Rosemary Ogu

Outcome of an intervention to improve the quality of private sector provision of postabortion care in northern Nigeria

The outcomes of an intervention aimed at improving the quality of postabortion care provided by private medical practitioners in 8 states in northern Nigeria are reported. A total of 458 private medical doctors and 839 nurses and midwives were trained to offer high‐quality postabortion care, postabortion family planning, and integrated sexually transmitted infection/HIV care. Results showed that among the 17009 women treated over 10 years, there was not a single case of maternal death. In a detailed analysis of 2559 women treated during a 15‐month period after the intervention was established, only 33 women experienced mild complications, while none suffered major complications of abortion care. At the same time, there was a reduction in treatment cost and a doubling of the contraceptive uptake by the women. Building the capacity of private medical providers can reduce maternal morbidity and mortality associated with induced abortion in northern Nigeria.

Qualitative assessment of women’s satisfaction with maternal health care in referral hospitals in Nigeria

BackgroundAvailable evidence suggests that the low use of antenatal, delivery, and post-natal services by Nigerian women may be due to their perceptions of low quality of care in health facilities. This study investigated the perceptions of women regarding their satisfaction with the maternity services offered in secondary and tertiary hospitals in Nigeria.MethodsFive focus group discussions (FGDs) were held with women in eight secondary and tertiary hospitals in four of the six geo-political zones of the country. In all, 40 FGDs were held with women attending antenatal and post-natal clinics in the hospitals. The questions assessed women’s level of satisfaction with the care they received in the hospitals, their views on what needed to be done to improve patients’ satisfaction, and the overall quality of maternity services in the hospitals. The discussions were audio-taped, transcribed, and analyzed by themes using Atlas ti computer software.ResultsFew of the participants expressed satisfaction with the quality of care they received during antenatal, intrapartum, and postnatal care. Many had areas of dissatisfaction, or were not satisfied at all with the quality of care. Reasons for dissatisfaction included poor staff attitude, long waiting time, poor attention to women in labour, high cost of services, and sub-standard facilities. These sources of dissatisfaction were given as the reasons why women often preferred traditional rather than modern facility based maternity care. The recommendations they made for improving maternity care were also consistent with their perceptions of the gaps and inadequacies. These included the improvement of hospital facilities, re-organization of services to eliminate delays, the training and re-training of health workers, and feedback/counseling and education of women.ConclusionA women-friendly approach to delivery of maternal health care based on adequate response to women’s concerns and experiences of health care will be critical to curbing women’s dissatisfaction with modern facility based health care, improving access to maternal health, and reducing maternal morbidity and mortality in Nigeria.Trial registrationTrial Registration Number NCTR No: 91540209. Nigeria Clinical Trials Registry. http://www.nctr.nhrec.net/. Registered April 14th 2016.

Abdominal scar endometriosis

BackgroundAbdominal scar endometriosis is an uncommon pathology. It can occur in any abdominal scar, most often after a surgical procedure on the uterus.AimThe purpose of this study is to highlight the potential pitfall in the diagnosis of this disease.Patients and methodsThis retrospective study reviewed all cases of proven abdominal scar endometriosis seen in a 5-year period (2002–2006) in our hospital, noting the demographic data of the patients and management. They were all treated by the same surgeon and also had histopathological confirmation of the lesion.ResultsA total of 14 women were treated during this period. They were all pre-menopausal. The mean age was 29.1years (range 20 to 42). Presenting symptoms included painful ‘heaped-up’ scars and cyclical pain related to their menstrual periods. They were referred to the general surgical clinic with various diagnoses such as incisional hernia, granuloma, keloid scar etc. All the patients had history of previous surgical procedures on the uterus for various indications. Treatment was a wide excision of the lesion with apposition of the edges only. Specimens were examined histologically and confirmed to be endometriosis. The follow up periods were rather short as the patients stopped to attend the hospital. During this period, there was no recurrence or wound break-down.ConclusionAlthough scar endometriosis is a rare entity, a good and diligent surgical history and a high index of suspicion are the keys for a pre-operative diagnosis.

Assessment of sublingual misoprostol as first-line treatment for primary post-partum hemorrhage: results of a multicenter trial.

The study investigated the effectiveness of sublingual misoprostol when used as primary treatment of primary post‐partum hemorrhage (PPH) in a low‐income country.

Views of senior health personnel about quality of emergency obstetric care: A qualitative study in Nigeria

Background Late arrival in hospital by women experiencing pregnancy complications is an important background factor leading to maternal mortality in Nigeria. The use of effective and timely emergency obstetric care determines whether women survive or die, or become near-miss cases. Healthcare managers have the responsibility to deploy resources for implementing emergency obstetric care. Objectives To determine the nature of institutional policies and frameworks for managing obstetric complications and reducing maternal deaths in Nigeria. Methods Thirty-six hospital managers, heads of obstetrics department and senior midwives were interviewed about hospital infrastructure, resources, policies and processes relating to emergency obstetric care, whilst allowing informants to discuss their thoughts and feelings. The interviews were audiotaped, transcribed and analyzed using Atlas ti 6.2software. Results Hospital managers are aware of the seriousness of maternal mortality and the steps to improve maternal healthcare. Many reported the lack of policies and specific action-plans for maternal mortality prevention, and many did not purposely disburse budgets or resources to address the problem. Although some reported that maternal/perinatal audit take place in their hospitals, there was no substantive evidence and no records of maternal/perinatal audits were made available. Respondents decried the lack of appropriate data collection system in the hospitals for accurate monitoring of maternal mortality and identification of appropriate remediating actions. Conclusion Healthcare managers are handicapped to properly manage the healthcare system for maternal mortality prevention. Relevant training of healthcare managers would be crucial to enable the development of strategic implementation plans for the prevention of maternal mortality.

