Odidika Ugochukwu Joannes Umeora

Maternal mortality in rural Nigeria

Preventable maternal deaths remain the bane of obstetric practice in developing countries. The mean Nigerian maternal mortality ratio (MMR) of 1000 per 100000 live births was mainly derived from data provided by urban hospitals. The present study evaluated the MMR and its major causes in rural Nigeria and analyzed all maternal deaths recorded at Ebonyi State University Teaching Hospital (EBSUTH) Abakaliki Nigeria from January 2000 to December 2003. Of 4192 live births recorded there were 79 maternal deaths for an MMR of 1884 per 100000 live births. This finding far exceeds the Nigerian national average. The case records of only 49 (62%) of these maternal deaths were complete and included in this review. The relative fall in MMR over the years may be accounted for by the free antenatal care policy of the Ebonyi State Government introduced in February 2001 making quality prenatal care more accessible with women currently benefiting from an average of six prenatal visits. (excerpt)

contraceptive prevalence and preference in a cohort of south-east nigerian women

Background Rates of fertility, population growth, and maternal deaths in Nigeria are among the highest in the world, with an estimated 4% of all births being unwanted and 7% mistimed. These are caused mainly by nonuse, inappropriate choice, and difficulty in accessing contraceptive commodities. The purpose of this study was to determine the prevalence and factors influencing the choice and sources of contraceptive options among market women in Ebonyi State, Nigeria. Methods This was a questionnaire-based, cross-sectional, descriptive study involving 330 market women of reproductive age in Abakaliki, Ebonyi State, Nigeria. A survey was carried out to identify their knowledge, use, and sources of contraception and the factors that influence their contraceptive practices. Results Knowledge of contraception was high (275 [83.3%]), and 229 (69.4%) of the study population approved of contraceptive use. However, only 93 (28.3%) of the respondents were currently using any form of contraception. Fifty-four women (16.3%) were using modern methods. The commonly used forms of modern contraception were the barrier method (male condoms, 27 [8.2%]), the oral contraceptive pill (10 [3.0%]), injectables (8 [2.5%]), and the intrauterine contraceptive device (7 [2.0%]). The most common source of contraceptive products was patent medicine dealers (58 [51%]). The main barriers to use of contraception were desire for more children (86 [26.1%]), religious prohibition (62 [18.8%]), spousal disapproval (32 [9.7%]), and the perceived side effects of modern contraceptives (25 [7.6%]). There was a significant association for approval of contraception when the model was adjusted for religion (odds ratio [OR] 0.39, 95% confidence interval [CI] 0.18–0.84; P=0.02); educational status (OR 2.84, 95% CI 0.96–8.40; P=0.04); parity (OR 1.78, 95% CI 1.09–2.85; P=0.03); and social class (OR 2.54, 95% CI 1.26–5.11; P=0.01). Conclusion There is good knowledge about contraception among Nigerian women, but use of these products is low. The main barriers to use of contraception are the desire for more children, religious prohibition, and spousal disapproval.

Anemia in pregnancy in Abakaliki, South East Nigeria

[1] Lindsay KL, Walsh CA, Brennan L, McAuliffe FM. Probiotics in pregnancy and maternal outcomes: a systematic review. J Matern Fetal Neonatal Med 2013;26(8):772–8. [2] Pelucchi C, Chatenoud L, Turati F, Galeone C, Moja L, Bach J-F, et al. Probiotics supplementation during pregnancy or infancy for the prevention of atopic dermatitis: a meta-analysis. Epidemiology 2012;23(3):402–14. [3] Barrett HL, Callaway LK, Nitert MD. Probiotics: a potential role in the prevention of gestational diabetes? Acta Diabetol 2012;49(Suppl. 1):S1–S13. [4] Dugoua J-J, Machado M, Zhu X, Chen X, Koren G, Einarson TR. Probiotic safety in pregnancy: a systematic reviewandmeta-analysis of randomized controlled trials of Lactobacillus, Bifidobacteriumand Saccharomyces spp. J Obstet Gynaecol Can 2009;31(6):542–52.

