Community health workers' knowledge and practice in relation to pre-eclampsia in Ogun State, Nigeria: an essential bridge to maternal survival.

BACKGROUND: Pre-eclampsia is a leading cause of maternal and fetal morbidity and mortality worldwide. Early detection and treatment have been instrumental in reducing case fatality in high-income countries. To achieve this in a low-income country, like Nigeria, community health workers who man primary health centres must have adequate knowledge and skills to identify and provide emergency care for women with pre-eclampsia. This study aimed to determine community health workers' knowledge and practice in the identification and treatment of pre-eclampsia, as they are essential providers of maternal care services in Nigeria. METHODS: This study was part of a multi-country evaluation of community treatment of pre-eclampsia. Qualitative data were obtained from four Local Government Areas of Ogun State, in south western Nigeria by focus group discussions (N = 15) and in-depth interviews (N = 19). Participants included a variety of community-based health care providers - traditional birth attendants, community health extension workers, nurses and midwives, chief nursing officers, medical officers - and health administrators. Data were transcribed and validated with field notes and analysed with NVivo 10.0. RESULTS: Community-based health care providers proved to be aware that pre-eclampsia was due to the development of hypertension and proteinuria in pregnant women. They had a good understanding of the features of the condition and were capable of identifying women at risk, initiating care, and referring women with this condition. However, some were not comfortable managing the condition because of the limitation in their 'Standing Order'; these guidelines do not explicitly authorize community health extension workers to treat pre-eclampsia in the community. CONCLUSION: Community-based health care providers were capable of identifying and initiating appropriate care for women with pre-eclampsia. These competencies combined with training and equipment availability could improve maternal health in the rural areas. There is a need for regular training and retraining to enable successful task-sharing with these cadres. TRIAL REGISTRATION: NCT01911494 .

Birthweight and sociobiological factors in Ilorin, Nigeria.

Social and biological factors influencing birthweight of 3053 Ilorin babies were studied. The mean birth weights were 2.998 kg +/- 0.133 (SD) for males and 2.932 kg +/- 0.154 (SD) for females. Multiple regression analysis showed that maternal weight, height, age, education and ethnicity, and child's sex, significantly affected birthweight of infants. Some quadratic and interaction terms also contributed significantly to the prediction of birthweight. The strategies to control the incidence of low birth weight are discussed.

PIP: This study fills in the gap in data for Nigeria on distribution and correlates of birth weight among ethnic groups in the northern region, principally in Ilorin, the capital city of Kwara State. Data were taken from 50% of the records of normal live births from University Hospital during 1986, and may not represent those rural births delivered by traditional birth attendants. The population constitutes 80% of all city hospitals births and those referred for complications. Data included birth weight in metric units, maternal weight, age, height, parity, occupation, ethnic group, and education. Incidence of low birth weight was 18.2% (males) and 20.8% (females) and did not differ significantly by weight and sex. The mean birthweight 2.998 kg for males and 2.932 kg for females is slightly lower than those reported for southwestern Nigeria infants (3.162 kg for males and 3.015 kg for females in Ibidan). This is also lower that the mean birthweights of 3.145 kg recorded in southeastern Nigeria. The Ilorin babies, however, are considerably above northern Nigeria figures in southern Zaria (2.235 kg for males and 2.170 kg for females. Ilorin figures are similar to other equatorial Africa; i.e., rural Cameroon of 3.119 kg, Tanzania of 3.009 kg or 2.850 kg. British and American babies are higher at 3.415 kg and 3.400 respectively. The sex ratio was M:F 1.05:1. For male births, there is tendency for birthweight to rise with maternal height. There is a consistent rise in birthweight with maternal weight, and maternal education; there were significant differences by maternal occupation but not ethnicity. 68% of the variance was accounted for in the multiple regression by maternal weight, age education, height and ethnicity, and child's sex; this confirms the results of other investigators. The introduction of quadratic terms such as maternal weight and age improved the equation. Other variables such as length of gestation, maternal smoking improvement in the nutrition of pregnant women, sex education in school, and encouragement to defer marriage along with nutritional education for teenagers and reproductive age women. These measures may enhance the birthweight and hence survivability of children.

The application of operational research (OR) procedures to maternal mortality from puerperal sepsis in a rural community.

An operation research (OR) procedure on maternal mortality from puerperal sepsis was carried out in Irepodun Local Government Area of Kwara State of Nigeria. The study involved ten focus groups discussion (FGD) in two districts of the Local Government Area. The findings were analysed from three broad perspectives, that is, consumers' views, providers' views and community decision takers' views. In general, the analysis revealed that the community knowledge of puerperal sepsis is poor. In addition, limited access and prohibitive cost of orthodox health care services prevented the community from full utilization of the few available health care centres in the community. The study also revealed that there is urgent need to introduce three key interventions for an improved maternity care in the community. These interventions are community health education, health institutions development and community participation in provision of ancillary services such as transportation.

