Trends in the Management of Miscarriages with the Implementation of the Volunteer Obstetrician Scheme in Selected Primary Health Care Centres in Maiduguri, Northeastern Nigeria.

BACKGROUND: Post-abortion care (PAC) is a crucial component of emergency obstetric care, and many of the primary health care centres (PHC) in the internally displaced person (IDP) camps and host communities in Maiduguri lack it. Improved access to high-quality PACs is essential for meeting the reproductive health needs of the IDPs and reducing the maternal morbidity and mortality that can result from miscarriages. OBJECTIVE: To determine the trend in managing miscarriages in the IDP camps and host communities in Maiduguri and the impact of the volunteer obstetrician scheme (VOS) on PAC. METHODOLOGY: We conducted a longitudinal study in selected PHCs serving IDP camps and host communities in Maiduguri. The study spanned five (5) years, and we compared the management of miscarriages and PAC services one year before the VOS project, two years during the project and two years after the project. During the two-year VOS project, staff manning the PHCs had supportive supervision with hands-on training on PAC. Chi-square for trend and odd ratio with a 95% confidence interval was used as appropriate to compare the trend in PAC services provided during the study period. RESULTS: One thousand eight hundred and eight (1808) women presented with miscarriages, and 1562 (86.4%) required uterine evacuation. Medical evacuation with oral misoprostol was offered to 974 (62.4%), and manual vacuum aspiration (MVA) was used in 422 (27.0%) of the women who needed uterine evacuation. There was a statistically significant rise in the use of medical evacuation throughout the study period (52.2% before VOS, and 71.4% by the second year of VOS) with ꭓ2=41.64 and P<0.001. In comparison, the use of MVA fell from 38.6% in 2015 to 27.7% in 2019 (ꭓ2=34.74 and P<0.001). Similar rising trends were also observed in postabortion family planning acceptance (ꭓ2=22.27, P<0.001). CONCLUSION: The Volunteer Obstetrician Scheme project appears to have improved PAC services, especially medical evacuation and family planning uptake in the PHCs in IDP camps and host communities in Maiduguri, Borno State, Nigeria. We recommend task shifting of PAC services and periodic supportive supervision to ensure the quality of care.

CONTEXTE: Les soins après avortement (PAC) sont une composante cruciale des soins obstétricaux d'urgence, et de nombreux centres de soins de santé primaires (PHC) dans les camps de personnes déplacées internes (PDI) et les communautés d'accueil à Maiduguri en sont dépourvus. Un accès amélioré à des PAC de haute qualité est essentiel pour répondre aux besoins de santé reproductive des PDI et réduire la morbidité et la mortalité maternelles qui peuvent résulter des fausses couches. OBJECTIF: Déterminer la tendance dans la gestion des fausses couches dans les camps de PDI et les communautés d'accueil à Maiduguri et l'impact du Programme de bénévoles obstétriciens (VOS) sur la PAC. MÉTHODOLOGIE: Nous avons mené une étude longitudinale dans des PHC sélectionnés desservant des camps de PDI et des communautés d'accueil à Maiduguri. L'étude a duré cinq (5) ans, et nous avons comparé la gestion des fausses couches et les services de PAC un an avant le projet VOS, deux ans pendant le projet et deux ans après le projet. Pendant les deux ans du projet VOS, le personnel des PHC a bénéficié d'une supervision avec formation pratique sur la PAC. Le chi carré pour la tendance et le rapport de cotes avec un intervalle de confiance de 95% ont été utilisés, le cas échéant, pour comparer la tendance des services de PAC fournis pendant la période de l'étude. RÉSULTATS: Mille huit cent huit (1808) femmes ont présenté des fausses couches, et 1562 (86,4%) ont nécessité une évacuation utérine. Une évacuation médicale avec du misoprostol oral a été proposée à 974 (62,4%), et l'aspiration manuelle sous vide (AMV) a été utilisée chez 422 (27,0%) des femmes ayant besoin d'une évacuation utérine. On a observé une augmentation statistiquement significative de l'utilisation de l'évacuation médicale tout au long de la période de l'étude (52,2% avant le VOS et 71,4% la deuxième année du VOS) avec ꭓ2=41,64 et P<0,001. En revanche, l'utilisation de l'AMV est passée de 38,6% en 2015 à 27,7% en 2019 (ꭓ2=34,74 et P<0,001). Des tendances similaires à la hausse ont également été observées dans l'acceptation de la planification familiale après avortement (ꭓ2=22,27, P<0,001). CONCLUSION: Le projet de Programme de bénévoles obstétriciens semble avoir amélioré les services de PAC, en particulier l'évacuation médicale et l'acceptation de la planification familiale dans les PHC des camps de PDI et des communautés d'accueil à Maiduguri, dans l'État de Borno, au Nigéria. Nous recommandons de déléguer les services de PAC et une supervision de soutien périodique pour garantir la qualité des soins. MOTS-CLÉS: Communauté d'accueil, Camps de PDI, Aspiration manuelle sous vide, Évacuation médicale, Misoprostol, Soins après avortement.

Maternal mortality at the State Specialist Hospital Bauchi, Northern Nigeria.

