Non‑pregnancy related gynaecological causes of death in a Nigerian Tertiary Hospital

Background: Most gynaecological causes of death are related to pregnancy such as ectopic pregnancy, unsafe abortion, septic incomplete abortion, and gestational trophoblastic diseases. Hence, it was necessary to review the non‑pregnancy related causes of gynaecological deaths in our centre.Aims and Objectives: The aim of this study was to review gynaecological deaths due to non‑pregnancy related causes among women in our centre at the University of Calabar Teaching Hospital (UCTH).Materials and Methods: This was a 5‑year retrospective review of case notes of women who died in the gynaecological ward of UCTH. The demographic profile of the women, the diagnosis and the cause of death were extracted for analysis. All those whose diagnoses were pregnancy related were excluded.Results: There were 38 gynaecological deaths, which were not pregnancy related. Of these, ovarian cancer (19) and cervical cancer (11) constituted 30 cases or 78.9% of causes of death. Endometrial cancer (3), uterovaginal prolapse (3), uterine leiomyosarcoma (1), and vulvovaginal cancer (1) constituted 8 cases or 21.1% of deaths. No deaths were recorded from uterine fibroids, dysfunctional uterine bleeding, pelvic inflammatory disease, etc.,Conclusion: Cancers constitute the majority of causes of gynaecological deaths in women who are not pregnant. This emphasises the need for cancer prevention, early diagnosis and effective treatment.Keywords: Death; gynaecological disease; non‑pregnant women; University of Calabar Teaching Hospita

Awareness of Birth Preparedness and Complication Readiness in Southeastern Nigeria

The aims of this study are to assess the awareness and intention to use maternity services. This was a multicentric study involving 800 women. Educational status was the best predictor of awareness of birth preparedness (P = 0.0029), but not a good predictor of intention to attend four antenatal clinic sessions (P = 0.449). Parity was a better predictor of knowledge of severe vaginal bleeding as a key danger sign during pregnancy than educational level (P = 0.0009 and P = 0.3849, resp.). Plan to identify a means of transport to the place of childbirth was related to greater awareness of birth preparedness (χ2 = 0.3255; P = 0.5683). Parity was a highly significant predictor (P = 0.0089) of planning to save money. Planning to save money for childbirth was associated with greater awareness of community financial support system (χ2 = 0.8602; P = 0.3536). Access to skilled birth attendance should be promoted

Effect of Free Maternal Health Care Program on Health-seeking Behavior of Women during Pregnancy, Intra-partum and Postpartum Periods in Cross River State of Nigeria: A Mixed Method Study

BACKGROUND: Increasing the percentage of maternal health service utilization in health facilities, through cost-removal policy is important in reducing maternal deaths. The Cross River State Government of Nigeria introduced a cost-removal policy in 2009, under the umbrella of “PROJECT HOPE†where free maternal health services are provided. Since its inception, there has been no formal evaluation of its effectiveness. AIM: This study aims to evaluate the effect of the free maternal health care program on the health care-seeking behaviours of pregnant women in Cross River State, Nigeria.METHOD: A mixed method approach (quantitative and qualitative methods) was used to describe the effect of free maternal health care intervention. The quantitative component uses data on maternal health service utilisation obtained from PROJECT HOPE and Nigeria Demographic Health Survey. The qualitative part uses Focus Group Discussions to examine women's perception of the program.RESULTS: Results suggest weak evidence of change in maternal health care service utilization, as 95% Confidence Intervals overlap even though point estimate suggest increase in utilization. Results of quantitative data show increase in the percentage of women accessing maternal health services. This increase is greater than the population growth rate of Cross River State which is 2.9%, from 2010 to 2013. This increase is likely to be a genuine increase in maternal health care utilisation. Qualitative results showed that women perceived that there have been increases in the number of women who utilize Antenatal care, delivery and Post Partum Care at health facilities, following the removal of direct cost of maternal health services. There is urban and rural differences as well as between communities closer to health facility and those further off. Perceived barriers to utilization are indirect cost of service utilization, poor information dissemination especially in rural areas, perceived poor quality of care at facilities including drug and consumables stock-outs, geographical barriers, inadequate health work force, and poor attitude of skilled health workers and lack of trust in the health system.CONCLUSION: Reasons for Maternal health care utilisation even under a cost-removal policy is multi-factorial. Therefore, in addition to fee-removal, the government must be committed to addressing other deterrents so as to significantly increase maternal health care service utilisation

