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

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

Factors associated with contraceptive use and initiation of coital activity after childbirth

John E Ekabua1, Kufre J Ekabua2, Patience Odusolu1, Chritopher U Iklaki1, Thomas U Agan1, Aniekan J Etokidem21Department of Obstetrics and Gynecology, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria; 2Department of Community Medicine, University of Calabar Teaching Hospital, Calabar, Cross River State, NigeriaAbstract: The aim of the study is to identify the factors influencing contraceptive use and initiation of sexual intercourse after childbirth. This was a cross-sectional descriptive survey involving 256 consecutive women, who delivered between April and October, 2007, presenting at the Immunization Clinic, University of Calabar Teaching Hospital, Nigeria in April, 2008. Data was obtained using an interviewer-administered structured questionnaire. Women who had antenatal and postnatal counseling were significantly more likely to use contraceptives than those who did not have counseling (odds ratio (OR) 0.29; 95% confidence interval (CI) 0.14–0.59; P = 0.0002 and OR 0.18; 95% CI 0.08–0.38; P = 0.0000002 respectively). Other variables significantly associated with contraceptive use included education (P = 0.0470) and reproductive goal (P = 0.0303). Linear regression analysis showed direct relationship between caesarean section and episiotomy as modes of delivery, and initiation of coitus (r2 = 0.439 and 0.45 respectively). Concerning residence after childbirth, staying at home and with in-laws showed direct relationship with initiation of coitus (r2 = 0.208 and 10.750 respectively). The number of women abstaining from intercourse showed a decreasing trend with increasing months after childbirth. Initiation of coitus was significantly associated with resumption of menstruation (P < 0.0001) and non-contraceptive use (P = 0.0089). In conclusion, this study shows the need for use of postpartum contraception before fecund women become susceptible to pregnancy.Keywords: postpartum contraception, factors affecting us

A Review of Pregnancy Outcome in Women with Eclampsia at the University of Calabar Teaching Hospital, Calabar

Context: Eclampsia remains an important cause of maternal and perinatal morbidity and mortality throughout the world, particularly in developing countries. A constant review of treatment outcomes is therefore needed. Objective: To document the relative risk of adverse pregnancy outcome in eclamptic women who delivered in our hospital (vaginal vs. abdominal) and to proffer measures for risk-reduction. Study Design, Setting and Subjects: A comparative review of pregnancy outcome in women with eclampsia at the University of Calabar Teaching Hospital (UCTH), Calabar, over a 10-year period was conducted. Eighteen women who had abdominal delivery were compared with a control group of 11 who had vaginal delivery. Six women who had regional anaesthesia for abdominal delivery were compared with a control group of 12 cases that underwent general anaesthesia. Outcome Measures: Adverse maternal outcome including maternal death; adverse fetal outcome. Results: The relative risk (RR) of adverse fetal outcome with abdominal delivery was higher for parameters such as birth asphyxia (RR: 2.42), low birth weight (RR: 1.84) and neonatal death (RR: 1.22). The risk for adverse maternal outcome with abdominal delivery was also higher: hemiplegia (RR: 1.22), oliguria (RR: 1.84) and maternal death (RR: 1.22). The use of regional anaesthesia for abdominal delivery was associated with a risk of failed anaesthetic technique (RR: 2.00) and aspiration of gastric contents (RR: 1.20). Conclusion: Eclampsia is a serious but preventable obstetric complication associated with poor pregnancy outcome. Current treatment protocol in our hospital has not resulted in improved outcome, especially in eclamptics delivered by caesarean section. (Tropical Journal of Obstetrics and Gynaecology: 2001, 18(2): 66-68

Contraceptive practices in Nigeria: Literature review and recommendation for future policy decisions

Emmanuel Monjok1, Andrea Smesny1, John E Ekabua2, E James Essien11Institute of Community Health, University of Houston, Texas, USA; 2Department of Obstetrics and Gynecology, University of Calabar, NigeriaAbstract: The current prevalence rate for contraceptive use in Nigeria is approximately 11%–13%. This rate is very low in spite of the high rate of sexual activity and widespread awareness of the various contraceptive methods among Nigerian adolescence and youths. As a result there are many unintended pregnancies and illegal abortions contributing to a high maternal mortality ratio, which seems to indicate a large unmet need for contraceptive use. There is ample research evidence identifying the various factors that contribute to the low prevalence of modern contraceptive use in Nigeria, with the most common factor being the myth about the side effects of modern contraceptives. However, what is lacking is a political will in Nigeria to provide family planning programs on a much larger scale, using community-oriented approaches and communication programs, to help change the myth about the side effects of modern contraceptives. This review highlights current methods and concepts in contraception, reasons for low contraceptive use and practice in Nigeria, and the need for Nigeria to generate a political priority and a will to make a change in maternal health indicators, with the ultimate goal of providing direction to guide changes in the Nigerian Population Policy as it affects contraceptive use and family planning.Keywords: contraceptive practice, literature review, research, Nigeri

