Effect of upgraded emergency services on obstetric case fatality at a Tertiary Hospital in Cross River state, Nigeria

No Abstract

High ANC coverage and low skilled attendance in a rural Tanzanian district: a case for implementing a birth plan intervention

BACKGROUND: In Tanzania, more than 90% of all pregnant women attend antenatal care at least once and approximately 62% four times or more, yet less than five in ten receive skilled delivery care at available health units. We conducted a qualitative study in Ngorongoro district, Northern Tanzania, in order to gain an understanding of the health systems and socio-cultural factors underlying this divergent pattern of high use of antenatal services and low use of skilled delivery care. Specifically, the study examined beliefs and behaviors related to antenatal, labor, delivery and postnatal care among the Maasai and Watemi ethnic groups. The perspectives of health care providers and traditional birth attendants on childbirth and the factors determining where women deliver were also investigated. METHODS: Twelve key informant interviews and fifteen focus group discussions were held with Maasai and Watemi women, traditional birth attendants, health care providers, and community members. Principles of the grounded theory approach were used to elicit and assess the various perspectives of each group of participants interviewed. RESULTS: The Maasai and Watemi women's preferences for a home birth and lack of planning for delivery are reinforced by the failure of health care providers to consistently communicate the importance of skilled delivery and immediate post-partum care for all women during routine antenatal visits. Husbands typically serve as gatekeepers of women's reproductive health in the two groups - including decisions about where they will deliver- yet they are rarely encouraged to attend antenatal sessions. While husbands are encouraged to participate in programs to prevent maternal-to-child transmission of HIV, messages about the importance of skilled delivery care for all women are not given emphasis. CONCLUSIONS: Increasing coverage of skilled delivery care and achieving the full implementation of Tanzania's Focused Antenatal Care Package in Ngorongoro depends upon improved training and monitoring of health care providers, and greater family participation in antenatal care visits

Staff Attitude as a Barrier to the Utilisation of University of Calabar Teaching Hospital for Obstetric Care

Focus group discussions (FGD) to assess how the attitudes of hospital staff influence the utilisation of health facility for obstetric care at the University of Calabar Teaching Hospital (UCTH), Calabar, Nigeria, were conducted. The participants were women of childbearing age and men in two communities, as well as health staff at the teaching hospital. The aims were to establish community perception of attitudes of hospital staff and their influence on the utilisation of UCTH for obstetric care. Negative attitudes of hospital staff towards patients stood as a barrier to the utilisation of available obstetric care. Lack of incentives and inadequate materials to work with, as well as poor remuneration contributed to these negative attitudes. Provision of incentives to hospital staff, enhanced regular pay to workers, and regular workshops to train hospital staff are suggested as possible solutions to this problem. (Afr J Reprod Health 2000; 4[2]: 69–73) Résumé L'attitude du personnel comme obstacle à l'utilisation des soins obstétriques au Centre Hospitalier Universitaire de Calabar. L'étude s'est servie de la méthode de discussion en groupes cibles pour évaluer la manière dont l'attitude du personnel au Centre Hospitalier Universitaire de Calabar (CHUC) au Nigéria influence l'utilisation des facilitiés de santé pour les soins obstétriques. Comme participants, l'étude s'est servie des femmes encore en âge d'avoir des enfants, les hommes de deux communautés, ainsi que le personnel médical du Centre Hospitalier Universitaire de Calabar. Le but était d'établir la perception qu'a la communauté à l'égard des attitudes du personnel de l'hôpital et leurs influences sur l'utilisation des soins obstétriques de CHUC. Les attitudes négatives de la part du personnel de l'hôpital envers les patients constituent un obstacle à l'utilisation du soin obstétrique disponible. Ces attitudes négatives ont été attribuées au manque de primes, à l'insuffisance de matériaux de travail et aux bas salaires. L'étude suggère que les solutions possibles résident dans la stimulation du personnel, l'augementation et le paiement des salaires réguliers au cadre et dans l'organsisation des ateliers pour former le personnel de l'hôpital. (Rev Afr Santé Reprod 2000; 4 [1]: 69–73) Key Words: Attitudes, hospital staff, utilisation, health facility, obstetric care, barrie

Perinatal Outcome Following Singleton Vaginal Breech Delivery in the University of Calabar Teaching Hospital, Calabar: A 10-Year Review

All the patients who had vaginal breech delivery at the University of Calabar Teaching Hospital, Calabar over a 10 year period were reviewed. The aim was to determine the incidence of breech delivery and evaluate the perinatal outcome following vaginal breech delivery. Relavant information was obtained from the case notes of patients who had vaginal breech delivery. The incidence of singleton breech delivery during the study period was 1.41% and 69.34% of these had vaginal breech delivery. The perinatal mortality rate was 158/1000 births. Majority of vaginal breech deliveries occurred in multiparous women (56.8%) and at term (61.1%). The perinatal outcome was worse in babies who weighed above 3.5kg (50.0%), in those born to multiparous women (57.4%) and in those delivered by senior registrars (50.0%). There is need for the involvement of consultant obstetricians in the antenatal evaluation of all patients with breech presentation. Monitoring during labour and conduct of delivery must be by an obstetrician experienced in the art of vaginal breech delivery. Vaginal breech delivery should become part of every labour ward fire drill and appropriate training sessions should be organized for all obstetric residents. Key Words: Perinatal outcome, vaginal breech delivery, University of Calabar Teaching Hospital Mary Slessor Journal of Medicine Vol.4(1) 2004: 81-8

