A population-based estimation of maternal mortality in Lagos State, Nigeria using the indirect sisterhood method.

BACKGROUND: Pregnancy and delivery deaths represent a risk to women, particularly those living in low- and middle-income countries (LMICs). This population-based survey was conducted to provide estimates of the maternal mortality ratio (MMR) in Lagos Nigeria. METHODS: A community-based, cross-sectional study was conducted in mapped Wards and Enumeration Areas (EA) of all Local Government Areas (LGAs) in Lagos, among 9,986 women of reproductive age (15-49 years) from April to August 2022 using a 2-stage cluster sampling technique. A semi-structured, pre-tested questionnaire adapted from nationally representative surveys was administered using REDCap by trained field assistants for data collection on socio-demographics, reproductive health, fertility, and maternal mortality. Data were analysed using SPSS and MMR was estimated using the indirect sisterhood method. Ethical approval was obtained from the Lagos State University Teaching Hospital Health Research and Ethics Committee. RESULTS: Most of the respondents (28.7%) were aged 25-29 years. Out of 546 deceased sisters reported, 120 (22%) died from maternal causes. Sisters of the deceased aged 20-24 reported almost half of the deaths (46.7%) as due to maternal causes, while those aged 45-49 reported the highest number of deceased sisters who died from other causes (90.2%). The total fertility rate (TFR) was calculated as 3.807, the Lifetime Risk (LTR) of maternal death was 0.0196 or 1-in-51, and the MMR was 430 per 100,000 [95% CI: 360-510]. CONCLUSION: Our findings show that the maternal mortality rate for Lagos remains unacceptable and has not changed significantly over time in actual terms. There is need to develop and intensify community-based intervention strategies, programs for private hospitals, monitor MMR trends, identify and contextually address barriers at all levels of maternal care

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

Transcutaneous bilirubin nomograms in African neonates.

The use of transcutaneous bilirubin (TcB) as a screening tool, based on relevant population-specific nomogram, or proxy for total serum bilirubin (TSB) levels in assessing the risk of subsequent hyperbilirubinemia is supported by several clinical guidelines on the management of neonatal hyperbilirubinemia. However, while TcB has been found to significantly over-estimate TSB in neonates of African-American ancestry, with variations across TcB devices, no nomogram has been specifically reported for this racial group. This study therefore set out to develop TcB nomograms for healthy late pre-term and term black African neonates derived from two widely used bilirubinometers.A retrospective analysis of 12,377 TcB measurements obtained from 6,373 neonates in the first postnatal week, over a period of 48 months using Bilichek and JM-103 bilirubinometers. TcB percentiles were computed from hour-specific TcB values and nomograms developed for each of the screening devices. Predictive ability of the 75th and 95th percentiles to detect significant hyperbilirubinemia was evaluated between 24-96 hours of age. The 95th percentile curve was compared with those from other populations.The velocity of TcB rise at 75th and 95th percentiles was generally higher with JM-103 than Bilichek. Both percentiles also peaked at higher TcB levels with JM-103. The 95th percentile for both instruments showed a downward trend as from approximately 114 hours. Both instruments had high negative predictive values across the selected time-epochs and lower discriminatory ability than reported in non-black populations.The predictive utility of TcB as a potential screening tool varies across devices in black African neonates with or without risk of significant hyperbilirubinemia, and lower than levels reported in non-black populations. Equipment-specific nomograms should be considered for TcB monitoring in this racial population where TSB is not routinely available

Maternal detection of neonatal jaundice during birth hospitalization using a novel two-color icterometer

