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Background: Nigeria is one of the hyper-endemic countries for hepatitis B with national prevalence rate of 11%. No study has been done in Nigeria to the best of authors’ knowledge to assess the level of immunity among children vaccinated against HBV. Objective: To assess prevalence of Hepatitis B surface antigen, determine the presence of antibodies to hepatitis B surface antigen (anti-HBs) and determine the titre levels of anti-HBs among those who have anti-HBs. Design: This was a pilot and a cross-sectional study. Methods: Consecutive children aged between 2 and 17 years seen at the outpatient clinic of NAUTH, Nnewi, Nigeria were recruited. Questionnaire was interviewer-administered. Venous blood was collected from each participant, analyzed for HBV serological markers and anti-HBs titre. Results: A total of sixty children were recruited. There was equal male and female distribution. 36.7% were aged 10-14 years. One child did not receive HBV vaccine. There was no incidental finding of HbsAg positivity. 15% of respondents had their immunity assessed after completing vaccination. There was presence of antibodies to HBsAg in19 children, and the anti-HBs titre was protective in 78.9% of those who had antibodies. Conclusion: After 18 years of introduction of the HBV vaccine into the NPI and routine infant immunization against hepatitis B virus in Nigeria, this pilot study has shown immunity against hepatitis B is not usually assessed after immunization and a significant proportion of children who were adequately immunized are not adequately protected against HBV. A large-scale study would be desirable for confirmation.

BackgroundTo our knowledge, there is no prior randomized trial on the effectiveness of Mojeaga remedy (a special blend of Alchornea, Pennisetum, and Sorghum extracts) when co-administered with standard-of-care for correction of anemia in obstetrics practice. This study determined the efficacy, safety and tolerability of Mojeaga as adjunct to conventional oral iron therapy for correction of anemia in obstetric population.MethodsA pilot open-label randomized clinical trial. Participants with confirmed diagnosis of anemia in three tertiary hospitals in Nigeria were studied. Eligible participants were randomized 1:1 to either Mojeaga syrups 50 mls (200mg/50mls) administered three times daily in conjunction with conventional iron therapy (Mojeaga group) for 2 weeks or conventional iron therapy alone without Mojeaga (standard-of-care group) for 2 weeks. Repeat hematocrit level were done 2 weeks post-initial therapy. Primary outcome measures were changes in hematocrit level and mean hematocrit level at two weeks post therapy. Maternal adverse events and neonatal outcomes (birth anomalies, low birthweight, preterm rupture of membranes and preterm labor) were considered the safety outcome measures. Analysis was by intention-to-treat.ResultsNinety five participants were enrolled and randomly assigned to the Mojeaga group (n=48) or standard-of-care group (n=47). The baseline socio-demographic and clinical characteristics of the study participants were similar. At two weeks follow-up the mean rise in hematocrit values from baseline (10.42±4.13% vs 6.36±3.69%;p0.05).ConclusionMojeaga represents a new adjuvants for standard-of-care option for patients with anemia. Mojeaga remedy is safe for treating anemia during pregnancy and puerperium without increasing the incidence of congenital anomalies, or adverse neonatal outcomes. Clinical Trial Registration: www.pactr.samrc.ac.za: PACTR201901852059636 (https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=5822).

Objectives: To systematically review literature and identify mother-to-child transmission rates of human immunodeficiency virus, hepatitis B virus, and hepatitis C virus among pregnant women with single, dual, or triplex infections of human immunodeficiency virus, hepatitis B virus, and hepatitis C virus in Nigeria. PRISMA guidelines were employed. Searches were on 19 February 2021 in PubMed, Google Scholar and CINAHL on studies published from 1 February 2001 to 31 January 2021 using keywords: “MTCT,” “dual infection,” “triplex infection,” “HIV,” “HBV,” and “HCV.” Studies that reported mother-to-child transmission rate of at least any of human immunodeficiency virus, hepatitis B virus and hepatitis C virus among pregnant women and their infant pairs with single, dual, or triplex infections of human immunodeficiency virus, hepatitis B virus, and hepatitis C virus in Nigeria irrespective of publication status or language were eligible. Data were extracted independently by two authors with disagreements resolved by a third author. Meta-analysis was performed using the random effects model of DerSimonian and Laird, to produce summary mother-to-child transmission rates in terms of percentage with 95% confidence interval. Protocol was prospectively registered in PROSPERO: CRD42020202070. The search identified 849 reports. After screening titles and abstracts, 25 full-text articles were assessed for eligibility and 18 were included for meta-analysis. We identified one ongoing study. Pooled mother-to-child transmission rates were 2.74% (95% confidence interval: 2.48%–2.99%; 5863 participants; 15 studies) and 55.49% (95% confidence interval: 35.93%–75.04%; 433 participants; three studies), among mother–infant pairs with mono-infection of human immunodeficiency virus and hepatitis B virus, respectively, according to meta-analysis. Overall, the studies showed a moderate risk of bias. The pooled rate of mother-to-child transmission of human immunodeficiency virus was 2.74% and hepatitis B virus was 55.49% among mother–infant pairs with mono-infection of HIV and hepatitis B virus, respectively. No data exists on rates of mother-to-child transmission of hepatitis C virus on mono-infection or mother-to-child transmission of human immunodeficiency virus, hepatitis B virus, and hepatitis C virus among mother–infant pairs with dual or triplex infection of HIV, hepatitis B virus and HCV in Nigeria.

