Community cervical cancer screening and precancer risk in women living with HIV in Jos Nigeria

BACKGROUND

High HIV prevalence, and lack of organized screening for the indigent population receiving care and treatment within HIV clinics in low-resource settings increases cervical cancer incidence. We sought to determine predictors of cervical precancer in women living with HIV and receiving cervical cancer screening in Jos, Nigeria.

METHODS

A cross-sectional study of women living with HIV and receiving care and treatment in adult HIV/AIDS clinics in Jos-Metropolis, Nigeria between June 2020 and April 2023. Ethical approvals were obtained from the ethics committee in Jos, Nigeria and Northwestern University IRB, USA. Informed consent was obtained from eligible participants, and data on socio-demographics, cancer risk factors, and cytology reports were collected. The outcome variables were cervical precancer lesions. The independent variables were prior Pap smear status, socio-demographics, income, educational, and other reproductive health factors. Descriptive statistics was done to obtain means ± sd, frequencies, and percentages for the variables. Univariate and bivariate analyses were done to determine predictors of cervical dysplasia. Analyses were performed using R software.

RESULTS

Of 957 women screened, 570 were living with HIV and 566 women had cytology report and were included in the final analysis. The mean age was 45.08 ± 8.89 years and 81.6% had no prior evidence of Pap test (under-screened). Prevalence of cervical dysplasia was 24% (mild and severe dysplasia were 12.9% and 11.1%, respectively). Age above 45 years (aOR = 3.48, p = 0.009), postmenopausal status (aOR = 7.69, p = 0.000), and women with no history of prior IUCD use (aOR = 5.94, p = 0.0001), were predictors for severe dysplasia. Women who had history of STI (aOR = 0.17, p = 0.000), prior use of IUCD (aOR = 0.32, p = 0.004), prior use of condom (aOR = 2.50, p = 0.003) and had co-morbidities (aOR = 0.46, p = 0.009) were more likely to have had a Pap test in the past.

CONCLUSIONS

The majority of indigent women receiving care at HIV clinics had their first Pap test screening, and lack of organized screening among older and post-menopausal women with HIV, puts women at a higher risk of developing severe cervical precancer lesions.

Carboxymethylated and acetylated xerogel derivatives of Plectranthus esculentus starch protect Newcastle disease vaccines against cold chain failure

Developing vaccine stabilizers from local natural sources is desirable especially if the stabilizer would enhance the ability of the antigen to withstand frequent failures in cold chains. The study was undertaken to formulate immunogenic live Newcastle Disease (ND) LaSota vaccines stabilized with modified native starches for use at cold and ambient temperatures and to assess the immunogenicity of the starch stabilized vaccines in vaccinated chickens. Native starch extracted from the tubers of Plectranthus esculentus (Family, Lamiaceae) was modified by carboxymethylation and acetylation/xerogel formation and used as vaccine stabilizers of ND LaSota virus with/without buffers/bulking excipients. Cold Chain Failure (CCF) was simulated by storing the vaccines at 5 ± 2 °C for one month then at 37 ± 1 °C for 96 h. The stability of the samples were evaluated in comparison with peptone stabilized ND vaccines using pH, residual moisture, XRD, reconstitution time, mean embryo infective dose (EID50) and haemagglutination (HA) tests. Haemagglutination inhibition was used to evaluate the efficacy of the vaccines in conferring positive serum antibody titers (≥2³ log₂) in vaccine-naïve 2-week old broilers that were orally administered a single dose of the vaccines kept at 37 ± 1 °C for 96 h and bled weekly over four weeks. Temperature, pH, moisture content and amorphousness impacted vaccine stability. Peptone stabilized vaccines were significantly less stable and most affected by temperature changes with 1.2log₁₀EID50 loss while buffered/bulked trehalose, carboxymethylated and acetylated/xerogelized starch stabilized vaccines were most stable (0.2-0.5log₁₀EID50 loss in titer) after 96 h in CCF. Buffered trehalose stabilized vaccine (TVB) had lower HA titres than peptone and starch stabilized vaccines containing D-mannitol and Na₂HPO₄. Antibody titres of vaccinated broilers were between 3.3 ± 1.398 and 8.35 ± 2.678. All the vaccines were immunogenic (HI ≥ 2³) and developed HI titres (≥2⁴) considered to be protective. Carboxymethylated and acetylated/xerogel derivatives of P. esculentus starch have a great potential as vaccine stabilizers especially in areas prone to CCF.

Neonatal Blood Pressure and Anthropometric Indices in Newborns of Pre-Eclamptic and Normal Mothers in Jos, Nigeria

BACKGROUND AND OBJECTIVES

Preeclampsia is a significant public health problem associated with increased risk of hypertension for offsprings. We compared the blood pressure and presence of hypertension between neonates born to women with preeclampsia and those with normal pregnancy as well as its relationship to anthropometric indices.

METHODS

This is a comparative cross-sectional study of 40 neonates born to women with preeclampsia and those born following normal pregnancy in four tertiary health facilities located in Jos, Nigeria. Anthropometric and blood pressure values were measured within 6-12 hours of delivery using standard protocols. SPSS version 25 was used in all analyses. Statistical significance was taken at p <0.05.

RESULTS

The mean birth weight for neonates of preeclamptic women was 2,476.1±810.8 grams, compared with 2,994.2±529.6 grams in babies of normal pregnancy (p=0.002). The mean birth length for neonates of preeclamptic women was 45.4±6.2 cm compared with 49.8±3.1 cm in babies of normal pregnancy (p<0.001). The mean ponderal index (PI) in neonates of preeclamptic women was 2.6±0.6 g/cm3 compared with 2.4±0.4 g/cm3 in babies of normal pregnancy (p=0.17). The mean systolic blood pressure in neonates of women with preeclampsia was 74.53±16.99 mmHg compared with 75.26±15.20 mmHg in neonates following normal pregnancy (p=0.85). The mean diastolic blood pressure in neonates born following preeclampsia was 47.52±15.76 mmHg compared with 45.12±16.9 mmHg in those following normal pregnancy (p=0.46). Six (16%) of the neonates born to women with preeclampsia had systolic hypertension compared with 3(8%) of neonates of women with normal pregnancy. Similarly, 5(14%) of neonates born to women with preeclampsia had diastolic hypertension compared with 2(5%) of neonates of women with normal pregnancy. No significant association between neonatal hypertension and anthropometric indices.

