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OBJECTIVE: To determine the incidence, risk factors and outcomes of babies with neonatal jaundice in a network of referral-level hospitals in Nigeria. DESIGN: A cross-sectional analysis of perinatal data collected over a 1-year period. SETTING: Fifty-four referral-level hospitals (48 public and 6 private) across the six geopolitical zones of Nigeria. POPULATION: A total of 77 026 babies born at or admitted to the participating facilities (67 697 hospital live births; plus 9329 out-born babies), with information on jaundice between 1 September 2019 and 31 August 2020. METHODS: Data were extracted and analysed to calculate incidence and sociodemographic and clinical risk factors for neonatal jaundice. MAIN OUTCOME MEASURES: Incidence and risk factors of neonatal jaundice in the 54-referral hospitals in Nigeria. RESULTS: Of 77 026 babies born in or admitted to the participating facilities, 3228 had jaundice (41.92 per 1000 live births). Of the 67 697 hospital live births, 845 babies had jaundice (12.48 per 1000 live births). The risk factors associated with neonatal jaundice were no formal education (adjusted odds ratio [aOR] 1.68, 95% CI 1.11-2.52) or post-secondary education (aOR 1.17, 95% CI 0.99-1.38), previous caesarean section (aOR 1.68, 95% CI 1.40-2.03), booked antenatal care at <13 weeks or 13-26 weeks of gestation (aOR 1.58, 95% CI 1.20-2.08; aOR 1.15, 95% CI 0.93-1.42, respectively), preterm birth (aOR 1.43, 95% CI 1.14-1.78) and labour more than 18 hours (aOR 2.14, 95% CI 1.74-2.63). CONCLUSIONS: Hospital-level and regional-level strategies are needed to address newborn jaundice, which include a focus on management and discharge counselling on signs of jaundice.
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OBJECTIVE: To determine the prevalence of maternal morbidity and death from pregnancy loss before 28 weeks in referral-level hospitals in Nigeria. DESIGN: Secondary analysis of a nationwide cross-sectional study. SETTING: Fifty-four referral-level hospitals. POPULATION: Women admitted for complications arising from pregnancy loss before 28 weeks between 1 September 2019 to 31 August 2020. METHODS: Frequency and type of pregnancy loss were calculated using the extracted data. Multilevel logistic regression was used to determine sociodemographic and clinical factors associated with early pregnancy loss. Factors contributing to death were also analysed. MAIN OUTCOME MEASURES: Prevalence and outcome of pregnancy loss at <28 weeks; sociodemographic and clinical predictors of morbidity after early pregnancy loss; contributory factors to death. RESULTS: Of the 4798 women who had pregnancy loss at <28 weeks of pregnancy, spontaneous abortion accounted for 49.2%, followed by missed abortion (26.9%) and ectopic pregnancy (15%). Seven hundred women (14.6%) had a complication following pregnancy loss and 99 women died (2.1%). Most complications (26%) and deaths (7%) occurred after induced abortion. Haemorrhage was the most frequent complication in all types of pregnancy loss with 11.5% in molar pregnancy and 6.9% following induced abortion. Predictors of complication or death were low maternal education, husband who was not gainfully employed, grand-multipara, pre-existing chronic medical condition and referral from another facility or informal setting. CONCLUSION: Pregnancy loss before 28 weeks is a significant contributor to high maternal morbidity and mortality in Nigeria. Socio-economic factors and delays in referral to higher levels of care contribute significantly to poor outcomes for women.
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Background: There is a global trend towards domiciling Obstetric and Gynaecologic ultrasound scan services and training within the Obstetrics and Gynaecology Department. This requires readiness on the part of the Obstetrics and Gynaecology residency programmes to offer hands-on training and mentorship to its trainees. This study aims to assess the services and training potential of these centres in Obstetrics and Gynaecology ultrasound in Nigeria. Methodology: A cross-sectional descriptive questionnaire-based survey among the various tertiary health facilities which offer post graduate fellowship training in Obstetrics and Gynaecology in Nigeria was conducted. A list of all the centres accredited for obstetrics and gynaecology residency training by the National Postgraduate Medical College of Nigeria was obtained. An obstetrician was identified, and a pretested self-administered questionnaire was mailed to him as a hard copy and an electronic copy was forwarded as well. The questionnaire was filled by the Obstetrician and returned for collation. The completed forms were populated into an excel spreadsheet and summary and descriptive statistics carried out. Results: There was a valid 71% response rate from the 56 accredited centres. Thirty five percent of the centres had established subspecialty units. Only 10% had fully functional ultrasound service that catered for over half of their clients. Half of the responding centres did not have any ultrasound scan machines, and these too lacked any trained personnel in ultrasound within the department. Nearly all respondents supported the drive towards an obstetrician led ultrasound scan service but majority cited lack of protocols, trained personnel and dedicated time as major impediments to achieving this ideal. Conclusions: There is a lack of preparedness for domestication of obstetric ultrasound service and training in the obstetrics and gynaecology Department in Nigeria. There is the need to address the acute shortage of personnel to expand the frontiers of ultrasound service and training.
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OBJECTIVE: To assess the level of maternal autonomy in a Nigerian community using maternal preference to sign the consent for caesarean section as the assessment tool and to evaluate the sociodemographic and obstetric correlates. METHODS: A cross-sectional survey of parturients 2-5 days after caesarean delivery in a tertiary health facility in Benin City, Nigeria using a pretested interviewer administered questionnaire to obtain information on whom they would prefer to sign the consent form for caesarean section. RESULTS: A total of 197 parturients were interviewed. The consent form was signed by 177 (90%) of the respondents. However, 96 (48.7%) preferred their spouses to sign. Maternal attainment of tertiary level education and a higher mean maternal age was significantly associated with maternal preference to sign the consent form. CONCLUSION: The level of maternal autonomy on reproductive health issues based on this simple survey is less than satisfactory. However, this study has provided baseline data for surveillance and follow-up studies of this important variable.