Anaemia in HIV positive mothers on antiretroviral therapy for prevention of mother-to-child transmission HIV in a tertiary health institution in North Central Nigeria

Background: Anaemia in pregnancy and HIV infection are two common public health issues in sub-Saharan African with Nigeria bearing the greatest burden. The duo occurring together poses a higher risk of morbidity and mortality for both the foetus and the mother. We therefore conducted this study to determine the burden of anaemia and other haematological abnormalities among HIV positive pregnant mothers on antiretroviral therapy who attended antenatal clinical services in our health institution.Methods: A 10-year retrospective review from January 2010 to December 2019 of medical records of HIV positive mothers on highly anti-retroviral therapy in attendance for antenatal clinical services in our health institution was carried out for the above objectives. Information extracted were, age, HIV status, gestational age at delivery, type of antiretroviral drugs used, duration of use, haemoglobin level, platelet, and complete blood count at booking of the positive mothers.Results: Of a total of 330 HIV positive mothers seen during the review period, 82.7% were from rural communities, 88.8% were from middle socio-economic class, 80.0% were Christians, and 80.3% started their highly active antiretroviral therapy before their index pregnancy. Most, 51.5% and 42.7% were on zidovudine, lamivudine and nevirapine, and tenofovir with lamivudine and lopinavir boasted ritonavir combinations, while 94.2% were on 1st line antiretroviral medication. Their mean age, gestational age at delivery, and parity were 31.11±4.7 years, 38.57±3.1 weeks, and 2.0±1.6 respectively. The prevalence of anaemia, thrombocytopenia and leucopoenia were 36.1%, 4.8%, and 6.7% respectively while their mean CD4 cell count and viral loads at the point of booking were 543.63±283.7 cells/μl, and 2953.02±1619.9 copies/ml. The two maternal variables that showed significant relationship with haemoglobin concentration of <10 gm/dl was mother’s level of education x2=6.29, p=0.043, and her socio=economic class, x2=10.162, p=0.006.Conclusions: There is high burden of anaemia among HIV positive mothers on antiretroviral therapy in our environment. The prevalence of thrombocytopenia and leucopoenia was much lower. The burden of maternal anaemia was associated with maternal level of education and her socio-economic class

Risk factors for hypertensive disorders of pregnancy in Abuja, Nigeria: A prospective case‑control study

Background: Hypertensive disorders of pregnancy (HDP) are an important cause of maternal and perinatal morbidity and mortality throughout the world, particularly in developing countries like Nigeria. The study determined the risk factors for the development of HDP among women who booked early for antenatal care. Materials and Methods: This was a prospective case‑control study conducted from March 2015 to March 2016 involving pregnant women with gestational age less than 20 weeks at booking and were followed up until delivery and 6 weeks postpartum. Information on gestational age at recruitment, at diagnosis of HDP, mode of delivery, and fetal outcome were recorded. Risk factors for HDP were compared between women who developed HDP (cases) and those who did not develop HDP (controls) by Fisher’s exact test, Chi‑square, and student’s t‑tests. Univariate and multivariate logistic regression analysis was used to test the relationship between certain risk factors and the development of HDP. A P value of less than 0.05 was considered statistically significant. Results: The prevalence of HDP in the study was 19.4%. Family history of preeclampsia (OR: 5.339, 95% CI: 1.149–24.818, P = 0.033); previous history of preeclampsia (OR: 10.819, 95% CI: 3.570–32.792, P &lt; 0.001); multifetal gestation (OR: 13.275, 95% CI: 2.899–38.127, P = 0.010); chronic hypertension (OR: 3.431, 95% CI: 1.778–8.710, P &lt; 0.001) and diabetes; (OR: 2.846 95% CI: 0.460–17.584, P &lt; 0.251) were the risk factors associated with the development of HDP among the study population while nulliparity (OR: 0.726, 95% CI 0.366–1.440, P = 0.395); body mass index (BMI) (mean ± SD), (OR: 0.405, 95% CI: 0.173–0.945, P &lt; 0.037);and low educational level (OR: 0.582, 95% CI: 0.070–4.857, P = 0.613) were not. Conclusion: The prevalence of HDP in the study group was high. Risk factors for HDP included family history of hypertension, previous history of preeclampsia, multifetal gestation, and chronic hypertension. Key words: Abuja; hypertensive disorders of pregnancy; Nigeria

Uptake of long-acting reversible contraceptives in north central Nigeria: a five-year review

