Determinants of compliance to iron supplementation among pregnant women in Enugu, Southeastern Nigeria

Background: Anemia in pregnancy is highly prevalent among antenatal clinic attendees in Enugu, Nigeria despite the practice of routine iron supplementation in pregnancy. The major problem with iron  supplementation in pregnancy is compliance, and this may be a potential driver to the persistent high prevalence of anemia in this population.Objectives: To find out the compliance rate and determinants of  compliance to iron supplementation among pregnant women in Enugu, southeastern Nigeria.Materials and Methods: This was a questionnaire.based cross.sectional study of eligible pregnant women receiving antenatal care at the University of Nigeria Teaching Hospital (UNTH), Ituku/Ozalla, Enugu, Nigeria between April 1, 2012 and January 31, 2013.Results: The knowledge of iron supplementation was 76.3% (n = 302), however, the compliance rate was 65.9% (n = 261). Tertiary level of education and high social class were factors significantly associated with compliance to iron supplementation after adjusting for other factors in the binary logistic regression analysis (P < 0.05). The major barriers to compliance to iron supplementation included gastrointestinal side effects of iron supplements (41.7%), non.affordability of iron supplements (28.3%), and forgetfulness (15.0%) among the antenatal mothers.Conclusion: The compliance rate of 65.9% for iron supplementation by pregnant mothers in Enugu can further be improved by providing the drug free of charge in the short term and improvement in education and  socioeconomic class of the populace in the long run.Key words: Compliance, determinants, Enugu, iron supplementation,  pregnanc

Cesarean Delivery for a Life‑threatening Preterm Placental Abruption

Placental abruption is one of the major life‑threatening obstetric conditions. The fetomaternal outcome of a severe placental abruption depends largely on prompt maternal resuscitation and delivery. A case of severe preterm placental abruption with intrauterine fetal death. Following a failed induction of labor with a deteriorating maternal condition despite resuscitation, emergency cesarean delivery was offered with good maternal outcome. Cesarean delivery could avert further disease progression and possible maternal death in cases of severe preterm placental abruption where vaginal delivery is not imminent. However, further studies are necessary before this could be recommended for routine clinical practice.Keywords: Cesarean delivery, Intrauterine fetal death, Preterm placental abruptio

Utilization of insecticide treated nets among pregnant women in Enugu, South Eastern Nigeria

Background: The goal of roll back malaria partnership is to achieve universal coverage for all populations at risk using appropriate interventions for prevention and case management.Objective: The objective of this study is to determine the use of insecticide treated nets (ITNs) and other anti-vector measures among pregnant women in an area hyper-endemic for malaria.Materials and Methods: Questionnaires were administered to a cross-section of 832 consecutive pregnant women attending antenatal care in three hospitals in Enugu, Nigeria that have high client flow for maternity services. Data collected were analyzed using descriptive and inferential statistics by means of the Statistical Package for Social Sciences (SPSS) version 16. P-value of less than 0.05 was considered statistically significant.Results: The mean age of the women was 33.2 ± 2.9 (range: 15-45) years. Three hundred and fifty nine (43.1%) women owned insecticide treated nets (ITNs), however 325(90.5%) slept under the nets during the index pregnancies; equivalent to 39.1% utilization rate among the 832 women studied. Out of the 325 (39.1%) women that used ITNs; 236 (28.4%) used it singly, while 89 (10.7%) used it in combination with other anti-vector measures. Educational status and social class of the women had strong association with the use of ITNs (P < 0.0001). Women who used ITNs were significantly less likely to have acute malaria, anaemia and babies with low birth weight than women who did not use ITNs (P < 0.05).Conclusion: The use of ITNs is poor among pregnant women in Enugu, but associated with favorable maternal and feto-neonatal outcome. Future measures to increase its use should consider improvement in educational level and social class of our women.Key words: Insecticide treated nets, Malaria, Nigeria, pregnanc

Acceptability of human papilloma virus vaccine and cervical cancer screening among female health-care workers in Enugu, Southeast Nigeria

