Clinical characterisation and management outcomes of COVID-19 infection in pregnancy in a Nigerian tertiary hospital

Background: Literature on the antenatal and perinatal management and outcomes of COVID-19 infection in pregnancy in Nigeria and sub-Saharan Africa is gradually emerging but sparse. There is an urgent need to build up the knowledge base of COVID-19 infection in Nigerian pregnant women. The objective of the current study was to determine the clinical characteristics and management outcomes of COVID-19 infection in pregnancy at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria.Methods: A one-year retrospective review of all cases of COVID-19 infection in pregnancy managed at the OAUTHC. Relevant data were extracted from the case records of all cases managed using a purpose-designed proforma. Data collected was analysed using IBM-SPSS, version 24. Associations between categorical variables were assessed using chi square, with level of significance set at <0.05.Results: A total of 22 cases were managed. Majority (15, 68.2%) of the women were either asymptomatic or had mild symptoms. The commonest symptom was cough (8, 36.4%). The mean duration of admission was 6.6±4.2 days. The most common maternal and perinatal complication was preterm delivery/birth (3, 13.6%). There was no maternal mortality. The mean birth weight of the babies was 3226g±597g, with mean 1- and 5- minutes Apgar scores of 8.0±1.3 and 9.5±0.6 respectively.Conclusions: Although COVID-19 infection in pregnancy is an asymptomatic or mild infection in the majority of cases in Ile-Ife, Nigeria, it is associated with adverse maternal and perinatal outcomes. Further studies are recommended to determine transplacental transmission of COVID-19 infection and antibodies

Obstructed labour in a Nigerian tertiary health facility: a mixed-method study

Background: Obstructed labour remains a leading cause of maternal and perinatal mortality and morbidity in sub-Saharan Africa. This study aimed to determine the incidence, causes, complications and outcomes of obstructed labour at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Osun state, Nigeria.Methods: A mixed methods approach was employed for this study. A 10-year retrospective review of all cases of obstructed labour managed at the OAUTHC, between January 1, 2008, and December 31, 2017, was done. Ten in-depth interviews were conducted for some selected patients. The quantitative data was analysed using SPSS version 24, while the qualitative data was analyzed with NVivo version 12.Results: The incidence of obstructed labour was 1.99%. Most of the patients were unbooked (217, 90.4%), primigravid (138, 57.5%), and either had no formal or only primary/secondary education (120, 50%). Cephalopelvic disproportion (CPD) was the commonest cause of obstructed labour (227, 94.6%). The most common maternal complication was wound infection (48, 20%). There were three maternal deaths, giving a case fatality rate of 1.25%. The most common foetal complication was birth asphyxia (85, 34.7%). The perinatal mortality rate was 18.8 %. From the qualitative arm of the study, reasons given by parturients who suffered obstructed labour, for avoiding hospitals for delivery, included religion, finance, fear of hospitals, faith/belief in mission homes/maternity houses, and proximity.Conclusions: Obstructed labour remains an important obstetric problem in our environment, contributing significantly to the burden of maternal and perinatal mortality and morbidity.

The effect of integration of family planning education with infant vaccination visits on the uptake of postpartum family planning in Ile-Ife, Nigeria

Integration of maternal and child health services can improve service utilisation. An operations research was conducted in a Nigerian tertiary hospital. A pilot study was conducted at three family planning (FP) and vaccination sites. A formative assessment was carried out using client records and key-informant interviews. Pre- and post-integration questionnaires were administered to 715 women attending the infant vaccination clinics. Themes were developed from the qualitative data and some verbatim quotes were reported. The quantitative data were analysed using Stata, version 17. Univariate and multivariate analyses were done to compare associations between categorical independent and outcome variables where applicable, with level of significance set at <0.05 and 95% confidence interval. The health care workers were willing to integrate the two services but inadequate training and time constraint were key barriers. Significant increases in the knowledge of contraception (25.7% vs 34.7%, p = 0.001), intention to use contraception (31.2% vs 38.2%, p = 0.001), and number of new acceptors of FP (487 vs 664, p = 0.001), were recorded post-integration, even though it was difficult to determine whether the observed increase in new FP acceptors was due to increased patronage from the study participants and not from other clients who were not part of the study. Integration of FP education and infant vaccination services is a feasible and acceptable strategy for increasing contraceptive use among postpartum women, as vaccination clinic staff were willing to take on FP education along with their current duties.Impact statement What is already known on this subject? Few studies have reported on the outcomes related to FP and vaccination integration. What the results of this study add? A simple model of FP education and infant vaccination services integration is a feasible and acceptable strategy for increasing contraceptive use among postpartum women. However, inadequate training and time constraint were major concerns for healthcare providers. Implications of these findings for clinical practice and/or further research? Targeted family planning education and referral should be encouraged during infant vaccination visits. There is a need for further research to determine the providers’ skills necessary for integration and whether integration poses a risk to either service

Role of academia in enhancing technology and innovation for a post COVID-19 recovery and growth

