Birth preparedness and complication readiness among women of reproductive age group in Abakaliki, Southeast Nigeria.

BACKGROUND: Birth preparedness and complication readiness (BPCR) reduces delays in obstetric care, improves health-seeking behavior during an obstetric emergency, and improves knowledge on danger signs of pregnancy. AIMS: To assess the knowledge, perception, and practice of women on BPCR. SUBJECTS AND METHODS: This was a cross-sectional study conducted at Federal Teaching Hospital in Ebonyi state, Nigeria at the postnatal ward from June to December 2016. Women who delivered were recruited consecutively on discharge from the postnatal ward. Their knowledge, perception, and practice of BPCR in the last pregnancy were sought. Information obtained were analyzed using 2008 Epi-info™ software version 3.5.1 (Atlanta Georgia USA). RESULT: A total of 438 of 445 questionnaires were correctly filled and analyzed giving a response rate of 98.4%. Most of the women knew about birth preparedness 384 (87.7%) and complication readiness 348 (79.5%). A significant number of women did not access antenatal care within the first trimester 236 (53.9%), did not know that family planning is important in BPCR 216 (49.3%), and did not identify means of transport in the event of emergency 354 (80.8%). No provision of blood during antenatal care for the blood banking system was a common finding 258 (58.9%). In multivariate logistic regression analysis, choosing a health care provider was a common finding among literate mothers (OR = 2.8,95% CI = 1.02,7.72), woman within 25-29 years (OR = 1.09, 95%CI = 1.02,1.16), and multiparas (OR = 0.82, 95% CI = 0.67,0.99). CONCLUSION: There is increased knowledge and awareness of BPCR but the comprehensive components and practices of BPCR are still not optimal in our setting.

Rates and determinants of peripartum and puerperal anemia in Enugu, Nigeria.

BACKGROUND: Anemia in the peripartum or postpartum period could pose a significant risk for maternal morbidity and mortality during and after delivery. AIMS: To determine the rates of anemia at term and in the puerperium and describe the determinants of puerperal anemia among a cohort of women with both normal and cesarean deliveries, following uncomplicated term singleton pregnancies in Enugu, Nigeria. METHODS: A prospective longitudinal study involving women with uncomplicated singleton pregnancies who were recruited at term at two tertiary maternity centers and were followed up with the determination of hemoglobin and ferritin concentrations till 6 weeks after delivery. Data were analyzed with descriptive and inferential statistics at 95% level of confidence using the Statistical Package for Social Sciences computer software version 20.0 for Windows (IBM Corporation, Armonk, NY, USA). RESULTS: A total of 202 women were studied. The mean hemoglobin levels at term, 48 h, and 6 weeks postpartum were 11.1 ± 0.9 g/dL, 10.5 ± 0.8 g/dL, and 11.2 ± 1.0 g/dL, respectively. The proportions of women with anemia at term, 48 h, and at 6 weeks postpartum were 46.0%, 72.8%, and 47.5%, respectively. Forty-eight hours postdelivery, 17.3% had anemia with low serum ferritin compared to 7.4% by 6 weeks postdelivery. Anemia at term (adjusted odds ratio [aOR] 2.02; 95% confidence interval [CI] 1.01, 4.05), anemia at 48 h postdelivery (aOR 6.17; 95% CI 3.30, 11.6), and low ferritin at 48 h postdelivery (aOR 3.11; 95% CI 1.51, 5.09) all increased the likelihood of anemia at 6-week postpartum. CONCLUSIONS: A high proportion of low-risk pregnant women in the study centers could go through delivery with undetected anemia and this would predispose to high rates of postpartum anemia. Screening of low-risk women at term and in the immediate postdelivery periods may be necessary to improve detection of such cases.

Maternal risk factors for singleton preterm births and survival at the University of Nigeria Teaching Hospital, Enugu, Nigeria.

