Charles Njoku

Proposed Framework for Making Focused Antenatal Care Services Accessible: A Review of the Nigerian Setting

The aim of this paper is to propose a framework for making antenatal care an effective strategy in reducing the high maternal mortality ratio in Nigeria. On-site visits to five teaching hospitals were carried out between 2006 and 2008 to assess the practice of antenatal care. Group discussions with 200 parturients on their awareness of birth preparedness/complication readiness were conducted, in October, 2008. The findings of this study are discussed in line with the proposed practice of focused antenatal care. The practice of antenatal care in all the hospitals visited was the traditional approach based on earlier European models. Awareness of birth preparedness/complication readiness, by parturients, as a goal-directed intervention during antenatal care was low (21.5%). To reduce maternal deaths through antenatal care, it is critical to link care with detecting and treating causes of maternal mortality by a skilled attendant.

Determination of Accuracy of Fetal Weight Using Ultrasound and Clinical Fetal Weight Estimations in Calabar South, South Nigeria

Information on fetal weight is of importance to obstetricians in the management of pregnancy and delivery. The objective of this study is to compare the accuracy of clinical and sonographic methods of predicting fetal weights at term. This prospective comparative study of 200 parturients was conducted at the University of Calabar Teaching Hospital, Calabar. The study participants were mothers with singleton term pregnancy admitted for delivery. The mean absolute percentage errors of both clinical and ultrasound methods were 11.16% ± 9.48 and 9.036% ± 7.61, respectively, and the difference was not statistically significant (P = 0.205). The accuracy within 10% of actual birth weights was 69.5% and 72% for both clinical estimation of fetal weight and ultrasound, respectively, and the difference was not statistically significant (P = 0.755). The accuracy of fetal weight estimation using Dares formula is comparable to ultrasound estimates for predicting birth weight at term.

Sero-prevalence of hepatitis B infection and its risk factors among women admitted for delivery in Ucth, Calabar, Nigeria.

Background: Vertical transmission of hepatitis B virus infection during pregnancy and delivery remains the major route of transmission in low resource areas. The objectives of this study were to determine the sero-prevalence of hepatitis B infection (HBsAg) and the potential risk factors among pregnant women admitted for delivery. Materials and Methods: This cross-sectional study of 300 women admitted for delivery was conducted at University of Calabar Teaching Hospital, Calabar, Nigeria. A pretested questionnaire was used for the collection of socio-demographic data and possible risk factors. Blood sample was collected from each consented woman and the plasma tested for the presence of HBsAg using rapid ELISA test Kits in the laboratory of the hospital. All the data were analyzed using microsoft Original Research Article Iklaki et al.; BJMMR, 8(4): 324-333, 2015; Article no.BJMMR.2015.455 325 SPSS version 17 statistical program. Results: Out of the 300 women studied, positive HBsAg was detected in 14 women, giving a seroprevalence rate of 4.7%. The age of the women studied varied from 16 to 43 years with mean age of 27.9±4.6 years and mean parity of 1.1±1.5. Hepatitis B viral infection was significantly higher among pregnant women who did not attend any antenatal care (unbooked women) than pregnant women who attended antenatal care (booked women). There were statistically significant relationships between HBV infection and 2 or more sexual partners and previous history of induced abortion. Previous histories of blood transfusion, previous surgeries/dental manipulations, tribal marks/tattoos, previous contact with somebody with hepatitis B infection were not statistically significant. The data are related to 14 (4.7%) of HBV infected women in the study. Conclusion: An intermediate prevalence of hepatitis B virus infection was identified which justifies the need for routine screening in pregnancy especially among unbooked women in order to identify and treat the infection.

Obstetric outcomes of booked teenage pregnancies at University of Calabar Teaching Hospital, Nigeria

Background Teenage pregnancy is high-risk and associated with complications due to adverse physiological, anatomical, and socioeconomic factors. The purpose of this study was to determine the patterns and obstetric outcomes of booked teenage pregnancies at the University of Calabar Teaching Hospital (UCTH) in Nigeria. Methods A retrospective comparative analysis of teenage pregnancies and mature mothers at UCTH was carried out from January 2011 to December 2011. A total of 82 teenage pregnancies and 72 mature pregnancies were compared. Results There were 145 teenage deliveries from a total of 2313 deliveries, ie, 6.3% of total deliveries. There was no statistically significant difference in the mode of delivery (cesarean section, spontaneous vaginal delivery, instrumental delivery) between the groups of mothers. There was also no difference in risk of complications, including obstructed labor, retained placenta, uterine atony, pre-eclampsia/eclampsia, and antepartum hemorrhage. However, teenage mothers had more perineal lacerations (P = 0.02) and more preterm labor (P = 0.05), and delivered more low-birth-weight babies (P = 0.02). Conclusion Supervised teenage pregnancy may not be as hazardous as previously thought.

