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Lassek WD, Gaulin SJC. Does Nubility Indicate More Than High Reproductive Value? Nubile Primiparas' Pregnancy Outcomes in Evolutionary Perspective. EVOLUTIONARY PSYCHOLOGY 2021; 19:14747049211039506. [PMID: 34524917 PMCID: PMC10355305 DOI: 10.1177/14747049211039506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 11/16/2022] Open
Abstract
The idea that human males are most strongly attracted to traits that peak in women in the nubile age group raises the question of how well women in that age group contend with the potential hazards of a first pregnancy. Using data for 1.7 million first births from 1990 U.S. natality and mortality records, we compared outcomes for women with first births (primiparas) aged 16-20 years (when first births typically occur in forager and subsistence groups) with those aged 21-25 years. The younger primiparas had a much lower risk of potentially life-threatening complications of labor and delivery and, when evolutionarily novel risk factors were controlled, fetuses which were significantly more likely to survive despite lower birth weights. Thus, nubile primiparas were more likely to have a successful reproductive outcome defined in an evolutionarily relevant way (an infant of normal birth weight and gestation, surviving to one year, and delivered without a medically necessary cesarean delivery). This suggests that prior to the widespread availability of surgical deliveries, men who mated with women in the nubile age group would have reaped the benefit of having a reproductive partner more likely to have a successful first pregnancy.
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Affiliation(s)
- William D. Lassek
- Department of Anthropology, HSSB 2001, University of California, Santa Barbara, CA, USA
| | - Steven J. C. Gaulin
- Department of Anthropology, HSSB 2001, University of California, Santa Barbara, CA, USA
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Espinoza C, Samandari G, Andersen K. Abortion knowledge, attitudes and experiences among adolescent girls: a review of the literature. Sex Reprod Health Matters 2020; 28:1744225. [PMID: 32284012 PMCID: PMC7888105 DOI: 10.1080/26410397.2020.1744225] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Adolescent girls comprise a considerable proportion of annual abortion deaths, worldwide, with 15% of all unsafe abortions taking place among girls under 20 years of age. Despite recent global attention to the health and welfare of adolescent girls, little is known about their abortion experience, particularly of those under the age of 15 years. This review examines existing peer-reviewed and grey literature on abortion-related experiences of adolescent girls, paying particular attention to girls ages 10-14. In December 2019, the authors conducted a comprehensive search of five major online resource databases, using a two-part keyword search strategy for articles from 2003 to 2019. Of the original 3,100+ articles, 1,228 were individually screened and 35 retained for inclusion in the analysis. Findings show that while adolescent girls may have knowledge of abortion in general, they lack specific knowledge of sources of care and delay care-seeking due to the fear of stigma, lack of resources and provider bias. Adolescent girls do not experience higher rates of physical complications compared to older cohorts, but they are at risk of psychosocial harm. For girls ages 10-14, abortion experience may be compounded by pregnancy due to sexual abuse or transactional sex, and they face even more barriers to care than older adolescents in terms of provider bias and lack of agency. Adolescents have unique needs and experiences around abortion, which should be accounted for in programming and advocacy. Adolescent girls need information about safe abortion at an early age and a responsive and stigma-free health system.
