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

Have you seen a rape kit? A snapshot at the quality of care of rape survivors in Nigerian tertiary hospitals

Context: The rape kit has become a fundamental tool in the evaluation of the rape survivor in many countries. Itsavailability and use in Nigeria has however not been documented.Objective: To assess the current availability and usage of the rape kit in Nigerian tertiary hospitals, and evaluate the management of rape survivors.Methodology: Resident Doctors attending the Obstetrics and Gynaecology update course, held in Abuja in March,2009 were interviewed using a self-administered questionnaire assessing experience in rape management, knowledge about the rape kit and its availability, as well as current management of rape survivors.Results: There were 138 respondents from 25 tertiary hospitals, with a male-to-female ratio of 2.8:1 and a meanduration of 3.3 (SD 1.4) years in training. 120 (87%) had personally managed one or more rape survivor(s), but none of the respondents had ever seen a rape kit, and only 29% were aware of it. Although all the respondents indicated availability of emergency contraception, antibiotics and tetanus prophylaxis in their centres, only 32.4% had access to HBV vaccine, and about 8% indicated lack of HIV prophylaxis. Only 28.7% and 45.6% indicated access to clinical psychologists and medical social workers respectively.Conclusion: The rape kit is not available in Nigerian tertiary hospitals. We recommend its provision, and regulartraining of doctors, especially Obstetrics and Gynaecology Residents on rape management, to improve the care ofrape survivors in Nigeria.Key Words: Rape, Rape kit, Rape survivor, Nigeria

Declining prevalence of duodenal ulcer at endoscopy in Ile-Ife, Nigeria

Background. Duodenal ulcer is the most common peptic ulcer disease worldwide. In the past, sub-Saharan Africa has been described as an area of mixed prevalence for peptic ulcer disease, but recent reports have disputed this. Changes in the prevalence of duodenal ulcer have been reported, with various reasons given for these.Objective. To describe the change in endoscopic prevalence of duodenal ulcer at Obafemi Awolowo University Teaching Hospital (OAUTH), Ile-Ife, Nigeria, between January 2000 and December 2010.Methods. This was a retrospective, descriptive study of patients who underwent upper gastrointestinal endoscopy in the endoscopy unit of OAUTH between January 2000 and December 2010. The data were obtained from the endoscopy register, demographic indices, presenting symptoms and post-endoscopic diagnoses being retrieved for each patient. The study period was divided into the years 2000 - 2004 and 2005 - 2010, the frequencies of duodenal ulcer and other post-endoscopic diagnoses being compared between these two time periods to see whether there were changes.Results. Over the study period, 292 patients (15.8%) were diagnosed with duodenal ulcer, second only to 471 patients (26.2%) with acute gastritis. The prevalence of duodenal ulcer for 2000 - 2004 was 22.9% (n=211 patients) compared with 9.2% (n=81) for 2005 - 2010 (p&lt;0.001).Conclusion. There was a significant decline in the endoscopic prevalence of duodenal ulcer over the decade.

Phytochemical, Scavenging Properties and Glycemic Index of Soy-Enriched Maize-Based Gruel Fortified with Moringa Leaves and Wonderful Kola

In this study, defatted soybean cake, Moringa oleifera leaves and wonderful kola combination were used to raise the nutritional value and scavenging properties of maize-based formulated diets. After blanching and fermentation process, maize (popcorn), moringa leaves, wonderful kola seeds, defatted soybean cake were milled into flour and blended to obtain six samples (R1, R2, B1, B2, F1, F2). Samples were analyzed for antinutrients, phytochemicals, scavenging properties and glycemic index using standard methods. Both processing methods reduced antinutrient levels; particularly for phytic acid. Of the methods used, fermentation is the most effective in increasing the protein content of the formulated diets, it also had the highest scavenging ability and the lowest glycemic index. For DPPH (1,1 diphenyl-2-picryhydrazyl) assay, R1, B1, F1 had high&nbsp; scavenging abilities with F1 having the highest. Albino rats fed with 1 g of sample F1 showed a great decrease in blood glucose level below 5 mmol/l when compared with other samples and reference sample (glucose). This shows the importance of a healthy diet and the effectiveness of Moringa oleifera leaves in the prevention and management of diabetes

