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

Prévalence et corrélats de la morbidité maternelle à Enugu, au sud-est du Nigéria.

The objective of the study was to determine the prevalence and correlates of maternal morbidity following childbirth in Enugu, South East Nigeria. A questionnaire-based cross-sectional study of women with recent deliveries in Enugu was done. Respondent were 8 times more likely to report a symptom than not (OR 8.14 95% C.I. 5.48, 12.68). Puerperal sepsis, perineal pain, dyspareunia, postpartum haemorrhage, gestational (postpartum) hypertension and utero-vaginal prolapse were the commonest obstetric/gynaecological morbidities. Multivariate analysis showed that the main predictors of specific morbidities were high parity category, abdominal delivery and delivery by unskilled birth attendant. It is concluded that the prevalence of morbidity following childbirth in the population sampled was high due mainly to obstetric factors and that reportage of morbidity had little to do with the demographic characteristics of respondents. A population based study is recommended to determine the actual prevalence and predictors of morbidity following childbirth in the populationCette étude avait pour objectif de déterminer la prévalence et les corrélats de la morbidité maternelle suite à l’accouchement, à Enugu au sud est du Nigéria. Nous avons mené une étude tranversale à base des questionnaires auprès des femmes qui ont accouché récemment à Enugu. Les répondantes avaient huit fois de plus la chance de signaler un symptôme que non (OR 8,14 95% C, 1, 5,48, 12,68). La septicémie puerpérale, la douleur périnéale, la dyspareunie, l’hémorragie de la délivrance, l’hypertension (de la délivrance) et le prolapsus utéro-vaginal, étaient parmi les morbidités particulières obstétriques / gynécologiques les plus communes. L’analyse multifactorielle a montré que les indices principaux des morbidités particulières étaient une catégorie élevée de la parité, l’accouchement abdominal et l’accouchement par un accoucheur non qualifié. Comme conclusion, nous avons affirmé que la prévalence de la morbidité suite à l’accouchement auprès de la population échantillonnée était élevée à cause des facteurs obstétriques et que le fait de signaler la morbidité a très peu à voir avec les traits démographiques des répondantes. Nous préconisons une étude basée sur la population pours déterminer la vraie prévalence et les vrais indices de la mortalité suite à l’accouchement dans la populatio

Mortalité maternelle vue à travers un hôpital transitoire à Enugu, Sud-est du Nigéria

Nigeria has one of the highest maternal mortality ratios in the world. The study was to determine the trend of maternal mortality ratio in the hospital as it transits from a General through a Specialist to a Teaching hospital. It was a retrospective review of maternal deaths at Enugu State University Teaching Hospital Parklane, over its 5 year transition period (January 2004 to December 2008). There were 7146 live births and 60 maternal deaths giving an overall maternal mortality ratio (MMR) of 840/100,000 livebirths. The MMR rose from 411 to 1137/100 000 live births as a specialist hospital, with a decline to 625/100 000 as a Teaching hospital. Pre-eclampsia/eclampsia was the leading cause (29.63%) of maternal death. MMR was highest as a Specialist hospital due to limited manpower and inadequate facilities to properly manage the rising number of referred obstetric emergencies. Adequate preparations should be made before upgrading a hospital, to enable it cope with the challenges of managing referred obstetric emergencies (Afr J Reprod Health 2009; 13[4]:67-72).Le Nigéria a une de plus grandes proportions de la mortalité maternelle du monde. L’étude avait pour but de déterminer la tendance de la proportion de la mortalité maternelle dans l’hôpital dans sa transition d’un Hôpital Général en passant par l’Hôpital spécialisé à un Centre Hospitalier Universitaire. Il s’agissait d’une analyse rétrospective des décès maternels au Centre Hospitalier Universitaire à Enugu à travers sa période de 5ans de transition (janvier 2004 – décembre 2008). Il y avait 7146 naissances vivantes et 60 décès maternels, ce qui donne dans l’ensemble une proportion de la mortalité maternelle (PMM) de 840/100,000 naissances vivantes. La PMM a augmenté de 411 a 1137/100.000 naissances vivantes dans l’hôpital spécialisé avec une baisse jusqu'à 625/100,000 dans un Centre Hospitalier Universitaire. La pré-éclampse/éclampsie était la cause principale (29,63%) du décès maternel. La PMM était plus élevée dans l’hôpital spécialisé à cause d’une main-d’œuvre limitée et du manque de facilités qui ne permettent pas de bien prendre en charge le nombre montant de cas obstétriques d’urgence qui sont orientés vers ces hôpitaux spécialisés. Il faut prendre des dispositifs adéquats avant d’améliorer un hôpital, afin de lui permettre de se débrouiller avec les défis de la prise en charge des urgences obstétriques qui sont adressées d’un autre hôpital (Afr J Reprod Health 2009; 13[4]:67-72)

Patterns of gestational weight gain and its association with birthweight in Nigeria

Background: Despite the increasing global importance of gestational weight gain (GWG) and its impact on birthweight, little is known about the patterns of GWG in African populations.Objectives: To determine the pattern of GWG and its association with birthweight in Nigeria.Methods: It was a longitudinal study of 200 pregnant women receiving antenatal care at two tertiary hospitals in Enugu, south eastern Nigeria. The women were consecutively recruited at <14 weeks gestation and their body mass indexes recorded upon recruitment. Thereafter, weight measurements were taken at each visit until 38–39 weeks.Results: Mean total GWG was 10.7 ± 3.4 kg, while mean birthweight was 3.3 ± 0.6 kg. GWG in second trimester had positive correlation with birthweight (r = 0.164, P = 0.02). Obese women gained above the recommended limits by the "institute of medicine" while underweight women gained below the limits. Excessive total GWG was associated with higher risk of macrosomia [8/21 (38.1%) vs. 7/179; RR: 9.74; 95% CI: 3.9–24.2; P < 0.001] while inadequate total GWG was associated with higher risk of low birth weight [7/72 (9.7%) vs. 3/128 (2.3%; RR: 4.15; 95% CI: 1.1–15.4; P = 0.03]. Maternal age of <35 years, high social class, nulliparity, and regular antenatal care were associated with normal GWG while maternal age <35 years and regular antenatal care were associated with normal birthweight (P < 0.05).Conclusions: Women should be counseled on the factors that influence GWG and birthweight. Interventions to assist women achieve appropriate GWG may need to include components related to improved dietary intake for the underweight and increased physical activity for the obese.Keywords: birthweight, body mass index, pregnancy, Nigeria, weight gai