Outcome of caesarean section at the Edward Francis Small Teaching Hospital, Banjul The Gambia

Background: Caesarean section is a very important procedure to decrease maternal and perinatal morbidity and mortality. Anecdotal evidence suggests that more than half of all caesarean sections done in The Gambia are done at the Edward Francis Small Teaching Hospital.Objective: The aim of the study was to determine the caesarean section rate at the Edward Francis Small teaching Hospital. The study also aimed to determine the socio-demographic factors associated with caesarean section and maternal and fetal outcomes of caesarean section at the hospital.Method: A retrospective review of all caesarean sections carried out at the Edward Francis Small Teaching Hospital from 1st January 2014 to 31st December 2014 was done. Data was extracted from patients’ record. Descriptive statistics was done using Epi Info 7 statistical software.Results: The Caesarean section rate in the hospital is 24.0%. The commonest indications for caesarean section were previous caesarean section (20.6%) and cephalopelvic disproportion (20.2%). There were 21 maternal deaths (1.8%) and 71 fresh stillbirths (6.0%) in the study population.Conclusion: About a quarter of all deliveries in the hospital were caesarean sections most of which were done as emergencies. The commonest indications for caesarean section were cephalopelvic disproportion and previous caesarean section.Keywords: Caesarean section, Banjul The Gambia

High-risk human papilloma virus and cervical abnormalities in HIV-infected women with normal cervical cytology

Background: The prevalence of High-Risk Human papilloma virus (HR-HPV), a necessary cause of invasive cervical cancer (ICC) is relatively high in HIV infected women. Gaps exist in our knowledge of the optimal approaches for managing women who have HR-HPV with normal cervical cytology (NCC) particularly in settings of HIV infection. Methods: Between May 2012 and June 2013 we conducted a colposcopic assessment of HIV-infected women with prior (NCC) and known HR-HPV status to compare cervical abnormalities in women with and without HR-HPV. Colposcopic examinations were done at the Operation Stop Cervical Cancer (OSCC) unit of the Jos University Teaching Hospital (JUTH), Jos, Nigeria. Abnormal colposcopic finding (ACF) was defined as areas of aceto-white epithelium involving the squamo-coulumnar junction, areas of punctation, mosaic pattern or atypical vessels. We compared proportions of ACF as well as histologic grades of cervical intra-epithelial neoplasia (CIN) in women with or without HR-HPV. Statistical analysis was done on STATA. Results: We conducted colposcopic examinations in 78 out of 89 (86.5%) eligible women. The mean age of the cohort was 32.4 years (SD ±4.6) with a median 32 years (IQR 29–36). After a mean follow up time of 20.1 months from the initial cervical pap cytology and HR-HPV testing, we found 12 of 78 (15.4%) women with ACF. The odds for an ACF was statistically higher [OR = 4.0 (95% CI: 1.1-14.7)] in women with HR-HPV compared to those without. Of the twelve women with ACF, subsequent histologic examination of colposcopically directed cervical biopsies confirmed CIN 1 in 4 cases (33.3%), CIN 2 in 1 case (8.3%), CIN 3 in 2 cases (16.7%), carcinoma-in-situ (CIS) in 2 cases (16.7%), and normal cervix in 3 (25.0%). Overall, the proportion of women detected with any grade of CIN was 11.5% (9/78) and 6.4% (5/78) were CIN 2 or greater lesion (CIN2+). Conclusion: HIV-infected women with NCC and HR-HPV had a four-fold higher likelihood for an ACF. The practice of early colposcopic examination of HIV-infected women with prior NCC and HR-HPV may increase early detection of higher grade CIN and CIS cancer stages in our setting

Reasons for current pregnancy amongst grand multiparous Gambian women - a cross sectional survey

BACKGROUND: While grand multiparity is now relatively rare in the developed world it is still common in Sub Saharan Africa. Although significant resources have been committed to providing modern contraceptive methods in the Gambia, the total fertility rate is still high at 5.6. Determining the reasons grand multiparous women proffer for the current pregnancy may help in understanding this trend and tailoring appropriate messages to address any specific concerns. METHOD: A cross sectional survey of grand multiparous women was carried out at the Royal Victoria Teaching Hospital (now Edward Francis Small Teaching Hospital) to determine the reasons for the current pregnancy. RESULTS: The prevalence of grand multiparity was 26.5 % while the average parity among the study population was 7.2 (sd 1.8). The most common reasons given for the current pregnancy were: the desire for another child (22.8 %), the pregnancy was unplanned - a “mistake” (18.4 %) and the need to replace a dead child (15.4 %). CONCLUSION: Grand multiparity is still very common in The Gambia. Additional efforts are required to target those with unplanned pregnancies. Improving child survival may also decrease the prevalence of grand multiparity. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12884-016-1016-7) contains supplementary material, which is available to authorized users

The effect of stress on cardiovascular system and its awareness among bank workers in Makurdi, Benue state

