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Objectives To determine the prevalence of antioxidant micronutrient deficiencies in pregnant women with pre-eclampsia and healthy pregnant women, and to assess the relationships between trace element deficiency in pregnancy and the severity of pre-eclampsia in Enugu, Nigeria. Methods We performed a secondary analysis of a cross-sectional analytical study of serum concentrations of copper, selenium, zinc, magnesium, and manganese in 81 pregnant women with pre-eclampsia and healthy pregnant women (controls) who were matched for age, gestational age, body mass index, and parity. This study was performed at the University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu. Participants’ sera were analyzed with an atomic absorption spectrophotometer. Results Trace element deficiencies were common and similar between women with pre-eclampsia and controls. However, women with pre-eclampsia were more likely to be deficient in manganese than controls (odds ratio = 2.28, 95% confidence interval: 1.90–2.75). Among the micronutrients studied, only manganese concentrations were significantly lower in women without severe symptoms of pre-eclampsia than in those with severe symptoms of pre-eclampsia. Conclusions Micronutrient deficiency is common in pregnant women with pre-eclampsia and in healthy pregnant women in Enugu, Nigeria. Only manganese deficiency is higher in women with pre-eclampsia than in healthy pregnant women.

Objectives: There are several studies from sub-Saharan Africa on postpartum urinary incontinence and anal incontinence, but very rare in pregnancy. Such data will guide obstetric caregivers in providing appropriate counseling to the women as well as in minimizing the risk factors. This study aimed to determine the comparative effects of different trimesters of pregnancy on urinary incontinence and anal incontinence, and their possible risk factors. Methods: The study was longitudinal in design, and the study population consisted of 223 pregnant women receiving care at the two largest tertiary health institutions in Enugu, South-East Nigeria. The recruitment was in the first trimester and the women were followed up to term. Interviews were conducted at specific times in the three trimesters and data regarding urinary incontinence and anal incontinence symptoms were obtained using validated questionnaires. Results: The incidence of urinary incontinence increased across the trimesters: 22%, 30.5%, and 48% in the first trimester, second, and third trimesters, respectively, with a cumulative incidence rate of 50.2%. The incidence of anal incontinence also increased across the trimesters but not as high as urinary incontinence: 1.7%, 3.6%, and 5.8%, respectively, with a cumulative incidence rate of 6.7%. The risk factors for urinary incontinence were maternal age >35 years, multiparity, previous prolonged second-stage labor, and previous history of neonatal macrosomia, while that of anal incontinence were previous instrumental vaginal delivery and previous prolonged second stage of labor. Conclusion: Our study demonstrated an increase in the incidence of urinary incontinence and anal incontinence as pregnancy advances. Obstetricians are therefore encouraged to discuss these pelvic floor issues during antenatal care services and make more efforts toward reducing the modifying obstetric risk factors.

Background: Anecdotal evidence suggests that placentas may be improperly disposed of due to the lack of knowledge of the best approaches. The reason women request for their placenta in Nigeria remains unclear. Aim: The aim is to determine the knowledge and perceptions of doctors and nurses about the use of WHO guidelines for the safe disposal of hospital wastes in placenta disposal and to explore their placenta disposal practices at tertiary and secondary health facilities in Enugu state. Materials and Methods: This was a mixed-method study design in which 163 doctors and nurses drawn from 3 secondary and 3 tertiary hospitals in Enugu Metropolis were studied. Quantitative component involved the use of interviewer-administered questionnaires. Knowledge and perceptions of respondents on the use of WHO guidelines to dispose of the placenta were documented. Knowledge of WHO guidelines was assessed and graded: good knowledge (score ≥12) and poor knowledge (score

