Facilitators and barriers to optimal home blood pressure management in patients with hypertensive disorders of pregnancy in a tertiary care facility in Abuja, Nigeria: a qualitative research study.

BACKGROUND: Nigeria has one of the highest burdens of maternal deaths globally, and hypertensive disorders of pregnancy (HDP) are the leading cause of maternal morbidity and mortality in the country. There is a significant implementation gap in utilizing evidence-based practices for the management of HDP in Nigeria. This study evaluated facilitators and barriers to implementing a home blood pressure monitoring program to improve management of HDP. METHODS: From August 2022 to September 2022, we conducted 15 semi-structured, key informant interviews and 4 focus group discussions among patients, health care workers, and administrators at University of Abuja Teaching Hospital (UATH), a tertiary care centre in Nigeria. The study used the Consolidated Framework for Implementation Research to assess five domains: individual characteristics, inner and outer settings, intervention characteristics, and process of implementation. Audio files were transcribed, and data were analysed using a combination of inductive and deductive approaches. We also conducted 32 brief surveys on the participants to assess acceptability, appropriateness, and feasibility of a blood pressure monitoring program. RESULTS: The study sample consisted of healthcare workers (n=22) including specialists in cardiology, obstetrics and gynaecology, maternal-foetal medicine, nurses/midwives and resident doctors as well as patients (n=10). Mean (SD) age was 39.5 (10.9), and 78% were female. Participants identified facilitators including the perceived simplicity of home blood pressure monitoring program, high burden of HDP, and availability of a multi-disciplinary team of healthcare professionals with expertise in HDP management. Barriers identified were cost, limited knowledge of HDP amongst patients, limited transportation networks, inconsistent management protocols, and inadequate manpower and facilities. Survey results indicated that between 81% and 88% of participants reported that a blood pressure monitoring program would be acceptable, 56%-72% reported that it would be appropriate, and 47%-69% reported that it would be feasible. CONCLUSION: This study identified facilitators and barriers while highlighting key implementation strategies to leverage and effectively address these respectively to enable successful implementation of a home blood pressure monitoring program. It also demonstrated that a home blood pressure monitoring program was considered acceptable, appropriate and feasible among respondents interviewed at UATH.

Correlation of female age with outcome of IVF in a low-resource setting.

OBJECTIVE: To determine the effect of female age on pregnancy outcome after in vitro fertilization/embryo transfer (IVF-ET). METHODS: A prospective study was conducted involving 266 women who had IVF-ET at Nisa Fertility and Genetic Center, Abuja, Nigeria. All eligible consenting women were recruited to the study. The main outcome measure was clinical pregnancy. Data were analyzed using IBM SPSS Statistics version 25. P < 0.05 at 95% confidence intervals was taken as significant. RESULTS: A total of 266 patients were recruited and included in the study; 104 pregnancies were recorded, giving an overall pregnancy rate of 39.1%. The age range of the patient was 26-43 years (mean age 33.9 ± 2.41 years) while the mean number of embryo transfers per patient was 2.2. The clinical pregnancy rate for women aged below 30 years was 69.4% while the pregnancy rate for patients aged 30-34 years, 35-39 years, and 40-43 years was 52.6%, 24.7%, and 9.4%, respectively (P < 0.0001). CONCLUSION: The study found that the success rate of IVF-ET decreases significantly in women aged over 34 years. Women should be counseled about the age-related risk of infertility and referred to a fertility center as early as possible.

A comparative study on the effectiveness of paracervical block and parenteral diclofenac for pain relief during manual vacuum aspiration.

Objective: To compare the effectiveness of paracervical block with intramuscular Diclofenac for pain relief during manual vacuum aspiration (MVA) for early pregnancy losses. Methodology: This was an open label randomized controlled trial. Participants were randomized into two therapeutic groups (A and B) using computer generated numbers. Group A received intramuscular Diclofenac 75 mg. Group B received paracervical block using 1% Lidocaine. Participants were asked to rate their pain level on a continuous 10 cm visual analogue scale (VAS) from 0 (no pain) to 10 (the worst pain ever) within 5 minutes of completing the procedure. Participants' level of satisfaction was assessed within 30 minutes of completing the MVA using Likert scale. Data was analysed using the Statistical Package for Social Sciences (SPSS), Version 20. Test of statistical significance was set at 95% confidence level (P < 0.05). The primary outcome was the level of pain felt by the patient during the procedure (10 cm VAS). Secondary outcomes included patient's satisfaction and adverse events. Results: There was significant difference in the mean pain level between the intramuscular diclofenac group; 6.5±1.5 (moderate) and those that received paracervical block; 2.3±1.5 (mild), (p-value=0.005). Patients' satisfaction was also better in paracervical block group compared to intramuscular diclofenac group, (p-value=0.005). Both groups were comparable in terms of complications and drug side effects. Conclusion: Findings from the study suggest that the use of paracervical block compared to intramuscular Diclofenac for pain relief during MVA for incomplete miscarriage significantly reduced pain, improved patients' satisfaction and was comparably safe.

