Baird-Pattinson Aetiological Classification and Phases of Delay Contributing to Stillbirths in a Nigerian Tertiary Hospital.

PURPOSE: This study aims to identify triggers of stillbirth in the study setting and to make suggestions to reduce the prevalence. METHOD: A three-year retrospective case-control study of stillbirths at Ekiti State University Teaching Hospital. RESULTS: The stillbirth rate was 33 per 1000 births. Based on Baird-Pattinson classification of the primary obstetric causes of stillbirth, adverse intrapartum events, hypertensive diseases, and unexplained intrapartum fetal deaths were topmost causes of stillbirths. In comparison with the controls, other identified predictors of SB were grand multiparity (p = 0.016), delays in seeking medical care and/or in receiving treatment (p = 0.001), wrong initial diagnosis (p = 0.001), inadequate intrapartum monitoring (p = 0.001), and inappropriate clinical management (p = 0.001). CONCLUSION: Stillbirth rate remains high in our setting. Elimination of obstacles to accessing care, effective management of hypertensive disorders in pregnancy, updated health facilities, improved dedication to duty, and retraining of health workers will reduce the prevalence

Ruptured tubal pregnancy: predictors of delays in seeking and obtaining care in a Nigerian population.

PURPOSE: Morbidity and mortality from ruptured tubal pregnancies (RTPs) have been linked with delays in seeking and receiving care. Evaluation of the reasons for these delays and their contributions to maternal deaths is rarely done for women with RTPs in resource-constrained settings. PATIENTS AND METHODS: This was a 3-year retrospective review of the case records of women with tubal pregnancies managed at the Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria. Clinical and sociodemographic parameters were obtained, including information on onset of symptoms and intervals between the symptoms and when help was sought and obtained at the hospital. RESULTS: There were 92 cases of tubal pregnancies, giving an incidence of 18 per 1,000 births. Most of the patients were married (74.7%), parous (64.9%), and urban dwellers (76.9%), and 11% were severely anemic on arrival. The case-fatality rate was 1.1% and 74.7% had delay in seeking care, while 82.4% of the women spent more than 2 hours after admission before surgical intervention. Rural dwellers (adjusted odds ratio 2.96, 95% confidence interval 1.08-8.36) and those without formal education (adjusted odds ratio 6.39, 95% confidence interval 1.06-67.30) had delays in seeking help, while problems with funds (χ (2)=7.354, P=0.005) and initial misdiagnosis (χ (2)=5.824, P=0.018) predicted delay in obtaining help at the hospital. CONCLUSION: RTPs are common gynecological emergencies in our environment that are often associated with delayed decisions to seek help and obtain care. Efforts should be geared toward women's education and financial independence, improved hospital accessibility, and better diagnostic skills

Recurrent child mortality risks and parity transition in Nigeria

BackgroundFertility rates remain persistently high in Nigeria, with little difference across socioeconomic groups. While the desire for large family size is culturally rooted, there is little understanding of how repeated child mortality experiences influence fertility behaviour and parity transition in Nigeria.MethodsUsing birth history data from the 2013 Nigeria Demographic and Health Survey (NDHS), we applied life table techniques and proportional-hazard regression model to explore the effect of child survival experience on parity transitions. We hypothesize that a woman with one or more child death experience is at elevated risk of progressing towards higher parities.ResultsOur findings show that child mortality is concentrated among mothers living in deprived conditions especially in rural areas of the northern part of Nigeria and among those with little or no education and, among those belonging to Hausa/Fulani ethnicity and Islam religion. Mothers with repeated experience of child deaths were significantly at a higher rate of progressing to higher parities than their counterparts (HR: 1.45; 95% CI: 1.31–1.61), when adjusted for relevant biological and socio-demographic characteristics.ConclusionRecurrent experience of child deaths exacerbates the risks to higher parity transition. Interventions aimed at reducing fertility in Nigeria should target promoting child survival and family planning concurrently

Survey of the Problems of Girl Child in Ekiti State, Nigeria

Objectives: To determine the prevalence of teenage pregnancy and knowledge of reproductive health problems among adolescent girls in Ekiti State, Southwest Nigeria.Methods: A cross-sectional community based study was conducted. Using convenient random sampling technique, four local government areas were selected. Eligible participants were both in and out of school children between the ages of 13 -18 years. A hundred respondents were sampled from each selected local government, making a total sample size of 400. Consenting participants were administered questionnaire in their homes by trained LGA enumerators. It elicited information on socio-demographic and reproductive health issues. Data collected were subsequently collated and analyzed.Results: Majority of the girls (78%) were still in-school. All were already menstruating, mostly attaining menarche between the age 15-16years. Only 212 (53%) could remember their last menstrual period. Sexual derby mainly occurred around age 15-16years; 53.3% were already sexually exposed. A quarter of respondents had been pregnant before. Only 187 (46.8%) were aware of modern contraception. The girls had a fair knowledge of implication of early sexual derby and unprotected intercourse, though it did not translate to behavioural change.Conclusion: There is a high prevalence of teenage pregnancy and poor reproductive health knowledge among teenagers in Ekiti State. More collective efforts involving parents, community heads, opinion leaders, civil societies and the state are needed to help our girls attain and sustain healthy reproductive behaviours

Prevalence and determinants of unintended pregnancies amongst women attending antenatal clinics in Pakistan

Background: Unintended pregnancies are a global public health concern and contribute significantly to adverse maternal and neonatal health, social and economic outcomes and increase the risks of maternal deaths and neonatal mortality. In countries like Pakistan where data for the unintended pregnancies is scarce, studies are required to estimate its accurate prevalence and predictors using more specific tools such as the London Measure of Unplanned Pregnancies (LMUP). Methods: We conducted a hospital based cross sectional survey in two tertiary care hospitals in Pakistan. We used a pre tested structured questionnaire to collect the data on socio-demographic characteristics, reproductive history, awareness and past experience with contraceptives and unintended pregnancies using six item the LMUP. We used Univariate and multivariate analysis to explore the association between unintended pregnancies and predictor variables and presented the association as adjusted odds ratios. We also evaluated the psychometric properties of the Urdu version of the LMUP. Results: Amongst 3010 pregnant women, 1150 (38.2%) pregnancies were reported as unintended. In the multivariate analysis age \u3c 20 years (AOR 3.5 1.1-6.5), being illiterate (AOR 1.9 1.1-3.4), living in a rural setting (1.7 1.2-2.3), having a pregnancy interval of = \u3c 12 months (AOR 1.7 1.4-2.2), having a parity of \u3e2 (AOR 1.4 1.2-1.8), having no knowledge about contraceptive methods (AOR 3.0 1.7-5.4) and never use of contraceptive methods (AOR 2.3 1.4-5.1) remained significantly associated with unintended pregnancy. The Urdu version of the LMUP scale was found to be acceptable, valid and reliable with the Cronbach\u27s alpha of 0.85. Conclusions: This study explores a high prevalence of unintended pregnancies and important factors especially those related to family planning. Integrated national family program that provides contraceptive services especially the modern methods to women during pre-conception and post-partum would be beneficial in averting unintended pregnancies and their related adverse outcomes in Pakistan