The Growing Burden of Tuberculosis in Nigeria: trends of the disease prevalence and treatment outcome in Enugu state

Background: The burden of tuberculosis in Nigeria is the third highest in the world. The data from the TB programme of the States' ministries of health are usually unpublished which possibly contributes to the prevailing ignorance and poor attitude of Nigerians to the disease. Objectives: To determine the trends of TB burden and treatment outcome in Enugu state; and compare the State's disease burden to that of the Nation. Methods: The study was a quantitative action research of secondary data from the TB control programme, Ministry of health, Enugu state, the National annual report of 2008, and WHO TB database within the 10 year period of 2000-2009. Data analysis and presentations were descriptive. Results: The modal age group for new ss+ PTB cases in Enugu state was 25-34 years .The number of female cases was higher than males within the 0-14 year ager group. The annual number of all TB cases showed a raising trend from 914 cases in the year 2000 to 1684 in 2009; but, the reported new ss+ PTB cases fluctuated in a wave-like pattern. The median number of extra-pulmonary TB cases for 2005-2009 was 150 cases while that for the period 2000-2004 was 36 - a four fold increase. The mean prevalence of HIV for all TB cases and new ss+ PTB were 34.4% and 30.7% respectively for the period 2008-2009. Also, the median treatment success rate was 82% (range: 78-85). On the average, Enugu State contributed 1.77% of all TB cases and 2.10% of new ss+ PTB to the national annual TB register and a TB case reported in Enugu state was more likely to be a new ss+ PTB when compared to the whole nation [P < 0.001, OR = 1.33 (95% CI: 1.26, 1.40)] The possible impediments to TB control programme in the State include inadequate funds, ignorance and health seeking pattern of the residents, lack of confidence in the public health care delivery system, non-compliance of private medical practitioners to the approved TB treatment guidelines. Conclusion: Though the burden of TB in Enugu state had increased over the study period, the State's contribution to the disease burden in Nigeria is low. Community participation in TB control and PPM, among other recommendations, will improve TB case detection and treatment in the State.JINTH395JMAMD-INT

Magnitude and predictors of female domestic abuse in pregnancy in a patriarchal African society: a cross-sectional study of pregnant women in Enugu, South East Nigeria

Introduction:&nbsp;domestic abuse against women is very common globally and has far-reaching consequences on the society. Therefore, it is essential to deeply study the seriousness of this public health issue among our pregnant women. The objectives were to determine the prevalence, pattern, and predictors of domestic abuse among pregnant women in Enugu, Nigeria. Methods:&nbsp;a cross-sectional study of 400 consenting pregnant women at the antenatal clinics of the University of Nigeria Teaching Hospital Ituku-Ozalla, Nigeria. Each woman completed a modified abuse assessment screen structured questionnaire. Data analysis was descriptive and inferential with Chi-square and multivariate binary logistic regression using SPSS version 21. A p-value of &lt;0.05 was considered statistically significant. Results:&nbsp;a total of 172 out of 400 respondents (43.0%) had ever experienced domestic abuse in their pregnancies. One hundred and ten (37.2%; 110/296) of the multigravid women were abused in previous pregnancies while 137 (34.3%; 137/400) of all respondents were being abused in the current pregnancy. For all pregnancies, the most common type of abuse experienced by the respondents was verbal abuse (85.5%; 147/172), while the commonest perpetrators of abuse were the respondents´ spouses for both the index pregnancy (82.5%; 113/137) and previous pregnancies (84.5%; 93/110). The most common women perceived cause of abuse was financial constraints (68.6%; 118/172). Age less than 25 years (AOR=1.9, 95% CI=1.01-3.76, p=0.048), not having tertiary education (AOR=2.0, 95% CI=1.17 - 3.25, p=0.01), having at least a male child (AOR=3.3, 95% CI=1.71 - 6.40, p=&lt;0.001), and maternal unemployed status (AOR=2.0, 95% CI=1.27 - 3.19, p=0.003) were the identified predictors among women abused in pregnancy. Conclusion:&nbsp;the prevalence of domestic abuse was high among pregnant women in the University of Nigeria Teaching Hospital Ituku-Ozalla, Enugu, Nigeria. The predominant women perceived cause of domestic abuse was financial constraints while age less than 25 years, not having tertiary education, having at least a male child, and maternal unemployed status were the predictors in abused women. Domestic abuse poses a great threat to women´s reproductive health, and so, its screening should be incorporated into antenatal care in our environment

Mermaid Syndrome in Enugu, Nigeria

Mermaid syndrome is a type of gross fetal anomaly, characterized by the fusion of lower extremities, absent external genitalia, and apparentlywell‑formed abdomen, chest, upper extremities, and head. The neonatal mortality rate due to this anomaly is high, but the disorder is relatively rare.Hence, few cases have been reported in the medical literature, and none in University of Nigeria Teaching Hospital, Ituku‑Ozalla, Enugu State. Keywords: Congenital anomaly, mermaid syndrome, sirenomeli

Comparison of Pregnancy Outcomes of History-Indicated and Ultrasound-Indicated Cervical Cerclage: A Retrospective Cohort Study

Background. Cervical cerclage is the procedure of choice for preventing preterm delivery due to cervical insufficiency. The indication for its application may be based on the woman’s reproductive history, findings at ultrasound, or clinical findings on vaginal examination. Pregnancy outcomes from these indications are variable according to the available literature. Objective. To compare the effectiveness and reproductive outcomes (miscarriage, preterm birth rates, and birth weights) of McDonald’s cervical cerclage after history-indicated and ultrasound-indicated cervical cerclage in pregnant women. Methods. The retrospective cohort study was conducted at Life International Hospital Awka, Nigeria and Life Specialist Hospital Nnewi, Nigeria. Pregnant women, who had a McDonald’s cervical cerclage performed due to either history or ultrasound indication between January 1, 2011, and December 31, 2020, were included in the study. Women with multiple pregnancies and those with physical examination-indicated or emergency cerclages were excluded. The main outcome measures included the prevalence of cervical cerclage, miscarriage, and preterm delivery rates. Outcomes were compared between groups with the chi-square test, Fisher’s exact test, or Student’s t test. p value of < 0.5 was set as significant value. Results. Overall, during the study period, 5392 deliveries occurred in the study sites, of which 103 women had a history-indicated or ultrasound-indicated cervical cerclage. This resulted in a 1.91% prevalence rate for history-indicated and ultrasound-indicated cervical cerclage. Of these, 68 (66%) had history indicated, while 35 (34%) had ultrasound-indicated cerclage. There was no difference in the sociodemographic characteristics of both groups. Both groups had similar miscarriage rates: 1.18 in 1000 and 1.04 in 1000 deliveries, respectively (RR 1.160, 95% CI: 0.3824 to 3.5186, p=0.793). There was more preterm delivery in history-indicated cerclage than ultrasound-indicated cervical cerclage (26.50% vs. 17.10%; p=0.292), though the difference was not statistically significant. The ultrasound group had a higher average birthweight than the history group (2.67±0.99 vs. 2.53±0.74). However, this difference was not statistically significant. Conclusion. The effectiveness and reproductive outcomes (miscarriage, preterm birth rates, and birth weights) of pregnant women with cervical cerclage due to history-indicated and ultrasound-indicated cervical cerclage appear similar. When needed, cervical cerclage should be freely applied for cervical insufficiency, irrespective of the type of indication