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Birth Preparedness and Complication Readiness among Pregnant Women in a Secondary Health Facility in Abakaliki, Ebonyi State, Nigeria. BIOMED RESEARCH INTERNATIONAL 2020; 2020:9097415. [PMID: 32775449 PMCID: PMC7399737 DOI: 10.1155/2020/9097415] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/04/2020] [Accepted: 07/07/2020] [Indexed: 11/23/2022]
Abstract
Background Birth preparedness and complication readiness (BP/CR) concept is based on the premise that preparing for birth and being ready for complications reduce all three phases of delay to a bad obstetric outcome. Objectives To determine the knowledge of BP/CR with its determinants and BP/CR index among pregnant women in Abakaliki, southeast Nigeria. Methods A cross-sectional survey was done between 1st March 2019 and 31st July 2019 among 450 randomly selected antenatal attendees at Mile Four Hospital, Abakaliki, Nigeria. The data were obtained using a pretested interviewer-administered structured questionnaire adapted from the maternal and neonatal health program handbook of the Johns Hopkins Program for International Education in Gynaecology and Obstetrics (JHPIEGO). The data obtained were analyzed using percentages, chi-square, and odds ratios. The level of significance is at P value < 0.05. Results The birth preparedness and complication readiness index was 41.9%. Only 44.9% and 36.9% of the study population had adequate knowledge of birth preparedness (BP) and complication readiness (CR), respectively. Upper social class, lower educational level, urban residence, and less than 30 years of age were associated with increased odds of respondents having adequate knowledge of BP and CR (P > 0.05). However, only booking in the 1st or 2nd trimester was a significant determinant of the respondent's adequate knowledge of BP (AOR = 0.63, 95% CI 0.40-0.98) and CR (AOR = 0.62, 95% CI 0.39-0.97). Identification of transport and saving of money was the commonest birth plan while the commonest danger sign known to the participants was bleeding. Conclusion This study revealed that knowledge of BP/CR is suboptimal. The determinant of this knowledge is antenatal booking. It is recommended that women should have adequate antenatal care education to improve their knowledge of BP/CR. This will help to increase the low BP/CR index seen in our study.
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Severe Life-Threatening Pregnancy Complications, "Near Miss" and Maternal Mortality in a Tertiary Hospital in Southern Nigeria: A Retrospective Study. Obstet Gynecol Int 2020; 2020:3697637. [PMID: 32665779 PMCID: PMC7349465 DOI: 10.1155/2020/3697637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 02/18/2020] [Accepted: 06/05/2020] [Indexed: 11/18/2022] Open
Abstract
Background Investigating severe life-threatening pregnancy complications that women encounter and the maternal morbidities (near miss) may help to evaluate the quality of care in health facility and recommend ways to improve maternal and infant survival especially in low-income countries. The aim of this review was to identify, classify, and determine the frequency and nature of maternal near miss events and the maternal and perinatal outcomes. Methods A retrospective facility-based review of cases of near miss and maternal mortality occurring between 1st January 2012 and 31st December 2016 at the University of Calabar Teaching Hospital was conducted. Near miss case definition was based on the WHO disease specific criteria. The main outcomes included the maternal mortality ratio (MMR), maternal near miss ratio (MNMR), mortality index, maternal morbidities, and perinatal outcome. Results There were 10,111 pregnancy-related admissions, 790 life-threatening pregnancy complications that resulted in 99 maternal deaths, and 691 near miss cases. The maternal mortality ratio was 979 maternal deaths per 100,000 live births, and the maternal near miss ratio was 6,834 per 100,000 maternities. The MMR to MNMR ratio was 1 : 8. Sepsis and severe anaemia had high case-specific mortality indices of 0.4 and 0.53, respectively. The perinatal outcome was poor compared to that of uncomplicated pregnancies: perinatal mortality rate (PMR) 266 per 1000 live births (OR 7.74); neonatal intensive care (NIC) admissions 11.6 percent (OR 1.83); and low birth weight (LBW) (<2.5 kg) 12.19 percent (OR 1.89). Conclusion Antenatal care and early recognition of danger signs in pregnancy as well as prompt referral and early institution of essential obstetrics care are important for maternal and infant survival.