Background: There are no national data on hepatitis C virus awareness and burden among pregnant women to justify its routine screening. Objectives: To investigate awareness, seroprevalence and risk factors for hepatitis C virus infection among pregnant women in Nigeria. Methods: A total of 159 pregnant women from antenatal clinics across six geopolitical zones in Nigeria consented to anti-hepatitis C virus testing which was confirmed using polymerase chain reaction technique. Confirmed hepatitis C virus positive women were further tested for hepatitis B and HIV. Participants were evaluated for risk factors for hepatitis C virus. Odds ratios, adjusted odds ratios, and their 95% confidence intervals (CIs) were determined, and p-values of Results: Of 159 participants, 77 (48.4%; 95% confidence interval = 38.2%–60.5%) were aware of hepatitis C virus infection and awareness of hepatitis C virus was associated with young age (odds ratio = 2.21; 95% confidence interval = 1.16–4.21), high educational level (odds ratio = 3.29; 95% confidence interval = 1.63–6.64), and participants’ occupation (odds ratio = 0.51; 95% confidence interval = 0.26–0.99). In multivariable logistic regression, adjusted for confounders, the association between awareness of hepatitis C virus and participants’ young age (adjusted odds ratio = 1.60; 95% confidence interval = 1.09–2.35; p = 0.018) and high educational level (adjusted odds ratio = 1.48; 95% confidence interval = 1.17–1.86; p = 0.001) remained significant. Hepatitis C virus seroprevalence was found to be 1.3% (95% confidence interval = 0.2%–4.5%). All (100.0%, 95% confidence interval = 12.1%–100.0%) the hepatitis C virus-positive participants and 99 (63.1%, 95% confidence interval = 51.3%–76.8%) hepatitis C virus-negative participants had identifiable hepatitis C virus risk factors. Dual seropositivity of anti-hepatitis C virus/anti-HIV and anti-hepatitis C virus/hepatitis B surface antigen each accounted for 0.6%. The most identified risk factors were multiple sexual partners (15.7%), shared needles (13.8%), and blood transfusion (11.3%). There was no significant association between the risk factors and hepatitis C virus positive status. Conclusion: Awareness of hepatitis C virus infection among pregnant women in Nigeria is low and those aware are positively influenced by young age and high educational level. The prevalence of hepatitis C virus infection is high and provides preliminary evidence to justify antenatal routine screening.

