Pregnancy outcome among patients with sickle cell disease in Jos, north central Nigeria

Background: With advances in management, education, awareness and improved nutrition, men and women with sickle cell disease are enjoying an improved quality of life well into adulthood, when they elect to plan a family. As a result, sickle cell disease is a common haemoglobinopathy encountered during pregnancy in Nigeria. Reports from other parts of the country have documented increased maternal andperinatal morbidity and mortality, but none has been reported from Jos.Materials and Methods: A retrospective review of pregnancy outcome in patients with sicle cell disease managed at the Jos University Teaching Hospital, Jos over a 5year period was carried out. Data extracted from patients' case files were analysed using simple statistical methods with Epi info 2002 statistical software.Results: Case files of patients with sickle cell disease in pregnancy during the period under review were retrieved. The mean maternal age was 25.1±3.9 years. The mean gestational age at booking or first presentation was 19.3±7.7 weeks. The antenatal complications included anaemia (62.9%), vaso-oclusive (bone pain) crisis (58.1%), intra uterine growth restriction (45.7%), pregnancy induced hypertension and malaria 25.7% each. The maternal and perinatal mortality rates were 53 and 384 per 1000 live births respectively.Conclusion: Pregnancy in sickle cell disease patients is associated with high maternal and perinatal morbidity and mortality as reported in other parts of the country. The importance of early presentation for antenatal care and a call for preconception care is made.Keywords: Pregnancy, outcome, sickle cell, disease, Jo

Declining Rate of Infection with Maternal Human Immunodeficiency Virus at Delivery Units in North-Central Nigeria

HIV testing during labour and delivery provides a critical opportunity for  administering appropriate interventions to prevent mother-to-child- transmission (PMTCT). We studied current HIV rates and infection trend among women tested during delivery following scale-up of PMTCT and antiretroviral therapy (ART) programs in Jos, north central Nigeria. Between March 2010 and January 2012, provider-initiated HIV testing and  counselling was offered in early labour. Women were recruited from a government tertiary health centre, a faith-based hospital, and a private health centre. Those who previously tested HIV negative during antenatal care (ANC) and those who presented at the labour ward with unknown HIV status were tested. A total of 944 subjects (727 re-tested for HIV infection and 217 with unknown HIV status) were enrolled and tested during labour. The HIV incidence and sero-conversion rates during pregnancy among  women who repeated HIV testing at delivery was 1.7 per 100 person-years of observation (pyo) and 0.6% (4/727), respectively, while the rate among those who tested for the first time in labour was 1.8% (4/217). Women who accessed ANC were older and had achieved a higher educational status than those who did not access ANC. A 3- to 5-fold decline in HIV incidence and prevalence rates was detected among women tested at delivery when compared to data from a report in 2004. It is not certain whether the decline in maternal HIV infection is due to the major state-wide scale-up of PMTCT and HIV treatment programs. A broader and purposefully designed evaluation study would be required to verify observed occurrence. Afr J Reprod Health 2013 (Special Edition); 17[4]: 138-145).Keywords: HIV, PMTCT, incidence, Labour/delivery, Nigeri