Socio-economic determinants of prenatal anaemia in rural communities of South-West Nigeria: a preliminary report

BACKGROUND

Anaemia is common worldwide and pregnant women are one of the most vulnerable group. Although, anaemia in the general population including pregnant women is multi-factorial in aetiology, the most frequent cause in pregnancy worldwide is iron deficiency. In Nigeria, an estimated prevalence of anaemia among pregnant women ranges from 35-75%. Anaemia in pregnancy (AIP) is associated with significant perinatal and maternal morbidity and mortality including premature birth and low birth weight.

AIM

The aim of this study was to determine the prevalence, demographic and socio-economic determinants of anaemia in pregnancy in a rural community of South-West Nigeria.

MATERIALS AND METHODS

One-hundred and fifty consenting pregnant women aged 18-42 years in the three trimesters were recruited from four primary health centres of Ikene Local Government of Ogun State of Nigeria after ethical approval was obtained from the Ethics Unit of the Medical officer of Health of the Local Government. Pre-tested interviewer-administered questionnaire was used to collect data on socio-demographic information and 24-hour dietary recall. Using a finger prick, the haemoglobin concentration of each respondent was determined with a haemoglobinometer (DG-300HB manufactured by DouBle, China). Data was analyzed using the Statistical Package for Social Sciences (SPSS) version 20.

RESULTS

All the respondents belonged to low socio-economic class. The mean haemoglobin (Hb) concentration obtained in this study was 10.22±1.60 g/dL with a range of 6-14.8 g/dL. Using WHO cut-off Hb concentration of 11 g/dL, the prevalence of anaemia in this study was 67.3%. The frequency of anaemia increased with increase in age group. P=0.010. About 21.4% of those with adequate dietary iron intake were anaemic when compared with 72.1% (98 of 136) of those with inadequate dietary iron intake who were anaemic. AOR-0.090; 95% CI- 0.018-0.457; P=0.004.

CONCLUSION

Increasing age, low socio-economic status, poor health education and low dietary iron intake were the predominant socio-economic determinants of prenatal anaemia in the population studied. Efforts must be intensified to alleviate poverty in rural areas and give health education on iron-rich foods to girls and women of children-bearing age in the rural communities.

Anticoagulation in pregnant women with mechanical heart valve prostheses: Case reports and a literature review

The choice and regimen of anticoagulation therapy in pregnant women with mechanical valve prostheses have always been a daunting task. It is a delicate balance that takes into consideration the risk of thromboembolic complications in the mother and the risk of potential Warfarin embryopathy to the foetus. Medical practice in a low socioeconomic setting also has the peculiar challenge of financial constraints on the part of the patients and difficulties in monitoring the efficacy of anticoagulation therapy. We report our experience in managing two pregnant women with mechanical valve prostheses and review the existing literature on this complex but interesting subject.

Serum Iron Parameters among Pre-Eclamptic and Normotensive Pregnant Patients in The Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria

Objective-To compare the serum iron parameters in parturients with and without preeclampsia Study design- Acase-control study Materials and Methods-Thirty-nine pre-eclamptic patients who presented in labour or about to be delivered by Caesarean section were selected as cases while fifty-eight normotensives admitted within the same period served as the controls. Blood samples were taken from informed participants before delivery and sent to the laboratory for analysis. Relevant bio-data was obtained from case records of the participants while the results of serum iron, ferritin, binding capacity and percentage saturation were recorded. Results-There were no statistically significant differences between the two groups regarding maternal age, parity, birth weight and gestational age at delivery, p>0.05.There were no differences also between the two groups with regard to the mode of delivery and fetal outcome, p>0.05. Even though total iron binding capacity was lower in preeclamptic patients, it didn't reach statistical significance. However, statistically significant differences were found between the two groups regarding serum iron and ferritin, p<0.05. Conclusion -Serum iron and ferritin were increased in patients with preeclampsia which may promote oxidative stress and therefore preeclampsia. More studies with larger sample sizes are advocated to validate the reliability of these findings.

