Background and objective: The discovery of innovative pharmacological preventative measures in Human Immunodeficiency Virus transmission has boosted optimism in the successful control of HIV/AIDS with the objective of eradication and the end of the epidemic. Hence, assessing the effect of pre-exposure prophylaxis (PrEP) on HIV prevention among key populations (KPs) is imperative in advancing the conversation on ending HIV/AIDs.
Methods: This was a cross-sectional study using data from KPs (female sex workers (FSWs), men who have sex with men (MSM), and people who inject drugs (PWIDs) enrolled in Heartland Alliance Ltd/GTE One Stop Shops (OSS) between May 2019 and April 2023 in the six selected Nigerian states (Lagos, Bayelsa, Cross River, Akwa Ibom, Jigawa, and Niger). Data were cleaned in a spreadsheet and analyzed using IBM-SPSS version 28.0. Descriptive statistics, including frequency and percentage calculations, were conducted to analyze the dataset. Additionally, cross-tabulation analysis was performed, with a significance level set at 0.05, to explore relationships between variables.
Results: The study population comprised 13,580 participants, with 56.1% female. In all, 43.9% were aged 18-35 and 97.3% were single. Among the three KPs examined, FSW was the largest subgroup (50.8%), followed by MSM (28.1%) and PWID (21.1%). Most participants had been on PrEP for 0-3 months (87.8%), and PrEP was initiated for 81.6% due to high-risk sexual behaviors and 9.9% for serodiscordant relationship reasons. Most of them were enrolled in community healthcare settings (97.0%). The results showed that 99.9% remained HIV negative, while only two (0.01%) were seroconverted while on PrEP. The HIV-positive cases did not complete one-month PreP treatment, comprising an FSW and a PWID. Recent HIV contact or poor compliance with PrEP medication are two possible causes of seroconversion.
Conclusion and global health implications: The findings underscore the significance of integrating PrEP into a comprehensive HIV prevention approach, including newer molecules that will improve adherence and the necessity of ongoing monitoring and support for PrEP users. With these insights, there can be an advocacy for promoting PrEP among the KPs as a vital component of Nigeria's HIV prevention strategy.
Background and objective: Pulmonary injuries resulting from urinary tract infections (UTIs) during pregnancy are rare. Prompt detection of pulmonary complications in pregnant patients with UTIs is crucial to prevent adverse outcomes in both the mother and the fetus. These complications may include respiratory issues, pulmonary edema, and exacerbation of preexisting conditions, such as asthma. We aimed to detect reported cases of pulmonary injury after UTIs among pregnancies.
Methods: We retrospectively reviewed the reported cases and articles in the PubMed database up to September 2023 on pulmonary injury after UTIs among pregnancies through a detailed search strategy. The titles and abstracts of the selected 15 articles were assessed, and ultimately, 7 articles were chosen based on adherence to our inclusion and exclusion criteria.
Results: Approximately 1-2% of women may develop acute pyelonephritis due to persistent UTIs, which has been associated with an increased risk of pulmonary edema in certain cases. UTIs can affect pulmonary health. Uremia, a consequence of UTIs, can lead to alterations in the respiratory drive, mechanics, muscle function, and gas exchange. Furthermore, urinary infection-induced inflammation activates neutrophils and promotes their recruitment to the lungs, compromising lung function and damaging the surrounding tissue.
Conclusion and global health implications: Although systematic research on this topic is limited, there may be a link between UTIs and pulmonary damage. However, it remains unclear whether pregnancy exacerbates this association. For maternal health, child health, and the whole public health, it is important to raise awareness of physicians and gynecologists, as well as the different specialties like emergency and intensive care units, with more information about pulmonary injury after UTI in pregnancy; it is important to note that UTIs may not directly cause pulmonary complications, but physiological changes associated with pregnancy can increase this risk, so more care, observation, early detection, and treatment are critical for treating these complications and achieving best outcome in pregnant women with UTIs. More research is needed in this area, as the mechanism underlying the existence of pulmonary damage post-UTI in pregnancy is unclear.
Background and objective: Hypertension is one of the most common medical complications during pregnancy and a leading cause of maternal mortality and morbidity. Severe preeclampsia is defined as blood pressure (BP) >160/110 mmHg with warning signs such as headache, blurring of vision, and epigastric pain. Nifedipine (C17H18N2O6), labetalol (C19H24N2O3), and hydralazine (C8H8N4) are commonly used drugs, and all are recommended as first-line agents. Hydralazine is associated with a higher incidence of adverse outcomes, so oral nifedipine has been proposed as a first-line alternative to intravenous labetalol. Consequently, this study aims to compare the efficacy and safety of oral nifedipine with that of intravenous labetalol. The objective is to compare the ability/effectiveness of oral nifedipine and intravenous labetalol to normalize acute hypertension in severe preeclampsia and to assess the birth outcome. Relations between different factors were established by appropriate statistical tests. The p-value <0.05 was considered statistically significant.
Methods: The study was conducted on 120 antenatal women with blood pressure ≥160/110 mmHg admitted to our hospital, a tertiary care center, from January 1st, 2020 to June 30th, 2021. Patients were randomized by a single blinding method to receive intravenous labetalol and oral nifedipine. The primary outcome measures were the time taken to control the blood pressure and the number of doses of drugs required. The secondary outcome measures were the birth outcome like a method of delivery, side effect profile, and the number of admissions in the neonatal intensive care unit.
Results: A total of 120 patients were included with 60 patients in each group. The labetalol group took 48.67 ± 17.80 minutes and the nifedipine group took 64.33 ± 9.81 minutes to achieve a target BP of <=140/90 mmHg (p < 0.05). No side effects were seen in 70% of patients in the labetalol group and 71.67% in the nifedipine group (p > 0.05).
