Evaluation of anxiety and depression among pregnant women in Enugu, Nigeria

Background

Maternal depression and anxiety during pregnancy are public health concerns. They are commonly reported among pregnant women from all over the world. Maternal mental health has not been prioritized, especially in low- and middle-income countries.

Aim

To evaluate depression and anxiety among pregnant women who receive antenatal care in four randomly selected hospitals in Enugu, Nigeria.

Materials and Methods

A multicenter questionnaire-based cross-sectional survey of 434 pregnant women was conducted at four selected health institutions offering antenatal services in Enugu, Enugu State. The prevalence of anxiety and depression was assessed using the hospital anxiety and depression scale (HADS). Factors associated with anxiety and depression were determined using logistic regression. P <0.05 was taken as significant.

Results

The mean age of study participants was 30.09 ± 5.12 years. The proportion of participants with depressive symptoms and borderline depressive symptoms was 9.7% and 11.1%, respectively. The proportion of participants with anxiety symptoms and borderline anxiety symptoms was 10.1% and 15.7%, respectively. Husband's employment status (P = 0.033, odds ratios (OR) =0.354, 95% confidence intervals (CI) =0.137-0.918) and gestational age (P = 0.042, OR = 2.066, 95% CI = 1.028-4.151) were the only factors associated with depressive symptoms, while only educational level (P = 0.001, OR = 3.552, 95% CI = 1.674-7.537) and husband's employment status (P = 0.013, OR = 0.295, 95% CI = 0.113-0.772) were the only factors associated with anxiety symptoms.

Conclusions

Anxiety and depressive symptoms are relatively common in antenatal women in Enugu. The factors associated with depressive and anxiety symptoms were the respondent's educational level, gestational age, and the employment status of the husband.

Effect of late antenatal booking on maternal anemia and fetus birth weight on parturients in Enugu, Nigeria: An analytical cross-sectional study

Background

The benefits of antenatal care are maximized when women book early for care. However, despite these resounding benefits, women still book late, while others do not book at all, resulting in dire feto-maternal consequences.

Aim

Determine the effect of late prenatal booking on maternal anemia and birth weight in babies of women who delivered in public health facilities in Enugu and deduce the reasons for booking late.

Patients and Methods

A cross-sectional study of two groups of women (235 participants in each group) who delivered in 4 randomly selected hospitals in Enugu. Descriptive statistics were obtained for continuous variables, and frequency and percentages were used for categorical variables. Degree of associations was determined using the Chi-square, the student's t-test, and 2 x 2 table.

Results

The prevalence of anemia among women that booked late and early were (69.7%; n = 147) and (50.7%; n = 107) respectively. Women who booked late were two times more likely to have anemia than those who booked early (OR = odds ratio, p = p-value, CI = confidence interval,). Those who booked late were six times more likely to deliver low birth weight babies than those who booked early (OR = 5.934, 95% CI = 1.299-27.119, P = 0.022).

Conclusions

Late prenatal booking is associated with a high prevalence of maternal anemia in labor, low mean maternal hemoglobin, and low birth weight compared to those of women who booked early and the reasons for booking late are multifactorial.

Evaluation of maternal preferences for neonatal male circumcision in Enugu Nigeria

BACKGROUND

Although circumcision in male neonates is one of the most common procedures performed in neonatal surgery, mothers' preferences concerning the aspects of circumcision are not well-known. Since mother is the likely parent to present child for circumcision, her preferences should be given adequate consideration.

OBJECTIVES

The objective of this study is to evaluate maternal preferences for neonatal male circumcision in Enugu.

METHODOLOGY

A cross-sectional study where questionnaire was distributed by the researchers to consenting pregnant women attending antenatal clinics in two teaching hospitals in Enugu. Data analysis was performed using the SPSS. The results presented as means, percentages and tables. Test for significance was done using the Chi-square test.

