Introduction: WHO's global target of eliminating cervical cancer is just 5 years away, and women living in low-resource settings like Nigeria may be left behind, because a significant proportion may not be aware of cervical cancer and its preventive measures. Thus, there is an urgent need to review and possibly scale up awareness of cervical cancer prevention among women residing in rural communities in Nigeria through free medical outreach programs. The aim of this study was to assess the level of awareness and perceptions of cervical cancer prevention among participants of a community health outreach program in Ituku, Enugu State, Nigeria.Methods: This mixed-methods study was a quantitative survey of 352 participants and qualitative interviews of 10 purposively selected women attendees at the 2024 free medical outreach at the community of Ituku, Awgu local government area, Enugu State. A pre-tested and validated questionnaire was used to collect data from participants. Quantitative data analysis was done using the Statistical Package for the Social Sciences, while thematic analysis was done for qualitative components.Results: Out of 525 eligible women who attended the health outreach, 352 (67.0%) were recruited into the study. Awareness of cervical cancer was reported by 27.8% (n=98) of respondents, while 27.3% (n=96) were aware of cervical cancer screening methods. Only 9.1% (n=32) had heard of HPV vaccination as a preventive measure, and 4.5% (n=16) were aware that HPV infection is a causative factor for cervical cancer. Only 4.5% (n=16) of respondents had ever undergone cervical cancer screening. Awareness of screening methods was associated with age of 40 years or less and being Roman Catholic, while willingness to vaccinate children was associated with having formal education.Conclusion: In a rural community in Enugu State, Nigeria, only 3 out of every 10 women were aware of cervical cancer and its preventive measures. Although 1 in every 10 knew that HPV vaccination prevents against cervical cancer, over 9 of 10 of them were willing to vaccinate their children. To join the global community in eliminating cervical cancer by 2030, there is an urgent need to intensify awareness campaigns through outreach programs targeting rural dwellers in low- and middle-income countries about cervical cancer, its etiology and prevention.

Background: Intestinal helminthiasis (IH) in pregnancy is an important public health issue that depletes iron stores with poor maternal and neonatal outcomes. The study aimed to determine the prevalence of IH and its relationship with maternal haemoglobin (Hb) concentration among pregnant women in rural communities of Enugu state, Nigeria. Materials and Methods: This was a cross-sectional study conducted among 405 pregnant women in rural primary health centres of Enugu State, Nigeria. Stool and blood were collected using screw-capped bottle with applicator and HemoCue photometer, respectively. Data were analysed using IBM Statistical Product and Service Solutions software version 25. Statistical test was set at 0.05. Results: The mean age of the participants was 28.3 ± 5.40. The prevalence of helminthiasis was 9.2% of which majority, 94.6% was of hookworm type. About four-fifth, 81.1% of helminth-infected pregnant women were anaemic compared to one-fifth and 12.3% of non-helminth infected pregnant women. The differences in the mean Hb concentration were significant (t = −8.375, P < 0.0001). The risk of anaemia among helminth-infected pregnant women was 31 times. There was a significant strong negative correlation between helminthiasis count and haemoglobin concentration (R = −0.833, P < 0.0001). Conclusion: Infected helminthiasis in pregnancy was sub-endemic with hookworm the most common. The risk of anaemia was higher among helminth-infected pregnant women. The relationship with anaemia was a strong negative correlation. Helminthiasis prevention should be strengthened in antenatal services.

