Maternal deaths in Sagamu in the new millennium: a facility-based retrospective analysis

BACKGROUND: Health institutions need to contribute their quota towards the achievement of the Millennium Development Goal (MDG) with respect to maternal health. In order to do so, current data on maternal mortality is essential for careproviders and policy makers to appreciate the burden of the problem and understand how best to distribute resources. This study presents the magnitude and distribution of causes of maternal deaths at the beginning of the 21st century in a Nigerian referral hospital and derives recommendations to reduce its frequency. METHODS: A retrospective descriptive analysis of all cases of maternal deaths at Olabisi Onabanjo University Teaching Hospital, Sagamu, Southwest Nigeria between 1 January 2000 to 30 June 2005. RESULTS: There were 75 maternal deaths, 2509 live births and 2728 deliveries during the study period. Sixty-three (84.0%) of the deaths were direct maternal deaths while 12 (16.0%) were indirect maternal deaths. Major causes of deaths were hypertensive disorders in pregnancy (28.0%), haemorrhage (21.3%) and sepsis (20.0%). Overall, eclampsia was the leading cause of deaths singly accounting for 24.0% of all maternal deaths. Abortion and HIV-related mortality accounted for 1.3% and 4.0% of maternal deaths, respectively. The maternal mortality ratio of 2989.2 per 100,000 live births was significantly higher than that reported for 1988–1997 in the same institution. Up to 67/794 (8.4%) patients referred from other facilities died compared to 8/1934 (0.4%) booked patients (OR: 22.1; 95% CI: 10.2–50.1). Maternal death was more likely to follow operative deliveries than non-operative deliveries (27/545 vs 22/2161; OR: 5.07; 95% CI: 2.77–9.31). CONCLUSION: At the middle of the first decade of the new millennium, a large number of pregnant women receiving care in this centre continue to die from preventable causes of maternal death. Adoption of evidence-based protocol for the management of eclampsia and improvement in the quality of obstetric care for unbooked emergencies would go a long way to significantly reduce the frequency of maternal deaths in this institution

Outcome of Instrumental Deliveries in Lagos Nigeria Implications For its Use at the Second Tier Healthcare Level

The case notes of patients undergoing instrumental delivery at the Lagos University Teaching Hospital between 1st January 1994 and 31st December 1996 were analysed. The overall instrumental delivery rate was 4.9% with an overall forceps delivery rate of 1.8% and vacuum extraction rate of 2.9%. Vacuum extraction was used in 59.4% of cases and forceps in 36.3% to assist vaginal delivery. Patients aged 20-29years accounted for 57% and nulliparous patients 67% of those Undergoing instrumental delivery. In 47.7% of cases the procedure was elective. The commonest indication being pre-eclampsia and eclampsia (25.4%). Prolonged second stage in 28.4% of cases was the commonest indication for emergency delivery. Maternal complications were twice as common in patients undergoing forceps delivery (26.9%) as opposed to vacuum extraction (13.8%). Neonatal complications were more common following forceps delivery (37.9%) compared to vacuum extraction (13.4%) There were four neonatal deaths all following forceps delivery. Vacuum extraction appears to be a safer method of instrumental delivery than the obstetric forceps. Maternal and perinatal morbidity and mortality may benefit from the training of midwives and non-specialist doctors in the procedure of vacuum extraction in an emergency at the secondary health care level. Key Words: Instrumental delivery, secondary health care, Lagos Nigeria. Nigerian Medical Practitioner Vol. 45 No 6, 2004 (106-110

The acceptance rate of intrauterine contraceptive device(IUCD) amongst family planning clinic users in Lagos University Teaching Hospital (LUTH)

No Abstract

Perinatal Mortality at the Close of the 20th Century in Lagos University Teaching Hospital

Objective: To determine the perinatal mortality rate in Lagos University Teaching Hospital at the close of the 20th century. Materials and Methods: Routinely collected data from the Departments of Obstetrics & Gynaecology and Paediatrics from January 1996 to December 2000, were analysed. The data included total deliveries, stillbirths and early neonatal deaths. Results: A total of 6,759 deliveries, including 163 multiple pregnancies, occurred during the period. There were 573 perinatal deaths comprising 471(69.7/1000) stillbirths and 102(16.2/1000) early neonatal deaths. Autopsy was performed on 115 of the 573 deaths resulting in a perinatal autopsy rate of 20.1 percent. The overall perinatal mortality rate was 84.8/1000 while the perinatal mortality rate for singletons was 83/1000. Analysis of the deaths by the Wigglesworth classification showed that 46.6 percent of the deaths were normally formed macerated stillbirths, 38.7 percent were due to asphyxial conditions and 8.9 percent were attributed to conditions associated with immaturity. Lethal congenital malformations accounted for 3.7 percent while other specific conditions were responsible for 2.1 percent of the deaths. Conclusion: These rates are still very high and strategies to decrease perinatal mortality will need to focus on antenatal and intrapartum obstetric care. All those involved in obstetric and neonatal care require regular education on the need for prompt identification of problems, early referral and prompt intervention. Key words: Perinatal mortality, antenatal and intrapartum obstetric care. Nigerian Journal of Paediatrics Vol.31(1) 2004: 14-1

Femal surgical contraception at the Lagos University Teaching Hospital, Lagos, Nigeria - A five year Review

Nigerian Quarterly Journal of Hospital Medicine Vol.10(2) 2000: 137-14

Trends in Maternal Mortality at the Lagos University Teaching Hospital, Lagos, Nigeria.