Background: Cervical cancer, a leading cause of cancer deaths in women in developing countries can be prevented primarily by vaccinating  adolescent girls and women against infection by the human papillomavirus (HPV) before their first sexual exposure, and secondarily through screening and treatment of identified precancerous lesions.Aim: To determine the awareness and acceptability of the HPV vaccine and screening for cervical cancer among female health-care workers in Enugu, southeastern Nigeria.Materials and Methods: Questionnaires were administered to a cross-section of 177 female health-care workers selected systematically from the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria. Statistical analysis was both descriptive and inferential at 95% confidence level using the Statistical Package for Social Sciences (SPSS) computer software version 16. A P value of less than 0.05 was considered statistically significant.Results: The awareness of screening for cervical cancer (91%) was significantly higher than that of the HPV vaccine (62.7%) [odds ratio (OR): 0.17; 95% confidence interval (CI): 0.09–0.30]. However, the acceptability rate of the HPV vaccine (91.0%) was significantly higher than that of cervical screening (71.4%) (OR: 4.04;95% CI: 1.94–8.42)]. Only25 (14.1%) of the health-care workers had done cervical screening, but 30 (49.2%) of the 61respondents with adolescent daughters had immunized their daughters with the HPV vaccine. Although no reason was given for the low participation in cervical screening, cost and availability of HPV vaccine was a major deterrent for the latter.Conclusion: With more public enlightenment, available and affordable HPV vaccine appears to hold the key for prevention of cervical cancer in developing countries where the burden is high.Key words: Acceptability, health workers, HPV vaccine, Nigeri

Spectrophotometric Determination and Thermodynamic Parameters of Charge Transfer Complexation Between Stavudine and Chloranilic Acid

Purpose: The official assay methods for most antiretroviral drugs are limited by cost and unavailability of good test equipment in several developing countries. Therefore, this study investigates the use of charge transfer complexation in the spectrophotometric assay of stavudine as an alternative method to conventional methods.Methods: Charge transfer complex formation between stavudine (n-donor) and chloranilic acid (Π-acceptor) in 1,4-dioxan using a spectrophotometer was employed. Thermodynamic parameters of the complex formed were determined. The proposed method was employed in the analysis of commercially available stavudine dosage form.Results: The wavelength of maximum absorption (λmax) of the complex was at 526 nm compared to 457 nm for p-acceptor alone. Beer’s law was obeyed in the range of 5 - 40 mg % while the stoichiometry of the complex was found to be 2:1. The complex formed was still stable 24 h later. Its formation was spontaneous with a ΔHo of -3.78×103 J/mol. The standard entropy change was from 12.18 ± 0.78 to 11.08 ± 1.23 cal/deg/mol over the temperature range of 30 - 60 oC while molar absorptivity decreased from 2.45×105 to 1.2×105 over the same temperature range. The assay result of the standard stavudine solution was of high accuracy with a recovery value of 99.85 ± 1.95 %.Conclusion: The proposed method is reliable and reproducible and should be suitable for the quality control of stavudine in bulk and dosage forms.Keywords: Assay, Charge transfer, Stavudine, Spectrophotometric analysis, Chloranilic acid, Thermodynamic

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

Antimicrobial activities of methanolic extract of Gongronema latifolia stem on clinical isolate of Escherichia coli from diarrhoea patients

This study was carried out to investigate the antimicrobial activities of Gongronema latifolia stem extract on clinical isolates of Escherichia coli from diarrhoea patients. Twenty five isolates of E. coli were obtained from stool samples of diarrhoea patients within the ages of 1-5 in Nsukka Health Centre, Nsukka. The antimicrobial activity of the methanolic extract was then carried out using agar cup diffusion technique. The result of the study showed that the E. coli was moderately sensitive to methanolic extract of G. latifolia stem. This shows that in the treatment of infections caused by E. coli, methanolic extract of G. latifolia stem may be used

Case Report on Septate Uterus: An Incidental Finding in a Multiparous Woman who Had an Emergency Cesarean Section

Background: Septate uterus is caused by incomplete resorption of the Mullerian duct during embryogenesis which may alter the reproductive outcome of the patients. It is the commonest form of structural uterine anomaly and has the highest reproductive failure rate. Case Report: A 21-year-old booked G4P2 +1 woman with two living male children admitted into the Antenatal ward through the Accident and Emergency ward at 33 weeks gestation for conservative management of preterm premature rupture of membrane. She had a previous history of miscarriage, preterm delivery, and elective caesarean section due to breech presentation in her first, second, and third pregnancies in 2007, 2008, and 2009, respectively. She, however, had an emergency caesarean section due to fetal distress at 33 weeks plus 4 days with the delivery of a live female baby that weighed 2.0 kg with APGAR scores of 7 and 8 in the 1st and 5th minutes, respectively. There was intraoperative finding of septate uterus with dimple at the fundus. The other abdominal viscera were normal. Conclusion: congenital uterine anomalies especially septate uterus, though rare, should be suspected in women with positive history of miscarriage, preterm delivery and malpresentation.Keywords: Asia, fetal distress, multiparous, preterm, septate, uteru

