Successful pregnancy in a unicornuate uterus

Uterine anomalies are generally rare and are usually asymptomatic. When present, these anomalies are implicated in complications such as recurrent miscarriages, preterm labor, malpresentation, intrauterine growth restriction, uterine rupture, and a variety of menstrual disturbances. We report a case of a pregnancy carried to term in a unicornuate uterus with an accessory horn, diagnosed intraoperatively during an emergency cesarean section with favorable outcome to the mother and baby.Keywords: Cesarean section; successful pregnancy; unicornuate uterus; uterine anomal

Examining vulnerability and resilience in maternal, newborn and child health through a gender lens in low-income and middle-income countries : a scoping review

Funding This work was supported by the Bill & Melinda Gates Foundation under investment INV-015806 awarded to the Viable Helpers Development Organisation.Introduction Gender lens application is pertinent in addressing inequities that underlie morbidity and mortality in vulnerable populations, including mothers and children. While gender inequities may result in greater vulnerabilities for mothers and children, synthesising evidence on the constraints and opportunities is a step in accelerating reduction in poor outcomes and building resilience in individuals and across communities and health systems. Methods We conducted a scoping review that examined vulnerability and resilience in maternal, newborn and child health (MNCH) through a gender lens to characterise gender roles, relationships and differences in maternal and child health. We conducted a comprehensive search of peer-reviewed and grey literature in popular scholarly databases, including PubMed, ScienceDirect, EBSCOhost and Google Scholar. We identified and analysed 17 published studies that met the inclusion criteria for key gendered themes in maternal and child health vulnerability and resilience in low-income and middle-income countries. Results Six key gendered dimensions of vulnerability and resilience emerged from our analysis: (1) restricted maternal access to financial and economic resources; (2) limited economic contribution of women as a result of motherhood; (3) social norms, ideologies, beliefs and perceptions inhibiting women’s access to maternal healthcare services; (4) restricted maternal agency and contribution to reproductive decisions; (5) power dynamics and experience of intimate partner violence contributing to adverse health for women, children and their families; (6) partner emotional or affective support being crucial for maternal health and well-being prenatal and postnatal. Conclusion This review highlights six domains that merit attention in addressing maternal and child health vulnerabilities. Recognising and understanding the gendered dynamics of vulnerability and resilience can help develop meaningful strategies that will guide the design and implementation of MNCH programmes in low-income and middle-income countries.Publisher PDFPeer reviewe

Places Nigerians visited during COVID-19 government stay-home policy: evidence from secondary analysis of data collected during the lockdown

Introduction. Compliance with the Government’s lockdown policy is required to curtail community transmission of Covid-19 infection. The objective of this research was to identify places Nigerians visited during the lockdown to help prepare for a response towards future infectious diseases of public health importance similar to Covid-19 Methods. This was a secondary analysis of unconventional data collected using Google Forms and online social media platforms during the COVID-19 lockdown between April and June 2020 in Nigeria. Two datasets from: i) partnership for evidence-based response to COVID-19 (PERC) wave-1 and ii) College of Medicine, University of Lagos perception of and compliance with physical distancing survey (PCSH) were used. Data on places that people visited during the lockdown were extracted and compared with the sociodemographic characteristics of the respondents. Descriptive statistics were calculated for all independent variables and focused on frequencies and percentages. Chi-squared test was used to determine the significance between sociodemographic variables and places visited during the lockdown. Statistical significance was determined by P<0.05. All statistical analyses were carried out using SPSS version 22. Results. There were 1304 and 879 participants in the PERC wave-1 and PCSH datasets, respectively. The mean age of PERC wave-1 and PCSH survey respondents was 31.8 [standard deviation (SD)=8.5] and 33.1 (SD=8.3) years, respectively. In the PCSH survey, 55.9% and 44.1% of respondents lived in locations with partial and complete covid-19 lockdowns, respectively. Irrespective of the type of lockdown, the most common place visited during the lockdown was the market (shopping); reported by 73% of respondents in states with partial lockdown and by 68% of respondents in states with the complete lockdown. Visits to families and friends happened more in states with complete (16.1%) than in states with partial (8.4%) lockdowns. Conclusions. Markets (shopping) were the main places visited during the lockdown compared to visiting friends/family, places of worship, gyms, and workplaces. It is important in the future for the Government to plan how citizens can safely access markets and get other household items during lockdowns for better adherence to stay-at-home directives for future infectious disease epidemics

Society of obstetrics and gynecology of Nigeria – Clinical practice guidelines: Guidelines for the prevention of cervical cancer

