Ad Ekanem

The prevalence of congenital malaria among neonates with suspected sepsis in Calabar, Nigeria

SUMMARY We studied the prevalence of congenital malaria among neonates with suspected sepsis and its outcome at the University of Calabar Teaching Hospital, Calabar, Nigeria. All in-born neonates admitted to the newborn unit with clinical features suggestive of sepsis were recruited. They were screened for bacterial sepsis and malaria. The mothers of the neonates that had parasitaemia were further screened for malaria and anaemia. A total of 546 in-born neonates were admitted to the neonatal unit and 202 (37%) presented with clinical signs suggested of sepsis. Of these, 71 babies (35% of 202 or 13% of the total in-born nursery admissions) had congenital malaria and 14 also had sepsis. Sixty-three (88.7%) of the parasitaemic babies were delivered by mothers who received antenatal care at our centre. Eighty-six percent of the mothers of the 71 babies also had the malaria parasite in their blood. The majority (67%) of the 71 mothers were gravidae 2 and below. Thirty (42.3%) of the affected neonates were anaemic and 5 (7%) of them required a blood transfusion. Congenital malarial is not uncommon in Calabar among babies with suspected sepsis. It appears that the antenatal chemoprophylaxis with pyrimethamine (25 mg weekly) currently used for malaria in our centre no longer protects the mother and fetus. An alternative is needed in order to stem maternal, fetal and neonatal morbidity and wastage. Babies with features of sepsis should be routinely screened for malaria.

Socio-demographic and reproductive characteristics of women who default from orthodox obstetric care in Calabar, Nigeria.

This study was designed to identify the socio-demographic and reproductive characteristics of women in Calabar Nigeria who booked for antenatal care at the University of Calabar Teaching Hospital (UCTH) but delivered in unorthodox delivery facilities. Study participants comprised women who gave birth via unorthodox delivery while the control population comprised women who completed antenatal care and gave birth at UCTH or any orthodox health facility. Overall the results noted a greater tendency of young women to default from orthodox obstetric care than older women with the church being the most preferred facility by these unorthodox antenatal clinic defaulters. Moreover any woman who had a vaginal delivery in her previous pregnancy is young and nulliparous is of low socioeconomic class from an indigenous population in Calabar and worships in a spiritual church is likely to default from orthodox obstetric care. Hence there is a need for one-on-one education and counseling of these women in antenatal clinics. Above all general improvement in socioeconomic status by creating employment opportunities and reducing cost of living would ameliorate the poverty factor which appears to contribute to the high defaulting rate.

Post-partum practices among women in Calabar, Nigeria.

We carried out a study on post-partum practices amongst women in Calabar at the maternal and child health clinic at University of Calabar Teaching Hospital between 1March and 31 May 2002. Three hundred women were interviewed. One hundred and ninety-three (64.3%) resumed coitus prior to 6 weeks of puerperium. There was no significant difference in parity (P=0.20) and educational status (P=0.10) between women who resumed coitus earlier than 6 weeks and those who resumed later. One out of every 10women resumed coitus without any contraception. The majority [212 (70.7%)] sat in hot water (sitz bath) to aid perineal wound healing and improve vaginal tone.

The influence of cultural practice on puerperal anemia

Puerperal anemia is one of the main causes of maternal morbidity and mortality in Nigeria and other developing countries [l]. This is probably due to the high incidence of obstetric hemorrhage. It is not always possible to successfully treat the anemia before discharge from the hospital as most of the health institutions in developing countries do not have blood transfusion services. Even where the blood transfusion services exist, the response of the population to blood donation is usually discouraging. Hence most of the patients are usually discharged from the hospital with hemoglobin less than 10 g%. In the south-eastern region of Nigeria where Calabar is situated, women are culturally given intensive nutritional care after delivery in preparation for the ‘outing’ ceremony. The local foodstuffs used are rich in iron and folic acid. The foodstuffs include green vegetables, yams, plantain, fish and other aquatic protein foodstuffs. The aquatic protein sources are edible snails (J4~uparu quadrutu), periwinkle (Lifhotiru littoreu), crayfish (Pulumonettes uiuiuns), and clam (Egreriu

Hysterectomies amongst teenagers in Calabar, Nigeria.

A 10-year retrospective study of hysterectomies performed on teenagers in Calabar was carried out.

Bacterial contamination of women in labor supervised by traditional birth attendants.

Most pregnant women in Nigeria prefer to be delivered at home in a spiritual setting and by traditional birth attendants. For this reason many arrive very late at the hospital when they experience obstruction of labor usually with intrauterine infections because traditional birth attendants do not observe aseptic procedures during vaginal examinations. After delivery these women commonly develop genital sepsis wound infection or peritonitis and effective treatment requires pathogen characterization and sensitivity to antimicrobial agents. (excerpt)