Je Ekabua

Trends in maternal mortality at the University of Calabar Teaching Hospital, Nigeria, 1999–2009

Background Maternal mortality remains a major public health challenge, not only at the University of Calabar Teaching Hospital, but in the developing world in general. Objective The objective of this study was to assess trends in maternal mortality in a tertiary health facility, the maternal mortality ratio, the impact of sociodemographic factors in the deaths, and common medical and social causes of these deaths at the hospital. Methodology This was a retrospective review of obstetric service delivery records of all maternal deaths over an 11-year period (01 January 1999 to 31 December 2009). All pregnancy-related deaths of patients managed at the hospital were included in the study. Results A total of 15,264 live births and 231 maternal deaths were recorded during the period under review, giving a maternal mortality ratio of 1513.4 per 100,000 live births. In the last two years, there was a downward trend in maternal deaths of about 69.0% from the 1999 value. Most (63.3%) of the deaths were in women aged 20–34 years, 33.33% had completed at least primary education, and about 55.41% were unemployed. Eight had tertiary education. Two-thirds of the women were married. Obstetric hemorrhage was the leading cause of death (32.23%), followed by hypertensive disorders of pregnancy. Type III delay accounted for 48.48% of the deaths, followed by Type I delay (35.5%). About 69.26% of these women had no antenatal care. The majority (61.04%) died within the first 48 hours of admission. Conclusion Although there was a downward trend in maternal mortality over the study period, the extent of the reduction is deemed inadequate. The medical and social causes of maternal deaths identified in this study are preventable, especially Type III delay. Efforts must be put in place by government, hospital management, and society to reduce these figures further. Above all, there must be an attitudinal change towards obstetric emergencies by health care providers.

Prevalence of anemia in women with asymptomatic malaria parasitemia at first antenatal care visit at the University of Calabar Teaching Hospital, Calabar, Nigeria.

Background: Anemia in pregnancy in malaria endemic areas is a public health challenge that has contributed either directly or indirectly to maternal morbidity and mortality in our environment. Anemia and malaria during pregnancy are highly preventable and treatable. Objective: The aim of this study is to assess the prevalence of anemia in asymptomatic malaria parasitemic women at first antenatal visit in a tertiary hospital facility. Method: The study was conducted at the antenatal clinic of the University of Calabar Teaching Hospital, Calabar, Nigeria over a three-month period. Five hundred and forty-five pregnant women were recruited after obtaining an informed consent. A structured questionnaire was administered to each participant and two thin and thick blood films were used to identify the malaria parasites and estimate density. The average of two packed cell volumes at booking was determined using two capillary tubes and read from a Hawksleys microhematocrit reader. Results: A total of 545 pregnant women participated in the study. The mean ages of primigravidas and multigravidas were 21.4 ± 3.1 and 24.3 ± 4.0 years. Two hundred and ninety (53.2%) were primigravidas while 255 (46.8%) were multigravidas. The parasite density in primigravidas was 1297 ± 1234 while that for multigravidas was 661 ± 497 (t = 7.7, P < 0.001). The prevalence of anemia in the study population was 59.6%. There was no statistically significant difference in the prevalence of anemia among the primigravidas (60.3%) and the multigravidas (58.8%) (χ2 = 1.3, P = 0.08). There was a statistically significant association between severity of parasitemia and degree of anemia (χ2 = 441.1, P < 0.001). There was a statistically significant association between antimalarials use before booking and severity of parasitemia (χ2 = 36.52, P < 0.001). Conclusion: Anemia at first antenatal booking was significantly associated with malaria parasitemia. Routine screening for anemia and malaria parasites at booking, prompt parasite clearance, use of intermittent preventive treatment (IPT) during pregnancy and correction of anemia can reduce the prevalence of malaria related anemia and obstetric complications associated with it.

Awareness of Birth Preparedness and Complication Readiness in Southeastern Nigeria

The aims of this study are to assess the awareness and intention to use maternity services. This was a multicentric study involving 800 women. Educational status was the best predictor of awareness of birth preparedness (P = 0.0029), but not a good predictor of intention to attend four antenatal clinic sessions (P = 0.449). Parity was a better predictor of knowledge of severe vaginal bleeding as a key danger sign during pregnancy than educational level (P = 0.0009 and P = 0.3849, resp.). Plan to identify a means of transport to the place of childbirth was related to greater awareness of birth preparedness (χ 2 = 0.3255; P = 0.5683). Parity was a highly significant predictor (P = 0.0089) of planning to save money. Planning to save money for childbirth was associated with greater awareness of community financial support system (χ 2 = 0.8602; P = 0.3536). Access to skilled birth attendance should be promoted.

