Oluwafemi Kuti

National data system on near miss and maternal death: shifting from maternal risk to public health impact in Nigeria

BackgroundThe lack of reliable and up-to-date statistics on maternal deaths and disabilities remains a major challenge to the implementation of Nigerias Road Map to Accelerate the Millennium Development Goal related to Maternal Health (MDG-5). There are currently no functioning national data sources on maternal deaths and disabilities that could serve as reference points for programme managers, health advocates and policy makers. While awaiting the success of efforts targeted at overcoming the barriers facing establishment of population-based data systems, referral institutions in Nigeria can contribute their quota in the quest towards MDG-5 by providing good quality and reliable information on maternal deaths and disabilities on a continuous basis. This project represents the first opportunity to initiate a scientifically sound and reliable quantitative system of data gathering on maternal health profile in Nigeria.ObjectiveThe primary objective is to create a national data system on maternal near miss (MNM) and maternal mortality in Nigerian public tertiary institutions. This system will conduct periodically, both regionally and at country level, a review of the magnitude of MNM and maternal deaths, nature of events responsible for MNM and maternal deaths, indices for the quality of care for direct obstetric complications and the health service events surrounding these complications, in an attempt to collectively define and monitor the standard of comprehensive emergency obstetric care in the country.MethodsThis will be a nationwide cohort study of all women who experience MNM and those who die from pregnancy, childbirth and puerperal complications using uniform criteria among women admitted in tertiary healthcare facilities in the six geopolitical zones in Nigeria. This will be accomplished by establishing a network of all public tertiary obstetric referral institutions that will prospectively collect specific information on potentially fatal maternal complications. For every woman enrolled, the health service events (care pathways) within the facility will be evaluated to identify areas of substandard care/avoidable factors through clinical audit by the local research team. A summary estimate of the frequencies of MNM and maternal deaths will be determined at intervals and indicators of quality of care (case fatality rate, both total and cause-specific and mortality index) will be evaluated at facility, regional and country levels.ManagementOverall project management will be from the Centre for Research in Reproductive Health (CRRH), Sagamu, Nigeria. There will be at least two meetings and site visits for efficient coordination of the project by regional coordinators and central coordinating staff. Data will be transferred electronically by hospital and regional coordinators and managed at the Data Management Unit of CRRH, Sagamu, Nigeria.Expected outcomesThe outcome of the study would provide useful information to the health practitioners, policy-makers and international partners on the strengths and weaknesses of the infrastructures provided for comprehensive emergency obstetric care in Nigeria. The successful implementation of this project will pave way for the long-awaited Confidential Enquiries into Maternal Deaths that would guide the formulation and or revision of obstetric policies and practices in Nigeria. Lessons learnt from the establishment of this data system can also be used to set up similar structures at lower levels of healthcare delivery in Nigeria.

Analysis of perinatal mortality in a Nigerian teaching hospital.

A 5-year retrospective analysis of perinatal mortality was carried out at Wesley Guild Hospital, Ilesa Nigeria between January 1996 and December 2000. The perinatal mortality rate during the study period was 77.03 per 1000 total births. There was a steady increase in rate over the study period. The most common cause of perinatal death was asphyxia (55.2%), immaturity (23.1%), and macerated stillbirth (18.3%). The high incidence of unbooked patients, multiple pregnancies and low birth weight babies are the main reasons for the high perinatal mortality rates in our environment. Education of the public on danger signs of prolonged labour and regular retraining of health personnel on intrapartum care in addition to upgrading neonatal facilities are important measures necessary to reduce the currently high perinatal mortality rate in Nigeria.

A prospective randomized clinical trial of urethral catheter removal following elective cesarean delivery

To compare immediate and 24‐hour postoperative removal of urethral catheters for elective cesarean delivery.

A randomised controlled trial of early initiation of oral feeding after cesarean section

Objective. To evaluate the safety and efficacy of early oral feeding after cesarean delivery. Methods. Two hundred women who had cesarean section were randomly assigned to early feeding or routine feeding. Women in the early feeding group were encouraged to take sips of water 8 h post-operatively, followed by oral tea of 100 mL at the time of supervision. Women in the routine feeding group were managed by restricting oral intake for the first 24 h and administration of sips of water 24–48 h post-operatively. The outcome measures include the rate of ileus symptoms, post-operative time interval to presence of bowel sounds, passage of flatus and bowel movement, time interval to return to regular diet, length of hospital stay, post-operative complications, acceptability and benefit of early oral feeding. Results. The early feeding group had a shorter mean post-operative time interval to bowel sounds 18.90 ± 4.17 h versus 36.21 ± 3.52 h (p < 0.001), passage of flatus 44.81 ± 3.73 h versus 60.58 ± 4.40 h (p < 0.001) and bowel movement 58.30 ± 5.91 h versus 72.76 ± 4.25 h (p < 0.001). There was no significant difference in paralytic ileus symptoms. Early feeding group had a shorter mean hospital stay 4.80 ± 0.59 days versus 6.69 ± 0.71 days (p = 0.001). Early feeding group required less intravenous fluid 7.14 ± 1.34 bottles versus 11.8 ± 1.32 bottles (p < 0.001). Conclusions. Early feeding after cesarean section was well tolerated and safe and can be implemented without an increase in adverse outcome.

