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Hepatitis and TB co-infection in PLWHA is now a major source of co-morbidity and of public health concern. HIV and Hepatitis are two viruses with overlapping epidemics and shared routes of transmission. The clinical course of HCV is accelerated in patients with HIV with resultant end-stage Liver disease as a major cause of death. Most studies in my environment failed to identify significant risk factors for HCV infection thus making intervention difficult. The study was a descriptive cross-sectional study carried out among consecutive consenting HIV positive pregnant women attending the antenatal clinic of ABUTH-Zaria Nigeria. Relevant information was obtained using a structurally administered questionnaire while Enzyme Linked Immunosorbent assay Biotech Laboratories UK was used for anti Hepatitis C antibodies assay. Twenty four of the 285 samples tested positive for anti HCV antibodies giving a co-infection rate of 8.4%. Lack of formal education was associated with HCV-HIV co-infection (p 0.05). This study revealed a high HCV co-infection with significant association with non-formal educational status. Improving female education may be one important strategy for its prevention.

Background In 2015, Nigeria’s estimated 317,700 stillbirths accounted for 12.2% of the 2.6 million estimated global stillbirths. This suggests that Nigeria still makes substantial contribution to the global burden of stillbirths. This study was conducted to determine the prevalence and identify the causes and factors associated with stillbirth in eight referral hospitals in Nigeria. Methods This was a cross-sectional study of all deliveries over a period of 6 months in six general hospitals (4 in the south and 2 in the north), and two teaching hospitals (both in the north) in Nigeria. The study population was women delivering in the hospitals during the study period. A pre-tested study protocol was used to obtain clinical data on pregnancies, live births and stillbirths in the hospitals over a 6 months period. Data were analyzed centrally using univariate, bivariate and multivariate logistic regression analyses. The main outcome measure was stillbirth rate in the hospitals (individually and overall). Results There were 4416 single births and 175 stillbirths, and a mean stillbirth rate of 39.6 per 1000 births (range: 12.7 to 67.3/1000 births) in the hospitals. Antepartum (macerated) constituted 22.3% of the stillbirths; 47.4% were intrapartum (fresh stillbirths); while 30.3% was unclassified. Acute hypoxia accounted for 32.6% of the stillbirths. Other causes were maternal hypertensive disease (6.9%), and intrapartum unexplained (5.7%) among others. After adjusting for confounding variables, significant predictors of stillbirth were referral status, parity, past experience of stillbirth, birth weight, gestational age at delivery and mode of delivery. Conclusion We conclude that the rate of stillbirth is high in Nigeria’s referral hospitals largely because of patients’ related factors and the high rates of pregnancy complications. Efforts to address these factors through improved patients’ education and emergency obstetric care would reduce the rate of stillbirth in the country. Trial registration Trial Registration Number NCTR91540209. Nigeria Clinical Trials Registry. http://www.nctr.nhrec.net/ Registered April 14th 2016.

Pregnancy and lactation are usual but stressful physiological conditions accompanied by changes in calcium and phosphate metabolism and their regulatory hormones which may lead to calcium-related disorders in pregnant women. This study aimed to evaluate the changes in serum levels of calcium, phosphate, vitamin D and their regulatory hormones in pregnant and lactating women in Zaria, Nigeria. A cross‑sectional descriptive study was conducted at Ahmadu Bello University Teaching Hospital, Zaria for three (3) months. Blood samples were collected, anthropometric measurements (weight, height and body mass index) of 179 women were taken. Serum calcium, phosphate, vitamin D, parathyroid hormone and calcitonin were determined using standard methods. Data were presented as mean ± SD, analysis was performed using one-way ANOVA and Pearson’s correlation analysis. Values were considered significant at p ≤ 0.05. There was a significant decrease in serum calcium concentration (p < 0.01) during the third trimester of pregnancy and lactation. An increase in serum concentration of vitamin D, parathyroid hormone, and calcitonin in the 2nd trimester and a decrease during the third trimester and lactation although not statistically significant when compared with the control. There was a negative correlation between serum calcium concentration and gestational age (r = 0.255) while no correlation between gestational age and serum phosphate concentration. Changes in serum calcium, vitamin D, parathyroid hormone and calcitonin during pregnancy and lactation has been demonstrated suggesting a relationship between calcium metabolism and these hormones at some stages of pregnancy