Clinical practice guidelines have been developed by professional societies globally. Each guideline although based on published scientific evidence reflected each country’s socioeconomic peculiarities and unique medical environment. The Society of Obstetrics and Gynaecology of Nigerian has published guidelines in other clinical areas; however, this is the first edition of practice guidelines for the prevention of cervical cancer. The Guidelines Committee was established in 2015 and decided to develop the first edition of this guideline following Delphi pool conducted among members which selected cervical cancer prevention as the subject that guideline is urgently needed. These guidelines cover strategies for cervical cancer prevention, screening, and management of test results. The committee developed the draft guideline during a 2‑day workshop with technical input from Cochrane Nigeria and Dr. Chris Maske, Lancet Laboratories, South Africa. The recommendations for each specific area were developed by the consensus, and they are summarized here, along with the details. The objective of these practice guidelines is to establish standard policies on issues in clinical practice related to the prevention of cervical cancer.Keywords: Cervical cancer; guideline; management; prevention; screening; Society of Obstetrics and Gynecology of Nigeria

Prevalence of surgically correctable conditions among children in a mixed urban-rural community in Nigeria using the SOSAS survey tool:Implications for paediatric surgical capacity-building

BackgroundIn many low- and middle-income countries, data on the prevalence of surgical diseases have been derived primarily from hospital-based studies, which may lead to an underestimation of disease burden within the community. Community-based prevalence studies may provide better estimates of surgical need to enable proper resource allocation and prioritization of needs. This study aims to assess the prevalence of common surgical conditions among children in a diverse rural and urban population in Nigeria.MethodsDescriptive cross-sectional, community-based study to determine the prevalence of congenital and acquired surgical conditions among children in a diverse rural-urban area of Nigeria was conducted. Households, defined as one or more persons 'who eat from the same pot' or slept under the same roof the night before the interview, were randomized for inclusion in the study. Data was collected using an adapted and modified version of the interviewer-administered questionnaire-Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey tool and analysed using the REDCap web-based analytic application.Main resultsEight-hundred-and-fifty-six households were surveyed, comprising 1,883 children. Eighty-one conditions were identified, the most common being umbilical hernias (20), inguinal hernias (13), and wound injuries to the extremities (9). The prevalence per 10,000 children was 85 for umbilical hernias (95% CI: 47, 123), and 61 for inguinal hernias (95% CI: 34, 88). The prevalence of hydroceles and undescended testes was comparable at 22 and 26 per 10,000 children, respectively. Children with surgical conditions had similar sociodemographic characteristics to healthy children in the study population.ConclusionThe most common congenital surgical conditions in our setting were umbilical hernias, while injuries were the most common acquired conditions. From our study, it is estimated that there will be about 2.9 million children with surgically correctable conditions in the nation. This suggests an acute need for training more paediatric surgeons

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

PMTCT Implementation and Early Infant Diagnosis of HIV Infection in Lagos, Nigeria: The Mix, Missed and the Muffed

