Prevention of mother to child transmission (PMTCT) of human immunodeficiency virus (HIV): perceptions and practice of antenatal clients in Nnewi, south-east Nigeria

Context: With increasing feminization of the human immunodeficiency virus (HIV) pandemic especially in Africa, more seropositive women are getting pregnant. There is therefore an increasing need for prevention of mother to child transmission (PMTCT) of HIV and increased need for awareness by our women.Objective: To determine the perceptions and practice of PMTCT of HIV among antenatal clients in Nnewi, south-eastern Nigeria.Study design, setting and subjects: This was a cross sectional descriptive study of six hundred (600) consecutive antenatal clients attending the Nnamdi Azikiwe University Teaching Hospital and five private specialist hospitals in Nnewi, a semi-urban town in Anambra State, south-eastern Nigeria. The study was questionnaire based and was conducted over a six-month period.Results: The mean age of all the 600 clients was 31.4 (SD2.8) years. Most of the clients were married (94%) and in the third trimester of pregnancy (69%). Majority (65%) lived in the semi-urban town of Nnewi and place of domicile did not make any significant difference to knowledge of MTCT (p=0.96). All the clients studied were Christians. Most – 348 (58%) attended secondary school while 5 (0.83%) had no formal education. There was a statistically significant relationship between level of education and knowledge ofMTCT (p<0.00001). Specifically, 544 clients (92.33%) knew about MTCT; 393 (65.50%) clients were aware MTCT could be prevented (PMTCT) but only 37% knew about specific PMTCT measures. HIV counselling and testing (HCT) was done for only 216 (51.55%) of the clients.Conclusion: The study showed that even though a majority of the women were aware of MTCT, they lacked adequate knowledge of the various modalities of PMTCT. Mandatory HIV testing without counselling is still widely practiced in our environment. Concerted efforts are needed to further increase knowledge of MTCT, institute widespread HCT and thus improve PMTCT

Attitudes and perceptions of pregnant women towards the use of Anti-Retroviral Therapy in Nigeria

Background Mother-to-child transmission of Human Immunodeficiency Virus continues to be a major problem in Nigeria. Despite several initiatives, the number of infected pregnant women receiving Anti-Retroviral Therapy to prevent Mother-to-child transmission of the virus remains low in Nigeria. Evidence suggests that attitudes and perceptions of the pregnant women influence their use of Anti-Retroviral Therapy. Aim To understand the attitudes and perceptions of Human Immunodeficiency Virus   infected pregnant women towards the use of Anti-Retroviral Therapy for prevention of mother-to-child transmission in Nigeria. Method Twenty four Human Immunodeficiency Virus infected pregnant women were purposively selected from antenatal clinics. Women’s attitudes and perceptions towards the use of Anti-Retroviral Therapy were explored using semi-structured in-depth interviews conducted in May/June 2016. All interviews were recorded, transcribed and analysed using thematic approach. Findings Overall, participants reflected a positive attitude about using Anti-Retroviral Therapy to prevent mother-to-child transmission and perceived the treatment as beneficial. The main themes identified included: perceived benefits of Anti-Retroviral Therapy; barriers to using Anti-Retroviral Therapy; threat from the susceptibility to the illness and the severity; perceived roles in treatment; and the negative behaviours of healthcare providers. Conclusion The findings provide useful insights to inform Nigeria’s health policies on Anti-Retroviral Therapy. There is a need to educate the women on the benefits of the treatment as well as how they can cope with side effects and the daily regimen of the therapy during pregnancy. The findings also indicate the need for training healthcare providers on facilitative patient-provider relationship

Awareness of Human Immunodeficiency Virus (HIV) infection among antenatal clients in Nnewi Nigeria