Trend and Causes of Maternal Mortality in a Nigerian Tertiary Hospital: A 5-year Retrospective Study (2010-2014) at the University of Calabar Teaching Hospital, Calabar, Nigeria

BACKGROUND: Maternal mortality ratios (MMR) are still unacceptably high in many low-income countries especially in sub-Saharan Africa. MMR had been reported to have improved from an initial 3,026 per 100,000 live births in 1999 to 941 in 2009, at the University of Calabar Teaching Hospital (UCTH), Calabar, a tertiary health facility in Nigeria. Post-partum haemorrhage and hypertensive diseases of pregnancy have been the common causes of maternal deaths in the facility.AIM: This study was aimed at determining the trend in maternal mortality in the same facility, following institution of some facility-based intervention measures.METHODOLOGY: A retrospective study design was utilised with extraction and review of medical records of pregnancy-related deaths in UCTH, Calabar, from January 2010 to December 2014. The beginning of the review period coincided with the period the “Woman Intervention Trial†was set up to reduce maternal mortality in the facility. This trial consists of the use of Tranexamic acid for prevention of post-partum haemorrhage, as well as more proactive attendance to parturition.RESULTS: There were 13,605 live births and sixty-one (61) pregnancy-related deaths in UCTH during the study period. This yielded a facility Maternal Mortality Ratio of 448 per 100,000 live births. In the previous 11-year period of review, there was sustained the decline in MMR by 72.9% in the initial four years (from 793 in 2010 to 215 in 2013), with the onset of resurgence to 366 in the last year (2014). Mean age at maternal death was 27 ± 6.5 years, with most subjects (45, 73.8%) being within 20-34 years age group. Forty-eight (78.7%) were married, 26 (42.6%) were unemployed, and 33 (55.7%) had at least secondary level of education. Septic abortion (13, 21.3%) and hypertensive diseases of pregnancy (10, 16.4%) were the leading causes of death. Over three quarters (47, 77.0%) had not received care from any health facility. Most deaths (46, 75.5%) occurred between 24 and 97 hours of admission.CONCLUSION: Compared with previous trends, there has been a significant improvement in maternal mortality ratio in the study setting. There is also a significant change in the leading cause of maternal deaths, with septic abortion and hypertensive disease of pregnancy now replacing post-partum haemorrhage and puerperal sepsis that was previously reported. This success may be attributable to the institution of the Woman trial intervention which is still ongoing in other parts of the world. There is, however, need to sustain effort at a further reduction in MMR towards the attainment of set sustainable development goals (SDGs), through improvement in the provision of maternal health services in low-income countries

Non-pregnancy related gynaecological causes of death in a Nigerian Tertiary Hospital

Background: Most gynaecological causes of death are related to pregnancy such as ectopic pregnancy, unsafe abortion, septic incomplete abortion, and gestational trophoblastic diseases. Hence, it was necessary to review the non-pregnancy related causes of gynaecological deaths in our centre. Aims and Objectives: The aim of this study was to review gynaecological deaths due to non-pregnancy related causes among women in our centre at the University of Calabar Teaching Hospital (UCTH). Materials and Methods: This was a 5-year retrospective review of case notes of women who died in the gynaecological ward of UCTH. The demographic profile of the women, the diagnosis and the cause of death were extracted for analysis. All those whose diagnoses were pregnancy related were excluded. Results: There were 38 gynaecological deaths, which were not pregnancy related. Of these, ovarian cancer (19) and cervical cancer (11) constituted 30 cases or 78.9% of causes of death. Endometrial cancer (3), uterovaginal prolapse (3), uterine leiomyosarcoma (1), and vulvovaginal cancer (1) constituted 8 cases or 21.1% of deaths. No deaths were recorded from uterine fibroids, dysfunctional uterine bleeding, pelvic inflammatory disease, etc., Conclusion: Cancers constitute the majority of causes of gynaecological deaths in women who are not pregnant. This emphasises the need for cancer prevention, early diagnosis and effective treatment