Comparison of ceftriaxone versus triple drug regimen in the prevention of cesarean section infectious morbidities

Objective. To compare the effectiveness of single dose ceftriaxone versus multiple doses of ampiclox, gentamicin, and metronidazole to prevent infectious morbidity at elective cesarean section. Methods. This was a randomized clinical trial involving 200 pregnant women who had an elective cesarean section for various reasons during the study period. Outcome measures included endometritis, urinary tract infections, febrile morbidities, wound infections, duration of hospital stay, and cost of antibiotic therapy. Data were managed using SPSS. Results. There was no statistically significant difference in the mean duration of hospital stay between the two groups, but a significant statistical difference was found in the mean cost of antibiotic treatment (

Rate of increase in oxytocin dose on the outcome of labor induction.

15 for the combination and

Experiences and needs of Nigerian women after stillbirth.

9 for ceftriaxone; p = 0.000), with the group of patients taking a single dose of ceftriaxone (ROPHEX) having a lower mean cost of treatment than those taking a combination of ampiclox, gentamicin, and metronidazole. The study groups did not differ significantly in the incidence of endometritis (14% versus 15%), urinary tract infection (11% versus 15%), wound infections (7% versus 8%), febrile morbidity (7% versus 6%), and peritonitis (0% versus 0%). Conclusion. Single dose ceftriaxone was as effective as a combination of ampiclox, gentamicin, and metronidazole in preventing post-elective cesarean section complications.

A comparative study between intramuscular iron dextran and oral ferrous sulphate in the treatment of iron deficiency anaemia in pregnancy.

Objective: To compare the efficacy and safety of arithmetic and geometric increases in oxytocin infusion dosage during induction of labor. Methods: A total of 120 pregnant women requiring induction of labor at term were randomly assigned to receive oxytocin at dosages increasing arithmetically or geometrically. Maternal demographics, labor delivery data, and newborn outcomes were compared. The setting was the maternity unit of the Obafemi Awolowo University Teaching Hospitals Complex, Ile‐Ife, Nigeria. Results: The mean maximum rates of oxytocin delivery needed to achieve adequate uterine contractions were similar in the 2 groups (24.66 ± 8.34 mU/min vs. 26.38 ± 8.77 mU/min, P = 0.24). Labor duration was significantly shorter in the geometric progression group (496.33 ± 54.77 min vs. 421.34 ± 63.91 min, P < 0.001). There were no differences in the rates of cesarean sections, vaginal deliveries, or uterine hyperstimulation, or in neonatal outcomes. Conclusion: A geometric rise in the rate of oxytocin infusion delivery reduced the duration of labor without affecting the rates of cesarean sections and uterine hyperstimulation, or newborn outcomes.

The effect of amniotomy on the outcome of spontaneous labour in uncomplicated pregnancy

To determine the type of care that Nigerian women would find useful after stillbirth.

A randomised controlled study of non-closure of peritoneum at caesarean section in a Nigerian population.

A comparative study was conducted to demonstrate the difference, if any, in effectiveness of treatment of iron deficiency anaemia in pregnancy with either iron dextran or ferrous sulphate. Sixty pregnant women with iron deficiency anaemia were assigned randomly to either group and treated for 6 weeks. The age and parity distributions with mean packed cell volumes (PCVs) and gestational age at onset of treatment in the two groups were comparable. Comparing the mean PCVs at week 2, week 4 and week 6 of treatment the iron dextran group recorded higher and statistically significant mean PCVs (P < 0.001). Thirty-six per cent of patients in the iron dextran group compared to 3.3% in the oral iron group (P = 0.004) had their anaemia corrected by the sixth week. No significant side effects accompanied the use of intramuscular iron dextran. It was concluded that iron dextran corrects iron deficiency anaemia faster than ferrous sulphate. Parenteral iron should be considered in pregnant woman with moderate and asymptomatic severe anaemia between gestation ages of 28 weeks and 34 weeks; this may reduce the frequency of blood transfusion both in the antenatal and postnatal periods in these patients.