Clinical characteristics and outcome of the first 200 patients hospitalized with coronavirus disease-2019 at a treatment center in Abuja, Nigeria: a retrospective study.

Introduction: globally, the ravaging effect of the coronavirus disease-2019 (COVID-19), pandemic is evident on public health and the global economy. We aimed at describing the clinical characteristic and management outcome of COVID-19 patients in Abuja, Nigeria. Methods: we conducted a retrospective study by reviewing the hospital charts of the first 200 COVID-19 patients admitted at the isolation center, University of Abuja Teaching Hospital (UATH), Gwagwalada. Extracted data includes; demographic data, clinical symptoms, underlying comorbidities, and clinical outcomes. The outcome of interest was either discharged or died. Data was analyzed using the Statistical Package for Social Sciences (SPSS) version 20.0. Results: the median age was 45 years (range 2-84 years). Majority of the patients were males (66.5%). The most affected age group was 50-59 years (21%). Children and adolescents were least affected; less than 10 years constituted 2.5% and 10-19 years constituted 4.5%. The commonest symptoms at presentation were fever (94%) and cough (92%). Ninety-four patients (47%) had underlying comorbidities; the commonest was hypertension (36%). Based on disease severity; 126 (63%) had mild disease, 22 (11%) had moderate disease and 52 (26%) had severe disease. The commonest complication was Acute Respiratory Distress Syndrome (ARDS) seen in 29 (14.5%) patients. Out of the 200 cases managed, 189 (94.5%) were discharged in a stable condition while 11 (5.5%) died. Patients with under lying comorbidities had 9.6% death rate while those without comorbidities had 1.9% death rate. Conclusion: among Nigerian patients', COVID-19 affects males more than females while children and adolescents were least affected. The study highlighted the clinical features of COVID-19 patients. The overall mortality rate is low among Nigerian patients compared to patients in the USA and Europe. This study shows that advanced age, presence of underlying comorbidities and disease severity is associated with the risk of dying from COVID-19.

Prevalence and materno-fetal outcomes of preeclampsia/eclampsia amongst pregnant women at a teaching hospital in north-central Nigeria: a retrospective cross-sectional study.

BACKGROUND: Preeclampsia/eclampsia (PE/E) contributes significantly to maternal, perinatal morbidity and mortality in Nigeria. The objectives of the study were to ascertain the prevalence, materno-fetal outcomes and sociodemographic factors associated with PE/E at Nigerian Teaching Hospital from September 2014 to August 2019. METHODS: This was a retrospective cross-sectional study that analyzed deidentified secondary data of women managed for PE/E at a teaching hospital in north-central, Nigeria. Descriptive statistics were used to determine sample characteristics and study outcome estimates. Bivariate analysis was used to test for associations between sociodemographic factors and PE/E, materno-fetal outcomes while logistic regression analysis was used to test for the magnitude of these associations. The significance level was set at P < 0.05. RESULTS: The prevalence of PE/E in this study was 3.60%. Preeclampsia was diagnosed in 3.02% of cases while eclampsia was the diagnosis in 0.58%. Case fatality rate was 3.9% and still birth rate was 10.7%. Majority of women (85.4%) did not have any maternal complication nor unfavorable outcome. Majority (67.7%), of babies weighed less than 2500 g and birth weight was the only sociodemographic factor that was significantly associated with fetal outcome (X2 = 15.6, P < 0.001). CONCLUSIONS: The prevalence of PE/E in this study is high and is associated with high maternal and perinatal deaths. Majority of the cases of PE/E as well the fatalities occurred in women who had no formal education, unbooked and referred to the teaching hospital with worsening conditions. There is need for explorative research on community factors associated with PE/E and its outcome towards prevention and early management of cases.

Applying the WHO ICD-MM classification system to maternal deaths in a tertiary hospital in Nigeria: A retrospective analysis from 2014-2018.