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Affiliation(s)
- Cecilia Espinoza
- Ipas Senior Advocacy Advisor, Ipas, Chapel Hill, North Carolina, USA
| | | | - Kathryn Andersen
- Chief Scientific and Technical Officer, Ipas, Chapel Hill, North Carolina, USA
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Adeniran AS, Ocheke AN, Nwachukwu D, Adewole N, Ageda B, Onile T, Umezulike AC, Aboyeji AP, Oladapo OT. Non-obstetric causes of severe maternal complications: a secondary analysis of the Nigeria Near-miss and Maternal Death Survey. BJOG 2019; 126 Suppl 3:41-48. [PMID: 30897278 DOI: 10.1111/1471-0528.15623] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the burden, causes and outcomes of severe non-obstetric maternal complications in Nigerian public tertiary hospitals. DESIGN Secondary analysis of a nationwide cross-sectional study. SETTING Forty-two tertiary health facilities. POPULATION Women admitted with complications during pregnancy, childbirth or puerperium. METHODS All cases of severe maternal outcome (SMO: maternal near-miss or maternal death) due to non-obstetric causes were prospectively identified over a 1-year period. Maternal near-miss was defined using organ-system dysfunction (WHO), clinical, or management-based criteria. MAIN OUTCOME MEASURES Causes and contributions of non-obstetric complications to SMO; fetal and neonatal outcomes; health service events associated with non-obstetric complications; and mortality index (% of maternal death/SMO). RESULTS Of 100 107 women admitted with complications, 9401 (9.4%) were for non-obstetric causes; and 4.0% (375/9401) suffered severe non-obstetric complications. Of the 375 cases of severe non-obstetric complications, 48.8% (183/375) were near-misses and 51.2% (192/375) were maternal deaths. Severe anaemia unrelated to haemorrhage contributed 61.2% of near-misses and 32.8% of maternal deaths. The highest mortality indices were observed for cancer (91.7%), hepatic diseases (81.8%) and HIV/AIDS/HIV wasting syndrome (80.4%). Fatality was significantly high with extremes of age and no formal education. Regarding organ dysfunctions, neurological (77.1%) and cardiovascular (75.0%) dysfunctions had the highest mortality indices. Perinatal mortality was 65.9%. Time from diagnosis of severe non-obstetric complications to review by senior medical personnel, and to definitive intervention was <30 minutes in 30.2% and 29.8% of women with SMO, respectively. However, over 240 minutes elapsed between diagnosis and definitive intervention in more than one-third of women with SMO. CONCLUSION Non-obstetric complications are associated with poorer pregnancy outcomes and deserve attention similar to that accorded obstetric complications. FUNDING The original research that generated the data for this secondary analysis and the publication of this secondary analysis were funded by the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a co-sponsored programme executed by the World Health Organization (WHO). TWEETABLE ABSTRACT Non-obstetric causes are important contributors to maternal deaths and life-threatening morbidities in Nigerian hospitals.
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Affiliation(s)
- A S Adeniran
- Department of Obstetrics & Gynaecology, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - A N Ocheke
- Department of Obstetrics & Gynaecology, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - D Nwachukwu
- Department of Obstetrics & Gynaecology, Federal Medical Centre, Bida, Nigeria
| | - N Adewole
- Department of Obstetrics & Gynaecology, University of Abuja Teaching Hospital, Gwagwalada, Nigeria
| | - B Ageda
- Department of Obstetrics & Gynaecology, Federal Medical Centre, Makurdi, Nigeria
| | - T Onile
- Department of Obstetrics & Gynaecology, Federal Medical Centre, Lokoja, Nigeria
| | - A C Umezulike
- Department of Obstetrics & Gynaecology, National Hospital, Abuja, Nigeria
| | - A P Aboyeji
- Department of Obstetrics & Gynaecology, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - O T Oladapo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Muhammad R, Isah A, Agida T, Akaba G. A prospective study to compare the effectiveness of adjunctive rectal misoprostol or oxytocin titration in the prevention of primary post-partum haemorrhage in at risk patients. Afr Health Sci 2019; 19:1517-1524. [PMID: 31148979 PMCID: PMC6531961 DOI: 10.4314/ahs.v19i1.25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Adjunctive uterotonic in patients at risk of primary post-partum haemorrhage may reduce its incidence. Objective To compare the effectiveness and safety of adjunctive rectal misoprostol with adjunctive intravenous oxytocin for the prevention of primary post-partum haemorrhage in at risk patients. Materials and methods A total of 122 patients with risk factors for uterine atony were allocated to receive either 600µg of rectal misoprostol (n= 61) or 20IU of oxytocin infusion (n=61) after routine management of third stage of labour. Post-partum blood loss was measured using differential delivery towel and pad weighing. Results There was similarity in the estimated post-partum blood loss, with no significant difference in the mean post-partum hematocrit levels between the adjunctive rectal misoprostol group and oxytocin infusion group (P=0.712). There was no difference in the need for additional intervention of uterotonics between the two groups. There were however, higher incidences of shivering and pyrexia among those that received misoprostol compared with the oxytocin group. Conclusion Rectal misoprostol is as effective and safe as oxytocin when used as an adjunctive uterotonic in preventing primary post-partum haemorrhage in patients with risk factors for uterine atony after active management of third stage of labour.