IntroductionDespite much emphasis on the reproductive health of women, maternal mortality is still high, especially in postnatal period.ObjectiveTo assess the prevalence of postnatal care use and reasons for defaults among mothers attending the child immunization clinics in Enugu, Nigeria.MethodsThis was a cross-sectional comparative study of 400 consecutive nursing mothers who presented at the Institute of Child Health of UNTH and ESUTH, Enugu for Second dose of the Oral Polio Vaccine (OPV2) for their babies at 10 weeks postpartum. Data was collected using Interviewer-administered questionnaire and subsequently analyzed with version 22.0 IBM SPSS software, Chicago, Illinois. A p-value of less than 0.05 was considered as statistically significant.ResultThe prevalence of the 6th week postnatal clinic attendance among the mothers was 59%. The majority of the women (60.6%) who had antenatal care by skilled birth attendants attended postnatal clinic. Unawareness and being healthy were the main reasons for not attending postnatal clinic. Following multivariate analysis, place of antenatal (OR = 2.870, 95% C.I = 1.590-5.180, p < 0.001) and mode of delivery (OR = 0.452, 95% C.I = 0.280-0.728, p = 0.001) were the only significant predictors of postnatal clinic attendance (p < 0.05).ConclusionPostnatal clinic attendance by women in Enugu is still suboptimal. The main reason for non-attendance of the 6th week postnatal clinic was lack of awareness. There is need for healthcare professionals to create awareness about the importance of postnatal care and encourage mothers to attend.

Objective: The objective of this study was to determine the proportion of the Anambra State population that had been infected by the SARS-CoV-2 virus and developed antibodies before the second wave. Methods: The WHO-recommended health facility-based cross-sectional approach was adapted for this survey. Between 8th and 15th December 2020, 3142 participants across the 21 local government areas (LGAs) of the State, aged one year and over, attending randomly selected health facilities, were recruited. Demographic and symptom-related information were collected from the participants as well as whole peripheral blood, which was tested for SARS-CoV-2 IgG and IgM with rapid test kits. Results: 425 participants tested positive for IgG only, 74 for IgM only, while 54 were positive for both IgG and IgM. Overall, 553 positives were recorded, giving a crude seroprevalence of 17.6% (95% CI = 16.26 – 18.98). It ranged widely from 31.9% (95% CI = 24.43 – 40.22) in Onitsha North LGA to 5.4% (95% CI = 2.19 – 10.78) in Awka north. Bayesian Adjustments yielded a state seroprevalence of 16.1%. Conclusion: One in six state residents had been infected by SARS-CoV-2 and developed antibodies before the second wave. All LGAs, age groups, sexes, and settlement types were affected by COVID-19. A large proportion of the population remained susceptible to SARS-CoV-2.

Background: The first wave of the COVID-19 outbreak resulted in the restriction of physical meetings/gatherings worldwide as part of disease preventive measures. This restriction affected formal teaching and learning globally, including medical residency training programs in Nigeria. To sustain educational meetings during the COVID-19 disease outbreak, the Postgraduate Studies unit of the University of Nigeria Teaching Hospital (UNTH) Enugu, Nigeria, directed all clinical departments of the hospital to switch from physical meetings to virtual video conferencing (VVC). Aim: To determine the experience and perception of VVC during COVID-19 by resident doctors and their consultants in UNTH Enugu, Nigeria. Materials and Methods: Questionnaires were administered to 220 consenting medical doctors randomly selected from the population of resident doctors (trainees) and Consultants (trainers) at the UNTH, Enugu, Nigeria. The data were collected by an online generated Google form (self-administered questionnaire), some of which were printed and self-administered. Data analysis was done with SPSS version 20.0. Results: Out of 220 participants, 202 participants filled the questionnaires appropriately and were analyzed. Of the participants, 196 (97.0%) participated in VVC since COVID-19. Only 107 (54.6%) agreed they were satisfied while 89 (45.4%) were not satisfied. Only 108 (55.1%) respondents agreed that they preferred virtual meetings over physical meetings. A majority of respondents (79.1%, 155/196) preferred physical meetings over virtual meetings. The most common reason for preferring VVC over the physical meeting is its convenience, whereas in the converse, the commonest reason is its ability to cover all the academic programs. Conclusion: There is an improved participation level in academic residency programs by residents and consultants since the introduction of VVC, during the COVID-19 pandemic at UNTH Enugu.