BACKGROUND: Addressing the problem of maternal mortality in Nigeria requires proper identification of maternal deaths and their underlying causes in order to focus evidence-based interventions to decrease mortality and avert morbidity. OBJECTIVES: The objective of the study was to classify maternal deaths that occurred at a Nigerian teaching hospital using the WHO International Classification of Diseases Maternal mortality (ICD-MM) tool. METHODS: This was a retrospective observational study of all maternal deaths that occurred in a tertiary Nigerian hospital from 1st January 2014 to 31st December,2018. The WHO ICD-MM classification system for maternal deaths was used to classify the type, group, and specific underlying cause of identified maternal deaths. Descriptive analysis was performed using Statistical Package for Social Sciences (SPSS). Categorical and continuous variables were summarized respectively as proportions and means (standard deviations). RESULTS: The institutional maternal mortality ratio was 831/100,000 live births. Maternal deaths occurred mainly amongst women aged 25-34 years;30(57.7%), without formal education; 22(42.3%), married;47(90.4%), unbooked;24(46.2%) and have delivered at least twice;34(65.4%). The leading causes of maternal death were hypertensive disorders in pregnancy, childbirth, and the puerperium (36.5%), obstetric haemorrhage (30.8%), and pregnancy related infections (17.3%). Application of the WHO ICD-MM resulted in reclassification of underlying cause for 3.8% of maternal deaths. Postpartum renal failure (25.0%), postpartum coagulation defects (17.3%) and puerperal sepsis (15.4%) were the leading final causes of death. Among maternal deaths, type 1, 2, and 3 delays were seen in 30(66.7%), 22(48.9%), and 6(13.3%), respectively. CONCLUSION: Our institutional maternal mortality ratio remains high. Hypertensive disorders during pregnancy, childbirth, and the puerperium and obstetric haemorrhage are the leading causes of maternal deaths. Implementation of evidence-based interventions both at the hospital and community levels may help in tackling the identified underlying causes of maternal mortality in Nigeria.

Hepatitis B virus sero-prevalence amongst pregnant women in the Gambia.

BACKGROUND: Infection with Hepatitis B virus (HBV) is a serious public health problem worldwide, with over 360 million carriers. Sixty million of these are resident in Sub-saharan Africa. Hepatitis B infection is the cause of Hepatocellular carcinoma (HCC), which is the second commonest cause of death from cancers among women in The Gambia. Vertical transmission is the commonest route of spread of Hepatitis B Virus in many endemic areas. The main aim of the study was to determine the sero-prevalence of Hepatitis B surface antigen (HBsAg) among pregnant women attending antenatal clinic at the Edward Francis Small Teaching Hospital, Banjul, The Gambia. METHODS: Four hundred and twenty six pregnant women were recruited from our antenatal clinics and tested for HBsAg. Serum Hepatitis B surface antigen (HBsAg) was tested using commercial rapid diagnostic Elisa kits at the point of care. RESULTS: A prevalence rate of 9.20% among all pregnant women studied was found. Women who were likely to have been vaccinated had a prevalence rate of 2.30% whiles those unlikely to have been vaccinated had a prevalence of 13.71%. There was a statistically significant difference between those likely to have been vaccinated and those unlikely to have been vaccinated. CONCLUSION: The prevalence of hepatitis B infection is very high among pregnant women at EFSTH as in the high endemic zone that is more than 8%. However the prevalence rate is lower than the national average of 15%. The prevalence is of moderate endemicity among the women who likely received vaccination during childhood. More interventions during pregnancy need to be undertaken if more successes are to be registered.

Early Versus Delayed Oral Feeding after Uncomplicated Cesarean Section under Spinal Anesthesia: A Randomized Controlled Trial.

OBJECTIVE: The objective of this study is to compare the safety of early versus delayed oral feeding after uncomplicated cesarean section (CS) under spinal anesthesia. METHODS: This was a randomized, controlled trial that enrolled 152 women who had uncomplicated CS under spinal anesthesia between January 2014 and June 2014. Women in the early feeding group had sips of oral fluid 6 h postoperatively while those in the delayed feeding group were on nil per oral for the first 24 h after surgery before commencement on liquid diet. Primary outcome measure was development of symptoms of paralytic ileus while secondary outcome measures included time interval to return of bowel sound, duration of hospital stay, and patients satisfaction which was determined using a visual analog score. RESULTS: The incidence of mild ileus symptoms was similar in both groups. Early-fed group had significantly shorter mean postoperative time intervals to return of bowel sound, (7.3 h vs. 11.5 h [P = 0.005]), passage of flatus, (30.7 h vs. 37.5 h [P = 0.009]). Hospital stay was also significantly shorter in the early feeding group, (4.2 days vs. 4.9 days [P < 0.001]). Early-fed women had higher levels of satisfaction. CONCLUSION: Early initiation of oral feeding after uncomplicated CS under subarachnoid block is not associated with increased incidence of gastrointestinal symptoms or paralytic ileus.

