RESUMO
Background: Puerperal sepsis is one of the leading causes of pregnancy-related maternal morbidity and mortality in developing countries. This study explored the complications, treatment modalities, and management outcomes of puerperal sepsis. Methods: A 10-year retrospective review of women managed for puerperal sepsis at University College Hospital, Ibadan, Nigeria between January 2009 and December 2018. Information on their socio-demographic and obstetrics characteristics, presenting complaints, treatment modalities, complications, and outcomes were obtained from the medical records. Data was analyzed with SPSS version 20. Descriptive statistics was done and results were presented in tables and chart. Results: The prevalence of puerperal sepsis during the period reviewed was 0.83%. The mean age of the women was 29.0±6.7 years. The primiparous women 53(33.5%) were mostly affected. Klebsiella spp 25(15.8%) was the most common organism isolated and most sensitive to the third generation of Cephalosporin and Quinolones. Anaemia 90(56.8%) was the most common complication and all the women had intravenous antibiotics while about half (46.5%) of those with abdominopelvic collections were managed surgically via laparotomy. The case fatality rate was 16.5%. Conclusion: Despite the low prevalence of puerperal sepsis within the period reviewed, a high case fatality was recorded. Cephalosporin and Quinolones should be considered in managing puerperal sepsis in our facility but more importantly prevention of maternal sepsis is essential.
RESUMO
Background: Universal health coverage and healthcare financing for maternal health services are essential for quality care, prevention of complication and a reduction in maternal morbidity and mortality. Objective: To evaluate the modes of healthcare financing for antenatal and delivery care among pregnant women in a tertiary health facility in South-West Nigeria. Methods: This is a four-year retrospective review of maternal healthcare financing models adopted by pregnant/postpartum women at the antenatal clinic and labour/delivery unit. Data for health financing in antenatal booking clinic for a four-year period from 2016-2019 and labour & delivery for a two-year period from 2018 and 2019 were reviewed. The information collected were - number of women that paid out-of-pocket for services, number of women that paid for services using health insurance and other means of payment during the period. Data were analysed using SPSS version 23. Result: A total of 7,129 women accessed antenatal care services during the period under review. About 58.9% of the women paid for antenatal care services out-of-pocket, 36.6% were covered under the health insurance (social and private health insurance). A total of 2,881 women accessed delivery services at the health facility. About 66.4% of the women paid out-of-pocket for both caesarean section and vaginal delivery. Prepaid health insurance was used by about 31% of the women. Conclusion: Health insurance has been available for over a decade; however prepaid healthcare financing model remains less popular. Out-of-pocket payment constitutes the predominant mode of healthcare financing for maternal healthcare among pregnant women at the tertiary health facility. The out-of-pocket payment exposes the pregnant women and her family to financial burden and catastrophic spending especially in obstetric emergency.