Jamilu Tukur

The use of magnesium sulphate for the treatment of severe pre-eclampsia and eclampsia.

BACKGROUND Pre-eclampsia and eclampsia are important causes of maternal and perinatal morbidity and mortality in the developing countries. There is need to provide the most effective management to pre-eclamptic and eclamptic patients. There is now evidence that magnesium sulphate is the most effective anticonvulsant. METHOD In this article , a literature review was made on the contribution of pre-eclampsia and eclampsia to maternal mortality and how it can be curtailed by the use of magnesium sulphate. RESULTS The drug is administered by the Pritchard or Zuspan regimen, although modifications in the two protocols have been reported. CONCLUSION A Nigerian national protocol has been developed on its use. There is need for further training of health workers on how to use this important drug.

Pattern of Eclampsia in a Tertiary Health Facility Situated in a Semi-Rural Town in Northern Nigeria

BACKGROUND/OBJECTIVE To determine the pattern of eclampsia and its contribution to maternal mortality at the Federal Medical Centre, Birnin Kudu, Jigawa State in Northern Nigeria. METHOD A 4-year retrospective review of the case records of all women who presented with eclampsia at the center. All the case records were retrieved from the medical record department and analyzed. RESULTS There were 207 cases of eclampsia out of 2197 deliveries during the period giving an incidence of 9.42%. 171 (82.6%) of the patients were unbooked. Majority (58.5%) of the patients were aged less than 20 years. The highest frequency (78.3%) was recorded in the primigravida. Delay before reaching the hospital was established in 116 (56%) of patients. The condition was antepartum in 68 (32.9%), intrapartum in 112 (54.1%) and postpartum in 27 (13%). 107 (51.7%) of the patients were delivered by cesarean section. Twenty two (10.6%) of the mothers died. Eclampsia was the commonest cause of maternal mortality and contributed 43.1% of all maternal deaths. 180 (87%) of the babies were delivered alive while 27 (13%) died. CONCLUSION Eclampsia is a major cause of maternal mortality. There is need for health education on the need for patients to avail themselves of antenatal care.

Benefits of using magnesium sulphate (MgSO4) for eclampsia management and maternal mortality reduction: lessons from Kano State in Northern Nigeria

BackgroundDespite clear emphasis through the Millennium Development Goals, the problem of high maternal mortality persists especially within low and middle income countries. Various studies report remarkably high maternal mortality rates in northern Nigeria, where maternal mortality rates exceed 1,000 deaths per 100,000 live births and eclampsia contributes approximately 40% of maternal deaths. Across Nigeria, diazepam is routinely used for the management of eclampsia. Prior to February 2008, diazepam was widely used for the management of eclampsia in Kano State (within northern Nigeria) with case fatality rate being over 20%. While magnesium sulphate (MgSO4) is recognized as the most effective drug for the management of eclampsia; this study aims to compare MgSO4 therapy with diazepam therapy in terms of case fatality rates and costs.FindingsThis retrospective study, including 1045 patients with eclampsia and pre-eclampsia during the years 2008 and 2009, reports a drop in case fatality rates from 20.9% (95% CI: 18.7, 23.2) to 2.3% (95% CI: 1.4, 3.2) among eclampsia patients following the MgSO4 intervention. The study observed no significant difference in the cost of using MgSO4 therapy compared to diazepam therapy.ConclusionsThe study found a remarkable reduction in case fatality rate due to eclampsia in those who received MgSO4 therapy with minimal increase in costs when compared to diazepam therapy. Concerted efforts should be focused on properly introducing MgSO4 into emergency obstetric protocols especially within developing countries to reduce maternal mortality and also impact on health system performance.

Sexual stimulants and their effects on women of reproductive age group in Kano, northern Nigeria

Introduction: Sexual stimulants are preparations used for increasing pleasure during sexual intercourse. The study sought to determine the use and effect of such preparations on women of reproductive age group in Kano, northern Nigeria. Materials and Methods: A self administered questionnaire was used to obtain information from 500 women to determine if they use sexual stimulants and the effects of the drugs on them (if any). Results: There were 423 women that responded. Majority 228 (53.9%) of them use sexual stimulants. Most (47.4%) of them were between the ages of 21 and 30 years, married (85.5%), multiparous (46.9%), and attained tertiary education (58.3%). About 39.9% of the respondents benefited from increased sexual pleasure and satisfaction, 20.2% obtained extra favors from their husbands while 29.9% did not benefit anything from the preparations. About 37.3% developed complications, which included coital laceration (5.9%), copious vaginal discharge (16.5%), vulval itching and rashes (17.5%), lower abdominal pains (14.1%), painful intercourse (16.5%), vaginal dryness (13.0%), and irregular menses (5.9%). Conclusion: A large number of women use sexual stimulants mainly sold by traditional healers. There is need for setting up more orthodox care for sexual dysfunction. There is need for more community health education on female sexual dysfunction.