Evaluating Impact of a Residency Training Program Rural Rotation on Obstetric Care in Rural Southeast Nigeria

Context: Obstetric practice in rural Nigeria might be hindered by inadequately equipped and staffed care facilities. Resident doctors can increase medical capacity in rural settings. nObjective: To evaluate the impact of resident doctors on rotational postings on service delivery, Caesarean section rates and maternal mortality in a mission hospital in rural Nigeria. nMethods: A before and after evaluation of health services and indices at St Vincent catholic Hospital, Ndubia. Resident doctors commenced rotation at the rural hospital in November 2013. Health care services between Nov 2012 and October 2013 were compared with same services between November 2013 and October 2014. Analysis was by epi info statistical software version 7.1.4 of 2014 (DCD Atlanta USA). nResults: twelve residents have undergone rotation at the hospital in 12 months. There was an attendant increase in uptake of services in the hospital. Complications were better managed and though there were more emergency caesarean deliveries undertaken, the overall Caesarean section rate dropped. A reduction in maternal mortality ratio to 444/100,000 live births was recorded. nConclusion: Maternal health indices are improved upon by increased medical staff capacity in obstetric care. A nationwide scale up is advocated.

Perception of labor pain and utilization of obstetric analgesia by Igbo women of Southeast Nigeria

Context: Pain is subjective and labor pain perception is said to be influenced by personality, culture, parity, educational status and maternal weight. Objectives: This study assessed the Igbo Womens perception of labor pain and evaluated factors influencing their perception of labor pain as well as ascertained the level of utilization of obstetric analgesia by parturients. Materials and Methods: This was a cross-sectional study that spanned 6 months (January 1, to June 30, 2011) and involved parturients of Igbo extraction who delivered by vaginal route in 3 different referral hospitals. They were interviewed with self-administered questionnaires within the first 24-48 hours postpartum. Labor pains were rated using a 3-pont verbal rating scale (VRS). Data were analysed with MathCAD 7 statistical soft ware package. Results: A total of 530 parturients were interviewed but only 500 were analysed. Fifty-two percent of parturients rated labor pain as severe. While 67.6% of parturients desired labor pain alleviation, only 38% actually requested for analgesia, and only 27% of parturients received pain relief during labor. The commonest pain relief available was intramuscular injection of Pentazocine Hydrochloride (92.6%) The influence of age, parity, educational status, maternal weight and companionship, on pain perception was statistically significant. Conclusion: Though most Igbo women found labor painful, they tend to cope with it. Most Igbo parturients did not request for pain relief and only a fraction of those who did request received it. Adequate antenatal preparation for the birthing process is necessary.

Improving maternal, newborn and women's reproductive health in crisis settings

This is the protocol for a review and there is no abstract. The objectives are as follows: To identify, synthesise and evaluate the effects of health system and other interventions aimed at improving maternal, newborn and womens reproductive health in crisis settings.

Outcomes of asymptomatic malaria parasitaemia in neonates in a tertiary hospital, southeast Nigeria

Background: Malaria infestation during pregnancy is mostly asymptomatic and untreated especially in unbooked pregnancies. It presents with almost all the fetal complications of overt malaria in pregnancy. The aim of this study was to determine the effect of asymptomatic malaria parasitaemia on the neonates of unbooked parturients delivered at term at the Federal Teaching Hospital, Abakaliki. Materials and Methods: This study was conducted in the labour ward complex of the Federal Teaching Hospital, Abakaliki from March to May 2012. Unbooked pregnant women who fulfilled the inclusion criteria and gave consent were consecutively recruited. Cord blood and placenta tissue were collected for haemoglobin concentration determination and histology, respectively. Birth weights were determined with an electronic weighing machine. Statistical Analysis was done with 2008 Epi Info™ software and level of significant was set at P-value <0.05. Results: A total of 250 unbooked parturients were recruited, of which 194 (77.6%) had asymptomatic malaria parasitaemia while 227 (90.8%) had placental parasitisation. The prevalence of low birth weight in the study was 16.4%. There was significant relationship between asymptomatic malaria parasitemia and birth weight (X2 = 43.70, P-value < 0.001). There were no low-birth-weight deliveries among paturients without placental parasitemia. No neonate, however, had anaemia in the study. Conclusion: Asymptomatic malaria parasitemia and placental parasitisation by malaria parasites contribute to the outcome of the foetal birth weight. Asymptomatic malaria parasitaemia and placental parasitaemia did not result in a corresponding foetal anaemia on babies delivered.