Background: Cardiovascular diseases (CVDs) remain the leading cause of global mortality, and stress is a key modifiable risk factor, particularly in occupational settings such as banking. This study assessed the effect of stress on the cardiovascular system and the level of awareness among bank workers in Makurdi, Benue State, Nigeria. Methods: A descriptive cross-sectional study was conducted among 133 bank employees from five banks. Physical measurements including blood pressure, fasting blood sugar, and body mass index (BMI) were collected using standard instruments. A structured questionnaire was administered to assess lifestyle factors and awareness of cardiovascular risk factors. Chi-square tests were applied using statistical package for the social sciences (SPSS) version 26 to determine associations at a 5% significance level. Results: The prevalence of hypertension was significantly higher among males (33.8%) compared to females (10.7%), and among older age groups (>40 years, 73.3%) versus younger groups (21–30 years, 28.7%). Longer job tenure (>10 years) was associated with higher prevalence of hypertension (32.1%). Significant associations were found between hypertension and lack of knowledge, overtime work, BMI and alcohol use (p<0.05). Additionally, diabetes mellitus and obesity were linked to job tenure and snacking habits. However, some variables, such as blood glucose level, smoking and exercise, showed no significant association with hypertension (p>0.05). Conclusions: The study concludes that occupational stress contributes significantly to CVD risk factors among bank workers in Makurdi. Awareness levels of cardiovascular risk factors were generally low, underscoring the need for targeted interventions on stress management and cardiovascular health

Determination of gross alpha and beta radioactivity concentration along Jakara waste water canal, Kano Metropolis, Kano State, Nigeria

This research undertook an assessment of the radioactivity level along the Jakara waste water canal. Six soil samples and five water samples were taken for gross alpha and beta activity concentration using the gas–flow–proportional counter (IN20). Results for gross alpha activity concentration for the soil samples range from 4.597E-03 Bq/g to 1.425E-02 Bq/g, while that of gross beta activity for soil has the range from 3.341E+01 Bq/g to 8.092E+01 Bq/g. In the same vein, results for gross alpha activity concentration for the water samples have the range from 6.035E-03 Bq/L to 1.433E+00 Bq/L while the value for the gross beta activity concentration ranges from 5.038E+00 Bq/L to 2.853E+01 Bq/L for the same water samples. These results show that the alpha and beta activity concentration in the analysed samples are higher than the minimum permissible concentration by World Health Organisation (WHO, 2003). This may pose health risk because the waste water is used by people to irrigate vegetables along the waste water canal. Keywords: Background Radiation, Activity Concentration, Gross Alpha, Gross Bet

Obstetric outcome of female genital mutilation in the Gambia – an observational study

Background: A 2010 survey in The Gambia among women of reproductive age put the prevalence rate of FGM/C at 76.3%. FGM/C was banned in 2015, but there is no real effort at enforcement of the ban. This study aimed to provide national data on obstetric outcomes to support advocacy and health education.A multicentre observational study to assess the obstetric and neonatal outcomes of parturient women with and without FGM/Cwas carried out across 4 healthcare facilities in The Gambia. The primary outcome was postpartum haemorrhage (>500ml) andsecondary outcomes were caesarean section, perineal tears (including episiotomy), neonatal resuscitation and perinatal death.Of the 1,569 participants recruited into the study, 23% had no FGM/C while 77% had FGM/C of varying severity. The riskof postpartum haemorrhage was doubled for women with type I FGM/C, tripled in type II FGM/C and increased by 5-foldfor those with type III and IV FGM/C. Caesarean section and perineal tears were also increased. FGM/C was associated withincreased risk for neonatal resuscitation and perinatal death.FGM/C is associated with poor obstetric and neonatal outcomes in the Gambia with degree of risk correlating with the severityof FGM/C. Keywords: Female genital mutilation; obstetric outcome; Gambia

Community Perspectives Associated With the African PsA-TT (MenAfriVac) Vaccine Trials.

BACKGROUND: The Meningitis Vaccine Project (MVP) was established to address epidemic meningitis as a public health problem in sub-Saharan Africa and, to that end, worked to develop a group A meningococcal conjugate vaccine, PsA-TT. METHODS: Experiences in 4 clinical trial sites are described. Culturally sensitive collaborative strategies were adopted to manage acceptable communication methods, peculiarities with the consent process, participant medical issues, community care, and death. RESULTS: The clinical trials were completed successfully through community acceptance and active community collaboration. The trials also strengthened the capacities in the participating communities, and actively worked to resolve community problems. CONCLUSIONS: The understanding and integration of sociocultural realities of communities were major assets in the conduct and acceptance of these trials. MVP succeeded in these sites and provided a sound example for future clinical studies in Africa. CLINICAL TRIALS REGISTRATION: ISRTCN78147026 (PsA-TT 002); ISRCTN87739946 (PsA-TT 003); ISRCTN82484612 (PsA-TT 004); PACTR ATMR2010030001913177 (PsA-TT 006); and PACTR201110000328305 (PsA-TT 007)

Immunogenicity of pneumococcal conjugate vaccine formulations containing pneumococcal proteins, and immunogenicity and reactogenicity of co-administered routine vaccines - A phase II, randomised, observer-blind study in Gambian infants.