CONCLUSION

Newborns of women with preeclampsia have associated higher odds of elevated blood pressure. Elevated blood pressure has no significant relationship to birthweight, length or ponderal index. Early infant blood pressure surveillance is advocated in order to monitor and hence prevent complications ensuing in later life.

MATERNAL AND NEONATAL OUTCOMES OF HISTOLOGICAL CHORIOAMNIONITIS

BACKGROUND

Clinical Chorioamnionitis contributes to maternal and neonatal morbidity and mortality but the effect of histological chorioamnionitis is sparse in our environment.

AIM

To determine the maternal and neonatal outcomes of histological chorioamnionitis amongst pregnant women and their babies.

DESIGN OF THE STUDY

Cross sectional longitudinal study.

SETTING

Jos University Teaching Hospital (JUTH), Jos, Nigeria.

METHODOLOGY

Parturients were interviewed and examined as well as had their placenta examined histologically for chorioamnionitis. They and their babies were followed up for 6 weeks after delivery to monitor for any complications that may arise.

RESULTS

A total of 148 parturients were enrolled from the labour ward of Jos University Teaching Hospital and of these 90 (60.8%) had histologic chorioamnionitis (HCA). As regards outcome, 9(10%) with histologic chorioamnionitis as well as 5(8.62%) of those without HCA had premature delivery. Low birth weight occurred in 12(13.33%) and 6(10.34 %) of those with HCA and without HCA respectively. In all, 1(1.47%) and 1(2.56%) of women with HCA and without HCA correspondingly had neonatal sepsis. Puerperal sepsis occurred in 2(2.94%) of those with HCA and 2(5.13%) of those without HCA.

CONCLUSION

Our study has demonstrated that histological chorioamnionitis had no adverse maternal or neonatal effect. There is the need for more studies investigating the cause and the implication of histological chorioamnionitis.

Treatment Discontinuation in Adult HIV-Infected Patients on First-Line Antiretroviral Therapy in Nigeria

BACKGROUND

Retention in care and treatment services is critical to health outcomes of individuals diagnosed and living with HIV. We evaluated the incidence of and risk factors for treatment discontinuation (TD) in a large adult HIV population on ART in Nigeria.

METHOD

A retrospective cohort study of adult HIV patients initiated on first-line ART between 2004 and 2011 at the Jos University Teaching Hospital (JUTH) in Nigeria. Follow up information of participants was retrieved from various sources (patient visit database, pharmacy data and patients charts) up to the end of 2012. The primary study endpoint was TD, defined as discontinuation of ART for any reason, including death or loss to follow-up (lack of pharmacy pick-up for periods≥12 months). The Incidence and hazard for TD were estimated by Kaplan-Meier and Cox proportional regression analysis, respectively.

RESULT

Overall, 3,362 (28%) patients discontinued treatment during 49,436 person-years (py) of follow-up (incidence rate (IR) 6.8 TD per 100 py). The hazard of treatment discontinuation decreased with increasing age (adjusted hazard ratio (aHR 0.99; 95% CI 0.98-0.99). Other independent risk factors for treatment discontinuation were: being unmarried (aHR 1.24; 95% CI: 1.12-1.38), having primary or secondary level of education as compared to tertiary level education (aHR 1.24; 95% CI: 1.12-1.40) and average percent adherence to drug refill visits<95% (adjusted hazard ratio (aHR) 2.13; 95% CI: 1.9-2.40). Compared to tenofovir, greater hazard of TD was noted in patients initiated on ART containing didanosine (aHR) 1.73; 95% CI: 1.03-2.91), but lower in those initiated on zidovudine containing regimen (aHR 0.77; 95% CI: 0.69-0.86).

CONCLUSION

Long-term treatment discontinuation rate in this study was comparable to estimates in resource-rich countries. Younger patients, as well as patients with lower educational levels and those with poor adherence had significant hazards for treatment discontinuation and should be the target of interventions to reduce treatment discontinuation and improve retention, especially within the first year of ART.

BODY WEIGHT CHANGES IN WOMEN USING IMPLANON IN JOS, NIGERIA

BACKGROUND

The fear of weight gain is one of the adverse events that make women to discontinue Implanon® (etonorgestrel) contraceptive. Black women are more prone to gain weight with the use of such progestogen-only contraceptives than women of other racial groups. The weight of women is also an important consideration since it influences the concentration of the active drug and may predispose to failure at a higher weight profile.Information on weight changes with the use of etonorgestrel implant is scarce in our sub-region. We therefore explored the direction and extent of weight changes among women in different weight categories and determined the predictors of the final body weight during use of Implanon®.

MATERIALS AND METHOD

This was a retrospective study of all women that accepted implanon at the Family Planning Unit of the Jos University Teaching Hospital, Jos Nigeria from March 2007 to March 2014. Data analysis was carried out using Stata version 12.1. The socio-demographic data and reproductive histories were extracted from the records and the duration of use of the implant, reasons for discontinuation and the initial weight and at follow up were analysed.

