Neonatal Morbidity And Mortality In Calabar, Nigeria: A Hospital- Based Study

Background: The morbidity and mortality pattern amongst neonates admitted into the University of Calabar Teaching Hospital were reviewed from 1st June 2003 to 30th November 2004. Results: The major indications for admission for inborn babies were infections (27.4%), jaundice (21%) and low birth weight (LBW) (18.4%). The out born babies were admitted largely for sepsis (26.8%), jaundice (17.7%), tetanus (13.9%) and low birth weight (11.2%). Staphylococcus aureus (61.2%) and unclassified coliforms (21.9%) were the dominant isolates of septicaemia. The overall mortality rate of 19.3% was largely contributed by outborn infants (73.2% of the deaths). In descending order of magnitude, the total of 153 deaths during the period was due to infections (neonatal tetanus 20.9%, septicaemia 19.6%), birth asphyxia 23.3% and LBW 19%. Most of the deaths (70.6%) occurred within the first 7 days of life. Fifty-three (34.6%) of the deaths (most outborn infants) occurred within 24 hours of admission. Conclusion: Nigerian government needs to improve funding of the health sector in order to reduce neonatal wastage. Training and retraining of traditional birth attendants is inevitable. More effort should be made towards improving coverage rate of tetanus toxoid among women of childbearing age. Keywords: Neonatal Morbidity, Mortality. Nigerian Journal of Clinical Practice Vol. 11 (3) 2008: pp. 285-28

A systematic review of the effects of residency training on patient outcomes

<p>Abstract</p> <p>Background</p> <p>Residents are vital to the clinical workforce of today and tomorrow. Although in training to become specialists, they also provide much of the daily patient care. Residency training aims to prepare residents to provide a high quality of care. It is essential to assess the patient outcome aspects of residency training, to evaluate the effect or impact of global investments made in training programs. Therefore, we conducted a systematic review to evaluate the effects of relevant aspects of residency training on patient outcomes.</p> <p>Methods</p> <p>The literature was searched from December 2004 to February 2011 using MEDLINE, Cochrane, Embase and the Education Resources Information Center databases with terms related to residency training and (post) graduate medical education and patient outcomes, including mortality, morbidity, complications, length of stay and patient satisfaction. Included studies evaluated the impact of residency training on patient outcomes.</p> <p>Results</p> <p>Ninety-seven articles were included from 182 full-text articles of the initial 2,001 hits. All studies were of average or good quality and the majority had an observational study design.Ninety-six studies provided insight into the effect of 'the level of experience of residents' on patient outcomes during residency training. Within these studies, the start of the academic year was not without risk (five out of 19 studies), but individual progression of residents (seven studies) as well as progression through residency training (nine out of 10 studies) had a positive effect on patient outcomes. Compared with faculty, residents' care resulted mostly in similar patient outcomes when dedicated supervision and additional operation time were arranged for (34 out of 43 studies). After new, modified or improved training programs, patient outcomes remained unchanged or improved (16 out of 17 studies). Only one study focused on physicians' prior training site when assessing the quality of patient care. In this study, training programs were ranked by complication rates of their graduates, thus linking patient outcomes back to where physicians were trained.</p> <p>Conclusions</p> <p>The majority of studies included in this systematic review drew attention to the fact that patient care appears safe and of equal quality when delivered by residents. A minority of results pointed to some negative patient outcomes from the involvement of residents. Adequate supervision, room for extra operation time, and evaluation of and attention to the individual competence of residents throughout residency training could positively serve patient outcomes. Limited evidence is available on the effect of residency training on later practice. Both qualitative and quantitative research designs are needed to clarify which aspects of residency training best prepare doctors to deliver high quality care.</p

Maternal death and obstetric care audits in Nigeria: A systematic review of barriers and enabling factors in the provision of emergency care.