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Amjad S, MacDonald I, Chambers T, Osornio-Vargas A, Chandra S, Voaklander D, Ospina MB. Social determinants of health and adverse maternal and birth outcomes in adolescent pregnancies: A systematic review and meta-analysis. Paediatr Perinat Epidemiol 2019; 33:88-99. [PMID: 30516287 DOI: 10.1111/ppe.12529] [Citation(s) in RCA: 115] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 09/24/2018] [Accepted: 10/31/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Adverse outcomes in adolescent pregnancies have been attributed to both biological immaturity and social determinants of health (SDOH). The present systematic review evaluated the evidence on the association between SDOH and adverse maternal and birth outcomes in adolescent mothers. METHODS Comprehensive literature searches were conducted to identify observational studies evaluating the relationship between SDOH and adverse adolescent pregnancy outcomes. Study selection, risk of bias appraisal, and data extraction of study characteristics were independently performed by two reviewers. Pooled odds ratios (pOR) with 95% confidence intervals (95% CI) were calculated to assess the association between SDOH and adverse birth outcomes. RESULTS Thirty-one studies met the inclusion criteria. The most frequently evaluated SDOH was race while the most commonly reported maternal and birth outcomes were caesarean section and preterm birth (PTB), respectively. The risk of bias of included studies was fair on the Newcastle-Ottawa Scale. Meta-analyses of retrospective cohort studies showed that, compared to White adolescent mothers, African American teens had increased odds of PTB (pOR 1.67; 95% CI 1.59, 1.75) and low birthweight (pOR 1.53; 95% CI 1.45, 1.62). Rural residence was consistently linked with PTB while low maternal socio-economic (SES) and illiteracy were found to increase the risk of adolescent maternal mortality and LBW infants. CONCLUSION Social determinants of health contribute to the risk of adverse pregnancy outcomes in adolescent mothers. African American race, rural residence, inadequate education, and low SES are markers for poor pregnancy outcomes in adolescent mothers. Further research needs to be done to understand the underlying causal pathways to inequalities in adolescent pregnancy outcomes.
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Affiliation(s)
- Sana Amjad
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Isaiah MacDonald
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Thane Chambers
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, Alberta, Canada
| | | | - Sujata Chandra
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Don Voaklander
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Maria B Ospina
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada.,Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada
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Neal S, Mahendra S, Bose K, Camacho AV, Mathai M, Nove A, Santana F, Matthews Z. The causes of maternal mortality in adolescents in low and middle income countries: a systematic review of the literature. BMC Pregnancy Childbirth 2016; 16:352. [PMID: 27836005 PMCID: PMC5106816 DOI: 10.1186/s12884-016-1120-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 10/21/2016] [Indexed: 12/02/2022] Open
Abstract
Background While the main causes of maternal mortality in low and middle income countries are well understood, less is known about whether patterns for causes of maternal deaths among adolescents are the same as for older women. This study systematically reviews the literature on cause of maternal death in adolescence. Where possible we compare the main causes for adolescents with those for older women to ascertain differences and similarity in mortality patterns. Methods An initial search for papers and grey literature in English, Spanish and Portuguese was carried out using a number of electronic databases based on a pre-determined search strategy. The outcome of interest was the proportion of maternal deaths amongst adolescents by cause of death. A total of 15 papers met the inclusion criteria established in the study protocol. Results The main causes of maternal mortality in adolescents are similar to those of older women: hypertensive disorders, haemorrhage, abortion and sepsis. However some studies indicated country or regional differences in the relative magnitudes of specific causes of adolescent maternal mortality. When compared with causes of death for older women, hypertensive disorders were found to be a more important cause of mortality for adolescents in a number of studies in a range of settings. In terms of indirect causes of death, there are indications that malaria is a particularly important cause of adolescent maternal mortality in some countries. Conclusion The main causes of maternal mortality in adolescents are broadly similar to those for older women, although the findings suggest some heterogeneity between countries and regions. However there is evidence that the relative importance of specific causes may differ for this younger age group compared to women over the age of 20 years. In particular hypertensive conditions make up a larger share of maternal deaths in adolescents than older women. Further, large scale studies are needed to investigate this question further.
