Effect of trace elements in the immune system of pregnant women attending antenatal clinic in alex ekwueme federal university teaching hospital

Copper, iron, selenium and zinc are important trace elements during pregnancy. They function as antioxidants and play major roles in strengthening the immune system. This study evaluates the importance of these trace elements in the immune system and their concentrations during pregnancy. These trace elements were evaluated using 75 pregnant women attending antenatal clinic in Alex Ekwueme Federal University Teaching Hospital, Abakaliki as Test participants and 75 non-pregnant women were used as control participants. The analysis was done using Atomic Absorption Spectrophotometer. The socio-demographic, Obstetrics and Gynaecological characteristics of the participants were obtained using questionnaire. A cross-sectional comparative study design was adopted for this. The results showed that the mean and standard deviation (M±SD) in mg / l of the test and control of trace elements (copper, iron, selenium and zinc) are; 0.13±0.03 and 0.38±0.03, 0.48±0.07 and 0.82±0.09, 0.86±0.11 and 0.94±0.07, 0.52±0.07 and 0.52±0.05 respectively. Also mean levels of Cu and Fe were significantly decreased in the pregnant women than in control (p=<0.001; 0.002) respectively. Nevertheless, there was no statistically significant differences between selenium and zinc levels in the pregnant women when compared to their controls (p=0.575; 0.982) respectively. Low concentration of iron is suggestive of iron deficiency and this study revealed 65.3% non-compliance to routine iron supplement given during antenatal. Trimester, age and parity appeared not to have any significant effect on the level of these trace elements. Hence, there is need to ensure the intake well-balanced meal to optimize copper levels during pregnancy.

Isolation, Marginalisation and Disempowerment – Understanding How Interactions with Health Providers Can Influence Smoking Cessation in Pregnancy

BackgroundMaternal smoking during pregnancy can lead to serious adverse health outcomes for both women and their infants. While smoking in pregnancy has declined over time, it remains consistently higher in women with lower socioeconomic circumstances. Furthermore, fewer women in this group will successfully quit during pregnancy. AimThis study explores the barriers to smoking cessation experienced by socially disadvantaged pregnant women and investigates how interactions with health providers can influence their smoking cessation journey.Methodsomen (either pregnant or birthed in the previous 10 years, who smoked or quit smoking in pregnancy) were recruited from a metropolitan public hospital antenatal clinic in South Australia and community organisations in surrounding suburbs. Seventeen women participated in qualitative semi-structured small focus groups or interviews. The focus groups and interviews were recorded, transcribed and thematically analysed. FindingsFour interconnected themes were identified: 1) smoking embedded in women’s challenging lives and pregnancies, 2) cyclic isolation and marginalisation, 3) feeling disempowered, and 4) autonomy and self-determination. Themes 3 and 4 are characterised as being two sides of a single coin in that they coexist simultaneously and are inseparable. A key finding is a strong unanimous desire for smoking cessation in pregnancy but women felt they did not have the necessary support from health providers or confidence and self-efficacy to be successful.ConclusionWomen would like improvements to antenatal care that increase health practitioners’ understanding of the social and contextual healthcare barriers faced by women who smoke in pregnancy. They seek assistance from health providers to make informed choices about smoking cessation and would like women-centred care. Women feel that with greater support, consistency and encouragement from health providers they could be more successful at antenatal smoking cessation.

Incidence of Asymptomatic Bacteriuria in Pregnant Women

Background: Asymptomatic bacteriuria is the presence of bacteria in the properly collected urine of a patient that has no signs and symptoms of urinary tract infection. Aim: This study was carried out to determine the incidence of asymptomatic bacteriuria in pregnant women in Saveetha medical college, Thandalam, Tamil Nadu. Materials and Methods: A total of 250 pregnant women attending antenatal clinic at civil hospital, Saveetha medical college, over a period of 3 months, with age groups between 18 to 30 years agreed to enter the study and were clinically evaluated. All these women were asked to submit clean catch midstream urine samples and it was examined under the microscope and by culture method. Results: A total of 250 pregnant women included in our study, with varying age groups between 18 to 30 years and the highest incidence was seen in between the 26 to 30 age group. Asymptomatic bacteriuria was seen in 27.2% of the pregnant women. The prevalence of Escherichia coli was among the most dominant organism, followed by Staphylococcus aureus ,klebsiella and proteus species. Conclusion: The study showed 27.2% of the pregnant women to have asymptomatic bacteriuria. This can be reduced by screening the mothers in first trimester and routine urine culture test must be carried out.

