Survey on the use of misoprostol for induction of labour among Obstetricians in the west African sub region

Context: Wide spread use of misoprostol is increasingly commoner in our obstetrics and gynaecological practice, most especially for Induction of labour in spite of its serious associated risks of maternal and fetal complicationsObjective: To determine the use of Misoprostol for induction of labour among the Obstetricians in the West African sub region.Methodology and settings: During the October 2007 pre examination workshop of the West African College of Surgeons (FWACS), Faculty of Obstetrics and Gynaecology 42 examiners responded through structuredquestionnaires on the use of misoprostol for induction of labour (IOL) in their institutions of practice. Results: About 91 % admit using misoprostol for IOL with only half (50%) having written protocols for labour induction with misoprostol. Almost all (93%) prefer the vaginal route for the administration of misoprostol andabout 74% do not use misoprostol for those with Caesarean section scar compared to only 19% who do. Misoprostol is used for cervical ripening and control of post partum haemorrhage among 24.4% and 50% of theObstetricians respectively. The commonest complications encountered were Fetal distress, uterine rupture and uterine hyper tonus among 54.8%, 52.4% and 45.2% of the respondents.Conclusions: Misoprostol use was high with yet serious complication occurring among those using it for IOL. Despite the manufacturers and other regulatory agents warning against its use in pregnancy because of serious maternal and fetal complications, misoprostol use for IOL is widespread. A regulated use of this drug especially in pregnancy is advocated

A continuing tragedy of maternal mortality in a rural referral center in Northeast Nigeria: A wake‑up call

Context: While reasonable progress has been made worldwide in reducing maternal mortality at the end of the millennium development goal, the same cannot be said of underserved rural communities where the tragedy continuous unabated.Aim: To determine the maternal mortality ratio, causes, and some socioeconomic determinants of maternal deaths in the last triennium of the Millennium Development Goal (MDG) in a rural tertiary center in Northeast Nigeria.Materials and Methods: Retrospective descriptive study of maternal mortality at the Federal Medical center (FMC) Nguru,Northeast Nigeria from January 1st 2013 to December 31st 2015. The center attends largely to underserved rural populace. Results were presented in simple percentages and means with a P value <0.05 considered as significant.Results: The maternal mortality ratio for the triennium was 7,364/100,000 live births with 2015 having the highest MMR of 8,517/100,000. Majority of the deaths occurred in unbooked (n = 87; 46.5%) women with no formal education (n = 120; 64.2%). A third of the maternal deaths occurred in women at the peak of their reproductive age of 25 to 34 years (n = 69; 36.9%). Grandmultiparity is a major risk factor for maternal deaths (43.9%; P = 0.02) compared to nulliparous women (31.5%; P = 0.08). Eclampsia (n = 64; 34.2%), Obstetrics hemorrhages (n = 22; 11.8%) and sepsis (n = 18; 9.6%) still remain the most common direct causes of maternal deaths while anemia was responsible for nearly 60% of the indirect causes. Significant number (36%) of these women reside in communities with secondary or tertiary health care facilities. Majority (39.5%) presented to a health care facility more than 24 hours from the onset of obstetric incidence with 52% of them dying within 24 hours of presenting to the FMC. Interestingly, 82% of the deaths from Nguru local government area are in those who reside within 5 kilometers of the FMC.Conclusion: This region has consistently maintained high MMR but this ratio of 7,364/100,000 live births is the highest so far. The causes of maternal deaths are still the same as they were 2 decades ago. The question still remains unanswered: why are many women not seeking healthcare services even when it is as close as 5 km from their residence? Why do women present with obstetric emergencies when over 70% of them reside were there are health care facilities? We recommend further research to answer these questions and to guide policies and programs that will lead to the achievement of sustainable development goal 3.1 by the year 2030.Keywords: Last triennium; maternal death; maternal mortality ratio; rural referral cente

Maternal and fetal determinants of perinatal transmission of HIV among HIV positive mothers attending ANC at a northern Nigerian tertiary health institution