OBJECTIVE: To analyse and document our experiences with maternal mortality with the view of finding the trends over the last seven years, common causes and attributing socio-demographic factors. DESIGN: A prospective analysis of maternal mortality. SETTING: State Specialists Hospital Bauchi, Bauchi Northeastern Nigeria. MAIN OUTCOME MEASURES: These include maternal mortality ratio for the period under review and the annual trends, age and parity most affected the direct and indirect causes of maternal mortality in our environment. RESULTS: The Maternal Mortality Ratio (MMR) for the period under review was 1,732 per 100, 000 live births. Six hundred and twenty one of the deaths (81.0%) occurred in 12,067 unbooked deliveries giving a maternal mortality ratio of 5,146 per 100,000 for unbooked mothers. This ratio is approximately eleven times that obtained in booked live deliveries. Age range was 14-44 years and the mean age was 27.8 years. The highest maternal death was in the adolescent mothers. The primigravidas had the highest maternal mortality of 28.9%. The direct obstetric causes of maternal death accounted for 79.4% of the deaths. The major causes of deaths were eclampsia 31.9%, haemorrhage 19.2% and sepsis 10.4%. Amongst the indirect causes of maternal death, anaemia was the leading cause accounting for 12.1%. The annual MMR was highest for the year 2006 (2,586 per 100,000). CONCLUSION: Maternal mortality is unacceptably high in our environment. The provision of more health facilities where basic and comprehensive antenatal care are provided, skilled attendants at birth, community mobilisation to improve antenatal attendance and the use of TBAs as a link between the pregnant women, families and communities providing important messages for a healthy pregnancy, and safe birth remain the bedrock of containing maternal mortality in our environment.

Effectiveness of Manual Vacuum Aspiration (MVA) in the Management of First Trimester Miscarriage: Experience in a Specialist Centre in North-Eastern Nigeria

Background: Safe management of abortion with an easy; simple and effective procedure is mandatory to minimise abortion related morbidities and mortalities. Aim: To assess the pattern of presentation of cases of first trimester miscarriage and the value of manual vacuum aspiration (MVA) in the management of abortion. Methods: Clinical records of 251 cases of miscarriage managed over a 3-year period 2005 - 2007 using MVA ipas aspirator were retrieved and information pertaining to age parity; gestational age at presentation; indication for MVA use; duration of hospital stay and complications encountered were retrieved for analysis and interpretation. Results: A total of 1899 gynaecological procedures were carried out over the 3-year period; out of which 251 were MVA procedures performed for various first trimester miscarriages; accounting for 13.2of the total gynaecological admissions. Sixty one (24.3) of the patients who benefited from MVA were in the 25-29 years age group; while those in the age 20-24 and 30-34 years group constituted 21.5and 20.7respectively. Grandmultiparas (53.7) constituted the majority. The procedure was performed for 50.2of the patients at 9-11 wks of gestation. Most (88.0) of the patients had the procedure performed for incomplete abortion and while the remaining 12.0were for check MVA after complete abortion and missed abortion. Most (67) of the cases were perform as outpatient procedures. There were three maternal deaths which were not related to the procedure. Conclusions: First trimester miscarriage appeared to be most common among grandmultipara and during the 9-11weeks of gestation. Most of the patients fell into the 25-29 years age group. It appears MVA is being effectively utilized in our centre

Attitude of Nigerian women to contraceptive use by men.

This study was aimed at finding the attitude of Nigerian women to contraceptive use by their male partners. A total of 417 women received the questionnaire; 71% of these were sexually active and 34.8% were not aware of any male contraceptive method. Only 1.7% reported regular use of condoms by their spouses, however this was significantly higher if the women were better educated. Most of the women had a positive attitude to contraceptive use by their spouses, as 54% (225/417) of them showed preference to male dependant contraceptives in their relationship. However, only 32.3% (135/417) of the women had ever-requested their spouse to use a condom and in just 18.5% (25/135) was such a request regularly complied with. Significantly more Muslim women prefer their partners to use a contraceptive rather than themselves (p = 0.001), but the condom usage by their spouses is significantly lower than their Christian counterparts (p = 0.000). There is a need to offer counselling on male contraceptives to both genders so that they can make an informed choice, especially with the dual protection offered by the use of condoms.

Knowledge, perceptions and attitudes of Islamic scholars towards reproductive health programs in Borno State, Nigeria.

Some reproductive health policies and activities of international development organizations continued to be criticized by some religious groups. Such criticisms can be serious obstacles in the provision of reproductive health and rights information and services in many communities. This study was conducted to find the knowledge, perception and attitude of Islamic scholars on reproductive health programs and to get some suggestions on the scholars' role in the planning and implementation of reproductive health advocacy and programming. The data were collected by in-depth interview with representative sample of selected Muslim scholars in and around Maiduguri town in Bomo State, Nigeria. All the scholars had vague or no idea of what reproductive health is all about. When they were explaining reproductive health, most of the scholars mentioned some of the rights of women especially the need for maintaining the good health of women and their children as reproductive health. Even though they have poor knowledge, all the Muslim scholars interviewed believed that reproductive health is an essential component of healthy living and the programs of the international development organizations are mostly good, but they have reservations and concern to certain campaigns and programs. Scholars that promised their contributions in enhancing reproductive health have a common condition for their continuous support to any international development organization or reproductive health program. Conformity to Islamic norms and principles are prerequisites to their loyalties. The scholars also advised the international development organizations on the need to identify themselves clearly, so that people know from where they are coming, what are their background, and the program that they want to do and the reasons for doing the program in the community.