Background The paucity of human resources for health buoyed by excessive workloads has been identified as being responsible for poor quality obstetric care, which leads to high maternal mortality in Nigeria. While there is anecdotal and qualitative research to support this observation, limited quantitative studies have been conducted to test the association between the number and density of human resources and risk of maternal mortality. This study aims to investigate the association between client-provider ratios for antenatal and delivery care and the risk of maternal mortality in 8 referral hospitals in Nigeria. Methods Client-provider ratios were calculated for antenatal and delivery care attendees during a 3-year period (2011–2013). The maternal mortality ratio (MMR) was calculated per 100,000 live births for the hospitals, while unadjusted Poisson regression analysis was used to examine the association between the number of maternal deaths and density of healthcare providers. Results A total of 334,425 antenatal care attendees and 26,479 births were recorded during this period. The client-provider ratio in the maternity department for antenatal care attendees was 1343:1 for doctors and 222:1 for midwives. The ratio of births to one doctor in the maternity department was 106:1 and 18:1 for midwives. On average, there were 441 births per specialist obstetrician. The results of the regression analysis showed a significant negative association between the number of maternal deaths and client-provider ratios in all categories. Conclusion We conclude that the maternal mortality ratios in Nigeria’s referral hospitals are worsened by high client-provider ratios, with few providers attending a large number of pregnant women. Efforts to improve the density and quality of maternal healthcare providers, especially at the first referral level, would be a critical intervention for reducing the currently high rate of maternal mortality in Nigeria. Trial registration Trial Registration Number: NCTR91540209. Nigeria Clinical Trials Registry. Registered 14 April 2016.

Context: Consequent upon changes in social norms over the years, there has been an increase in the age of marriage and childbirth in women. The older parturient poses a great challenge to the managing obstetrician and a greater challenge to attaining safe motherhood. Aim: To determine the obstetric performance and complications developed during pregnancy and delivery of women with advanced maternal age. Settings and Design: This was a retrospective (case–control) study. Setting: This study was conducted in an ANC and labour ward of ABUTH, Zaria, Nigeria. Materials and Methods: The antenatal and delivery records of women with advanced maternal age (≥35 years) and those within 20–25 years of age from 2002 to 2006 were reviewed. Records of 294 women with advanced maternal age, and 322 of those aged 20–25 years were used. Results: A total of 57% of women with advanced maternal age developed complications compared with 24% in those aged 20–25 years. A total of 13% had chronic hypertension, while 26.2% had pregnancy-induced hypertension. Labour was augmented in 12.2% of those who had spontaneous vertex delivery and 6.2% had EMLSC/S. Low birth weight babies occurred in 11.6% necessitating admission into the SCBU and 5.4% had stillborn. Conclusion: This shows the considerable risk in pregnancies of women with advanced maternal age. It is recommended that to minimise complications; preconception care, antenatal care and skilled attendant at delivery are paramount.

Ovarian cysts in pregnancy are usually managed conservatively but surgical treatment is done for complicated cases. The diagnosis of complicated ovarian cyst in pregnancy is challenging, management often poses a dilemma to the obstetrician and is a source of anxiety to the patient because it can be associated with adverse pregnancy outcome. Complicated ovarian cysts in pregnancy accounted for 16.7% of all surgically managed ovarian cyst accidents (3/18) in our institution. It was also the most common indication for non-pregnancy-related laparotomy in pregnancy (3/6). The mean age of the patients was 31 ± 5.6 years, 66.7% (2/3) were primigravidae and all had cyst complication in the second trimester. All women presented with abdominal pain but accurate initial preoperative diagnosis was made in only 33.3%. Mean presentation to surgery interval was 46.7 h. All patients received tocolytic argents. The mean size of the cyst was 10.9 cm, commonest complication was torsion, and all cysts were benign. The commonest surgery performed was salpingo-oophorectomy. Surgical intervention was associated with favorable perinatal outcome in most cases with fetal loss seen when cyst was rapidly increasing in size or ≥15 cm in size. Prompt diagnosis and intervention enables preservation of affected adnexa.