Maternal and fetal outcomes of emergency obstetric referrals to a Nigerian teaching hospital.

Our study sought to determine the maternal and fetal outcomes of emergency obstetric referrals to a Nigerian teaching hospital as well as assess reasons for these referrals. We enrolled women referred or who presented themselves to the emergency obstetric unit for management of complications of pregnancy, labour, delivery or the puerperium. The majority presented late, their mean duration of stay at the referring facility being 22.25 h. Only nine (7.3%) were transported by ambulance. Severe pre-eclampsia and eclampsia (in 33, 26.8%) were the commonest obstetric indications for referral. Stillbirths occurred in 20/122(16.4%). There were eleven maternal deaths, giving an emergency referral fatality rate of 8.9%. Both maternal and fetal outcomes of these emergency obstetric referrals were poor owing mainly to late presentation, this being the result, among other factors, of an inefficient referral system.

Hypertensive disorders in pregnancy among pregnant women in a Nigerian Teaching Hospital.

BACKGROUND: Hypertensive disorders in pregnancy (HDP) represent a group of conditions associated with high blood pressure during pregnancy. It is an important cause of feto-maternal morbidity and mortality, particularly in developing countries. The aims of the study were to find the prevalence of hypertensive disorders and its associated risk factors among women attending the antenatal clinic of Usmanu Danfodiyo University Teaching Hospital,(UDUTH) Sokoto. MATERIALS AND METHODS: A longitudinal study of 216 consecutively recruited women that were less than 20 weeks pregnant at booking was carried out. Blood pressure was measured for each woman at booking and at subsequent visits. Urinalysis was done at booking and whenever blood pressure was elevated. Patients were followed-up to delivery and 6 weeks postpartum. Data entry and analysis was done using Statistical Analysis System (SAS) statistical package. RESULTS: The prevalence of HDP in the study was 17% while preeclampsia was 6%. Previous history of preeclampsia (P < 0.001; Relative risk (RR) 4.2; conficence interval (CI) 2.144-6.812), multiple gestation (P < 0.03; RR 3.8; CI 1.037-6.235), gestational diabetes (P < 0.02; RR 4.8; CI 1.910-6.751) and obesity (P < 0.002; RR 2.7; CI 1.373-5.511) were the significant risk factors in the development of HDP among the study population. CONCLUSION: The prevalence of HDP in the study group is high. Therefore, paying attention to the risk factors will ensure early detection and prevention of the progression of the disease and its sequelae.

On the safety of diagnostic ultrasound in pregnancy: have we handled the available data correctly?

Robust evidence of the bioeffects of ultrasound is available from animal studies but human studies are less convincing. Nevertheless, it is disturbing that the only response to safety issues is a twenty-year old principle known as ALARA (As Low As Reasonably Applicable). Using experience from obstetrics and toxicology, and drawing information mainly from two recent systematic reviews and meta-analysis that extensively covered the subject of ultrasound safety, this review captures the current knowledge of ultrasound bioeffects and suggests that it may be time for an international, multidisciplinary meeting on ultrasound safety to decide how to provide the evidence (available data) to patients and sonographers in a succinct manner.

On the Safety of Diagnostic Ultrasound in Pregnancy: Have we Handled the Available Data Correctly?

Robust evidence of the bioeffects of ultrasound is available from animal studies but human studies are less convincing. Nevertheless; it is disturbing that the only response to safety issues is a twenty-year old principle known as ALARA (As Low As Reasonably Applicable). Using experience from obstetrics and toxicology; and drawing information mainly from two recent systematic reviews and meta-analysis that extensively covered the subject of ultrasound safety; this review captures the current knowledge of ultrasound bioeffects and suggests that it may be time for an international; multidisciplinary meeting on ultrasound safety to decide how to provide the evidence (available data) to patients and sonographers in a succinct manner

Prevalence of malaria parasitemia amongst asymptomatic pregnant women attending a Nigerian teaching hospital.