Prevalence of Hepatitis B Virus (HBV) among Antenatal Clinic Attendees in Karu Local Government Area, Nasarawa State, Nigeria

The aim of this research was to determine the prevalence of Hepatitis B virus (HBsAg) among antenatal clinic attendees in Massaka, Karu Local Government Area of Nassarawa State, North Central Nigeria. Formal consent was obtained from the State Hospital Board to carry out the survey. The study which involved 200 pregnant women aged 18-45 years randomly selected using a systematic random sampling technique was conducted between the months of May-June was a cross sectional health facility-based study. Structured questionnaire was used to generate data from respondents, after which blood samples aseptically collected were screened for hepatitis B surface antigen. Socio-demographic characteristics as well as some of the factors that influence infection were evaluated. Results obtained from the study revealed a 6.5% prevalence rate of infection in the studied population. Prevalence of infection among the subjects within the age range of 35-45 years was lowest (5.8%). However, while it was 5.2% for the married, it was 6.6% for the unmarried. Prevalence of infection was higher among the category with no formal education. Similarly, prevalence was higher among the rural dwellers (6.8%) than their urban counterparts (5.6%). Factors examined were not statistically significant predisposing to HBV infection. In conclusion, the prevalence of HBsAg among ante-natal clinic attendees in Masaka was (6.5%) lower than the reported national prevalence (14.1%). Owing the outcome of this study, it is recommended that improved surveillance for HBV infection and screening of women attending ANC be instituted.

Translation, Cross-Cultural Adaptation and Validation of the Gestational Diabetes Mellitus Knowledge Questionnaire in the Western Cape, South Africa

Background. Gestational diabetes mellitus (GDM) is a major public health concern. The International Diabetes Federation estimated that the global prevalence of hyperglycemia in pregnancy is 16.2%. In South Africa, the most recent prevalence of GDM ranges between 9.1-25.8%. Serious adverse events associated with GDM can be mitigated by lifestyle modifications and education. Good comprehension of GDM, and improved understanding has been shown to translate into better glycemic control and reduces peri-natal complications. Assessing the knowledge base of mothers with GDM, whether in a country like South Africa, or any other similar country, is therefore imperative in bridging the gap and improving their understanding and control of their condition. Objective. To ascertain the validity and reliability of translated, cross-culturally adapted South African English, Afrikaans and isiXhosa versions of the Malaysian GDM Knowledge Questionnaire (M-GDMKQ). Methods. This mixed-method study was conducted prospectively within a high-risk antenatal clinic setting. The study consisted of three phases. Women ≥18-years, with GDM who were able to read basic level English, Afrikaans or isiXhosa; and attended the high-risk antenatal clinic throughout the index pregnancy were consecutively sampled and stratified into three language groups across phases. Results. The cross-culturally adapted English, Afrikaans and isiXhosa South African GDMKQ demonstrated reasonable face and content validity. Kappa values ranged between Kappa (SE), -0.03 (0.18) to 0.89 (0.13) for the English version, Kappa (SE), -0.07 (0.18) to 0.53 (0.13) for the Afrikaans version and Kappa (SE), 0.28 (0.18) to 0.87 (0.17) for the isiXhosa version respectively. Cronbach alpha for the individual questions ranged from 0.31 to 0.90, while correlation between overall scores was rho=0.79 (p<0.001). Conclusion. While the translated and cross-culturally adaptation South African English, Afrikaans and isiXhosa versions of the GDMKQ were found to be feasible, acceptable and easy to comprehend, more research is required to confirm validity and reliability.

Predictors and Utilization of Health Institution Services for Childbirth among Mothers in a Southern Nigerian City

Background. Poor maternal health indices, including high maternal mortality, are among Nigeria’s major public health problems. Most of these deaths can be prevented by timely access and utilization of maternity healthcare services by women. Aim/Objective. This study seeks to identify factors affecting the utilization of health facilities for the delivery of babies among mothers in Calabar, Cross River State, Nigeria. Methodology. The study was a community-based cross-sectional study. A structured questionnaire was administered to 422 women of reproductive age residents in the study area who had given birth at least once within the last five years prior to the survey using a multistage random sampling technique. Data generated were entered, coded, and analyzed using Statistical Packages for Social Sciences (SPSS version 22.0), and results were presented in tables and charts. Chi-squared tests and multiple logistic regression were used for the identification of variables associated with health facility-based delivery. Result. The mean age of respondents was 27.3 years (SD = 8.4). Fifty-two percent of the respondents utilized the health facility for delivery, 89.6% attended at least one antenatal clinic (ANC), and 18.9% completed at least 3 ANC sessions. There was a statistically significant association between health facility delivery and marital status ( P = 0.007 ), education ( P = 0.042 ), and family size ( P = 0.002 ). Older women (OR = 0.7, CI = 0.169–3.714), Christians (OR = 1.9, CI = 0.093–41.1), divorcees (OR = 3.7, CI = 0.00–0.00), and respondents who registered early (first trimester) for ANC (OR = 4.9, CI = 0.78–31.48) were found to be higher users of delivery services at the health facility. Conclusion. Community health intervention focusing on improving the knowledge and awareness of the significance of utilizing available delivery services at the healthcare facility should be developed and implemented.