Available evidence suggests that the low use of antenatal, delivery, and post-natal services by Nigerian women may be due to their perceptions of low quality of care in health facilities. This study investigated the perceptions of women regarding their satisfaction with the maternity services offered in secondary and tertiary hospitals in Nigeria. Five focus group discussions (FGDs) were held with women in eight secondary and tertiary hospitals in four of the six geo-political zones of the country. In all, 40 FGDs were held with women attending antenatal and post-natal clinics in the hospitals. The questions assessed women’s level of satisfaction with the care they received in the hospitals, their views on what needed to be done to improve patients’ satisfaction, and the overall quality of maternity services in the hospitals. The discussions were audio-taped, transcribed, and analyzed by themes using Atlas ti computer software. Few of the participants expressed satisfaction with the quality of care they received during antenatal, intrapartum, and postnatal care. Many had areas of dissatisfaction, or were not satisfied at all with the quality of care. Reasons for dissatisfaction included poor staff attitude, long waiting time, poor attention to women in labour, high cost of services, and sub-standard facilities. These sources of dissatisfaction were given as the reasons why women often preferred traditional rather than modern facility based maternity care. The recommendations they made for improving maternity care were also consistent with their perceptions of the gaps and inadequacies. These included the improvement of hospital facilities, re-organization of services to eliminate delays, the training and re-training of health workers, and feedback/counseling and education of women. A women-friendly approach to delivery of maternal health care based on adequate response to women’s concerns and experiences of health care will be critical to curbing women’s dissatisfaction with modern facility based health care, improving access to maternal health, and reducing maternal morbidity and mortality in Nigeria. Trial Registration Number NCTR No: 91540209. Nigeria Clinical Trials Registry. http://www.nctr.nhrec.net/ . Registered April 14th 2016.

Background Late arrival in hospital by women experiencing pregnancy complications is an important background factor leading to maternal mortality in Nigeria. The use of effective and timely emergency obstetric care determines whether women survive or die, or become near-miss cases. Healthcare managers have the responsibility to deploy resources for implementing emergency obstetric care. Objectives To determine the nature of institutional policies and frameworks for managing obstetric complications and reducing maternal deaths in Nigeria. Methods Thirty-six hospital managers, heads of obstetrics department and senior midwives were interviewed about hospital infrastructure, resources, policies and processes relating to emergency obstetric care, whilst allowing informants to discuss their thoughts and feelings. The interviews were audiotaped, transcribed and analyzed using Atlas ti 6.2software. Results Hospital managers are aware of the seriousness of maternal mortality and the steps to improve maternal healthcare. Many reported the lack of policies and specific action-plans for maternal mortality prevention, and many did not purposely disburse budgets or resources to address the problem. Although some reported that maternal/perinatal audit take place in their hospitals, there was no substantive evidence and no records of maternal/perinatal audits were made available. Respondents decried the lack of appropriate data collection system in the hospitals for accurate monitoring of maternal mortality and identification of appropriate remediating actions. Conclusion Healthcare managers are handicapped to properly manage the healthcare system for maternal mortality prevention. Relevant training of healthcare managers would be crucial to enable the development of strategic implementation plans for the prevention of maternal mortality.