Maternal serum vitamin D levels and pregnancy outcomes: from Lagos, Nigeria

In an attempt to investigate the effect of vitamin D deficiency on pregnancy complications including caesarean section and foetal outcome in our population, blood samples of 461 pregnant women who attended antenatal booking clinic between 10 and 28 weeks of pregnancy were taken for vitamin D estimation and followed up. Details concerning pregnancy complications, labour and foetal outcome were obtained after delivery. They were divided into three groups according to the serum vitamin D level: group 1 (0-20)ng/ml (deficiency), group 2 (21-30)ng/ml (insufficiency), and group 3 (more than 30 mg/ml) normal. The prevalence of vitamin D deficiency was 29%. There were no differences between the groups regarding complications during pregnancy, including preeclampsia and rate of caesarean section. A multicenter study was advocated to elucidate further the role of vitamin D during pregnancy in our population.

Role of healthcare in childbearing decision-making of WLHA in Nigeria: Application of PEN-3 cultural model

Healthcare experiences among women living with HIV/AIDS (WLHA), determine their utilisation of sexual and reproductive health services, which ultimately influences their decisions on childbearing. This study aimed to understand the importance of healthcare support in the childbearing decision-making processes of WLHA, and its impact on eliminating new paediatric HIV infections. We conducted in-depth interviews between July and August 2012 with 15 WLHA receiving clinical HIV care at a teaching hospital in Lagos. Using PEN-3 cultural model, as a guide we explored perceptions of healthcare support pre- and post-partum. Findings indicate that faith in God for the delivery of a healthy child is significant during the pre-partum period, while the advice of healthcare workers concerning childbearing and access to available healthcare services carry more weight post-partum. Our findings have important implications for HIV treatment and care programmes geared towards WLHA considering childbearing, and ultimately the UN Global plan to eliminate mother-to-child transmission of HIV, as we move towards the 2030 agenda for sustainable development.

Seroprevalence of hepatitis B virus infection among pregnant women at the antenatal booking clinic of a Tertiary Hospital in Lagos Nigeria

OBJECTIVES

The objectives were to determine the seroprevalence of hepatitis B virus (HBV) infection and assess the major risk factors among Nigerian pregnant women.

SUBJECTS AND METHODS

This was a cross-sectional descriptive study carried out among pregnant women at the antenatal clinic of a Tertiary Hospital in Lagos, Nigeria. A total number of 150 consenting pregnant women were selected for the study. A structured pretested interviewer-administered questionnaire was used for the data collection. Sera were collected and tested for hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg).

RESULTS

Of the 150 women screened during the study, 11 (7.3%) were seropositive for HBsAg. Of these 11 women, 4 (36.4%) were also positive for HBeAg. There was no statistically significant difference in the mean ages of participants who were seropositive for HBsAg and those who were negative for the virus (P=0.888). There were statistically significant differences in the seroprevalence of HBsAg recorded among respondents with previous surgery (odd ratio [OR]-2.97; 95% confidence interval [CI]-1.08-16.67; P=0.046), previously affected sibling or spouse (OR-5.03; 95% CI-1.11-25.27; P=0.001) and those with two or more lifetime sexual partners (OR-4.11; 95% CI-2.85-9.22; P=0.024).

CONCLUSION

The sero-prevalence rate of HBV infection and also its infectivity is high in Lagos, Nigeria. These findings thus support the need for a nationwide policy of routine and widespread HBV screening among pregnant women.

Factors influencing CD4 cell count in HIV-positive pregnant women in a secondary health center in Lagos, Nigeria

Background

Immunity in pregnancy is physiologically compromised, and this may affect CD4 count levels. It is well-established that several factors affect CD4 count level in pregnancy. This study aimed to determine the mean and reference range of CD4 count in human immunodeficiency virus (HIV)-positive pregnant women in Lagos, Nigeria.

Methods

A retrospective study was carried out at antenatal clinics of the Maternal and Child Center of a secondary health center in Lagos State, Nigeria. Records of HIV-positive pregnant women at various gestational ages, including CD4+ cell count at booking, packed cell volume (PCV) at booking and labor, gestational age at delivery, and infant weight and sex were retrieved. The descriptive data was given as mean ± standard deviation (SD). Pearson’s chi-squared test and correlation were used for analytical assessment.

