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Adebayo T, Adefemi A, Adewumi I, Akinajo O, Akinkunmi B, Awonuga D, Aworinde O, Ayegbusi E, Dedeke I, Fajolu I, Imam Z, Jagun O, Kuku O, Ogundare E, Oluwasola T, Oyeneyin L, Adebanjo-Aina D, Adenuga E, Adeyanju A, Akinsanya O, Campbell I, Kuti B, Olofinbiyi B, Salau Q, Tongo O, Ezekwe B, Lavin T, Oladapo OT, Tukur J, Adesina O. Burden and outcomes of postpartum haemorrhage in Nigerian referral-level hospitals. BJOG 2024. [PMID: 38686455 DOI: 10.1111/1471-0528.17822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/13/2024] [Accepted: 03/24/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE To determine the prevalence of primary postpartum haemorrhage (PPH), risk factors, and maternal and neonatal outcomes in a multicentre study across Nigeria. DESIGN A secondary data analysis using a cross-sectional design. SETTING Referral-level hospitals (48 public and six private facilities). POPULATION Women admitted for birth between 1 September 2019 and 31 August 2020. METHODS Data collected over a 1-year period from the Maternal and Perinatal Database for Quality, Equity and Dignity programme in Nigeria were analysed, stratified by mode of delivery (vaginal or caesarean), using a mixed-effects logistic regression model. MAIN OUTCOME MEASURES Prevalence of PPH and maternal and neonatal outcomes. RESULTS Of 68 754 women, 2169 (3.2%, 95% CI 3.07%-3.30%) had PPH, with a prevalence of 2.7% (95% CI 2.55%-2.85%) and 4.0% (95% CI 3.75%-4.25%) for vaginal and caesarean deliveries, respectively. Factors associated with PPH following vaginal delivery were: no formal education (aOR 2.2, 95% CI 1.8-2.6, P < 0.001); multiple pregnancy (aOR 2.7, 95% CI 2.1-3.5, P < 0.001); and antepartum haemorrhage (aOR 11.7, 95% CI 9.4-14.7, P < 0.001). Factors associated with PPH in a caesarean delivery were: maternal age of >35 years (aOR 1.7, 95% CI 1.5-2.0, P < 0.001); referral from informal setting (aOR 2.4, 95% CI 1.4-4.0, P = 0.002); and antepartum haemorrhage (aOR 3.7, 95% CI 2.8-4.7, P < 0.001). Maternal mortality occurred in 4.8% (104/2169) of deliveries overall, and in 8.5% (101/1182) of intensive care unit admissions. One-quarter of all infants were stillborn (570/2307), representing 23.9% (429/1796) of neonatal intensive care unit admissions. CONCLUSIONS A PPH prevalence of 3.2% can be reduced with improved access to skilled birth attendants.
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Affiliation(s)
| | | | - Idowu Adewumi
- Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria
| | | | - Bola Akinkunmi
- University of Medical Sciences Teaching Hospital Ondo, Ondo, Nigeria
| | | | | | - Ekundayo Ayegbusi
- Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria
| | | | | | - Zainab Imam
- Lagos State University Teaching Hospital, Ikeja, Nigeria
| | - Olusoji Jagun
- Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria
| | | | - Ezra Ogundare
- Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | | | - Lawal Oyeneyin
- University of Medical Sciences Teaching Hospital Ondo, Ondo, Nigeria
| | | | | | | | | | | | - Bankole Kuti
- Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria
| | | | | | | | - Bosede Ezekwe
- Department of Ageing and Life Course, World Health Organization, Nigeria Country Office, Abuja, Nigeria
| | - Tina Lavin
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Olufemi T Oladapo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Adelaiye S, Wanonyi I, Adanikin A, Mairiga A, Kadas A, Morrupa J, Lavin T, Lamara A, Yahaya I, Tukur J, Chama C. Determinants of obstructed labour and associated outcomes in 54 referral hospitals in Nigeria. BJOG 2024. [PMID: 38616567 DOI: 10.1111/1471-0528.17826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/22/2024] [Accepted: 03/24/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE To estimate the prevalence of obstructed labour, associated risk factors and outcomes across a network of referral hospitals in Nigeria. DESIGN Retrospective observational study. SETTING A total of 54 referral-level hospitals across the six geopolitical regions of Nigeria. POPULATION Pregnant women who were diagnosed with obstructed labour during childbirth and subsequently underwent an emergency caesarean section between 1 September 2019 and 31 August 2020. METHODS Secondary analysis of routine maternity care data sets. Random-effects multivariable logistic regression was used to ascertain the factors associated with obstructed labour. MAIN OUTCOME MEASURES Risk factors for obstructed labour and related postpartum complications, including intrapartum stillbirth, maternal death, uterine rupture, postpartum haemorrhage and sepsis. RESULTS Obstructed labour was diagnosed in 1186 (1.7%) women. Among these women, 31 (2.6%) cases resulted in maternal death and 199 (16.8%) cases resulted in postpartum complications. Women under 20 years of age (OR 2.03, 95% CI 1.50-2.75), who lacked formal education (OR 1.88, 95% CI 1.55-2.30), were unemployed (OR 1.94, 95% CI 1.57-2.41), were nulliparous (OR 2.11, 95% CI 1.83-2.43), did not receive antenatal care (OR 3.34, 95% CI 2.53-4.41) or received antenatal care in an informal healthcare setting (OR 8.18, 95% CI 4.41-15.14) were more likely to experience obstructed labour. Ineffective referral systems were identified as a major contributor to maternal death. CONCLUSIONS Modifiable factors contributing to the prevalence of obstructed labour and associated adverse outcomes in Nigeria can be addressed through targeted policies and clinical interventions.