RESULTS

Over 99% of the women who had Implanon® were parous and the commonest contraceptive they had used previously was the injectables. However, almost a quarter (22.8%) were accepting Implanon® as their first ever contraceptive method. The mean baseline weight was 64.4 ± 12.1 kg and the median weight was 63.0 kg. The average months of use of Implanon® in this study was 27 months and there was a mean increase in body weight of 2.5 kg during the study. However, there was a broad variability in the individual change in body weight with about 38.6% losing weight or not having any net weight change. Over three-fifths (61.4%) of the women had a net weight gain while using Implanon®. Of these women, 36.0% gained 1-5 kg, 19.2% gained 6-10 kg, 4.2% gained 11-15 kg and 2.0% gained more than 16 kg with the maximum gain at 26 kg. The mean weight changes were 0.8 kg, 1.6 kg, 3.2 kg and 3.3 kg respectively for the first, second, third and fourth years of Implanon® use respectively. Implanon® was removed on account of weight gain in 3.8% of those women who had removed the implant. There was no statistically significant difference in weight gain among the different weight categories: women who had an initial weight above 90 kg gained less than 1 kg compared to those who had normal weight (for this study <70 kg) at the baseline that gained on average more than 2.0 kg. The most significant predictor of the final body weight with Implanon® use was the initial body weight which predicts it in 83.5% of the time (p-value 0.000, CI 0.99, 1.05).

CONCLUSION

There was a broad variability in weight changes with the use of Implanon® and the initial body weight is the most significant predictor of the final body weight. Therefore implanon can be used by women of all weight categories including those considered to be obese.

DECLINING PREVALENCE OF HIV AND OTHER SEXUALLY TRANSMITTED INFECTIONS AMONG FEMALE SEX WORKERS IN JOS, NORTH-CENTRAL NIGERIA

BACKGROUND

Female Sex Workers (FSWs) are key reservoirs of human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs) from which transmission to the general population fuels epidemics. STIs amplify HIV infectiousness and susceptibility. We determined the status of HIV and STIs among brothel-based FSWs in Jos as part of an ongoing prevention intervention.

METHOD

Between January and May 2012, consenting consecutive brothel-based FSWs were recruited from previously designated brothels across Jos. HIV counseling and testing as well as screening for gonorrhoea, syphilis, trichomonasis, candidasis and Bacteria vaginosis (BV) were performed. Positive cases were provided free treatment and follow-up at Solat Women Hospital, Jos. Ethical clearance was obtained from Jos University Teaching Hospital (JUTH) ethical committee.

RESULT

Two hundred FSWs aged 27.6 ± 4.6 years (range 15-55 years) were recruited and of these, 47 (23.5%) were HIV Positive, 20 (10.0%) had syphilis, 9 (4.5%) had Neisseria gonorrhea, 3 (1.5%) had Trichomonas vaginalis and 86 (43.0%) had BV. The association between HIV and bacterial vaginosis was statistically significant (OR of 2.2, 95% CI of 1.1-4.2, P-value=0.02). In comparison to similar prevalence in 2006, the current findings represent 51.5% decline in HIV prevalence, 40.8% decline for syphilis and over 83.3% decline in prevalence for Trichomonas vaginalis. There was no significant change in the prevalence of Neisseria gonorrhoea and BV.

CONCLUSION

The prevalence of HIV and STIs among brothel-based FSWs in Jos remain unacceptably high, although, there is a declining trend. A comprehensive HIV prevention program targeting these women is required to block transmission to the general population.

Obstetrics Risk of HIV Infection among Antenatal Women in a rural Nigerian hospital

BACKGROUND: Obstetrics risk and practices can lead to the spread of HIV/AIDS. Identification of such obstetrics risk of HIV infection is a useful step in the prevention of transmission of the virus. OBJECTIVE: We sought to determine obstetrics risk of HIV infection in pregnant women attending antenatal clinic in a rural Northern Nigerian hospital. METHODS: We conducted a cross-sectional descriptive study of pregnant women attending antenatal clinic of a rural mission hospital in northern Nigeria between June and October 2005. Data were collected using structured questionnaire. HIV screening and confirmation was carried out on pregnant women after voluntary counseling. RESULTS: 350 pregnant women were enrolled with a mean age (±SD) of 26.8± 6.4years. The highest number of HIV infected women was observed in those who had their first coitus between 16 and 20 years. The age at first coitus was not significantly related to the HIV infection (P=0.41). Neither parity (P=0.13) nor past history of abortion (P=0.42) was associated with HIV infection. None of the 41 women who had their last delivery at home had HIV infection compared with 9.8% of the 194 women who delivered in the hospital or clinic (P=0.008). Forty percent of those who had their last delivery in primary health centre had HIV infection while 22.2% of those who delivered under the care of traditional birth had HIV infection. CONCLUSION: Obstetrics practices may encourage transmission of HIV infection. This calls for re-examination of the obstetrics practices especially in our primary health centers in order to prevent transmission of HIV infection.

HIV risk factors among pregnant women in a rural Nigerian hospital

OBJECTIVE

Specific risk behaviours and practices promote the spread of HIV/AIDS. Identification of those at risk of the Human Immunodeficiency Virus (HIV) infection is an important step toward prevention of both vertical and horizontal transmission of HIV. This study sought to identify risk factors for HIV infection in pregnant women attending a rural antenatal clinic in Northern Nigerian.

METHODS

A cross-sectional descriptive study of pregnant women attending antenatal clinic at a rural mission hospital in Northern Nigeria between June and October 2005 was conducted. Data were collected with a structured questionnaire. HIV screening and confirmation were done for the pregnant women after voluntary counselling.

RESULTS

The study enrolled 350 pregnant women with a mean (+/- SD) age of 26.8 +/- 6.4 years. HIV infection was not associated with smoking habits in women, alcohol intake in the women or their partners, prior blood transfusion, history of sexually transmitted infection or history of scarification. In multiple logistic regression, HIV infection was independently associated with suspecting their partner of extramarital sex (adjusted odds ratio 3.8, 95% CI 1.6, 9.0), post-primary education (AOR 2.4, 95% CI 1.1, 5.3), multiple sexual partners (AOR 2.4, 95% CI 0.97, 6.2) and cigarette smoking by a partner (AOR 3.0, 95% CI 0.95, 9.4).