Objective: To ascertain the major determinants of perinatal transmission of HIV among HIV positive women attending ANC and delivery at the University of Maiduguri Teaching Hospital, Maiduguri.Patients and methods: A prospective case control study of 52 HIV positive pregnant women who were attending ANC and delivery at university of Maiduguri Teaching Hospital (UMTH) was carried out. Known HIV positive mothers sent from the adult HIV clinic and those found during ANC HIV screening and diagnosis using rapid tests were recruited, while Fetal diagnosis of HIV was done using polymerase chain reaction (PCR) technique at 6 and/or at 12 weeks of birth age. Socio demographic and obstetrics history were obtained and analyzed using SPSS version 11 and test of significance was carried out using chi square tests.Results: Of the 52 women that were found to be HIV positive, the perinatal transmission rate was 11.5%. Elective caesarean section (ELCS) was offered to 11(21.2%) and all the babies delivered through ELCS were negative for HIV. Advanced maternal age (X2 =33.53 P <0.001), Low CD4 count (X2 =15.58 P =0.016), high maternal viral load (X2 =21.85 P =0.005), prematurity (X2 = 9.872 P= 0.007), low birth weight (X2 = 63.80 P < 0.001) and birth asphyxia(X2 = 24.149 P< 0.001) were the major determinants of perinatal transmission of HIV infection in this study.Conclusion: The perinatal transmission of HIV is high. Prompt identification of both maternal and fetal risks' factors and Effective interventions aim at minimizing the impact of these factors before or during pregnancy will help to lower some of the preventable determinants of perinatal transmission.Recommendations: A prenatal and antenatal risks reduction strategy should be advocated. All effort should be geared toward identifying those positive and minimized or modify risks factors through behavior change, prompt initiation of treatment and prophylaxis for those found positive with a view to reduce the incidence of perinatal transmission.Key Words: perinatal transmission, HIV, maternal, fetal determinants, Maidugur

Predictors of extra care among magnesium sulphate treated eclamptic patients at Muhimbili National Hospital, Tanzania

\ud The inclusion of Magnesium Sulphate (MgSO4) as a gold standard in the treatment of eclampsia has substantially reduced incidences of repeated fits, eclamptic morbidity and deaths. However, despite treatment with MgSO4, a proportion of patients need extra medical/nursing attention and prolonged stay in the intensive care unit (ICU). The literature on the underlying factors for the need of extra care in the MgSO4 era is lacking. This study sought to establish predictors of extra care in ICU among eclamptic patients after treatment with MgSO4 at Muhimbili National Hospital (MNH). Data were obtained from hospital records of eclamptic patients who were admitted at MNH and treated with MgSO4 from January 1st to December 31st, 2008. Based on set criteria, patients who needed extra care were identified. Analysis was performed using PASW statistics 18 whereby frequencies, cross-tabulations, bivariate and multiple logistic regressions were performed. A total of 366 eclamptic patients were admitted and treated with MgSO4 at MNH during a 12 month study period in 2008. Most of these (76%) were referred from district hospitals and 132 (36%) met the criteria for extra care in ICU. After adjusting for other variables, the risk of extra care in ICU for patients who were admitted with altered consciousness was double (OR = 2.3; 95% CI: 1.3-4.0) that of the ones admitted in alert state. The risk or need of extra care increased by increasing time to delivery and was doubled (OR = 2.0; 95% CI:1.1-3.7) if it was between 12 and 24 hours and tenfold elevated (OR = 10.0; 95% CI:4.3-23.6) if beyond 24 hours as compared to when time to delivery was less than 12 hours.Abdominal delivery was also independently associated with increased risk compared to vaginal delivery (OR = 2.5; 95%CI: 1.4-4.5). The type of referral and number of fits were associated with extra care in ICU but this association was wholly explained by the clinical status of the patient on admission to MNH and prolonged time lag to delivery. We concluded that even with MgSO4 used as the gold standard in the treatment of eclampsia, effective pre-referral care and expedited delivery were crucial in minimizing the need for extra care in ICU.\u

Maternal death review and outcomes : an assessment in Lagos State, Nigeria

Strong political will by hospital management and supervising government agencies are a prerequisite for effectively addressing the human and infrastructural deficits that predispose to maternal mortality in Lagos State. Failure to address the patients and facility-related causes of maternal mortality could account for the persistently high maternal mortality ratio (MMR) in the hospitals. Interventions aimed at redressing all causes identified in the reviews will likely reduce MMRs. The study investigates results of Maternal and Perinatal Death Surveillance and Response (MPDSR) conducted in three referral hospitals in Lagos State, Nigeria over a two-year period and reports outcomes and lessons learned

Maternal death and obstetric care audits in Nigeria: A systematic review of barriers and enabling factors in the provision of emergency care.

Acknowledgements We would like to thank Yutaka Osakabe for co-ordinating the retrieval of full text articles. The John D. and Catherine T. MacArthur Foundation supported this study, grant number 12-100074-000-INPPeer reviewedPublisher PD

A 5-year review of maternal mortality associated with eclampsia in a tertiary institution in northern Nigeria

Objective : To determine the incidence of maternal mortality associated with eclampsia and to determine how socio-demographic and clinical characteristics of the women influence the deaths. Methodology : Records of 52 eclampsia-related mortalities from January 2003 to December 2007 were reviewed, retrospectively. Their social demography, mode and place of delivery, time of eclampsia, and fetal outcome were extracted for analysis. Results : Eclampsia accounted for 52 (46.4%) of the 112 total maternal deaths recorded within the 5-year period, with case fatality of 22.33%. Age grou