CONTEXT: Risk factors for and survival of singleton preterm births may vary according to geographical locations because of socioeconomic differences and lifestyle. AIMS: The aim was to describe maternal risk factors and survival-to-discharge rate for singleton preterm births at the University of Nigeria Teaching Hospital and determine the relationship between maternal risk factors and the survival of singleton preterm babies. SUBJECTS AND METHODS: A comparative retrospective review of singleton preterm and term births from January 2009 to December 2013 was carried out. Statistical analysis involved descriptive and inferential statistics at 95% level of confidence using the Statistical Package for Social Sciences (SPSS) version 15 for Windows. P≤0.05 was considered significant. RESULTS: A total of 784 births including 392 singleton preterm births (aged 26-36+6) and 392 singleton term births were studied. The mean age of mothers who delivered singleton preterm babies did not differ significantly from that of mothers who delivered singleton term babies (30.2±4.9 years vs. 30.8±4.7; P=0.06). Lack of antenatal care (adjusted odds ratio [aOR]=2.63; 95% confidence interval [CI] 1.92, 6.07), Previous preterm birth (aOR=5.06; 95% CI: 2.66, 9.12), having pregnancy complications including antepartum hemorrhage, preeclampsia/eclampsia or premature rupture of membranes (aOR=5.12; 95% CI: 2.4, 11.8), being unmarried (aOR=2.41; 1.56, 3.71) and nulliparity (aOR=2.08, 95% CI: 1.22, 4.91) were independent risk factors for singleton preterm births. The average survival-to-discharge rate for preterm babies during the period was 38.4%. The mean duration of admission for singleton preterm babies was 16±5.8 days (range: 2-75 days). Whereas survival was dependent on, gestational age at birth (P<0.001) and mode of delivery (P=0.01), it was not dependent on maternal risk factors of parity, marital status, complications of pregnancy, and antenatal care. CONCLUSIONS: There was a low rate of survival of singleton preterm babies at the study center and survival was dependent on gestational age at birth and mode of delivery, but not on maternal sociodemographic risk factors for singleton preterm births. Active collaboration between the obstetrician and the neonatologist in deciding when and how to deliver these babies may provide improved chances of survival.

Effects of maturation and aging on the skeletal muscle glucose transport system.

Insulin resistance in old, compared with young, humans and animals has been well documented. The resistance is due primarily to defects in skeletal muscle. In the present study, skeletal muscle sarcolemmal membranes were purified from five age groups of female Fischer rats ranging from 2 to 24 mo. Basal specific D-glucose transport was not significantly different among any of the groups. Maximum insulin-stimulated transport was progressively decreased from 96.4 +/- 5.0 pmol.mg-1.15 s-1 in the 2-mo-old animals to 70.8 +/- 8.9 pmol.mg-1.15 s-1 in the 24-mo-old animals. Most of the decrease occurred during maturation, and in fact there was no significant difference in maximum transport among the 8-, 16-, and 24-mo-old rats. The decrease in insulin-stimulated transport in the 24-mo-old animals was due to a reduction in the number of glucose transporters translocated into the sarcolemma membrane (9.8 +/- 0.6 vs. 7.8 +/- 0.6 pmol/mg protein). The intracellular or microsomal pool of glucose transporters was not significantly different between the 2- and 24-mo-old animals (8.8 +/- 0.6 vs. 8.5 +/- 0.9/mg protein). Western blotting revealed no differences in the cellular GLUT-4 contents between the 2- and 24-mo-old rats. The number of insulin receptors (2.3 +/- 0.4 vs. 2.1 +/- 0.5 pmol/mg protein) was not significantly different. Tyrosine kinase activity of the insulin receptor was, however, significantly reduced in the 24-mo-old compared with the 2-mo-old animals.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of NIDDM on the glucose transport system in human skeletal muscle.

The purpose of this study was to investigate cellular changes in the glucose transport system in skeletal muscle of lean non-insulin-dependent diabetes mellitus (NIDDM) compared to lean nondiabetic control patients. NIDDM patients had significantly elevated fasting levels (means +/- SE) of serum glucose (10.1 +/- 1.3 vs. 5.4 +/- 0.4 mM, P less than 0.001) and serum insulin (110.8 +/- 31.1 vs. 35.9 +/- 3.6 pM, P less than 0.0025). Basal glucose transport (35.1 +/- 5.5 vs. 30.8 +/- 8.0 pM/mg protein) and cytochalasin-beta binding (3.5 +/- 1.2 vs 3.8 +/- 1.0 pM/mg protein) in isolated sarcolemmal vesicles were not significantly different between NIDDM and control groups. Insulin binding was reduced in NIDDM (0.82 +/- 0.03 vs. 1.63 +/- 0.18 pM/mg protein) as was the Kd (0.93 +/- 0.03 vs. 1.38 + 0.12 nM). Tyrosine kinase activity, as assessed from incorporation of [32P]ATP into Glu 4:Tyr 1, was significantly (P less than 0.005) reduced in NIDDM at insulin concentrations from 1-100 nM. Maximum kinase activity was depressed (1.88 +/- 0.04 vs. 2.97 +/- 0.07 fM 32P/fM insulin binding at 100 nM insulin). The number of glucose transporters in the low-density microsomes was not significantly different between NIDDM and control groups (7.01 +/- 1.40 vs. 7.65 +/- 0.90 pM cytochalasin-beta bound/mg protein). These results suggest that decreased insulin binding and diminished receptor tyrosine kinase activity play a substantial role in the development of skeletal muscle insulin resistance associated with NIDDM.