A population-based estimation of maternal mortality in Lagos State, Nigeria using the indirect sisterhood method

BACKGROUND

Pregnancy and delivery deaths represent a risk to women, particularly those living in low- and middle-income countries (LMICs). This population-based survey was conducted to provide estimates of the maternal mortality ratio (MMR) in Lagos Nigeria.

METHODS

A community-based, cross-sectional study was conducted in mapped Wards and Enumeration Areas (EA) of all Local Government Areas (LGAs) in Lagos, among 9,986 women of reproductive age (15-49 years) from April to August 2022 using a 2-stage cluster sampling technique. A semi-structured, pre-tested questionnaire adapted from nationally representative surveys was administered using REDCap by trained field assistants for data collection on socio-demographics, reproductive health, fertility, and maternal mortality. Data were analysed using SPSS and MMR was estimated using the indirect sisterhood method. Ethical approval was obtained from the Lagos State University Teaching Hospital Health Research and Ethics Committee.

RESULTS

Most of the respondents (28.7%) were aged 25-29 years. Out of 546 deceased sisters reported, 120 (22%) died from maternal causes. Sisters of the deceased aged 20-24 reported almost half of the deaths (46.7%) as due to maternal causes, while those aged 45-49 reported the highest number of deceased sisters who died from other causes (90.2%). The total fertility rate (TFR) was calculated as 3.807, the Lifetime Risk (LTR) of maternal death was 0.0196 or 1-in-51, and the MMR was 430 per 100,000 [95% CI: 360-510].

CONCLUSION

Our findings show that the maternal mortality rate for Lagos remains unacceptable and has not changed significantly over time in actual terms. There is need to develop and intensify community-based intervention strategies, programs for private hospitals, monitor MMR trends, identify and contextually address barriers at all levels of maternal care.

Interoceptive awareness in anorexia nervosa

Interoceptive awareness - the sense and awareness of the internal state of our bodies - has been of increasing interest in anorexia nervosa (AN) given the observation that people with AN do not respond appropriately to hunger cues. Despite the interest in the area, very little research has been undertaken to specifically assess interoceptive awareness in AN. The aim of this study was to explore levels of interoceptive awareness in individuals at different stages of AN, as well as first-degree relatives. Eighty participants were compared on self-reported interoceptive awareness using the Multidimensional Assessment of Interoceptive Awareness (MAIA), including participants with a current diagnosis of AN (c-AN), individuals who were weight-restored from AN (wr-AN), biological sisters of individuals with AN (AN-sis), and healthy controls (HC). Significant group differences were found for the noticing, not-distracting, self-regulation and trusting subscales of the MAIA; but not for the not-worrying, attention regulation, emotional awareness or body listening subscales. Specifically, wr-AN and AN-sis scored higher on the noticing subscale than HC; c-AN and wr-AN scored lower on the not-distracting subscale than HC; and the c-AN group showed lower scores on the self-regulation and trusting subscales than other groups. The results suggest that specific aspects of interoceptive awareness such as increased awareness of body sensations and reduced trusting of one's body, may relate to AN symptomatology such as ignoring hunger cues, and may represent trait factors that increase the risk of developing AN.

Two Sisters Family Histories: Self-In-Transit

Departing from meanings of experiences and experiencing, of memory and poetics, the aim of this article was to describe and analysis the experience of the encounter of two sisters by means of a common ground represented by family narratives. It was based on collaborative auto ethnography. The study involved two sisters that lost their parents and home. The older sister - I-conserved memories of her parents and house; the little one, did not. The main conclusion was that my sister and I constructed narratives that signal something common to both: pointing to the origin in family history.

Revisiting the association between maternal and offspring preterm birth using a sibling design

Background

Previous studies have reported an intergenerational association between maternal and offspring preterm birth (PTB) but the nature of the association remains unclear. We assessed the association between maternal and offspring preterm birth using a quasi-experimental sibling design and distinguishing between preterm birth types.

Methods

We conducted a retrospective intergenerational cohort study of 39,573 women born singleton in Manitoba, Canada (1980–2002) who gave birth to 79,198 singleton infants (1995–2016). To account for familial confounding we defined a subcohort of 1033 sisters with discordant PTB status who subsequently gave birth and compared offspring PTB rates between 2499 differentially exposed cousins using log-binomial fixed-effects generalized estimating equation models. PTB was defined as a delivery < 37 gestation weeks, divided into spontaneous and provider-initiated.

Results

In the population cohort, mothers born preterm were more likely to give birth preterm [Adjusted Relative Risk (ARR): 1.39; 95% Confidence Interval (CI): 1.25, 1.54] and very preterm birth [ARR: 1.76; 95% CI: 1.29, 2.41]. However, in the siblings cohort, the intergenerational association was not apparent among births to sisters with discordant PTB status [ARR: 1.02; 95% CI: 0.77, 1.34 for preterm birth and ARR: 0.88; 95% CI: 0.38, 2.02 for very preterm birth]. Mothers born at term with a sister born preterm had a similarly elevated risk of delivering a preterm infant (10%) than their preterm sisters. Intergenerational patterns were observed for spontaneous PTB but not for provider-initiated PTB.

Conclusions

Our findings suggest that it is not the fact of having been born preterm that puts women at higher risk of delivering preterm, but the fact of having been born to a mother who ever delivered preterm. Consideration of a female family history of PTB may better identify women at higher risk of preterm delivery than relying on maternal preterm birth status alone. Further research may benefit from distinguishing preterm birth types.

An Extremely Rare Presentation of Zimmermann-Laband Syndrome in a Twin

Zimmermann–Laband syndrome is a rare condition which manifests as hereditary gingival tissue hypertrophy along with other clinical features. Till date, only few cases have been reported in the literature. This case report focuses on an extremely rare presentation of Zimmermann–Laband syndrome in a twin. There has not been a single case report of Zimmermann–Laband syndrome in twins.