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Rafiq S, Syed W, Ghaffar SF. Trends and causes of maternal mortality in a tertiary care hospital over five years: 2013-2017. Pak J Med Sci 2019; 35:1128-1131. [PMID: 31372155 PMCID: PMC6659062 DOI: 10.12669/pjms.35.4.1091] [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: 11/18/2022] Open
Abstract
Background and Objective: Maternal death measurement is essential to a country’s wellbeing and development status. In emerging countries like Pakistan, it remains an intimidating and failed public health challenge. Objectives of our audit were to estimate trends and causes of maternal demise in Lady Reading Hospital, Peshawar, Pakistan. Methods: Between January 2013 to December 2017, a retrospective study was carried out at Medical Teaching Institute, Lady Reading Hospital, Peshawar. A structured proforma was used to collect data from the medical records. To detect trends in mother demise maternal mortality ratio was calculated for each year and for all five years, Spss version 23 was used for data analysis. Results: In the five-year periods 134 deaths were recorded. The maternal mortality during the study period was 431/100,000 live births. An unstable trend in mortality with two crowning periods in 2013 and 2017 was observed. Hemorrhage persisted as the foremost cause of maternal death over the five years period, accounting for 47.76% deaths followed by hypertension, accounting for 25.37% deaths. An increased risk of 35.08% was observed among women aged 25-29 years, followed by 26.11% in 20-24 years and 23.88% in >30 years. Conclusion: There is a decreasing trend of maternal death from 2013 to 2016 but a slight increase was noted in 2017. Hemorrhage was the top cause responsible for the maternal death.
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Affiliation(s)
- Sonia Rafiq
- Dr. Sonia Rafiq, FCPS. Department of Obstetrics & Gynaecology, Lady Reading Hospital, Peshawar, Pakistan
| | - Wajeeha Syed
- Dr. Wajeeha Syed, FCPS. Department of Obstetrics & Gynaecology, Lady Reading Hospital, Peshawar, Pakistan
| | - Simi Fayaz Ghaffar
- Dr. Simi Fayaz Ghaffar, FRCOG, FCPS. Department of Obstetrics & Gynaecology, Lady Reading Hospital, Peshawar, Pakistan
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Agan TU, Monjok E, Akpan UB, Omoronyia OE, Ekabua JE. Trend and Causes of Maternal Mortality in a Nigerian Tertiary Hospital: A 5-year Retrospective Study (2010-2014) at the University of Calabar Teaching Hospital, Calabar, Nigeria. Open Access Maced J Med Sci 2018; 6:1153-1158. [PMID: 29983819 PMCID: PMC6026429 DOI: 10.3889/oamjms.2018.220] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 04/23/2018] [Accepted: 04/30/2018] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Maternal mortality ratios (MMR) are still unacceptably high in many low-income countries especially in sub-Saharan Africa. MMR had been reported to have improved from an initial 3,026 per 100,000 live births in 1999 to 941 in 2009, at the University of Calabar Teaching Hospital (UCTH), Calabar, a tertiary health facility in Nigeria. Post-partum haemorrhage and hypertensive diseases of pregnancy have been the common causes of maternal deaths in the facility. AIM This study was aimed at determining the trend in maternal mortality in the same facility, following institution of some facility-based intervention measures. METHODOLOGY A retrospective study design was utilised with extraction and review of medical records of pregnancy-related deaths in UCTH, Calabar, from January 2010 to December 2014. The beginning of the review period coincided with the period the "Woman Intervention Trial" was set up to reduce maternal mortality in the facility. This trial consists of the use of Tranexamic acid for prevention of post-partum haemorrhage, as well as more proactive attendance to parturition. RESULTS There were 13,605 live births and sixty-one (61) pregnancy-related deaths in UCTH during the study period. This yielded a facility Maternal Mortality Ratio of 448 per 100,000 live births. In the previous 11-year period of review, there was sustained the decline in MMR by 72.9% in the initial four years (from 793 in 2010 to 215 in 2013), with the onset of resurgence to 366 in the last year (2014). Mean age at maternal death was 27 ± 6.5 years, with most subjects (45, 73.8%) being within 20-34 years age group. Forty-eight (78.7%) were married, 26 (42.6%) were unemployed, and 33 (55.7%) had at least secondary level of education. Septic abortion (13, 21.3%) and hypertensive diseases of pregnancy (10, 16.4%) were the leading causes of death. Over three quarters (47, 77.0%) had not received care from any health facility. Most deaths (46, 75.5%) occurred between 24 and 97 hours of admission. CONCLUSION Compared with previous trends, there has been a significant improvement in maternal mortality ratio in the study setting. There is also a significant change in the leading cause of maternal deaths, with septic abortion and hypertensive disease of pregnancy now replacing post-partum haemorrhage and puerperal sepsis that was previously reported. This success may be attributable to the institution of the Woman trial intervention which is still ongoing in other parts of the world. There is, however, need to sustain effort at a further reduction in MMR towards the attainment of set sustainable development goals (SDGs), through improvement in the provision of maternal health services in low-income countries.