BACKGROUND: Two conserved pneumococcal proteins, pneumolysin toxoid (dPly) and pneumococcal histidine triad protein D (PhtD), combined with 10 polysaccharide conjugates from the pneumococcal non-typeable Haemophilus influenzae protein D-conjugate vaccine (PHiD-CV) in two investigational pneumococcal vaccine (PHiD-CV/dPly/PhtD) formulations were immunogenic and well-tolerated when administered to Gambian children. Here, we report immunogenicity of the polysaccharide conjugates, and immunogenicity and reactogenicity of co-administered routine vaccines. METHODS: In this phase II, controlled, observer-blind, single-centre study, healthy infants aged 8-10 weeks were randomised (1:1:1:1:1:1) to six groups. Four groups received 3+0 schedule (2-3-4 months [M]) of PHiD-CV/dPly/PhtD (10 or 30 µg of each protein), PHiD-CV, or 13-valent pneumococcal conjugate vaccine; and two groups received 2+1 schedule (2-4-9 M) of PHiD-CV/dPly/PhtD (30 µg of each protein) or PHiD-CV. All infants received diphtheria-tetanus-whole cell pertussis-hepatitis B-Haemophilus influenzae type b (DTPw-HBV/Hib) and oral trivalent polio vaccines (OPV) at 2-3-4 M, and measles, yellow fever, and OPV vaccines at 9 M. We evaluated immune responses at 2-5-9-12 M; and reactogenicity 0-3 days post-vaccination. RESULTS: 1200 infants were enrolled between June 2011 and May 2012; 1152 completed the study. 1 M post-primary vaccination, for each PHiD-CV serotype except 6B and 23F, ≥97.4% (3+0 schedule) and ≥96.4% (2+1 schedule) of infants had antibody concentrations ≥0.2 μg/mL. Immune responses were comparable between groups within the same vaccination schedules. Observed antibody geometric mean concentrations (GMCs) increased by 1 M post-primary vaccination compared to pre-vaccination. In the following months, GMCs and opsonophagocytic activity titres waned, with an increase post-booster for the 2+1 schedule. Immune responses to protein D and, DTPw-HBV/Hib, OPV, measles, and yellow fever vaccines were not altered by co-administration with pneumococcal proteins. Reactogenicity of co-administered vaccines was comparable between groups and did not raise concerns. CONCLUSION: Immune responses to the 10 PHiD-CV polysaccharide conjugates and co-administered vaccines were not altered by addition of dPly and PhtD. ClinicalTrials.gov identifier NCT01262872

What are the threats from antimicrobial resistance for maternity units in low- and middle- income countries?

No abstract available

Patient Retention and Adherence to Antiretrovirals in a Large Antiretroviral Therapy Program in Nigeria: A Longitudinal Analysis for Risk Factors

Substantial resources and patient commitment are required to successfully scale-up antiretroviral therapy (ART) and provide appropriate HIV management in resource-limited settings. We used pharmacy refill records to evaluate risk factors for loss to follow-up (LTFU) and non-adherence to ART in a large treatment cohort in Nigeria.We reviewed clinic records of adult patients initiating ART between March 2005 and July 2006 at five health facilities. Patients were classified as LTFU if they did not return >60 days from their expected visit. Pharmacy refill rates were calculated and used to assess non-adherence. We identified risk factors associated with LTFU and non-adherence using Cox and Generalized Estimating Equation (GEE) regressions, respectively. Of 5,760 patients initiating ART, 26% were LTFU. Female gender (p < 0.001), post-secondary education (p = 0.03), and initiating treatment with zidovudine-containing (p = 0.004) or tenofovir-containing (p = 0.05) regimens were associated with decreased risk of LTFU, while patients with only primary education (p = 0.02) and those with baseline CD4 counts (cell/ml(3)) >350 and <100 were at a higher risk of LTFU compared to patients with baseline CD4 counts of 100-200. The adjusted GEE analysis showed that patients aged <35 years (p = 0.005), who traveled for >2 hours to the clinic (p = 0.03), had total ART duration of >6 months (p<0.001), and CD4 counts >200 at ART initiation were at a higher risk of non-adherence. Patients who disclosed their HIV status to spouse/family (p = 0.01) and were treated with tenofovir-containing regimens (p < or = 0.001) were more likely to be adherent.These findings formed the basis for implementing multiple pre-treatment visit preparation that promote disclosure and active community outreaching to support retention and adherence. Expansion of treatment access points of care to communities to diminish travel time may have a positive impact on adherence