Results

Data were retrieved for a total of 143 patients. The mean age was 31.15±3.78 years. The mean PCV was 31.01%±3.79% at booking and 30.49%±4.80% during labor. The mean CD4 count was 413.87±212.09 cells/μL, with a range of 40 to 1,252 cells/μL. The mean infant weight was 3.05±0.45 kg, with a range of 2 to 5 kg. Age of the mother, gestational age, and PCV at booking were not statistically significantly associated with CD4 count.

Conclusion

Maternal age, gestational age, and PCV at booking had no significant effects on CD4+ cell count levels in pregnancy. The mean CD4+ cell count of HIV-positive pregnant women in Lagos is 413.87±212.09 cells/μL.

Substance use and sexual behaviour among female students in Nigerian universities

Substance use continues to constitute social and health problems, more so among adolescents and young adults. One consequence is risky sexual behavior, a major problem in sub-Saharan Africa already facing the synergistic problems of poverty and HIV/AIDS. This study of female students aged ≥ 18 years in two universities in Nigeria uses a multi-stage stratified random sampling method, and each subject that gave consent to the study was administered with a structured questionnaire by trained interviewers; 2,408 female students were studied (1,854 from the University of Ibadan and 554 from the Bayero University, Kano). The mean age of the respondents was 21.6 (SD = 2.9), and about two-thirds (65.7%) were aged between 20-24, with 2,204 (91.5%) being single and 4.3% married. In all, 23.4% of the subjects used one form of substance. Alcoholic drinks of palm wine, alcoholic wine, and beer were the most common of substances used (22.7%), followed by tobacco (2%) and cannabis (1%). Substance use was significantly associated with religious affiliation of the students (p < 0.001), as the prevalence of substance use was least among Muslim students (11.7%) and highest among those who professed traditional religion (39.4%). Alcohol use was also positively associated with sexual activity (p < 0.001). Among the 547 students who used alcohol, 147 (26.9%) had sex in the 4 weeks prior to the survey, while among the 1,861 non-users, only 8.9% did so. The practice of unprotected sex was found not to be associated with substance use: a slightly lower proportion (29.5% vs. 36.6%) of substance users engaged in unprotected sex in their last encounter compared to non-users. There is need to scale up public health education on the dangers of substance use and its associated sexual risk behavior.

Knowledge of, Perception of, and Attitude towards Uterine Fibroids among Women with Fibroids in Lagos, Nigeria

Objectives. The study was to assess the level of knowledge of, perception of, and attitude towards uterine fibroids among women diagnosed with the condition. Methods. It is a cross-sectional descriptive study carried out among women diagnosed as having uterine fibroids in two gynaecological clinics in Lagos, Nigeria. Eligible women were recruited and a structured interviewer-administered questionnaire was used to collect the required information. Statistical analysis of data was done using EPI Info 2008. Results. Knowledge of fibroids was reported in 98.6% of the respondents and the information on uterine fibroids was obtained from radio, parents/relatives, health workers, and television in 29%, 27.3%, 18.7%, and 18.3%, respectively, by the respondents. Most of the women believed that being black, being nulliparous, or having positive family history predisposes women to having uterine fibroids. Up to 69.0% of the respondents believed that fibroid is a spiritual problem and many thought it requires spiritual healing. Fear of complications of surgery keeps most sufferers away from the hospital until fibroids become advanced or associated with complications. Conclusion. Awareness of uterine fibroids is high, but correct knowledge on aetiology and proper treatment is low. Intensive enlightenment of the populace using the mass media by trained personnel is recommended.

Cord blood haemoglobin and ferritin concentrations in newborns of anaemic and non-anaemic mothers in Lagos, Nigeria

BACKGROUND

Pre-delivery haemoglobin and serum ferritin concentrations of anaemic and non-anaemic mothers were determined, and cord blood haemoglobin and serum ferritin concentrations of their newborns were compared. This is to establish the mean values for pre-delivery haemoglobin and serum ferritin concentrations of anaemic and non-anaemic mothers and the cord blood haemoglobin and serum ferritin concentrations of their newborns at term.

MATERIALS AND METHODS

A case-control study was done involving 142 pregnant women and their newborns. They were divided into two groups - the anaemic group (n = 65) and the non-anaemic (n = 77) group. Five millilitres of blood was collected from each woman and 2 ml was collected from the cord of their newborns into ethylenediaminetetraacetic acid (EDTA) bottle and plain bottle for full blood count analysis and ferritin assay, respectively.