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Affiliation(s)
- Thomas U Agan
- Department of Obstetrics and Gynecology, the University of Calabar and University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Emmanuel Monjok
- Departments of Family Medicine and Community Medicine, University of Calabar and University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Ubong B Akpan
- Department of Obstetrics and Gynecology, the University of Calabar and University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Ogban E Omoronyia
- Department of Community Medicine, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - John E Ekabua
- Department of Obstetrics and Gynecology, the University of Calabar and University of Calabar Teaching Hospital, Calabar, Nigeria
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Orazulike NC, Alegbeleye JO, Obiorah CC, Nyengidiki TK, Uzoigwe SA. A 3-year retrospective review of mortality in women of reproductive age in a tertiary health facility in Port Harcourt, Nigeria. Int J Womens Health 2017; 9:769-775. [PMID: 29081673 PMCID: PMC5652918 DOI: 10.2147/ijwh.s138052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Purpose To determine the causes of death and associated risk factors among women of reproductive age (WRA) in a tertiary institution in Port Harcourt, Nigeria. Patients and methods This was a retrospective survey of all deaths in women aged 15–49 years at the University of Port Harcourt Teaching Hospital that occurred from January 1, 2013 to December 31, 2015. Data retrieved from ward registers, death registers, and death certificates were analyzed with Epi Info version 7. Comparison of socioeconomic and demographic risk factors for maternal and nonmaternal deaths was done using a multivariate logistic regression model. Results There were 340 deaths in the WRA group over the 3-year period. The majority (155 [45.6%]) of the women were aged 30–39 years. There were 265 (77.9%) nonmaternal deaths and 75 (22.1%) maternal deaths. Among the nonmaternal deaths, 124 (46.8%) had infectious diseases, with human immunodeficiency virus being the most common cause of infection in this group. Breast cancer (13 [4.9%]), cervical cancer (12 [4.5%]), and ovarian cancer (11 [4.2%]) were the most common malignant neoplasms observed. Hypertensive disorders of pregnancy (31 [41.3%]) and puerperal sepsis (20 [26.7%]) were the most common causes of maternal deaths. Age and occupation were significantly associated with deaths in WRA (p<0.05). Older women aged >30 years (odd ratio =1.86, 95% CI =1.07–3.23) and employed women (odds ratio =2.55, 95% CI =1.46–4.45) were more likely to die from nonmaternal than maternal causes. Conclusion Most of the deaths were nonmaternal. Infectious diseases, diseases of the circulatory system, and malignant neoplasms were the major causes of death among WRA, with maternal deaths accounting for approximately a quarter. Public health programs educating women on safer sex practices, early screening for cancers, benefits of antenatal care, and skilled attendants at delivery will go a long way to reducing preventable causes of deaths among these women.