CONCLUSION

Multiple partners and extramarital sex remain a hindrance to the fight against HIV infection. Promoting the ABC approach (abstinence, be faithful, condom) may reduce risky behaviour as it has in other parts of Africa.

Heterotopic pregnancy at term masquerading as intrauterine twin gestation, a case report

A case of combined intrauterine and abdominal pregnancies in a 29-year-old primigravida occurring in a natural cycle is presented. She booked for routine antenatal care in the obstetric unit of the hospital. An early scan at 10 weeks showed a twin gestation (diamniotic, dichorionic placentation). She was admitted between 10-21 weeks on account of severe hyperemesis gravidarum and anaemia in pregnancy. She was managed with antiemetics, intravenous fluids and two units of blood transfused before discharge for follow up in the antenatal clinic. Pregnancy was uneventful between 22 weeks to 38 weeks when she had elective Caesarean section on account of twin gestation, primigravida and borderline pelvis. At Caesarean section a combined intrauterine and abdominal pregnancies were found. She was delivered of first twin (intrauterine), a baby boy weighing 2.5 kg with Apgar scores of 8 and 9 in 1 and 5 minutes respectively; second twin (abdominal) a baby boy weighing 2.7 kg with Apgar scores of 8 and 9 at 1 and 5 minutes respectively.

Evaluation of cardiovascular morbidity in Nigerian women after 3 years of Norplant contraception

This study was conducted to determine any cardiovascular morbidity with Norplant use by electrocardiography. Thirty Nigerian women seeking long-term reversible contraception were recruited. The clients had baseline blood pressure checks and electrocardiography (ECG) tracings. These were repeated at the 12, 24 and 36 months follow-up visits and the results were analysed. The mean age of subjects was 32.4 +/- 3.98 years. The mean weight at pre-insertion and at the 12, 24 and 36 months follow-up visits showed a statistically significant rise after 2 years (p < 0.01). The blood pressures did not show any significant changes throughout the period of study. There was statistically significant prolongation of the PR and QRS intervals at the 12 month visit; mean PR interval (seconds) pre-insertion 0.153 +/- 0.003, and at 12 months 0.173 +/- 0.006 (P = 0.019), mean QRS interval (seconds) pre-insertion 0.056 +/- 0.003 and at 12 months 0.074 +/- 0.002 (P = 0.005). After 3 years of Norplant use, prolongation of the mean QRS interval remained evident (p = 0.011) while mean PR interval had returned to pre-insertion levels. There is a tendency to prolongation of PR and QRS (ECG) intervals in Norplant users; accordingly, it may be prudent for clients with cardiac conditions showing longer ECG intervals, to consider alternative methods of contraception.

Thyroid hormone: the modulator of erectile function in the rabbit

The possible role of thyroid hormones in the Nitric Oxide (NO)-mediated response to sexual stimulation, and on prostaglandin E1 (PGE1) and Sildenafil in the treatment of erectile dysfunction was investigated using the corpus cavernosum of the New Zealand rabbit animal model. The parameters studied were penile erection monitored as contractile force of the erectile tissue, sperm count and motility; in parallel with the haematocrit, red cell count or rheology, Heart Rate (HR), Mean Arterial Pressure (MAP), Thyroid Stimulating Hormones (TSH) and Thyroxine levels. Hypothyroidism or thyroidectomy was found to cause depletion of Endothelium Derived Relaxant Factor (EDRF) thereby causing very feeble contraction of the cavernosum muscle, in both prostaglandin E1 (PGE1) and sildenafil, oligospermia and less than 45 % motile sperms. Thyroxine treatment produced contraction proportionate to the concentrations of PGE1 and Sildenafil; providing evidence that the erectogenic actions of both PGE1 and Sildenafil are possible only in the presence of adequate thyroid hormone level.

HIV status of partners of HIV positive pregnant women in different regions of Nigeria: matters arising

This study was conducted to determine the pattern of HIV sero-status of Partners of HIV Positive Pregnant Women in three different regions of Nigeria and to explore the implications for HIV prevention interventions. The Site Coordinators of PMTCT programs in three Nigerian cities obtained data of the HIV status of the partners of HIV positive pregnant women. The selection of Benin City, Jos and Kano was made after consideration of their ethnic, religious and cultural representation of Nigeria. Benin City represents a traditional southern Nigeria city, Kano a traditional northern city and Jos, a middle-belt, ethnically diverse cosmopolitan setting. The data were analyzed using frequencies. A total of 500 partners of HIV infected pregnant women were tested for HIV using Determine Abbott test kits. Positive results were confirmed using Western blot or a second rapid test kit. The city-by-city results showed that in Benin City (Southern Nigeria), 78.8% (104/132) of the partners were HIV negative (sero-discordant), Jos (Middle-Belt) had 48.4% (103/213) sero-discordance while Kano (Northern Nigeria) recorded a sero-discordance rate of only 7.7% (12/155). These results indicate that the dynamics of HIV transmission in marital settings in Nigeria are different in the various regions of the country. Socio-cultural and religious settings play a significant role in HIV transmission among couples. These findings should guide prevention interventions in order to achieve maximal impact.

Partner disclosure of HIV status among HIV positive mothers in Northern Nigeria

Partner consent and support can substantially enhance adherence to PMTCT interventions. This study explores the issues concerning disclosure of HIV status to partners of HIV sero-positive mothers in a PMTCT programme in Jos, Northern Nigeria. Previously field-tested questionnaires were administered by trained counsellors to 570 consenting HIV positive mothers who were participating in the PMTCT programme at Jos University Teaching Hospital (JUTH), Jos. The findings were entered into Epi Info and analysed using frequencies. The median age of respondents was 29 years while that of their partners was 37 years. Five hundred and fifty-five (99.5%) of respondents were married. Majority of the women were Christians (82.9%) while 16.9% were Moslems. Seventy four percent (419/563) of the mothers were aware of their husband's HIV sero-status. Of these, 65.4% (274/419) of the partners were HIV positive while 34.6% were sero-negative. Eighty nine percent (500/560) of the women have disclosed their HIV status to their partners. Of these, 39.6% (199/502) required the assistance of health workers while 59.4% (298/502) did it by themselves. Following disclosure of HIV status, 86.9% (430/495) of the partners were supportive, 5.7% were indifferent, 6.7% were quarrelsome and abusive while 1.0% was violent. The reactions of partners of HIV positive mothers to disclosure of their wives' HIV status are predominantly supportive. This should strengthen strategies to promote partner disclosure.