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Affiliation(s)
- Sarah Neal
- Department of Social Statistics and Demography, University of Southampton, Southampton, UK.
| | | | - Krishna Bose
- Sustainable Development and Health, Ferney Voltaire, France
| | - Alma Virginia Camacho
- SRH Team, Latin America and the Caribbean Regional Office, United Nations Population Fund, Panama City, Panama
| | - Matthews Mathai
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine , Liverpool, UK
| | | | | | - Zoë Matthews
- Department of Social Statistics and Demography, University of Southampton, Southampton, UK
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Ajah LO, Ozonu NC, Ezeonu PO, Lawani LO, Obuna JA, Onwe EO. The Feto-Maternal Outcome of Preeclampsia with Severe Features and Eclampsia in Abakaliki, South-East Nigeria. J Clin Diagn Res 2016; 10:QC18-QC21. [PMID: 27790527 PMCID: PMC5072027 DOI: 10.7860/jcdr/2016/21078.8499] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 08/01/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Preeclampsia with severe features and eclampsia has remained a serious challenge in tropical obstetric practice. It is a major cause of maternal and perinatal morbidity and mortality in Nigeria. AIM This study was aimed at determining the prevalence, the risk factors and feto-maternal outcome of preeclampsia with severe features and eclampsia in Abakaliki. MATERIALS AND METHODS This was a 5-year retrospective case-control study of preeclampsia with severe features and eclampsia at the Federal Teaching Hospital, Abakaliki. Case notes of preeclampsia with severe features and eclampsia between January 2008 and December, 2012 were retrieved. Similarly, the case file of next parturient that did not have any medical disease was included in the study. The cases and controls were selected at the ratio of 1:1. The data assessed were information on maternal age, parity, booking status, diagnosis, mode of delivery, complications, maternal and perinatal outcomes. RESULTS A total of 13,750 deliveries were recorded within the study period. The prevalence of preeclampsia with severe features and eclampsia were 136(0.99%) and 104(0.76%) respectively. Preeclampsia with severe features and eclampsia was more common among adolescents, rural dwellers, poorly educated, unemployed, unbooked and nulliparous women. It was more associated with preterm delivery, caesarean section, low birth weight babies, maternal and perinatal mortality. CONCLUSION Preeclampsia with severe features and eclampsia is common among the adolescents, unbooked, rural, and low socio-economic group of women in this study. It has also contributed to high maternal and perinatal morbidity and mortality. There is need for policy makers to formulate policies toward female education, women empowerment and provision of social amenities in rural areas. These policies may reverse the current ugly trend in this environment.
