Awareness and perception of maternal mortality among women in a semi-urban community in the Niger Delta of Nigeria

Background: Maternal mortality rates are very high in Nigeria. Increased level of awareness and perception will reduce maternal mortality rates. Objective: The study was aimed at assessing the awareness and perception of maternal mortality among women in the reproductive age group at Ogunu community in Warri South Local Government Area of Delta State. Methodology: This was a descriptive cross-sectional study that was carried out in Ogunu town in Delta State. A simple random sampling technique was used to select 400 women, who gave consent to be enrolled in the study. They were assisted in filling a semi-structured questionnaire containing questions on awareness and perception of maternal mortality among women in the community. Information generated was recorded on a data collection sheet designed for the study. The coded data were fed into the computer using the SPSS program to determine the mean values and frequencies. Results: A total of 400 questionnaires were distributed; of these, 349 were completely filled and returned. The mean age of the study subjects was 31.6 \ub1 7.7 years. Among these subjects, 54.7% were married, while 32.7%, 28.7% and 26.5% had tertiary, secondary and primary education, respectively. The study revealed that 96.3% of the subjects felt that death can occur from pregnancy-related problems, while 69.1% were aware of maternal mortality. Majority of the subjects agreed that one or more forms of delay could be responsible for their death. This study shows that a good proportion of subjects was aware of maternal mortality and also had a good perception of it. Conclusion: Efforts should be directed towards educating women about the risk of delivering in homes of traditional birth attendants, maternity homes and health centers, and the concept of early referral of women to the hospital should be reinforced. Providing information to women on prevention of maternal mortality and community participation and mobilization will help prevent maternal mortality to some extent in Nigeria

Criteria-based audit on management of eclampsia patients at a tertiary hospital in Dar es Salaam, Tanzania

\ud Criteria-based audits have been used to improve clinical management in developed countries, but have only recently been introduced in the developing world. This study discusses the introduction of a criteria-based audit in a tertiary hospital in an African setting, assesses the quality of care among eclampsia patients and discusses possible interventions in order to improve the quality of care. We conducted a criteria based audit of 389 eclampsia patients admitted to Muhimbili National Hospital (MNH), Dar es Salaam Tanzania between April 14, 2006 and December 31, 2006. Cases were assessed using evidence-based criteria for appropriate care. Antepartum, intrapartum and postpartum eclampsia constituted 47%, 41% and 12% of the eclampsia cases respectively. Antepartum eclampsia was mostly (73%) preterm whereas the majority (71%) of postpartum eclampsia cases ware at term. The case fatality rate for eclampsia was 7.7%. Medical histories were incomplete, the majority (75%) of management plans were not reviewed by specialists in obstetrics, specialist doctors live far from the hospital and do not spend nights in hospital even when they are on duty, monitoring of patients on magnesium sulphate was inadequate, and important biochemical tests were not routinely done. Two thirds of the patient scheduled for caesarean section did not undergo surgery within agreed time. Potential areas for further improvement in quality of emergency care for eclampsia relate to standardizing management guidelines, greater involvement of specialists in the management of eclampsia and continued medical education on current management of eclampsia for junior staff.\u

Strengthening the emergency healthcare system for mothers and children in The Gambia

A system to improve the management of emergencies during pregnancy, childbirth, infancy and childhood in a region of The Gambia (Brikama) with a population of approximately 250,000 has been developed

Predictors of extra care among magnesium sulphate treated eclamptic patients at Muhimbili National Hospital, Tanzania

