Determinants of compliance to iron supplementation among pregnant women in Enugu, Southeastern Nigeria

Background: Anemia in pregnancy is highly prevalent among antenatal clinic attendees in Enugu, Nigeria despite the practice of routine iron supplementation in pregnancy. The major problem with iron  supplementation in pregnancy is compliance, and this may be a potential driver to the persistent high prevalence of anemia in this population.Objectives: To find out the compliance rate and determinants of  compliance to iron supplementation among pregnant women in Enugu, southeastern Nigeria.Materials and Methods: This was a questionnaire.based cross.sectional study of eligible pregnant women receiving antenatal care at the University of Nigeria Teaching Hospital (UNTH), Ituku/Ozalla, Enugu, Nigeria between April 1, 2012 and January 31, 2013.Results: The knowledge of iron supplementation was 76.3% (n = 302), however, the compliance rate was 65.9% (n = 261). Tertiary level of education and high social class were factors significantly associated with compliance to iron supplementation after adjusting for other factors in the binary logistic regression analysis (P < 0.05). The major barriers to compliance to iron supplementation included gastrointestinal side effects of iron supplements (41.7%), non.affordability of iron supplements (28.3%), and forgetfulness (15.0%) among the antenatal mothers.Conclusion: The compliance rate of 65.9% for iron supplementation by pregnant mothers in Enugu can further be improved by providing the drug free of charge in the short term and improvement in education and  socioeconomic class of the populace in the long run.Key words: Compliance, determinants, Enugu, iron supplementation,  pregnanc

Wandering spleen: A common presentation of an uncommon anomaly

Background: With the advent of real time ultrasonography of the abdomen, the spleen is no longer an inaccessible organ. Wandering spleen is a rare entity with only less than 500 cases reported so far. Method: This case report presents a 16-year- old Nigerian girl admitted in a medical centre but referred for ultrasonography on account of a clinical history of lower abdominal tenderness. Result: Ultrasonography examination revealed that the spleen was not found in its normal anatomical position. However, a well defined acoustic signature of the spleen was seen in the pelvis. Conclusion: Ultrasonography which is far cheaper than magnetic resonance imaging (MRI) and computed tomography (CT) is a valuable diagnostic aid in this conditio

Utilization of insecticide treated nets among pregnant women in Enugu, South Eastern Nigeria

Background: The goal of roll back malaria partnership is to achieve universal coverage for all populations at risk using appropriate interventions for prevention and case management.Objective: The objective of this study is to determine the use of insecticide treated nets (ITNs) and other anti-vector measures among pregnant women in an area hyper-endemic for malaria.Materials and Methods: Questionnaires were administered to a cross-section of 832 consecutive pregnant women attending antenatal care in three hospitals in Enugu, Nigeria that have high client flow for maternity services. Data collected were analyzed using descriptive and inferential statistics by means of the Statistical Package for Social Sciences (SPSS) version 16. P-value of less than 0.05 was considered statistically significant.Results: The mean age of the women was 33.2 ± 2.9 (range: 15-45) years. Three hundred and fifty nine (43.1%) women owned insecticide treated nets (ITNs), however 325(90.5%) slept under the nets during the index pregnancies; equivalent to 39.1% utilization rate among the 832 women studied. Out of the 325 (39.1%) women that used ITNs; 236 (28.4%) used it singly, while 89 (10.7%) used it in combination with other anti-vector measures. Educational status and social class of the women had strong association with the use of ITNs (P < 0.0001). Women who used ITNs were significantly less likely to have acute malaria, anaemia and babies with low birth weight than women who did not use ITNs (P < 0.05).Conclusion: The use of ITNs is poor among pregnant women in Enugu, but associated with favorable maternal and feto-neonatal outcome. Future measures to increase its use should consider improvement in educational level and social class of our women.Key words: Insecticide treated nets, Malaria, Nigeria, pregnanc

Acceptability of human papilloma virus vaccine and cervical cancer screening among female health-care workers in Enugu, Southeast Nigeria

