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Aims The aim of this study was to describe the incidence, clinical characteristics and risk factors of peripartum cardiomyopathy (PPCM) in Nigeria. Methods and Results The study was conducted in 22 hospitals in Nigeria, and PPCM patients were consecutively recruited between June 2017 and March 2018. To determine factors associated with PPCM, the patients were compared with apparently healthy women who recently delivered, as controls. Four hundred six patients were compared with 99 controls. The incidence and disease burden (based on the rate of consecutive recruitment of subjects) varied widely between the six geographical zones of Nigeria. From the North–West zone, 72.3% of the patients was recruited, where an incidence as high as 1 per 96 live births was obtained in a centre, while the disease was uncommon (7.6% of all recruited patients) in the South. Majority of the patients (76.6%) and controls (74.8%) (p = 0.694) were of Hausa–Fulani ethnic group. Atrial fibrillation, intracardiac thrombus, stroke, and right ventricular systolic dysfunction were found in 1.7%, 6.4%, 2.2%, and 54.9% of the patients, respectively. Lack of formal education (odds ratio [OR] 3.08, 95% confidence interval [1.71, 5.53]; P < 0.001), unemployment (OR: 3.28 [2.05, 5.24]; P < 0.001), underweight (OR: 13.43 [4.17, 43.21]; P < 0.001) and history of pre‐eclampsia (OR: 9.01 [2.18, 37.75]; P = 0.002) emerged as independent PPCM risk factors using regression models. Customary hot baths (OR: 1.24 [0.80, 1.93]; P = 0.344), pap enriched with dried lake salt (OR: 1.20 [0.74, 1.94]; P = 0.451), and Hausa–Fulani ethnicity (OR: 1.11 [0.67, 1.84]; P = 0.698) did not achieve significance as PPCM risk factors. Conclusions In Nigeria, the burden of PPCM was greatest in the North–West zone, which has the highest known incidence. PPCM was predicted by sociodemographic factors and pre‐eclampsia, which should be considered in its control at population level. Postpartum customary birth practices and Hausa–Fulani ethnicity were not associated with PPCM in Nigeria.

Artemisinin-based combination therapies (ACTs) are first-line agents in malaria chemotherapy, but often abused in malaria endemic countries including Nigeria. This study investigated the effects of prolong treatment of artesunate-amodiaquine (ATS-Amod), artesunate-sulfadoxine-pyrimethamine (ATS-SP) and artemether-lumefantrine (ATM-Lum) on testicular indices in guinea pigs. Sixty-five pigs were grouped into 13 (n = 5 per group). Six groups were given standard or double therapeutic dose equivalents of ATS-Amod, ATS-SP or ATM-Lum daily for 14 day and sacrificed 24 hr after treatments. Six other groups (recovery groups) received similar drug treatments but allowed to recover for 14 day before sacrificed. Control group received distilled water. ATS-Amod, ATS-SP and ATM-Lum, respectively, decreased (p < .01) sperm count (17.7%, 37.7% and 33.8%), motility (48.6%, 50% and 51.4%), viability (32.7%, 43.7% and 35.9%) and morphology (123.5%, 0% and 0%), compared to control. These effects were reversed in recovery animals. Also, they decreased (p < .01) luteinising hormone and testosterone serum levels, without affecting follicle-stimulating hormone. Testicular malondialdehyde level was elevated, and glutathione was decreased, while catalase and superoxide dismutase enzymes were unaffected by the drugs. The alterations were all reversed in recovery animals. The study reveals that prolong administration of ACTs results in reversible alteration of sperm parameters and reduction of testosterone which is partly attributable to oxidative stress.

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AimsThe prospective, multicentre Peripartum Cardiomyopathy in Nigeria (PEACE) registry originally demonstrated a high prevalence of peripartum cardiomyopathy (PPCM) among patients originating from Kano, North-West Nigeria. In a post hoc analysis, we sought to determine if this phenomenon was characterized by a differential case profile and outcome among PPCM cases originating elsewhere. Methods and results Overall, 199 (81.6%) of a total 244 PPCM patients were recruited from three sites in Kano, compared with 45 patients (18.4%) from 11 widely dispersed centres across Nigeria. Presence and extent of ventricular myocardial remodelling during follow-up, relative to baseline status, were assessed by echocardiography. During median 17 months follow-up, Kano patients demonstrated significantly better myocardial reverse remodelling than patients from other sites. Overall, 50.6% of patients from Kano versus 28.6% from other regions were asymptomatic (P = 0.029) at study completion, with an accompanying difference in all-cause mortality (17.6% vs. 22.2% respectively, P = 0.523) not reaching statistical significance. Alternatively, 135/191 (84.9%) of Kano patients had selenium deficiency (<70 μg/L), and 46/135 (34.1%) of them received oral selenium supplementation. Critically, those that received selenium supplementation demonstrated better survival (6.5% vs. 21.2%; P = 0.025), but the supplement did not have significant impact on myocardial remodelling. Conclusions This study has shown important non-racial regional disparities in the clinical features and outcomes of PPCM patients in Nigeria, that might partly be explained by selenium supplementation.