Social problems of indeterminate and false positive HIV test results among clients attending a Nigerian HIV treatment clinic

Increased availability of Human Immunodeficiency Virus (HIV) screening test and more public enlightenment have resulted in more people coming forward to access counseling and testing at the HIV counseling and testing centers in Nigeria. Some of the clients however obtained indeterminate and false positive results leading to emotional disturbance and occasionally, dilemma to the attending physician. This article/case series looked at some of these situations and discussed how they were attended to.Keywords: Social problems; Indeterminate results, False positive result

Blood transfusion requirement during caesarean delivery: Risk factors

Background: Group specific blood is often cross-matched ready for all patients scheduled for caesarean section in anticipation of haemorrhage during the surgery. This study was conducted to determine the risk factors for blood transfusion during anaesthesia for caesarean section.Methods: This was a prospective cross-sectional study. A total of 706 pregnant patients scheduled for emergency or elective Caesarean section at the University College Hospital, Ibadan, Nigeria between March and August 2011 were recruited. Participants were followed-up from the date of delivery till the end point of the study which could fall into either of the following conditions: satisfactory postoperative clinical status up to 48 hours post-delivery or death. Transfusion rate was determined and Chi-square test was used to determine if there exist an association between blood transfusion status and preoperative haematocrit level, years of experience of obstetrician, indication for Caesarean Section(CS), CS type (primary or repeat) and HIV status.Results: Transfusion rate was 9.1 %; variables found to be significantly associated with blood transfusion were; preoperative haematocrit less than 26%, increasing parity, years of experience of resident obstetrician, indication for CS (bleeding or not bleeding) and estimated blood loss. Being HIV positive does not increase the need for blood transfusion.Conclusion: Preoperative anaemia, increasing parity and severe blood loss at surgery significantly contribute to the requirement for blood transfusion in patients undergoing caesarean section.Keywords: Blood transfusion, Caesarean delivery, Risk factors, Anaemi

Assessment of the living conditions of rural based people living with HIV/AIDS with clinical presentations in Nigeria

Objective: To describe the living conditions of rural based people living with HIV/ AIDS (PLWHA) and their clinical presentationsDesign: Descriptive cross-sectional studySetting: University College Hospital, IbadanSubjects: PLWHA on anti-retroviral therapyResults: One hundred and fifty PLWHA participated. The mean age of the respondents was 28.7±8.9 years. Majority of the respondents visited had advanced disease (97%), were poor (75%) and presented with opportunistic infections such as oral candidiasis (92%), chronic diarrhoea (70%) and pulmonary tuberculosis (46%). Majority were treated for malaria (72%) and anaemia (61%). All respondents lived in homes predisposed to these opportunistic infections. They drink unsafe water and had poor disposal of their domestic wastes.Conclusion: PLWHA visited lived in homes that predispose them to various opportunistic infections. Improved living conditions and economic empowerment will improve the health conditions of PLWHA

Molluscum contagiosum virus infection amongst plwha in ibadan, Nigeria

Background: Molluscum contagiosum (MC) infection is caused by a pox virus and the virus is probably passed on by direct skinto- skin contact which may affect any part of the body. There is anecdotal evidence associating facial lesions with HIV-related immunodeficiency. This study was aimed to determine the prevalence and associated risk factors of Molluscum contagiosum infection among PLWHAs attending ART clinic at the University College Hospital, Ibadan, Nigeria. Methods: This is a descriptive cross-sectional survey of 5,207 patients (3519 female and 1688 males) attending ART clinic between January 2006 and December 2007. Physicians performed complete physical and pelvic examinations. Diagnosis of Molluscum Contagiosum infection was based on the clinical findings of typical lesions on the external genitalia, perianal, trunk, abdominal and facial regions.Results: The mean age of the patients was 34.67 yrs. ± 9.16). About 10% (542) had various sexually transmitted infections (STIs). The male to female ratio was 1: 4.2. One hundred and twenty seven subjects (23.4%) had no formal or primary education with 247 (45.6 %) beingtreatment naïve while 295 (54.4 %) were treatment experienced. Of the 542 PLWHAs with STIs, 3.3 % had undetectable viral load (< 200 copies/ ml) while 272 (50.1 %) had low CD4 count (< 200 cells / mm3.) and The Mean log10 viral load was 5.02 + 0.94. Molluscum Contagiosum infection was diagnosed in 13 patients (0.024%; 8 females and 5 males). Vaginal Candidiasis was the commonest genital infection diagnosed in 223 (41.1%) of the patients with STIs. MC patients had higher viral load, lower CD4 count and more likely to be treatment experienced”.Conclusions: Molluscum Contagiosum infection is not uncommon among the HIV-infected patients, but underreported. Awareness of this cutaneous manifestation should be known to Physicians in AIDS care.Key Words: Molluscum contagiosum, HIV, Sexually Transmitted Infectio