Obstetric outcome of teenage pregnancy and labour in Obafemi Awolowo University Teaching Hospitals complex, Ile-Ife: A ten year review

Background: Teenage or adolescent pregnancy is a recognized problem of public health significance. Every year, in excess of 14 million teenage girls give birth to a child; most of these young mothers are living in non-industrialized countries. In view of the high prevalence, there is a need to audit such cases regularly to identify areas of possible improvement in its management. Results obtained from the audit can help in policy formulation and strengthen advocacy on issues ranging from abortion complications to early marriage. Objectives: The objectives of this 10-year retrospective study are to document the pattern of prevalence, presentation, obstetric outcome of teenage pregnancy, and labor at the Ife Hospital unit of obafemi awolowo university teaching hospitals complex (OAUTHC), Ile-Ife. Materials and Methods: The study involved a 10-year retrospective analysis of the data collected from the records of all cases of teenage pregnancies during the period from January 1999 to December 2008. Results: During the period studied there were 6,250 deliveries of which teenage pregnancies accounted for 255 giving an incidence of 4.08% of the total deliveries. Majority (51.76%) of the pregnant teenagers were unbooked for antenatal care and 92.12% of them were nulliparous. Antepartum hemorrhage, abnormal presentations, obstructed labor, and anemia were the commonest complications seen occurring in 54.5, 36.5, 14.1, and 11.4 per cent of the teenagers respectively which was significantly higher when compared to the adult pregnant women (P = 0.000). Delivery was by caesarean section in 32.2% of the teenagers compared to 22.6% in the other women (P = 0.000). The overall perinatal mortality rate was 68.8/1000 births while teenagers had a perinatal mortality rate of 106/1000 births (P = 0.013). Conclusion: Teenage pregnancy still remains a major recognized problem of public health significance. Most of these patients are from low socio-economic class and their obstetric performance is relatively poor compared to the adult group. The concept of women's sexual and reproductive health rights needs to be reinforced in most developing countries. Improving access to contraception and discouragement of early marriage will help to reduce teenage pregnancy and the overall burden of maternal mortality. Optimal care should be given to teenage mothers not only to improve the pregnancy outcome but also to enhance their social, educational, and emotional adjustment

Correlation of alanine aminotransferase levels and a histological diagnosis of steatohepatitis with ultrasound-diagnosed metabolic-associated fatty liver disease in patients from a centre in Nigeria

Abstract Background Metabolic-associated fatty liver disease (MAFLD) is defined as the occurrence of hepatic fat accumulation in patients with negligible alcohol consumption or any other cause of hepatic steatosis. This study aimed to correlate the ultrasound-based diagnosis of MAFLD with the histological diagnosis of nonalcoholic steatohepatitis (NASH) and alanine aminotransferase (ALT) levels in patients with MAFLD. Methods This was a hospital-based cross-sectional study of 71 patients with MAFLD diagnosed by ultrasound. Percutaneous liver biopsy was performed for histological evidence of NASH in all patients, regardless of liver function test (LFT) values, provided that they had no contraindications. Liver histology was graded using the NASH Clinical Research Network MAFLD Activity Score. The data obtained were entered into SPSS version 21 and analysed using descriptive and inferential statistics. The significance level was set at < 0.05. Results A total of 71 patients (26 males and 45 females) with MAFLD were included. Thirty-nine (76.5%) patients with MAFLD and normal ALT levels had NASH, while 14 (82.4%) had elevated ALT levels. There was no statistically significant difference in the histological grade of NASH between patients with normal and elevated ALT levels. A weak correlation was found between the severity of steatosis on ultrasound scan and NASH incidence (p = 0.026). The sensitivity and specificity of ALT levels for predicting NASH according to the area under the receiver operating characteristics (AUROC 0.590) at an ALT cut-off value of 27.5 IU/L were 55.8% and 64.7%, respectively. Conclusion NASH can occur in patients with MAFLD, irrespective of alanine transaminase (ALT) levels, and ultrasound grading of the severity of steatosis cannot accurately predict NASH. Liver biopsy remains the investigation of choice