Abstract Background Pre-eclampsia is a common obstetric complication of pregnancy in Nigeria, and oxidative stress has been implicated in its aetiopathogenesis. Despite this fact, there is a paucity of information regarding the serum antioxidant micronutrient status of pre-eclamptic Nigerian women. The objective of the was to determine the mean serum levels of some antioxidant trace elements (copper, zinc, selenium, magnesium, manganese) in pre-eclamptic pregnant women and compare with that of healthy pregnant women in Enugu, South-Eastern, Nigeria. Methods A cross-sectional analytical study was carried out at the Obstetrics and Gynaecology department of the University of Nigeria, Teaching Hospital Ituku-Ozalla, Enugu. Using atomic absorption spectrophotometry, the sera of 81 pregnant pre-eclamptic and 81 matched healthy pregnant controls were analyzed for the antioxidant micronutrients. Both descriptive and inferential analysis was performed using the statistical package for social sciences (SPSS) version 21.0 and a P value of 0.05). All the mean serum levels of micro-nutrients studied did not vary by category of pre-eclampsia (with or without severity findings) except manganese which was significantly lower in pre-eclamptic women without severity findings when compared to those with severity findings (p = 0.043). Conclusions The serum levels of copper, selenium, and magnesium were significantly lower among pre-eclamptics when compared to their normal healthy controls. Low levels of selenium, copper, and magnesium may have contributed to the incidence of pre-eclampsia in our environment.

Background: The placenta is a feto-maternal organ that plays a vital role in normal fetal growth and perinatal outcome. Sonographic studies have shown that placental diameter (PD) and thickness (PT) increase linearly with gestational age, and may have relationships with fetal parameters and estimated weight. Aim: To determine the relationship between PT and PD with fetal biometric parameters and estimated weight, as well as establish a model for estimating birth weight from these placental parameters. Materials and Methods: This was a cross-sectional study of 400 antenatal women with normal, third-trimester, singleton pregnancies at the University of Nigeria Teaching Hospital Ituku-Ozalla, Enugu. Ultrasound was used to evaluate their PD and PT. Fetal weight was estimated (EFW) using fetal biparietal diameter, abdominal circumference and femur length. Data were analyzed with SPSS, version 20. Results: The mean PD of participants before 37 weeks of gestation (183.8 ± 8.7 mm) was significantly shorter than that of participants at term (205.7 ± 2.5 mm), P < 0.001. For PT, the mean values for participants before term and at term were 36.3 ± 2.4 mm versus 43.2 ± 1.0 mm, respectively, P < 0.001. There were varying positive correlations between each placental parameter and the three fetal biometric parameters. Both PD and PT had a high positive correlation with EFW (P < 0.001). Regression analysis predicted fetal weight using PD and PT. Conclusion: PD and PT showed a high positive correlation with fetal weight and can be used as a sonographic parameter in estimating fetal weight.

Introduction: Routine urinary catheterisation during elective caesarean section is a common practice. However, this practice involves some urinary bladder morbidities. Aim: To determine the effect of non-catheterisation of the urinary bladder on the incidence of significant bacteriuria and other perioperative urinary bladder morbidities during elective caesarean section in Enugu, Nigeria. Materials and Methods: A multicentre, non-inferiority randomised controlled study was conducted. The study centres were the University of Nigeria Teaching Hospital (UNTH), Mother of Christ Specialist Hospital (MOCSH), and Blessed Assurance Specialist Hospital (BASH), all in Enugu State, Southeast Nigeria. A total of 264 eligible consenting term pregnant women who had a caesarean section in these three specialist centres in Enugu, Nigeria over a one-year period were recruited and they completed the study and their results were analysed. Study group (A) did not receive urethral catheterisation while the control group (B) had urethral catheterisation on the operating table and the catheters were removed 24 hours after the surgery. Clean catched urine samples were collected from each participant 72 hours after the surgery for urine microscopy and culture. The primary outcome measure was the incidence of significant bacteriuria 72 hours postoperatively while the secondary outcome measures included incidence of intraoperative bladder injury (accidental cystostomy), primary postpartum haemorrhage and urinary retention. Results: Nine (6.8%) women in the non-catheter group (n=132) had significant bacteriuria as against 17 (12.9%) women in the catheter group (n=132), (Relative Risk (RR)=0.5 (95% CI: 0.24-1.14) p-value=0.098). Urinary retention was observed in 10.6% (14/132) of the non-catheter group while there was no case of urinary retention in the control group (p

