Aetiology of maternal mortality using verbal autopsy at Sokoto, North-Western Nigeria

Background: Maternal mortality in developing countries is higher than that in developed countries. There are few published articles on the factors associated with maternal deaths in northern Nigeria. Objectives: The objective of this study was to identify the medical causes and factors associated with maternal mortality in Sokoto, northern Nigeria. Method: A verbal autopsy questionnaire was used to interview close relatives of women within the reproductive age group who had died of pregnancy-related complications in theSokoto metropolis during the preceding two years. A multistage sampling method using simple random sampling at each step was used to select areas of study within the Sokoto metropolis. Data analysis was carried out using a statistical package for social sciences (SPSS),version 19, and the Spearman correlation was used to test association. Significance level was set at 0.05. Results: The major causes of death were haemorrhage (48.3%), eclampsia (19%) and prolonged labour (13.8%). The association between maternal mortality and the absence of antenatal booking was significant (p < 0.001); the association between maternal mortality andthe ‘three delays’ was also significant (p = 0.013). The association between maternal mortality and educational status and occupation was, however, not significant (p = 0.687 and p = 0.427respectively). Conclusion: The medical causes of maternal mortality identified in this study were similar to those of the hospital-based studies in the area. In addition, an association between maternal deaths and the ‘three delays’ and the absence of antenatal booking was found. There is a need for public education efforts to address these factors in order to reduce maternal mortality in the study area

Effect of hormonal and copper IUDs on genital microbial colonisation and clinical outcomes in North-Western Nigeria

Background: Intrauterine devices are one of the popular long term reversible contraceptive methods. Earlier forms were associated with genital infections, however more recent types such copper IUDs and hormonal types have been shown to have better safety profile. However, there is no conclusive evidence to demonstrate that hormonal IUD is less associated with genital infection when compared with copper IUDs. The objectives include determination of prevalence of genital tract infections among IUD users, to determine the type of IUD that is less associated with genital infection, and also determine clinical features seen among IUD users.Methods: We conducted a descriptive, cross sectional study of clients who were at 6 months following IUD insertion. Endocervical and high vaginal samples were taken to isolate microbes.Results: The prevalence of genital tract infection was 20% in Copper IUD users and 8.6% among LNG-IUS users. Genital infection was significantly higher among copper IUD users compared to hormonal IUD users (p=0.038, OR= 2.88). Abnormal vaginal discharge was the commonest symptoms among IUD users and formal education was associated with less risk of genital infections (p=0.048).Conclusions: Hormonal IUDs are less associated with genital tract infection compared to copper IUDs and women with formal education are less likely to have genital infection among IUD users

Major dietary patterns and their associations with socio-demographic characteristics and obesity among adolescents in Petaling District, Malaysia

Dietary pattern analysis has emerged as important instruments to identify modifiable dietary risk factors for non-communicable diseases. The aim of this study was to determine the major dietary patterns among adolescents in Petaling District, Selangor and their associations with socio-demographic characteristics and obesity. An analytic cross- sectional study design was conducted in selected secondary schools in Petaling District. Sampling with probability proportionate to size was used and five schools were selected. Self-administered semi-quantitative food frequency questionnaire was used for data collection. Weight was measured with a digital bathroom scale (TANITA model) and height was measured using SECA body meter. Principal component factor analysis using varimax orthogonal transformation was used to identify the dietary patterns. Chi square was used to test for associations of dietary patterns with socio-demographic characteristics and obesity. Three major dietary patterns were identified: firstly, fruits and vegetables; secondly, sugar and fat and finally, meat and chicken which explained for 12.7%, 11.6% and 10.7% variation in food intake, respectively. There were significant associations between ethnicity, religion, family income, educational level of parents and the dietary patterns. However, there was no significant association between obesity and the dietary patterns. It may be more effective to describe a healthy diet using results of dietary pattern analysis in public health intervention, rather than describing single food items or nutrients. It is recommended that nutrition education programmes should be implemented in schools so as to prevent the development of obesity in the non-obese

Knowledge and acceptability of prenatal diagnosis among pregnant women attending antenatal clinic in a tertiary health institution in Sokoto, Nigeria

Background: Technology and advances in research have made it possible for the fetus to become a patient whose illness can be investigated, diagnosed and treated in utero. The study was aimed at assessing the knowledge and acceptability of prenatal diagnosis among pregnant women.Methods: This was a cross-sectional study carried out between December 2016 and March, 2017. Pregnant women attending antennal care clinic at the Usmanu Danfodiyo University Teaching Hospital, Sokoto (UDUTH) were recruited via convenient sampling method using semi-structured interviewer questionnaire.Results: A total of 417 pregnant women were interviewed. The mean maternal age was 28.35±5 years with a range between 17 to 45 years. Up to 188 (69.10%) had at least secondary school level of education. There was an overall poor knowledge of prenatal diagnosis, as 406 (97.36%) had little to no idea. There was statistically significant association between knowledge and educational status at p value- 0.0001. Majority, 353 (87.8%) will accept prenatal diagnosis if offered. There was also statistically significant association between educational status and acceptability as well as knowledge of prenatal diagnosis at p value- 0.001 and 0.001 respectively. The noninvasive method, ultrasound was the most preferred by the majority, 332 (84.3%). Termination of pregnancy as an option of management in fetal abnormality was acceptable by up to 2/3 (63.1%) of the respondents.Conclusions: The knowledge of prenatal diagnosis among the respondents was generally poor. The identifiable factor that determined knowledge and acceptability of prenatal diagnosis was level of education