An innovation for improving maternal, newborn and child health (MNCH) service delivery in Jigawa State, northern Nigeria: a qualitative study of stakeholders’ perceptions about clinical mentoring

BackgroundAn effective capacity building process for healthcare workers is required for the delivery of quality health care services. Work-based training can be applied for the capacity building of health care workers while causing minimum disruption to service delivery within health facilities. In 2012, clinical mentoring was introduced into the Jigawa State Health System through collaboration between the Jigawa State Ministry of Health and the Partnership for Transforming Health Systems Phase 2 (PATHS2). This study evaluates the perceptions of different stakeholders about clinical mentoring as a strategy for improving maternal, newborn and child health service delivery in Jigawa State, northern Nigeria.MethodsInterviews were conducted in February 2013 with different stakeholders within Jigawa State in Northern Nigeria. There were semi-structured interviews with 33 mentored health care workers as well as the health facility departmental heads for Obstetrics and Pediatrics in the selected clinical mentoring health facilities. In-depth interviews were also conducted with the clinical mentors and two senior government health officials working within the Jigawa State Ministry of Health. The qualitative data were audio-recorded; transcribed and thematically analysed.ResultsThe study findings suggest that clinical mentoring improved service delivery within the clinical mentoring health facilities. Significant improvements in the professional capacity of mentored health workers were observed by clinical mentors, heads of departments and the mentored health workers. Best practices were introduced with the support of the clinical mentors such as appropriate baseline investigations for pediatric patients, the use of magnesium sulphate and misoprostol for the management of eclampsia and post-partum hemorrhage respectively. Government health officials indicate that clinical mentoring has led to more emphasis on the need for the provision of better quality health services.ConclusionStakeholders report that the introduction of clinical mentoring into the Jigawa State health system gave rise to an improved capacity of the mentored health care workers to deliver better quality maternal, newborn and child health services. It is anticipated that with a scale up of clinical mentoring, health outcomes will also significantly improve across northern Nigeria.

Obstetric knowledge of nurse-educators in Nigeria: Levels, regional differentials and their implications for maternal health delivery

Objective: To assess the knowledge of nurse-midwife educators on the major causes of maternal mortality in Nigeria. Setting: Schools of nursing and midwifery in Nigeria. Method: A total of 292 educators from 171 schools of nursing and midwifery in Nigeria were surveyed for their knowledge of the major causes of maternal mortality as a prelude to the design and implementation of a train-the-trainer intervention geared towards improved maternal health-care delivery. Results: There was paucity of knowledge across all major causes. Only 57.2% and 62.7% of educators could diagnose pre-eclampsia and severe pre-eclampsia, respectively. While 86% knew about magnesium sulphate (MgSO4) as the ‘gold standard’ for treating eclampsia, only 16.8% knew of calcium gluconate as an antidote to MgSO4 toxicity. Of the educators, 63.7% could not describe the components of active management of third stage of labour, while 29.5% were not aware of uterine atony as a cause of postpartum haemorrhage. Furthermore, 65.4% believed that misoprostol is the preferred oxytocic for hospital delivery. Other potentially harmful knowledge gaps were also found, such as 47.3% of the participants reporting that they would perform episiotomies on all primigravidae. Conclusion: Nurse/midwife educators in Nigeria are not as knowledgeable as previously thought, especially concerning the causes of maternal mortality. In order to scale up the quality of obstetric care, updated pre-service curricula should be implemented fully while in-service appraisal and continuing education should be introduced.

Bridging Human Resources for Health (HRH) gaps by applying clinical mentoring in selected health facilities: evidence from Jigawa State in northern Nigeria

Background In July 2012, a clinical mentoring intervention commenced in Jigawa State through collaboration between the Jigawa State Ministry of Health and the Partnership for Transforming Health Systems Phase 2 project. After 6 months, an evaluation was undertaken to assess whether clinical mentoring has benefits for the health workforce situation within the intervention health facilities as well as whether it improved maternal, newborn and child health service delivery in Jigawa State within northern Nigeria.

A Randomized controlled trial of intramuscular pentazocine compared to intravenous paracetamol for pain relief in labor at Aminu Kano Teaching Hospital, Kano

