Environmental cadmium exposure: a possible factor in the pathogenesis of preeclampsia

Cadmium is a toxic metal, an environmental contaminant and a multi-organ poison which has been implicated in the derangement of a number of biological and molecular systems. Exposure to cadmium is a serious global health threat particularly in developing countries and pregnant women are at great risk, This is because they have increased gastrointestinal absorption and retention of cadmium and the tendency for increased risk of complications owing to its toxic effects. Preeclampsia is a pregnancy complication characterized by the development of onset of hypertension and significant proteinuria after 20 weeks of gestation or during labour and/or within 48 hours of delivery. This pregnancy-specific syndrome is a leading cause of maternal death particularly in developing countries. Several reports have provided evidence of remote association between preeclampsia and cadmium but the mechanism of the involment of this toxic metal in this disease is still surrounded with uncertainty. Some possible mechanistic pathways such as induction of oxidative stress, acting as an antimetabolite to zinc and deregulation of epigenetic mechanisms have been elucidated in this article may be interconnected, work synergistically or act independently. However, pertinent to understand them in a bid to possibly prevent the disease or forestall its devastating consequences. Environmental cadmium exposure may be considered a factor that merits further serious attention in the continuous search for the precise an etiology of preeclampsia particularly in developing countries that experience uncontrolled cadmium release into the environment

Correlation between Body mass index, Waist Hip ratio, blood sugar levels and blood pressure in apparently healthy adult Nigerians

Abstract: Background: Obesity is a global epidemic and is on the rise. Obesity is defined as a body mass index (BMI) BMI and RBS (0.083, p=0.020), SBP (0.206, p=0.000) and DBP (0.152, p=0.000). There was a slightly stronger correlation between WHR and RBS (0.093, p=0.009), SBP (0.273, p=0.000) and DBP (0.217, p=0.00

A process evaluation plan for assessing a complex community-based maternal health intervention in Ogun State, Nigeria

Background: Despite increased investment in community-level maternal health interventions, process evaluations of such interventions are uncommon, and can be instrumental in understanding mediating factors leading to outcomes. In Nigeria, where an unacceptably number of maternal deaths occur (maternal mortality ratio of 814/100,000 livebirths), the Community Level Interventions for Pre-eclampsia (CLIP) study (NCT01911494) aimed to reduce maternal and neonatal mortality and morbidity with a complex intervention of five interrelated components. Building from previous frameworks, we illustrate a methodology to evaluate implementation processes of the complex CLIP intervention, assess mechanisms of impact and identify emerging unintended causal pathways. Methods: The study was conducted from 2013–2016 in five Local Government Areas in Ogun State, Nigeria. A six-step approach was developed to evaluate key constructs of context (external factors related to intervention), implementation (fidelity, dose, reach, and adaption) and mechanisms of impact (unintended outcomes and mediating pathways). The steps are: 1) describing the intervention by a logic model, 2) defining acceptable delivery, 3) formulating questions, 4) determining methodology, 5) planning resources in context, lastly, step 6) finalising the plan in consideration with relevant stakeholders. Results: Quantitative data were collected from 32,785 antenatal and postnatal visits at the primary health care level, from 66 community engagement sessions, training assessments of community health workers, and standard health facility questionnaires. Forty-three focus group discussions, 38 in-depth interviews, and 23 structured observations were conducted to capture qualitative data. A total of 103 community engagement reports and 182 suspected pre-eclampsia case reports were purposively collected. Timing of data collection was staggered to understand feedback mechanisms that may have resulted from the delivery of the intervention. Data will be analysed using R and NVivo. Diffusions of innovations and realist evaluation theories will underpin analysis of the interaction between context, mechanisms and outcomes. Conclusion: This comprehensive approach can serve as a guide for researchers and policy makers to plan the evaluation of similar complex health interventions in resource-constrained settings, and to aid in measuring 'effectiveness' of interventions and not just 'efficacy'. Trial registration This research is a part of the Community Level Interventions for Pre-eclampsia Study, NCT01911494. The trial is registered in Clinicaltrials.gov, the URL is https://clinicaltrials.gov/ct2/show/NCT01911494 The trial was registered on June 28, 2013 and the first participant was enrolled for intervention on March 1, 2014.Medicine, Faculty ofOther UBCNon UBCObstetrics and Gynaecology, Department ofReviewedFacult

The incidence of pregnancy hypertension in India, Pakistan, Mozambique, and Nigeria: A prospective population-level analysis.

BackgroundMost pregnancy hypertension estimates in less-developed countries are from cross-sectional hospital surveys and are considered overestimates. We estimated population-based rates by standardised methods in 27 intervention clusters of the Community-Level Interventions for Pre-eclampsia (CLIP) cluster randomised trials.Methods and findingsCLIP-eligible pregnant women identified in their homes or local primary health centres (2013-2017). Included here are women who had delivered by trial end and received a visit from a community health worker trained to provide supplementary hypertension-oriented care, including standardised blood pressure (BP) measurement. Hypertension (BP ≥ 140/90 mm Hg) was defined as chronic (first detected at ConclusionsPregnancy hypertension is common in less-developed settings. Most women in this study presented with gestational hypertension amenable to surveillance and timed delivery to improve outcomes.Trial registrationThis study is a secondary analysis of a clinical trial - ClinicalTrials.gov registration number NCT01911494