Is menarche really occurring earlier? A study of secondary school girls in Ile-Ife, Nigeria

Context: A secular trend of progressively earlier attainment of menarche has been described in various populations. The existence of this trend in Ile-Ife, Nigeria, has not been documented. Aim: To determine the current age of menarche and its trend in comparison with previous studies among secondary school girls in Ile-Ife, Nigeria. Settings and Design: School-based cross-sectional analytical study. Materials and Methods: Three-hundred secondary school girls in the lower four classes (JSS 1--SSS 1) were studied. Sociodemographic and menstrual data such as cycle length, duration of menstrual flow, and presence of dysmenorrhoea were obtained using a structured self-administered questionnaire. The mean age at menarche was compared with figures from previous local studies to determine the trend in Ile-Ife. Menstrual characteristics were also analyzed. Statistical Analysis: Data was analyzed with SPSS version 20. Means and standard deviations were generated for continuous variables, while frequencies and proportions were determined for categorical variables. Results: Out of the 300 subjects studied, a total of 198 (66%) had attained menarche at the time of this study. Their reported ages at menarche ranged from 11 to 17 years with a mean of 13.08 ± 1.61 years. This was lower than the 13.98 ± 1.30 and 13.94 ± 1.31 years reported in Ile-Ife in 1992 and 1997, respectively. These three figures show a trend of progressive decline in the mean age at menarche. The subjects' mean duration of menstrual flow was 4.26 ± 0.87 days, with 97.5% of them reporting flow of ≤5 days. Only 22 (11.1%) of the respondents had a cycle length of 28 days. Dysmenorrhoea was reported by 75% of the respondents and 24% reported loss of concentration during periods. Conclusion: Similar to the widely reported secular trend, menarche indeed appears to be occurring progressively earlier in Ile-Ife, Nigeria

Upright or dorsal? childbirth positions among antenatal clinic attendees in Southwestern Nigeria

Background: Upright childbirth positions are associated with better delivery outcomes. These positions such as kneeling and squatting were the norm for childbirth in indigenous Nigerian custom. However, westernization has largely replaced them with supine positions. Objective: This study was conducted to compare the knowledge, attitude and experience regarding childbirth positions between antenatal clinic attendees in southwest and northwest Nigeria. Materials and Methods: A mixed methods design was employed. Quantitative data were obtained using a structured questionnaire in Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife (n = 201) and Federal Medical Centre, Katsina (n = 104). Knowledge was graded as poor, fair or good whereas attitude toward each position was graded as favoured, indifferent or against. The resulting proportions were compared using Chi-square. Qualitative data were obtained through key-informant interviews. Results: Knowledge of childbirth positions was generally poor. Overall, only to women (0.6%) had good knowledge, whereas 60 (19.7%) had fair knowledge and the rest (79.7%) had poor knowledge. More women in Katsina than Ile-Ife knew the squatting position (32.7% vs. 16.4%; P < 0.001) and favoured it (25.0% vs. 7.5%; P < 0.001), whereas more Ile-Ife women knew the lithotomy position (42.3% vs. 26.9%; P = 0.01). Attitudes towards the remaining positions were comparable between them. Key-informant interviews of the midwives revealed that they were trained to conduct delivery exclusively in the supine positions. They were, however, interested in learning the use of upright positions. Conclusion: Knowledge about childbirth positions was very poor. Women in northwestern Nigeria were more aware and favorably disposed to childbirth in their customary squatting position. Training of Nigerian midwives on upright childbirth positions is recommended