COVID-19 and Pregnancy: A Prospective Descriptive Study from a Tertiary Hospital in Nigeria

BACKGROUND

It is known that pregnant women are more susceptible to viral infectious diseases, with an attendant risk of adverse foetal and maternal outcomes. The objective of this descriptive study is to evaluate the epidemiologic and clinical pattern, as well as the obstetric and COVID-19 outcome among pregnant women seen at a tertiary hospital in Southern, Nigeria.

METHODS

This was a descriptive prospective study of all pregnant women seen and diagnosed with COVID-19 based on positive RT-PCR for SARS-COV-2, at the University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria from March 2020 to August 2020.

RESULTS

Seven (5.2%) pregnant patients were diagnosed with COVID-19 out of 134 patients. The common presenting symptoms were fever 4(57.1%), Productive cough 3 (42.9%), shortness of breath 3 (42.9%), myalgia 3 (42.9%), rhinorrhoea 3 (42.9%), and anosmia 3 (42.9%). The majority (85.7%) of patients were in the second and third trimesters at diagnosis. All deliveries occurred at term, with a mean gestational age of 38±0.82 weeks. Four patients (57.1%) had caesarean section (CS) deliveries for obstetric indications. No adverse outcomes were recorded for mothers and babies with birth weight ranging from 2.5 to 3.5 Kg. No case fatality was recorded.

CONCLUSION

In this study, pregnant women with COVID-19 did not have adverse maternal and foetal outcome. The pattern of symptoms and the presence of severe disease also did not differ from what is observed in the general non-pregnant population. The impact of COVID-19 on pregnancy is less severe when compared to other high consequence viral infectious diseases.

Risk factors for diabetes mellitus among adult residents of a rural District in Southern Nigeria: Implications for prevention and control

INTRODUCTION

Diabetes Mellitus is a non-communicable disease that affects people worldwide and poses major public health and socioeconomic challenges.

METHODS

This was a descriptive cross-sectional community based survey carried out in Abua, a rural district located in the Niger Delta region of Nigeria among 462 adults recruited through multi-stage sampling. Data was collected using the structured WHO STEPS instrument for Chronic Disease Risk Factor Surveillance. The questionnaire included questions that assessed socio-demographic characteristics, diabetic risk factors, anthropometric measures, and biochemical parameters. Fasting blood glucose and blood pressure was measured using the WHO recommendations.

RESULTS

Equal number of males and females aged between 18 and 82 years were recruited. Mean age of 40.4614.36 years and median age of 38.5 years. The prevalence of diabetes mellitus was 37 (8.0%), of which 28 (6.1%) were previously diagnosed while 9 (1.9%) were newly diagnosed. Alcohol intake (AOR = 10.69; 95% CI = 2.60-43.87; P = 0.001) physical activity (AOR = 4.78; 95% CI = 1.16-19.65; P = 0.03), diastolic blood pressure (AOR= 32.67; 95% CI = 3.68-289.65; P = 0.002), age and family history of DM showed significant independent association (OR 1.09, 95% CI: 0.000, P < 0.001, OR 0.072, 95% CI: 0.014-0.380, P = 0.007) with diabetes mellitus.

CONCLUSION

Study findings underscore the need for diabetes prevention and control activities that address the four major risk factors identified by WHO. These interventions will positively impact prevalence of diabetes and other NCDs. Intervention strategies should not only target urban populations but also focus on education and health promotion among rural populations in a bid to forestall rising prevalence of diabetes.

Adherence counseling and reminder text messages improve uptake of antiretroviral therapy in a tertiary hospital in Nigeria

CONTEXT

Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) is one of the world's most challenging pandemics. For treatment with Highly Active Anti-Retroviral Therapy (HAART) to be effective, high rate of adherence is essential.

AIM

To demonstrate the effect of adherence counseling and text message reminders in improving patients' adherence to HAART.

SETTINGS AND DESIGN

A randomized control trial among non-adherents was carried out in a tertiary hospital in Nigeria between March and July, 2011.

MATERIALS AND METHODS

A total of 104 patients: 45 males (43.3%) and 59 females (56.7%) participated in the study. They were randomized into intervention and control groups. The intervention group received monthly adherence counseling and twice weekly short message reminders for four months, while the control group received only standard care. Self-reported adherence and CD4+ cell counts were measured pre- and post-intervention.

STATISTICAL ANALYSIS USED

Data was analysed using Statistical Package for Social Sciences (SPSS) version 18. Risk rates, Chi-square, Mann-Whitney U test and Cohen's effect size were calculated. Level of significance was set at P = 0.05.

RESULTS

At post-intervention, 76.9% of the intervention group and 55.8% of the control group achieved adherence (χ2 = 5.211, P = 0.022, RR = 0.75 (0.55-0.96), Cohen's w = 0.224). Also, median CD4+ cell count of the intervention group increased from 193 cells/ml to 575.0 cells/ml against 131.0 cells/ml to 361.5 cells/ml in the control group (P = 0.007).

CONCLUSION

Adherence counseling and text message reminders improved adherence among HIV patients. Its adoption for HIV patient management is advocated.

High-frequency ultrasound imaging of the duodenum and colon in patients with symptomatic giardiasis in comparison to amebiasis and healthy subjects

AIM

The application of ultrasound may be suitable for evaluating the effects of intestinal cytoskeletal rearrangement of the duodenum and colon as a result of exposure to live Giardia lamblia trophozoites. We studied the sonographic appearance of the duodenum and colon in giardiasis compared with amebiasis and healthy subjects.

METHODS

Sonographic images obtained from 100 consecutive patients with symptomatic giardiasis were compared to those taken from 40 patients with amebiasis and 40 healthy subjects. B-mode ultrasound examination of the duodenum and colon was performed using a 7.5 MHz annular array transducer. Gray scale images with water contrast were acquired.

RESULTS

Normal duodenum and colon echoanatomy were demonstrated. Giardial lesions of the duodenum and colon were associated with increased wall thickness when compared with healthy subjects (P < 0.05). Furthermore, giardial lesions were characterized by increased wall echogenicity, flattening or loss of duodenal folds and/or colonic haustration, hyperechoic floating foci (HFF) demonstrating chaotic motility, increased peri-lesional tissue echogenicity, and altered colonic peristalsis. In amebiasis, focal hyperechoic wall thickening was seen at lesion sites identified as amebomas with increased wall echogenicity, but otherwise normal duodenal folds and colonic haustration. There were no HFF with chaotic motility, rather intestinal contents showed bulk motility in patients with amebiasis. There was no focal colonic wall motion abnormality observed.

CONCLUSION

B-mode imaging with water contrast demonstrated details of duodenal and colonic echoanatomy. There were sonographic features of giardial lesions of the duodenum and colon that were distinct from those in amebiasis and healthy subjects.