Acknowledgements We would like to thank Yutaka Osakabe for co-ordinating the retrieval of full text articles. The John D. and Catherine T. MacArthur Foundation supported this study, grant number 12-100074-000-INPPeer reviewedPublisher PD

Morbidity And Mortality Following Emergency Obstetric Hysterectomy In Calabar, Nigeria

Objective: To review the maternal morbidity and mortality following emergency subtotal hysterectomy and total abdominal hysterectomy in the University of Calabar Teaching Hospital (UCTH) the differences in the their outcome and the influence of the cadre of surgeon on the outcome of these procedures. Design: A ten year retrospective review of cases between 1st January 1990 and 31st December 1999. Setting: University of Calabar Teaching Hospital, Calabar, Nigeria, a tertiary institution in a developing country. Patients: Forty – five patients who underwent emergency obstetric hysterectomy Result: The commonest indications for emergency obstetric hysterectomy were ruptured gravid uterus in 27 (60%). Primary postpartum heamorrhage in 15 (33.3%) of the case and hysterectomy for puerperal sepsis was an indication in 3 (6.7%) of the cases Complication associated with emergency obstetric hysterectomy were seen in (91. 1%) of the case. These were haemorrrhage 10 (24.4%), wound sepsis 8 (19.5%) septicemia, post operative shock and vesico – vaginal fistula each contributed 3 (7.3%). Others were pelvic abscess in 2 (5.0%), ureteric injury, pulmonary oedema and bed sores contributed (2.4%) each. There were nine maternal deaths giving a case fatality rate (CFT) of 20%. There was no statistical significant difference in the outcome between the two types of hysterectomy. However, when these variables were compared in relation to the cadre of surgeons and the type of hysterectomy, morbidity and mortality were significantly higher amongst the registrars, who however performed better with subtotal hysterectomy than with total abdominal hysterectomy. Suggestions are made on how to reduce the conditions that necessitated these operations and improve the outcome. KEY WORDS: Morbidity, mortality, Obstetrics hysterectomy Nigerian Journal of Clinical Practice Vol.6(1) 2003: 52-5

The role of institutional factors in maternal mortality from obstructed labour

We conducted a ten-year review of maternal mortality from obstructed labour in University of Calabar Teaching Hospital (UCTH), between January 1st 1990 and December 31st 1999. The aim was to examine the role of Institutional factors in maternal mortality arising from this condition. The review showed that a total of 702 patients were managed as a result of obstructed labour giving an incidence of 3.7%. Fifty-five patients died giving a case fatality rate (CFR) of 7.8%. Fifty-one (92.7%) of the patients who died were not booked, thirty-four (61%) were brought from spiritual churches, while 17(31%) were from the traditional birth attendants' (TBAs) homes. Four (7.2%) were booked cases who were earlier scheduled for elective caesarean section but defaulted and reported late in labour with ruptured uterus. All patients were in social classes IV and V. Although 48 (47.3%) of these patients were seen by doctors within one hour of admission, only 6(10.9%) had initial assessment by senior doctors. Five (9.1%) had surgery within two hours of admission, 21(38.2%) had surgery in four hours of admission whereas 29(52.7%) had surgery after four hours of admission. The probable causes of maternal deaths were haemorrhage 24(43.6%), septicemia 5(27.3%), post operative shock 8(14.5%) renal failure 5(9.1%) anaesthetic deaths 3(5.5%). The twenty-four patients who died from haemorrhage had no blood transfusion. Nine of the patients who died from septicemia had no antibiotics before surgery. Anaesthetic deaths were seen in those who were managed by junior residents in conjunction with the anaesthetic nursing staff. Suggestions are offered on how to improve the quality of services provided by our hospitals with the aim of reducing maternal mortality from it. Keywords: Maternal mortality, Obstructed Labour, Institutional factors (Global J Med Sci: 2003 2(1): 13-17

Knowledge, Attitude And Practice Of Family Planning Amongst Women With Unplanned Pregnancy In Calabar - Nigeria

Women with unplanned pregnancy who came to the University of Calabar Teaching Hospital (UCTH), Calabar, Nigeria, for antenatal care were studied. The aim was to establish the knowledge, attitude and practice of family planning amongst these women. The incidence of unplanned pregnancy in our antenatal population is about 30%. The women considered their pregnancies unplanned because they were unmarried (31.4%), were still in school (25%) and were not economically prepared for the pregnancy (25.1%). Over 85% of the women with unplanned pregnancy were aware of, at least, one family planning method. Most of them knew the benefits of contraception, about 86% of them agreed that family planning is useful but only 8.7% of them ever used a family planning method. The reason for non-use of contraceptive methods were: refusal by husbands (54%), the belief that the methods “cause infertility and ill-health” (35%) and that it was against their religion (28%). Intensive male- targeted information, education, and public enlightenment campaigns may reverse this trend. Key words: Knowledge; Attitude; Practice; Family Planning; Women with Unplanned Pregnancy Nigerian Journal of Physiological Sciences Vol.18(1-2) 2003: 65-7