Background: Nigeria has a large population of people living with HIV infection, with Lagos state as one of the six priority states for national HIV prevention interventions because of its high HIV prevalence. In Lagos state, the primary health care system is the most proximal to the populace, including pregnant women infected with HIV. National and state efforts to prevent new pediatric HIV infection using prevention of mother-to-child transmission (PMTCT) strategies, including early infant diagnosis (EID) of HIV infection have evolved and has been scaled since 2002 when PMTCT interventions commenced in Nigeria. With suboptimal uptake of PMTCT strategies and EID of HIV in Lagos, the dissertation research assessed the contemporary evidence on interventions to increase EID uptake and health systems barriers to a seamless implementation of PMTCT intervention at the primary health care level of Lagos state, Nigeria. Objectives: This dissertation comprises four studies. A systematic review and meta-analysis, a quantitative survey of service providers’ knowledge of the Nigerian PMTCT guidelines recommendations, mixed-method research, and a qualitative study. The studies’ aims were to achieve the following 1). Synthesize and provide the evidence quality of interventions to increase uptake of early infant diagnosis of HIV at 4-8 weeks of life for an HIV-exposed infant. 2). Assess the knowledge of PMTCT service providers of the Nigerian PMTCT treatment guidelines. 3). Assess the uptake and challenges of early infant diagnosis of HIV at the primary health level in Lagos state. 4). Assess the barriers encountered by service providers in the routine provision of PMTCT services at the primary health care level in Lagos state, Nigeria. Methods: A systematic review and meta-analysis were conducted between May and December 2020 to identify and critically appraise the evidence quality of interventions to increase uptake of early infant diagnosis of HIV infection at 4-8 weeks of life. Five databases (PUBMED, CINAHL, EMBASE, PsycINFO and Web of Science) were searched for eligible studies. Search output and data extraction were performed using Covidence® by two researchers independently. GRADE (Grading of recommendations, assessment, development, and evaluations) was used to present the quality of evidence of interventions. Data collection for the dissertation research involved quantitative and qualitative data collection. The quantitative data collection was both primary survey of health workers knowledge of the Nigerian PMTCT guidelines and secondary data collection using PMTCT program registers of the facilities. The qualitative research was in-depth interviews of service providers. The dissertation research was conducted in 23 primary health centers across all five administrative districts of Lagos state from July to September 2021. For the quantitative survey to assess knowledge of service providers and secondary data collection, REDCap® was used for data collection and statistical analysis was conducted with R. Responses of in-depth interviews were recorded on electronic voice recorders and transcription done verbatim before analysis with MAXQDA®. Inductive and deductive themes were created from the transcripts. The dissertation research was approved by the Human Research Ethics Committee of Lagos University Teaching Hospital, Lagos, Nigeria and given an Ethical deferral by the University of Arizona Institutional Review Board. Results: The systematic review and meta-analysis included 16 eligible studies involving 13,956 HIV-exposed infants. Included studies were published between 2014 and 2019 from sub-Saharan Africa and India. Nine experimental and seven observational studies included had low to moderate risk of bias and evaluated eHealth services, service improvement projects, service integration programs, behavioral interventions, and male partner involvement, compared to usual care.There was no evidence that eHealth, health systems improvements, integration of EID, conditional cash transfer, mother-to-mother support, or partner (male) involvement interventions increased uptake of EID at 4-8 weeks of age. There was also no evidence that any intervention was effective in increasing HIV-infected infants’ identification at 4–8 weeks of age. Aim 2: One hundred and thirteen (113) respondents participated in the survey. Most respondents knew that HIV screening at the first prenatal clinic was an entry point to PMTCT services (97%) and that posttest counseling of HIV-negative women was necessary (82%). Similarly, most respondents (89%) knew that early infant diagnosis (EID) of HIV should occur at 6-8 weeks of life (89%). However, only four (3.5%) respondents knew the group counseling and opt-out screening recommendation of the guidelines; 63% did not know that hematocrit check should be at every antenatal clinic visit. Forty-eight (42.5%) service providers had good knowledge scores. Knowledge score was not influenced by health worker cadre (p=0.436), training(P=0.537) and professional qualification of 5years (P=0.43) Aim 3: Twenty-two Lagos state primary health centres participated in the research. Fifteen (68.2%) PHCs had both PMTCT HIV counseling and Infant follow-up registers. The documentation of DBS sample collection was observed in 12 (54.6%) PHCs, while both DBS sample collection and EID results documentation was observed in only 9 (40.9%) PHCs. There were both maternal and health systems’ challenges to early infant diagnosis of HIV infection. The denial of HIV status was the only maternal factor reported to militate against the utilization of EID services. Health systems challenges include unavailability of IED services, uncertainty of service providers about the provision of EID services in the facility in which they work, referral to secondary health facilities (with potential to loss to follow-up) for EID services and delayed availability of EID results in the facility. For aim 4: Twenty-two service providers participated in the in-depth interviews, comprising 18 nurses/midwives and four physicians. Patient-level barriers to PMTCT services encountered by service providers included non-disclosure of HIV status to husband, denial of HIV infection, non-compliance with combined antiretroviral therapy (cART), non-compliance with referral, sense of guilt and shame, loss to follow-up, difficulty in identifying HIV-infected women when they come in labour, mixed infant feeding and formular feeding challenges, non-compliance with infant prophylaxis with nevirapine and financial constraints. Health systems related barriers are unavailability of PMTCT services (PMTCT deserts), challenges with HIV counseling and testing, including inadequate test kits, challenges with repeat prenatal HIV screening for women with previous HIV-negative results, stigma and discrimination, lack of treatment guidelines, and manpower shortage. Conclusion: There was no evidence that common interventions increased uptake of EID at 4-8 weeks of age. Hence, further research is required to identify interventions that increase early infant diagnosis of HIV at 4-8 weeks of age.Service providers’ knowledge of PMTCT guidelines recommendations varied, with poor knowledge of group counseling and opt out screening recommendation. Also, the low uptake and constraints of EID uptake as well as the patient-level and health systems barriers to optimal PMTCT service provision require re-training of service providers on timing and documentation of EID and proper counseling of newly diagnosed HIV-infected pregnant women to ameliorate both individual and health systems barriers to a reducing new pediatric HIV infection in Lagos, Nigeria.Release after 10/26/202

Scaling up Prevention of Mother to Child Transmission of HIV Infection to Primary Health Facilities in Nigeria: Findings from Two Primary Health Centres in Northwest Nigeria