Background: Long-acting reversible contraceptives (LARC) are methods used in the prevention of pregnancy that are long lasting. They are effective and efficacious methods of contraception and return to fertility after removal is prompt. Objectives was to determine the uptake of long-acting reversible contraception and assess the characteristics of acceptors of these methods in the area.Methods: This was a retrospective study of clients’ who visited the family planning unit of the University of Abuja teaching hospital over a 5-year period, from 01 January 2015 to 31 December 2019. Information on socio-demographic characteristics and specific methods selected were extracted from their records and represented on simple tables, graphs, and charts.Results: A total of one thousand eight hundred and ninety-one (1,891) clients accepted available methods of contraceptives during the five-year study period. One thousand seven hundred and twenty-four (1,724) accepted LARC (91.1%) while only one hundred and sixty-seven (167) accepted non-LARC (8.9%). Majority 946 (54.9%) of the clients that accepted LARC were aged between 30-39 years and clients less than 20 years were 22 (1.3%). Clients with parity 3 and above were 1162 (67.7%), and majority of LARC acceptors wanted more children 1145 (66.4%). Amongst the LARC acceptors, most of the clients opted for subdermal implant either Jadelle or Implanon 940(49.7%). Three hundred and ninety-eight (23.1%) discontinued a form of LARC during the study period while 1127 (65.4%) continued with one form of LARC or another.Conclusions: The uptake of LARC in this region is very high. Teenagers and low parity rarely attended the family planning clinic

Trends in female sterilization in north central Nigeria

Background: Contraception is key to the reduction of maternal mortality. Tubal ligation is a good option for women seeking out a safe, effective, permanent and convenient form of contraceptive. However, due to variety of reasons, there is aversion to it especially in developing world. The objective of this study was to determine the trends, uptake, socio-demographic characteristics of acceptors, indications and complications of bilateral tubal ligation (BTL) in our environment.Methods: A retrospective study of BTL at UATH was conducted over a five year period, from 1 January 2015 to 31 December 2019. The records of women who had BTL were retrieved from the medical records department, family planning clinic, and the theatre. The data was analyzed using SPSS 21.Results: The mean age and parity were 36.0±4.0 and 5.0±2.0 respectively. The incidence of BTL was 1.3%. Majority of those that had BTL had at least secondary level of education 100 (83.4%) and 58 (48.3%) were grand multiparous. Majority of cases 87 (72.5%) were done during caesarean section/laparotomy. Postpartum BTL accounted for 15.0%, while interval BTL accounted for 12.5%. Completed family size was the commonest indication 48.3%. No client came back with regrets. There was one case of failed BTL.Conclusions: BTL is a safe and effective method of sterilization. There is an increasing trend in utilization of BTL however the rate is still low

Age-specific prevalence of human papilloma virus infection among Nigerian women

Background: Inconsistent trends in HPV prevalence by age have been described in Africa. We examined the age prevalence pattern and distribution of 37 HPV-DNA types among urban Nigerian women. Methods: The study population was a sample of 278 women who presented to cervical cancer screening programs in Abuja, Nigeria, between April and August 2012. Using a nurse administered questionnaire, information on demographic characteristics and risk factors of cervical cancer was collected and samples of cervical exfoliated cells were obtained from all participants. Roche Linear Array HPV Genotyping Test® was used to characterize prevalent HPV and log-binomial regression models were used to examine the association between potential correlates and the prevalence of HPV infection. Results: The mean age (SD) of the women enrolled was 38 (8) years. The overall prevalence of HPV was 37%. HPV 35 was the most prevalent HPV type in the study population. Among women age ≤ 30 years, 52% had HPV infection compared to 23% of those women who were older than 45 years (p = 0.006). We observed a significant linear association between age and the prevalence of HPV infections. The prevalence ratio (PR) and 95% confidence interval (CI) was 2.26 (1.17, 4.34) for any HPV infection, 3.83 (1.23, 11.94) for Group 1 HPV (definite carcinogens), and 2.19 (0.99, 4.84) for Group 2a or 2b HPV (probable or possible carcinogens) types, among women aged 18–30 years, compared to women who were older than 45 years. Conclusion: The prevalence of HPV infection was highest among younger women and decreased steadily with age among this population of urban Nigerian women

Review of Twin Pregnancies in a Tertiary Hospital in Abuja, Nigeria

Studies on twin pregnancy are uniquely important to Africa and particularly Nigeria where the highest incidence in the world exists. This study was designed to determine the trend, rate, and obstetric outcomes of twin deliveries in the University of Abuja Teaching Hospital, Gwagwalada. This was a retrospective study of twin deliveries in the hospital over a period of 10 years. During the study period, there were 349 twin births out of 10,739 deliveries, giving an overall twining rate of 32.5 per 1,000 deliveries. Preterm delivery occurred in 39.7% cases and was, therefore, the most common complication. Mode of delivery was vaginal in 72.7% while 27.3% were delivered by caesarean section. Emergency caesarean section for delivery of both the babies was carried out in 22.3% while elective caesarean section for both the babies accounted for 1.0 %. Combined vaginal and abdominal delivery occurred in 4.0% of deliveries. The stillbirth rate was 102 per 1,000 births. There were 24 (8.0%) and 37 (12.3%) stillbirths among the first and the second baby respectively. The mean foetal weight was 2.395\ub10.63 kg while the female-to-male ratio was 1:1.1. The rate of twin deliveries in our centre is high. Successful vaginal delivery of twins is high when the mothers are booked and the presentations of the twins are favourable. The use of antenatal care services and good intrapartum management will help improve outcome in twin pregnancies