Dependence of calcium on thyroid hormone for the regulation of cellular functions

Recently, the thyroid hormone has been shown to cause increase in Ca2+ concentration by mobilizing intracellular Ca2+. The mobilization of intracellular Ca2+ in the absence of transmembrane Ca2+ influx has been accepted as evidence for a cell-surface Ca2+- receptor. The possible role of thyroid hormone in the regulation of cellular functions by Ca2+-channel was investigated using parameters proven to indispensably involve Ca2+: Bleeding and clotting times and rat uterine muscle activity in Ca2+-free Tyrode's solution. Adult female Wistar rats divided into four groups, namely; (i) Control, (ii) Thyroidectomized, (iii) Throidectomized-treated with thyroxine and (iv) Thyroxine-treated; were fed on rat chow. While groups i and ii were allowed access to tap water ad libitum for 60 days, groups iii and iv received tyroxine (10mg/kg body weight) every alternate day and tap water ad libitum for 60 days. All groups were kept in an air-conditioned room till they were euthanized. The results showed that thyroxine elicited biphasic contraction in Ca2+ - depletion and potentiated uterine contraction during Ca2+- loading (P<0.001). Inhibition of contractions in thyroidectomy, showed dependency of Ca2+ on thyroid hormones for the regulation of cellular functions.

HIV and hepatitis B seroprevalence in trauma patients in North Central Nigeria

BACKGROUND

With the high prevalence rate of HIV and Hepatitis B virus infections in sub-Saharan Africa, infected surgical patients, especially those with fresh open wounds, pose significant danger of occupationally-acquired infections to health workers.

METHOD

A two-year double blind study aimed at determining the seroprevalence rates of HIV and Hepatitis B virus infections among trauma patients with fresh open wounds in North Central Nigeria.

RESULTS

There were 134 patients with fresh open wounds in this study; their ages ranged between 17-80 years with a mean of 30.9 +/-9.6 years and the male:female ratio was 5:1. All the patients were tested for both HIV and Hepatitis B virus infections. Six(4.5%) patients were positive for HIV-1 while 95(70.9%) patients were positive for Hepatitis B. In all, 3(2.2%) male and 3(2.2%) female patients tested positive for HIV-1 while 77(57.4%) males and 18(13.4%) females tested positive for Hepatitis B; 5(3.7%) patients tested positive for both HIV and Hepatitis B. Though every social class was represented, HIV infection rate was higher in Social Class V than in Social Class 1 but the class incidence rate for Hepatitis B was about the same ranging between 1.2 and 1.6 for both the upper and lower classes. The significance of this study was that the incidence of Hepatitis B virus infection in trauma patients was remarkably higher than the incidence of HIV infection. The implication is that emphasis on control of exposure of health care workers to blood borne infections in the workplace should be as strong for Hepatitis B virus infection as it is for HIV.

CONCLUSION

The main finding of this study was the determination of the seroprevalence of HIV and Hepatitis B virus infections in trauma patients with open wounds which underpinned the dangers they pose to health care workers.

Rapid HIV testing and counselling in labour in a northern Nigerian setting

Between April and August 2004, all pregnant women in labour at JUTH, were offered rapid HIV testing and counselling with opportunity to decline testing. HIV positive women were offered the standard nevirapine mono-therapy prophylaxis regimen (HIVNET 012). Four hundred and thirty (99.8%) of the 431 pregnant women who were offered rapid HIV testing and counselling, agreed to test. A sero-conversion rate of 2.1% (5 of 235) was found among women who had previously tested negative for HIV during the index pregnancy. A seroprevalence rate of 9.6% (16 of 166) was found among women with unknown HIV status. One patient who had an indeterminate HIV status prior to labour tested positive in labour. Rapid HIV testing and counselling in labour is a useful practice in high prevalence settings since it detects a substantial number of HIV-infected women and HIV-exposed babies that would otherwise have missed interventions to prevent MTCT.

HIV infection among pregnant women in Nigeria

OBJECTIVES

To determine risk factors for HIV among pregnant women (N = 2657) receiving antenatal services in Jos, Plateau state, Nigeria.

METHODS

Information about potential risk factors was obtained at interview. Biological samples were collected for detection of HIV and other sexually transmitted infections (STIs).

RESULTS

The prevalence of HIV was 8.2%. Women aged 20-29 years had more than 4-fold increased risk of HIV. Women of Catholic (adjusted odds ratio (AOR) = 1.72, 95% CI = 1.01-2.95) and Pentecostal (AOR = 2.57, 95% CI = 1.46-4.52) denominations were more likely to be HIV-infected when compared to Moslem women. The risk of HIV was also increased among women with multiple marriages and in women married to a banker/accountant. Other predictors of HIV were having a husband with other partners, perceived risk of HIV, STIs, candidiasis and bacterial vaginosis.

CONCLUSIONS

Development of effective interventions, including behavioral change, expansion of perinatal HIV prevention services and STI control, should be given the highest priority.

