Preventing Maternal Mortality during Childbirth: The Scourge of Delivery with Unskilled Birth Attendants

The death of a woman during childbirth is devastating. The Sustainable Development Goals aim to reduce the global maternal mortality ratio to less than 70 per 100,000 births. No country is expected to have a maternal mortality ratio of more than twice the global average. In settings with weak health systems and suboptimal service delivery, more and more women continue to utilize traditional birth attendants during childbirth. Traditional birth attendants are unskilled and unable to prevent or treat the complications during pregnancy or childbirth that leads to maternal deaths. Every effort must be made to prevent maternal mortality. This chapter utilizes qualitative research methodology and discusses the challenges of preventing maternal deaths in a setting where women routinely utilize traditional birth attendants. The reasons for the persistence of the traditional birth attendants are examined. A solution out of the predicament is fundamental

Diabetes advocacy and care in Nigeria: A review

Background: The political commitments necessary to tackle the growing burden of Diabetes Mellitus (DM) and related noncommunicable diseases (NCDs) have increased in recent years in Nigeria. This has resulted in the development of national policy and strategic objectives by the Federal Ministry of Health for the prevention and control of NCDs in Nigeria. This review paper aims to highlight the increasing burden of Diabetes in Nigeria; the advocacy; policy and frame-work for integrating Diabetes care into the primary healthcare system in Nigeria.Methodology: This is a review paper and sources of information were from International and local healthcare policies and plan of action including national advocacy activities.Results: The issues for diabetes advocacy in Nigeria are provision of integrated Diabetes care at the primary level, awareness about diabetes and related NCDs, mobilization for increased political will, strengthening of the health system (funding, infrastructure, capacity building etc.) and a national diabetes/NCDs survey including gestational diabetes using the new evidence-based World Health criteria. Advocacy, policy and care are essential  components in the prevention and control of diabetes and a large evidence-base is available on cost-effective primary interventions. Implementing these interventions as part of the National Policy on NCDs and a plan of action has been adopted by the National Council on Health in 2013. Actualizing the delivery of care in such scenario will require ongoing policy advocacy which is a deliberate and structured process of informing and influencing decision-makers in support of evidence-based policy.Conclusion: Diabetes and related NCDs are increasing in prevalence in Nigeria and their complications pose an immense public health burden. There is an urgent need for our health decision-makers at all levels to implement adopted policies and plans of action to halt the escalating trend and burden of Diabetes through effective primary care, especially in rural communities of Nigeria.Keywords: Diabetes; Non-communicable diseases; Advocacy; Primary car

Miscarriage and Maternal Health

Miscarriage also known as spontaneous abortion is the termination of pregnancy before the age of fetal viability or expulsion of fetus or embryo weighing less than 500g. It occurs naturally without any human intervention and complicates about 15–20% pregnancies globally. The age of fetal viability varies from country to country depending on the level of technological development and fetal salvage rate. The age of fetal viability in Norway is 16 weeks, in Australia its 20 weeks, 24 weeks in the UK, 26 weeks in Spain and Italy while in Nigeria the age of fetal viability is 28 weeks of gestation. Causes of miscarriage include morphologic/genetic/chromosomal abnormalities, immunological and endocrine factors, structural uterine anomalies, cervical incompetence, maternal infections and toxins. It is classified into threatened miscarriage, inevitable miscarriage, incomplete miscarriage, septic miscarriage, missed miscarriage and complete miscarriage. Miscarriage has profound and tremendous psychologic and emotional effects on mothers before or during subsequent gestations. Every effort must be made to show understanding and empathy

Pre Menstrual Syndrome

Approximately 80–90% of women experience some symptoms in the premenstrual period at some point in their reproductive years. Teenagers often present with moderate to severe symptoms, while women in the fourth decade of life appear to have worse symptoms with the severity of the disease worsening with increasing age up until menopause. Obesity and smoking have also been identified as risk factors. Symptoms could be physical, psychological, emotional, environmental and/or behavioral and affect the ability to perform normal daily activities as well as adversely affect interpersonal relationships. Though several theories have been propounded, the exact cause of premenstrual syndrome is unknown. Management of this disorder requires a multi-disciplinary approach involving the general practitioner, the general gynecologist or a gynecologist with a special interest in PMS, a mental health professional (psychiatrist, clinical psychologist or counselor), physiotherapist and dietician

Assessing the knowledge and skills on emergency obstetric care among health providers : implications for health systems strengthening in Nigeria

A questionnaire was used to obtain information relating to health providers’ socio-demographic characteristics; respondents’ knowledge and skills in offering specific Emergency Obstetrics Care (EMOC) services (as compared to standard World Health Organization recommendations); and their confidence in transferring the skills to mid-level providers. Findings indicate that knowledge and reported skills in EMOC by health providers was lower than average in referral facilities in Nigeria. Recommendations include in-service training and re-training of health providers along with health policy and programs that address maternal mortality