\ud The inclusion of Magnesium Sulphate (MgSO4) as a gold standard in the treatment of eclampsia has substantially reduced incidences of repeated fits, eclamptic morbidity and deaths. However, despite treatment with MgSO4, a proportion of patients need extra medical/nursing attention and prolonged stay in the intensive care unit (ICU). The literature on the underlying factors for the need of extra care in the MgSO4 era is lacking. This study sought to establish predictors of extra care in ICU among eclamptic patients after treatment with MgSO4 at Muhimbili National Hospital (MNH). Data were obtained from hospital records of eclamptic patients who were admitted at MNH and treated with MgSO4 from January 1st to December 31st, 2008. Based on set criteria, patients who needed extra care were identified. Analysis was performed using PASW statistics 18 whereby frequencies, cross-tabulations, bivariate and multiple logistic regressions were performed. A total of 366 eclamptic patients were admitted and treated with MgSO4 at MNH during a 12 month study period in 2008. Most of these (76%) were referred from district hospitals and 132 (36%) met the criteria for extra care in ICU. After adjusting for other variables, the risk of extra care in ICU for patients who were admitted with altered consciousness was double (OR = 2.3; 95% CI: 1.3-4.0) that of the ones admitted in alert state. The risk or need of extra care increased by increasing time to delivery and was doubled (OR = 2.0; 95% CI:1.1-3.7) if it was between 12 and 24 hours and tenfold elevated (OR = 10.0; 95% CI:4.3-23.6) if beyond 24 hours as compared to when time to delivery was less than 12 hours.Abdominal delivery was also independently associated with increased risk compared to vaginal delivery (OR = 2.5; 95%CI: 1.4-4.5). The type of referral and number of fits were associated with extra care in ICU but this association was wholly explained by the clinical status of the patient on admission to MNH and prolonged time lag to delivery. We concluded that even with MgSO4 used as the gold standard in the treatment of eclampsia, effective pre-referral care and expedited delivery were crucial in minimizing the need for extra care in ICU.\u

Twinning across the Developing World

Contains fulltext : 95481.pdf (publisher's version ) (Open Access)5 p

Male responsibility and maternal morbidity: a cross-sectional study in two Nigerian states

<p>Abstract</p> <p>Background</p> <p>Nigeria continues to have high rates of maternal morbidity and mortality. This is partly associated with lack of adequate obstetric care, partly with high risks in pregnancy, including heavy work. We examined actionable risk factors and underlying determinants at community level in Bauchi and Cross River States of Nigeria, including several related to male responsibility in pregnancy.</p> <p>Method</p> <p>In 2009, field teams visited a stratified (urban/rural) last stage random sample of 180 enumeration areas drawn from the most recent censuses in each of Bauchi and Cross River states. A structured questionnaire administered in face-to-face interviews with women aged 15-49 years documented education, income, recent birth history, knowledge and attitudes related to safe birth, and deliveries in the last three years. Closed questions covered female genital mutilation, intimate partner violence (IPV) in the last year, IPV during the last pregnancy, work during the last pregnancy, and support during pregnancy. The outcome was complications in pregnancy and delivery (eclampsia, sepsis, bleeding) among survivors of childbirth in the last three years. We adjusted bivariate and multivariate analysis for clustering.</p> <p>Findings</p> <p>The most consistent and prominent of 28 candidate risk factors and underlying determinants for non-fatal maternal morbidity was intimate partner violence (IPV) during pregnancy (ORa 2.15, 95%CIca 1.43-3.24 in Bauchi and ORa 1.5, 95%CI 1.20-2.03 in Cross River). Other spouse-related factors in the multivariate model included not discussing pregnancy with the spouse and, independently, IPV in the last year. Shortage of food in the last week was a factor in both Bauchi (ORa 1.66, 95%CIca 1.22-2.26) and Cross River (ORa 1.32, 95%CIca 1.15-1.53). Female genital mutilation was a factor among less well to do Bauchi women (ORa 2.1, 95%CIca 1.39-3.17) and all Cross River women (ORa 1.23, 95%CIca 1.1-1.5).</p> <p>Interpretation</p> <p>Enhancing clinical protocols and skills can only benefit women in Nigeria and elsewhere. But the violence women experience throughout their lives – genital mutilation, domestic violence, and steep power gradients – is accentuated through pregnancy and childbirth, when women are most vulnerable. IPV especially in pregnancy, women's fear of husbands or partners and not discussing pregnancy are all within men's capacity to change.</p

The impact of tubal ectopic pregnancy in Papua New Guinea - a retrospective case review