RESULTS

The mean pre-delivery haemoglobin concentrations of the women in anaemic group and non-anaemic group were 9.5 ± 1.01 g/dl and 12.15 ± 1.07 g/dl, respectively, and their mean serum ferritin concentrations were 64.45 ± 138.76 μg/l and 32.83 ± 35.36 μg/l, respectively. The mean cord blood haemoglobin concentrations for anaemic and for non-anaemic groups were 12.54 ± 2.54 g/dl and 13.44 ± 2.23 g/dl (P = 0.02), respectively, and the mean cord blood serum ferritin concentrations (non-anaemic, 69.38 ± 78.88 μg/l; anaemic, 7.26 ± 115.60 μg/l) (P = 0.00) were higher in the newborns of non-anaemic than of anaemic mothers. Significant association was found between maternal anaemia and cord blood ferritin concentrations (P = 0.025).

CONCLUSION

Maternal anaemia has significant effects on cord blood haemoglobin and serum ferritin concentrations.

Haemoglobin and ferritin concentrations of pregnant women at term

BACKGROUND

Anaemia in pregnancy is defined as haemoglobin (Hb) concentrations of less than 11 g/dL while low ferritin is defined as serum ferritin (SR) levels of less than 10 µg/L. Hb and ferritin concentrations of pregnant women at term were determined to establish their mean values and to determine the prevalence of anaemia in our locality.

METHODS

Haemoglobin and ferritin levels of 170 non-smoking and HIV-negative pregnant women were determined at term. The majority 143 of 170 (84.1%) of the pregnant women recruited for the study, booked at the beginning of the second trimester and received 200 mg elemental iron in three divided doses and 5 mg folic acid daily which were commenced at booking. Five millilitres of blood were collected from each patient at term into EDTA bottles for full blood count analysis and another 5 mL into plain bottles for SR assay.

RESULTS

The mean Hb and ferritin values were 10.9 ± 1.9 and 47.84 ± 98.39 µg/L, respectively. The prevalence of anaemia at term was 46.4%. Only 11.2% (19 of 170) of pregnant women at term had low SR (iron stores). A statistically significant relationship was found between women's education and SR (P = 0.032). Booking status also correlated directly with SR and haemoglobin concentrations, while increasing age and parity did not.

CONCLUSION

About half of the patients were anaemic. Iron deficiency is not the major cause of anaemia in pregnancy in this study because the majority of the pregnant women had normal iron stores. Education and booking status are possible factors that contribute to anaemia.

Haemoglobin and ferritin concentrations in cord blood in a tertiary health centre in Nigeria

BACKGROUND

Haemoglobin(Hb) and serum ferritin (SF) concentrations of cord blood of babies born at term at the Lagos State University Teaching Hospital, Maternity Centre (Ayinke House), Ikeja in the South-Western part of Nigeria were determined to establish mean values for these substances in our locality.

OBJECTIVES

To establish the mean values for haemoglobin and serum ferritin concentrations of cord blood of babies born at term in our environment and to determine the prevalence of foetal anaemia and low iron store in cord blood in our locality.

METHODS

Haemoglobin and ferritin levels in cord blood of 142 newborns were determined. Two millilitres of blood was collected from the cord of each newborn into EDTA bottle for complete blood count analysis and another 2mls into a plain bottle for serum ferritin assay. Cut-off values for cord blood Hb and serum ferritin concentrations were 12.5g/dL and 60 microg/L respectively.

RESULTS

The mean Hb and ferritin values were 13.024 +/- 2.41 g/dL and 70.85 +/- 97.07 microg/dL respectively. The prevalence of foetal anaemia is 32.4 %. About 59.2% of full term newborns had low iron store. Birth weight was significantly associated with Hb concentration (p=0.039) and apga sscore (p=0.002).

CONCLUSION

The prevalence of foetal anaemia was 32.4%. More than half (59.2%) of the newborns had low cord blood serum ferritin.