The acceptability and feasibility of a low-cost device for gestational age assessment in a low resources setting: A qualitative assessment (Preprint)

BACKGROUND Ultrasound for gestational age (GA) assessment is not routinely available in resource-constrained settings, particularly in rural and remote locations. The TraCer device combines a handheld wireless ultrasound probe and a tablet with Artificial Intelligence (AI)-enabled software that obtains GA from videos of the fetal head by automated measurements of the fetal trans-cerebellar diameter and head circumference. OBJECTIVE In this study we assess perceptions of pregnant women, their families and health care workers regarding feasibility and acceptability of this device in an appropriate setting. METHODS A descriptive study using qualitative methods was conducted in two public health facilities in Kilifi county in coastal Kenya prior to introduction of the new technology. Study participants were shown a video role-play of the use of TraCer at a typical antenatal clinic visit. Data were collected through 6 focus group discussions (n=52) and 18 in-depth interviews. RESULTS Overall, TraCer was found to be highly acceptable to women, their families and health care workers, and its implementation at health care facilities was considered to be feasible. Its introduction was predicted to reduce anxiety regarding fetal well-being, increase antenatal care attendance, increase confidence by women in their care providers as well as save time and cost by reducing unnecessary referrals. It was felt to increase the self-image of health care workers and reduce time spent providing antenatal care. Some participants expressed hesitancy towards the new technology indicating the need to test its performance over time before full acceptance by some users. The preferred cadre of healthcare professional to use the device were antenatal clinic nurses. Important implementation considerations included adequate staff training and the need to ensure sustainability and consistency of the service. Misconceptions were common with a tendency to over-estimate the diagnostic capability and expectations that it would provide complete reassurance of fetal and maternal well-being and not primarily a GA. CONCLUSIONS This study shows a positive attitude towards TraCer and highlights the potential role of this innovation that uses AI-enabled automation to assess GA. Clarity of messaging about the tool and its role in pregnancy is essential to address misconceptions and prevent misuse.

Prevalence and risk factors of self-medication in pregnancy: A cross-sectional study from a tertiary care hospital in Eastern India

Background: Self-medication in pregnancy is a common but unsafe practice. There is a possibility of surreptitious exposure of the developing fetus to the teratogenic and abortifacient effects of the drugs. Aims and Objectives: In this study, we assessed the prevalence and risk factors of self-medication in pregnant mothers visiting the antenatal clinic in our hospital. Materials and Methods: A standard questionnaire seeking information on the socio-demographic profile, clinical characteristics, laboratory data, and knowledge and habits was administered to the pregnant mothers (n=190). The risk factors of self-medication were determined using Fischer’s exact test. P<0.05 was deemed statistically significant. Results: The prevalence of self-medication in pregnancy was found to be 6.3%. Low education level (P<0.027), employed women (P<0.031), and history of miscarriage (P<0.036) in the previous pregnancy were the main determinants of self-medication in the present pregnancy. Conclusion: The prevalence of self-medication in the study sample was low as compared to contemporary studies. High literacy (94.2%) and easy availability of health facility (98%) may be the possible reasons. Further studies are warranted to confirm the prevalence and risk factors of self-medication in this part of the country.

Choline intake and associations with egg and dairy consumption among pregnant women attending a high-risk antenatal clinic in South Africa: the NuEMI study

Background The importance of adequate choline intake during pregnancy has been well documented, but low intake is common. Total choline intake, main food sources of choline, as well as associations between choline intake and egg and dairy consumption were determined in a sample of pregnant women attending the high-risk antenatal clinic at a regional hospital in Bloemfontein, South Africa. Methods A cross-sectional study design was used. Trained fieldworkers collected dietary intake data using a validated quantified food frequency questionnaire (QFFQ), after which all food items were matched to foods in the USDA Database for the Choline Content of Common Foods (Release 2) to quantify choline intake. Logistic regression with backward selection (p < 0.05) was used to determine whether egg and dairy consumption were independently associated with a choline intake below the adequate intake (AI) level. Results The median daily intake of choline was 275 mg (interquartile range 185 mg – 387 mg) (N = 681). Most participants (84.7%) consumed less than the AI of 450 mg/day for choline. Meat and meat products, cereals, eggs and dairy contributed mostly to choline intake. Food items that contributed most to choline intake included full-cream milk, maize porridge, brown bread, deep-fried potatoes and deep-fried dough (vetkoek). A choline intake below the AI was significantly associated with lower egg and dairy intakes (p < 0.0001 and p = 0.0002 respectively). Conclusion Most pregnant women in the current study had choline intakes below the AI. It is recommended that public health messaging targeted at pregnant women promote the consumption of foods that can significantly contribute to choline intake, such as eggs and dairy.