The COVID-19 pandemic represents one of the greatest challenges of this century with wide ranging impacts not only on health but practically every sector of the human society. The pandemic stretched our resources and coping capacities to almost breaking points even in wealthy economies and further exposed crucial weaknesses in infrastructure, human resources and emergency preparedness of most nations. This review article explored the role of technology and innovation in post COVID-19 growth and recovery.The academia has facilitated better understanding of the COVID-19 pandemic by increasing the body of knowledge on the disease. Better understanding of the disease informed technology and innovations which has made it possible to end the pandemic lockdown, and chart the course for recovery and growth.Relevant articles from a search of electronic databases were reviewed and the role of academia as well as some of the innovations that opened the pathway for recovery were highlighted.Recovery and growth after the COVID-19 pandemic will require synergistic efforts between the academia and the industry, more like taking the “Gown” to “Town”. Research and development in academia, and industrial technology and innovation are veritable tools for a post COVID-19 recovery

The effect of post-cesarean rectal misoprostol on intestinal motility

OBJECTIVE:To determine whether rectally administered misoprostol can induce intestinal motility compared with oxytocin infusion when used to prevent primary postpartum hemorrhage after cesarean delivery.METHODS:In a prospective randomized double-blind study in Nigeria, 218 parturients undergoing cesarean delivery who had risk factors for primary postpartum hemorrhage were enrolled between July 1, 2010, and March 31, 2011. Participants received 600 ?g of rectal misoprostol or 20 intravenous units of oxytocin for 4 hours after surgery. The primary outcome was time until passage of flatus. Adverse effects, need for additional analgesic, and length of hospital stay were also assessed.RESULTS:The misoprostol group had a significantly shorter mean postoperative interval to passage of flatus (20.27 ± 7.77 hours versus 38.34 ± 10.98 hours; P&lt;0.001) and commencement of regular diet (21.08 ± 7.69 hours versus 39.13 ± 10.94 hours; P&lt;0.001). Gastrointestinal adverse effects were more frequent, albeit not significantly, in the misoprostol group: nausea, 6.4% versus 1.8%; vomiting, 7.3% versus 2.8%; and abdominal distension, 3.7% versus 2.8%. The need for additional analgesic was the same in the 2 groups.CONCLUSION:After cesarean delivery, rectal misoprostol had the added benefit of inducing intestinal motility. Misoprostol might be considered in a clinical setting where postoperative ileus is anticipated

Additional file 1 of A snapshot of the prevalence of dihydropteroate synthase-431V mutation and other sulfadoxine-pyrimethamine resistance markers in Plasmodium falciparum isolates in Nigeria

Review of surveys on dhps mutation in Nigeria and neighbouring countries

A snapshot of the prevalence of dihydropteroate synthase-431V mutation and other sulfadoxine-pyrimethamine resistance markers in Plasmodium falciparum isolates in Nigeria

BACKGROUND: Malaria is a major public health issue with substantial risks among vulnerable populations. Currently, the World Health Organization (WHO) recommends SP-IPTp in the second and third trimesters. However, the efficacy of SP-IPTp is threatened by the emergence of sulfadoxine-pyrimethamine resistant malaria parasites due to single nucleotide polymorphisms in the Plasmodium falciparum dihydrofolate reductase and dihydropteroate synthetase genes. This study aimed to assess the current prevalence of Pfdhfr/Pfdhps mutations in P. falciparum isolates collected from individuals residing in Ile-Ife, Nigeria, and also present maps of the prevalence of Pfdhps 431V and 581G within Nigeria and surrounding countries. METHODS: Between October 2020 and April 2021, samples were collected as dried blood spots among 188 participants who showed malaria positivity with a histidine-rich-protein-based rapid diagnostic test (RDT). Nested PCR assays were used to confirm falciparum in the samples with RDT positivity, and to amplify fragments of the Pfdhfr/Pfdhps genes followed by targeted amplicon sequencing. Published data since 2007 on the prevalence of the Pfdhps genotypes in Nigeria and the neighbouring countries were used to produce maps to show the distribution of the mutant genotypes. RESULTS: Only 74 and 61 samples were successfully amplified for the Pfdhfr and Pfdhps genes, respectively. At codons resulting in N51I, C59R, and S108N, Pfdhfr carried mutant alleles of 97.3% (72/74), 97.3% (72/74) and 98.6% (73/74), respectively. The Pfdhps gene carried mutations at codons resulting in amino acid changes at 431-436-437-540-581-613; I431V [45.9%, (28/61)], A581G [31.1% (19/61)] and A613S [49.2% (30/61)]. Constructed haplotypes were mainly the triple Pfdhfr mutant 51I-59R-108N (95.9%), and the most common haplotypes observed for the Pfdhps gene were the ISGKAA (32.8%), ISGKGS (8.2%), VAGKAA (14.8%), VAGKAS (9.8%) and VAGKGS (14.8%). In the context of the previously published data, a high prevalence of 431V/581G mutations was found in the study population. It seems quite evident that the Pfdhps 431V, 581G and 613S often co-occur as Pfdhps-VAGKGS haplotype. CONCLUSION: This study showed that the prevalence of VAGKGS haplotype seems to be increasing in prevalence. If this is similar in effect to the emergence of 581G in East Africa, the efficacy of SP-IPTp in the presence of these novel Pfdhps mutants should be re-assessed