Nigeria is scaling up prevention of mother-to-child transmission (PMTCT) of HIV interventions to primary health care centres (PHCs). This retrospective study of PMTCT was at two PHCs in Northwest Nigeria with the main outcome measure being HIV infection rate of exposed infants at 6 weeks of life. Of 10,289 women who had antenatal HIV test, 74 had positive results. This gave a prevalence of 0.7%. The uptake of antenatal (99.8%) and intrapartum (97.3%) tests was high at both centres. 30% of HIV infected mothers and 25% of exposed infants were lost to follow-up (LFU). Most women (85.7%) had highly active antiretroviral therapy (HAART) and vaginal delivery (98%). Perinatal mortality rate was 66/1000 births and 95.3% of exposed infants had negative HIV-DNA polymerase reaction test at 6 weeks of life. Despite a high LFU, a new vista has been opened to attaining a zero infection rate.Le Nigeria intensifie la prévention de la transmission de la mère à l’enfant (PTME) des interventions du VIH dans des centres de soins de santé primaire (CSSP). Cette étude rétrospective de la PTME était à deux CSSP dans le nord-ouest du Nigeria, ayant comme le principal critère de jugement le taux d&apos;infection chez des nourrissons exposés à 6 semaines de vie. Sur 10 289 femmes qui avaient subi l’analyse prénatale pour détecter le VIH, 74 ont eu des résultats positifs. Cela a donné une prévalence de 0,7%. L&apos;absorption des soins prénatals (99,8%) et (97,3%) des analyses des intra-partum étaient élevées dans les deux centres. 30% des mères infectées par le VIH et 25% des nourrissons exposés ont été perdus au suivi (LFU). La plupart des femmes (85,7 %) ont eu un traitement antirétroviral hautement actif (TARTHA) et l&apos;accouchement vaginal (98%). Le taux de mortalité périnatale était de 66/1000 naissances et 95,3 % des nourrissons exposés avaient subi l’analyse de réaction de polymérase ADN-VIH négatif à 6 semaines de vie. Malgré une forte LFU, une nouvelle perspective a été ouverte pour atteindre un taux d&apos;infection zéro

Circulating levels of plasma lipids and cardiovascular risk in Nigerian women with severe preeclampsia

Background and Objectives: Preeclampsia has been associated with disorders of lipid metabolism. In the general population, dyslipidemia has been identified as a cause of endothelial damage and cardiovascular disease. Few studies have evaluated these relationships in Nigerian women with preeclampsia. This study aims to determine the level of plasma lipids in severe preeclampsia and assess the relationship between dyslipidemia, organ damage, and C-reactive protein (CRP) in Nigerian women with severe preeclampsia. Materials and Methods: This was a case-control study conducted on 50 women with severe preeclampsia and 50 with normal pregnancy matched for gestational age. The women were included from the antenatal clinic of the Lagos University Teaching Hospital, Lagos, Lagos State, Nigeria. Informed consent was obtained and sociodemographic and clinical data were obtained using a questionnaire. Blood was collected from the women after an overnight (10-12 h) fast for biochemical analysis. Employing the IBM SPSS statistical software, comparisons of the continuous variables and categorical variables were done using the Student′s t-test and Chi-square test, respectively. Correlation analysis was used to determine the associations between the variables. Statistical significance was set at P < 0.05. Results: The levels of high-density lipoprotein (HDL) cholesterol were significantly lower (P < 0.0003) and the levels of triglyceride (TG), low-density lipoprotein (LDL) cholesterol, and total cholesterol (TC) were significantly higher in women with severe preeclampsia compared to the controls (P < 0.0005, P < 0.007, P < 0.009, respectively). The HDL/LDL ratio was significantly lower and CRP was significantly higher in severe preeclampsia (P < 0.0001 and P ˂ 0.0002, respectively). The lipid profile parameters showed a significant association with the markers of organ dysfunction. TG showed a statistically significant correlation with uric acid, creatinine, alkaline phosphatase (ALP), systolic blood pressure (SBP), and diastolic blood pressure (DBP). HDL showed a statistically significant correlation with uric acid, ALP, aspartate aminotransferase (AST), SBP, and DBP. While TC showed a statistically significant correlation with SBP and DBP, TG, in addition, had a statistically significant correlation with CRP in women with severe preeclampsia. Conclusion: Severe preeclampsia is associated with dyslipidemia, which has been linked to organ damage and an increased cardiovascular risk in Nigerian women. Although dyslipidemia resolves with each pregnancy, risk of cardiovascular disease in the future remains. Thus, continuous monitoring of Nigerian women with a history of severe preeclampsia is suggested