Introduction: Cervical cancer is a leading cause of cancer-related mortality in Sub-Saharan Africa. Although the disease is largely preventable via routine cervical cancer screening, the uptake is ridiculously poor in the sub-region. In Nigeria, current efforts are directed at counselling and screening of eligible women in health care facilities. Therefore, the routine post-natal clinic visit at six weeks postpartum provides a good opportunity to offer cervical cancer screening services. Aim: To compare the acceptability of Pap-test and prevalence of abnormal cervical cytology between post-natal clinic attendees and other non-pregnant women at the University of Nigeria Teaching Hospital Enugu, Nigeria. Materials and Methods: A cross-sectional analytical study was conducted from January to November 2014 in which acceptability and Pap-test results of 172 women attending the post-natal clinic were compared with an equal number of non-pregnant women from gynaecology and family planning clinics of the hospital. Both groups were selected by systematic sampling method. Outcome measures for each group included the prevalence of abnormal Pap-test and the proportion of women that accepted the Pap-test after appropriate cervical cancer education. Statistical analyses were both descriptive and inferential at 95% confidence level. Results: Prior to the study, 44.2% (76/172) of participants in postpartum group, and 47.7% (82/172) in control group were aware of Pap-test (p=0.473); while 9.3% (16/172) and 10.5% (18/172) had used Pap-test in the two groups respectively (p=0.718). All participants in each group accepted the Pap-test after cervical cancer education. Prevalence of cervical Squamous Intraepithelial Lesion (SIL) in the postpartum group was similar to that of the control group (OR: 1.8; 95%CI: 0.75-4.10; p=0.21). The most common SIL in both groups was low-grade squamous intraepithelial lesion. There was no statistically significant difference in the distribution of SIL categories (p>0.05). Conclusion: Acceptability and outcome of Pap-test are similar in post-natal and non-pregnant women in Enugu, Nigeria. Post-natal clinic visit provides an effective opportunity for routine cervical cancer information and screening in Nigeria.

Introduction: Low Birth Weight (LBW) is associated with poor health conditions during neonatal period, infancy and in adult life. It is possible that some form of fetal growth restriction occurs in babies of HIV sero-positive women. Aim: To determine the effect of maternal HIV infection on neonatal birth weight and other neonatal anthropometric indices. Materials and Methods: The study was prospective cohort in design. Neonatal birth weight, head circumference, and crownheel length of babies of 87 consecutive consenting HAART experienced HIV sero-positive pregnant women on HAART (study group) were compared with those of 92 matched HIV sero-negative women (control group). Data analyses were both descriptive and inferential at 95% confidence level. Results: The incidence of low birth weight was 25.3% (22/87) among the HIV sero-positive group and 14.1% (13/92) among the control group (p=0.060, R.R=1.8, 95% CI: 0.96-3.33). The mean neonatal head circumference in the study and control groups were 33.7±2.93 cm and 34.5±2.31 cm respectively, p=0.036 while the mean crown-heel length was 47.9±4.59 cm versus 48.7±4.02 cm, p=0.217. Conclusion: Maternal HIV treatment with Highly Active Antiretroviral Therapy (HAART) was not associated with high incidence LBW in Enugu, Nigeria. However, the head circumference was reduced. Careful measurement of the head circumferences of neonates of HIV sero-positive mothers, during routine new-born examination, is encouraged, so that any disproportionate growth would receive further appropriate assessment.

Introduction: Antenatal sonographic estimation of foetal weight is a common practice. The use of these estimates to predict actual birth weight is crucial for appropriate management of certain pregnancy conditions, to improve fetomaternal outcome. Aim: To evaluate the accuracy of foetal weights derived from six selected sonographic modules, in estimating the actual birth weight of neonates in Enugu, Nigeria. Materials and Methods: This was a cross-sectional, analytical study of 245 consenting consecutive antenatal women with term singleton pregnancies at the UNTH, Enugu, Nigeria, from October 2013 to May 2014. For the Estimated Foetal Weights (EFW), foetal parameters obtained after obstetric ultrasound scan of each participant were keyed into the sonographic modules. Actual Birth Weight (ABW) and Scan Delivery Interval (SDI) were obtained after delivery. Accuracy of the sonographic modules in estimating the ABWs was determined using percentage (%) error, the proportion of EFW within 10% of ABW, sensitivity/ specificity tests, and ROC curve analysis. Results: The Hadlock Biparietal Diameter (BPD)/Abdominal Circumference (AC)/Femur Length (FL) and Hadlock BPD/AC modules had the least systematic error (-0.5% and -0.7% respectively) compared to other modules, and higher proportions of accurate estimated foetal weight within 10% of actual birth weights (78% versus 78.4%). For new-borns in the normal weight category, Hadlock BPD/AC module best predicted the ABW (ROC curve area=0.737, p=0.006). Conclusion: The Hadlock BPD/AC formula consistently showed a high accuracy for estimation of foetal weight. It is comparable with Hadlock BPD/AC/FL module but, has an advantage of requiring fewer foetal parameters.