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Affiliation(s)
- Leonard Ogbonna Ajah
- Lecturer, Department of Obstetrics, Faculty of Medical Sciences, University of Nigeria, Enugu Campus
| | - Nelson Chukwudi Ozonu
- Senior Registrar, Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Abakaliki
| | - Paul Olisaemeka Ezeonu
- Associate Professor, Department of Obstetrics and Gynaecology, Ebonyi State University /Federal Teaching Hospital, Abakaliki
| | - Lucky Osaheni Lawani
- Lecturer, Department of Obstetrics and Gynaecology, Ebonyi State University/ Federal Teaching Hospital, Abakaliki
| | - Johnson Akuma Obuna
- Senior Lecturer, Department of Obstetrics and Gynaecology, Ebonyi State University/Federal TeachingHospital, Abakaliki
| | - Emeka Ogah Onwe
- Lecturer, Department of Paediatrics, Ebonyi State University/Federal Teaching Hospital, Abakaliki
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Buchmann EJ, Mnyani CN, Frank KA, Chersich MF, McIntyre JA. Declining maternal mortality in the face of persistently high HIV prevalence in a middle-income country. BJOG 2014; 122:220-7. [PMID: 25213804 DOI: 10.1111/1471-0528.13064] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To estimate maternal mortality ratio (MMR) and determine maternal death causes and trends in Greater Soweto, Johannesburg, South Africa. DESIGN Cross-sectional study. SETTING Chris Hani Baragwanath Maternity Hospital (CHBMH) in Greater Soweto. POPULATION Maternal deaths at CHBMH. METHODS Record review of maternal deaths from 1997 to 2012, using hospital death records, with denominator data from the district health information system and the hospital. MAIN OUTCOME MEASURES Maternal mortality ratio per 100,000 live births, and causes of death classified as in the South African confidential enquiries. RESULTS There were 479 deaths, with a peak MMR of 139 in 2004 and a decline to 86 in 2012. Of 332 women tested, 245 (74%) were HIV-infected. Nonpregnancy-related infection (40%) was the most frequent cause of death, followed by hypertension (16%) and obstetric haemorrhage (13%). HIV infection rates in these groups were 92%, 30% and 61%, respectively. Previous caesarean section was associated with obstetric haemorrhage death (odds ratio [OR] 3.2, 95% confidence interval [95% CI] 1.7-6.0), maternal age ≥35 years with hypertension death (OR 2.2, 95% CI 1.2-3.7) and antenatal anaemia with nonpregnancy-related infection death (OR 4.0, 95% CI 2.3-6.9), compared with other causes of death. CONCLUSION There is evidence of a decline in MMR since HIV treatment for pregnant women was introduced in 2004. Previous caesarean section, advanced maternal age, and anaemia were associated with death from obstetric haemorrhage, hypertensive disorders of pregnancy and nonpregnancy-related infections, respectively. MMR may be further reduced with accelerated initiation of HIV treatment during pregnancy.
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Affiliation(s)
- E J Buchmann
- Department of Obstetrics and Gynaecology, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa
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Ugwu IA, Enabor OO, Adeyemi AB, Lawal OO, Oladokun A, Olayemi O. Sublingual misoprostol to decrease blood loss after caesarean delivery: A randomised controlled trial. J OBSTET GYNAECOL 2014; 34:407-11. [DOI: 10.3109/01443615.2014.899329] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Igberase GO, Ebeigbe PN. Maternal mortality in a rural referral hospital in the Niger Delta, Nigeria. J OBSTET GYNAECOL 2007; 27:275-8. [PMID: 17464810 DOI: 10.1080/01443610701213687] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Almost two decades after the safe motherhood initiative, maternal mortality figures remain very high in Nigeria. Very few studies are available on the features of maternal mortality in rural Nigeria. The objective of this study was to determine the incidence and causes of maternal mortality in a rural referral hospital in the Niger Delta, Nigeria. An audit of 115 consecutive maternal mortalities over a 10-year period at a rural-based tertiary hospital was undertaken. There were 5,153 deliveries and 115 maternal deaths during the study period, with a maternal mortality ratio of 2,232/100,000 live births. The most common causes of maternal mortalities were puerperal sepsis, abortion complications, pre-eclampsia/eclampsia, prolonged obstructed labour, haemorrhage accounting for 33%, 22.6%, 17.4%, 13.0% and 7.8%, respectively. The percentage mortality for unbooked was 10 times that for booked patients. Unbooked status is a risk factor for maternal mortality as this was statistically significant p < 0.0001. Traditional birth attendants were involved in the initial management of at least two-fifths (38.2%) of the non-abortion mortalities while half had been managed in private hospitals and maternities. Maternal mortality will continue to increase unless appropriate steps are taken to improve the use of antenatal care, thereby reducing unbooked emergencies. Hospitals need to be equipped with facilities for emergency obstetric care. Continuous programmes that will integrate TBAs and orthodox practices should be put in place as this will reduce delays and improve referral systems.
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Affiliation(s)
- G O Igberase
- Department of Obstetrics and Gynaecology, Baptist Medical Centre, Eku, Sapele.
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