OBJECTIVE:This study assesses the process and adequacy of informed consent for elective and emergency caesarean section in two teaching hospitals in Enugu, South-East Nigeria. METHODS:This was a descriptive cross-sectional study. Pre-tested questionnaires were administered to consenting 386 mothers after caesarean sections at the postnatal wards of University of Nigeria Teaching Hospital (UNTH) Ituku-Ozalla, and Enugu State University Teaching Hospital (ESUTH), Enugu. The adequacy of maternal counseling was assessed by evaluating the basics of the consent process for caesarean section. Descriptive statistics, including counts and percentages, were used to summarize the data, and 95% confidence intervals (CIs) were calculated to assess the precision of the estimates using the IBM Statistical Product and Service Solutions (IBM-SPSS) Statistics for Windows, version 25. RESULTS:Of the 386 respondents, the majority (29.8%) were in the 31-35 age group and most of the respondents (56.7%) had tertiary level of education. The proportion of women who received adequate counseling for caesarean section was 41.7%. The prevalence of adequate informed consent among women who had elective versus emergency caesarean section was 67.9% and 39.9%, respectively, (OR = 3.2, CI 95% [2.40-4.28]). Only 20.2% (78) of the respondents had full documentation of the consent process in their case notes, including the patient's response after being given the relevant information. CONCLUSION:Overall, there was inadequate maternal counseling at the two teaching hospitals in Enugu State, Nigeria, which provide are the highest level of health care in the state. Adequate and consistent counseling for caesarean section can be achieved in the study area using standardized consent forms and healthcare workers' training in patient communication and counseling.

Obstetric anal sphincter injuries (OASIS) are serious complications of vaginal birth. The burden is expected to be high in Nigeria due to high fertility and aversion to caesarean section (C/S); however, the incidence, effects on urinary incontinence (UI)/anal incontinence (AI), and quality of life (QoL) are largely unknown. This study determined the incidence of and risk factors for OASIS, as well as the effects of OASIS on UI/AI after childbirth, and QoL. A prospective cohort study of post-partum women in Nigeria over a 16-month period, from January 2022 to April 2023. The study consisted of three groups—the OASIS group (group A) and two comparison groups (groups B and C). Group A had OASIS, group B had episiotomy/2nd degree spontaneous perineal tear (SPT), while group C had intact perineum/1st degree SPT. The women were followed-up for 3 months to determine incidence of and risk factors for OASIS, as well as the effects of OASIS on UI/AI, and QoL using validated questionnaires. There were 3027 vaginal births with 60 OASIS (1.98

The perennial underperformance of the Nigerian Health System necessitated enhanced advocacy for health to be placed at the centre of a renewed social contract and as a means of bolstering public trust. The hospital management of the University of Nigeria Teaching Hospital (UNTH) introduced initiatives to improve the hospital’s operational environment and service performance in response to the population served. Following these changes, an Organizational Capacity Assessment (OCA) is critical to direct further development in the organization. A comprehensive Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis was conducted for the UNTH across twelve broad areas. The Modified Delphi Technique was adopted for the identification and prioritization of the organizational SWOTs. Thirty key stakeholders and leaders in the organization were first consulted to identify the SWOTs. This was followed by a structured ranking of the SWOTs by 109 staff of UNTH to isolate the priority assets and needs of the organization. The top strengths were mainly related to the hospital's resources like its large expanse of land, staff capabilities like their skills and training, as well as their prevailing language, and existing hospital partnerships. The identified weaknesses were associated with challenges such as transportation for staff to work, infrastructure (lack of staff accommodation and office space), and health workforce shortages due to migration. The highest ranked opportunity was in the Epidemiology and Disease Surveillance broad area while the highest ranked threat was in the leadership and governance broad area. This SWOT analysis has highlighted the strategic aspects of UNTH's operations. By identifying its internal strengths and weaknesses and external opportunities and threats, the hospital can thus formulate effective strategies to enhance its performance and maintain its position as a leading healthcare institution.