The use of the sisterhood method for estimating maternal mortality ratio in Lagos state, Nigeria

Summary Estimates of maternal mortality are crucial to inform the planning of reproductive health programmes and guide advocacy. The aim of this study was to obtain a population-based estimate of maternal mortality in Lagos State, Nigeria. The sisterhood method was used in 2008 to carry out the survey using a questionnaire in which respondents were asked about their sisters who died during pregnancy, childbirth or within 6 weeks after childbirth. The survey involved 4,315 respondents who provided information on 9,910 ever married sisters. The life-time likelihood (risk) of maternal death for women aged 15-49 years was found to be 0.0239 or 1 in 42. The estimated maternal mortality ratio was 450 per 100,000 live births with a 95% CI of 360 and 530. Out of 111 reported deaths, 35 (31.5%) occurred during pregnancy, 49 (44.1%) occurred during delivery and 27 (24.3%) within 6 weeks of delivery.

Efficacy of HIV PCR techniques to diagnose HIV in infants born to HIV infected mothers at LASUTH

BACKGROUND

There has been so many difficulties encountered in the diagnosis of HIV infection in infants < 18 months of age born to HIV-infected mother. In these infants, definitive diagnosis can only be carried out by antigen based techniques which are expensive and not widely available in developing countries.

OBJECTIVE

To generate information on the rate of mother to child transmission in Nigeria and to compare the efficacies of both the HIV-1 RNA and HIV-1 DNA PCR techniques in the diagnosis of this infections in infants.

METHOD

Ninety (90) whole blood samples were obtained from 45 HIV positive mothers and 45 infants born to these mothers from the Department of Obstetrics and Gynaecology, Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos. The presence of HIV was determined using the Amplicor HIV-1 DNA test and an in-house RNA PCR method.

RESULTS

All the infants were HIV antibody positive, however, only 5 infants were positive by HIV-1 DNA PCR, indicating an 11% rate of transmission from HIV positive mothers. Among the 5 infants positive by the DNA PCR, only 4 were positive for the in-house RNA PCR.

CONCLUSION

The 11% transmission rate recorded in this study was similar to that from mothers' who had Nevirapine ART interventions and both the HIV-1 DNA test and the in-house RNA PCR tests were sensitive and specific in the diagnosis of infection in infants, depending on the level/ state of HIV infection in infants.

Sources of contraceptive commodities for users in Nigeria

BACKGROUND

Understanding the sources of contraceptive commodities is an important aspect of the delivery of family planning services and is required by planning programme managers for strategic planning purposes. Findings from the 2003 Nigeria Demographic and Health Survey have previously showed that the private sector was the most frequently reported source of contraceptive supply, providing contraception to two and a half times as many women as the public sector. We conducted a community-based study to examine further the sources of contraceptive commodity for users in Nigeria with a view to identifying their preferences for distribution centres. This information would be useful to improve commodity distribution and to build the necessary capacity for satisfactory delivery of contraceptives.

METHODS AND FINDINGS

A multi-stage random sampling technique was used. A state was randomly selected to represent each of the four health zones in Nigeria. Two local government areas (LGAs) were then selected representing both urban and rural areas. Ten enumeration areas were subsequently selected from each LGA. Of the 2,001 respondents aged 15-49 years, 1,647 (82.3%) were sexually active, out of which 244 were found to be using contraceptive methods at the time of the study, giving a contraceptive prevalence of 14.8%. The commonest source of information on contraceptives was through friends (34%), followed by the radio (11.5%) and husbands (10.2%). Most respondents procured their contraceptives from chemist/patent medicine shops (19.7%), while only 0.8% obtained them from designated family planning clinics. The younger groups in this study (15-24 years), single people, Catholics, and Muslims, showed a greater preference for chemist/patent medicine shops for their sources of contraceptives. The older groups and married respondents, however, made use of government and private hospitals to obtain their contraceptives.

CONCLUSION

Strategies to increase contraceptive use must take into consideration these identified sources of contraceptives with a view to enhancing the quality, quantity, and variety of methods available, and to building capacity for effective service delivery. There is also a need to encourage the establishment of adolescent-friendly clinics where young people can go for counselling and obtain contraceptives of their choice, including emergency contraceptive pills.