Management of aplastic anaemia in pregnancy in a resource poor centre

Aplastic anaemia occurring in pregnancy is a rare event with life threatening challenges for both mother and child. We present a successful fetomaternal outcome despite the challenges in the management of this rare condition in a tertiary but resource poor centre. This is case of a 37 year old Nigerian woman G6P0+5managed with repeated blood transfusions from 28 weeks of gestation for bone marrow biopsy confirmed aplastic anaemia following presentation with weakness and gingival bleeds. She had a cesarean section at 37 weeks for pre-eclampsia and oligohydraminous with good feto-maternal outcome. She was managed entirely with fresh whole blood and received 21 units. Aplastic Anaemia in Pregnancy is a rare event with poor feto maternal prognosis. Successful management is possible with good multi-disciplinary approach and availability of supportive comprehensive obstetric care.Pan African Medical Journal 2016; 2

Where do delays occur when women receive antenatal care? A client flow multi-site study in four health facilities in Nigeria

Objectives: The objective of the study was to identify where delays occur when women present for antenatal care in four Nigerian referral hospitals, and to make recommendations on ways to reduce delays in the course of provision of antenatal care in the hospitals.Design: Prospective observational studySetting: Four Nigerian (1 tertiary and 3 secondary) HospitalsParticipants: Women who presented for antenatal care.Interventions: A process mapping. The National Health Service (NHS) Institute Quality and Service Improvement Tool was used for the assessment.Main outcome measures: The time women spent in waiting and receiving antenatal care in various departments of the hospitals.Results: Waiting and total times spent varied significantly within and between the hospitals surveyed. Mean waiting and total times spent were longest in the outpatients’ departments and shortest in the Pharmacy Departments. Total time spent was an average of 237.6 minutes. χ2= 21.074; p= 0.0001Conclusion: There was substantial delay in time spent to receive care by women seeking routine antenatal health services in the four secondary and tertiary care hospitals. We recommend managers in health facilities include the reduction of waiting times in the strategic plans for improving the quality of antenatal care in the hospitals. This should include the use of innovative payment systems that excludes payment at time of service delivery, adoption of a fast-track system such as pre-packing of frequently used commodities and the use of new tech informational materials for the provision of health education.Funding: The Alliance for Health Policy and Systems Research, World Health Organization, Geneva; Protocol IDA65869.Keywords: Delays; Waiting time; antenatal; Hospitals; Women; Maternity care; Process mapping; Nigeria

Improving Maternal Health: The Safe Childbirth Checklist as a Tool for Reducing Maternal Mortality and Morbidity

Ensuring healthy lives and promoting the well-being for all at all ages is essential to sustainable development. The UN’s adoption of the sustainable development goals (SDGs) in September 2015 reaffirmed the reduction of maternal and newborn mortality as global priorities in the coming decade. The World Health Organisation Safe Childbirth Checklist has been developed to ensure the delivery of essential maternal and perinatal care practices. The Safe Childbirth Checklist aims to help frontline health workers to prevent avoidable childbirth-related mortality and morbidity. The Checklist addresses the major causes of maternal death (haemorrhage, infection, obstructed labour and hypertensive disorders), intrapartum-related stillbirths (inadequate intrapartum care), and neonatal deaths (birth asphyxia, infection and complications related to prematurity). Successful completion of checklist items by healthcare workers will help keep the woman and baby safe as the checklist catalogues a core set of practices that are proven to reduce maternal and newborn harm. The practices described in the checklist items should be conducted at every birth. This chapter utilises experiences gained in Cameroon, Ghana, Nigeria and Zambia during the Pfizer Independent Grant for Learning and Change supported Medical Women’s Association of Nigeria Improving Maternal Health in sub-Saharan Africa project to describe the checklist and how it can be used to deliver lifesaving midwifery care and enhance maternal health

Prevalence and risk factors for maternal mortality in referral hospitals in Nigeria : a multicenter study

This study determines maternal mortality ratios (MMR) and identifies risk factors for maternal deaths in referral health facilities in Nigeria. Results show an MMR of 2,085 per 100,000 live births in hospital facilities. Efforts to reduce MMR requires the improvement of emergency obstetric care; public health education so that women can seek appropriate and immediate evidence-based pregnancy care; the socioeconomic empowerment of women; and the strengthening of the health care system. In the past ten years contraceptive prevalence rates have remained low at 10%; antenatal attendance has remained at 64%, skilled birth attendance of 33% is one of the lowest in sub-Saharan Africa.World Health Organizatio