This study determined the feasibility of investing revenues raised through Nigeria's sugar-sweetened beverage (SSB) tax of 10 Naira/l to support the implementation of the National, Surgical, Obstetrics, Anaesthesia and Nursing Plan, which aims to strengthen access to surgical care in the country. We conducted a mixed-methods political economy analysis. This included a modelling exercise to predict the revenues from Nigeria's SSB tax based on its current tax rate over a period of 5 years, and for several scenarios such as a 20% ad valorem tax recommended by the World Health Organization. We performed a gap analysis to explore the differences between fiscal space provided by the tax and the implementation cost of the surgical plan. We conducted qualitative interviews with key stakeholders and performed thematic analyses to identify opportunities and barriers for financing surgery through tax revenues. At its current rate, the SSB tax policy has the potential to generate 35 914 111 USD in year 1, and 189 992 739 USD over 5 years. Compared with the 5-year adjusted surgical plan cost of 20 billion USD, the tax accounts for ∼1% of the investment required. There is a substantial scope for further increases in the tax rate in Nigeria, yielding potential revenues of up to 107 663 315 USD, annually. Despite an existing momentum to improve surgical care, there is no impetus to earmark sugar tax revenues for surgery. Primary healthcare and the prevention and treatment of non-communicable diseases present as the most favoured investment areas. Consensus within the medical community on importance of primary healthcare, along the recent government transition in Nigeria, offers a policy window for promoting a higher SSB tax rate and an adoption of other sin taxes to generate earmarked funds for the healthcare system. Evidence-based advocacy is necessary to promote the benefits from investing into surgery.

SETTING:This study is a retrospective review of a large-scale systematic TB screening project conducted in six states of Nigeria. OBJECTIVE:To determine the magnitude and characteristics of subclinical TB and the relative contributions of bacteriological versus clinical diagnosis in its identification in Nigeria. DESIGN:Data were retrospectively analysed from six states of Nigeria, where parallel screening with any TB symptoms and chest X-ray (CXR) with artificial intelligence (AI) was used for active case finding. Diagnosis of TB among presumptive was confirmed using either bacteriological tests or clinical review of CXR. RESULTS:Out of 8,516 presumptive identified during the project, 172 (2.0%) had no TB symptoms (males: 73.8%, females: 26.2%). The overall prevalence of TB among all presumptive was 21.9% (n = 1,867), including 62 (3.3%) subclinical TB and 1,805 (97.3%) active TB cases. The proportion of clinical diagnosis using CXR was significantly higher in the subclinical TB group than in the active TB group (79.0% vs. 63.5%; P = 0.012, OR = 2.2, 95% CI 1.17-4.03). CONCLUSION:Subclinical TB contributed 3.3% of the large TB burden in this study (22 per 100 presumptive). These cases would have been missed if only symptom-based TB screening had been employed.

BACKGROUND:Son preference is known to be prevalent in developing countries and has dire consequences for the family, particularly girls and women. It is speculated that the prevalence of son preference may be high among fertility clinic attendees, and that son preference may be the reason for seeking fertility care in Nigeria. OBJECTIVES:To determine the prevalence and risk factors for son preference among fertility seekers in Enugu, Nigeria. MATERIALS AND METHODS:Questionnaire-based cross-sectional study of fertility clinic attendees from the University of Nigeria Teaching Hospital Ituku-Ozalla Enugu and the Pink Petals Fertility Clinic Enugu from April 1 to September 30, 2023. Eligible and consenting participants were interviewed. Data collection was with a pretested interviewer-administered questionnaire, which contained three sections: biodata, obstetrics and gynecological data and 3-point son preference questions. The proportion of those who scored 3 (son preference) was documented. The analysis was both descriptive and inferential using IBM SPSS statistics for Windows, version 22.0 Armonk, NY, USA: IBM Corp. RESULTS:Of the 422 participants interviewed, 416 (98.6%) completed the study with a nonresponse rate of 6 (1.4%). The overall prevalence of son preference was 10.1% (42/416) and all 42 (10.1%) were in the clinic to have a male baby. The risk factors for son preference were less than tertiary education (P < 0.001, adjusted odds ratio [AOR] = 6.46, confidence interval [CI] 2.79-14.98) and family pressure to have a male baby (P = 0.03, AOR = 3.41, CI 1.72-7.13). CONCLUSIONS:One in 10 couples who attend an infertility clinic in Enugu, Nigeria, has a preference for son, and having a male child is the sole purpose of such a visit. Being under family pressure and not having tertiary education were the predictive risk factors for son preference in the study population.