Dependence of calcium on thyroid hormone for the regulation of cellular functions

Recently, the thyroid hormone has been shown to cause increase in calcium ion (Ca(2+)) concentration by mobilizing intracellular calcium((2+)). The mobilization of intracellular calcium((2+)) in the absence of transmembrane calcium((2+)) influx has been accepted as evidence for a cell-surface Ca((2+))-receptor. The possible role of thyroid hormone in the regulation of cellular functions by ca((2+)-channel was investigated using parameters proven to indispensably involve Ca(2+). Bleeding and clotting times and rat uterine muscle activity in Ca(2+)-free Tyrode's solution. Adult female Wistar rats divided into four groups, namely; (i) Control, (ii) Thyroidectomized, (iii) Throidectomized-treated with thyroxine and (iv) Thyroxine-treated; were fed on rat chow. While groups i and ii were allowed access to tap water ad libitum for 60 days, groups iii and iv received tyroxine (10 mg/kg body weight) every alternate day and tap water ad libitum for 60 days. All groups were kept in an air-conditioned room till they were euthanized. The results showed that thyroxine elicited biphasic contraction in Ca (2+)-depletion and potentiated uterine contraction during Ca(2+)-loading (P < 0.001). Inhibition of contractions in thyroidectomy, showed dependency of Ca (2+) on thyroid hormones for the regulation of cellular functions.

Prolongation of electrocardiographic intervals in women on Norplant contraceptive: what dangers?

This study used electrocardiography to determine any inherent cardiovascular dangers with the use of Norplant, an implant contraceptive among Nigerian females using the device. As part of a major study of metabolic, physical and cardiovascular changes consequent upon the use of Norplant implant contraceptive, all subjects underwent serial electrocardiograms at pre-insertion, 3, 6, and 12 months of use. Given the observed prolongation ofelectrocardiographic intervals, the ECG of all the study subjects were secondarily analysed for QT and corrected QT (QTc) dispersions. QT intervals was measured from the ECG of each of the 21 subjects who were available at pre-insertion and 12 months post-insertion; from the onset of QRS to the end of T wave or nadir of the curve between T and U waves as the case may be. Corrected QT intervals was calculated by determining the RR interval and using the Bazett's formula. The difference of the lowest and highest QT intervals and QTc intervals over the 12 leads determined their respective dispersions. These were then analysed. The subjects whose ages ranged from 25-45 years weighed between 43 and 87.2 kg. The mean QT dispersion increased with time but did not reach statistical significance by the twelve month visit (ANOVA - QT dispersion 0 month vs 12 months: F=0.98, p=0.48). However the mean QTc dispersion increased and reached statistical significance by 12 months (0 month vs 12 months: F=5.49, p=0.006). QT and QTc dispersion increases are known to predict cardiovascular death in health and disease. With the use of this device, these indices rose gradually with time reaching statistical significance by 12 months only with the QTc dispersion. The use of this device may increase the tendency to cardiovascular morbidity and mortality. Whether this translates into real risk will require a long-term study to determine. For now, application of the device on patients with cardiovascular disease or tendency thereof should still attract caution.

Fifteen years analysis of complications following minilaparotomy female sterilization in Jos Nigeria

A retrospective analysis of complications following female sterilization via minilaparotomy performed in Jos University Teaching Hospital between January 1985 and December 1999 was undertaken to determine the incidence, the type of complications and identify ways of improving the service. 2986 clients had female surgical contraceptions. Major surgical complications occurred in 0.87% of the clients. Minor complications were seen in 4.15% with wound sepsis contributing 3.75% to the rate. The crude failure rate was 0.23%. Re-anastomosis was the reason for the failures not surgical misapplication of devices nor fistulous opening as found elsewhere. There was no death in the series. Clients seeking surgical contraception should be counseled about the minimal major surgical and minor complications that could occur during the procedures. Our center will need to focus on infection prevention in female surgical contraception in order for the services to enjoy continuous acceptance by the clients.

Evaluation of menstrual and haematological parameters, after 36 months of Norplant contraception

This ongoing prospective longitudinal study involved 23 women who had complete records, of 37 healthy non-breastfeeding informed volunteers recruited from our family planning clinic since August 1997 to the Norplant training programme. Packed cell volume (PCV), white blood cell (WBC) concentration (total and differential and platelet concentration were analysed at pretreatment and at 12, 24 and 36 months' followup. Statistical analysis was with paired t-tests. The level of significance was set at 5%. Each acceptor received a menstrual calendar to document all events of bleeding. The mean PCV was 40.5 +/- 2.4% at pretreatment. This rose to a statistically significant (P < 0.001) mean value of 44.9 +/- 4.4% at 36 months. The mean WBC concentration at pretreatment was 5552 +/- 1423 per mm3 which declined statistically (P < 0.001) to a mean value of 4400 +/- 1281 per mm3 at 12 months without any further significant changes at 24 months (P > 0.6; 4143 +/- 1301 per mm3 and at 36 months (P > 0.9; 4070 +/- 875 per mm3). At 24 months of study the mean concentration of neutrophils, lymphocytes, monocytes eosinophils and basophils did not change significantly from their respective mean concentrations at 12 months. These insignificant changes were also manifested at 36 months of study in the lymphocytes (P > 0.2), eosinophils (P > 0.5) and basophils (P > 0.2), even though there was a significant decrease in the neutrophils (P < 0.05) with a corresponding significant increase (P < 0.001) in the monocyte concentration. However, there was still a significant decrease (P < 0.001) in the WBC at 36 months of study compared with the mean preinsertion value, which was manifested mainly in the neutrophil concentration (1403 +/- 517 per mm3 (P < 0.001). The mean value of platelet count (136260 +/- 27664 per mm3) at 24 months showed no significant change compared with the 12 months value (126174 +/- 37977 per mm3). The value at 36 months (125391 +/- 18858 per mm3), however, still showed a significant decline over the pretreatment mean concentration (208043 +/- 27250 per mm3). None of the acceptors had thrombocytopenia at 24 and 36 months. At 2 years and 3 years of studies 60.9% and 47.8% of Norplant users reported irregular bleeding patterns, mainly of reduced episodes. The continuation rate at 36 months was 100%. Women using the Norplant implant are at an advantage, because in spite of the variable aberrations in their menstrual pattern, the packed cell volume increased. The changes ob-served in the white cell and the platelet concentrations did not lead to adverse effects.