HIV associated high-risk HPV infection among Nigerian women

Background: In developed countries, the incidence of cervical cancer has remained stable in HIV+ women but the prevalence and multiplicity of high-risk HPV (hrHPV) infection, a necessary cause of cervical cancer, appears different comparing HIV+ to HIV- women. Little is known about HIV and HPV co-infection in Africa. Methods: We enrolled women presenting at our cervical cancer screening program in Abuja, Nigeria between April and August 2012, and collected information on demographic characteristics, risk factors of HPV infection and samples of exfoliated cervical cells. We used Roche Linear Array HPV Genotyping Test® to characterize prevalent HPV and logistic regression models to estimate the association between HIV and the risk of hrHPV infection. Results: There were 278 participants, 54% (151) were HIV+, 40% (111) were HIV-, and 6% (16) had unknown HIV status. Of these, data from 149 HIV+ and 108 HIV- women were available for analysis. The mean ages (±SD) were 37.6 (±7.7) years for HIV+ and 36.6 (±7.9) years for HIV- women (p-value = 0.34). Among the HIV+ women, HPV35 (8.7%) and HPV56 (7.4%) were the most prevalent hrHPV, while HPV52 and HPV68 (2.8%, each) were the most prevalent hrHPV types among HIV- women. The multivariate prevalence ratio for any hrHPV and multiple hrHPV infections were 4.18 (95% CI 2.05 – 8.49, p-value <0.0001) and 6.6 (95% CI 1.49 – 29.64, p-value 0.01) respectively, comparing HIV + to HIV- women, adjusted for age, and educational level. Conclusions: HIV infection was associated with increased risk of any HPV, hrHPV and multiple HPV infections. Oncogenic HPV types 35, 52, 56 and 68 may be more important risk factors for cervical pre-cancer and cancer among women in Africa. Polyvalent hrHPV vaccines meant for African populations should protect against other hrHPV types, in addition to 16 and 18

RPS19 and TYMS SNPs and Prevalent High Risk Human Papilloma Virus Infection in Nigerian Women

High risk HPV (hrHPV) infection is a necessary cause of cervical cancer but the host genetic determinants of infection are poorly understood. We enrolled 267 women who presented to our cervical cancer screening program in Abuja, Nigeria between April 2012 and August 2012. We collected information on demographic characteristics, risk factors of cervical cancer and obtained samples of blood and cervical exfoliated cells from all participants. We used Roche Linear Array HPV Genotyping Test® to characterize the prevalent HPV according to manufacturer's instruction; Sequenom Mass Array to test 21 SNPs in genes/regions previously associated with hrHPV and regression models to examine independent factors associated with HPV infection. We considered a p<0.05 as significant because this is a replication study. There were 65 women with and 202 women without hrHPV infection. Under the allelic model, we found significant association between two SNPs, rs2305809 on RPS19 and rs2342700 on TYMS, and prevalent hrHPV infection. Multivariate analysis of hrHPV risk adjusted for age, body mass index, smoking, age of menarche, age at sexual debut, lifetime total number of sexual partners and the total number of pregnancies as covariates, yielded a p-value of 0.071 and 0.010 for rs2305809 and rs2342700, respectively. Our findings in this unique population suggest that a number of genetic risk variants for hrHPV are shared with other population groups. Definitive studies with larger sample sizes and using genome wide approaches are needed to understand the genetic architecture of hrHPV risk in multiple populations

Recurrence of cervical intraepithelial lesions after thermo-coagulation in HIV-positive and HIV-negative Nigerian women

Background: The burden of cervical cancer remains huge globally, more so in sub-Saharan Africa. Effectiveness of screening, rates of recurrence following treatment and factors driving these in Africans have not been sufficiently studied. The purpose of this study therefore was to investigate factors associated with recurrence of cervical intraepithelial lesions following thermo-coagulation in HIV-positive and HIV-negative Nigerian women using Visual Inspection with Acetic Acid (VIA) or Lugol’s Iodine (VILI) for diagnosis. Methods: A retrospective cohort study was conducted, recruiting participants from the cervical cancer “see and treat” program of IHVN. Data from 6 sites collected over a 4-year period was used. Inclusion criteria were: age ≥18 years, baseline HIV status known, VIA or VILI positive and thermo-coagulation done. Logistic regression was performed to examine the proportion of women with recurrence and to examine factors associated with recurrence. Results: Out of 177 women included in study, 67.8 % (120/177) were HIV-positive and 32.2 % (57/177) were HIV-negative. Recurrence occurred in 16.4 % (29/177) of participants; this was 18.3 % (22/120) in HIV-positive women compared to 12.3 % (7/57) in HIV-negative women but this difference was not statistically significant (p-value 0.31). Women aged ≥30 years were much less likely to develop recurrence, adjusted OR = 0.34 (95 % CI = 0.13, 0.92). Among HIV-positive women, CD4 count <200cells/mm3 was associated with recurrence, adjusted OR = 5.47 (95 % CI = 1.24, 24.18). Conclusion: Recurrence of VIA or VILI positive lesions after thermo-coagulation occurs in a significant proportion of women. HIV-positive women with low CD4 counts are at increased risk of recurrent lesions and may be related to immunosuppression