Mainstreaming youth-friendly health services into existing primary health care facilities: experiences from South-South Nigeria

Abstract Background Youth friendly services, an evidence based approach to overcome the barriers experienced by youths in accessing care, is poorly implemented. The Medical Women’s Association of Nigeria (MWAN) Rivers State chapter, was supported by Ford Foundation to mainstream youth-friendly health services (YFHS) into existing primary health care facilities in two hard-to-reach communities. This paper presents the interventions, findings, challenges and recommendations. Methods This study project was implemented in stages: design, baseline survey, interventions and evaluation, between 2014 and 2016. Interventions included facility modifications, health worker capacity building, school and community outreaches, peer group activities, and interpersonal communication. Pre-and-post-intervention surveys were carried out among in- and out-of-school youths to determine the effects of the interventions. Results The most commonly stated barriers to uptake of youth friendly health services included: unavailability of services (154; 33.1%), unavailability of health care workers (167; 38.9%), unaffordability of services (108; 45.8%) and difficulty in communicating with health workers (85; 36.0%). Post-intervention, utilization improved across all services while the perception of barriers to utilization of services reduced (p < 0.05). The interventions implemented increased the odds of youths utilizing YFHS 1.81 times (95% CI = 1.39–2.37). Conclusion Facility modifications, capacity building of health workers, school and community outreaches, peer group activities, and interpersonal communication improved utilization across all services while the perception of barriers to utilization of services reduced. Implementation of YFHS is impacted by external factors often beyond the control of project implementers. Innovative solutions outside of routine health care delivery systems are critical for success. Further evaluation to explore the effect of these interventions is needed. Strengthening of health systems remains a vital strategy for scale-up of YFHS.

Prevalence and risk factors for maternal mortality in referral hospitals in Nigeria: a multicenter study

Introduction While reports from individual hospitals have helped to provide insights into the causes of maternal mortality in low-income countries, they are often limited for policymaking at national and subnational levels. This multisite study was designed to determine maternal mortality ratios (MMRs) and identify the risk factors for maternal deaths in referral health facilities in Nigeria. Methods A pretested study protocol was used over a 6-month period (January 1–June 30, 2014) to obtain clinical data on pregnancies, births, and maternal deaths in eight referral hospitals across eight states and four geopolitical zones of Nigeria. Data were analyzed centrally using univariate, bivariate, and multivariate statistics. Results The results show an MMR of 2,085 per 100,000 live births in the hospitals (range: 877–4,210 per 100,000 births). Several covariates were identified as increasing the odds for maternal mortality; however, after adjustment for confounding, five factors remained significant in the logistic regression model. These include delivery in a secondary health facility as opposed to delivery in a tertiary hospital, non-booking for antenatal and delivery care, referral as obstetric emergency from nonhospital sources of care, previous experience by women of early pregnancy complications, and grandmultiparity. Conclusion MMR remains high in referral health facilities in Nigeria due to institutional and patient-related factors. Efforts to reduce MMR in these health facilities should include the improvement of emergency obstetric care, public health education so that women can seek appropriate and immediate evidence-based pregnancy care, the socioeconomic empowerment of women, and the strengthening of the health care system.

Screening for Gestational Diabetes Mellitus: Findings from a Resource Limited Setting of Nigeria

Diabetes is a growing non communicable disease (NCD) epidemic. Current international guidelines dictate that in pregnancy, universal screening for GDM for early detection is essential to improve feto-maternal outcomes. However in resource limited settings, risk based screening is still in practice. We undertook records-based review of 837 women who accessed antenatal care between November 2014 and October 2015. The aim was to evaluate the pattern of screening and clinical outcomes of GDM in a resource limited setting of the Niger Delta region of Nigeria. Only 3.7% of the study population representing 31 women was screened for GDM, giving the Original Research Article Ogu et al.; BJMMR, 20(11): 1-8, 2017; Article no.BJMMR.31966 2 overall prevalence of GDM among study participants as 3.3% (28 women). A comparison of fetomaternal outcomes between women screened for GDM and those not screened for GDM showed comparable proportions for gestational age at delivery, mode of delivery and fetal outcome relating to hypoglycaemia, respiratory distress and neonatal jaundice. Also, a significantly higher proportion of babies born to mothers who were screened for GDM were admitted into the Special Care Baby Unit (SCBU). There was no significant difference between the prevalence of stillbirths, neonatal jaundice, hypoglycaemia and respiratory distress in babies born to women diagnosed with GDM compared with babies born to women not screened for GDM. Selective risk based screening for GDM may be leading to missed cases of GDM. The need for universal screening is hereby reiterated.