Sociodemographic characteristics and handling of life‑threatening obstetric cases by traditional birth attendants in Cross River State, Nigeria

Background: Majority of pregnant women, especially in remote rural areas still desire to be delivered by traditional birth attendants (TBAs) who neither have the skills nor the equipment to treat life-threatening complications. Objective: To determine the sociodemographic characteristics of TBAs and how they manage life-threatening obstetric cases. Methodology: This was a prospective study carried out over a 3-month period during the training of TBAs in the state on the reduction of maternal mortality. A total of 540 TBAs from 18 Local Government Area of the state participated in the study. Data obtained were sex, age, levels of education, number of deliveries conducted per month, difficult cases encountered, and how they managed them. The data were analyzed using Epi Info version-7 and presented in tables. Results: TBAs are mostly females, i.e. 538 (99.6%) and only 2 (0.4%) were males. Majority of the TBAs were above the age of 55 years, i.e. 488 (88.9%); had primary education 416 (77.0%); married 396 (71.6%); and grand multiparous 293 (54.3%). Most TBAs deliver 4 newborn monthly, i.e. 148 (22.6%), and the mean number of newborn delivered monthly was 3.9. Concerning the mode of handling of the difficult cases, majority, i.e. 338 (62.6%) have a nurse/midwife they always call for assistance while only 147 (27.2%) refer their life-threatening cases directly to the nearby hospital. Conclusion: TBAs still plays a role in deliveries in most rural and urban areas. Majority of TBAs do not refer their life-threatening cases directly to the nearby hospital. Therefore, TBAs should be trained on how to identify life-threatening cases and promptly refer to hospitals for better outcome.

Vesicovaginal fistula presenting as urogenital prolapse

Vesicovaginal fistula (VVF) is an abnormal fistulous communication between the bladder and the vagina that allows continuous involuntary discharge of urine into the vagina. It is one of the most abhorred morbidities in obstetric practice because of the profound effect on the patient′s emotional well-being. Here, we present a case of VVF presenting as urogenital prolapse following an automobile accident. A large fistulous defect with complete bladder base prolapse was successfully repaired with adequate flap mobilization after two failed attempts by a surgical team. VVF should be considered in cases of urogenital prolapse especially following traumatic pelvic injuries.

The social class and reasons for grand multiparity in Calabar, Nigeria

Background: Grand multiparity is a high-risk pregnancy, and it is a common phenomenon in this part of the world, and when added to low socioeconomic status, it significantly increases obstetrics risk to mother and fetus. Objective: To determine the social class and reasons for grand multiparity in Calabar. Materials and Methods: This prospective cross-sectional study was carried out in the Department of Obstetrics and Gynaecology of the University of Calabar Teaching Hospital, Calabar. The study comprised 150 grand multiparous women who were admitted for delivery and consented to the study during the period. The social class, educational level, and reasons for grand multiparity were determined. The data obtained were collated and analyzed using SPSS version 18. Results: The incidence of grand multiparity in this study is 8.7%, and most grand multiparous women belong to low social class 63 (42.0%). Grand multiparity was higher among women with primary education, polygamous marriage, and traders. Gender desirability (31.3%) was the most common reason for grand multiparity followed by desire for more offspring to maintain large family size (16.7%). Conclusion: This study showed that the incidence of grand multiparity is still high in our environment, and the reasons were complex, multiple, interrelated but preventable. Health awareness on the dangers of grand multiparity, reorientation of our long-held culture of gender preference, female education, and economic empowerment will help women to discard wrong sociocultural and religious beliefs.

Use of combined oral contraceptive pills among teenage girls in Calabar, Nigeria

The objective of this study was to find out about the use of combined oral contraceptive pills by women in Calabar Nigeria with a particular interest in single nulliparous teenage women. During the period from 2006 to 2010 a total of 1980 women seen in the University of Calabar Teaching Hospitals family planning unit used various methods of contraception. Of these 316 (15.96%) used combined oral contraceptive pills. Twenty girls aged between 13 and 19 years accounted for 6.3% of those who used combined oral contraceptive pills. There were 296 (93.6%) women between the ages of 20 and 34 years who accounted for the remaining users. Of these women 195 (61.5%) were educated to the secondary level and 34 (10.8%) were educated to primary level. No women without formal education used combined oral contraceptive pills during the period of study. The majority of the users were nulliparous (128; 40.4%); the rest had parity values of at least one to more than four. One hundred thirty-seven (43.4%) of the users were single 112 (35.4%) were married and the remaining 67 (21.1%) were separated divorced or widowed. There is a growing need to educate young Nigerian women about the use of combined oral contraceptive pills; this medication is suitable and effective for most young women and it also has additional noncontraceptive health benefits.