Declining uptake of HIV testing among tuberculosis patients in Enugu state of Nigeria: The need for a reappraisal of strategy

Background: The prevalence of HIV in Enugu State is the highest in Southeastern Nigeria. Since HIV is associated with TB, it is important to assess the performance of the Enugu State TB program as regards HIV screening of TB cases. This study assesses the proportions of TB cases that are screened for HIV as well as the prevalence of HIV among individuals with TB at the Enugu State TB program of Nigeria.Materials and Methods: The study was a retrospective review of data from the Enugu State TB program, Nigeria, from 2008 to 2009. Analysis was both descriptive and inferential at 95% confidence levels.Results: A total of 3,286 TB cases were registered within the 2‑year period. Out of these, 1,867 (56.8%) were new sputum smear positive (ss+). In all, 67.9% and 78.9% of all‑TB cases were screened for HIV in 2009 and 2008 respectively [OR=0.57 (0.48–0.67)]. Also, 83.0% and 87.9% of new ss+ cases were screened for HIV in 2009 and 2008 respectively [OR=0.68 (0.52–0.88)]. The mean HIV prevalence for all TB cases was 34.5%.Conclusion: The performance of the State’s TB program with respect to HIV screening of TB patients reduced significantly in 2009 when compared to 2008. Improved program monitoring and the opt‑out approach of the provider initiated HIV testing and counseling are recommended

Towards improving cervical cancer screening in Nigeria: A review of the basics of cervical neoplasm and cytology

Cervical cancer screening is the key to reducing the incidence and mortality of cervical cancer in developing countries. In the absence of a national screening program, healthcare givers in Nigeria are encouraged to routinely inform and screen eligible women. This review aims at equipping health workers for this task by re-educating them on the basics of the disease and its screening by cytology. Relevant texts and online databases including Pubmed, African Journal Online, and Google Scholar, were searched for relevant literature on the subject area. Persistent infection by a high-risk human papilloma virus, especially types 16 and 18, is necessary for the development of cervical cancer. The exfoliation of cells from the metaplastic squamous cells of transformation zone of the cervix is the basis of cervical cytology. Organized Pap screening reduces the incidence and mortality of cervical cancer, but screening protocols vary. Nevertheless, annual screening is not recommended except for high-risk women such as HIV-positive women. Abnormal Pap smear results are currently reported using either the Bethesda System or the British Society for Clinical Cytology classification, and colposcopy with or without biopsy are necessary when indicated. In conclusion, the use of cervical cytology to detect precancerous lesions followed by an appropriate treatment when necessary is the key to reducing invasive cervical cancer. The task of provider-initiated counseling and testing for cervical cancer by health practitioners requires update on the current etio-pathology of cervical cancer, and its screening as reviewed

Hematocrit, anemia, and arm preference for blood sample collection: a cross sectional study of pregnant women in Enugu, south eastern, Nigeria

Background: Anemia in pregnancy is a common cause of maternal morbidity and mortality in developing countries. Regular review of hematocrit (HCT) and anemia patterns in pregnancy is necessary in our environment. Aim: The aim was to determine the average HCT, prevalence, and pattern of anemia, as well the arm preferences for blood sample collection among pregnant women in Enugu, South East Nigeria. Subjects and Methods: HCT was determined using venous blood of 200 antenatal women at the University of Nigeria Teaching Hospital (UNTH) Enugu, Nigeria. Questionnaires were used to assess participants’ arm preference for blood sample collection for clinical investigations. Data analysis was descriptive and inferential at 95% confidence level. Results: Participants’ mean HCT was 33.3 (3.7%). The average HCT in second trimester 33.3% (3.76%) was significantly lower than that of third trimester (34.6 [3.4%], P = 0.01,). Prevalence of anemia was 28.0% (56/200), and a majority (94.6%, 53/56) of anemic women belong to the mild category. Only parity groups had a significant association with anemia in pregnancy (P = 0.04). None of the participants reported being asked about her arm preference during blood collection for routine antenatal investigations. One hundred and five (52.5%) women expressed preference for either left (34.5%, 69/200) or right arm (18.0%, 36/200) for blood sample collection. Conclusion: The average HCT among pregnant women at the UNTH, Enugu Nigeria was within normal range and the prevalence of anemia was relatively low. The majority of women expressed a preference for either right or left arm for blood sample collection for clinical investigations and would wish their choices sought for and respected.Keywords: Anemia in pregnancy, Arm preference, Enugu, Hematocrit, Nigeri