Context: It is speculated that obstetrics health workers in Nigeria may be lacking adequate knowledge of the Labour Care Guide (LCG) tool. Aim: To determine the awareness, level of knowledge, perceptions, and impediments toward use of the LCG tool for management of labor by doctors and nurses in Nigeria. Materials and Methods: This is a mixed-method study of 201 doctors and nurses at six selected health facilities in Enugu, Nigeria, over a 1-month period. For the quantitative component of the study, eligible and consenting participants were randomly selected and interviewed using a pretested questionnaire, while for the qualitative component, the six heads of labor ward nurses were purposively selected and in-depth interview conducted on the use, reasons for nonuse, and impediments to the use of LCG. Statistical Analysis: Statistical analysis was performed using IBM Statistical Package for Social Sciences for Windows, version 24.0 (Armonk, NY) for quantitative data. It was descriptive and inferential. The level of significance was set at P < 0.05. For qualitative data, thematic analysis was done. Result: A total of 168 (83.6%) were aware of LCG; 60 (35.7%) had poor knowledge (mean score: 20.1 +/- 7.5), and 89 (53.0%) had negative perception (mean score: 0.11 +/- 0.11). Impediments to LCG use included being time-consuming, insufficient manpower, insufficient knowledge, and lack of training. Negative perception was associated with poor knowledge of LCG (P < 0.001, AOR =60.9, CI =13.9-267.1). Conclusion: One in three obstetric care workers has poor knowledge of LCG in labor care. We recommend creating training opportunities for them at all levels of healthcare on the use of LCG.

Background: In 2022, KNCV Nigeria’s social media messaging strategy leading up to World Tuberculosis Day (WTBD) shifted from organisational stories to success stories. Objective: The objective of this study was to compare the impacts of the pre-WTBD social media messages used before 2022 (organisational stories) with the type used in 2022 (success stories). Materials and Methods: The reach and engagement of the KNCV Nigeria pre-WTBD organisational stories for 2021 and success stories for 2022 were retrieved from Facebook and Instagram and compared. Results: The reach of the success stories was 18,297 persons while that of organisational stories was 7817 persons. Furthermore, the overall engagement of 795 in 2022 was significantly higher than 267 in 2021 (P < 0.001). Conclusion: KNCV Nigeria’s pre-WTBD success stories reached a significantly larger audience and generated higher engagement on social media organisational stories.

Background Despite the increased risk of cervical cancer (CC) among women living with HIV (WLHIV), CC screening and treatment (CCST) rates remain low in Africa. The integration of CCST services into established HIV programs in Africa can improve CC prevention and control. However, the paucity of evidence on effective implementation strategies (IS) has limited the success of integration in many countries. In this study, we seek to identify effective IS to enhance the integration of CCST services into existing HIV programs in Nigeria. Methods Our proposed study has formative and experimental activities across the four phases of the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework. Through an implementation mapping conducted with stakeholders in the exploration phase, we identified a core package of IS (Core) and an enhanced package of IS (Core+) mostly selected from the Expert Recommendations for Implementing Change. In the preparation phase, we refined and tailored the Core and Core+ IS with the implementation resource teams for local appropriateness. In the implementation phase, we will conduct a cluster-randomized hybrid type III trial to assess the comparative effectiveness of Core versus Core+. HIV comprehensive treatment sites ( k = 12) will be matched by region and randomized to Core or Core+ in the ratio of 1:1 stratified by region. In the sustainment phase, we will assess the sustainment of CCST at each site. The study outcomes will be assessed using RE-AIM: reach (screening rate), adoption (uptake of IS by study sites), IS fidelity (degree to which the IS occurred according to protocol), clinical intervention fidelity (delivery of CC screening, onsite treatment, and referral according to protocol), clinical effectiveness (posttreatment screen negative), and sustainment (continued integrated CCST service delivery). Additionally, we will descriptively explore potential mechanisms, including organizational readiness, implementation climate, CCST self-efficacy, and implementation intentions. Discussion The assessment of IS to increase CCST rates is consistent with the global plan of eliminating CC as a public health threat by 2030. Our study will identify a set of evidence-based IS for low-income settings to integrate evidence-based CCST interventions into routine HIV care in order to improve the health and life expectancy of WLHIV. Trial registration Prospectively registered on November 7, 2023, at ClinicalTrials.gov no. NCT06128304. https://classic.clinicaltrials.gov/ct2/show/study/NCT06128304