Background Nigeria contributes significantly to the global burden of HIV, Hepatitis B and C infections, either singly or in combinations, despite progress in HIV care regionally and globally. Although some limited data on mono infection of HIV, Hepatitis B and C virus infections do exists, that of dual and triplex infections, including seroconversion and mother-to-child transmission (MTCT) rates necessary for planning to address the scourge of infections in pregnancy are not available. Objectives To determine the seroprevalence, rate of new infections, MTCT of dual and triple infections of HIV, Hepatitis B and C viruses and associated factors, among pregnant women in Nigeria. Method A multicenter prospective cohort study will be conducted in six tertiary health facilities randomly selected from the six geopolitical zones of Nigeria. All eligible pregnant women are to be tested at enrollment after informed consent for HIV, Hepatitis B and C virus infections. While those positive for at least two of the infections in any combination will be enrolled into the study and followed up to 6 weeks post-delivery, those negative for the three infections or positive for only one of the infections at enrolment will be retested at delivery using a rapid diagnostic test. On enrolment into the study relevant information, will be obtained, and laboratory test of CD4 count, liver function test and full blood counts, and prenatal ultrasonography will also be obtained/performed. Management of mother-newborns pairs will be according to appropriate national guidelines. All exposed newborns will be tested for HIV, HBV or HCV infection at birth and 6 weeks using PCR technique. The study data will be documented on the study case record forms. Data will be managed with SPSS for windows version 23. Ethical approval was obtained from National Health Research Ethics Committee (NHREC) (NHREC/01/01/2007–23/01/2020). Conclusion Pregnant women with multiple of HIV, HBV and HCV infections are at increased risk of hepatotoxicity, maternal and perinatal morbidity and mortality. Additionally, infected pregnant women transmit the virus to their unborn baby even when asymptomatic. Children born with any of the infection have significantly poorer quality of life and lower five-year survival rate. Unfortunately, the seroconversion and MTCT rates of dual or triplex infections among pregnant women in Nigeria have not been studied making planning for prevention and subsequent elimination of the viruses difficult. The study is expected to fill this knowledge gaps. Nigeria joining the rest of the world to eliminate the triple infection among children rest on the availability of adequate and reliable data generated from appropriately designed, and powered study using representative population sample. The establishment of the three-in-one study of prevalence, rate of new infection, rate and risk factor for MTCT of dual and triple infection of HIV, Hepatitis B and C viruses among pregnant women in Nigeria is urgently needed for policy development and planning for the improvement of the quality of life of mothers and the elimination of childhood triplex infection.

George Uchenna Eleje,1,2 Henrietta Aritetsoma Ogbunugafor,1,3 Chiemelu Dickson Emegoakor,1,4 Ebere Innocent Okoye,1,5 Ogochukwu Ifeanyi Ezejiofor,6 Shirley Nneka Chukwurah,7 Joseph Ifeanyichukwu Ikechebelu,1,2 Godwin W Nchinda,8 Chidozie Godwin Ugochukwu,3 Lucy Ijeoma Nnaji-Ihedinmah,9 Festus Basden C Okoye,1,10 Frank Uchenna Eneh,3 Michael Emeka Onwukamuche,11 Charles Okechukwu Esimone1,12 1Biomedicine Research Group, Nnamdi Azikiwe University, Awka, Nigeria; 2Effective Care Research Unit, Faculty of Medicine, College of Health Sciences, Nnamdi Azikiwe University, Awka, Nigeria; 3Department of Applied Biochemistry, Nnamdi Azikiwe University, Awka, Nigeria; 4Department of General Surgery, Nnamdi Azikiwe University, Awka, Nigeria; 5Department of Pharmaceutics and Pharmaceutical Technology, Nnamdi Azikiwe University, Awka, Nigeria; 6Department of Medicine, Nnamdi Azikiwe University, Awka, Nigeria; 7Gastroenterology Unit, Department of Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria; 8Laboratory of Vaccinology/Biobanking, CIRCB BP 3077, Messa Yaounde, Cameroon; 9Department of Chemical Pathology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria; 10Department of Pharmaceutical and Medicinal Chemistry, Nnamdi Azikiwe University, Awka, Nigeria; 11Department of Histopathology, Faculty of Medicine, Nnamdi Azikiwe University, Awka, Nigeria; 12Department of Pharmaceutical Microbiology and Biotechnology, Nnamdi Azikiwe University, Awka, Nigeria Background: To our knowledge, there is no prior randomized study on the utility of Syferol-IHP (blend of virgin coconut oil and Ocimum sanctum oil) when coadministered with a triple therapy schedule.Aim: This study determined the efficacy and safety of Syferol-IHP as adjunct to conventional triple therapy for the treatment of peptic ulcer disease (PUD).Methods: A pilot double-blind randomized trial was conducted in patients with confirmed diagnosis (endoscopy-guided biopsy) of PUD. Eligible patients were randomized to Pylorest (a three-in-one tablet containing rabeprazole 20mg, amoxicillin 1g, and clarithromycin 500mg) and Syferol-IHP for 2weeks, followed by rabeprazole and Syferol-IHP for 2weeks or Pylorest and placebo for 2weeks, followed by rabeprazole and placebo for 2weeks. Repeat endoscopy-guided biopsy and histology were done 4weeks posttherapy. Primary outcome measures were the healing of ulcer and eradication of Helicobacter pylori. Secondary outcome measures were the disappearance of epigastric pain, gastritis, and duodenitis. Analysis was by intention-to-treat.Results: Of the 63 patients enrolled, 60 patients had complete evaluation, with 37 patients receiving Pylorest and Syferol-IHP and 23 patients receiving Pylorest and Placebo. Healing of the PUD in favor of Pylorest and Syferol-IHP was significantly higher for gastric ulcer (RR=0.000, 95% CI=undefined, P=0.048) but not for duodenal ulcer (RR=0.400, 95% CI=0.07–2.37, P=0.241). H. pylori eradication was 100% with Syferol-IHP vs 50% with placebo (P=0.066). Epigastric pain (reduction to 16.2% vs 43.5%; P=0.021), gastritis (reduction to 13.5% vs 39.1%; P=0.024), and duodenitis (reduction to 0% vs 8.7%; P=0.327) were observed in the Syferol-IHP and Pylorest vs placebo and Pylorest groups, respectively. Adverse events (RR=0.971, 95% CI=0.46–2.04, P=0.937) and laboratory parameters were not significantly different pre- and posttherapies (P>0.05, for both groups).Conclusion: Although both treatment arms were equally safe, co-administration of Syferol-IHP and triple therapy is more efficacious than triple therapy alone for treating PUD. Pan African Clinical trial registry identifier number is PACTR201606001665364. Keywords: gastritis, duodenitis, virgin coconut oil, Ocimum sanctum oil, triple therapy, Pylorest, gastric ulcer

