Quality and outcomes of maternal and perinatal care for 76,563 pregnancies reported in a nationwide network of Nigerian referral-level hospitals.

Background: The WHO in collaboration with the Nigeria Federal Ministry of Health, established a nationwide electronic data platform across referral-level hospitals. We report the burden of maternal, foetal and neonatal complications and quality and outcomes of care during the first year. Methods: Data were analysed from 76,563 women who were admitted for delivery or on account of complications within 42 days of delivery or termination of pregnancy from September 2019 to August 2020 across the 54 hospitals included in the Maternal and Perinatal Database for Quality, Equity and Dignity programme. Findings: Participating hospitals reported 69,055 live births, 4,498 stillbirths and 1,090 early neonatal deaths. 44,614 women (58·3%) had at least one pregnancy complication, out of which 6,618 women (8·6%) met our criteria for potentially life-threatening complications, and 940 women (1·2%) died. Leading causes of maternal death were eclampsia (n = 187,20·6%), postpartum haemorrhage (PPH) (n = 103,11·4%), and sepsis (n = 99,10·8%). Antepartum hypoxia (n = 1455,31·1%) and acute intrapartum events (n = 913,19·6%) were the leading causes of perinatal death. Predictors of maternal and perinatal death were similar: low maternal education, lack of antenatal care, referral from other facility, previous caesarean section, latent-phase labour admission, operative vaginal birth, non-use of a labour monitoring tool, no labour companion, and non-use of uterotonic for PPH prevention. Interpretation: This nationwide programme for routine data aggregation shows that maternal and perinatal mortality reduction strategies in Nigeria require a multisectoral approach. Several lives could be saved in the short term by addressing key predictors of death, including gaps in the coverage of internationally recommended interventions such as companionship in labour and use of labour monitoring tool. Funding: This work was funded by MSD for Mothers; and UNDP/UNFPA/ UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a co-sponsored programme executed by the World Health Organization (WHO).

Acceptability of measures aimed at preventing mother-to-child transmission of HIV among pregnant women.

OBJECTIVE: To assess the acceptability of measures aimed at preventing mother-to-child transmission of HIV among counseled and yet-to-be-counseled antenatal women in a federal medical center in Nigeria. METHODS: A valid and reliable questionnaire was interviewer administered to newly booking antenatal women who were yet to be counseled about HIV/AIDS and women on an antenatal follow-up visit who had already been counseled about HIV/AIDS. RESULTS: A total of 108 newly booked women and 116 women on follow-up visit responded to the questionnaire. The proportion of the counseled women who accepted HIV screening (98%) was significantly higher than the proportion of the yet-to-be-counseled women who would want to be screened (88%). Also, the proportions of the counseled women who accepted HIV screening so as to benefit from interventions like prevention of mother-to-child transmission, antiretroviral therapy and prevention of transmission to partner were significantly higher than the proportions among the yet-to-be-counseled women. The majority of the women in the study would accept antiretroviral drugs and avoidance of breastfeeding to prevent mother-to-child transmission, while only 29 (14%) respondents would accept cesarean section to prevent mother-to-child transmission. There was no statistically significant difference in the proportion of the counseled women (15%) who would accept cesarean section to prevent mother to child transmission when compared to the proportion among the yet-to-be-counseled women (11%). CONCLUSION: Antenatal HIV screening is acceptable to most pregnant women attending our hospital, and while many would accept antiretroviral drugs and avoidance of breastfeeding to prevent mother-to-child transmission of HIV, there is low acceptability of elective cesarean section.

Awareness and knowledge of mother-to-child transmission of HIV among pregnant women.

OBJECTIVE: To evaluate the awareness and knowledge of mother-to-child transmission of HIV and its prevention among pregnant women attending the antenatal clinic of a federal medical center in Nigeria. METHODOLOGY: Valid and reliable questionnaires were interviewer administered to pregnant women at antenatal booking during the study period, prior to being counseled on HIV/AIDS. RESULTS: All respondents were aware of HIV/AIDS. The main sources of information included posters/billboards (37%), radio (36%), television (28%) and health workers (34%). The majority (90%) of the respondents were aware that HIV/AIDS can coexist with pregnancy, but only 68% were aware of mother-to-child transmission. Transplacental route, vaginal delivery and breastfeeding were identified as routes of transmission from mother to child by 65%, 38% and 52% of respondents, respectively. Caesarean section was believed to be a route of transmission by 43% of respondents, but only 3% identified caesarean section as a method of prevention of mother-to-child transmission. CONCLUSION: Though the level of awareness of HIV/AIDS among women attending our antenatal clinic is high, the level of knowledge about mother-to-child transmission is inadequate. There is a need for adequate counseling and education about HIV/AIDS and mother-to-child transmission in antenatal clinics and also through public campaign media.