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.

Introduction Despite much emphasis on the reproductive health of women, maternal mortality is still high, especially in postnatal period. Objective To assess the prevalence of postnatal care use and reasons for defaults among mothers attending the child immunization clinics in Enugu, Nigeria. Methods This 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. Result The 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). Conclusion Postnatal 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.

Dear Editor, Assisted reproductive technology (ART), according to the Centers for Disease Control, is defined as all fertility treatments in which eggs or embryos are handled in vitro. It completely excludes treatments in which only spermatozoa are handled or ovarian stimulation without oocyte retrieval. ART such as in vitro fertilization and embryo transfer (IVF-ET) has revolutionized infertility treatment in both developed and developing countries and has resulted in improved live birth rates among infertile couples. According to the Human Fertility and Embryology Authority (HFEA), between 1991 and 2019, over 1 million IVF cycles and 260,000 donor insemination cycles resulted in 390,000 babies being born in the UK.[1] These figures are quite high and are in line with the advances in IVF + ET techniques in developed nations. In Nigeria, the procedure has witnessed tremendous success since the first documented success of IVF in 1984, particularly in privately operated fertility clinics. There is an increasing demand for IVF services globally. In developed countries such as the UK, in a population-based study, more than 50% of infertile couples required ART.[2] These couples received treatment from private facilities, HFEA-licensed tertiary facilities, and non-HFEA-licensed secondary care facilities.[2] Similarly, increasing trends in the demand for such services have also been reported in Nigeria. The demand may be due to increased success rates, awareness, the advanced age of women at first conception, the high prevalence of tubal factor infertility due to sexually transmitted diseases, post-abortion complications, puerperal sepsis, or severe male factor infertility. These factors are the main indications for IVF and are common in Nigeria. Despite the high demand for IVF in sub-Saharan Africa, only 1.5% of the population receives these services.[3] According to The Guardian newspaper, Nigeria, with a population of more than 200 million, was reported to have provided only 7000 IVF cycles per year in 100 clinics in 2022. This presents a serious unmet need that has been perceived to be worse than the available report,[4] which is the motivation for this letter. Access to IVF services in sub-Saharan Africa is strongly limited due to their expensive nature; where it is available, unavailability, lack of expertise, and poor acceptability of such services. IVF services are commonly provided by profit-driven private fertility clinics and a few tertiary hospitals in Nigeria. The condition is even worse for couples seeking fertility care because Nigeria's National Health Insurance Scheme excludes IVF services from its scope of operations.[5]Worse still, where IVF services are not available as in the tertiary facilities, the patients usually seek the services of private fertility clinics at exorbitant fees. For instance, a decade ago, at the University of Nigeria Teaching Hospital Enugu, 27.9% of 168 patients who needed IVF could not get it and were referred to private fertility clinics.[4] This figure is envisaged to be the tip of the iceberg on the magnitude of the condition in other tertiary facilities in Nigeria. Unfortunately, despite the expected increase in this population, they appear to be ignored, neglected, and unspoken of, and that worries me. This condition causes psychological distress, especially for those who may not be able to afford the exorbitant fee for IVF services at private fertility clinics. Due to the perceived under-reported nature of the condition and the need to bring it to the attention of the scientific community and policy makers, I have decided to write to you. Authors Contribution JEN was responsible for study conception; JEN, CCD, MIE, EOU, and UIN were involved in literature review, preparing the manuscript for intellectual content, revising the manuscript, and approving the manuscript for publication. Ethical approval Not required for this letter. Informed consent Not required for this letter. Availability of research data Not required for this letter. Declaration of Helsinki Authors declare that the study was conducted in accordance with ethical principles of Helsinki declaration. Acknowledgment Nil. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