The impact of motorcycle accidents on the obstetric population in Calabar, Nigeria

Contexts: Motorcycle accidents are very common in most cities in Nigeria since the introduction of motorcycle for public commercial transportation in the early 1980s and because most pregnant women use this popular means of transport it may contribute to non-obstetric causes of maternal and perinatal morbidity and mortality. The impact of this on our obstetric population is yet to be studied in Calabar. Objectives: is to assess the influence of motorcycle accidents on maternal and perinatal performance in patients manage in the University of Calabar Teaching Hospital, Calabar. Study Design, Setting and Subjects: This was a retrospective descriptive study carried out in the maternity Annex of the University of Calabar Teaching Hospital (UCTH), Calabar. One hundred and four patients managed as a result of motorcycle accidents in the index pregnancy over two years were studied. Results: Motorcycle accounted for 7.1% of all obstetric emergencies during the period. The victims were mostly married (43.3%); multiparous (23.1%) and 34.6% were civil servants. Twenty (19.2%)of patients were ridding the motorcycles themselves. Of the 64 victims who were passengers, 68.8% sat sideways. Most of the victims (40.4%) were in the third trimester of gestation while 23.0% were actually in labor. The maternal complications included premature labour and deliveries (7.6%), abruptio placentae (3.8%) and ruptured uterus (1.9%). Complications occurred in 33.0% of the babies, which included birth asphyxia and prematurity with perinatal death of 5.5%. Conclusion: Motorcycle accidents are common among the Obstetric population in Calabar. There is high rate of life threatening maternal complications and perinatal morbidity. Relevant authority should ensure that only those duly licensed are allowed to ride the motorcycle when carrying pregnant women who should be the only passenger and sit astride.Keywords: motorcycles accidents, obstetric populationTropical Journal of Obstetrics and Gynaecology Vol. 22(2) 2005: 164-16

Complications associated with macrosomic fetus in Calabar South Eastern Nigeria

A retrospective study to determine adverse perinatal outcome associated with macrosomic births was carried out at the University of Calabar Teaching Hospital, Calabar (1994-2000). The incidence of macrosomic births was 1 in 25 deliveries. Perinatal mortality rate (PNMR) was 83 per 1000 births was highest in the birth weight range of 4.0 – 4.4kg (P = 0.004) and in macrosomic babies born by caesarean section (P=0.0019). The commonest indication for abdominal delivery was obstructed labour (14.4%) with an associated PNMR of 21.8 per 1000 births. Perinatal morbidity and mortality were seen in 25.3% of cases. Perinatal mortality is significantly high in the birth weight range of 4.0-4.4kg and in babies born abdonminally, mainly because of obstructed labour and ruptured uterus. Intervention before these complications occur may significantly reduce the adverse pregnancy outcome associated with macrosomic births. Keywords: fetal complications, macrosomia Mary Slessor Journal of Medicine Vol. 5(2) 2005: 5-

Extrauterine Decidual Reaction in Pregnancy Presenting as an Acute Abdomen: A Case Report

Ectopic decidua is usually an incidental finding at caesarean section and is not usually associated with symptoms. A 37-year-old multiparous patient presented with features of acute abdomen in the third trimester of pregnancy. Laparotomy revealed haemoperitoneum of about 2 litres, multiple pelvic adhesions and nodular lesions (measuring 2-4mm across) on the serosa of the uterus. Histology of biopsy specimens from the lesions showed them to be decidual in nature. Postnatal examination at 6 weeks revealed a healthy looking lady with complete involution of pelvic organs. (Tropical Journal of Obstetrics and Gynaecology: 2001, 18(2): 91-92

Obstructed Labour in Resource-poor Settings: The Need for Revival of Symphysiotomy in Nigeria

Symphysiotomy is an operation in which the fibres of the pubic symphysis are partially divided to allow separation of the joint and thus enlargement of the pelvic dimensions thereby facilitating vaginal delivery of the foetus in the presence of mild to moderate cephalopelvic disproportion. It is performed with local anaesthesia, does not require an operating theatre or advanced surgical skills. It can be a lifesaving procedure for both mother and baby in obstructed labour, especially in rural areas and resource-poor settings of developing countries, where a 24 hours availability of a caesarean section cannot be guaranteed. It is a simple underused technology that can be performed by a graduate doctor or midwife in rural health facilities and hospitals where most of the times, in Nigeria, there are no practicing specialist obstetricians. In rural hospital and in communities where sympysiotomy is still being performed, it is evident that it is preferred to caesarean section because of the socio-cultural desire to achieve a vaginal delivery. This paper highlights our experiences with symphysiotomy in a rural Roman Catholic hospital providing evidence on the safety of symphysiotomy and the need for its revival and reinstatement in the obstetric arsenal in Nigeria and similar countries in sub-Saharan Africa where maternal mortality as a result of prolonged and neglected obstructed labour still occur (Afr J Reprod Health 2012; 16[3]: 93-100)