BACKGROUND: Malaria parasitemia among pregnant women is associated with complications to mother and the unborn fetus. There is paucity of data on asymptomatic malaria parasitemia, particularly in the northwest region of Nigeria. The objectives of this study were to determine the prevalence of malaria parasitemia in asymptomatic pregnant women and to estimate the packed cell volume (PCV) of this group of pregnant women. MATERIALS AND METHODS: This was a cross-sectional, descriptive study of only well pregnant women recruited consecutively at the time of booking for antenatal care. Thick film microscopy and qualitative immunoassay test for malaria parasite (MP) were performed for all the women. PCV estimation was also done using the micro-centrifuge method and comparison was made for women with parasitemia with those without MP. Some socio-demographic variables were also analyzed. Chi-square test was used to test for significance and a P-value less than 0.05 was considered statistically significant. RESULTS: Two hundred and twenty-five healthy pregnant women were studied. Seven women (3.1%) had MP by direct microscopy while 11 (4.8%) were MP positive with the qualitative immunoassay test. One hundred and eighty-five (82%) of the women were literate while 128 (57%) used insecticide treated mosquito nets in their homes. The mean PCV of the women with positive MP was 30.57 ± 2.26 as against 32.89 ± 2.45 for those without parasitemia (P < 0.05). CONCLUSION: The prevalence of asymptomatic malaria parasitemia in the study group was low but there was associated anemia in those with parasitemia. The use of intermittent preventive treatment is recommended for all pregnant women including those who are asymptomatic to forestall complications like maternal anemia.

Magnesium sulphate therapy in eclampsia: the Sokoto (ultra short) regimen.

BACKGROUND: Continuing the administration of magnesium sulphate for 24 hours after the last fit in patients with eclampsia is at best empirical. The challenge of such a regimen is enormous in low-resource countries. The objective of this study was to assess the effectiveness of an ultra-short regimen of magnesium sulphate in eclamptics. FINDINGS: This was a prospective, cohort study of eclamptic patients admitted between July 2007 and June 2008 that were given 4 grams magnesium sulphate intravenously and 10 grams intramuscularly (5 grams in each buttock) as the sole anticonvulsant agent. Main outcome measure was the absence of a repeat fit. Other aspects of eclampsia management were as in standard practice. One hundred and twenty one (121) patients were managed with this regimen. There were 29 ante partum, 76 intrapartum and 16 post partum cases of eclampsia. Most of the patients were primigravidae (100; 83%) with an average age of 18.7 years. There were nine cases (7.4%) of recurrent fits that occurred within four hours of the loading dose. One recurrent fit occurred in the ante partum group, seven in the intra partum and one in the post partum group. There were 12 maternal deaths giving a case fatality rate of 9.9%. CONCLUSION: Limiting the dosage of magnesium sulphate to 14 grams loading dose (4 grams intravenous and 10 grams intramuscular) was effective in controlling fits in 92.6% of cases in the study group. A properly conducted, randomized controlled trial is needed to test our proposed regimen.

Fetal outcome following cesarean section in a university teaching hospital.

OBJECTIVE: To evaluate fetal outcome for the various indications for cesarean section. METHODOLOGY: A review of all cases of cesarean section that were done in the maternity unit at Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria, between January 2006 and April 2007, with emphasis on indications and perinatal outcome. RESULTS: There were 2562 total deliveries within the study period and 112 perinatal deaths giving a perinatal mortality rate of 43.7 per 1000 live births. Cesarean section accounted for 216 of the deliveries (8.4%) with 24 perinatal deaths (11.1%). Perinatal mortality from Cesarean sections accounted for 21.4% of the total deaths with severe birth asphyxia responsible for most perinatal deaths, 17 of 24 (70.8%). There were 174 emergency sections with 22 perinatal deaths, while 42 elective sections had 2 perinatal deaths. The main indications for cesarean section were cephalopelvic disproportion, 86 (39.8%); previous section plus an obstetric abnormality, 39 (18.1%); and prolonged obstructed labor, (10.2%), with perinatal deaths of 3, 2 and 1, respectively. CONCLUSIONS: The perinatal mortality among the cesarean deliveries were 11.1%, and the main cause of death was severe birth asphyxia. Emergency cesarean section was more likely than elective to result in a perinatal loss. The indication with the poorest fetal outcome was prolonged obstructed labor.

National data system on near miss and maternal death: shifting from maternal risk to public health impact in Nigeria.