Background: Labor is generally considered to be a very painful experience. Epidural analgesia which is the gold standard for labor pain relief is not widely available, affordable, or feasible, especially in our environment. Parenteral opioid analgesics, which are more commonly used, can cause nausea and vomiting in the patient and respiratory depression in the neonate; hence, they cannot be used in all stages of labor. There is thus the need for an alternative analgesic with similar or superior analgesic effect to opioids but without their fetomaternal side effects. Objectives: The objective of this study was to compare the efficacy of intramuscular (IM) pentazocine and intravenous (IV) paracetamol infusion in relieving labor pain at Aminu Kano Teaching Hospital, Kano. Study Design: It was a randomized controlled study. Methodology: One hundred women with singleton uncomplicated pregnancies and spontaneous labor at term were randomly assigned to the study group or control group. Women in the study group received an IV infusion of 1000 mg of paracetamol while women in the control group received a single dose of 30 mg of pentazocine intramuscularly. Labor pain perception was assessed using visual analog scale (VAS) scores at presentation and after delivery while maternal satisfaction assessed using Likert scale, and maternal and fetal complications were recorded after delivery. Statistical analysis was done using computer software SPSS Version 20.0. Chi-square, Fishers exact test, t-test, and Mann–Whitney U-tests were used to compare means and proportions as appropriate for statistically significant differences, setting the level of significance (P value) at <0.05. Results: There were no statistically significant differences between the two groups in their sociodemographic characteristics, obstetric characteristics, and labor characteristics. There was also no statistically significant difference in the VAS pain scores between the two groups before administration of the analgesics (P = 0.968) and after administration of the analgesics (P = 0.225). The maternal satisfaction with pain relief among the patients in the two groups was also found to be similar (P = 0.341). Nausea (P = 0.002), vomiting (P = 0.012), and drowsiness (P < 0.001) were significantly higher in the pentazocine group when compared with the paracetamol group. None of the patients in the two groups developed dyspnea during labor, skin rashes, or persistently low systolic blood pressure of <90 mmHg, and none had persistent fetal heart rate abnormalities during labor or appearance, pulse, grimace, activity, and respiration (APGAR) scrores <7 at the 1st or 5th min after delivery. However, the mean APGAR score of the neonates at 1 min was significantly higher in the paracetamol group (P = 0.033), while there was no difference in the mean APGAR scores of the neonates in the two groups at 5 min after delivery (P = 0.152). Conclusion: The analgesic efficacy of IV paracetamol was similar to that of IM pentazocine in labor, with similar levels of maternal satisfaction with pain relief, but IV paracetamol was associated with significantly lower rates of adverse effects.

Appropriate anaesthesia technology for improved access to surgical services in resource constrained facilities in Northern Nigeria: A pilot study of the Universal Anaesthesia Machine

Background: The provision of safe anesthesia in developing countries is often challenging due to multiple health systems and infrastructural challenges. We explored the suitability and reliability of the Universal Anaesthesia Machine (UAM) in Northern Nigeria. Patients and Methods: Over an 18-month period from 1st June 2012 to 30th November 2013, Nurse anesthetists and biomedical technicians were trained on the use, maintenance, and installation of the UAM in the study facilities. Patients requiring general anesthesia (GA) were then randomly assigned to the UAM or other forms of GA. Availability, ease of ues ans safety were monitored. Results: A total of 1562 patients had anesthesia administered with 54.8% using UAM. Cesarean section due to obstructed labor was the most common indication. There was no malfunctioning of the UAM and its use was preferred over other forms of GA. Complications were less than with other form of GA provided by the same staff. Conclusion: The UAM is suitable for health facilities with limited equipment and manpower. It has the potential to improve access to surgery and emergency obstetric care as it can be safely used by non-physician anesthetists.

A randomised controlled trial of opioid only versus combined opioid and non-steroidal anti inflammatory analgesics for pain relief in the first 48 hours after Caesarean section.

Background: Post-Caesarean section pain is complex in nature, requiring a combination of pharmacological and non-pharmacological methods. Effective management of postoperative pain will reduce postoperative morbidity, hospital stay and cost. The objective of this study was to compare the clinical effectiveness and adverse effects of a combination of non-selective cyclooxygenase (COX) inhibitor (Diclofenac sodium 50 mg) and opioid (Pentazocine 60 mg) to opiod only (Pentazocine 60 mg) for pain management after Caesarean section (CS) at Aminu Kano Teaching Hospital (AKTH). Materials and Methods: This was a randomised double-blind controlled study conducted at AKTH, Kano, Nigeria. A total of 166 patients scheduled to undergo either emergency or elective Caesarean section were studied. Group I received a combination of COX inhibitor and opiod while Group II received opiod only for pain management after CS. Results: The average age of the patients was 28.35 years (SD ± 6.426) in the group I and 26.9(SD ± 6.133) in group II. The mean parity was 3.27(SD ± 2.67) and 2.75(SD ± 2.14) while the mean gestational age at admission was 37.68(SD ± 2.69) and 38.18(SD ± 2.63) weeks in the first and second groups, respectively. Comparison of the level of pain experienced and patients satisfaction during the first 48 hours postoperatively revealed that the level of pain was statistically significantly less and patients satisfaction significantly better in group I compared to group II (P-value 0.00001). Conclusion: The use of combined compared to single agent analgesia is safe, significantly reduced pain and improved patient satisfaction after a caesarian section (CS).