Abdulkarim G. Mairiga

Trends in maternal mortality in a tertiary institution in Northern Nigeria

OBJECTIVE To look at the trends in maternal mortality in our institution over 5 years. METHODS Records of 112 maternal deaths were retrospectively reviewed to determine the trends and the likely direct cause of each death over the study period. RESULTS There were a total of 112 maternal deaths, while 3931 deliveries were conducted over the 5-year period. The maternal mortality ratio (MMR) was 2849/100,000 deliveries. The highest MMR of 6234/100,000 was observed in 2003, with remarkable decline to 1837/100,000 in 2007. Eclampsia consistently remained the leading cause, accounting for 46.4% of the maternal deaths, followed by sepsis and postpartum hemorrhage (PPH) contributing 17% and 14.3%, respectively. There were no statistically significant differences in the corresponding percentages of maternal deaths between various age groups (chi2=6.68; P =0.083). Grandmultiparas accounted for a significant proportion of maternal deaths as compared to low parity, with chi2=10.43; P =0.00054. Lack of seeking antenatal care (unbooked) and illiteracy were observed to be significant determinants of maternal mortality (chi2=64.69, P =0.00000; and chi2=18.52, P =0.0000168, respectively). CONCLUSION In spite of decrease in the maternal mortality ratio over the years, it still remains high, with eclampsia persistently contributing most significantly. Community enlightenment on the need to avail of antenatal care and hospital delivery services, and improvement in the quality of skilled maternity care will, among other factors, drastically curtail these preventable causes of maternal death and reduce MMR.

Community perspective of maternal mortality: experience from Konduga Local Government Area, Borno State, Nigeria.

BACKGROUND/OBJECTIVE High maternal mortality in Nigeria in particular and Sub-Saharan Africa in general has remained one of the key indicators of our poor health care services, infrastructural facilities and negative socio-cultural attitudes to healthy living. The objective is to identify barriers to prompt and effective treatment of obstetric complications leading to maternal mortality in order to develop appropriate strategies to address them at the community level. METHOD The study took place between 10th October and 10th December 2003. An in-depth interview guide developed by the network for the prevention of maternal mortality (NPMM), which contains mainly open ended questions, modified to suit our socio-cultural setting was used. RESULTS There was a good understanding among the people of the area that women are dying during pregnancy, labour and puerperium. 28(93.3%) of the respondents recognized some obstetric complications. The main obstacles to accessing the hospital for emergency obstetric care were lack of money and transportation difficulties. Equipping the health facilities, employment of qualified staff, community supported emergency funds for obstetric emergency and the provision of reliable, effective and affordable transport are identified as necessary measures to prevent maternal mortality. The Local Government Areas and community leaders are to champion the cause for the provision of these facilities in their localities. CONCLUSION There is a good understanding of obstetric complications in the community leading to maternal death. The main reasons for delay in seeking care are ignorance, poverty, lack of transportation and distance. Community enlightenment, health education, training of TBAs, poverty reduction and effective, affordable and reliable transportation are means of obviating delays in the decision and transportation leading to maternal mortality. Upgrading and re-equipping of health facilities to provide emergency obstetric care services are mandatory. Community participation in the safe motherhood drive can be ensured using the traditional rulers, religious leaders and the Local Government Authority.

Sociocultural factors influencing decision-making related to fertility among the Kanuri tribe of north-eastern Nigeria

ABSTRACT Background The Kanuri tribe is found in the Lake Chad basin. However, the majority of the tribe lives in Borno State, Nigeria. Before this study was undertaken, factors related to fertility decisions among the tribe were not known. Objectives This study is aimed at describing and documenting the sociocultural factors affecting decisions related to fertility among the Kanuri tribe. Method The study applied the qualitative research method. In-depth interviews and focus-group discussions were used as data collection methods. Analysis was done manually. Results Children among the Kanuri were highly valued and desired irrespective of their gender. The ideal family size, according to most of the respondents, was 16 children. Kanuri men are polygamous and can marry up to four wives in order to form large families. However, it is an abomination among Kanuri women to fall pregnant in quick succession; a phenomenon they termed konkomi. Other reasons for child-spacing were related to child welfare and maternal well-being. Methods for child-spacing included prolonged breastfeeding (Nganji yaye), ornaments in various forms and shapes, spiritual invocations and dried herbs (Nganji Yandeye). Few Kanuri women practiced modern methods of family planning. Conclusion Trends in fertility among the Kanuri tribe need to be monitored regularly and appropriate measures be taken to introduce and promote modern family planning and child health services to ensure a healthier family life.

Attitude of Nigerian women to contraceptive use by men

Summary This study was aimed at finding the attitude of Nigerian women to contraceptive use by their male partners. A total of 417 women received the questionnaire; 71% of these were sexually active and 34.8% were not aware of any male contraceptive method. Only 1.7% reported regular use of condoms by their spouses, however this was significantly higher if the women were better educated. Most of the women had a positive attitude to contraceptive use by their spouses, as 54% (225/417) of them showed preference to male dependant contraceptives in their relationship. However, only 32.3% (135/417) of the women had ever-requested their spouse to use a condom and in just 18.5% (25/135) was such a request regularly complied with. Significantly more Muslim women prefer their partners to use a contraceptive rather than themselves (p = 0.001), but the condom usage by their spouses is significantly lower than their Christian counterparts (p = 0.000). There is a need to offer counselling on male contraceptives to both genders so that they can make an informed choice, especially with the dual protection offered by the use of condoms.

