Causes and trends in maternal mortality in a tertiary health facility in North Central Nigeria

Background: Nigeria remains one of the top three countries with the highest maternal mortality worldwide. Due to poor vital registration in the country, hospital-based maternal mortality statistics still remain an important source for tracking trends and causes of maternal mortality. The aim of the study was to determine the causes and trends of maternal mortality in a tertiary health facility in North Central Nigeria. Methods: This was a retrospective review of cases of maternal deaths at the Jos University Teaching Hospital from 1st January 2016 to 31st December 2022. Case records of patients that died from pregnancy-related complications were retrieved from the medical records department and other service points of the hospital. The information extracted was maternal socio-demographic characteristics, clinical diagnosis on admission, and duration of hospital stay before demise. The maternal mortality ratio was calculated per 100,000 live births. Results: There were 80 maternal deaths during the period, and 10,348 live births during the same period, giving a maternal mortality ratio of 773/100,000 live births. The mean age of the women was 27.0±8.1 years, 12.5% were teenage mothers, 6.4% were women ≥40 years. About 27.5% were nulliparous, 16.5% para 5 or more. For women where information on educational level were available 68(85.0%), 48.5% had only primary education or no formal education, 42.5% had no antenatal care. About 72.5% of the maternal deaths were due to direct causes-pre-eclampsia/eclampsia (30.0%), maternal sepsis (17.5%), complications of unsafe abortion (12.5%), obstetric haemorrhage and uterine rupture 6.3%. The main causes of indirect maternal deaths were sickle cell disease, cardiac disease, diabetes mellitus and liver disease in pregnancy. Most (41.3%) of the maternal deaths occurred within the 24 hours of admission. There was no consistent trend noted in maternal mortality between 2016 and 2019; however, a remarkable increase was observed during the Covid-19 period from 2020-2021. Conclusions: The maternal mortality ratio in Jos, North Central Nigeria remains high, with major causes related to pre-eclampsia/eclampsia, maternal sepsis, unsafe abortion and obstetric haemorrhage. The global Covid-19 pandemic led to an increased maternal mortality in the health facility

Predisposing factors and outcome of uterine rupture in Jos, North-central Nigeria

Background: Uterine rupture has continued to be an obstetric catastrophe with tragic maternal and foetal outcomes particularly in Nigeria.Methods: an institutional, cross sectional retrospective study was carried out at Jos University Teaching Hospital, North-Central Nigeria. Case files of mothers with uterine rupture managed at the hospital from 1 January 2011 to 31 December 2019 were retrieved and included in the study. Data extracted from case files included maternal age, parity, gestational age, booking status, presence of uterine scar, obstetric interventions prior to rupture, site of rupture, type of surgery, units of blood transfused, intensive care unit admission and duration of hospital stay and maternal or foetal death.Results: the incidence of uterine rupture was 1 in 497 deliveries (0.2%). The mean age of the patients was 30.1±5.1years. About 75% of the patients were para 1-4. Seventeen (70.8%) patients were unbooked while fourteen (58.3%) had unscarred uterine rupture. Eight out of 14(57.1%) patients with unscarred uterus had uterotonics for induction or augmentation of labour. Fourteen (58.3%) patients had rupture involving anterior lower uterine segment. Over half of the patients had uterine repair only (58.3%), 29.2% had uterine repair with bilateral tubal ligation while 12.5% had subtotal hysterectomy. Twenty-two (91.7%) required blood transfusion, five patients had 5 or more units of blood transfused. The perinatal mortality was 69.6%, there was no maternal death.Conclusions: the major predisposing factors to uterine rupture in our facility were lack of antenatal care, presence of previous caesarean section scar and injudicious use of uterotonics

Seroprevalence of rubella virus infection in women with recurrent miscarriage: a case control study in Jos, Nigeria

Background: Recurrent pregnancy loss is an emotionally and physically tasking situation for couples, especially in developing countries where lack of children is a cultural taboo. Rubella infection in early conception has a 90% probability of developing congenital rubella  syndrome (CRS) or miscarriage. The aim of this study was to compare the seroprevalence of rubella virus infection in women with and without recurrent miscarriage. Methods: It was a hospital based case control study. Sampling was done by purposive. Subjects were recruited consecutively until the  required number was reached. Control subjects were selected by simple random sampling. Healthy postnatal women who consented for the study were asked to pick a piece of paper from a covered container, those who picked yes were then recruited. A semi structured researcher administered questionnaire was used to collect data. Enzyme-Linked Immunosorbent Assay (ELISA) was used to check for rubella specific IgG and IgM. We compared the prevalence of rubella virus infection in cases and controls by Chi-square analysis. A p-value < 0.05 was considered significant. Results: The overall mean age of the participants was 30.62±3.60 years. None of the participants had received rubella virus vaccination. The seroprevalence rates of rubella IgG and IgM among the cases were 85% and 16.7%, while in the controls were 80% and 13.3%. The prevalence of Primary + + rubella infection (IgG IgM ) was 10 (16.7%) and 8 (13.3%) among the cases and the controls respectively. Rubella virus + - seropositivity (IgG IgM ) was 68.3% among cases versus 66.7% - - among controls, and rubella virus seronegativity (IgGIgM) was 15.0% and 20.0% among cases and control respectively. Conclusion: The high seroprevalence of rubella virus infection observed in this study suggest that majority of women in our setting are exposed to rubella virus infection before pregnancy. There was no significant difference in the seroprevalence of rubella virus infection between women with and those without a history of recurrent miscarriage