Review Paper: Hydatidiform mole in Calabar, Nigeria: a ten-year review

A total of 79 patients who were managed for hydatidiform mole in University of Calabar Teaching Hospital over ten years were reviewed with the aims of establishing the incidence and assessing outcome of management. Relevant information was obtained from the case files and analyzed. The incidence of 1 in 187 of total deliveries was obtained. Most of the patients (65.5%) were between 21 and 30 years old from low socioeconomic class (75.6%) and 75.7% presented in the hospital in the third trimester of pregnancy. Anaemia (82.4%), abnormal vaginal bleeding (79.7%) and passage of vesicular mole (67.6%) were the most common presentations in the hospital. Recurrent disease occurred in 4.1%. The uterus was evacuated by electrical suction method in 42.9% while 4.1% had hysterectomy. Maternal complications included severe haemorrhage requiring blood transfusion in 25.6%, 14.9% had infections and uterine perforations occurred in 6.7%. There was no maternal dead. Problem of outpatient clinical follow up was highlighted as only 6.7% was seen at one year. Public enlightenment campaign on the need for women with symptoms suggestive of the disease to present in hospital for assessment should be mounted. High index of suspicion by the clinicians especially in those patients at risk of the disease will reduce the incidence of late or missed diagnosis. Keywords: hydatidiform mole, pregnancy, outcome Mary Slessor Journal of Medicine Vol. 5 (1), 2005: 72-7

Reasons For Preference Of Delivery In Spiritual Church-Based Clinics Bywomen Of South-south Nigeria

Objectives: To investigate the various reasons for patronizing the spiritual church-based clinics by women from South-South Nigeria. Design: Forty seven spiritual church-based clinics were studied between 1st February 2003 and 31st July 2003. Setting: Forty seven spiritual church-based clinics in both Akwa Ibom and Cross River State in South- South Nigeria. Patients: Two thousand and sixty three pregnant women who were regular attendants of the spiritual church-based clinics. Results: Various reasons for preferring church delivery included: Spiritual protection against satanic attacks and safe delivery in 975 (36.8%) lack of funds in 629(30.5%), harsh attitude of health workers in 249 (12.1%), convenience in 212 (10.3%), faith in God and previous delivery in church 83 (4.0%) each help and good care guaranteed in 48 (2.35). Conclusion: It is suggested that the spiritual churches with interest in obstetric care establish properly staffed and well equipped health clinics as an annex to the church. Keywords: Preference, Church-Based ClinicsNigerian Journal of Clinical Practice Vol. 11 (2) 2008: pp. 100-10

Effect Of Anaesthesia On Morbidity And Mortality In Emergency Caesarean Section Patients In Calabar, Nigeria

The outcome of obstetric anaesthesia following emergency Caesarean sections was studied retrospectively. The study which was carried out in the University of Calabar Teaching Hospital covered the period between 1st August 1995 – 31st August 2000. The aim was to evaluate the morbidity and mortality from anaesthesia during the period under review. Out of 1533 Caesarean sections performed 920 were emergency giving an emergency Caesearean section rate of 60%. The main indications for the emergency Caesearean sections were obstructed labour 220 (23.9%), foetal distress 193 (19.9%) and pre-eclampsia/eclampsia 142 (15.4%). General anaesthesia was employed in 555 (60.3%) while spinal was used in 365 (39.7%). Morbidity recorded in the spinal anaesthesia group were severe hypotension 110(30%), post dural puncture headache (PDPH) 46(2.6%) and transient neurologic symptoms (TNSs) 1 (0.022%). No mortality was recorded in the spinal anaesthesia group. Morbidity in the general anaesthesia group was mainly sore throat 364(65.6%) Five deaths were recorded in the general anaesthesia group. Four deaths occurred probably due to hypoxia following failed intubation, while the fifth death followed an unsuccessful cardiopulmonary resuscitation in an eclamptic patient, or due to eclampsia. From this study, mortality was recorded in the general anaesthesia group. Spinal anaesthesia, when there is no contra- indication is therefore recommended for safe obstetric anaesthesia. Brisk pre-operative evaluation, optimization of pre-operative clinical status of parturients and competent anaesthetist are of paramount importance. Key words: Obstetric anaesthesia; emergency caesarean section; morbidity and mortality. Nigerian Journal of Physiological Sciences Vol.18(1-2) 2003: 77-8

Prevalence of tobacco use among youths in five centres in Nigeria: A global youth tobacco survey (GYTS) approach

No Abstract