Cigarette smoking and perception of its advertisement among antenatal clinic attendees in referral health facilities in Enugu, Nigeria

Background: The most predominant form of tobacco use is cigarette smoking, and it poses serious threats to maternal and child health. The magnitude of cigarette smoking in pregnancy in our environment is not well.known. The study aimed to determine the prevalence of cigarette smoking among pregnant women in Enugu, Nigeria as well as their exposures and perceptions of cigarette smoking advertisement.Materials and Methods: Questionnaires were administered to a  cross.section of pregnant women randomly selected from three hospitals in Enugu, South.East Nigeria, from May 2, 2012 to June 12, 2012. Analysis was both descriptive and inferential at 95% confidence levels.Results: The prevalence of tobacco smoking in pregnancy was 4.5%  (9/200). Over 90% of respondents admitted that cigarette smoking could harm both mother and unborn baby. In all, 79.5% (159/200) of respondents had seen or heard of advertisement for cigarette smoking as against 82.5% (165/200) that had seen or heard of antismoking  advertisement (P = 0.444, odds ratio = 1.2 [95% confidence intervals: 0.74, 2.00]).Conclusions: The prevalence of cigarette smoking in pregnancy in Enugu, Nigeria was low, and there was high exposure to both pro.and anti.smoking advertisement. The awareness of harmful health effect of smoking was high but, that of the specific diseases associated with smoking in pregnancy was limited. Hence, antenatal classes and antismoking  advertisement should be scaled.up to include maternal and peri-natal diseases/conditions associated with cigarette smoking. Key words: Cigarette advertisement, cigarette smoking, Enugu-Nigeria, pregnanc

Asymptomatic bacteriuria among pregnant women with sickle cell trait in Enugu, South Eastern Nigeria

Context: Asymptomatic bacteriuria (ASB) in pregnancy is a major risk factor for developing acute cystitis and pyelonephritis, especially, among women with sickle cell disease. This study compared the prevalence, pattern, and microbiological characteristics of ASB in pregnancy between sickle cell trait (HbAS) and normal hemoglobin AA(HbAA) genotype subjects.Materials and Methods: Culture and sensitivity of mid‑stream urine samples were collected from 300 HbAS women and 300 matched HbAA control at the antenatal clinic of University of Nigeria Teaching Hospital Enugu, Nigeria from August 2010 to December 2011. Analysis was both descriptive and inferential at 95% confidence levels.Results: Prevalence of ASB in HbAS and HbAA women were 32.7% (98/300) and 32% (96/300) respectively (odd ratio (OR) =1.03 [95% confidence interval (CI) 0.73, 1.45]). Escherichia coli was the most common organism isolated in both the HbAS group (56.1%, 55/98) and control group (61.4%, 59/96), (OR = 0.80 [95% CI 0.45, 1.42]). The  antibiotics with the highest microbial sensitivity were ciprofloxacin 90.8% (89/98) and gentamicin 100% (98/98) for HbAS and HbAA women respectively.Conclusions: The prevalence of ASB in pregnant women with HbAS in Enugu, Nigeria was high and did not vary significantly from that of woman with HbAA. Therefore, pregnant women irrespective of their sickle cell status would benefit from routine screening for ASB.Key words: Asymptomatic bacteriuria, Enugu‑Nigeria, pregnant women, sickle cell trai

Maternal and perinatal outcome of severe pre-eclampsia in Enugu, Nigeria after introduction of Magnesium sulfate