Outcome of an intervention to improve the quality of private sector provision of postabortion care in northern Nigeria

The outcomes of an intervention aimed at improving the quality of postabortion care provided by private medical practitioners in 8 states in northern Nigeria are reported. A total of 458 private medical doctors and 839 nurses and midwives were trained to offer high‐quality postabortion care, postabortion family planning, and integrated sexually transmitted infection/HIV care. Results showed that among the 17009 women treated over 10 years, there was not a single case of maternal death. In a detailed analysis of 2559 women treated during a 15‐month period after the intervention was established, only 33 women experienced mild complications, while none suffered major complications of abortion care. At the same time, there was a reduction in treatment cost and a doubling of the contraceptive uptake by the women. Building the capacity of private medical providers can reduce maternal morbidity and mortality associated with induced abortion in northern Nigeria.

Social and health reasons for lime juice vaginal douching among female sex workers in Borno State, Nigeria

ABSTRACT Background Vaginal douching with lime juice and other agents has been perceived to enhance sexual excitement through sensations of vaginal dryness, tightness or warmth, as well as prevent sexually transmitted infections and restore and tighten the vagina after delivery. Its effectiveness as a contraceptive has also been reported. However, the social and health reasons/consequences of such a practice have not been adequately documented in the communities of Borno State, Nigeria. Objectives This study aimed to determine the extent of, reasons for, and the reproductive health effects of, the use of lime juice for vaginal douching among the commercial sex workers (CSWs) in selected areas of the three senatorial regions of Borno State, Nigeria. Method This was a community-based descriptive study conducted among female CSWs in selected communities of Borno State, Nigeria. A sample of 194 CSWs were randomly selected and interviewed on their sexual history and douching practices. Results One hundred and twenty (62%) respondents admitted practicing vaginal douching with lime juice, with 85% having been CSWs for a period greater than three years. More than half douched for sexual pleasure, hygiene and contraception. Significantly more lime juice users had increased susceptibility to sexually transmitted infections (STIs) than non-users. Users had a higher prevalence of HIV infection than non-users. The Papanicouleaua (pap) smear test for cervical lesions also showed that moderate to severe dysplastic changes were more prevalent among lime-juice users. Conclusion Many CSWs in this community use lime juice for douching, for various reasons. Indications are that its use is associated with a higher prevalence of sexually transmitted diseases, including HIV infections and dysplastic cervical changes. Owing to confounding issues, such as the number of sexual partners, frequency of sexual exposure per day and the duration of exposure, it cannot, therefore, be deduced that douching with lime juice is the only reason for the higher prevalence of STIs and HIV. Nevertheless, there is an obvious need to mount extensive campaigns to educate the CSW on the possible risks of using such a practice.

Spatial and Temporal Variations of Maternal Deaths in Borno State of Nigeria: An Institutional Based Study

Aim: The aim of the study is to describe and explain the spatial and temporal variations of maternal mortality between different regions of Borno State, Nigeria. Method: This is a retrospective patient record study, which included antenatal attendance, hospital deliveries and maternal deaths over a ten year period (2001-2010). The data was collected from the Health Information Management System (HIMS) unit of the Borno State Ministry of Health and at the record departments of thirty one (31) selected general hospitals across Borno state. The state was stratified into three senatorial zones for the purpose of data collection, namely Central Borno, Northern Borno and Southern Borno, Original Research Article Kolo et al.; IJTDH, 27(1): 1-14, 2017; Article no.IJTDH.36007 2 Results: It was identified that Central Borno in comparison to the other zones recorded the highest antenatal care attendance and hospital delivery because of the high concentration of health facilities and easy accessibility. Over the 10 year period, more antenatal care visits were recorded in 2008, while hospital deliveries were highest in 2004. Maternal Mortality Ratios (MMR) computed over the 10year period indicated 1630 maternal deaths in 146,829 deliveries, yielding an MMR of 1110/100,000. The spatial pattern of MMR observed revealed that Northern Borno had the highest MMR of 1373/100,000, suggestive of the extent to which maternal mortality is a major health problem in the state. Conclusion: The study concluded that maternal deaths remained one of the major health challenges in the state. It is thus recommended that both government and international agencies should put more effort in the underserved areas of the state.

O498 Social and health reasons for lemon or lime juice vaginal douching among female commercial sex workers in Borno state Nigeria

(from 20 to 40 years old) which received either uFSH (n 30) and rFSH (n 21). In the first group we had 61 cycles, in the second one were 47 cycles, in total no = 108 cycles. A maximum of three cycles, using low-dose-step-up protocol, with the same gonadotropin were undertaken. Results: Pregnancy rate/cycle, the abortion rate/cycle, total multiple pregnancy rate, mean follicular diameter of the dominant follicle and the mean endometrial thickness on the day of HCG administration were not statistically different in two groups. A statistically significant upper mean total gonadotropin dose (1251.6UI versus 1010.1UI) was needed in the uFSH group to reach ovulation, while the duration of stimulation was similar between the two groups. Significantly, more cycles with triple follicular and single follicle development were seen respectively in uFSH and rFSH groups. Conclusions: uFSH and rFSH are both useful and safe for inducing ovulation with low-dose-step-up protocol in women with Clomifene Citrate resistant PCOS, but the pregnancy rate is low and abortion rate still remain high.