Background: Recent reports suggest that the burden of maternal mortality remains heavy in Sub-Saharan Africa; and that the fifth millennium development goal might not be achieved. As the target date 2015 draws near, we carried out a review of maternal mortality in a Teaching Hospital unit to assess the current situation.Objectives: To determine the Maternal Mortality Ratio (MMR), the clinical causes of maternal deaths and the numerical and etiological trends in maternal mortality at the Lagos University Teaching Hospital (LUTH).Method: The records of births and maternal deaths at LUTH over a five year period were reviewed. The data collected was analyzed to determine the maternal mortality ratio, the socio-biological factors associated with maternal death and the clinical causes. Comparisons are made with findings from previous studies done in LUTH and elsewhere.Results: The maternal mortality ratio was 2096 per 100000 live births. The mortality ratio has more than doubled over a period of 3 decades. Unbooked patients accounted for 7.1% of deliveries but contributed 88.1% of the maternal deaths.Majority (59.0%) of the deaths occurred within 24 hours of admission. The main clinical causes of death included sepsis (17.9%), hypertensive diseases (17.9%), abortion (11.2%), HIV/ AIDS infection (11.2%)), haemorrhage (9.0%) and medical disorders (18.7%).Conclusion: The maternal mortality ratio remains high in our unit in line with some other reports from Nigeria but in contrast to the trends in other developed and developing countries. Unless urgent action is taken, the 5th millennium development goal may not be achieved.Key words: Maternal mortality, maternal death,sepsis,hypertensive  diseases, HIV/AIDS, haemorrhage, abortio

Molecular Assessment Of African Swine Fever In North- Central Nigeria

Tissue samples consisting of visceral lymph nodes, liver, spleen and kidneys were collected from apparently healthy and ill pigs at various slaughter slabs and from local pig farms in 3 neighbouring Nigerian states and assayed for African Swine Fever (ASF) virus DNA. Polymerase chain reaction (PCR) was applied on 266 samples collected from Plateau, Benue and Kaduna states. 135 of the test samples were declared positive after successfully amplifying a 278bp gene fragment from tissues using diagnostic primers prescribed by OIE Manual of Standards for Diagnostic Tests and Vaccines. ASF1 and ASF2 primers, designed from the VP72 gene, a conserved gene region in the ASF virus genome, are designed for specific amplification and detection of ASF virus DNA. Viral DNA was detected at varying rates; Plateau and Kaduna states had higher rates even in healthy pigs which did not present any clinical signs of ASF indicating high endemicity of the disease in these states. Benue state had the least. The study explains the implication of having a free market zone common to all northern pig producing areas in the country and trans-border movement of the virus as a result of trade in pig and pig products in Nigeria.Des échantillons de tissu prélevés des ganglions lymphatiques viscéraux, du foie, de la rate et des reins étaient collectés des porcs malades et apparemment en bonne santé sur divers étals d\'abattoirs et dans différentes exploitations porcines locales de 3 Etats voisins au nord du Nigeria, puis examinés pour détecter l\'ADN du virus de la peste porcine africaine (PPA). La réaction en chaîne par polymérase a été appliquée sur 266 échantillons collectés dans les Etats du Plateau, de Benue et de Kaduna. Cent trente-cinq des échantillons examinés étaient déclarés positifs après une amplification réussie d\'un fragment de gène 278bp issu de tissus, à l\'aide des amorces de diagnostic tel que recommandé par le Manuel de l\'OIE sur les normes pour les tests de diagnostic et les vaccins. Les amorces PPA1 et PPA2, conçues pour le gène VP72, une partie de gène conservée dans le génome du virus de PPA, sont destinées à l\'amplification spécifique et à la détection de l\'ADN du virus PPA. L\'ADN du virus a été détecté à divers taux. Les Etats du Plateau et de Kaduna avaient les taux les plus élevés même chez les porcs en bonne santé qui n\'avaient aucun signe clinique de PPA, ce qui montre la forte endémicité de la maladie dans ces Etats. L\'Etat de Benue était le moins touché. Selon la présente étude, il s\'agit de la conséquence d\'une zone de marché libre commune à toutes les zones de production de porc dans le nord du Nigeria et d\'un mouvement transfrontalier du virus à cause du commerce de porc et des produits de porc dans le pays.Bulletin of Animal Health and Production in Africa Vol. 55 (2) 2007: pp. 96-10