BACKGROUND: Ectopic pregnancy (EP) is an important cause of morbidity and mortality amongst women of reproductive age. Tubal EP is well described in industrialised countries, but less is known about its impact in low-resource countries, in particular in the South Pacific Region. METHODS: We undertook a retrospective review of women with tubal EP treated at a provincial referral hospital in coastal Papua New Guinea over a period of 56 months. Demographic and clinical variables were obtained from patients’ medical records and analysed. The institutional rate of tubal EP was calculated, and diagnosis and management reviewed. Potential risk factors for tubal EP were identified, and delays contributing to increased morbidity described. RESULTS: A total of 73 women had tubal EP. The institutional rate of tubal EP over the study period was 6.3 per 1,000 deliveries. There were no maternal deaths due to EP. The mean age of women was 31.5+/−5.7 years, 85% were parous, 67% were rural dwellers and 62% had a history of sub-fertility. The most commonly used diagnostic aid was culdocentesis. One third of women had clinical evidence of shock on arrival. All women with tubal EP were managed by open salpingectomy. Tubal rupture was confirmed for 48% of patients and was more common amongst rural dwellers. Forty-three percent of women had macroscopic evidence of pelvic infection. Two-thirds of patients received blood transfusions, and post-operative recovery lasted six days on average. Late presentation, lack of clinical suspicion, and delays with receiving appropriate treatments were observed. CONCLUSIONS: Tubal EP is a common gynaecological emergency in a referral hospital in coastal PNG, and causes significant morbidity, in particular amongst women residing in rural areas. Sexually transmitted infections are likely to represent the most important risk factor for tubal EP in PNG. Interventions to reduce the morbidity due to tubal EP include the prevention, detection and treatment of sexually transmitted infections, identification and reduction of barriers to prompt presentation, increasing health workers’ awareness of ectopic pregnancy, providing pregnancy test kits to rural health centres, and strengthening hospital blood transfusion services, including facilities for autotransfusion

Breast Examination Practices among Nursing Students in Warri, Delta State

Objective: To ascertain influencing factors and breast examination practices among student nurses in Warri, Delta state. Design: Cross-sectional survey.Setting: State School of Nursing, Warri, Delta State. Subjects: Two hundred and ninety six student nurses attending the school in 2010 with exclusion of introductory students.Results: Self breast examination was practiced by four-fifths(79.39%) of respondents; of the self breast examination practitioners, 88.52% had a monthly self breast exam. Clinical breast examination had been utilized by one-sixth (17.35%) of respondents. Self perception of proficiency at self breast examination was agreed to by four-fifths(82.35%) of respondents. About a third (21.6%) knew a family member or friend with breast cancer while a fourth (26.71%) had breast complaints in the past requiring Physician consultation. A previous breast procedure was admitted to by a fourth(24.01%) of respondents. There was a strong positive association between self breast examination and previous breast procedure,

Ruptured uterus resulting from an undiagnosed hydrocephalic fetus: the menace of unskilled attendant in pregnancy and delivery.

No Abstract Ebonyi Medical Journal Vol. 6 (1) 2007 pp. 59-6

Intestinal Obstruction due to Bilateral Ovarian Cystic Teratoma in a Pregnant Woman: Report of a Case

Teratoma is the most common ovarian tumour associated with pregnancy. The complications in pregnancy include torsion, rupture and malignant transformation mimicking ovarian carcinoma. Its association with intestinal obstruction is uncommon. Case: A 35 year old gravida 5 para 4 woman with 18 week gestation was referred to our hospital with a 2 week history of abdominal pain, abdominal distension and vomiting. Initial physical examination and ultrasound scan showed bilateral ovarian masses andintrauterine singleton viable pregnancy. At surgery the right mass was observed to be adherent to a part of the small intestine. The masses were excised and confirmed grossly and histologically as benign cystic teratoma. She was well and discharged nine days post operatively. The pregnancy was managed conservatively and she was delivered of a normal male baby at term by spontaneous vertex delivery. Although intestinal obstruction due to benign cystic teratoma in pregnancy is uncommon, abrupt surgical intervention and conservative management is important for favourable outcome (Afr J Reprod Health 2011; 15[1]: 115-118)