Treatment of Bacterial Sexually Transmitted Infections in Resource-Limited Settings

Globally, bacterial sexually transmitted infections (STIs) are a major health challenge. It is more challenging in resource-limited settings, where diagnostic capabilities are limited, health insurance is almost nonexistent and medical bills are settled out-of-pocket. In resource-limited settings, most clinicians adopt the syndromic case management approach for effective treatment due to the paucity of resources. The highest levels of multidrug resistant bacterial STIs have been found in resource-limited countries. The reasons are complex and include poor quality of health services, high burden of disease, lack of accessible, accurate, and confirmed diagnostic assays, ineffective regulations, overuse of antibiotics, inappropriate dosing, and lack of knowledge about the risks of microbial resistance. This chapter thus brings to the fore the challenges of treating bacterial sexually transmitted infections in resource-poor settings and the current evidence on the topic for scholars, researchers, and practitioners

Abnormalities of semen parameters among male partners of infertile couples in a sub-urban tertiary hospital in Nigeria

Background: Infertility is a common reason for gynecological clinic visits in Nigeria. Men contribute significantly to the cause of infertility; however male factor infertility remain underreported compared to commonly reported female factor infertility. This study aimed to evaluate the abnormalities of semen parameters among male partners of infertile couples in Irrua Specialist Teaching Hospital in Edo State, Nigeria. Methods: A prospective cross-sectional study of 285 semen samples of male partners of infertile couples was conducted at Irrua specialist teaching hospital. The laboratory staff carried out analysis of the semen samples using set parameters outlined by the World Health Organization laboratory manual for the examination and processing of human semen. Socio-demographic data of the participants was also taken in a proforma. The data obtained was then analyzed with the Statistical Package for Social Sciences. Results: The age range of participants in this study was 20 to 65 years, with a mean age of 33.38 years. A total of 80.7% of the cases reviewed had one or more abnormal semen parameters. In 45.6%, 51.6%, and 47.0% of the analyzed samples, sperm cell count, morphology and total motility were below the WHO reference level, respectively. The severe forms of abnormal semen analysis findings detected in this study were asthenozoospermia (47%), oligozoospermia (15.8%), azoospermia (45.6%), and oligoasthenoteratozoospermia (15.5%). There was also statistically significant finding of rising cases of oligospermia with increasing age among the participants Conclusions: Male factor infertility although grossly under reported, contributes significantly to the burden of infertility in our setting. There is a need to raise awareness so that men are properly evaluated and treated

A standardised Phase III clinical trial framework to assess therapeutic interventions for Lassa fever

BACKGROUND: Only one recommendation currently exists for the treatment of Lassa fever (LF), which is ribavirin administered in conjunction with supportive care. This recommendation is primarily based on evidence generated from a single clinical trial that was conducted more than 30 years ago-the methodology and results of which have recently come under scrutiny. The requirement for novel therapeutics and reassessment of ribavirin is therefore urgent. However, a significant amount of work now needs to be undertaken to ensure that future trials for LF can be conducted consistently and reliably to facilitate the efficient generation of evidence. METHODOLOGY: We convened a consultation group to establish the position of clinicians and researchers on the core components of future trials. A Core Eligibility Criteria (CEC), Core Case Definition (CCD), Core Outcome Set (COS) and Core Data Variables (CDV) were developed through the process of a multi-stakeholder consultation that took place using a modified-Delphi methodology. RESULTS: A consensus position was achieved for each aspect of the framework, which accounts for the inclusion of pregnant women and children in future LF clinical trials. The framework consists of 8 core criteria, as well as additional considerations for trial protocols. CONCLUSIONS: This project represents the first step towards delineating the clinical development pathway for new Lassa fever therapeutics, following a period of 40 years without advancement. Future planned projects will bolster the work initiated here to continue the advancement of LF clinical research through a regionally-centred, collaborative methodology, with the aim of delineating a clear pathway through which LF clinical trials can progress efficiently and ensure sustainable investments are made in research capacity at a regional level

Factors influencing the use of modern contraceptives amongst postpartum women in a rural tertiary hospital in South-South Nigeria

The postpartum period is a critical time to address the high unmet needs of family planning and reduce the risks associated with closely spaced pregnancies. Unintended pregnancies immediately following childbirth are associated with increased maternal mortality, morbidity, and poor pregnancy outcomes. Adoption of postpartum family planning is a cost-effective way that would reduce maternal and child morbidity and mortality. This study aimed to establish the prevalence, the clients' sociodemographic factors, and health care workers' influences on modern contraceptive uptake amongst postpartum women at Irrua Specialist Teaching Hospital (ISTH), Irrua. This descriptive cross-sectional study was carried out amongst postpartum mothers attending maternal and child health clinics in ISTH, Irrua, Edo State, Nigeria. The selection of participants was by simple random sampling technique. All consented participants selected through simple random sampling were administered questionnaires, and completed ones were coded and analysed while the level of significance was set at 5%. In this study, over 90% of the women were aware of a method of modern contraception. However, this did not translate to increased contraceptive uptake as only 17.8% of the respondents were currently on a method of postpartum contraception. The statistically significant sociodemographic factors influencing the utilization of modern contraceptives by postpartum women, as seen in this study, were: Age (p<0.001), level of education (p<0.001), religion (p=0.048), and parity (p=0.010). The women who have higher educational status, higher parity, and adequate information provided by healthcare providers were more likely to use at least a method of modern contraceptive postpartum. The uptake of modern contraceptives amongst postpartum women was low in this study. Strengthening family planning counseling services during prenatal care and emphasizing the girl child education, provision of adequate information by healthcare providers on the need for postpartum contraception could enhance modern contraceptive use for postpartum women