Induced abortion in Nigeria: findings from focus group discussion

Abortion is carried out daily in Nigeria despite the restrictive abortion law. This study was carried out to obtain information on societal attitude to the issues of family planning, unwanted pregnancy, abortion, adoption of children and laws relating to them. Focus group discussions were held in south-western Nigeria among 11 sub-groups. Participants felt that there was high prevalence of unwanted pregnancy and abortion particularly among youths. They had high level awareness of contraceptives and ascribed its low use to negative side effects, high cost and provider bias. Christians favoured planning of pregnancies while the Muslims did not. Majority of the respondents had negative perception of induced abortion. Some of them supported abortion if the education of the young girl would be disrupted, if paternity of pregnancy is in dispute, or if it would save the family from shame. Participants supported the enactment of laws that would make adoption of unwanted children easier.

Community-based survey of unwanted pregnancy in southwestern Nigeria

Unwanted pregnancy, and consequently unsafe abortion, remains major reproductive health problems in Nigeria that needs to be tackled. Unfortunately, there is a dearth of information on this problem at the community level. This study therefore examined the prevalence of unwanted pregnancy in the community as well as associated factors including the views, perceptions and attitudes of community members towards unwanted pregnancy and the pattern of help-seeking behaviour on unwanted pregnancy. Information was obtained from 3,743 women in urban and rural communities in two Nigerian states of Lagos and Edo. At some point in life, 26.6% of the respondents had had unwanted Pregnancy while abortion prevalence was 21.7%. Short birth intervals (21.1%), high cost of raising children (20.1%), interruption of education (20.1%) and being unmarried (17.3%) were the most common reasons for not wanting pregnancies. Most of the respondents (91.3%) were aware of some form of contraception but ever-use rate was only 36.6% while current use rate was 23.4%. Both abortion and contraceptive use were significantly associated with increasing levels of education. Unwanted pregnancy constitutes a problem even at the community level and more research is needed to understand the persistent disparity between contraceptive knowledge and usage, as increased usage will reduce unwanted pregnancy and induced abortion.

Voluntary counselling and testing (VCT) for Human Immunodeficiency Virus: a study on acceptability by Nigerian women attending antenatal clinics

This study was carried out among 345 pregnant women attending antenatal clinics at two health facilities in Lagos, Nigeria. It was undertaken to determine their knowledge and acceptability of HIV voluntary counselling and testing in pregnancy as a strategy for the prevention of mother-to-child transmission (PMTCT) of HIV. Data were collected on issues relating to mother-to-child transmission of HIV, willingness to go for voluntary counselling and testing, actions to be taken if a pregnant woman was found to be HIV positive including infant feeding options. Majority of the women (89.9%) had good knowledge of the modes of HIV transmission, however, knowledge of specific aspects of PMTCT was poor. Close to half of the women (41.7%) were not aware of the association between breast milk and HIV transmission. Almost all the women (96.1%) were willing to undergo HIV testing in pregnancy particularly if it would assist preventing transmission of HIV to their babies; but only few would undergo the test if the result would be shared with relatives. Many of the women would still prefer breastfeeding even if they were found to be HIV positive. Awareness of anti-retroviral drugs among the study group was very poor. As the country is about to embark on its PMTTCT programme, there is need to increase the level of knowledge, acceptability and adoption of VCT and other PMTCT strategies among potential beneficiaries. Innovative information and education techniques need to be developed to provide HIV positive mothers with knowledge and skills that can enable them to make informed choices about infant feeding options and other forms of care.

Contraceptive usage among abortion seekers in Nigeria

A study on contraceptive usage among abortion seekers in 150 randomly selected health institutions in the most and the least urbanized states of the health zone B representing the South Western states of Nigeria was conducted over a period of 2 months. There were 1839 abortion seekers during the period. About 30.4% (559) of the respondents admitted to ever used any form of contraceptive methods. Most of the respondents who admitted to ever used any form of contraceptives i.e. 81.2% (454/559) were not using the contraceptive methods regularly and this cut across all the methods. Oral contraceptive pill was the commonest method used, though not on regular basis. The most frequent reason for not ever used contraceptive methods was ignorance. There is a need for intensification of strategies for promotion of use of family planning methods, which can be achieved through good counselling, sexuality education, and availability of cheap, and affordable contraceptive methods and services.