Background: Cervical cancer, a leading cause of cancer deaths in women in developing countries can be prevented primarily by vaccinating  adolescent girls and women against infection by the human papillomavirus (HPV) before their first sexual exposure, and secondarily through screening and treatment of identified precancerous lesions.Aim: To determine the awareness and acceptability of the HPV vaccine and screening for cervical cancer among female health-care workers in Enugu, southeastern Nigeria.Materials and Methods: Questionnaires were administered to a cross-section of 177 female health-care workers selected systematically from the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria. Statistical analysis was both descriptive and inferential at 95% confidence level using the Statistical Package for Social Sciences (SPSS) computer software version 16. A P value of less than 0.05 was considered statistically significant.Results: The awareness of screening for cervical cancer (91%) was significantly higher than that of the HPV vaccine (62.7%) [odds ratio (OR): 0.17; 95% confidence interval (CI): 0.09–0.30]. However, the acceptability rate of the HPV vaccine (91.0%) was significantly higher than that of cervical screening (71.4%) (OR: 4.04;95% CI: 1.94–8.42)]. Only25 (14.1%) of the health-care workers had done cervical screening, but 30 (49.2%) of the 61respondents with adolescent daughters had immunized their daughters with the HPV vaccine. Although no reason was given for the low participation in cervical screening, cost and availability of HPV vaccine was a major deterrent for the latter.Conclusion: With more public enlightenment, available and affordable HPV vaccine appears to hold the key for prevention of cervical cancer in developing countries where the burden is high.Key words: Acceptability, health workers, HPV vaccine, Nigeri

Avascular necrosis in sickle cell (homozygous S) patients: Predictive clinical and laboratory indices

Background: Pathogenetic mechanism as well as laboratory and clinical correlates of osteonecrosis in sickle cell have not been fully investigated. The aim of this study is to investigate the predictive value of the steady state white cell and platelet count as well as the frequency of bone pain crisis per annum to detect sickle cell patients who will eventually develop avascular necrosis (AVN).Patients and Methods: A 5 year retrospective analysis of 122 homozygous S (HbSS) patients, aged 6‑49 years (mean age 24.7 ± 7 years), out of which 16 patients (13.1%) had developed AVN within the years under review.Results: The prevalence of AVN in sickle cell patients was determined to be 13.1 per 1000. The steady state white cell count, platelet count, frequency of bone pain crisis and hematocrit, was compared in patients that develop AVN and those who had not over the period. Only the steady state platelet count was found to differ significantly (P = 0.011) between these two patient groups and to correlate positively (Pearson correlation coefficient = −0.251) with development of AVN. The hematocrit, white cell count, and frequency of bone pain crisis were found neither to differ significantly nor correlate with the development of AVN.Conclusion: In conclusion, patients with a raised steady state platelet count may have a higher tendency to develop AVN and may require closer orthopedic review and prophylactic intervention.Key words: Avascular necrosis, homozygous S, platelet count, sickle cell anemia, white cell coun

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Wandering spleen: A common presentation of an uncommon anomaly

Background: With the advent of real time ultrasonography of the abdomen, the spleen is no longer an inaccessible organ. Wandering spleen is a rare entity with only less than 500 cases reported so far. Method: This case report presents a 16-year- old Nigerian girl admitted in a medical centre but referred for ultrasonography on account of a clinical history of lower abdominal tenderness. Result: Ultrasonography examination revealed that the spleen was not found in its normal anatomical position. However, a well defined acoustic signature of the spleen was seen in the pelvis. Conclusion: Ultrasonography which is far cheaper than magnetic resonance imaging (MRI) and computed tomography (CT) is a valuable diagnostic aid in this condition

Sonographic evaluation of cervical length changes during normal pregnancy

This study was aimed to establish reference values of cervical length in normal pregnancy. We studied a cross-sectional sample of 144 pregnant women by transabdominal sonography. The inclusion criteria were sonographic confirmation of gestational age, the absence of any risk factors for preterm birth, and uncomplicated pregnancy. Cervical length was measured in a straight line. Height, age and weight of patients were also obtained. There was a relationship between gestational age and cervical length, which could be described with a linear regression (R = 0.44;

Patter of Gynaecological Cancers in University of Nigeria Teaching Hospital, Enugu, South Eastern Nigeria

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