Socio-clinical characteristics of modern contraceptives users at the University of Maiduguri Teaching Hospital.

OBJECTIVES: To determine the incidence and socio-clinical characteristics of modern contraceptive users. And the common methods clients received their first information on family planning. DESIGN: A retrospective observational review of clients between 1st of January 1996 and 31st of December 2001. SETTING: University of Maiduguri Teaching Hospital (UMTH) Maiduguri, Nigeria. METHODS AND METHODS: Records of new family planning clients were reviewed to determine among other things, age of the patients, educational background, religion, number of living children and the methods chosen by the clients. The data extracted were analyzed by absolute values and percentages. Where necessary mean values and student t-test were calculated. RESULTS: There was a family planning consultation prevalence of 10% of total gynaecological consultations. All the clients were females, 79.7% were for child spacing and 17% for birth control. About 90% of those women who decided not to have any more children opted for temporary methods of contraception. Contraceptive use in teenagers was only 3.6% with peak age prevalence at 25 to 29 years. Almost half of the clients had 4 or more living children. Only 11.6% of clients first heard of family planning through the Radio or Television. CONCLUSION: For a family planning program to be effective in our community, strategic planning should target the males, teenagers and multiparous women. The electronic and print media should be involved more in the propagation of family planning programs. And women who have completed their family size should be encouraged to go for sterilization.

Survival of infants and children born to women who died from pregnancy and labour related complications.

OBJECTIVE: In response to concern raised on the high rate of maternal mortality in developing countries, this cross-sectional survey was conducted to assess the survival of infants born to mothers who died during the process of child birth. METHODOLOGY: The survey was conducted in Gwoza and Konduga Local Government Areas of Borno State, Nigeria over a 12 week period; January to March, 1996. RESULTS: Sixty four live-born infants of 76 deceased mothers were studied. The majority of the infants were either nursed by the deceased's sister or mother. Alternative or donor breast milk by a surrogate mother (usually the deceased close relation), goat or cow milk were the common form of feeding from birth to 6 months of age followed by groundnut enriched pap. Twenty (31.3%) of the infants survived upto 5 years of age while 44 (68.6%) did not. Factors favouring infant survival include nursing, up-bringing and breast-feeding by a surrogate mother (who is usually either the deceased's sister or mother), infant feeding with goat's or cow's milk, Immunization, hospital treatment of aliments, hospital delivery or maternal death in the hospital and finally when the caretaker is of low party and upper social class status. Factors responsible for infant death included prematurity, cause of maternal death was due to sepsis as a result of prolonged labour or premature rupture of fetal membranes, birth asphyxia, tetanus, respiratory problems, fever, convulsions, diaorrhea and vomiting and malnutrition. CONCLUSION: These babies are readily accepted by the society because it is believed that the caretaker would receive a lot of blessing from God. On the other hand, the death of such babies is considered a double loss even though there is a low expectation for their survival.

Community perspective of maternal mortality: experience from Konduga Local Government Area, Borno State, Nigeria.

BACKGROUND/OBJECTIVE: High maternal mortality in Nigeria in particular and Sub-Saharan Africa in general has remained one of the key indicators of our poor health care services, infrastructural facilities and negative socio-cultural attitudes to healthy living. The objective is to identify barriers to prompt and effective treatment of obstetric complications leading to maternal mortality in order to develop appropriate strategies to address them at the community level. METHOD: The study took place between 10th October and 10th December 2003. An in-depth interview guide developed by the network for the prevention of maternal mortality (NPMM), which contains mainly open ended questions, modified to suit our socio-cultural setting was used. RESULTS: There was a good understanding among the people of the area that women are dying during pregnancy, labour and puerperium. 28(93.3%) of the respondents recognized some obstetric complications. The main obstacles to accessing the hospital for emergency obstetric care were lack of money and transportation difficulties. Equipping the health facilities, employment of qualified staff, community supported emergency funds for obstetric emergency and the provision of reliable, effective and affordable transport are identified as necessary measures to prevent maternal mortality. The Local Government Areas and community leaders are to champion the cause for the provision of these facilities in their localities. CONCLUSION: There is a good understanding of obstetric complications in the community leading to maternal death. The main reasons for delay in seeking care are ignorance, poverty, lack of transportation and distance. Community enlightenment, health education, training of TBAs, poverty reduction and effective, affordable and reliable transportation are means of obviating delays in the decision and transportation leading to maternal mortality. Upgrading and re-equipping of health facilities to provide emergency obstetric care services are mandatory. Community participation in the safe motherhood drive can be ensured using the traditional rulers, religious leaders and the Local Government Authority.