Proposed Framework for Making Focused Antenatal Care Services Accessible: A Review of the Nigerian Setting

The aim of this paper is to propose a framework for making antenatal care an effective strategy in reducing the high maternal mortality ratio in Nigeria. On-site visits to five teaching hospitals were carried out between 2006 and 2008 to assess the practice of antenatal care. Group discussions with 200 parturients on their awareness of birth preparedness/complication readiness were conducted, in October, 2008. The findings of this study are discussed in line with the proposed practice of focused antenatal care. The practice of antenatal care in all the hospitals visited was the traditional approach based on earlier European models. Awareness of birth preparedness/complication readiness, by parturients, as a goal-directed intervention during antenatal care was low (21.5%). To reduce maternal deaths through antenatal care, it is critical to link care with detecting and treating causes of maternal mortality by a skilled attendant

Parturients’ Awareness and Perception of Benefits of Breast Feeding in the Prevention of Infant and Childhood Oral and Dental Diseases

Background: Breastfed babies have a better chance of improved oral and dental health than their counterparts that were artificially-fed. Objective: To assess the knowledge and attitude of postnatal mothers on the benefits of breastfeeding in prevention of oral and dental diseases. Materials and Methods: A cross – sectional descriptive survey of 206 mothers attending the postnatal clinic of theUniversity of Calabar Teaching Hospital, Calabar on the knowledge and attitude of breastfeeding in prevention of oral diseases in infants.Results: Initiation of breastfeeding was early within 3 days of childbirth in 90.3% of mothers. The lack of awareness or knowledge of specific childhood dental/ oral disorders prevented by breastfeeding by majority (89.3%) of the respondents was statistically significant. Actual willingness to breastfeed baby for longer periods after instruction on specific oral health benefits of breastfeeding was elicited in 180 (87.4%) mothers.Conclusion: There is a need to improve the knowledge of specific benefits of breastfeeding in prevention of dental diseases. This calls for education of the health professionals beside the dental practitioners who handle the mothers for themselves to be aware.Funding: The study was funded by the authors.Keywords: Breastfeeding, prevention, oral, dental, disease

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

Review of Obstetrics Genito-urinary Fistulae in the University of Calabar Teaching Hospital Calabar, Nigeria

Obstetric fistulae with Urinary incontinence are one of the most distressing maternal morbidities. It is associated with physical and social deprivation such as wife abandonment and violent reactions against the victims particularly in the developing countries of the world. To study the demographic and reproductive profiles as well as management of patientswith obstetric fistulae inUCTH,Calabar,Nigeria. Afiver-year retrospective study of case records of 37 patients managed inMaternity Annex of University of Calabar Teaching Hospital, Calabar Nigeria for obstetric genito-urinary fistulae was carried out. One in every 122 parturients during the period had fistula. Eleven (29.7%) were teenagers. Many patients weremarried (54.1%), nulliparous (59.4%), come from low socioeconomic class (72.9%) and did not utilize modern obstetric facilities properly. Many cases resulted from prolonged obstructed labour (51.4%) and 70.2% presented with total incontinence of urine. Eighteen (48.7%)were diagnosed within 6 month of delivery. Themain types encountered includedwere vesico-vaginal (34.4%) or complex (10.8%) fistulaewho were manage conservatively (21.6%) or with bladder repairs. Majority (29.7 %) were referred for further treatment. Parturient in Calabar still suffer from this age long obstetric morbidity mainly due to poor utilization of modern obstetric care facilities. Results of treatment are largely unsatisfactory; therefore resources should be channeled towards prevention.Keywords: Obstetrics, : Genito-urinary, fistula

Beliefs And Practice Concerning Pregnancy Delivery And Puerperium In Rural Akwa Ibom State