SETTING: KNCV Nigeria implements seven key TB case-finding interventions. It was critical to evaluate the efficiency of these interventions in terms of TB yield to direct future prioritisation in the country.OBJECTIVES: To compare the efficiency of active case-finding (ACF) interventions for TB in Nigeria.DESIGN: Data from the 2020-2022 implementing period were analysed retrospectively. Intervention efficiencies were analysed using the number needed to screen (NNS), the number needed to test (NNT) and the true screen-positive (TSP) rate.RESULTS: Across the interventions, 21,704,669 persons were screened for TB, 1,834,447 (8.5%) were presumed to have TB (7.7% pre-diagnostic drop-out rate) and 122,452 were diagnosed with TB (TSP rate of 7.2%). The average TSP rate of interventions that used both the WHO four-symptom screen (W4SS) and portable digital X-ray (PDX) screening algorithm was significantly higher (22.6%) than those that employed the former alone (7.0%; OR 3.9, 95% CI 3.74-3.98; P < 0.001). The aver-age NNT for interventions with W4SS/PDX screening was 4 (range: 4-5), while that of W4SS-only screening was 14 (range: 11-22).CONCLUSIONS: Interventions using the PDX in addition to W4SS for TB screening were more efficient in terms of TB case yield than interventions that used symptom-based TB screening only.

Dear Editor, The COVID-19 pandemic has increased the global burden of TB.1 Nigeria is a high-burden country for TB, TB-HIV and multidrug-resistant TB (MDR-TB).1 In 2020, out of an estimated 452,000 incident TB cases in Nigeria, only 135,784 cases were notified.2 One of the strategies deployed by the National TB Programme (NTP) to find the missing TB cases is contact investigation (CI), which serves as an effective method for the timely diagnosis of TB patients and provision of TB preventive treatment (TPT) to eligible contacts.3 Although it is known that CI by NTPs will lead to earlier TB case detection and treatment,4 the practice in Nigeria has been largely passive and not client-centred. To improve the effectiveness of CI in Nigeria, the KNCV Tuberculosis Foundation introduced a client-centred approach through the USAIDfunded TB LON Project. We present the results of this approach in this article. From October 2020 to September 2021, KNCV Nigeria implemented active CI in 14 TB LON Project states (Bauchi, Kaduna, Katsina, Kano, Nasarawa, Plateau, Taraba, Anambra, Akwa Ibom, Benue, Cross River, Delta, Imo and Rivers). In each state, DOTS officers and health facility staff providing ad hoc TB screening were assessed and trained as contact investigators. The selected contact investigators were able to leverage the trust capital built with patients and were sensitive to cultural differences. Bacteriologically diagnosed pulmonary TB index cases (including childhood TB, MDR-TB and TB-HIV cases) were mapped, and their addresses compiled. The contact investigators visited the household of each assigned index case at a convenient time. Household contacts were identified, counselled and screened for TB. The WHO-four-symptom screen (W4SS),5 comprising cough, fever, night sweats and weight loss, was conducted for each consenting contact. A spot sputum specimen was collected from each presumptive contact and transported in a cold box to an assigned diagnostic facility for same-day Xpert test. Anyone who could not produce sputum was linked, at no cost, to chest X-ray facilities for clinical diagnosis. Diagnosed TB patients were offered treatment. Asymptomatic contacts were linked to health facilities for TPT eligibility assessment, and consenting eligible contacts were placed on TPT as appropriate. We conducted a cross-sectional study using de-identified programme data on CI extracted from an electronic platform used to record project data (CommCare app). Data were exported to SPSS version 21 for descriptive and inferential data analyses. P , 0.05 was considered statistically significant. Ethics approval was not required for this study because de-identified pooled programme data were used. Verbal consent was sought from index TB patients before household visits and from contacts before screening. All diagnosed TB patients were offered treatment. During the 1-year project, 28,354 TB index cases (males: 16,316, 57.5%; females: 12,038, 42.5%) had their contacts screened for TB. In all, 148,694 eligible contacts (males: 75,406, 50.7%; females: 73,288, 49.3%) were screened, giving an average of six screened contacts per index case. Out of all contacts screened, 45,258 (30.4%) presumptive TB cases were identified with a male to female proportion of 0.51 to 0.49, respectively (odds ratio [OR] 1.0, 95% confidence interval [CI] 0.97–1.02; P1⁄4 0.601) and modal age group for all contacts screened was 15–24 years. The details of the demographic characteristics of index cases, contacts and presumptive TB are shown in the Table. Of the 42,923 presumptive TB cases evaluated, 3,617 TB cases were identified, giving a TB prevalence of 8.4% among presumptive and 2.4% among the contacts screened. Prevalence of TB among male contacts was higher than among female contacts (2.7%, 2,001/75,406 vs. 2.2%, 1,616/ 73,288; OR 1.2, 95% CI 1.13–1.29; P , 0.001). For all contacts screened, the number needed to screen (NNS) was 42, while the number needed to test (NNT) was 12. The 25–34-years age group had the highest number of TB cases (n 1⁄4 811, 22.4%). Childhood TB contributed 15.0% of all confirmed TB cases. Twenty-seven (0.7%) TB cases were drugresistant, with a male to female ratio of 2:1. In all, 3,552 (98.2%) TB cases diagnosed were placed on treatment. Out of the eligible number, only 4,640 (29.0%) persons were placed on TPT. This one-year CI intervention was part of efforts to identify missing TB cases and improve TB case notification. Due to the large scope of the intervention, symptom screening was used to identify presumptive TB and diagnosis was done using Xpert test and chest radiography for clinical evaluation

