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

Clinical versus Sonographic Estimation of Foetal Weight in Southwest Nigeria

A prospective study was conducted at Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria, between 3 January and 31May 2004, to compare the accuracy of clinical and ultrasonographic estimation of foetal weight at term. One hundred pregnant women who fulfilled the inclusion criteria had their foetal weight estimated independently using clinical and ultrasonographic methods. Accuracy was determined by percentage error, absolute percentage error, and proportion of estimates within 10% of actual birthweight (birthweight of +10%). Statistical analysis was done using the paired t-test, the Wilcoxon signed-rank test, and the chi-square test. The study sample had an actual average birthweight of 3,255+622 (range 2,150–4,950) g. Overall, the clinical method overestimated birthweight, while ultrasound underestimated it. The mean absolute percentage error of the clinical method was smaller than that of the sonographic method, and the number of estimates within 10% of actual birthweight for the clinical method (70%) was greater than for the sonographic method (68%); the difference was not statistically significant. In the low birthweight (<2,500 g) group, the mean errors of sonographic estimates were significantly smaller, and significantly more sonographic estimates (66.7%) were within 10% of actual birthweight than those of the clinical method (41.7%). No statistically significant difference was observed in all the measures of accuracy for the normal birthweight range of 2,500-<4,000 g and in the macrosonic group (≥4,000 g), except that, while the ultrasonographic method underestimated birthweight, the clinical method overestimated it. Clinical estimation of birthweight is as accurate as routine ultrasonographic estimation, except in low-birthweight babies. Therefore, when the clinical method suggests weight smaller than 2,500 g, subsequent sonographic estimation is recommended to yield a better prediction and to further evaluate foetal well-being

Clinical Versus Sonographic Estimation of Foetal Weight in Southwest Nigeria

A prospective study was conducted at Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria, between 3 January and 31May 2004, to compare the accuracy of clinical and ultrasonographic estimation of foetal weight at term. One hundred pregnant women who fulfilled the inclusion criteria had their foetal weight estimated in dependently using clinical and ultrasonographic methods.Accuracy was determined by percentage error, absolute percentage error,and proportion of estimates within 10% of actual birth-weight (birth-weight of +10%). Statistical analysis was done using the paired t-test, the Wilcoxon signed-rank test, and the chi-square test. The study sample had an actual average birthweight of 3,255+622 (range 2,150-4,950) g. Overall, the clinical method overestimated birth-weight, while ultrasound underestimated it. The mean absolute percentage error of the clinical method was smaller than that of the sonographic method, and the number of estimates within 10% of actual birthweight for the clinical method (70%) was greater than for the sonographic method (68%); the difference was not statistically significant. In thelow birth-weight(&lt;&lt;2,500g)group, the mean errors of sonographic estimates were significantly smaller, and significantly more sonographic estimates (66.7%) were within 10% of actual birth-weight than those of the clinical method (41.7%). No statistically significant difference was observed in all the measures of accuracy for the normal birth-weight range of 2,500-&lt;4,000 g and in the macrosonic group ( 654,000 g), except that, while the ultrasonographic method underestimated birth-weight, the clinical method overestimated it. Clinical estimation of birth-weight is as accurate as routineultrasonographic estimation, except in low-birth-weight babies. Therefore, when the clinical method suggests weight smaller than 2,500 g, subsequent sonographic estimation is recommended to yield a better prediction and to further evaluate foetal well-being

Antenatal corticosteroids for women at risk of imminent preterm birth in low-resource countries: the case for equipoise and the need for efficacy trials

The scientific basis for antenatal corticosteroids (ACS) for women at risk of preterm birth has rapidly changed in recent years. Two landmark trials—the Antenatal Corticosteroid Trial and the Antenatal Late Preterm Steroids Trial—have challenged the long-held assumptions on the comparative health benefits and harms regarding the use of ACS for preterm birth across all levels of care and contexts, including resource-limited settings. Researchers, clinicians, programme managers, policymakers and donors working in low-income and middle-income countries now face challenging questions of whether, where and how ACS can be used to optimise outcomes for both women and preterm newborns. In this article, we briefly present an appraisal of the current evidence around ACS, how these findings informed WHO’s current recommendations on ACS use, and the knowledge gaps that have emerged in the light of new trial evidence. Critical considerations in the generalisability of the available evidence demonstrate that a true state of clinical equipoise exists for this treatment option in low-resource settings. An expert group convened by WHO concluded that there is a clear need for more efficacy trials of ACS in these settings to inform clinical practice

Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017

A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic

Perception of Labour Pain by Pregnant Women in Southwestern Nigeria

Objectives: This study was conducted to determine the Yoruba woman\'s perspective of labour pain, to ascertain what methods of pain relief in use during labour and the effectiveness of these methods. Methods: With the help of an epidemiologist, we designed a questionnaire to apply to women who have had at last one normal delivery. Women attending the antenatal booking clinic in three big hospitals in South-western Nigeria, with a predominant population of Yorubas, were interviewed. Questions asked were : Labour pain rating using a 3- point Verbal rating Scale (VRS), (2) what they would want done to pain when in labour, (3)analgesic use in previous labour (s), (4) patient\'s greatest worry during labour. Results: A total of 486 multiparous women were interviewed. Over 70% rated labour pain as moderately to severely painful. 32% would not want any pain relief while in labour but another 33% would want it eliminated. Labour pain was the greatest worry of 14% during labour while 40% claimed they had no worries. 95% claimed not to have had any analgesia during previous deliveries. All those who had analgesia were given only intramuscular injections while in labour. Conclusions: Though most Nigerian women find labour painful, they appear to tolerate it well. Methods available for pain relief in developed countries are not in use here. The only method in use is not very effective. Key Words: Labour Pain, Analgesia, Verbal Rating Scale. [Trop J Obstet Gynaecol, 2004; 21:153-155

The Role of Referring Centres in the Tragedy of ‘Unbooked' Patients

Context: Despite the proliferation of health centres in Nigeria, the number of ‘unbooked' obstetric patients seen in tertiary institutions remains high, and their obstetric outcome is usually poor. Since many of these patients are referred from these health centres, it is important to determine their contributions to the tragedy of these patients. Objectives: To assess the contribution of referring centres to the morbidity and mortality seen in unbooked patients. Study Design and Setting: Cross-sectional study at a University Teaching Hospital in Ilesa, Nigeria. Subjects and Methods: All unbooked patients admitted into the obstetric wards of the Wesley Guild Hospital, Ilesa between January and July 2000 had a proforma completed to record information on age, parity, social class, source of referral, the management given at the source of referral and the condition of the patient on admission. Results: Of the 148 unbooked patients admitted during the study period, 87 (58.8%) received care in various referring centres. Sixty-five of these 87 patients (74.7%) were mismanaged. The sources of referral were traditional birth attendants (TBA), mission houses and private hospitals where 100%, 87.5% and 80% respectively of the patients were mismanaged before being allowed to come to the hospital. Among referred patients, 62.1% were received in poor clinical condition compared to 39.3% of those who did not receive prior care anywhere. (P < 0.05). Conclusion: Inadequate care at sources of referral is a major contributor to morbidity and mortality in unbooked patients. We suggest that these health facilities be supervised and monitored to reduce the current high morbidity and mortality among unbooked patients. (Tropical Journal of Obstetrics and Gynaecology, 2001, 18(1): 24-26

Grandmultiparity: Mothers' Own Reasons For The Index Pregnancy

Context: Despite widespread availability of modern contraception, grandmultiparous women still constitute a significant proportion of our obstetric population. Although the socio-economic characteristics of these patients are well known, we need to know why they decide to get pregnant again despite the dangers involved. Such knowledge may help us find a lasting solution to this problem. Objective: This study aims at finding out from grandmultiparous women their reasons for the index pregnancy. Design: Cross-sectional study Setting: Department of Obstetrics and Gynaecology, State Specialist Hospital Ondo, Ondo State, Nigeria. Subjects: All grandmultiparous women that booked between January 1999 and September 1999. Methods: The mothers were asked to fill a questionnaire on the first day of visit. Items of information requested include the reasons for the current pregnancy, knowledge of family planning and demographic characteristics. Main Outcome Measure: Mother's reason for the current pregnancy. Results: Among the women, 94:1% were aware of family planning with a usage rate of 7.8 percent. The reasons given for the current pregnancy were: desire for large family (25.9%); loss of previous children (24.1%), mistake (16.7%); desire for male child (14.8%); desire to have a child for a new husband (11.1%) and failed contraception (7.4%). Conclusion: The major reasons grandmultipara conceive again are desire for large families and loss of previous offspring. To reduce the incidence of grandmultiparity in our society efforts must be geared towards raising the social status of our women through universal formal education and reducing the currently high childhood mortality. (Tropical Journal of Obstetrics and Gynaecology, 2001, 18(1): 31-33