Family planning practice among Nigerian student midwives.

An analysis of the various contraceptive methods practiced by a total of 462 student midwives from the Northern and Southern parts of Nigeria over a 3-years period is presented. The differences in age distribution, the type of contraceptive agents used, the reasons for using them, and the side effects in the two groups are statistically significant. The need to provide acceptable contraceptive advice to the rural communities by the midwives is discussed.

PIP: An analysis of the various contraceptive methods practiced by a total of 462 student midwives from the Northern and Southern parts of Nigeria over a 3-year period is presented. The differences in age distribution, the type of contraceptive agents used, the reasons for using them, and the side effects in the 2 groups are statistically significant. In order for the midwives to provide acceptable contraceptive advice to the rural communities they need a positive attitude toward contraception, a more involved role in family planning policy, program planning and implementation, special training in family planning practice, and to be equipped to train various community health workers on how to distribute different types of family planning techniques in all the rural areas, especially outside of the hospital setting. This survey showed that there is a high level of awareness of contraception among the Nigerian midwives studied. It also suggests that Nigerian student midwives practice family planning although many probably use less effective methods. Respondents were mostly single and young and a majority were only 3-4 years post-secondary school. The condom was highly favored, but its use requires a high degree of responsibility and self-control. 27.9% practiced the rhythm method, and 16.2% used oral contraceptives, a relatively low proportion. IUD users were few in number. Incidence of side effects for all methods was low. The midwives are in a unique position, by their practice in rural communities, to preach awareness of contraception in order to reduce the high fertility and population rate in developing countries.

Maternal mortality at Ilorin, Nigeria.

PIP: The objectives of this study are to determine the trend of maternal mortality at the University of Ilorin Teaching Hospital, to identify the causes of death, and to identify ways of minimizing the frequency of preventable deaths. Analysis of 75 cases of maternal deaths seen over 3 1/2 years (January 1983-June 1986) was conducted. During this period, there were 26,905 births, giving a maternal mortality rate of 279/100,000. 84% of the deaths were due to direct causes while the remaining 16% were classified under the indirect and pregnancy related categories. The main direct causes of death include hemorrhage (35.6%), septicemia (24.7%), and anemia (13.7%). Other direct obstetric causes include eclampsia, anesthetic death, hemoglobinopathy, and ruptured uterus. The most important indirect causes were native drug intoxication (6.8%), fulminant hepatitis (5.5%), and pulmonary embolism (2.7%). The maternal mortality was highest in the age ranges 25-29 years (31.5%). Median age and parity were 27 years and 4.5 respectively. While the maternal mortality rate of 2.8/1000 is an improvement over the previous years' (1972-1982) record of 4.3/1000, it is still unacceptable. The majority of these deaths could have been prevented if delivery had occurred in a well equipped hospital where blood transfusion and surgical facilities are available, if sterile manipulations for pregnant women had been employed, if appropriate antenatal care was available, and if specialist anesthetist services were accessible. Recommendations to reduce the maternal mortality rate include improved education and training of traditional birth attendants, improved immunization of women against tetanus, and increased community involvement through education. Furthermore, policy makers must set new priorities such as encouraging greater investment in improving clinics and hospital facilities, improving access to contraception, increasing awareness of the magnitude of the problem and encouraging community leadership and action.^ieng

Health implications of traditional female circumcision in pregnancy.

PIP: A case of traditional female circumcision during pregnancy, as practiced by her ethnic group, the Igbomina-Ekiti of Kawra State, with loss of the fetus as a result of infection, is presented. The woman was circumcised at age 20 at approximately 34 weeks' gestation. She had bled profusely during the procedure and was treated locally with herbs and snail juice. She had 5 days of pain and purulent bloody discharge. On hospital admission the patient was febrile and anemic, her vulva was hemorrhagic and edematous with partially excised clitoris and labia minora. Fetal heart sounds were present. She was given 2 units of blood, anti-tetanus toxoid, and prophylactic antibiotics. 2 days later the infecting organisms and their antibiotic sensitivity were identified, pseudomonas pyocyanea and Staph. Aureus, sensitive to erythromycin and gentamycin. Her fever abated, but she developed pre-eclampsia and she went into labor spontaneously. At 3 cm dilation, labor failed to progress despite artificial rupture of the membranes. A fresh stillborn female preterm infant was delivered by cesarean section. It was felt that the fetus died because of the infection. In Nigeria, female circumcision may be done in infancy by the Yorubas in the Western States, at puberty by the Igbos in Abakaliki, before marriage by the Isoko in Bendel States and the Hausas in the North, and during the 1st pregnancy by the Ogbaru in Anambra State and the Igbomina-Ekiti in Kawra State.^ieng