Umbilical cord prolapse in a secondary health center in South Eastern Nigeria: A 20-year experience

Introduction: Umbilical cord prolapse is a dire obstetric emergency that causes a lot of fetal morbidity and mortality and maternal morbidity. The incidence in our Center is not known and the outcome of the cases we have been managing in our Center had never been audited before with a view to finding out how to improve on our management. It is against this back drop that this work is carried out. Material and Method: This is a retrospective study involving all the cases of umbilical cord prolapse managed in Mater Misericordiae Hospital, Afikpo, Ebonyi State, Nigeria from January 1995 to December 2014. The case notes were got from the hospital′s Records Department and relevant information were retrieved and analyzed. Results: There were 92 cases of cord prolapse and 22,595 deliveries over the period giving an incidence of cord prolapse of 0.41% or one case of cord prolapse in every 246 deliveries. Twenty one or 22.8% had multiple pregnancy. Fifty two women (56.5%) had mal-presentation and 51 (55.4%) of the women had emergency lower segment caesarean section. Fifty (54.3%) of the babies weighed 2.5 Kg or below. Sixty three (65.6%) of the fetuses were alive while 33 (34.4%) had intra-uterine fetal death giving a perinatal mortality rate of 343.8 per 1000 births. There was no maternal mortality. Of the 63 babies delivered alive, 25(40.3%) had apgar scores of 8 to 10, 22(34.9%) 5 to 7 while16 (25.8%) 1 to 4 in one minute. Conclusion: Umbilical cord prolapse in rural Nigeria is a rare but devastating obstetric emergency with a high perinatal mortality rate and maternal morbidity. Obstetricians must continually update their skills in the management of this condition to help reduce its devastating consequences.

Seroprevalence of cytomegalovirus antibodies among antenatal clinic attendees in Abakaliki, Nigeria

Context: Cytomegalovirus infection is potentially neurotoxic to the fetus when it occurs during pregnancy. The prevalence is not known within our population. Aims: To determine the seroprevalence of Cytomegalovirus antibodies in pregnant Nigerian women at a tertiary health facility in Southeast Nigeria. Methods: This was a laboratory-based cross sectional descriptive study. Pregnant women who consented to the study were recruited from the antenatal clinics of the Teaching Hospital. Blood samples were collected from them and analysed using ELISA techniques. The relationships between positive CMV antibodies and socio-demographic variables were analysed using Chi square test and linear regression analysis. Results: Two hundred and four (204) serum samples were analysed. CMV seroprevalence was 96.08%. Two hundred and one (98.5%) participants were not aware of CMV infection. Lower socioeconomic class was associated with increased seroprevalence of Cytomegalovirus (P=0.004). Multiparous women were more likely to acquire CMV infection than primigravide women (P=0.009). There was a strong association between maternal place of residence and CMV seropositivity (P=0.023). The association between increasing maternal age and CMV seropositivity did not achieve statistical significance (P=0.246). Conclusion: Cytomegalovirus seroprevalence is high among participants and awareness of this disease is low. There is need to create further awareness of this disease.

Rate and predictors of low serum ferritin levels among healthy parturient women in Enugu, Nigeria

Background Low serum ferritin levels signify low iron stores and this could predispose to iron deficiency anemia. Objective To determine the rate and predictors of low serum ferritin levels during the puerperium in Enugu, Southeast Nigeria. Study design A hospital-based prospective longitudinal study involving parturient women who delivered singleton fetuses at term. Venous blood samples were collected to determine the serum ferritin concentration at 48 hours and 6 weeks postpartum. Data analysis involved descriptive and inferential statistics at 95% confidence interval (CI) using Statistical Package for Social Sciences (SPSS) computer software version 20.0. Results Two-hundred and two women who carried singleton pregnancies to term were studied. The mean serum ferritin levels at 48 hours and 6 weeks were 27.82±18.41 µg/L and 36.12±21.53 µg/L, respectively. Forty-eight hours postdelivery, 29.2% had low ferritin levels and this decreased to 12.4% at 6 weeks postpartum. There was a significant positive correlation between the serum ferritin level at 48 hours postdelivery and the serum ferritin level at 6 weeks postpartum (r=0.89, P<0.001). Predictors of the low ferritin level at 6 weeks included age <20 years (odds ratio [OR] =0.70, 95% CI =0.53, 0.93), multiparity (OR =63.7, 95% CI =3.18, 127.5), anemia at 48 hours postpartum (OR =61.7, 95% CI =13.27, 116.6), a low ferritin level at 48 hours (OR =78.1, 95% CI =8.8, 108.3), and intake of antenatal hematinics for <3 months (OR =0.04, 95% CI =0.01, 0.20). Conclusion There was a significant occurrence of low ferritin levels during the puerperium in the study centers, and this was associated mainly with pregnancy and delivery factors. Efforts to improve the iron stores in parturient women could benefit from early booking and compliance with antenatal hematinics and optimizing hemoglobin and iron levels before delivery.