ObjectiveTo assess the existing knowledge and skills relating to Emergency Obstetrics Care (EMOC) among health providers in eight referral maternity hospitals in Nigeria.Study designA cross-sectional study of skilled health providers (doctors, nurses and midwives) working in the hospitals during the period.SettingSix general hospitals (4 in the south and 2 in the north), and two teaching hospitals (both in the Northern part) of the country.PopulationAll skilled providers offering EMOC services in the hospitals during the study.MethodsA pre-tested self-administered questionnaire was used to obtain information relating to socio-demographic characteristics, the respondents' knowledge and skills in offering specific EMOC services (as compared to standard World Health Organization recommendations), and their confidence in transferring the skills to mid-level providers. Data were analyzed with univariate, bivariate, binary and multinomial logistic regression analyses. Main outcome measures: knowledge and skills in EMOC services by hospital and overall.ResultsA total of 341 health providers (148 doctors and 193 nurses/midwives) participated in the study. Averagely, the providers scored less than 46% in a composite EMOC knowledge score, with doctors scoring considerable higher than the nurses/midwives. Similarly, doctors scored higher than nurses/midwives in the self-reporting of confidence in carrying out specific EMOC functions. Health providers that scored higher in knowledge were significantly more likely to report confidence in performing specific EMOC functions as compared to those with lower scores. The self-reporting of confidence in transferring clinical skills was also higher in those with higher EMOC knowledge scores.ConclusionThe knowledge and reported skills on EMOC by health providers in referral facilities in Nigeria was lower than average. We conclude that the in-service training and re-training of health providers should be included in national policy and programs that address maternal mortality prevention in referral facilities in the country.Trial registrationNigeria Clinical Trials Registry 91540209.

Background: Early‑onset Group B Streptococcal (GBS) infection is an important cause of perinatal morbidity and mortality. Policy of active prevention by antepartum screening and treatment is not a popular practice in resource‑constrained settings.Objectives: This study determined the prevalence of asymptomatic GBS infection and antimicrobial sensitivity pattern. It also determined the outcome of Intrapartum antimicrobial prophylaxis (IAP).Methodology: It was a prospective and longitudinal study done in Ahmadu Bello University Teaching Hospital, Zaria, between June 2014 and April 2015. Two hundred and twenty consenting pregnant women with gestational ages between 35 and 37 completed weeks were participated in the study. Vagina and rectum were swabbed using different rayon swab sticks. Swabs were placed in Amies, nonnutritive transport medium. Bacteriological procedures to culture GBS and confirmation with biochemical tests and serological test were done. Antibiotic sensitivity pattern was determined. Participants who had GBS rectovaginal colonization had intrapartum antibiotic prophylaxis with penicillin G. All participants were followed up till to a week after birth.Results: Out of the 220 pregnant participants, 19 (8.6%) had GBS rectovaginal colonization. Antibiotic sensitivity pattern revealed that GBS isolates were all sensitive to penicillin, ampicillin, and cefazolin while 4 (21.1%) were resistant to ceftriaxone and 6 (31.6%) were resistant to both erythromycin and clindamycin. None of the isolates were resistant to erythromycin and sensitive to clindamycin or vice versa. Of the 19 participants with GBS rectovaginal colonization, 2 (10.5%) delivered low birth weight baby, but there was no incidence of early‑onset GBS disease.Conclusion: The prevalence of GBS rectovaginal colonization in this study is similar to figures from other parts of the country. The GBS sensitivity pattern to penicillin was similar to those reported elsewhere. Fetal outcome following intrapartum antibiotic prophylaxis was good.Keywords: Group B streptococcal infection; pregnancy; prevalence; sensitivity

Background: Iodine deficiency is a major public health problem worldwide, especially in pregnant women and young children. It is the most common cause of preventable mental retardation all over the world. Few among the devastating outcomes of iodine deficiency in pregnancy are increased perinatal mortality, abortions, stillbirths, neonatal hypothyroidism, goiter, and congenital anomalies. Objective: To assess the nutritional iodine status of pregnant women in Zaria. Methods: Four hundred subjects were recruited for this study consisting of three hundred apparently healthy pregnant women and one hundred apparently healthy nonpregnant age-matched controls. Random urine samples were collected and analyzed for iodine by modified Sandell-Kolthoff reaction. Data were analyzed using Epi-Info 3.5.3 to obtain the mean ages and median urinary iodine concentration (UIC) for pregnant women, controls and then for each trimester of pregnancy. P ≤ 0.05 was considered statistically significant. Results: Mean ages ± standard deviation for pregnant women and controls were 25.41 ± 5.98 and 26.70 ± 5.83 years, respectively (P > 0.05). Median UIC for pregnant women and controls were 193 μg/L and 205 μg/L, respectively. Trimester-specific UICs were 250 μg/L, 154 μg/L, and 150 μg/L for the first, second, and third trimesters, respectively. The percentage of women with iodine deficiency increased with advancing gestational age. Conclusion: Pregnant women in Zaria were iodine sufficient. There was a progressive decline in median UIC from the first through the third trimester.