Background: Magnesium sulfate (MgSO4) is the most effective seizure prophylaxis in the management of severe preeclampsia, and its use is progressively spreading in our environment. It was introduced at the pioneer teaching hospital of southeastern Nigeria in 2007. A study on the outcome of its use is therefore necessary.Objectives: The objective was to determine the effect of introducing MgSO4 on the maternal and perinatal outcomes of severe pre-eclampsia in Enugu, South eastern Nigeria.Materials and Methods: A retrospective study of all cases of severe pre-eclampsia managed at the University of Nigeria Teaching Hospital Enugu (UNTH), Nigeria, from 1 January 2005 to 31 December 2008 - 2 years before, and 2 years after the introduction of MgSO4 – was performed.Result: The prevalence of severe preeclampsia within the study period was 3.3%. The mean age of study participants was 24.5 ± 2.9 years. Thirty women received MgSO4 while 47 women received diazepam. Eclampsia occurred only in a member of the diazepam group but there were no maternal deaths. Babies from the diazepam group were more likely to have low 1 minute Apgar scores but the association was not significant [OR = 3.08 (95% CI 0.78, 13.33)]. Longer hospital stay was significantly lower among women who received MgSO4 [OR = 0.32 (95% CI 0.11, 0.93)]. Perinatal mortality did not differ between the groups.Conclusion: MgSO4 is effective in the management of severe pre-eclamptics at the UNTH, Enugu. Therefore, its accessibility and wider use should be promoted

Evaluation of some anthropometric indices for the diagnosis of obesity in pregnancy in Nigeria: a cross-sectional study

Background: Obesity in pregnancy is a global health problem which is associated with poor pregnancy outcomes. The use of weight and height, measured at about ten weeks of gestation, to produce pre-gestational body mass index is recommended for the diagnoses of the condition but limitations abound in under resourced settings.Objectives: To measure anthropometric indices such as mid upper arm circumference, calf circumference, waist circumference and waist to hip ratio, for identification of obesity in pregnancy.Methods:Anthropometric measurements were carried out on cohorts of pregnant women from 4 hospitals in Enugu, South-eastern Nigeria.Results: There were no significant difference in the mean mid upper arm circumference (MUAC) and calf circumference (CC) across the trimester groups. The mean values of waist circumferences, hip circumference and waist to hip ratios changed significantly across the trimesters. The 75th percentile of MUAC (33 cm) and CC (39 cm) in all trimesters, had sensitivity and specificity of more than 70% for identifying obesity in pregnancy.Conclusion: MUAC and CC values of 33cm and 39cm respectively might be reliable cut off points for diagnoses of obesity throughout pregnancy in Enugu, NigeriaKeywords: Anthropometric indices, Body mass index, obesity, oregnancy, NigeriaAfrican Health Sciences 2013; 13(4): 1034 - 104

Seroprevalence of Human Immunodeficiency Virus, Hepatitis B, Hepatitis C, syphilis, and co infections among antenatal women in a tertiary institution in south east, Nigeria

Background: Sexually transmitted infections and human immunodeficiency virus (HIV)/AIDS are a major public health concern owing to both their prevalence and propensity to affect offspring through vertical transmission. Aim: The aim was to determine the seroprevalence of HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), syphilis, and co‑infections among antenatal women in Enugu, South‑East Nigeria. Materials and Methods: A retrospective study of antenatal women at the University of Nigeria Teaching Hospital, Enugu, South‑East Nigeria from 1st May 2006 to 30th April 2008. A pretested data extraction form was used to obtain data on sociodemographic variables and screening test results from the antenatal records. The analysis was done with SPSS version 17 (Chicago, IL, USA). Results: A total of 1239 antenatal records was used for the study. The seroprevalence of HIV, HBV, HCV, and syphilis among the antenatal women were 12.4% (154/1239), 3.4% (42/1239) 2.6 (32/1239) 0.08% (1/1239), respectively. The HIV/HBV and HIV/HCV co‑infection prevalence rates were 0.24% (3/1239), 0.16% (2/1239), respectively. There was no HBC and HCV co‑infection among both HIV positive and negative antenatal women. There was no statistically significant difference in HBV and HCV infection between the HIV positive and negative antenatal women. The only woman that was seropositive for syphilis was also positive to HIV. Conclusion: The seroprevalence of HIV, HBV, HCV, and syphilis is still a challenge in Enugu. Community health education is necessary to reduce the prevalence of this infection among the most productive and economically viable age bracket.Keywords: Antenatal women, Co‑infection, Human immunodeficiency virus, Hepatitis C virus, Hepatitis B virus, Seroprevalence, Syphili