Anaesthesia for minilaparotomy female sterilization in JUTH, Nigeria: a fourteen-year review

This is a retrospective study aimed at evaluating the various anaesthetic methods used for minilaparotomy female sterilization. During the fourteen-year period, 2913 clients had minilaparotomy female sterilization. Their mean age was 36.35 +/- 4.19 years. Mean number of living children was 6.82 +/- 1.64. 74.87% of the clients did not have any formal education, but were aware of other contraceptive options. In all 98.42% of the clients were married and in a stable relationships. Local anaesthesia with 1% xylocaine (10-20 mls) was used in 83.69% of the cases. Local anaesthesia with sedation in 13.53% and general anaesthesia in only 2.78%. Above 93.55% (2725) of the sterilization was carried out as an interval procedure, while 6.45% (188) were done postpartum. Pomeroy's technique was used in 96.98% of the tubal ligation. There was no mortality. The morbidity was vomiting and hallucination and it occurred in 0.20% amongst the clients who had sedation or general anaesthesia. Minilaparotomy under local anaesthesia for female sterilization has been found to be safe an effective outpatient procedure, and it is currently and established family planning option in our institution. The use of local anaesthesia alone gradually rose from 1987 up to date. The successful outcome was attributable to psychological and emotional preparation of the clients who also had to learn abdominal breathing exercises (for easy access to the fallopian tubes) from the trained personnel before the procedure.

Glucose metabolism among Norplant users in northern Nigeria

Twenty-one women who were consecutive acceptors of Norplant were recruited for this study in our centre in August 1997. The patients had baseline (pre-insertion) investigations including a standard oral glucose tolerance test (OGTT). At their regular 3, 6, and 12 months follow-up visits, the OGTT was repeated and results were analyzed. The mean age of the clients was 31.3+/-4.51 years (range 24-40 years). The mean weights were 61.60+/-11.35, 57.63+/-7.51, 62.60+/-11.98, and 62.17+/-11.56 kg at pre-insertion, 3, 6, and 12 months follow-up visits respectively. The differences were statistically insignificant. All OGTT values at pre-insertion and at the follow-up visits were within the normal range. However, in comparison to pre-insertion levels (4.00+/-0.10 mmol/L), the fasting blood glucose concentration at 12 months (3.39+/-0.12 mmol/L) showed a statistically significant decline (p <0.001). The area under the glucose curve (AUC) rose by 5.8% (p = 0.018) at 3 months but declined by 5.8% (p = 0.110) and 7.3% (p = 0.103) at 6 and 12 months, respectively. The peak pre-insertion plasma glucose level following OGTT occurred at 30 min. At 3 months, the peak OGTT glucose level occurred at 30 minutes and plateaued until 60 min while at 6 and 12 months this occurred at 60 and 90 minutes, respectively. The overall trend of OGTT results within the study period showed that 12 months of Norplant use in Northern Nigerian women has no detrimental effect on glucose metabolism.

Changes in menstrual and haematological indices among Norplant acceptors

A longitudinal study of women using Norplant(R) was conducted to determine the effects of levonorgestrel implants on menstrual and haematological indices among the acceptors. Packed cell volume (PCV), white blood cell (WBC) concentrations (total and differential), and platelet concentration were performed at pre-insertion and at the 12-month follow-up. Each acceptor received a menstrual calendar to chart all bleeding, and spotting events. The mean PCV was 40.5 +/- 2. 4 at insertion and had a statistically significant (p <0.01) rise to a mean value of 42.2 +/- 2.6 at 12 months. The mean WBC concentration had a significant decrease at 12 months (p <0.001) when compared with the pre-insertion value. Similarly, the neutrophil and lymphocyte concentration had a statistically significant decrease (p <0.05 and p <0.01, respectively) at 12 months of use. The reduced values in the concentrations of monocytes, eosinophils and basophils did not reach significant levels. The mean value of the platelet concentrations had a significant decline at 12 months of use (p <0.001). Reduced bleeding patterns were more commonly reported compared to increased bleeding episodes. This pattern was associated with increased PCV, a change that may prevent anaemia in developing countries. The decline in the platelet concentration at 12 months of study was, however, a source of concern that will require follow-up.

How safe is motherhood in Nigeria?: the trend of maternal mortality in a tertiary health institution

OBJECTIVE

To determine the magnitude and trend of maternal mortality in Jos University Teaching Hospital, Jos, Nigeria.

DESIGN

Retrospective study.

SETTING

Jos University Teaching Hospital, Jos, Nigeria.

SUBJECT

All women dying in pregnancy, labour and puerperium.

MAIN OUTCOME MEASURES

Maternal mortality ratio, trend of maternal mortality, age, antenatal booking status, educational status, main causes of maternal death, factors contributing to maternal deaths.

RESULTS

The maternal mortality ratio was 739/100,000 total deliveries and trend rose from 450/100,000 in 1990 to 1,060/100,000 total deliveries in 1994. About 33% of all maternal deaths occurred among teenagers. The risk factors for maternal deaths included adolescence, grand multiparity, illiteracy and non-utilisation of antenatal services. The main causes of maternal mortality were haemorrhage (28.1%), sepsis (21.3%) and eclampsia (15.7%). The contributions of complicated induced abortion and anaesthetic deaths in this study are worthy of mention.

CONCLUSION

The maternal mortality ratio is unacceptably high in Jos University Teaching Hospital more particularly because of the rising trend. Socio-cultural and economic factors contributed immensely to the high maternal mortality in Jos. The objective of the World Health Organisation (WHO) to reduce maternal mortality by 50% by the year 2000 will not be achieved in this part of Nigeria. Nonetheless, improvement of the nation's economy coupled with a stable policy and provision of intrastructural facilities will assist to significantly reduce maternal mortality.