Obstructed labour at Usmanu Danfodiyo university teaching hospital Sokoto: a five-year review

Background: Obstructed labour is an obstetric emergency and one of the major causes of maternal and perinatal morbidity and mortality in the developing countries, Nigeria inclusive. The aim of this study was to determine the prevalence, causes and feto-maternal outcome of cases of obstructed labour managed at Usmanu Danfodiyo University Teaching Hospital Sokoto from 1st January, 2014 to 31st December, 2018.Methods: This was a retrospective review of all cases of obstructed labour managed at Usmanu Danfodiyo University Teaching Hospital Sokoto over 5 years. List of cases managed during the study period was obtained and case notes were retrieved. Relevant information such as age, booking status, parity, educational status, address, causes, mode of delivery and both maternal and foetal outcomes were obtained from the case notes. Data analysis was done using statistical package for social sciences version 22 (SPSS Inc, Chicago, IL, USA).Results: A total two hundred and seventy-six cases of obstructed labour were managed out of the 15,452 total deliveries during the study period. This gives an obstructed labour prevalence of 1.79%. The major cause of obstructed labour identified in this study was Cephalopelvic disproportion (74.6%) and majority of the patients were delivered by emergency lower segment caesarean section (70.6%). Up to 32.3% of the patients had no maternal complications and also 42.3% of them had live birth with no fetal complication. However, 20.2% of these patients had ruptured uterus and 37.9% of them had still birth, while 19.8% had live birth complicated by birth asphyxia.Conclusions: This study has found that obstructed labour resulted in adverse maternal and perinatal outcome. Hence, there is need to prevent obstructed labour in order to avert this consequence

Perception and acceptability of bilateral tubal ligation among women attending antenatal clinic at Usmanu Danfodiyo university teaching hospital Sokoto

Background: Contraception can be defined as all temporary or permanent measures designed to prevent pregnancy. Bilateral tubal ligation is a surgical and permanent form of contraception offered to women who completed their family size or for limitation of family size due to medical condition. The practices of bilateral tubal ligation is limited in Sub-Saharan African countries, Nigeria inclusive because of great desire for a large family size, cultural and religious factors, misunderstanding and fear of the procedure. The aim of the study was to determine the perception and acceptability of bilateral tubal ligation as a form of contraception among women attending Antenatal clinic at Usmanu Danfodiyo University Teaching Hospital Sokoto.Methods: This was a cross sectional study conducted among women attending antenatal clinic between 1st of May to 31st of July, 2018. The information was obtained using a structured questionnaire to obtain the respondent’s socio-demographic characteristics, questions on perception and acceptability of bilateral tubal ligation. Data analysis was done with statistical package for social sciences version 22 (SPSS Inc, Chicago, IL, USA).Results: The study revealed that 73% of the respondents were aware of bilateral tubal ligation, but only 44% of them have good perception towards it. Majority of the respondents (63.8%) reject BTL for contraception. Most of their reasons were cultural believe (33.3%), regret (31.6%), religious believe (26.6%) and fear of surgery (8.5%).Conclusions: There was poor perception and low acceptability toward bilateral tubal ligation among the study population, mostly due to cultural and religious believes, as well as fear of regret, despite awareness of BTL among majority of the respondents

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories : a pooled analysis of 2181 population-based studies with 65 million participants

Funding Information: The NCD-RisC database was supported by a Biomedical Resource and Multi-user Equipment Grant from the Wellcome Trust (101506/Z/13/Z) and was expanded to include children and adolescents with partial support by a charitable grant from AstraZeneca Young Health Programme. The analysis in this paper was partly supported by the STOP project which received funding from EU Horizon 2020 research and innovation programme under Grant Agreement 774548. The content of this publication reflects only the views of the authors, and the European Commission is not liable for any use that may be made of the information it contains. Editorial note: the Lancet Group takes a neutral position with respect to territorial claims in published maps and institutional affiliations. Funding Information: The NCD-RisC database was supported by a Biomedical Resource and Multi-user Equipment Grant from the Wellcome Trust (101506/Z/13/Z) and was expanded to include children and adolescents with partial support by a charitable grant from AstraZeneca Young Health Programme. The analysis in this paper was partly supported by the STOP project which received funding from EU Horizon 2020 research and innovation programme under Grant Agreement 774548. The content of this publication reflects only the views of the authors, and the European Commission is not liable for any use that may be made of the information it contains. Publisher Copyright: © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods: For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings: We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation: The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks. Funding: Wellcome Trust, AstraZeneca Young Health Programme, EU.Peer reviewe

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities(.)(1,2) This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity(3-6). Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.Peer reviewe

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks

Diminishing benefits of urban living for children and adolescents’ growth and development

Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1–6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5–19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was <1.1 kg m–2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified.This study was funded by: - The UK Medical Research Council (grant number MR/V034057/1) - The Wellcome Trust (Pathways to Equitable Healthy Cities grant 209376/Z/17/Z). - The AstraZeneca Young Health Programme and the European Commission (STOP project through EU Horizon 2020 research and innovation programme under Grant Agreement 774548)