Transplacental transfer of Lassa IgG antibodies in pregnant women in Southern Nigeria: A prospective hospital-based cohort study.

BackgroundEvidence from previous studies suggest that Lassa fever, a viral haemorrhagic fever endemic to West Africa has high case fatalities, particularly in pregnancy. While there have been remarkable innovations in vaccine development, with some Lassa vaccines undergoing early clinical trials. An understanding of Lassa antibody kinetics and immune responses will support vaccine design and development. However, there is currently no evidence on the antibody kinetics of Lassa (LASV) in pregnancy. Our study sought to estimate the efficiency of transplacental transfer of LASV IgG antibodies from the mother to the child.Methodology/principal findingsThe study made use of data from a prospective hospital-based cohort of pregnant women enrolled at the antenatal clinic and followed up at delivery between February and December 2019. Blood samples from mother-child pairs were evaluated for antibodies against Lassa virus. The study demonstrates a transplacental transfer of LASV IgG of 75.3% [60.0-94.0%], with a significant positive correlation between maternal and cord concentrations and a good level of agreement. The study also suggests that transfer may be more variable in women with 'de novo' antibodies compared to those with pre-existing antibodies.Conclusions/significanceThe study shows that maternal antibody levels play an important role in determining transfer efficiency of Lassa antibodies to the new-born; and while the evidence is preliminary, the study also suggests that transfer efficiency may be less stable in acute or recent infection, as such timing of vaccination before pregnancy, that is in women of childbearing age may be more appropriate for protection of both pregnant women and their neonates

Correlation plots for LASV IgG assessed by Spearman’s correlation (r) using linear regression.

Note: +/+ indicates seropositive from baseline. -/+ indicates seroconversion. The dotted black horizontal line indicates the line of efficient transfer (CMR = 1); IV- index value, an arbitrary antibody concentration unit based on manufacturer’s guide; mCMR- median cord maternal ratio; black and red lines are regression lines with the corresponding 95% confidence interval fitted to the regression line.</p

Linear regression analysis of the effect of maternal or neonatal characteristics on cord LASV IgG concentrations.

Linear regression analysis of the effect of maternal or neonatal characteristics on cord LASV IgG concentrations.</p

S4 Table -

(A) Linear regression analysis of the effect of different factors on the transfer ratio of LASV IgG antibodies amongst mothers with pre-existing antibodies. Note: β- regression coefficient showing change in cord LASV IgG concentration; CI- confidence interval; CMR- cord–maternal ratio; conc- concentration; IgG- immunoglobulin G; LASV- Lassa virus; LF- Lassa fever; N- total number of pregnant women included in analysis. a Adjusted for factors marginally significant in the univariate regression (crude p(B) Linear regression analysis of the effect of different factors on the transfer ratio of LASV IgG antibodies amongst mothers who seroconverted. Note: β- regression coefficient showing change in cord LASV IgG concentration; CI- confidence interval; CMR- cord–maternal ratio; conc- concentration; IgG- immunoglobulin G; LASV- Lassa virus; LF- Lassa fever; N- total number of pregnant women included in analysis. a Adjusted for factors marginally significant in the univariate regression (crude p(C) Linear regression analysis of the effect of different factors on the transfer ratio of LASV IgG antibodies amongst mothers who were seronegative. Note: β- regression coefficient showing change in cord LASV IgG concentration; CI- confidence interval; CMR- cord–maternal ratio; conc- concentration; IgG- immunoglobulin G; LASV- Lassa virus; LF- Lassa fever; N- total number of pregnant women included in analysis. a Adjusted for factors marginally significant in the univariate regression (crude p (DOCX)</p

TT IgG concentrations and cord maternal ratio by various maternal and neonate characteristics.

TT IgG concentrations and cord maternal ratio by various maternal and neonate characteristics.</p

Correlation between maternal and cord Lassa and TT IgG antibodies assessed by Spearman’s correlation (r).

Note: IV- index value; mCMR- median cord maternal ratio; black dotted horizontal line is line of seropositivity (LASV = 1.1, TT = 0.1IU/mL); blue line is the regression line; grey shaded are the 95% confidence interval fitted to the regression line.</p