Conclusion and global health implications: Intravenous labetalol is faster in restoring blood pressure in pregnant women with preeclampsia than oral nifedipine and may be used as a first-line drug in the acute control of blood pressure in a hypertensive emergency during pregnancy. More studies are needed in order to evaluate the findings from this pilot study in a large sample of patients.
Background and objective: Chronic diseases have progressively increased worldwide, impacting all areas and socioeconomic groups. Periodontal disease is an increasing global concern and contains risk factors similar to other chronic illnesses. The main risk factor for periodontitis is smoking. Smoking not only hastens periodontal disease but also complicates periodontal therapy. Serum glycosylated hemoglobin levels, which are derived from the average life span of an erythrocyte, are a good indicator of glycemic management during the preceding one to three months. This study was undertaken to assess the association between tobacco smoking and periodontal disease by evaluating plaque score, gingival score, extent and severity index (ESI), and glycemic status by estimating serum HbA1c in cigarette smoker patients compared to non-smokers.
Methods: The study was conducted with 40 patients in the age range of 20-40 years. Patients were divided into two groups: non-smokers (Group I) and cigarette smokers (Group II). Periodontal clinical parameters such as the plaque index (PI), gingival index (GI), and ESI were recorded during the oral cavity examination. The biochemical marker, serum glycosylated hemoglobin, was measured in both groups. All parameters were measured at baseline and three months after periodontal therapy. The statistical tests used were the paired t-test, and Chi-square test for comparison between both groups.
Results: The mean difference of PI of non-smokers was 0.33 ± 0.30, and smokers were 0.52 ± 0.32, which was statistically significant. The mean difference of GI of non-smokers was 0.34 ± 0.19 and smokers 0.36 ± 0.303, which was statistically significant. The mean difference of extent in non-smokers was 5.33 ± 1.59, 5.52 ± 2.43, and smokers were 0.18 ± 0.17. The mean difference in severity in non-smokers was 0.18 ± 0.17, and smokers were 0.31 ± 0.25, which was statistically significant. The mean difference of HbA1c in non-smokers and smokers was 0.43 ± 0.277 and 0.415 ± 0.230, which shows a higher mean difference in non-smokers, which was statistically non-significant.
Conclusion and global health implications: This study concluded that each of Group I and Group II showed substantial improvements in all clinical periodontal variables, which include plaque index (PI), gingival index (GI), extent and severity index (ESI), and biochemical marker serum glycosylated hemoglobin. Controlling inflammation with SRP can improve insulin resistance, lower glucose levels, and prevent non-enzymatic glycation of hemoglobin.
Background and objective: Every expectant mother is at risk of complications during pregnancy, delivery, or after delivery. Delays in receiving care with accompanying maternal morbidity and mortality can be significantly reduced with adequate birth preparedness and complication readiness (BPCR). This study aims to determine the factors affecting BPCR among antenatal attendees in Gusau, Zamfara State, a security-challenged setting.
Methods: A cross-sectional study was conducted among pregnant women attending the antenatal clinic at Federal Medical Center, Gusau, Nigeria. Data were collected using a pretested questionnaire and analyzed using the Statistical Package for Social Sciences (SPSS) Version 26. Descriptive data using means, percentages, and frequency were presented in tables. Statistical testing using Chi-square for bivariate analysis and binary logistic regression for multivariate analysis was carried out with a significance level of p < 0.05.
Results: One hundred and forty-seven women were recruited; 111 (75.5%) had good knowledge of the danger signs of pregnancy, labor, and the postpartum period. One hundred and fourteen (77.6%) were birth-prepared and complications-ready. One hundred and ten (75%) identified insecurity as the most important hindrance to BPCR. The respondents with higher educational levels were thrice more likely to be birth-prepared and complications-ready (OR: 2.95, 95% CI: [1.65-5.27]). The women were twice more likely to be birth-prepared and complications-ready with an increase of ₦20,000 ($46.3) in monthly income (OR: 2.53, 95% CI: 1.97-5.29).
Conclusion and global health implications: Education and wealth status are the key determinants of BPCR. Low educational status, financial constraints, and security challenges were identified as barriers that must be addressed to improve maternal and infant well-being.
Background and objective: An important indicator of the quality of antenatal care (ANC) is the satisfaction of the client. Despite this, women in Ethiopia are very dissatisfied with the quality of their ANC. In Ethiopia, a systematic review was conducted to estimate the pooled prevalence of client satisfaction (CS) with ANC services.
Methods: Only articles published in English were included in this review. Medline/PubMed, Web of Science, Google Scholar, Scopus, Ethiopian University Repository Online, and the Cochrane Library are the main databases. The review included cross-sectional studies written in English that met the inclusion requirements. Using a random effects model, the overall rate of CS with prenatal care was calculated. Additionally, Egger's test and funnel plots were used to examine publication bias. STATA version 14 was used to perform all statistical analyses.
Results: This review included 20 studies involving 8447 women attending prenatal care services. In Ethiopia, the overall customer satisfaction rate with prenatal care services was 60.42% (95% CI [51.33.99, 69.51]; I2 = 98.9%, P < 0.001). Previous ANC follow-up, iron and folic acid supplementation, and the last planned pregnancy were statistically associated with CS.
Conclusion and global health implications: In Ethiopia, 60% of women are satisfied with their ANC. This shows that 40% of women are dissatisfied with the prenatal care provided by healthcare professionals. This will lead to a low utilization of ANC services throughout the country. Therefore, the Ethiopian government, especially the Ministry of Health and nongovernmental organizations (NGOs), must take measures to address this severity and improve identified factors.
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