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Affiliation(s)
| | | | - Christopher C Obiorah
- Department of Anatomical Pathology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria
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Mgawadere F, Kana T, van den Broek N. Measuring maternal mortality: a systematic review of methods used to obtain estimates of the maternal mortality ratio (MMR) in low- and middle-income countries. Br Med Bull 2017; 121:121-134. [PMID: 28104630 PMCID: PMC5873731 DOI: 10.1093/bmb/ldw056] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 11/22/2016] [Accepted: 01/05/2017] [Indexed: 12/04/2022]
Abstract
Background The new global target for maternal mortality ratio (MMR) is a ratio below 70 maternal deaths per 100 000 live births by 2030. We undertook a systematic review of methods used to measure MMR in low- and middle-income countries. Sources of data Systematic review of the literature; 59 studies included. Areas of agreement Civil registration (5 studies), census (5) and surveys (16), Reproductive Age Mortality Studies (RAMOS) (4) and the sisterhood methods (11) have been used to measure MMR in a variety of settings. Areas of controversy Middle-income countries have used civil registration data for estimating MMR but it has been a challenge to obtain reliable data from low-income countries with many only using health facility data (18 studies). Growing points and areas for further research Based on the strengths and feasibility of application, RAMOS may provide reliable and contemporaneous estimates of MMR while civil registration systems are being introduced. It will be important to build capacity for this and ensure implementation research to understand what works where and how.
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Affiliation(s)
- Florence Mgawadere
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Terry Kana
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Nynke van den Broek
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
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Oloko O, Ogunbode OO, Roberts O, Arowojolu AO. Antenatal care visits' absenteeism at a secondary care medical facility in Southwest Nigeria. J OBSTET GYNAECOL 2016; 36:1026-1030. [PMID: 27616013 DOI: 10.1080/01443615.2016.1188270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Antenatal care (ANC) is a specialised pattern of care organised for pregnant women with the goal of maintaining good health and promoting safe delivery of healthy infants. It is an indispensable part of effective maternity care services. This study identified the factors responsible for absenteeism from ANC follow-up visits. It was a hospital-based prospective cross-sectional descriptive study conducted at a faith based secondary healthcare facility in Ibadan, Nigeria. Relevant data were retrieved using interviewer-administered structured questionnaires and antenatal health record cards. The major reasons identified for absenteeism were delay in receiving hospital services due to long queues at service points and understaffing. The pregnant women aged 35 years and above were the most likely to miss the visits. Therefore, there is the need for hospital administrators and health care givers to make the services patient-friendly.
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Affiliation(s)
- Olakunle Oloko
- a Department of Obstetrics and Gynaecology , Our Lady of Apostle Catholic Hospital, Oluyoro Oke-Offa , Ibadan , Nigeria
| | | | - Olumuyiwa Roberts
- c Department of Obstetrics and Gynaecology, College of Medicine , University of Ibadan , Ibadan , Nigeria
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Oyibo N, Weller G, Watt J. Evaluating lay perceptions of maternal mortality to improve risk communication: a case study in Rivers State, Nigeria. Glob Public Health 2016; 12:666-679. [DOI: 10.1080/17441692.2016.1211165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Natasha Oyibo
- Centre for Decision Analysis and Risk Management, School of Science and Technology, London, UK
| | - Gordon Weller
- School of Health and Education, Middlesex University, London, UK
| | - John Watt
- Centre for Decision Analysis and Risk Management, School of Science and Technology, London, UK
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Maro EW, Mosha NR, Mahande MJ, Obure J, Masenga G. Ten years trend in maternal mortality at Kilimanjaro Christian Medical Center Tanzania, 2003–2012: A descriptive retrospective tertiary hospital based study. ASIAN PACIFIC JOURNAL OF REPRODUCTION 2016. [DOI: 10.1016/j.apjr.2016.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Jithesh V, Ravindran TS. Social and health system factors contributing to maternal deaths in a less developed district of Kerala, India. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.jrhm.2015.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tebeu PM, Pierre-Marie T, Halle-Ekane G, Gregory HE, Da Itambi M, Maxwell DI, Enow Mbu R, Robinson EM, Mawamba Y, Yvette M, Fomulu JN, Nelson FJ. Maternal mortality in Cameroon: a university teaching hospital report. Pan Afr Med J 2015; 21:16. [PMID: 26401210 PMCID: PMC4561158 DOI: 10.11604/pamj.2015.21.16.3912] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 11/04/2014] [Indexed: 11/19/2022] Open
