Predictors of maternal mortality in institutional deliveries in Nigeria.

BACKGROUND: Maternal mortality in poor countries reflects the under-development in these societies. Global recognition of the burden of maternal mortality and the urgency for a reversal of the trend underpin the Millenium Development Goals (MDGs). OBJECTIVE: To determine risk factors for maternal mortality in institutional births in Nigeria. METHOD: Twenty one health facilities in three states were selected using stratified multi-stage cluster sampling strategy. Information on all delivered mothers and their newborn infants within a three-month period was culled from medical records. RESULTS: A total of 9 208 deliveries were recorded. About one-fifth (20.5%) of women had no antenatal care while 79.5% had at least one antenatal visit during pregnancy. Four-fifths (80.5%) of all deliveries were normal deliveries. Elective and emergency caesarean section rates were 3.1% and 11.5% respectively. There were 79 maternal deaths and 8 526 live births, giving a maternal mortality ratio of 927 maternal deaths per 100 000 live births. No antenatal care, parity, level of education, and mode of delivery were significantly associated with maternal mortality. Low maternal education, high parity, emergency caesarean delivery, and high risk patients risk independently predicted maternal mortality. CONCLUSION: Meeting goal five of the MDGs remains a major challenge in Nigeria. Multi-sectoral approaches and focused political will are needed to revert the high maternal mortality.

Asymptomatic bacteriuria in pregnancy: evaluation of reagent strips in comparison to microbiological culture.

Screening for asymptomatic bacteriuria during pregnancy, the major risk factor for symptomatic urinary tract infection during pregnancy have been recommended. This cross sectional study was conducted to determine prevalence of asymptomatic bacteriuria in Ibadan and evaluate the diagnostic accuracy and relative cost effectiveness of dipstick tests for nitrite and leucocyte esterase in comparison to laboratory culture. Two hundred and five patients, presenting for their first antenatal visit at the University College Hospital, Ibadan, participated in the study. Urine samples obtained from the participants were subjected to two tests; reagent dipstick test for nitrite and leucocyte esterase and routine laboratory culture, which is the gold standard for diagnosis. Main outcome measures were sensitivity, specificity, positive and negative predictive values of the reagent dipstick tests as well as likelihood ratios. The prevalence of asymptomatic bacteriuria in pregnancy with routine laboratory culture and using combined leucocyte esterase and nitrite strip tests were 10.7% and 11.7% respectively. Compared with laboratory culture, combined strip tests had sensitivity, specificity and negative predictive values of 50%, 92.9% and 93.9% respectively, indicating a statistically significant lower level of accuracy (P < 0.05). The corresponding likelihood ratios for positive and negative strip tests (LR+ and LR-) were 7 and 0.5 respectively. The study concludes that combined Leucocyte esterase-nitrite dipstick test is not sufficiently sensitive and specific to be used for routine screening of bacteriuria in pregnancy in place of laboratory culture, though may be more cost effective in low resource settings.

Prevalence of violence against pregnant women in Ibadan, Nigeria.

Women are at risk of violence at all stages of their life, including during pregnancy. Using a interviewer-administered questionnaire, 306 pregnant women were interviewed in two public secondary health facilities in Ibadan to compare prevalence and risk factors of VAW before and during pregnancy. Prevalence ofVAW a year before current pregnancy was 41.5% compared to 17.7% during pregnancy. Perpetrators before pregnancy were mostly relatives (22%), while during pregnancy, partners (64%). Major reasons for violence were "not obeying instructions" (33.3%) and "misbehaving" (26%). Education (OR 0.49; 95% CI 0.29-0.83) and polygamous union (OR 9.56; 95% CI 3.71-24.63) and consumption of alcohol (OR 7.19; 95% CI 0.04-0.53) were statistically significant a year before pregnancy. Mothers occupation (OR 0.19; 95% CI 1.05-4.49); type of union (OR14.13; 95% CI 6.13-32.59), alcohol consumption by partner (OR 6.06; 95% CI 0.05-0.54); and not wanting pregnancy (OR 3.53; 95% CI 1.20-9.30) were statistically significant in the index pregnancy. Hemorrhage (7.4% vs. 4.8%), abortion (1.9% vs. 1.2%), intrauterine death (3.7% vs. 1.2%) and premature labour (9.3% vs. 3.2%) were more often found in women who experienced VAW than those who did not, the latter was statistically significant (P < 0.05). Violence avoidance strategies included 'playing along' (51.3%) and 'praying' (21%). Pregnancy was protective against VAW. Empowerment of women through education and employment is crucial. Counselling on planning of families is also necessary. Screening for violence in pregnancy and close monitoring of the abused to ensure good obstetric outcome is recommended.