Colorectal cancer during pregnancy is uncommon and most patients present in late pregnancy. This report describes unusual presentations of colorectal cancer in relation to pregnancy in three patients. The first patient is a 30-year-old primipara that developed lower abdominal pain and constipation two weeks after an emergency cesarean section. She had no change in bowel habit, rectal bleeding, or weight loss. Within two weeks after delivery she developed progressive massive ascitis. She was found to have a hard mass in the rectum. Colonoscopy and biopsy was diagnostic of adenocarcinoma of the rectum. Patient died three days later from respiratory difficulty. (Published: 11 January 2010) Citation: Libyan J Med 2010, 5: 4632 - DOI: 10.4176/090806

Ectopic molar gestation is a rare event. Its malignant potential is similar to that of an intrauterine molar pregnancy.To document two cases of tubal molar gestations seen over a 10-year period.Case series.Two young Nigerian undergraduates presented with features of ruptured tubal pregnancy. They had total salpingectomy and histopathological analysis of the tubal specimens revealed complete hydatidiform mole. HCG level normalized in both cases within three weeks of treatment.Ectopic molar gestation does occur occasional in our setting. It is pertinent that clinicians in this part of the world be aware of this and to take routine histological examination of tubal specimens in ectopic pregnancy very seriously in order to diagnosed cases of ectopic molar gestations early and mount appropriate post treatment surveillance.

During 2007 we were invited at different times to review and manage four women with ureterovaginal fistula following caesarean section performed in different rural hospitals. We describe our experience of a simple technique of diagnosis and management of these indigent patients in a resourceconstrained hospital. The condition was diagnosed by the three-swab test in all four patients, and abdominopelvic ultrasound was employed to help find the ureter involved. Transvesical ureteral implantation with a stent was carried out. Stent was removed after 2 weeks. All four patients were dry. Amidst the complexity of and sophistication of modern health care, it is important to remind ourselves of the common occurrence of this distressing condition following caesarean section and the use of a well known simple diagnostic technique and subsequent management in resource-poor communities Keywords: Ureterovaginal fistula, Caesarean section, Resource constrained Libyan Medical Journal Vol. 4 (1) 2009: pp. 45-48

Background: Thyroid disorders are the second most common endocrine disorders found during pregnancy. Normal maternal thyroid function is critical for normal fetal development. Gestational thyroid dysfunctions complicate pregnancy with a significant increase in maternal and perinatal morbidity and mortality. Objective: To assess the prevalence of thyroid disorders among pregnant women in Zaria. Materials and Methods: Study population consisted of 300 apparently healthy pregnant women and 100 apparently healthy age-matched nonpregnant controls. Participants were not on any drug that can affect thyroid function. Serum thyroid hormones [thyroid stimulating hormone, free triiodothyronine (T 3 ), free thyroxine (T 4 ), and thyroid peroxidase (TPO) antibody] were assayed using enzyme-linked immunosorbent assay (ELISA). Data were analyzed using Epi Info 3.5.3 and P-values ≤0.05 were considered statistically significant. Results: Ages (mean ± SD) were 25.41 ± 5.98 and 26.70 ± 5.83 years for pregnant women and controls, respectively. Parity mean ± SD were 2.32 ± 2.24 and 2.63 ± 2.75 for pregnant women and controls, respectively. The mean gestational age ± SD was 21.68 ± 10.38 weeks. Three percent (3%) were hypothyroid, while 2.3% were hyperthyroid. Nine percent (9%) were TPO antibody positive. Conclusion: Prevalence of thyroid disorders among pregnant women in Zaria was high therefore routine screening of all pregnant women for thyroid disorders during antenatal care visits may be of benefit.