Abstract
More than 550,000 women die yearly from pregnancy-related causes. Fifty percent (50%) of the world estimate of maternal deaths occur in sub-Saharan Africa alone. There is insufficient information on the risk factors of maternal mortality in Cameroon. This study aimed at establishing causes and risk factors of maternal mortality. This was a case-control study from 1st January, 2006 to 31st December, 2010 after National Ethical Committee Approval. Cases were maternal deaths; controls were women who delivered normally. Maternal deaths were obtained from the delivery room registers and in-patient registers. Controls for each case were two normal deliveries following identified maternal deaths on the same day. Variables considered were socio-demographic and reproductive health characteristics. Epi Info 3.5.1 was used for analysis. The mean MMR was 287.5/100,000 live births. Causes of deaths were: postpartum hemorrhage (229.2%), unsafe abortion (25%), ectopic pregnancy (12.5%), hypertension in pregnancy (8.3%), malaria (8.3%), anemia (8.3%), heart disease (4.2%), and pneumonia (4.2%), and placenta praevia (4.2%). Ages ranged from 18 to 41 years, with a mean of 27.7 ± 5.14 years. Lack of antenatal care was a risk factor for maternal death (OR=78.33; CI: (8.66- 1802.51)). The mean MMR from 2006 to 2010 was 287.5/100,000 live births. Most of the causes of maternal deaths were preventable. Lack of antenatal care was a risk factor for maternal mortality. Key words: Maternal mortality, causes, risk factors, Cameroon.
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Affiliation(s)
| | - Tebeu Pierre-Marie
- Department of Obstetrics- Gynaecology, University Centre Hospital, Yaoundé Cameroon ; Ligue d'Initiative et de Recherche Active pour la Santé et l'Education de la Femme (LIRASEF), Cameroon
| | | | | | | | - Da Itambi Maxwell
- Department of Obstetrics- Gynaecology, University Centre Hospital, Yaoundé Cameroon
| | | | - Enow Mbu Robinson
- Department of Obstetrics-Gynecology, Central Hospital, Yaoundé, Cameroon
| | | | - Mawamba Yvette
- Department of Obstetrics- Gynaecology, University Centre Hospital, Yaoundé Cameroon
| | | | - Fomulu Joseph Nelson
- Department of Obstetrics- Gynaecology, University Centre Hospital, Yaoundé Cameroon
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Assarag B, Dujardin B, Delamou A, Meski FZ, De Brouwere V. Determinants of maternal near-miss in Morocco: too late, too far, too sloppy? PLoS One 2015; 10:e0116675. [PMID: 25612095 PMCID: PMC4303272 DOI: 10.1371/journal.pone.0116675] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 11/16/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In Morocco, there is little information on the circumstances surrounding maternal near misses. This study aimed to determine the incidence, characteristics, and determinants of maternal near misses in Morocco. METHOD A prospective case-control study was conducted at 3 referral maternity hospitals in the Marrakech region of Morocco between February and July 2012. Near-miss cases included severe hemorrhage, hypertensive disorders, and prolonged obstructed labor. Three unmatched controls were selected for each near-miss case. Three categories of risk factors (sociodemographics, reproductive history, and delays), as well as perinatal outcomes, were assessed, and bivariate and multivariate analyses of the determinants were performed. A sample of 30 near misses and 30 non-near misses was interviewed. RESULTS The incidence of near misses was 12‰ of births. Hypertensive disorders during pregnancy (45%) and severe hemorrhage (39%) were the most frequent direct causes of near miss. The main risk factors were illiteracy [OR = 2.35; 95% CI: (1.07-5.15)], lack of antenatal care [OR = 3.97; 95% CI: (1.42-11.09)], complications during pregnancy [OR = 2.81; 95% CI:(1.26-6.29)], and having experienced a first phase delay [OR = 8.71; 95% CI: (3.97-19.12)] and a first phase of third delay [OR = 4.03; 95% CI: (1.75-9.25)]. The main reasons for the first delay were lack of a family authority figure who could make a decision, lack of sufficient financial resources, lack of a vehicle, and fear of health facilities. The majority of near misses demonstrated a third delay with many referrals. The women's perceptions of the quality of their care highlighted the importance of information, good communication, and attitude. CONCLUSION Women and newborns with serious obstetric complications have a greater chance of successful outcomes if they are immediately directed to a functioning referral hospital and if the providers are responsive.