Benefit incidence analysis of free insecticide treated nets distribution in urban and rural communities of Enugu state, South East Nigeria

Background: Malaria is a leading cause of mortality as well as a barrier to economic and social development in developing countries. The use of insecticide‑treated nets (ITNs) for malaria vector control is effective in controlling malaria attacks in pregnant women and under‑5 children. The Nigerian government, in its bid to achieve the Millennium Development Goal (MDG) 4 and 5 distributes free ITNs to pregnant mothers and under‑five children in the Roll Back Malaria programme (RBM).Aim: This study compared the benefit incidence analysis of this government program between urban and rural areas.Materials and Methods: Pretested, semi‑structured questionnaires were administered to 150 pregnant women and also 150 mothers of under‑5 children, who were randomly selected from each of the two communities (rural and urban) from a local government area (LGA) in Enugu state, Nigeria. The study was conducted within the rainy season periods (March–August) of 2008. The information obtained included some socio‑economic variables, accessibility, usage and benefits of usage of ITNs. Data entry and analyses were done using the Statistical Package for Social Sciences (SPSS) version 15.0(Chicago IL, USA). Student’s t‑test and Chi‑square were used for comparison where appropriate. Significant values were taken as P value. Value of less than 0.05 was considered significant.Results: The respondents’ mean monthly expenditures on food utilities and anti‑malarials in the rural area and urban areas were N266.1 (74.02), range (143.3-395) and N473 (90) range (380-495.7) respectively (P < 0.001). Within each socio‑economic stratum (SES), the average monthly expenditure in the urban community was higher than that of the rural community except for least poor SES (P < 0.05). For the urban community, 106 (71.6%) respondents used ITNs as against 99 (66.9%) in the rural community [P = 0.778, OR = 1.3 (95% CI: 0.76, 2.05)]. Also, ITNs were always accessible to 112 (75.7%) and 54 (36.5%) respondents in the urban and rural communities respectively [P < 0.001, OR = 5.4 (95% CI: 3.28, 8.96)]. In the urban community, 130 (87.7%) respondents expressed some benefit from ITNs as against 123 (83.1%) respondents from the rural community [P = 0.258, OR = 1.5 (95% CI: 0.76, 2.28)].Conclusion: Most pregnant women and mothers of under‑five children in the rural study area belong to the poorest socio‑economic classes and they spend less on anti‑malarial treatment. Majority of the free ITN’s beneficiaries in both urban and rural study areas have used and benefitted from themKey words: BIA, ITNs, nigeria, pregnanc

Parity related changes in obesity and some antioxidant vitamins in non-pregnant women of South-Eastern Nigeria

Background: The delivery of many children at short interval is associated with micronutrient depletion and weight gain. However, the relationship between the levels of the micronutrients and the body weight is yet to be ascertained.Objectives: To determine the relationship between parity, body weight and some antioxidant vitamins in non-pregnant Nigerian women.Patients and Methods: Randomly recruited 200 non-pregnant women, comprising 82 primiparous and 118 multiparous women completed the study. Their age, parity, mid-arm circumference (MAC), waist circumference (WC), weight, height and body mass index (BMI) were determined. The serum levels of vitamins A, C and E were assayed using standardmethods.Results: The mean BMI, WC and MAC of the multiparous subjects (parity = 3.0 ± 0.58) were significantly higher than that of the primiparous subjects (parity = 1), (P < 0.05, P < 0.01 and P < 0.01 respectively). Furthermore, there were statistically significant decrease in the vitamin A, vitamin C and vitamin E in multiparous compared with the primiparous women (P < 0.005, P < 0.05 and P < 0.005), respectively.Conclusion: Multiparty enhances weight gain, but depletes antioxidant vitamin micronutrients in non-pregnant Nigerian women