Perception and practice of malaria prophylaxis in pregnancy among primary health care providers in Ibadan, Nigeria.

BACKGROUND: Pregnant women and their unborn babies are especially vulnerable to malaria. Malaria infection during pregnancy is associated with increased risk of maternal anaemia, spontaneous abortion, stillbirth, low birth weight and neonatal death. OBJECTIVE: To assess knowledge and practice of malaria prophylaxis during pregnancy among primary health care providers in Ibadan, south-western Nigeria. METHODS: Participants were randomly selected from primary health centres and private health facilities in two local governments within Ibadan municipality. All cadres of health professionals in the selected health facilities were interviewed using a semi-structured self -administered questionnaire. RESULTS: Two hundred and eighty-seven participants selected from 42 primary healthcare facilities comprising of 48 (16.7%) CHEWs, 133 (46.3%) auxiliary nurses, 84 (29.3%) trained nurses and 22 (7.7%) medical doctors completed the questionnaires. Healthcare providers in private health facilities formed the bulk (80.5%) of respondents. Respondents' knowledge of malaria prevention strategies was generally poor across all professional cadres. Only 40 (13.9%) respondents had correct knowledge of WHO strategies. Awareness of IPT was significantly higher among respondents from public health facilities compared with private health facilities--93.0% versus 80.9% (p < 0.05) One hundred and fifty-six (54.4%) respondents knew the correct drug, dosage and timing of IPT. Only forty-six (16.0%) respondents were aware that at least three doses of IPT were required for HIV patients. Pyrimethamine was significantly more commonly prescribed in private health facilities compared with public health facilities (p < 0.05) Chloroquine was still commonly prescribed by respondents in public and private health facilities. The use of insecticide treated nets was recommended by 77.4% of respondents. CONCLUSION: Knowledge about current malaria prevention strategies during pregnancy is poor among health care providers at the primary level of care. Efforts aimed at improving malaria prevention in the primary health care setting must incorporate providers in private health facilities who are responsible for a larger proportion of health care delivery at this level.

Parameters of nutrition in school girls in southwestern Nigeria.

OBJECTIVES: To document trends in parameters of nutrition in south-western Nigerian school girls in comparison with earlier reports and provide baseline data for future comparison. DESIGN: A cross-sectional study. SETTING: Fifteen secondary schools from the five local governments in Ibadan, Oyo State in south-western Nigeria. SUBJECTS: One thousand six hundred and seventy five apparently healthy female students aged between nine and twenty three years. RESULTS: One thousand six hundred and seventy three questionnaires were analysed. The mean age, mean height and mean body weight were 15.45 years +/- 2.06 (SD), 154.98cm +/- 8.4(SD) and 46.09kg +/- 8.8 (SD) respectively. The mean body fat was 11.12kg +/- 4.6 (SD); mean lean body mass (LBM) was 34.96kg +/- 4.6 (SD); mean total body water (TBW) was 25.17L +/- 3.3 (SD) and the mean body index (BMI) was 19.07kg/m2 +/- 2.7 (SD). Girls from upper socio-economic background had significantly higher values of anthropometric measurements and body composition for each age than lower socioeconomic class girls. Compared with their peers from another Nigerian city investigated two decades ago, girls in this study were significantly lighter and shorter. CONCLUSION: The study revealed a decline in nutritional parameters among adolescents. The implications of these findings for the reproductive health of Nigerian women are discussed. Serial studies to monitor trends in adolescents are recommended.