BACKGROUND: The lack of reliable and up-to-date statistics on maternal deaths and disabilities remains a major challenge to the implementation of Nigeria's Road Map to Accelerate the Millennium Development Goal related to Maternal Health (MDG-5). There are currently no functioning national data sources on maternal deaths and disabilities that could serve as reference points for programme managers, health advocates and policy makers. While awaiting the success of efforts targeted at overcoming the barriers facing establishment of population-based data systems, referral institutions in Nigeria can contribute their quota in the quest towards MDG-5 by providing good quality and reliable information on maternal deaths and disabilities on a continuous basis. This project represents the first opportunity to initiate a scientifically sound and reliable quantitative system of data gathering on maternal health profile in Nigeria. OBJECTIVE: The primary objective is to create a national data system on maternal near miss (MNM) and maternal mortality in Nigerian public tertiary institutions. This system will conduct periodically, both regionally and at country level, a review of the magnitude of MNM and maternal deaths, nature of events responsible for MNM and maternal deaths, indices for the quality of care for direct obstetric complications and the health service events surrounding these complications, in an attempt to collectively define and monitor the standard of comprehensive emergency obstetric care in the country. METHODS: This will be a nationwide cohort study of all women who experience MNM and those who die from pregnancy, childbirth and puerperal complications using uniform criteria among women admitted in tertiary healthcare facilities in the six geopolitical zones in Nigeria. This will be accomplished by establishing a network of all public tertiary obstetric referral institutions that will prospectively collect specific information on potentially fatal maternal complications. For every woman enrolled, the health service events (care pathways) within the facility will be evaluated to identify areas of substandard care/avoidable factors through clinical audit by the local research team. A summary estimate of the frequencies of MNM and maternal deaths will be determined at intervals and indicators of quality of care (case fatality rate, both total and cause-specific and mortality index) will be evaluated at facility, regional and country levels. MANAGEMENT: Overall project management will be from the Centre for Research in Reproductive Health (CRRH), Sagamu, Nigeria. There will be at least two meetings and site visits for efficient coordination of the project by regional coordinators and central coordinating staff. Data will be transferred electronically by hospital and regional coordinators and managed at the Data Management Unit of CRRH, Sagamu, Nigeria. EXPECTED OUTCOMES: The outcome of the study would provide useful information to the health practitioners, policy-makers and international partners on the strengths and weaknesses of the infrastructures provided for comprehensive emergency obstetric care in Nigeria. The successful implementation of this project will pave way for the long-awaited Confidential Enquiries into Maternal Deaths that would guide the formulation and or revision of obstetric policies and practices in Nigeria. Lessons learnt from the establishment of this data system can also be used to set up similar structures at lower levels of healthcare delivery in Nigeria.

Skilled attendance at delivery: who or where?

The third United Nations Process Indicator for emergency obstetric care is the proportion of all births that take place in maternity or obstetric facilities. This is in conflict with the concept of skilled attendance at delivery. Here, a case is made for emphasis to be on who conducts the delivery and not necessarily where.

Place of delivery among women who had antenatal care in a teaching hospital.

BACKGROUND: The utilization of antenatal care services does not necessarily equate to delivery at the health facility. The objectives of this study were to determine the proportion of pregnant women who had antenatal care and delivered in the hospital and the reasons for delivery elsewhere. MATERIALS AND METHODS: Pregnant women of low risk who initiated antenatal care at the University Teaching Hospital were recruited consecutively from January to June 2004 and longitudinally followed up until delivery. A two-part questionnaire was used to obtain information on biosocial data, place of delivery, accoucher, fetomaternal outcome, and reason(s) for delivery elsewhere. RESULTS: Of the 1,080 women studied, 740 (68.5%) delivered in the hospital while 340 (31.5%) delivered elsewhere. The majority (52) of the deliveries elsewhere were at the woman's home. There were more literate women amongst the hospital delivery group, while there were more women of high parity and with a previous home birth in the home delivery group (p<0.05). Fetomaternal outcomes were similar in both groups. Nurses/midwives conducted most (60%) of the home deliveries and the principal reasons for home births were privacy and lack of transport during labor. CONCLUSION: 68.5% of women who had uneventful antenatal care delivered in the hospital. Home delivery was the commonest site for delivery elsewhere and the main reasons were privacy and lack of transportation. Skilled attendants conducted most of the home deliveries with good fetomaternal outcome. There might be a need to encourage women during antenatal care to reach out for skilled attendants when home delivery becomes inevitable.