Understanding birthing preferences of women in Benin City, Nigeria: a qualitative study.

OBJECTIVE: The aim of this study was to explore women's birthing preferences and the motivational and contextual factors that influence their preferences in Benin City, Nigeria, so as to better understand the low rates of healthcare facility usage during childbirth. SETTING: Two primary care centres, a community health centre and a church within Benin City, Nigeria. PARTICIPANTS: We conducted one-on-one in-depth interviews with 23 women, and six focus groups (FGDs) with 37 husbands of women who delivered, skilled birth attendants (SBAs), and traditional birth attendants (TBAs) in a semi-rural region of Benin City, Nigeria. RESULTS: Three themes emerged in the data: (1) women reported frequently experiencing maltreatment from SBAs in clinic settings and hearing stories of maltreatment dissuaded women from giving birth in clinics, (2) women reported that the decision of where to deliver is impacted by how they sort through a range of social, economic, cultural and environmental factors; (3) women and SBAs offered systemic and individual level solutions for increasing usage of healthcare facilities delivery, which included decreasing costs, increasing the ratio of SBAs to patients and SBAs adopting some practices of TBAs, such as providing psychosocial support to women during the perinatal period. CONCLUSION: Women in Benin City, Nigeria indicated that they want a birthing experience that is emotionally supportive, results in a healthy baby and is within their cultural scope. Adopting a woman-centred care approach may encourage more women to transition from prenatal care to childbirth with SBAs. Efforts should be placed on training SBAs as well as investigating how non-harmful cultural practices can be integrated into local healthcare systems.

A facility-based study of factors associated with perinatal mortality in Tigray, northern Ethiopia.

OBJECTIVE: To identify perinatal mortality risk factors in the Southern Zone of Tigray, northern Ethiopia. METHODS: The present unmatched case-control study included data from 20 health facilities; stillbirths and neonatal deaths were included as a case group and patients with neonates who survived until discharge or day 7 postpartum were included as a control group. Perinatal mortality risk factors were investigated using bivariate and multivariate logistic regression analyses. RESULTS: There were 126 and 252 patients included in the case and control groups, respectively. Prematurity (adjusted odds ratio [AOR] 12.2; 95% confidence interval [CI] 3.46-43.17; P<0.001), delivery weight below 2500 g (AOR 11.5, 95% CI 3.16-42.36; P<0.001), and fewer prenatal visits (AOR 5.4; 95% CI 0.80-36.63; P=0.028) were determinants of perinatal mortality. Partograph use (AOR 0.2; 95% CI 0.08-0.48; P<0.001) and seeking labor care at the start of labor (AOR 0.1; 95% CI 0.01-0.96; P=0.010) were protective. Short childbirth interval (<2 years) (AOR 2.2; 95% CI 1.03-5.09; P=0.013), distance to facility (AOR 3.7; 95% CI 1.56-9.02; P=0.007), and lack of iron supplementation (AOR 3.3; 95% CI 1.16-9.76; P=0.021) were also predictors of perinatal mortality. CONCLUSION: Perinatal mortality was linked to prematurity and low delivery weight. Interventions including partograph and auscultation, as well as subsidizing transport and iron supplementation, could help in this region.

Determinants of severe anemia among laboring mothers in Mekelle city public hospitals, Tigray region, Ethiopia.

INTRODUCTION: Anemia is a global public health problem that has affected a significant number of pregnant mothers worldwide. The World Health Organization has estimated the prevalence of anemia in pregnant women at 18% and 56% in developed and developing countries, respectively. This study aimed to identify factors associated with severe anemia among laboring women in Mekelle city public hospitals, Tigray, Ethiopia. METHODS: This unmatched case-control study involved 264 (88 = cases and 176 = controls) pregnant women who were recruited when they came for delivery service in Mekelle city public hospitals. The data was collected from July to August, 2016. In this study, a systematic sampling technique was used inselecting controls, but the cases were enrolled until the required sample size was reached. Bivariate and multivariate analyses were conducted to find predictors of severe anemia. Statistically significant predictors of severe anemia were identified at P-value <0.05 and 95% confidence interval. RESULTS: A total of 264 pregnant women who came for delivery services were enrolled in this study. The major predicting variables for the occurrence of severe anemia among laboring women were residency (AOR = 3.28, 95% CI: 1.26-8.48), number of pregnancies (AOR = 2.46, 95% CI: 1.14-5.29), iron folate supplementation (AOR = 3.29, 95% CI: 1.27-8.49), dietary diversification score (AOR = 3.23, 95% CI: 1.19-8.71) and duration of menstrual cycle (AOR = 2.37, 95% CI: 1.10-5.10). The variable 'blood loss during pregnancy' (AOR = 6.63 95% CI: 2.96-14.86) was identified as a strong predictor of the outcome variable, severe anemia. CONCLUSION: This study identified determinants of severe anemia among laboring women in Mekelle city public hospitals, Northern Ethiopia. To reduce anemia, strengthening health education provision related to the importance of birth spacing and consuming diversified and iron-enriched food should be considered. Moreover, screening of pregnant women for state of anemia during their visits to health facilities, as well as de-worming for intestinal parasites infection are needed.

A novel obstetric medical device designed for autotransfusion of blood in life threatening postpartum haemorrhage.

Postpartum haemorrhage (PPH) is an obstetric emergency caused by excessive blood loss after delivery, which is the leading cause of maternal mortality worldwide. PPH can lead to volume depletion, hypovolemic shock, anaemia and ultimately death. The prevalence of PPH is disproportionately higher in low resource settings where there is limited access to skilled medical care and safe blood supplies. Current management strategies target both prevention and treatment of PPH however no alternatives currently exist to address the lack of safe blood supplies which are considered essential in emergency obstetrical care. Autotransfusion is used to salvage blood loss in a variety of clinical settings but has never been used in the context of vaginal delivery. We describe the development and testing of a novel device for the collection, filtration and autotransfusion of blood lost due to PPH. The prototype device is inexpensive and easily operated so that it may be practically deployed in low resource settings. The device is comprised of a blood collection drape, a pump apparatus, three leukocyte reduction filters and a reservoir for filtered blood. Preliminary testing demonstrates efficacy of microbial load reduction of up to 97.3%. To reduce cost and improve safety, the device is modular in design such that the drape, tubing, filters and transfusion bag may be stored sterile, used once and discarded; while the pump apparatus may be used indefinitely without the need for sterilisation. Preliminary results indicate the device confers a low cost and potentially effective means of collecting, pumping, filtering and returning blood to a patient following PPH in settings that lack safe blood supplies. This device shows promise as a method of stabilising patients suffering of PPH in low resource settings until definitive treatment is rendered with the ultimate goal of reducing maternal mortality globally.