Introduction: Alcohol consumption during pregnancy is a major public health problem because of the enormous deleterious effects on a developing fetus. Sub-Saharan Africa (SSA) is among the highest per capita rates of alcohol consumption in the world, thus suggesting a high burden of Fetal Alcohol Syndrome Disorder (FASD) in the sub-region. Despite this, there is limited data on alcohol exposed pregnancies for most SSA countries including Nigeria. Aim: To determine the prevalence and predictors of alcohol consumption during pregnancy in Enugu, South-Eastern Nigeria. Materials and Methods: It was a cross-sectional study of 380 consecutive consenting parturients accessing antenatal care at the University of Nigeria Teaching Hospital, Enugu, Nigeria. The information sought for, included the women’s socio-demographic characteristics, alcohol use in pregnancy, awareness of the harmful effects of alcohol on the babies including FASD, sources of initial information on awareness, type and quantity of alcohol ingested, reasons for taking alcohol and willingness to stop alcohol ingestion in pregnancy after counseling on the risk of alcohol use in pregnancy. Statistical analysis was both descriptive and inferential at 95% confidence level. A p-value of less than 0.05 was considered statistically significant. Results: The prevalence of alcohol consumption in pregnancy was 22.6%. The most common brand of alcoholic beverage consumed was stout beer (62.8%, 54/86). A total of 135 (35.5%) respondents were aware that alcohol is harmful to the fetus. Maternal age 30 years or less, nulliparity, less than tertiary education, pre-pregnancy alcohol consumption and lack of awareness of the harmful effect of alcohol on the fetus, were associated with alcohol consumption during pregnancy (p< 0.05). Conclusion: The prevalence of alcohol consumption during pregnancy among women in Enugu, South-Eastern Nigeria is high and lack of awareness of harmful effect of alcohol on fetus was a major predictor. There is need for a concerted public health campaign to improve the awareness of harmful effects of alcohol on the fetus.

Introduction: HIV-positive women are more likely to develop cervical neoplasm. HIV-positive women with low CD4 T-lymphocyte cell count may be more predisposed to cervical squamous intraepithelial lesions (SILs). This study aimed to determine the association between low cellular immunity of HIV positive women, and the prevalence and grade of cervical squamous intraepithelial lesions. Materials and Methods: Pap smear was carried out on two cohorts of Highly Active Anti Retroviral Therapy (HAART) experienced HIV-positive women (178 per group) at the AIDS Prevention Initiative in Nigeria-Centre for Disease Control Adult Anti-Retroviral clinic of the University of Nigeria Teaching Hospital, Enugu, Nigeria from June to November, 2012. The study group had CD4 cell count of < 200 cells/µl while the control group had CD4 cell count of ≥200 cells/µl. Results: The mean CD4 cell counts of participants in the study (low CD4) group was 127.9 ± 47.49 cells/ml while that of the control (high CD4) group was 489.2 ± 186.36 cells/ml (p < 0.001). The prevalence of SIL was 10.2% (18/176) for the low CD4 group, and 5.7% (10/176) for the high CD4 group [OR = 1.9 (95% CI: 0.85, 4.22)]. The commonest category of SILs identified was Low-grade Squamous Intraepithelial Lesion (LSIL), thus 11 (6.3%) in the study versus 7 (4.0%) in the control group (p = 0.703). Conclusion: Prevalence of cervical SILs among HIV positive women on HAART in Enugu, Nigeria is low and has no significant relationship with their CD4 cell count.