This study aimed to evaluate the pregnancy rates, adverse reactions, and medication costs of two luteal phase support regimens: oral dydrogesterone and micronized vaginal progesterone (MVP) pessary in in vitro fertilization cycles. A randomized open-label trial with participants randomly assigned to either 400 mg MVP twice daily or 10 mg dydrogesterone three times daily. The primary endpoints were pregnancy rates, and the secondary endpoints included tolerance, miscarriage rates, and medication cost. Per-protocol principle analysis was performed. The baseline characteristics of the 162 participants were similar. Dydrogesterone had statistically similar (p>0.05) positive pregnancy test rates fifteen days post embryo transfer (35.8% vs . 32.7%), clinical pregnancy rates at the gestational age of 6 weeks (32.1% vs . 28.8%), ongoing pregnancy rates (26.4% vs . 23.1%) and miscarriage rates at 14 weeks of gestation (9.2% vs . 9.4%) and safety profile to MVP. Dydrogesterone was better tolerated as vaginal itching was significantly more prevalent in the MVP arm (p=0.008). Dydrogesterone is significantly less expensive than MVP pessary. Oral dydrogesterone and MVP pessary had similar pregnancy rates and adverse effects. Dydrogesterone appears more user-friendly and less expensive in cases of luteal-phase support in in vitro fertilization cycles.