Pattern of gynaecological malignancies in Jos

Context: Female cancer is a public health problem the world over. The malignancies of the female genital organs are major causes of morbidity and mortality which necessitates data for policy formulation and health planning.Objective: To document the relative frequency, age distribution and histological patterns of gynaecological malignancies seen at the Jos University Teaching Hospital (JUTH).Methodology: A retrospective 5 year review of all gynaecological malignancies seen at the JUTH. Main outcome measures: frequency, age distribution and histological patterns of gynaecological malignanciesResult: Female genital tract cancers account for 5.4% of gynaecological disorders in JUTH. The complete records of 203 out of 250 patients with gynaecological malignancies were retrieved giving a retrieval rate of 81.2%. Of these 203 case records, 152(74.9%) cases were from the uterine cervix while 31(15.3%) and 13(6.5%) cases were from the ovary and uterine corpus respectively. The vagina and vulva accounted for 3(1.4%) and 4(1.9%) cases respectively. Squamous cell carcinoma accounted for 93.4% of cervical cancers and 100% of vaginal and vulval cancers. Epithelial tumours accounted for 61% of ovarian tumours while choriocarcinoma accounted for 53.8% of cancers of the corpus uteri.Conclusion: Squamous cell cervical cancer is still the most common gynaecological malignancy in Jos. The challenges of HIV/AIDS and cervical screening need to be addressed to reduce its incidence.Keywords: Gynaecological cancers, pattern, frequency, histology, JosTrop J Obstet Gynaecol, 30 (1), April 201

Présence des accoucheurs qualifiés : les défis clé au progrès dans l'accomplissement des ODM – 5 au nord central du Nigéria

The importance of skilled attendance at delivery, as reflected in the MDG 5, is being promoted in developing countries to address the high maternal/perinatal morbidity and mortality. Evaluation of personnel skills and availability of material resources are central to elimination of barriers to delivery of basic Emergency Obstetric Care (EOC) to the community. We designed a semi-structured, interviewee-administered questionnaire for 54 certified Nurse-Midwives working in Primary Health Care (PHC) clinics in Nasarawa State, central Nigeria, and examined their knowledge and competencies in the five major areas responsible for maternal mortality in sub-Saharan Africa, including power supply, referral linkages and motivation to work. Majority 51 (94.4%) of PHCs neither used the Partograph nor performed manual vacuum aspiration. Referral systems and feedback mechanisms were practically non-existent, 38 (70.4%) of facilities were >5km from the nearest referral centre, with 14(29.5%) connected to the national grid. Majority (68.5%) of respondents would want to work abroad. The quality of skilled attendance is low and basic EOC facilities are lacking, a situation further threatened by potential emigration to greener pastures. Governments and development partners need to address facility and skilled manpower shortages in developing countries to make a modest attempt at meeting the MDG on maternal health.L'importance de la présence du personnel qualifié pendant l'accouchement, tel que cela figure dans les ODM–5 est reconnue et encouragée dans les pays en voie de développement pour aborder la haute mortalité et la morbidité périnatale. L'évaluation de la compétence du personnel et la disponibilité des ressources matérielles jouent un rôle essentiel dans l'élimination des obstacles à la prestation des services obstétriques d'urgence de base (SOUB) à la communauté. Nous avons formulé un questionnaire semi–structuré pour 54 sages–femmes qui travaillent dans des cliniques des services médicaux primaires (SMP) dans l'état de Nassarawa, dans la région centrale du Nigéria. Nous avons étudié leur connaissance et compétences dans les cinq domaines principaux qui sont responsables de la mortalité maternelle en Afrique sub–saharéenne y compris l'alimentation électrique, les liaisons des services d'orientation des malades vers un spécialiste et la motivation pour travailler. La majorité des SMPs (94,4%) n'ont pas utilisé le partographe et ils n'ont pas fait l'aspiration pneumatique manuelle. Il n'existait pratiquement pas de systèmes d'orientations vers les spécialistes et des mécanismes pour des réactions. 38(70,4%) établissements étaient situés à>5km du centre des orientations le plus proche, alors que 14 (29,5%) étaient reliés au réseau électrique national. La majorité (68,5%) des interviewés aimeraient travailler à l'étranger. La qualité du personnel qualifié est basse et les structures de base manquent, une situation qui est davantage menacée par la possibilité de la migration ver les cieux plus cléments +++++v Il est nécessaire que les gouvernements et les partenaires en matière de développement abordent les problèmes du manque de structures et de personnel dans les pays en voie de développement afin d'essayer, d'une manière modeste, d'accomplir les ODMs dans le domaine de la santé maternelle