RESULTS

Four hundred and sixty-one pregnant women participated in the study. Ninety-five percent (438/461) wanted circumcision and 83.5% (385/461) wanted it on or before the 8^th day of life. The reasons were cultural/religious in 69% (302/447). Fifty-four percent (250/461) had no preferences as to methods, but for those who had, Plastibell was most preferred method in 28% (129/461) while 76% (235/309) preferred circumcision to be done in hospital. In 49.2% (227/461) preferred personnel were nurses but 79.6% (367/461) wanted doctors to attend to post-circumcision complications. In 79.2% (365/461), mothers will not insist on the use of anaesthesia for circumcision. Mothers with circumcised husbands were significantly more willing to circumcise a male child (P = 0.0018). Higher educational status of mother was significantly related to willingness to insist on the use of anaesthesia (P = 0.046) and use of analgesics after circumcision (P = 0.001).

CONCLUSIONS

Most mothers prefer neonatal male circumcision by nurses, while preferring doctors for post-circumcision complications. These choices are not affected by parents' educational status. Mothers with circumcised husbands accepted circumcision more than those with uncircumcised husbands. Higher maternal education encourages anaesthesia during circumcision and post-circumcision analgesia.

Prevalence and predictors of child labour among junior public secondary school students in Enugu, Nigeria: a cross-sectional study

BACKGROUND

Globally, millions of children are involved in child labour. However, low- and middle-income countries are mostly hit. This study examined the predictors of child labour among public secondary school students in the Enugu metropolis.

METHODS

This was a descriptive cross-sectional study of 332 junior secondary students attending public schools in Enugu metropolis, Nigeria. Multistage sampling technique was used to select the six secondary schools and the students that participated in the study. Data collection was done from September to October 2018. Pretested structured, interviewer-administered questionnaire was used for data collection. The questionnaire contained information on the sociodemographic variables, the kind of work done by the respondents and the number of working hours spent weekly. UNICEF's standard indicator for child labour was used to estimate the prevalence of child labour. Logistic regression was used to identify socioeconomic predictors of child labour.

RESULTS

The prevalence of overall child labour was 71.7%, while for domestic and economic child labour prevalence were 52.1 and 34.0%, respectively. About 35.2% of the respondents worked under hazardous conditions while 8% were forced to work. Two-thirds (236, 65%) of the respondents who have heard about child labour perceived it as wrong. The child labourers mainly worked to render financial assistance to their parents. The predictors of child labour were class of study (AOR = 2.208 (95% CI: 1.199-4.066) and weekly income earned (AOR = 0.316 (95% CI: 0.176-0.567).

CONCLUSION

The prevalence of child labour among junior students in public secondary schools in Enugu is high, and is predicted by the level of schooling and income earned. Economic and social reforms could contribute to addressing the predictors of child labour.

Analysis of cost burden of obstetric care among human immune-deficiency virus (HIV) positive women in Enugu metropolis, South-East Nigeria

The cost of obstetric care could hinder the capacity of human immune-deficiency virus (HIV) positive women to receive adequate care during pregnancy and delivery. This study was aimed at determining the relationship between antenatal/delivery care cost and delivery place choice among HIV positive women in Enugu metropolis. This was a cross-sectional study of 232 post-partum HIV-positive women who came for 6-weeks post-natal visit. Data were analysed using SPSS version 20. The ethical clearance number obtained at UNTH on 18/11/2015 was NHREC/05/01/2008BFWA00002458-1RB00002323. The average obstetric care cost among the respondents was N55,405.67 (US$346.28). The delivery cost (p-value-0.043) had positive relationship with delivery place choice. The women's proportion delivered by skilled birth attendants (SBA) was 93.1%. In conclusion, obstetric care cost among HIV positive women in Enugu was high. The high obstetric care cost influenced the delivery place of one-third of them. The choice of ill-equipped health facilities may result in higher risk of HIV transmission.IMPACT STATEMENTWhat is already known on this subject? The high HIV/AIDs burden in Nigeria could be attributed to poverty, ignorance, corruption and poor implementation of policies targeted at halting the spread of the infection. The cost of obstetric care could hinder the capacity of HIV positive women to receive adequate care during pregnancy and delivery.What do the results of this study add? The cost of antenatal care (p-value = .02) and delivery (p-value = .001) had a significant positive relationship with the choice of place of delivery by the respondents. The proportion of the women delivered by SBA was 93.1%. Approximately 31.9% of the women delivered at the health facilities different from where they had antenatal care.What are the implications of these findings for clinical practice and/or further research? This implies that the obstetric care cost among HIV positive women in Enugu metropolis was catastrophic. Though 93.1% of the respondents were delivered by SBA, the high cost of obstetric care influenced the delivery of one-third of them at centres different from where they had antenatal care. This may lead to women delivering in poorly equipped health facilities, which, in turn, may result in a higher risk of mother-to-child HIV transmission.