Objective: To determine the level of awareness of Human  Immunodeficiency Virus (HIV) infection among antenatal clients in Nnewi Nigeria.Subjects and Methods: A cross sectional descriptive study of six hundred consecutive antenatal clients attending the Nnamdi Azikiwe University Teaching Hospital and five private specialist hospitals (run by Consultant Obstetricians) in Nnewi was conducted over a six-month period (1st September 2008 -28th February 2009). Anonymous, structured, pretested questionnaire designed to assess the awareness of HIV infection was used.Results: The mean age of all the 600 clients was 31.4 (SD 2.8) years, majority were married (94%) and in the third trimester of pregnancy (69%). Most (58%) attended secondary school while 0.83% had no formal education. Only 2% had complete knowledge of the modes of HIV  transmission while majority (96.5%) had partial knowledge. There was a statistically significant relationship between level of education and  knowledge of HIV (p<0.00001). HIV test was done on 419(69.84%); 37 tested positive giving a seroprevalence rate of 8.83%. Among those tested, only 51.55% had counseling before testing.Conclusion: This study showed that the knowledge of HIV among women of child bearing age and the practice of voluntary counseling and testing are still poor in our environment. Improved public enlightenment and training of health workers are urgently needed.Key words: Antenatal, HIV, awareness, Counseling and Testing

Case Report: Placenta Percreta in a Booked Multiparous Woman with Minimal Risk Factors and Challenges of Management in a Low Resource Setting

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Predictors of puerperal menstruation.

BackgroundPuerperal period is an important and thought-provoking period for puerperal mothers. Surprisingly, reports have indicated that there is increasing number of women resuming menstruation within six weeks of childbirth (puerperal menstruation). To the best of knowledge, there is no prior study on predictors of puerperal menstruation.ObjectiveTo determine frequency and predictors of puerperal menstruation.MethodsThis was a single tertiary health institution cross-sectional study at ESUT Teaching Hospital, Parklane, Enugu, Nigeria that included data from May 2015 to December 2018. Women were interviewed at the end of the first six weeks of their childbirth. Women with HIV positive or had uterine rupture or peripartum hysterectomy were excluded. Bivariate analysis was performed by the chi-squared test and conditional logistic regression analysis was used to determine variables associated with puerperal menstruation. Statistical significance was accepted when P- value is ResultsA total of 371 women met the inclusion criteria. The return of menses within 6 weeks was present in 118(31.8%) women versus 253 (68.2%) women without puerperal menstruation, given a ratio of 1:3. Of the 371 women, 249 (67.1%) were on exclusive breastfeeding. The significant associated risk factors were age (p = 0.009), parity (p0.05, for all).ConclusionOne in 3 women resumes menstruation within 6 weeks of childbirth. The major predictor was early initiation of family planning, and exclusive breastfeeding with manual removal of placenta a major protective factor. These interesting issues require further investigation to better understand the mechanism of puerperal menstruation

Active versus expectant management for premature rupture of membranes at term: A randomized, controlled study

Objective To compare the effects on feto-maternal outcomes of expectant versus active management for premature rupture of membranes (PROM) at term. Methods This was a prospective randomized (1:1) controlled study involving 86 pregnant-women who received either expectant management (n = 43) or active management with misoprostol (n = 43) for PROM at term. Primary outcome was route of delivery. Secondary outcomes were: PROM to presentation interval; latency period; PROM to delivery interval; recruitment to delivery interval; labour and delivery complications. Results Baseline-characteristics were similar between groups. There was no significant difference between active and expectant groups in mean PROM to presentation/admission, or PROM to delivery. However, mean latency period (11.1 ± 7.3 hours vs 8.8 ± 5.5 hours) and mean recruitment to delivery intervals after PROM (14.7 ± 5.2 hours vs 11.8 ± 5.0 hours) were significantly shorter for the active group compared with the expectant group. Although the rate of caesarean section was less in expectant management group (21%) compared with the active management group (30%), the difference was not statistically significant. There were no significant differences between groups in delivery or perinatal complications. Conclusion Active and expectant management for PROM at term gave comparable outcomes in terms of methods of delivery and complications. However, active management significantly shortened the latency period and induction to delivery intervals compared with expectant management. Trial-Registration: Pan-African-trial-registry-(PACTR)-approval-number PACTR20220679773408