Community-based intervention is necessary for the control of HIV in North-Central Nigeria.

Objectives: To determine factors associated with the observed high prevalence of HIV in North-Central Nigeria. Methods: In a cross-sectional multisite study conducted in 2007, behavioral, medical, and demographic data were obtained from pregnant women (N = 1011) who were tested for the presence of antibody against HIV-1 and HIV-2. Results: The overall prevalence of HIV-1 in the 1011 women included in the study was 10.3% (95% confidence interval (CI) 8.4–12.2). In the multivariate analysis, HIV-1 seropositivity was significantly associated with women from the Makurdi (odds ratio (OR) 31.3, 95% CI 3.8–255.7) and Minna (OR 15.4, 95% CI 1.7–135.1) sites in comparison with Panyam site. The presence of tuberculosis (OR 10.7, 95% CI 2.4–48.3) was also significantly associated with HIV-1 seropositive status. Factors associated with HIV-1 also differed between sites. The presence of antibody against HIV-2 was not observed. Conclusions: The high HIV-1 prevalence observed in this study corroborates previous observations in North-Central Nigeria. Disparity in the prevalence across communities was also seen. This is the only detailed socio-epidemiological and behavioral study that has explored potential factors associated with HIV-1 in North-Central Nigeria, and it revealed that differences in risk factors explain the disparity in prevalence across communities

“It might be a statistic to me, but every death matters.”: An assessment of facility-level maternal and perinatal death surveillance and response systems in four sub-Saharan African countries

Maternal and perinatal death surveillance and response (MPDSR) systems aim to understand and address key contributors to maternal and perinatal deaths to prevent future deaths. From 2016–2017, the US Agency for International Development’s Maternal and Child Survival Program conducted an assessment of MPDSR implementation in Nigeria, Rwanda, Tanzania, and Zimbabwe. Methods A cross-sectional, mixed-methods research design was used to assess MPDSR implementation. The study included a desk review, policy mapping, semistructured interviews with 41 subnational stakeholders, observations, and interviews with key informants at 55 purposefully selected facilities. Using a standardised tool with progress markers defined for six stages of implementation, each facility was assigned a score from 0–30. Quantitative and qualitative data were analysed from the 47 facilities with a score above 10 (‘evidence of MPDSR practice’). Results The mean calculated MPDSR implementation progress score across 47 facilities was 18.98 out of 30 (range: 11.75–27.38). The team observed variation across the national MPDSR guidelines and tools, and inconsistent implementation of MPDSR at subnational and facility levels. Nearly all facilities had a designated MPDSR coordinator, but varied in their availability and use of standardised forms and the frequency of mortality audit meetings. Few facilities (9%) had mechanisms in place to promote a no-blame environment

Ureteric Injuries Arising from Obstetric and Gynaecological Operations at the University College Hospital Ibadan: a 20-year Review

Context: Iatrogenic ureteric injuries occur as a result of inadvertent ligation, transection or crushing of the ureters. A clinical condition with potential significant morbidity and mortality such as this should be a subject of regular reviews. Objective: The objective of the study is to determine the aetiology, the types and the various mode of management of ureteric associated with obstetric and gynaecological surgeries within the study period. Methods: This is a descriptive study of 20 years duration from January 1981 to December 2000, carried out at the University College Hospital, Ibadan Nigeria. The clinical and operative records of all patients who had ureteric injuries during the period under review were retrospectively analysed. Results: The incidence of ureteric injuries during the period of review was 0.4%. The mean age of the patients was 39.4 years and the injury occurs mostly in grand-multiparous women. The commonest surgical procedure leading to ureteric injuries in this study was total abdominal hysterectomy, whereby ligation of the ureter was the commonest mode of injury. Conclusion: The incidence of ureteric injury during the study period is fewer than in that of previous review. This is probably so because less radical pelvic surgeries are performed now than during the period covered by the previous review which was about three decades ago. Also improved surgical skill among gynaecologists coupled with better obstetric care might have contributed to the fever number of ureters that were injured. Key Words: Ureter, Iatrogenic, Injury, Fistula, Urinary Bladder. [Trop J Obstet Gynaecol, 2003, 20: 32-36

Recurrent Bartholin′s gland abscess in pregnancy: An uncommon presentation

Bartholin′s gland cysts and abscesses are the most common cystic swelling of the vulva in women of reproductive age and are usually small in size, as the discomfort associated with it necessitates early consultations. Huge Bartholin′s abscesses are uncommon and even fewer cases have been reported were among non-pregnant women. This case involved a 25-year old grandmultipara, who presented at a gestational age of 24 weeks with a huge vulval swelling measuring 14cm x 10cm, following failure of its resolution from self-medicated antibiotics. She had experienced similar but smaller vulvar enlargements in her two preceeding pregnancies that had resolved following similar medical treatment. She was treated successfully with marsupialization, without any adverse effect on the pregnancy. This case illustrates the likelihood of huge Bartholin′s abscess complicating pregnancy and that there should be no hesitation to apply marsupialization in its treatment. The recurrence of the abscess in three successive pregnancies in this woman, who kept using self-prescribed antibiotics is a worrying trend that will require the education of women at various reproductive health care clinics about vulvar swellings and warn against antibiotics abuse

The benefits of a guideline on safe termination of pregnancy for legal indications: an illustrative case report of a hydranencephaly

After years of the worsening burden of unsafe abortion and attendant morbidities and mortalities in Nigeria, a National Guideline on the Safe termination of pregnancy for legal indications was enunciated. This report presents and discusses an illustrative case of a hydranencephaly that benefited from it. A 43-year old multipara was informed during routine ultrasonography at booking for antenatal care, at 16 weeks of gestation, of a major defect in her baby and advised to meet her physician. Following a repeat highresolution ultrasonography and discussions between the Obstetricians, Neurosurgeon, and Ultrasonologist, the woman was counseled on the diagnosis. At her insistence and provision of written consent, medical abortion with Mifepristone and Misoprostol was successfully instituted.Keywords: Pregnancy termination, Hydranencephaly, misoprostol, abortio

Genetic Characteristics, Coreceptor Usage Potential and Evolution of Nigerian HIV-1 Subtype G and CRF02_AG Isolates

HIV-1 CRF02_AG and subtype G (HIV-1G) account for most HIV infections in Nigeria, but their evolutionary trends have not been well documented. To better elucidate the dynamics of the epidemic in Nigeria we characterised the gag and env genes of North-Central Nigerian HIV-1 isolates from pregnant women. Of 28 samples sequenced in both genes, the predominant clades were CRF02_AG (39%) and HIV-1G (32%). Higher predicted proportion of CXCR4-tropic (X4) HIV-1G isolates was noted compared to CRF02_AG (p = 0.007, Fisher’s exact test). Phylogenetic and Bayesian analysis conducted on our sequences and all the dated available Nigerian sequences on the Los Alamos data base showed that CRF02_AG and HIV-1G entered into Nigeria through multiple entries, with presence of HIV-1G dating back to early 1980s. This study underlines the genetic complexity of the HIV-1 epidemic in Nigeria, possible subtype-specific differences in co-receptor usage, and the evolutionary trends of the predominant HIV-1 strains in Nigeria, which may have implications for the design of biomedica