeria; 2Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Enugu, Nigeria Background: The association between hormonal contraception and cervical cancer is controversial. These controversies may hamper the uptake of hormonal contraceptives. Objective: To determine the association between hormonal contraceptives and cervical neoplasia. Materials and methods: This was a case-control study in which Pap-smear results of 156 participants on hormonal contraceptives were compared with those of 156 participants on no form of modern contraception. Modern contraception is defined as the use of such contraceptives as condoms, pills, injectables, intrauterine devices, implants, and female or male sterilization. Those found to have abnormal cervical smear cytology results were subjected further to colposcopy. Biopsy specimens for histology were collected from the participants with obvious cervical lesions or those with suspicious lesions on colposcopy. The results were analyzed with descriptive and inferential statistics at a 95% level of confidence. Results: A total of 71 (45.5%), 60 (38.5%), and 25 (16.0%) of the participants on hormonal contraceptives were using oral contraceptives, injectable contraceptives, and implants, respectively. Cervical neoplasia was significantly more common among participants who were &ge;35 years old (6% versus 1%, P&lt;0.0001), rural dwellers (6% versus 3.5%, P&lt;0.0001), unmarried (7.6% versus 3.5%, P&lt;0.0001), unemployed (6.8% versus 3.5%, P&lt;0.0001), less educated (6% versus 3.8%, P&lt;0.0001), and had high parity (6.8% versus 3.6%, P&lt;0.0001). There was no statistical significant difference in cervical neoplasia between the two groups of participants (7 [4.5%] versus 6 [3.8%], P=1.0). Conclusion: There was no association between hormonal contraceptives and cervical neoplasia in this study. Keywords: hormonal contraceptives, cervical neoplasia, Enugu, Nigeri