Community Perception of Maternal Mortality in Northeastern Nigeria

This study was conducted to find out community’s knowledge and perceived implications of maternal mortality and morbidity. The community members’ perception on ways to prevent the scourge was also explored. It was a population- based qualitative study which took place in two urban and two rural communities in Borno state,Nigeria. A total of one hundred and sixty eight (168) community members participated in Focus Group Discussions (FGD) and in-depth interviews. Most agreed that there were maternal deaths in the communities. Many of the respondents identified at least two of the five main direct causes of maternal mortality that are universal. But manyhave misconceptions about the causes of maternal mortality. There were many implications narrated by the respondents and various suggestions made to improve on the poor Maternal Health in the areas. The knowledge and implications of maternal mortality was good in the areas and therefore intervention programs should exploit andcapitalize on the linkages between the perceived implications and the causes of maternal deaths (Afr J Reprod Health 2008; 12[3]:27-34)

Survey on the use of misoprostol for induction of labour amon obstetricians in the West African sub-region

No Abstract

Knowledge, Perceptions and Attitudes of Islamic Scholars Towards Reproductive Health Programs in Borno State, Nigeria

Some reproductive health policies and activities of international development organizations continued to be criticized by some religious groups. Such criticisms can be serious obstacles in the provision of reproductive health and rights information and services in many communities. This study was conducted to find the knowledge, perception and attitude of Islamic scholars on reproductive health programs and to get some suggestions on the scholars\' role in the planning and implementation of reproductive health advocacy and programming. The data were collected by in-depth interview with representative sample of selected Muslim scholars in and around Maiduguri town in Borno State, Nigeria. All the scholars had vague or no idea of what reproductive health is all about. When they were explaining reproductive health, most of the scholars mentioned some of the rights of women especially the need for maintaining the good health of women and their children as reproductive health. Even though they have poor knowledge, all the Muslim scholars interviewed believed that reproductive health is an essential component of healthy living and the programs of the international development organizations are mostly good, but they have reservations and concern to certain campaigns and programs. Scholars that promised their contributions in enhancing reproductive health have a common condition for their continuous support to any international development organization or reproductive health program. Conformity to Islamic norms and principles are prerequisites to their loyalties. The scholars also advised the international development organizations on the need to identify themselves clearly, so that people know from where they are coming, what are their background, and the program that they want to do and the reasons for doing the program in the community. Connaissance, perceptions et attitudes des savants islamiques envers les programmes de la santé de reproduction dans l\'Etat de Borno, Nigéria Certains politiques et activités des organizations internationales pour le développement concerant la santé de reproduction font toujours l\'objet de la critique de la part de quelques groupes religieux. De telles critiques peuvent constituer d\'importants obstacles dans les prestations des services de la santé de reproduction et de l\'information sur les droits dans plusieurs communautés. Cette étude a été menée pour identifier la connaissance, la perception et l\'attitude des savants islamiques sur les programmes de la santé de reproduction et pour obtenir des suggestions sur le rôle des savants dans la planification et la mise en oeuvre du plaidoyers et de la programmation de la santé de reproduction. Les données ont été receuillies à l\'aide d\'une interview à fond avec un échantillon représentatif des intellectuels islamiques selectionnés dans la ville de Maiduguri et à l\'alentour dans l\'Etat de Borno, Nigéria. Tous les savants avaient une idée vague et parfois aucune idée de ce que représente la santé de reproduction. La plupart des savants, tout en expliquant la santé de reproduction, ont mentionné certains droits de la femme surtout la nécessité de maintenir la bonne santé de la femme et ses enfants comme étant la santé de reproduction. Bien qu\'ils aient une faible connaissance de la santé de reproduction, tous les savants islamiques qui ont été interviewés ont cru que la santé de reproduction est un constituent important d\'une vie saine et que les programmes des organizations pour le développement international sont bons dans la plupart des cas, ils ont leurs réserves et leurs soucis en ce qui concerne certains programmes et campagnes. Les savants qui ont accepté de contribuer à la promotion de la santé de reproduction ont une condition commune pour leur soutien continu des programmes d\'une organisation pour le développement international ou de la santé de reproduction. Leur fidelité est fondée sur la conformité aux normes et principes islamiques comme des conditions préalables. Les savants conseillent les organisations pour le développement international sur la nécessité de s\'identifier clairement, pour que les gens sachent d\'où elles viennent, leur milieu professionnel et le programme qu\'elles veulent mettre en place et les raisons pour justifier les programmes dans la communauté. Keywords: Islamic scholars, Reproductive health programs, International development organizations African Journal of Reproductive Health Vol. 11 (1) 2007: pp. 98-10