Perinatal Outcome in Unbooked Teenage Pregnancies in the University of Calabar Teaching Hospital, Calabar, Nigeria

Background. Teenage pregnancy being a high risk condition requires skilled attention for good outcome. Objectives. To determine the influence of antenatal care on perinatal outcome in teenage pregnancies in Calabar. Materials and Methods. A review of patient records in Calabar was conducted between 1st January, 2006 and 31st December, 2010, to determine perinatal outcome in teenage pregnancy. Results. Teenage pregnancy accounted for 644 (6.5%) of the total deliveries with 245 (38.0%) booked while 399 (62.0%) were unbooked. Teenage mothers contributed significantly to the proportion of women who were delivered without prior antenatal care (χ 2 = 6.360; P < 0.05). The mean duration of labour in booked teenagers was 10.85 ± 4.2 hours, while unbooked teenagers was 23.31 ± 3.6 hours (t-value = 77.1039; P < 0.05). There was statistically more caesarean sections among unbooked teenage pregnancies than booked (χ 2 = 36.75; P < 0.05). Stillbirth was statistically significant (χ 2 = 27.096; P < 0.05) among unbooked teenagers than booked. However, early neonatal death was not significantly different between booked and unbooked teenage pregnancies(χ 2 = 0.512; P < 0.05). Conclusion. Unbooked teenage pregnancies were significantly associated with increased operative intervention and poor perinatal outcome.

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.

Factors associated with contraceptive use and initiation of coital activity after childbirth

The aim of the study is to identify the factors influencing contraceptive use and initiation of sexual intercourse after childbirth. This was a cross-sectional descriptive survey involving 256 consecutive women who delivered between April and October 2007 presenting at the Immunization Clinic University of Calabar Teaching Hospital Nigeria in April 2008. Data was obtained using an interviewer-administered structured questionnaire. Women who had antenatal and postnatal counseling were significantly more likely to use contraceptives than those who did not have counseling (odds ratio (OR) 0.29; 95% confidence interval (CI) 0.14-0.59; P = 0.0002 and OR 0.18; 95% CI 0.08-0.38; P = 0.0000002 respectively). Other variables significantly associated with contraceptive use included education (P = 0.0470) and reproductive goal (P = 0.0303). Linear regression analysis showed direct relationship between caesarean section and episiotomy as modes of delivery and initiation of coitus (r² = 0.439 and 0.45 respectively). Concerning residence after childbirth staying at home and with in-laws showed direct relationship with initiation of coitus (r² = 0.208 and 10.750 respectively). The number of women abstaining from intercourse showed a decreasing trend with increasing months after childbirth. Initiation of coitus was significantly associated with resumption of menstruation (P < 0.0001) and non-contraceptive use (P = 0.0089). In conclusion this study shows the need for use of postpartum contraception before fecund women become susceptible to pregnancy.

Prevalence of asymptomatic malaria parasitaemia

Objective: To evaluate factors associated with prevalence of malaria parasitaemia at first antenatal care visit. Methods: The study was conducted at the University of Calabar Teaching Hospital from 1st June, 2007 to 31st July, 2007. A structured questionnaire was administered to a total of 545 pregnant women that were recruited in this study after obtaining informed consent and two slides of thin and thick films were prepared for each participant. Results: Five hundred and twenty (95.4%) out of the 545 participants suffered from malaria parasitaemia, the rest 4.6% of those who had no parasitaemia had experienced symptomatic malaria before and were treated in private hospitals prior to their recruitment into tire study. All participants (100%) who did not have antimalarials had parasitaemia compared with 91.1% among those that had antimalarials. The proportion of moderate to severe parasitaemia was also significantly higher among the former. Besides, the difference in parasitaemia between primigravidae and multigravidae was statistically significant (P=0.000) too. Among the methods used for vector control, only insecticide treated nets (ITNS) was associated with significant reduction in the level of parasitaemia (RR=0.83). Conclusion: Malaria parasitaemia at first booking is significantly higher in primigravidae and women who have no anti-malaria treatment. The use of safe and effective antimalarial treatment along with ITNs will significantly reduce the level of parasitaemia in pregnant women.

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.

Oral health among antenatal care attendees in Calabar, Nigeria

The objective of this study is to determine the oral health habits, awareness, oral health education and treatment needs among pregnant women who attend the antenatal clinics at the University of Calabar Teaching Hospital, Calabar, Nigeria. A total of 252 women at different stages of pregnancy responded to an interviewer-administered structured questionnaire. Of those, 238 (94.4%) of the respondents used toothbrush and toothpaste for oral cleaning, while 12 (4.8%) used a combination of toothbrush/toothpaste and local chewing sticks. Two (0.8%) adhered to the use of chewing sticks only. A total of 34 (13.5%) respondents were aware of and used dental services while pregnant; 18 (52.9%) of those who presented with dental complaints during pregnancy had bleeding gums. Based on the level of awareness of the need to attend a dental clinic during pregnancy (26.2%) and the percentage of respondents willing to have a dental examination during pregnancy (83.3%), it is recommended that oral health education be incorporated into the antenatal counselling of pregnant women in Nigeria.

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.