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Background Antenatal corticosteroids (ACS) have long been regarded as a cornerstone intervention in mitigating the adverse effects of a preterm birth. However, the safety and efficacy of ACS in hospitals in low-resource countries has not been established in an efficacy trial despite their widespread use. Findings of a large cluster-randomized trial in six low- and middle-income countries showed that efforts to scale up ACS use in low-resource settings can lead to harm. There is equipoise regarding the benefits and harms of ACS use in hospitals in low-resource countries. This randomized controlled trial aims to determine whether ACS are safe and efficacious when given to women at risk of imminent birth in the early preterm period, in hospitals in low-resource countries. Methods/design The trial design is a parallel, two-arm, double-blind, individually randomized, placebo-controlled trial of ACS (dexamethasone) for women at risk of imminent preterm birth. The trial will recruit 6018 women in participating hospitals across five low-resource countries (Bangladesh, India, Kenya, Nigeria and Pakistan). The primary objectives are to compare the efficacy of dexamethasone with placebo on survival of the baby and maternal infectious morbidity. The primary outcomes are: 1) neonatal death (to 28 completed days of life); 2) any baby death (any stillbirth postrandomization or neonatal death); and 3) a composite outcome to assess possible maternal bacterial infections. The trial will recruit eligible, consenting pregnant women from 26 weeks 0 days to 33 weeks 6 days gestation with confirmed live fetuses, in whom birth is planned or expected within 48 h. The intervention comprises a regimen of intramuscular dexamethasone sodium phosphate. The comparison is an identical placebo regimen (normal saline). A total of 6018 women will be recruited to detect a reduction of 15% or more in neonatal deaths in a two-sided 5% significance test with 90% power (including 10% loss to follow-up). Discussion Findings of this trial will guide clinicians, programme managers and policymakers on the safety and efficacy of ACS in hospitals in low-resource countries. The trial findings will inform updating of the World Health Organization’s global recommendations on ACS use. Trial registration ACTRN12617000476336. Registered on 31 March 2017. Electronic supplementary material The online version of this article (10.1186/s13063-019-3488-z) contains supplementary material, which is available to authorized users.

Unregulated work schedules have deleterious effects on trainees' productivity and patients' safety. For these reasons, duty hours have been capped in many developed countries. Such regulations, however, appear to be lacking in many parts of Africa, and the effects of unregulated work hours in this part of the world have only been scantily documented. This study evaluated the work schedule of Nigerian surgical trainees, and its impact on their wellbeing, as well as assessed the perception of trainees towards capped duty hours.A cross-sectional survey of 650 Nigerian Resident Doctors in surgical specialties was conducted in November 2020. Enquiries were made about their work schedules using a purpose-designed questionnaire, developed using Google FormsThe mean weekly work hours of surgical residents was 122.72 ± 34.17 h. Majority (228, 40.4%) of the residents had cumulative call hours of ≥ 72 h per week. One-half (283, 50.1%) of them worked continuously for up to 48-72 h during calls, with mean daily sleep hours of 3.53 ± 1.42 h during calls. The majority (558, 98.8%) of respondents had post-call clinical responsibilities. Seventy-five percent of the respondents reported hazards from prolonged work hours, and an overwhelming majority (530, 93.8%) desire official limits on work hours.Prolonged, unregulated work schedules appear to be the norm among Nigerian surgical trainees. This trend calls for urgent measures, to avoid potentially catastrophic consequences on both physicians and patients.

Background The unacceptably high stillbirth rate in Nigeria, which results mainly from antepartum fetal death demands evidence-based antenatal interventions. While evidence suggests that fetal surveillance using umbilical artery (UA) Doppler reduces perinatal mortality; normative references of fetal UA Doppler indices are not readily available in Nigeria. This study aims to construct indigenous, gestational age-specific normative references for fetal UA Pulsatility Index (PI), Resistance Index (RI) and Systolic/Diastolic ratio (S:D) of singleton pregnancies in Ile-Ife, Nigeria, and correlate this with pregnancy outcomes. Methods In a longitudinal study involving 415 women with singleton fetuses between the gestational ages of 26-40weeks at the Obafemi Awolowo University Teaching Hospital, Nigeria, fetal umbilical artery PI, RI and S:D were measured four-weekly till delivery. The means and normative centiles (95% range between 2.5th -97.5th) of the indices were determined. Regression equations were generated for the three indices, and Pearson’s correlation was used to establish the relationship with maternal age, parity, gestational age (GA) and birth weight. Results The three indices demonstrated significant inverse correlation with GA, such that the RI reduced by 0.013, while the PI and S:D ratio reduced by 0.027 and 0.71 respectively for each additional week of pregnancy. There was a significant negative correlation between the RI (r =-0.207; p = 0.001), PI (r = -0.17; p= 0.01), S:D ratio (r = -0.25; p