Maternal and perinatal outcome following rupture of gravid uterus in Calabar, Nigeria

No Abstract. Global Journal of Medical Sciences Vol. 5(1) 2006: 55-6

Current trends in caesarean section in University of Calabar Teaching Hospital Calabar-Nigeria

The rising caesarean section rate is becoming a cause for concern among many obstetricians all over the world more so in developing countries where there is strong aversion to caesarean section. A five year study was conducted between 1998 to 2002 to evaluate incidence of caesarean section in the University of Calabar Teaching Hospital and factors that influence the rising trend in caesarean section rate in our environment and also to find out the case fatality rate associated with this surgical operation. Caesarean section accounted for 19.8% of the total deliveries while spontaneous vaginal delivery accounted for 75.6%. Other modes of deliveries included assisted breech delivery (2.8%), vacuum (1.5%), forceps – (0.5%), destructive operations (0.14%). The caesarean section rate increased progressively from 17.9% in 1998 to 21.9% in 2002. Emergency caesarean sections (80.0%) were more frequently performed than elective cases (20.0%). Majority of the patients (82.9%) were booked while only 17.1% were unbooked. The commonest indication for emergency caesarean section was obstructed labour due to cephalopelvic disproportion (25%), followed closely by fetal distress (13.9%). The case fatality from caesarean section was calculated as 1.29%. It is obvious that there is increase in the caesarean section rate in our environment, which is in line with what is happening in the developed countries where the operation is more liberally used. In consonance with finding in other Teaching Hospitals, caesarean section appears to be on the increase in Nigeria. Although it has been suggested that increased rates of caesarean section would reduce the unusually high perinatal mortality in this area, this has not been subjected to objective scientific analysis. Keywords: caesarean section, cephalopelvic disproportion, obstructed labour Mary Slessor Journal of Medicine Vol. 5(1), 2005: 41-4

Outcome of pregnancy in women with motorcycle accidents in Calabar, Nigeria

Three hundred and seventeen pregnant women managed in the maternity section of the University of Teaching Hospital, Calabar as a result of motorcycle accidents were assessed to determine maternal and perinatal complications and outcome of such pregnancies. The incidence of 6.6% of all deliveries was established with a rising trend over the years of 3.3% in 2001 to 8.7% in 2003. Married (42.3%), civil servants (34.6%) and multiparous (59.6%) women were more prone to having accidents in pregnancy. Risk was increased among those who sat more than one as passengers (40.3%) or sideways (42.3%) and in the third trimester of pregnancy (40.4%). Even though majority had uneventful pregnancy (62.5%) and normal deliveries (59.6%) some had life threatening complications such as abruptio placentae, ruptured uterus and 21.1% were delivered by caesarean section. Pregnant women in the third trimester or in labour should be the only passenger on motorcycle and sit astride. Strict enforcement of traffic laws by the relevant authority ensuring that only those properly trained and licensed are allowed to operate commercial motorcycle transports. Pregnant women irrespective of gestational age and degree of trauma should report in the obstetric emergency unit for proper assessment to avoid overlooking life-threatening injuries. Keywords: motorcycle accidents, pregnancy complications Mary Slessor Journal of Medicine Vol. 5 (1), 2005: 46-5

Overcoming phase 1 delays: the critical component of obstetric fistula prevention programs in resource-poor countries

<p>Abstract</p> <p>Background</p> <p>An obstetric fistula is a traumatic childbirth injury that occurs when labor is obstructed and delivery is delayed. Prolonged obstructed labor leads to the destruction of the tissues that normally separate the bladder from the vagina and creates a passageway (fistula) through which urine leaks continuously. Women with a fistula become social outcasts. Universal high-quality maternity care has eliminated the obstetric fistula in wealthy countries, but millions of women in resource-poor nations still experience prolonged labor and tens of thousands of new fistula sufferers are added to the millions of pre-existing cases each year. This article discusses fistula prevention in developing countries, focusing on the factors which delay treatment of prolonged labor.</p> <p>Discussion</p> <p>Obstetric fistulas can be prevented through contraception, avoiding obstructed labor, or improving outcomes for women who develop obstructed labor. Contraception is of little use to women who are already pregnant and there is no reliable screening test to predict obstruction in advance of labor. Improving the outcome of obstructed labor depends on prompt diagnosis and timely intervention (usually by cesarean section). Because obstetric fistulas are caused by tissue compression, the time interval from obstruction to delivery is critical. This time interval is often extended by delays in deciding to seek care, delays in arriving at a hospital, and delays in accessing treatment after arrival. Communities can reasonably demand that governments and healthcare institutions improve the second (transportation) and third (treatment) phases of delay. Initial delays in seeking hospital care are caused by failure to recognize that labor is prolonged, confusion concerning what should be done (often the result of competing therapeutic pathways), lack of women’s agency, unfamiliarity with and fear of hospitals and the treatments they offer (especially surgery), and economic constraints on access to care.</p> <p>Summary</p> <p>Women in resource-poor countries will use institutional obstetric care when the services provided are valued more than the competing choices offered by a pluralistic medical system. The key to obstetric fistula prevention is competent obstetrical care delivered respectfully, promptly, and at affordable cost. The utilization of these services is driven largely by trust.</p