<div><p>Background</p><p>Mothers are frequently the first to observe the onset of jaundice in their newborn infants before the decision to seek treatment. However, simple-to-use tools that could facilitate early detection of jaundice and assist mothers to seek professional care, especially after hospital discharge, are rare. This study therefore, set out to evaluate the performance of a -two-color icterometer (Bilistrip™) as a possible screening tool for detecting significant jaundice by mothers or care-givers in the first week of life.</p><p>Methods</p><p>Prior to discharge, mothers in a maternity hospital were trained to use the Bilistrip™ on the blanched skin of their baby’s nose to ascertain absence (Light Yellow) or presence (Dark Yellow) of significant jaundice. Their babies had transcutaneous bilirubin (TcB) measurements independently, along with total serum bilirubin (TSB) if indicated. The reliability of Bilistrip™ as a screening test for significant jaundice was determined at different TcB and TSB thresholds. The predictive performance of Bilistrip™ was also evaluated with multivariable logistic regression.</p><p>Results</p><p>Some 2492 mother-infant pairs were enrolled over 15 months, of which 347 (13.9%) chose Dark Yellow. The mean TcB for Dark Yellow (10mg/dL) was significantly higher (p<0.001) than for Light Yellow (6.1mg/dL). Bilistrip™ showed increasing sensitivity (47.0% - 92.6%) and negative predictive value (NPV) (91.4% - 99.9%) for selected TcB thresholds (≥10mg/dL, ≥12mg/dL, ≥15mg/dL, and ≥17mg/dL). Among neonates with TSB measurements (n = 124), Bilistrip™ was associated also with increasing sensitivity (86.8% - 100%) and NPV (62.5% - 100%). The sensitivity and NPV for detecting neonates requiring phototherapy were 95.8% respectively. Only one of the 24 neonates who required phototherapy was missed by the Bilistrip™.</p><p>Conclusions</p><p>Bilistrip™ is a potential decision-making tool for empowering mothers to detect neonates with clinically significant jaundice that may require close monitoring or treatment, and neonates not requiring treatment for jaundice in the first week of life.</p></div

Characteristics of mother-infant pairs enrolled.

<p>Characteristics of mother-infant pairs enrolled.</p

Complicated unsafe abortion in a Nigerian teaching hospital: pattern of morbidity and mortality

Addressing unsafe abortion in developing countries may propel a rapid decline in overall maternal death. A retrospective review of patients with complicated unsafe abortion was conducted in a Nigerian Tertiary Hospital. In order to provide evidence that may inform policy changes, we describe patients’ clinical profiles, abortion providers, and morbidity and mortality patterns. Of 3122 gynaecological admissions, 231 (7.4%) had unsafe abortion-related complications. The majority (53.2%) of admissions were between 16 and 25 years. Single women constituted 51% while 57% were nulliparous. Common presentations were abdominal pain (62%), fever (54%) and vaginal bleeding (53%). The most frequent complications were anaemia (55%) and retained products of conception (47%). Doctors reportedly performed 42% of abortions. There were 392 maternal mortalities; 39 (9.9%) from unsafe abortions and sepsis was responsible in 31 (80%) patients. Abortion remains a major public health issue. Youths are mostly involved. Doctors were reportedly the highest abortion providers. Mortality is high, occurring mostly from sepsis.Impact Statement What is already known on this subject? Doctors are reported as being involved in a high proportion of unsafe abortions in low and middle income countries where abortion remains a significant contributor to maternal mortality and morbidity. What the results of this study add? Our study agrees with existing literature that doctors reportedly performed most of the unsafe abortions. It also found that doctors were reported as abortion providers in the majority (35.9%) of those unsafe abortions that ended in mortality. What the implications are of these findings for clinical practice and/or further research? There is a need to conduct studies that will verify the status of abortion providers rather than rely on clients’ report; and also inspect facilities to confirm adherence to minimum medical standards. Such research findings will be needed prior to local and possibly national healthcare interventions and policy changes

Hour-specific nomogram for transcutaneous measurements with JM-103 bilirubinometer in African neonates.

<p>Hour-specific nomogram for transcutaneous measurements with JM-103 bilirubinometer in African neonates.</p

Hour-specific nomogram for transcutaneous measurements with Bilichek bilirubinometer in African neonates.

<p>Hour-specific nomogram for transcutaneous measurements with Bilichek bilirubinometer in African neonates.</p