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Affiliation(s)
- Bouchra Assarag
- National School of Public Health, Rabat, Morocco
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Bruno Dujardin
- School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Alexandre Delamou
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
- National Centre for Research and Training in Rural Health, Maferinyah, Guinea
| | | | - Vincent De Brouwere
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Asibong U, Okokon IB, Agan TU, Oku A, Opiah M, Essien EJ, Monjok E. The use of the partograph in labor monitoring: a cross-sectional study among obstetric caregivers in General Hospital, Calabar, Cross River State, Nigeria. Int J Womens Health 2014; 6:873-80. [PMID: 25342920 PMCID: PMC4206378 DOI: 10.2147/ijwh.s49188] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Prolonged and obstructed labor is a significant cause of maternal morbidity and mortality in Nigeria, one of the six countries contributing significantly to the global maternal mortality crisis. The use of the partograph would engender a remarkable reduction in the number of these deaths since abnormal markers in the progress of labor would be identified early on. OBJECTIVE This study aimed to evaluate the non-physician obstetric caregivers' (OCGs) knowledge of partograph use, assess the extent of its use, determine the factors that impede its usage, and unravel the relationship between years of experience and partograph use among the respondents (OCGs) in General Hospital, Calabar, Nigeria. METHODOLOGY Using a self-administered semi-structured questionnaire, a cross-sectional descriptive study was conducted among 130 purposely selected and consenting OCGs working in the General Hospital, Calabar, Nigeria. RESULTS The majority of the respondents (70.8%) had good general knowledge of the partograph but lacked detailed and in-depth knowledge of the component parts of the partograph. Knowledge of partograph (χ(2) =12.05, P=0.0001) and partograph availability (χ(2) =56.5, P=0.0001) had a significant relationship with its utilization. Previous training (χ(2) =9.43, P=0.002) was significantly related to knowledge of partograph. Factors affecting utilization were: little or no knowledge of the partograph (85.4%), nonavailability (70%), shortage of staff (61.5%), and the fact that it is time-consuming to use (30%). CONCLUSION Lack of detailed knowledge of the partograph, nonavailability of the partograph, poor staff numbers, and inadequate training are factors that work against the effective utilization of the partograph in the study facility. Usage of this tool for labor monitoring can be enhanced by periodic training, making partographs available in labor wards, provision of reasonable staff numbers, and mandatory institutional policy.
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Affiliation(s)
- Udeme Asibong
- Department of Family Medicine, College of Medical Sciences, University of Calabar and University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Ita B Okokon
- Department of Family Medicine, College of Medical Sciences, University of Calabar and University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Thomas U Agan
- Department of Obstetrics and Gynecology, College of Medical Sciences, University of Calabar and University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Affiong Oku
- Department of Community Medicine, College of Medical Sciences, University of Calabar and University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Margaret Opiah
- Department of Maternal and Child Health, Faculty of Nursing, Niger Delta University, Wilberforce Island, Bayelsa State, Nigeria
| | - E James Essien
- Institute of Community Health, University of Houston, Texas Medical Center, Houston, TX, USA
| | - Emmanuel Monjok
- Department of Family Medicine, College of Medical Sciences, University of Calabar and University of Calabar Teaching Hospital, Calabar, Nigeria ; Institute of Community Health, University of Houston, Texas Medical Center, Houston, TX, USA
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14
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Perception of pregnant women about antenatal care in a cottage hospital in Port Harcourt, Nigeria. J Community Health 2013; 38:360-5. [PMID: 23054423 DOI: 10.1007/s10900-012-9625-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Antenatal care gives opportunity for care of women during pregnancy, prevention and treatment of diseases as well as behavioral change interventions. The perception of users about services influences service utilization. This study was performed to assess user satisfaction with antenatal care services at the centre and to identify constraints at service points. Women attending antenatal care at a cottage hospital In Nigeria were administered questionnaires to evaluate their satisfaction with services and their views about services at various points of care. Data analysis was made using Statistical Package for Social Science version 15.0. Statistical significance was set at P < 0.5. Four hundred correctly completed questionnaires were analysed. The mean age of the respondents was 29 years (SD of 4) and their parity ranged from 0 to 5 (mean 2.5 ± 1.9). The overall satisfaction with care was 94 % and it was highest (95.8 %) with health talks and least with medical consultations (64 %). Attributes valued at service points were educating nature of health talks, prompt attention, and friendly and polite staff. Reasons for dissatisfaction were unfriendly attitudes of staff and delay at service points. Additional care packages women would want were: more staff employed 61 (15.3 %), better organized services 34 (8.5 %) and routine ultrasound scans 25 (6.3 %). Women valued antenatal care and were highly satisfied with services received at the centre. Health education forums should be used to address issues with service delivery. Constraints at service points should be addressed to enhance better service delivery.