Esophageal varices can present with life-threatening hemorrhage and can be managed by surgery or medically. Banding is an endoscopic treatment for variceal bleeding and is a known management option for variceal bleeding but is not widely available in Nigeria due to lack of expertise and equipment. Previously, patients relied on medical management and surgery for treatment; however, these were not effective as mortality rates were high. Few centers in the country are known to offer this procedure to their patients and none has been reported in Southeast Nigeria, hence the justification for reporting our experience managing two cases of bleeding esophageal varices. We report two cases of variceal bleeding on the background of decompensated liver cirrhosis of alcohol and viral etiology, respectively. The first patient was on propranolol, but it was not effective in preventing variceal bleeding. The second patient was not on prophylaxis. Both the patients had variceal banding in NAUTH, Nnewi, and no complications were reported. Variceal banding is a safe procedure and is an effective measure in control of bleeding varices.

Objective: To determine the hepatitis B vaccination coverage, full-dose (⩾3) coverage and the associated factors affecting uptake among pregnant women. Methods: This was a cross-sectional study among pregnant women attending antenatal care in six tertiary hospitals across all the geopolitical zones of Nigeria. Pregnant women who consented to the study completed screening questions about their hepatitis B vaccination status and coverage. The main outcome measures were hepatitis B vaccination coverage rate, dose, and factors affecting uptake. Bivariate analysis was performed by the chi-square test and conditional logistic regression analysis was used to determine variables associated with uptake of the vaccination. Odds ratios (ORs) and adjusted odds ratios (aORs) were calculated and statistical significance was accepted when p-value was Results: Of 159 pregnant women who completed the interview questions, 21 [13.2%, 95% confidence interval (CI) 7.9–18.5%] were vaccinated for hepatitis B for one to three doses. The numbers of doses received were: three doses (8/159, 5.0%), two doses (5/159, 3.1%), and one dose (8/159, 5.0%). The reasons for non-uptake of vaccination included: lack of awareness of the vaccine 83/138 (60.1%), inadequate access to vaccine 11/138 (8.0%), and positivity to hepatitis B virus 10/138 (7.2%). The uptake of hepatitis B vaccination was significantly affected by the level of education (OR 0.284, 95% CI 0.08–1.01, p = 0.041), but in multivariable logistic regression, adjusted for confounders, the association between hepatitis B vaccination and participants’ level of education (aOR 3.09; 95% CI 0.95–10.16; p = 0.061) did not remain significant. Conclusions: In Nigeria, the national hepatitis B vaccination coverage among pregnant women appears poor, with the full-dose coverage even poorer. The level of education was not positively associated with uptake of hepatitis B vaccination, while lack of awareness of the vaccine was the commonest reason for non-uptake. Funding: TETFund National Research Fund 2019 (grant number TETFund/DR&D/CE/NRF/STI/33).