Gossypiboma: Spontaneous trans-urethral migration of a forgotten surgical gauze sponge 5 years post hysterectomy in grand multiparous post-menopausal woman

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Gauze sponge transmigration over 5years from the peritoneal cavity to the external urethral meatus is rare but possible.

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There have been few reported cases of gossypiboma due to under reporting for fear of litigation but the true incidence may be much higher.

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Migration of gossypiboma from initial site is a rare entity and could pose some diagnostic difficulties.

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High index of suspicion and prompt diagnosis of gossypiboma is key to management to help reduce the high morbidity that is associated with the condition.

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Gossypiboma in the urinary bladder though rare but can be prevented through appropriate documentation and recounting of all surgical sponges and instruments used during surgeries.

Introduction

Gossypiboma denotes a mass of cotton retained in the body following surgery. Migration of gossypiboma from initial site is a rare entity and could pose some diagnostic difficulties. Migration of gauze sponge has been reported to occur in several organs of the body. There have been few reported cases but the true incidence may be much higher due to under reporting for fear of litigation.

Presentation of case

We present an unusual case of a 58-year-old grand multiparous woman who had gauze retention for 5 years following a hysterectomy and presented with acute urinary symptoms. The gauze sponge transmigrated from the peritoneal cavity to the bladder and was partially extruded through the external urethral meatus. She had laparotomy for the removal of gauze sponge with good outcome.

Discussion

Retained foreign body especially surgical sponges (gossypiboma) infrequently occurs and can be a source of great concern to the surgeon and patient. Foreign bodies inside the body cavities and organs can present with several non-specific clinical features that can make diagnosis difficult. Migration of surgical sponge (gauze, mops) into the urinary bladder is uncommon when compared to other abdominal and pelvic viscus. A gossypiboma in the peritoneal cavity creates a fistulous tract through the thick wall of the urinary bladder from long period of chronic inflammation as seen in the index case where the previous surgery was performed 5 years prior to onset of symptoms. Due to the non-specific presentations of gossypiboma, especially those in the bladder, several investigative modalities need to be employed to help make a prompt diagnosis. Most long-standing cases would require laparotomy due to the dense adhesions that occur around the site of the gossypiboma. Lack of appropriate diagnosis leaves the patient with recurrence of distressful symptoms and the consequent morbidities.

Conclusion

Transmigration of a gauze sponge over 5 years from the peritoneal cavity into the urinary bladder and through the external urethral meatus following a hysterectomy is a rare occurrence and can present diagnostic difficulties. High index of suspicion, prompt diagnosis and management will help reduce the high morbidity that is associated with the condition as in the case reported.

Diagnostic value of Chorioquick for detecting chorioamnionitis in women with premature rupture of membranes

OBJECTIVE

To determine the accuracy of a semi-quantitative interleukin-6 (IL-6) vaginal secretion rapid test (Chorioquick) for detecting chorioamnionitis in women with premature rupture of membranes (PROM).

METHODS

A prospective cohort study in five tertiary hospitals in Nigeria involved women with confirmed PROM at term and preterm PROM with or without suspected chorioamnionitis from August 1, 2017, to October 31, 2018. Cervicovaginal fluid samples were tested for chorioamnionitis using the Chorioquick test. Samples were repeated at decision to deliver. The test was considered positive if at least the indicator 'IL-6 low' of the three Chorioquick biomarkers (low, medium, high) was positive, or negative if none of the biomarkers were positive. Chorioamnionitis was histologically confirmed post-delivery using three tissue samples. Primary outcome measures were sensitivity, specificity, and accuracy.