Audit of Childbirth Emergency Referrals by Trained Traditional Birth Attendants in Enugu, Southeast, Nigeria

Background: The essence of training traditional birth attendants (TBAs) is to attend to women in uncomplicated labor and to refer them immediately to hospitals when complications develop.Aim: The aim was to audit childbirth emergency referrals by trained TBAs to a specialist hospital in Enugu, Nigeria.Subjects and Methods: A retrospective study of 205 childbirth emergencies referred to Semino Hospital and Maternity (SHM), Enugu by trained TBAs from August 1, 2011 to January 31, 2014. Data analysis was descriptive and inferential at 95% confidence level.Results: Most of the patients (185/205, 90.2%) were married and (100/205, 48.8%) had earlier booked for antenatal care in formal health facilities. There were obstetric danger signs or previous bad obstetric histories (pregnancies with unfavourable outcome) in 110 (110/205, 53.7%) women on admission at SHM. One hundred and fifteen (115/205, 56.1%) women walked into the hospital by themselves while 50 (50/205, 24.39%) could not walk. The fetal heart sounds were normal in 94 (94/205, 45.6%), abnormal in 65 (65/205, 31.8%) and absent in 42 (42/205, 20.4%) of the women on admission. Five healthy babies were delivered by the TBAs before referring their mothers. Delays of more than 12 h had occurred in 155 (155/205, 76.6%) of the women before referrals. Prolonged labor (100/205, 48.8%), obstructed labor (40/205, 19.5%), attempted vaginal birth after previous cesarean delivery (40/205, 19.5%) and malpresentation (30/205, 14.6%) were the common indications for referrals. The maternal mortality and perinatal mortality ratios were 610/100,000 live births and 228/1000 total births respectively.Conclusion: Delays at TBA centers are common before referral and most patients are referred in poor clinical state. Further training and re‑training of the TBAs with more emphasis on recognition of obstetric danger signs and bad obstetric histories may help in screening high‑risk patients for prompt referral to hospitals before complications develop. Keywords: Childbirth emergencies, Delay, Outcomes, Referrals, Trained traditional birth attendant

Falls among pregnant women in Enugu, Southeast Nigeria

Background: Falls during pregnancy are major public health issues and a common cause of maternal injury during pregnancy. There is paucity of data on prevalence and risk factors of falls during pregnancy in African population including Nigeria.Objective: To determine the prevalence and risk factors associated with falls during pregnancy in Enugu, Nigeria.Materials and Methods: This was a cross.sectional study of 332 consecutive pregnant women presenting in labor for delivery at the University of Nigeria Teaching Hospital Enugu, Nigeria between 1st May and 31st December, 2012.Results: The mean age of the women was 32.2 } 2.7 (range: 20.42) years. One hundred and eight women (32.5%) reported falling at least once during the index pregnancy. Women aged . 30 years had twofold risk of falling during pregnancy than women aged > 30 years [41.1% (69/168) vs. 23.8% (39/164); odds ratio (OR): 2.23; 95% confidence interval (CI): 1.39.3.58; P < 0.001)]. Similarly, women . 160 cm in height had significantly higher risk of falling during pregnancy than women < 160 cm in height [43.5% (70/161) vs. 22.2% (38/171); OR: 0.37; 95% CI: 0.23.0.60; P < 0.0001)]. Furthermore, primigravidae had almost threefold risk of falling during pregnancy than multigravidae [45.3% (63/139) vs. 23.3% (45/193); OR: 2.73; 95% CI: 1.70.4.37; P < 0.0001)].Conclusion: Falls during pregnancy is common in Enugu, Nigeria. It is, therefore, recommended that women should be counseled during pregnancy on this public health problem and the above.identified risk factors emphasized in order to reduce the prevalence and morbidity.Key words: Enugu, falls, Nigeria, pregnant women, prevalence, risk factor