Marked variability in institutional deliveries and neonatal outcomes during the COVID-19 lockdown in Nigeria

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic and the interventions to mitigate its spread impacted access to healthcare, including hospital births and newborn care. This study evaluated the impact of COVID-19 lockdown measures on newborn service utilization in Nigeria.

METHODS

The records of women who delivered in hospitals and babies admitted to neonatal wards were retrospectively reviewed before (March 2019-February 2020) and during (March 2020-February 2021) the COVID-19 pandemic lockdown in selected facilities in Nigeria.

RESULTS

There was a nationwide reduction in institutional deliveries during the COVID-19 lockdown period in Nigeria, with 14 444 before and 11 723 during the lockdown-a decrease of 18.8%. The number of preterm admissions decreased during the lockdown period (30.6% during lockdown vs 32.6% pre-lockdown), but the percentage of outborn preterm admissions remained unchanged. Newborn admissions varied between zones with no consistent pattern. Although neonatal jaundice and prematurity remained the most common reasons for admission, severe perinatal asphyxia increased by nearly 50%. Neonatal mortality was significantly higher during the COVID-19 lockdown compared with pre-lockdown (110.6/1000 [11.1%] vs 91.4/1000 [9.1%], respectively; p=0.01). The odds of a newborn dying were about four times higher if delivered outside the facility during the lockdown (p<0.001).

CONCLUSIONS

The COVID-19 lockdown had markedly deleterious effects on healthcare seeking for deliveries and neonatal care that varied between zones with no consistent pattern.

Reasons for delay in accessing free treatment of obstetric fistula in South-East Nigeria - A qualitative study

Obstetric fistula continues to be a menace in Nigeria and other low- and middle-income countries. The national policy for its elimination makes surgical repair free in dedicated national centres. However, the majority of the clients present late for repair. The aim of the study was to explore the reasons for this delay in seeking treatment. It was a qualitative (exploratory) study carried out at the National Obstetric Fistula Centre (NOFIC), Abakaliki, Nigeria among obstetric fistula patients who presented for treatment with a duration of leakage of over six months. A consecutive sampling technique was used for patient recruitment. Data was collected from twenty patients using in-depth interviews. Thematic analysis of the responses and recurring patterns was done, with themes illustrated using the word cloud. The mean age of the participants was 37.1 years (range = 21-75 years) while the mean duration of leakage was 64.3 months (range = 8-564 months). Reasons for delay in accessing treatment of obstetric fistula were lack of awareness of the availability of free treatment in a specialized centre, delay in referral from index health care facilities, wrong information from health care workers, failed repairs at other health facilities, secondary delay due to transportation challenges, cultural beliefs and other issues peculiar to the patients. The commonest reason for the delay in accessing treatment for obstetric fistula is a lack of awareness on the part of patients, the public, and health workers. We recommend improved campaigns, advocacy, and community mobilization.

Use of off-label compounded oral sildenafil in the management of persistent pulmonary hypertension of the newborn: A case report

We report a case of a newborn with persistent pulmonary hypertension (PPHN) due to meconium aspiration syndrome with associated lung collapse. Echocardiogram revealed features of persistent pulmonary hypertension. He was treated with compounded oral sildenafil. Oral sildenafil has proven to be effective and safe in the management of PPHN in neonates with persistent pulmonary hypertension. Therefore, in situations where inhaled nitric oxide is not available it may be used as an alternative therapy in PPHN. Further randomized controlled studies are needed to determine its efficacy and pharmacokinetics.

Impact of Kangaroo Mother Care on Outcome of Very Low Birthweight Preterm Newborns in a Tertiary Hospital in Abakaliki, Nigeria

Introduction: KMC was developed for care of preterm and low birth weight babies due to shortage of staff and inadequate incubator care enabling early discharge from the hospital for close follow-up at home. It is essential in resource-limited countries where there is epileptic power supply. Therefore, strengthening the evidence for KMC becomes imperative in these resource-limited and adverse cultural regions. Methods: The KMC register of the Newborn Special Care Baby Unit of a tertiary hospital was used to analyse records from January 2016 to February 2018. A total of 55 preterm babies enrolled into KMC were studied. The age and parity of the mother, sex, birth weight, admission and discharge temperatures and weights, duration of KMC per day was retrieved from the KMC register. Results: The mothers’ ages ranged from 18 to 40 years (mean 28.6 ± 6.2 years) with 34% being inexperienced first-time mothers and 10% grand multipara. The birth weights of the babies ranged from 0.9 kg to 2.5 kg. Primiparous women were more likely to do KMC for longer durations. A linear regression model showed that the duration of KMC was related to parity. (R2 = 0.12, p = 0.02). On average there was significant weight gain on discharge with a paired t-test (t = 5.881, df = 44) comparing the discharge and commencement weights showing a mean difference of 0.123 kg (CI 0.081 kg, 0.165 kg, p < 0.001). Conclusions: KMC impacts positively on all parameters of the extremely LBW and premature babies and the duration of KMC is positively associated with better outcome.