Discrepancies in sperm count using improved Neubauer, Makler, and Horwells counting chambers

Semen analysis still remains an important diagnostic procedure in male infertility evaluation. For the purpose of standardization and uniformity in the interpretation of sperm count results, the accuracy of three different counting chambers (improved Neubauer (IMN), Makler, and Horwells) were evaluated. Semen samples produced by 50 men were analyzed with the three different counting chambers using World Health Organization guidelines. The overall precision values of sperm count were: IMN 9.7%, Makler 5.9%, and Horwells 7.1%. The mean sperm counts (+/- SEM) were 78.6 (+/- 10.1), 119.1 (+/- 14.1), and 211.5 (+/- 27.5) million spermatozoa/ml respectively. Statistically significant differences were revealed when the sperm count results obtained with the different counting chambers were compared, i.e., IMN vs Makler (P < 0.05), IMN vs Horwells (P < 0.001), and Makler vs Horwells (P < 0.01). The sperm count results obtained from the 50 samples were classified into four subgroups (A = 1-20, B = 21-50, C = 51-100, and D = > 100 million spermatozoa/ml) using IMN as a reference chamber. Errors reflected as progressively poor SEM of sperm count (A = 1.1, 3.2, 4.1; B = 3.0, 6.1, 12.4; C = 3.4, 17.0, 23.9; and D = 14.1, 21.3, 46.3) were observed for IMN, Makler, and Horwells counting chamber respectively in each group. This study revealed that inherent errors abound when different counting chambers are used for sperm count. While IMN gave the lowest sperm count, Horwells recorded the highest. Makler counting chamber gave midway values and conforms with recommendations in the literature about its accuracy.

Cholelithiasis in children with homozygous sickle cell anaemia in northern Nigeria

The prevalence of gall stones was studied prospectively by abdominal ultrasound examination in 65 consecutive children with sickle cell anaemia (SCA) aged 5-13 years, 35 males and 30 females, in Jos, northern Nigeria. The prevalence of cholelithiasis was 4.6%. This rate was similar to previous studies from southern Nigeria and higher than that reported in American children with SCA. The different dietary habits of children in southern and northern Nigeria appear not to play any role in the prevalence rate. None of the children followed up for more than 12 months had upper quadrant abdominal pain that warranted surgery.

Sexually transmitted diseases and medico-social factors associated with male infertility in Nigeria

Medico-social factors such as type of infertility, sexually transmitted diseases (STD), drug abuse, erectile dysfunction, divorce, and polygamy were evaluated among 64 infertile men (i.e. 32 oligo-asthenozoospermic and 32 azoospermic) and 23 men of proven fertility in Jos University Teaching Hospital, Jos, Nigeria. Of the 64 infertile men, 27 (42%) and 37 (58%) had primary and secondary infertility respectively. A history of STD, indicated by purulent urethral discharge, was recorded among 40 (63%) with 22 (55%) of this number having had repeated exposures to STD. While 17 (43%) of the infected infertile men were treated by qualified medical doctors, 23 (57%) either had self-medication or received treatment from quacks. Five (8%) of the 64 infertile men used hard drugs, 11 (17%) had erectile dysfunction, 15 (23%) were re-married due to broken marriage relationship or divorce, and 7 (11%) were polygamous. All the fertile men were monogamous with no history of either erectile dysfunction or usage of hard drugs. One (4%) of the fertile men had a history of a broken marriage relationships. Six (26%) had a history of STD with 5 (26%) of them having received treatment from qualified medical doctors. Although the study population is small, the results obtained in this study reveal higher incidences of STD, marital instability, and multiple marriage partnerships (polygamy) among infertile men than the fertile in Jos.

Resistance of recent Neisseria gonorrhoeae isolates in Nigeria and outcome of single-dose treatment with ciprofloxacin

One hundred four patients (71 males, 33 females) with acute gonococcal urethritis or cervicitis were treated with a single oral 250 mg dose of ciprofloxacin at Jos University Teaching Hospital, Jos, Nigeria. All gonococcal strains were isolated from appropriate pre-treatment swabs. Penicillinase-producing Neisseria gonorrhoeae (PPNG) accounted for 72.8% of all isolates. In vitro sensitivity of gonococcal isolates to ciprofloxacin was 100%, while that to penicillin, ampicillin and co-trimoxazole was below 15%. Of the 104 patients treated with ciprofloxacin, 73 (70%) attended a follow-up visit. Seventy-three (100%) patients showed clinical cure and elimination of N. gonorrhoeae from the respective site of infection. Post-gonococcal urethritis or cervicitis believed to be due to concomitant chlamydial infection was found in 22 (30.1%) patients--18 males and four females. No adverse reactions were reported by any patient. Our findings show that a single oral dose of ciprofloxacin (250 mg) is well tolerated and effective in the treatment of uncomplicated gonorrhoea and is particularly useful in regions with a high prevalence of PPNG.

Hysterosalpingogram, laparoscopy and hysteroscopy in the assessment of the infertile Nigerian female

Sixty-nine infertile Nigerian females were evaluated with hysterosalpingogram (HSG), laparoscopy and hysteroscopy as part of infertility workup at the endocrine-infertility clinic of the Jos University Teaching Hospital. HSG showed evidence of tubo-peritoneal disease in 45 (65%) women. This was confirmed by laparoscopy in 41 women giving an accuracy of 91% and a false positive rate of 9%. Intrauterine abnormalities were shown on HSG in 4 women and confirmed in 3 women at hysteroscopy giving an accuracy rate of 75% or a false positive rate of 25%. Intrauterine abnormalities were detected in 21 women in whom HSG was normal, giving a false negative rate of 30.4% for HSG. Tuboperitoneal disease was found at laparoscopy in 6 women in whom HSG was normal, giving a false negative rate for HSG of 8%. Our data confirm that laparoscopy and hysteroscopy are superior to HSG in detecting tubo-peritoneal and uterine abnormalities. Despite these findings, we believe that the three procedures are complementary in the evaluation of infertile couples in this country.