Focus group discussions involving 100 rural women in five communities of Akwa Ibom State, Nigeria were carried out over a six-month period. The aim was to determine if the beliefs and practices of our rural dwellers are such that contribute to maternal morbidity. The discussions revealed that the participants had a shallow knowledge of the causes of complications in pregnancy. Complications were largely attributed to spirits and other harmless events. Reducing physically demanding activities in pregnancy was ascribed to laziness and sexual intercourse was largely to be avoided. There was no food taboos specific to pregnancy, but food restrictions were described. Antenatal and intrapartum care by spiritual and traditional midwives was considered superior to orthodox care. Practices by the midwives include turning a baby in an abnormal lie, massaging the vagina with oil in labour; conducting delivery without gloves, pulling on the cord, manually removing or squeezing out the placenta if delivery is not spontaneous. Management of complications involves divinations, use of herbs and other concoctions, anointing oil, prayers and fasting. Puerperal seclusion practiced to varying degrees and maybe beneficial. Most beliefs and practices of our rural women are potential contributors to maternal morbidity. A few are harmless or even beneficial. Public enlightenment and education of our rural dwellers while incorporating the harmless/beneficial practices into modern obstetric care services will help reduce maternal morbidity. KEYWORDS: Pregnancy, Beliefs and Practice

Vesicovaginal fistula presenting as urogenital prolapse

Vesicovaginal fistula (VVF) is an abnormal fistulous communication between the bladder and the vagina that allows continuous involuntary discharge of urine into the vagina. It is one of the most abhorred morbidities in obstetric practice because of the profound effect on the patient’s emotional well‑being. Here, we present a case of VVF presenting as urogenital prolapse following an automobile accident. A large fistulous defect with complete bladder base prolapse was successfully repaired with adequate flap mobilization after two failed attempts by a surgical team. VVF should be considered in cases of urogenital prolapse especially following traumatic pelvic injuries.Keywords: Bladder base; trauma; urogenital; vesicovaginal fistul

Perinatal Outcome in Unbooked Teenage Pregnancies in the University of Calabar Teaching Hospital, Calabar, Nigeria

Background. Teenage pregnancy being a high risk condition requires skilled attention for good outcome. Objectives. To determine the influence of antenatal care on perinatal outcome in teenage pregnancies in Calabar. Materials and Methods. A review of patient records in Calabar was conducted between 1st January, 2006 and 31st December, 2010, to determine perinatal outcome in teenage pregnancy. Results. Teenage pregnancy accounted for 644 (6.5%) of the total deliveries with 245 (38.0%) booked while 399 (62.0%) were unbooked. Teenage mothers contributed significantly to the proportion of women who were delivered without prior antenatal care (χ2 = 6.360; P < 0.05). The mean duration of labour in booked teenagers was 10.85 ± 4.2 hours, while unbooked teenagers was 23.31 ± 3.6 hours (t-value = 77.1039; P < 0.05). There was statistically more caesarean sections among unbooked teenage pregnancies than booked (χ2 = 36.75; P < 0.05). Stillbirth was statistically significant (χ2 = 27.096; P < 0.05) among unbooked teenagers than booked. However, early neonatal death was not significantly different between booked and unbooked teenage pregnancies(χ2 = 0.512; P < 0.05). Conclusion. Unbooked teenage pregnancies were significantly associated with increased operative intervention and poor perinatal outcome

Effectiveness of Nutritional Counseling in the Management of Overweight/Obesity in Calabar Metropolis, Cross River State, Nigeria

Abstract A healthy diet is essential for optimal nutritional and health status and the prevention of chronic disease. However, poor diet contributes to the growing epidemics of overweight/obesity and chronic disease both in the developed and developing countries. Furthermore, most individuals lack nutrition knowledge necessary to develop healthier eating patterns. Weight control is considered the best non-medical means of managing overweight/obesity. Improving nutritional knowledge in individuals is also an appropriate strategy. Thus, this study presents the effectiveness of nutritional counseling in the management of overweight/obesity in an urban area in Nigeria. A cross-sectional descriptive clinic-based study was done using a validated interviewer-administered questionnaire to collect information from men and women aged 18-65 years. The effectiveness of nutritional counseling on weight reduction was evaluated; nutrition knowledge, food consumption, behavioural patterns and anthropometry of the overweight/obese individuals were assessed. The findings showed a significant reduction in the body mass index (BMI) within the short duration of intervention indicating a positive correlation between nutritional counseling therapy and nutritional status. Thus, the study postulated nutrition therapy as an important strategy in weight reduction. In addition, the study confirmed an existing evidence of an association between poor dieting and lack of physical exercise as predictors of overweight/obesity. Hence, adequate nutritional counseling and patient involvement in self care plan may be considered positive factors in obesity management