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Obiechina N, Okolie V, Okechukwu Z, Oguejiofor C, Udegbunam O, Nwajiaku L, Ogbuokiri C, Egeonu R. Maternal mortality at Nnamdi Azikiwe University Teaching Hospital, Southeast Nigeria: a 10-year review (2003-2012). Int J Womens Health 2013; 5:431-6. [PMID: 23901299 PMCID: PMC3726439 DOI: 10.2147/ijwh.s46988] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Maternal mortality is high the world over, especially in sub-Saharan Africa, including Nigeria. Nigeria has consistently demonstrated one of the most abysmally poor reproductive health indices in the world, maternal mortality inclusive. This is a sad reminder that, unless things are better organized, Southeast Nigeria, which Nnamdi Azikiwe University Teaching Hospital (NAUTH) represents, may not join other parts of the world in attaining Millennium Development Goal 5 to improve maternal health in 2015. Objectives This study was conducted to assess NAUTH’S progress in achieving a 75% reduction in the maternal mortality ratio (MMR) and to identify the major causes of maternal mortality. Materials and methods This was a 10-year retrospective study, conducted between January 1, 2003 and December 31, 2012 at Nnamdi Azikiwe University Teaching Hospital, Nnewi, Southeast Nigeria. Results During the study period, there were 8,022 live births and 103 maternal deaths, giving an MMR of 1,284/100,000 live births. The MMR was 1,709 in 2003, reducing to 1,115 in 2012. This is to say that there was a 24.86% reduction over 10 years, hence, in 15 years, the reduction should be 37%. This extrapolated reduction over 15 years is about 38% less than the target of 75% reduction. The major direct causes of maternal mortality in this study were: pre-eclampsia/eclampsia (27%), hemorrhage (22%), and sepsis (12%). The indirect causes were: anemia, anesthesia, and HIV encephalopathy. Most of the maternal deaths occurred in unbooked patients (98%) and within the first 48 hours of admission (76%). Conclusion MMRs in NAUTH are still very high and the rate of reduction is very slow. At this rate, it will take this health facility 30 years, instead of 15 years, to achieve a 75% reduction in maternal mortality.