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Affiliation(s)
- Samuel Adelaiye
- Department of Obstetrics and Gynaecology, Federal Medical Centre, Azare, Bauchi State, Nigeria
| | | | - Abiodun Adanikin
- Centre for Healthcare and Communities, Institute of Health and Wellbeing, Coventry University, Coventry, UK
| | - Abdulkarim Mairiga
- University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria
| | - Abubakar Kadas
- Obstetrics and Gynaecology Department, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
| | - Joel Morrupa
- Federal Medical Centre, Yola, Adamawa State, Nigeria
| | - Tina Lavin
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Abubakar Lamara
- Health Information Management Department, Federal Medical Centre, Azare, Bauchi State, Nigeria
| | - Ibrahim Yahaya
- Health Information Management Department, Federal Medical Centre, Azare, Bauchi State, Nigeria
| | - Jamilu Tukur
- Department of Obstetrics and Gynaecology, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Calvin Chama
- Obstetrics and Gynaecology Department, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
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Ikechebelu JI, Eleje GU, Onubogu CU, Ojiegbe NO, Ekwochi U, Ezebialu IU, Ezenkwele EP, Nzeribe EA, Umeh UA, Obumneme-Anyim I, Nwokeji-Onwe LN, Settecase E, Ugwu IA, Chianakwana O, Ibekwe NT, Ezeaku OI, Ekweagu GN, Onwe AB, Lavin T, Tukur J. Incidence, predictors and immediate neonatal outcomes of birth asphyxia in Nigeria. BJOG 2024. [PMID: 38560768 DOI: 10.1111/1471-0528.17816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/01/2024] [Accepted: 03/13/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE To determine the incidence and sociodemographic and clinical risk factors associated with birth asphyxia and the immediate neonatal outcomes of birth asphyxia in Nigeria. DESIGN Secondary analysis of data from the Maternal and Perinatal Database for Quality, Equity and Dignity Programme. SETTING Fifty-four consenting referral-level hospitals (48 public and six private) across the six geopolitical zones of Nigeria. POPULATION Women (and their babies) who were admitted for delivery in the facilities between 1 September 2019 and 31 August 2020. METHODS Data were extracted and analysed on prevalence and sociodemographic and clinical factors associated with birth asphyxia and the immediate perinatal outcomes. Multilevel logistic regression modelling was used to ascertain the factors associated with birth asphyxia. MAIN OUTCOME MEASURES Incidence, case fatality rate and factors associated with birth asphyxia. RESULTS Of the available data, 65 383 (91.1%) women and 67 602 (90.9%) babies had complete data and were included in the analysis. The incidence of birth asphyxia was 3.0% (2027/67 602) and the case fatality rate was 16.8% (339/2022). The risk factors for birth asphyxia were uterine rupture, pre-eclampsia/eclampsia, abruptio placentae/placenta praevia, birth trauma, fetal distress and congenital anomaly. The following factors were independently associated with a risk of birth asphyxia: maternal age, woman's education level, husband's occupation, parity, antenatal care, referral status, cadre of health professional present at the birth, sex of the newborn, birthweight and mode of birth. Common adverse neonatal outcomes included: admission to a special care baby unit (SCBU), 88.4%; early neonatal death, 14.2%; neonatal sepsis, 4.5%; and respiratory distress, 4.4%. CONCLUSIONS The incidence of reported birth asphyxia in the participating facilities was low, with around one in six or seven babies with birth asphyxia dying. Factors associated with birth asphyxia included sociodemographic and clinical considerations, underscoring a need for a comprehensive approach focused on the empowerment of women and ensuring access to quality antenatal, intrapartum and postnatal care.
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Affiliation(s)
- Joseph Ifeanyichukwu Ikechebelu
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Nnewi, Nigeria
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | - George Uchenna Eleje
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Nnewi, Nigeria
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | | | | | - Uchenna Ekwochi
- Department of Paediatrics, ESUT Teaching Hospital, Enugu, Nigeria
| | - Ifeanyichukwu Uzoma Ezebialu
- Department of Obstetrics and Gynaecology, Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Awka, Nigeria
| | - Eziamaka Pauline Ezenkwele
- Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu State, Nigeria
| | | | - Uchenna Anthony Umeh
- Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu State, Nigeria
| | - Ijeoma Obumneme-Anyim
- Department of Paediatrics, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu State, Nigeria
| | - Linda Nneka Nwokeji-Onwe
- Department of Paediatrics, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - Eugenia Settecase
- Department of Mother & Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | | | - Ogochukwu Chianakwana
- Department of Medical Records, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | - Nkechi Theresa Ibekwe
- Department of Medical Records, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | - Onyebuchi Ignatius Ezeaku
- Department of Medical Records, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu State, Nigeria
| | - Gloria Nwuka Ekweagu
- Department of Medical Records, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu State, Nigeria
| | - Abraham Bong Onwe
- Department of Obstetrics and Gynaecology, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - Tina Lavin
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Jamilu Tukur
- Department of Obstetrics and Gynaecology, Aminu Kano Teaching Hospital, Kano, Nigeria
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