Cervical epithelial changes in a tertiary hospital in northern Nigeria

Introduction: Cervical cancer is the commonest gynaecological malignancy in Nigeria, accounting for most deaths from cancers in women. Screening remains one of the best ways to prevent this catastrophe.Methodology: This was a cross sectional study conducted among patients that presented for cervical cancer screening at the Jos University Teaching Hospital, Jos, Plateau State, North Central Nigeria over a Five-year period (1st August, 2006-31st July, 2011). Data was analyzed for frequencies using EPI Info 3.5.1, CDC, Atlanta, USA.Results: During the period of study (74.5%) of the 7863 women screened were normal. Inflammatory changes, LSIL and HSIL, were the commonest abnormalities. Eight point four percent (8.4.%) were either ASC-US or ASC-H, 35 (0.4%) were AGUS or AGUS-N. LSIL and HSIL were 547 (7.0%) and 193 (2.4%) respectively. One thousand, six hundred and seventy two (21.2%) were inflammation changes, bacterial infection, or trichomoniasis. Thirty two (0.4%) cases of suspected invasive carcinoma were seen.Conclusion: The abnormal cytological abnormality rate was high. More effort needs to be put in place to ensure that women have access to screening to reduce the burden of cervical cancer in this environment.Keywords: Paps smear, intraepithelial changes, cervical cancer, Jos University Teaching HospitalTrop J Obstet Gynaecol, 30 (1), April 201

An audit of the uptake of key PMTCT interventions in the pre and post who rapid advice periods at the university college hospital, Ibadan

Prevention of vertical transmission of HIV may require the uptake of the culturally unacceptable options of cesarean delivery and formula feeding. The successful use of HAART, as enumerated by the WHO 2009 rapid advice, has the potential for facilitating the uptake of the more culturally acceptable vaginal delivery and breast feeding. These recommendations became operational at the PMTCT unit, University College Hospital, Ibadan. This retrospective study describes the impact of these recommendations on the uptake of PMTCT interventions at our center. The pre-rapid advice period was June 2009 to April 2011 and the post rapid period May 2011 till December 2012. Pre-rapid advise, antiretrovirals administered was zidovudine or Combivir for women with CD4 >200cells / ml and Combivir/nevirapine for CD4 <200 Cells/ ml. Post-rapid, all were eligible for HAART (mostly efavirenz/ truvada or efavirenz/ Combivir). Six weeks post-natally, the options adopted were documented and are presented here. Information from 1165 women was available. Thirty three (2.8%) did not have adequate information and were excluded. There were 711 women pre-rapid advise and 421 women post rapid. The women's characteristics were not significantly different over both periods, 69.0% had >6 years of education, 97.0% were married and slightly over half (56.9%) were involved with traders. Overall, more women were delivered by the vaginal route than Caesarean Delivery (70.5% vs. 29.5%), while more breastfed compared to formula feeding (67.2% vs. 32.8%). In the post rapid period (compared to the pre- rapid) advise, more women had vaginal delivery (73.5% vs. 64.8%, p = 0.54), more women breast-fed (77.0% vs. 50.1%, p= 0.00) and fewer women used contraception (21.5% vs. 27.3%, p= 0.023). The commonest method was the condom (83.4%). The new WHO guidelines appear to have facilitated a shift in uptake of the more culturally acceptable options of vaginal delivery and breast feeding. A follow-up evaluation of the infant HIV status will ascertain the ultimate impact on MTCT

Obstetric and newborn outcomes and risk factors for low birth weight and preterm delivery among HIV-infected pregnant women at the university college hospital Ibadan