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Affiliation(s)
- Nj Obiechina
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
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Ezegwui HU, Onoh RC, Ikeako LC, Onyebuchi A, Umeora OUJ, Ezeonu P, Ibekwe P. Investigating maternal mortality in a public teaching hospital, abakaliki, ebonyi state, Nigeria. Ann Med Health Sci Res 2013; 3:75-80. [PMID: 23634334 PMCID: PMC3634229 DOI: 10.4103/2141-9248.109511] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Maternal mortality in sub-Saharan Africa has remained high and this is a reflection of the poor quality of maternal services. AIM To determine the causes, trends, and level of maternal mortality rate in Abakaliki, Ebonyi. MATERIALS AND METHODS This was a review of the records of all maternal deaths related to pregnancy over a ten-year period, that is, January 1999 to December 2008. Relevant information on number of deaths, booking status, age, parity, educational level of women, mode of delivery, and causes of death were extracted and analyzed. RESULTS During the study period, there were 12,587 deliveries and 171 maternal deaths. The maternal mortality ratio (MMR) was 1,359 per 100,000 live births. The trend over the period was lowest in 2008 and highest in 1999 with an MMR of 757 per 100,000 live births and 4,000 per 100,000 live births, respectively. There was a progressive decline in the MMR over the period of study except in the years 2003 and 2006, when the ratio spiked a little, giving an MMR of 1,510 per 100,000 live births and 1,290 per 100,000 live births, respectively. The progressive decline in maternal mortality corresponded with the time that free maternal services were introduced. Hemorrhage was the most important cause of maternal death, accounting for 23.0% (38/165), whereas diabetic ketoacidosis, congestive cardiac failure, and asthma in pregnancy were the least important causes of maternal deaths, each accounting for 0.6% (1/165). Majority of the maternal deaths occurred in unbooked patients (82.4% (136/165)), whereas 17.6% (29/165) of the deaths occurred in booked cases. Forty-seven (28.5% (47/165)) patients died following a cesarean section, 8.5% (14/165) died as a result of abortion complications, and 10.9% (18/165) died undelivered. Seventy-seven (46.7% (77/165)) of the maternal death patients had no formal education. Low socioeconomic status, poor educational level, and grand multiparity were some of the risk factors for maternal mortality. CONCLUSION There was a decline in MMR during the period of study. The free maternal health services and adequate staff recruitment, which may have contributed to the observed decline in maternal mortality, should be sustained in developing countries.
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Affiliation(s)
- HU Ezegwui
- Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - RC Onoh
- Department of Obstetrics and Gynaecology, Federal Medical Centre, Abakaliki, Nigeria
| | - LC Ikeako
- Department of Obstetrics and Gynaecology, Anambra State University Teaching Hospital, Amaku, Awka, Nigeria
| | - A Onyebuchi
- Department of Obstetrics and Gynaecology, Federal Medical Centre, Abakaliki, Nigeria
| | - OUJ Umeora
- Ebonyi State University Teaching Hospital, Abakaliki, Nigeria
| | - P Ezeonu
- Department of Obstetrics and Gynaecology, Federal Medical Centre, Abakaliki, Nigeria
| | - P Ibekwe
- Ebonyi State University Teaching Hospital, Abakaliki, Nigeria
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Ghazal-Aswad S, Badrinath P, Sidky I, Safi TH, Gargash H, Abdul-Razak Y, Mirghani H. Severe Acute Maternal Morbidity in a High-Income Developing Multiethnic Country. Matern Child Health J 2012; 17:399-404. [DOI: 10.1007/s10995-012-0984-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mbassi SM, Mbu R, Bouvier-Colle MH. Use of routinely collected data to assess maternal mortality in seven tertiary maternity centers in Cameroon. Int J Gynaecol Obstet 2011; 115:240-3. [PMID: 21930267 DOI: 10.1016/j.ijgo.2011.07.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Revised: 07/05/2011] [Accepted: 08/22/2011] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To analyze the data available on obstetric complications, maternal deaths, and types of admission in 7 tertiary maternity centers in Cameroon. METHODS A descriptive retrospective study of all obstetric complications and maternal deaths that occurred in 7 tertiary level maternity hospitals between January 2005 and December 2006. Data were collected using the same registers, file records, and standardized questionnaires. RESULTS During the study period there were 34898 deliveries and 4069 cesareans were performed. There were 11014 obstetric complications and 249 maternal deaths were recorded, giving an MMR of 713 per 100000 deliveries. The risk of mortality among women referred to the tertiary level facilities was higher compared with women who were directly admitted to the facilities (odds ratio 3; 95% CI, 2.2-4.0). CONCLUSION The high rates of maternal mortality recorded in tertiary maternity centers among women who were referred reveal the urgent need for interventions to improve the referral system.
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Affiliation(s)
- Symplice Mbola Mbassi
- National Institute of Health and Medical Research (INSERM), Hôpital Tenon, Paris, France.
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