Background Cervical cerclage is the procedure of choice for preventing preterm delivery due to cervical insufficiency. The indication for its application may be based on the woman's reproductive history, findings at ultrasound, or clinical findings on vaginal examination. Pregnancy outcomes from these indications are variable according to the available literature. Objective To compare the effectiveness and reproductive outcomes (miscarriage, preterm birth rates, and birth weights) of McDonald's cervical cerclage after history-indicated and ultrasound-indicated cervical cerclage in pregnant women. Methods The retrospective cohort study was conducted at Life International Hospital Awka, Nigeria and Life Specialist Hospital Nnewi, Nigeria. Pregnant women, who had a McDonald's cervical cerclage performed due to either history or ultrasound indication between January 1, 2011, and December 31, 2020, were included in the study. Women with multiple pregnancies and those with physical examination-indicated or emergency cerclages were excluded. The main outcome measures included the prevalence of cervical cerclage, miscarriage, and preterm delivery rates. Outcomes were compared between groups with the chi-square test, Fisher's exact test, or Student's t test. p value of < 0.5 was set as significant value. Results Overall, during the study period, 5392 deliveries occurred in the study sites, of which 103 women had a history-indicated or ultrasound-indicated cervical cerclage. This resulted in a 1.91% prevalence rate for history-indicated and ultrasound-indicated cervical cerclage. Of these, 68 (66%) had history indicated, while 35 (34%) had ultrasound-indicated cerclage. There was no difference in the sociodemographic characteristics of both groups. Both groups had similar miscarriage rates: 1.18 in 1000 and 1.04 in 1000 deliveries, respectively (RR 1.160, 95% CI: 0.3824 to 3.5186, p = 0.793). There was more preterm delivery in history-indicated cerclage than ultrasound-indicated cervical cerclage (26.50% vs. 17.10%; p = 0.292), though the difference was not statistically significant. The ultrasound group had a higher average birthweight than the history group (2.67 ± 0.99 vs. 2.53 ± 0.74). However, this difference was not statistically significant. Conclusion The effectiveness and reproductive outcomes (miscarriage, preterm birth rates, and birth weights) of pregnant women with cervical cerclage due to history-indicated and ultrasound-indicated cervical cerclage appear similar. When needed, cervical cerclage should be freely applied for cervical insufficiency, irrespective of the type of indication.

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.

Background: Undiagnosed tuberculosis (TB) cases are the major challenge to TB control in Nigeria. An early warning outbreak recognition system (EWORS) is a system that is primarily used to detect infectious disease outbreaks; this system can be used as a case-based geospatial tool for the real-time identification of hot spot areas with clusters of TB patients. TB screening targeted at such hot spots should yield more TB cases than screening targeted at non-hot spots. Objective: We aimed to demonstrate the effectiveness of an EWORS for TB hot spot mapping as a tool for detecting areas with increased TB case yields in high TB-burden states of Nigeria. Methods: KNCV Tuberculosis Foundation Nigeria deployed an EWORS to 14 high-burden states in Nigeria. The system used an advanced surveillance mechanism to identify TB patients' residences in clusters, enabling it to predict areas with elevated disease spread (ie, hot spots) at the ward level. TB screening outreach using the World Health Organization 4-symptom screening method was conducted in 121 hot spot wards and 213 non-hot spot wards selected from the same communities. Presumptive cases identified were evaluated for TB using the GeneXpert instrument or chest X-ray. Confirmed TB cases from both areas were linked to treatment. Data from the hot spot and non-hot spot wards were analyzed retrospectively for this study. Results: During the 16-month intervention, a total of 1,962,042 persons (n=734,384, 37.4% male, n=1,227,658, 62.6% female) and 2,025,286 persons (n=701,103, 34.6% male, n=1,324,183, 65.4% female) participated in the community TB screening outreaches in the hot spot and non-hot spot areas, respectively. Presumptive cases among all patients screened were 268,264 (N=3,987,328, 6.7%) and confirmed TB cases were 22,618 (N=222,270, 10.1%). The number needed to screen to diagnose a TB case in the hot spot and non-hot spot areas was 146 and 193 per 10,000 people, respectively. Conclusions: Active TB case finding in EWORS-mapped hot spot areas yielded higher TB cases than the non-hot spot areas in the 14 high-burden states of Nigeria. With the application of EWORS, the precision of diagnosing TB among presumptive cases increased from 0.077 to 0.103, and the number of presumptive cases needed to diagnose a TB case decreased from 14.047 to 10.255 per 10,000 people.