There remains uncertainty about the impact of HIV on pregnancy outcomes and effects of highly active antiretroviral therapy on fetal development. This study describes obstetric outcomes among HIV positive parturients at the University College Hospital, Ibadan. HIV positive parturients were identified in the birth register. During the 30-month period, 318 of 6203 deliveries were HIV positive (5.1%) with 97.6% record retrieval. The mean age of the HIV positive parturients was 31.66 years (± 4.66); the mean gestational age at delivery was 38.02 weeks (± 2.75) and the mean birth weight 2.85kg (±0.59). There were 35.8% (109) preterm births, 2.9% stillbirths and 21.5% low birth weights. The regimen most commonly (198, 64.5%) used was a non-nucleoside reverse transcriptase (NNRTI) based HAART. Preterm births were similar following spontaneous vaginal delivery (31.5%) and elective section (31%) but higher (41.3%) with emergency section (ñ=0.4).On univariate analysis, the preterm infants had lower mean birth weights (2.46±0.61 vs 2.96±0.44; ñ=0.000). The proportion of preterm births was higher among Low birth weight infants (71.9% vs 28.1%; ñ=0.00). Variables with more preterm births were age >35 years (51.6%), ≤6years of schooling (51.5% vs 48.4%) and being on combination ARV (PI, 37.5% or non-PI, 36.2%). However, these differences did not attain statistical significance. Low birth weight infants had mothers who had higher mean ages (33.28 years ± 4.59 vs 31.28 years ± 4.59, ñ= 0.02), lower mean gestational age at delivery (35.72 weeks ± 3.16 vs 38.49 weeks ± 2.1, ñ= 0.00). Variables with more low birth weight include <12years of schooling and being on mono/ dual therapy (31.8%). These differences were not statistically significant. On logistic regression, factors that retained an association with low birth weight were mean maternal age at delivery (ñ= 0.002; â= 0.904; 95% CI, 0.848 – 0.966) and being on mono/ dual therapy (ñ= 0.039; â= 3.042; 95% CI, 1.055 – 8.768). The only factor that retained an association with preterm birth was mean maternal age at delivery (ñ= 0.015; â= 0.935; 95% CI, 0.886 – 0.987). HIV positive (especially older) women, have high rates of preterm deliveries and low birth weights. The beneficial effects of HAART on mother-to-child transmission are indisputable but monitoring antiretroviral therapy in pregnancy remains a priority and antenatal surveillance should include fetal growth assessment.

Short CommunicationAttitude of Infertile Women to Child Adoption in Nigeria

Infertility has serious consequences especially in Africa where a high premium is place on child bearing. An interviewer-administered questionnaire was administered on 396 consenting women seeking infertility treatment at the gynaecological clinic of the University College Hospital, Ibadan in an attempt to assess the attitude of infertile women in Nigeria to child adoption and its acceptability as a management option for infertility. Most (64%) believed its culturally unacceptable and only 17% will try it as an option. Sustained advocacy, community mobilization and enactment of supportive laws were some of the suggestions made by respondents to improve its uptake.Keywords; Infertility, Adoption, Assisted ConceptionNig. J. Physiol. Sci. 25(2010) 47 – 4

Knowledge of the Human Papilloma Virus vaccines, and opinions of Gynaecologists on its implementation in Nigeria

The objective of this study was to determine the knowledge and perception of Nigerian Obstetricians and Gynaecologists towards human papilloma virus vaccine use in Nigeria. A cross sectional study was conducted amongst participants that attended the 42nd Society of Gynaecology and Obstetrics of Nigeria. The findings revealed that 44.5% knew the correct HPV vaccine schedule. Regarding implementation in Nigeria, 87.4% suggested its incorporation into the national immunization program and about a third agreed that it should be a precondition for school enrolment. Regression analysis showed that senior residents were more likely to have adequate knowledge of the vaccine compared to junior residents (AOR 7.181 95% CI OR=1.792 – 28.782). We conclude that the knowledge of eligibility and schedule is poor. It is recommended that adequate information should be provided to this group of health workers because of their strategic position in its implementation in Nigeria (Afr J Reprod Health 2013); 17[2]:150-156).Keywords: Human papilloma Virus Vaccine, HPV, Knowledge, Perception, Nigeri

Lymphomas of the female genital tract in Ibadan

Context: Female genital tract cancers are second only to breast malignancies. Cervical cancer is the commonest while epithelial cancers constitute the major histologic type. Lymphoid neoplasms are extremely rare, with the Burkitt's variety accounting for majority of cases seen in the African female.Objective: This is a review of the obstetric/gynaecological patients seen at the University College Hospital, Ibadan between 1976 and 2005, predating the commencement of a nationwide research into non – Hodgkin's lymphoma funded by the Aboderin Foundation.Study Design: Records of subjects were analysed for their  sociodemographic and clinicopathological characteristics, recruiting only those who satisfy the criteria for diagnosing genital tract lymphomas according to Kosari et al1. Retrievable archival paraffin blocks of subjects were also analysed using immunophenotyping.Results: Fifteen cases were identified within the study period; the highest yearly incidence rate being 3 in 1977. In eighteen of the years studied no cases were seen. Most cases (80.0%) occurred in the ovaries. Eighty percent (12) of patients were 25 years or below and nulliparas and grandmultiparas formed 46.7 and 13.4% respectively. Unilateral orbilateral oophorectomy was the commonest surgical procedure (53.3%) while 20.0% had total abdominal hysterectomy with or without bilateral salpingoophorectomy. Data were unavailable concerning use of adjuvanttherapy and outcome of treatment. Four archival paraffin blocks were available for immunophenotyping using the affordable panel of CD20, CD10 and Bcl – 2 antibodies; all were Burkitt's lymphoma.Conclusion: Female genital lymphomas are very rare, affecting the young and nulliparous. The Burkitt's type is commonest