RESULTS

Of 73 women, on histological confirmation, 39 were true positive and 29 were true negative (for chorioamnionitis) to the Chorioquick test at repeat assessment. Overall, the Chorioquick test had a sensitivity of 97.5% (95% confidence interval [CI] 85.3-99.9), specificity 87.9% (70.9-96.0), and accuracy 93.2% (79.5-99.1). Sub-group analysis of women <37 weeks of pregnancy showed a sensitivity of 100.0% (95% CI 83.4-100.0), specificity of 91.3% (70.5-98.5), and accuracy of 95.8% (82.5-99.5). Triple positive samples were 100.0% specific in all gestations.

CONCLUSION

Chorioquick showed favorable utility for detecting chorioamnionitis in PROM and could be a reliable, non-invasive rapid tool in a real-world clinical setting.

Placenta percreta causing spontaneous uterine rupture and intrauterine fetal death in an unscared uterus: A case report

INTRODUCTION

Placenta percreta is a rare; a life-threatening disorder of placentation and one of the components of the placenta accreta spectrum. It can lead to uterine rupture, an obstetric catastrophe that can be associated with increased maternal and fetal morbidity and mortality.

PRESENTATION OF CASE

We present an unusual case of spontaneous uterine rupture due to placenta percreta in an unscarred uterus of a multiparous woman leading to spontaneous intrauterine fetal death. She presented with hypovolaemic shock following spontaneous rupture of the uterus and subsequent intra-peritoneal bleeding.

DISCUSSION

Uterine rupture occurs commonly in a scarred uterus from some form of trauma or injudicious use of oxytocics. However, uterine rupture occurring in the absence of prior scar or use of oxytocics is a rarity. Placenta percreta is an unusual cause of uterine rupture and subsequent intra-uterine fetal death. Placenta percreta occurs when the uterine wall is invaded by the placenta up to the level of the serosa. A high index of suspicion and thorough review of the patient is required for making this diagnosis. Misdiagnosis is associated with dare consequences of increased maternal morbidity and mortality.

CONCLUSION

Placenta percreta is a rare disorder of placentation that can cause uterine rupture which can easily be misdiagnosed. Prompt diagnosis and institution of the appropriate care can help prevent catastrophic outcomes as demonstrated in the case reported.

Association of MiRNA122 & ADAM17 with Lipids among Hypertensives in Nigeria

Background

Dyslipidaemia and hypertension are established major risk factors for cardiovascular diseases. The suggested roles of miRNA-122 and ADAM17 in lipid metabolism can therefore be applied in the management of metabolic disorders. The authors’ aim was to determine the association between miRNA-122 and ADAM17, as well as the association between miRNA-122 and lipid fractions, in the study participants.

Method

A comparative cross-sectional study was conducted among 200 hypertensive patients and 100 non-hypertensive adult controls between May, 2015, and June, 2016, in Nigeria. Lipids were analysed with spectrophotometric methods whereas ADAM17 and miRNA-122 were analysed with enzyme linked immunosorbent assay and quantitative polymerase chain reaction, respectively.

Results

The mean (standard deviation [SD]) ages of 200 hypertensives and 100 controls were 56.3 (6.9) and 54.9 (8.3) years, respectively. miRNA-112 and ADAM17 had significantly higher values among dyslipidaemic individuvals compared with non-dyslipidaemic participants. The correlation between miRNA-122 and ADAM17 levels was strongly positive, r=0.82, p<0.05. LDL-cholesterol and total cholesterol also showed statistically significant positive correlation with miRNA-122, r=0.53, r=0.51, (p< 0.001) respectively.

Conclusion

In this study, miRNA-122 showed a strong correlation with ADAM17 and a positive correlation with LDL-cholesterol and total cholesterol. These findings support the stimulant roles of miRNA-122 and ADAM17 in lipid metabolism and thus could be used in the management of dyslipidaemia.