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.

Objectives: The objective of the study was to assess how the current COVID-19 pandemic has affected cesarean section (C-section) rates, indications, and peripartum outcomes. Methods: This was a retrospective cross-sectional study that compared a 3-month rates of and indications for C-sections at three tertiary health care institutions in Nigeria before (October 2019–December 2019) and during the first wave of COVID-19 pandemic (March 2020–May 2020). Primary outcomes were C-section rate and indications between the two periods. Data were analyzed using SPSS 26.0 IBM Corporation. Rates and odds ratios with 95% confidence intervals were used to quantify indications and peripartum outcomes and statistical significance was accepted when p value was <0.05. Results: The baseline characteristics of the two groups were similar. The C-section rate during the COVID-19 period was significantly less than the period prior to the pandemic (237/580, 40.0% vs 390/833, 46.8%; p = 0.027). The rates of postdatism (odds ratio = 1.47, 95% confidence interval = 1.05–2.05, p = 0.022), fetal distress (odds ratio = 3.06, 95% confidence interval = 1.55–6.06, p = 0.017), emergency C-section (odds ratio = 1.43, 95% confidence interval = 1.01–2.05, p = 0.042), and anemia (odds ratio = 1.84, 95% confidence interval = 1.12–3.03, p = 0.016) were significantly higher during the pandemic than prepandemic. Conclusion: The overall C-section rate during the first wave of COVID-19 was significantly lower than the prepandemic period. There were higher rates of postdatism, fetal distress, emergency C-section, and postpartum anemia. Further studies on this changing C-section trend during the pandemic are needed.

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 < 0.05. 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).

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.

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