Polite I. Onwuhafua

The challenge of reducing maternal mortality in Nigeria

Despite the efforts of the Safe Motherhood Initiative in Nigeria maternal mortality remains a neglected problem in the country. The maternal mortality rate is 652 per 100000 and abdominal deliveries were approximately 5 times more common than vaginal deliveries. Nulliparity carried the greatest risk of maternal death (1072/100000); also this group contributed to the highest number of abortion-related deaths. Aside from abortion eclampsia ruptured uterus obstetric hemorrhage anesthetic death puerperal sepsis and amniotic fluid infusion contributed to the direct cause of maternal mortality. Due to the failure of the Safe Motherhood Initiative a structural adjustment program is needed for intensification of mass education provision of family planning services especially for adolescents and training of more obstetricians and midwives and re-training of traditional birth attendants.

The effect of frequency of antenatal visits on pregnancy outcome in Kaduna, Northern Nigeria

Context: The benefit of antenatal care is no longer in doubt, but the ideal number of encounters to achieve those benefits has been the subject of discussion among maternity care stakeholders. Objective: To study the effect of frequency of antenatal visits on pregnancy outcome. Materials and Methods: This is a prospective study of 228 pregnant women attending the antenatal clinic of the Ahmadu Bello University Teaching Hospital, Zaria, Nigeria, over a 3-month period. Maternal and fetal outcome were compared against the frequency of antenatal visits. Results: The mean frequency of visits was 6.77. Majority of the women 124 (54.4%) attended less than seven times. Compliance with antenatal drugs and mean hemoglobin level at delivery increased with increasing frequency of visits reaching 93.7% and 11.44 g/dl, respectively, in the moderate attendees (4–6 visits). Prevalence of anemia was high (56.7%) among the unbooked but lowest (9.5%) with moderate attendees. Thereafter, there was no significant improvement. Delivery mode, malaria parasitemia, and gestational age at delivery were fairly uniform in all the groups. The prevalence of low birth weight was 20% in the unregistered and decreased from 22% in the low frequency (1–3 visits) group, to 4.8% in the moderate attendees, and to 0% in the very high-frequency (ten and above visits) group. Mean Apgar scores at 1 and 5 min were also best (7.1/8.1) in the moderate attendees and worst in the unregistered. Conclusion: More than six visits conferred no significant advantage on fetomaternal outcome. Therefore, the new WHO recommendation on reduced antenatal visits can be satisfactorily implemented in Kaduna.

Evaluation of pattern of tubo-peritoneal abnormalities potentially responsible for infertility in Zaria, Nigeria: hysterosalpingographic assessment

Background: Structural abnormalities on hysterosalpingography (HSG) are among the important factors in the evaluation of female infertility. Aim and Objective: This study is mainly concerned with the pattern of tubal and peritoneal abnormalities and their effects on fertility outcome. Materials and Methods: A prospective study of 220 consecutive patients who underwent HSG between December, 2011 and May, 2013, at Department of Radiology, Ahmadu Bello University Teaching Hospital, Zaria. Clinical notes and radiological findings were analyzed for demographic data, tubal and peritoneal pathologies. Fertility outcome in patients with abnormal findings was compared with those with normal findings. Results: A total of 121 (55.0%) patients had normal tubes on HSG. Tube abnormalities were found in 99 (45.0%) patients; 37 (37%) patients with primary and 62 (63%) patients with secondary infertility. Totally, 203 (92.3%) patients had normal peritonea contrast medium spillage on HSG. Peritoneal cavity abnormality (pelvic adhesion) affected 17 (7.7%) patients; 8 (47%) patients with primary and 9 (53%) patients with secondary infertility. The fertility outcome showed that after 1-year of follow-up, 3 (2.6%) of the 116 patients with abnormal findings (tubal and peritoneal abnormalities) got pregnant, while 25 (34.7%) of the 72 patients with normal findings (tubal, peritoneum, cervical canal and endometrial cavity) got pregnant. The difference noted was statistically significant (P = 0.0000). Conclusion: Fertility outcome in patients with tubo-peritoneal abnormalities at HSG was low.