Burden and outcome of respiratory morbidities among children and adolescents with sickle cell disease-A retrospective review of emergency presentations in some Nigerian tertiary institutions.

BACKGROUND: Despite the huge burden of sickle cell disease (SCD) among Nigerian children, the burden and outcome of respiratory illnesses remain undocumented. Thus, we aimed to describe the spectrum and outcome of respiratory illnesses among SCD childrenand adolescentadmissions in ten Nigerian tertiary hospitals. METHOD: A retrospective review of the SCD admission records of children and adolescents with a confirmed diagnosis of respiratory illnesses from 2012 to 2021 in ten tertiary health facilities across five geopolitical zones in Nigeria was conducted. The data, collectedbetween March and June 2023, included the age, sex, diagnosis, complications, duration and outcome of hospitalization. RESULTS: Of the 72,333 paediatric admissions, 7,256 (10.0%) had SCD; the proportion of SCD from the total admission ranged from 2.1 to 16.3% in the facilities. Of the 7,256 children and adolescents with SCD, 1,213 (16.7%) had respiratory morbidities. Lower respiratory disease was the most common (70.0%) respiratory entity and the majority were pneumonia (40.1.0%), followed by acute chest syndrome (26.7%). Seventeen (1.4%) patients died; all had lower respiratory diseases [(acute chest syndrome ACS (11, 64.7%), pneumonia; 5, 29.4%, and asthma (1, 5.9%). Based on the proportion of deaths among overall SCD, the 17 death cases contributed 9.4% (95% CI 5.9 to 14.5). Factors associated with deaths included duration of hospitalization less than 72 hours and lower respiratory tract diseases. CONCLUSION: Sickle cell disease is a major contributor to hospitalization among Nigerian children and adolescents, with high respiratory morbidity and mortality. Pneumonia and acute chest syndrome were associated with mortality, andthe highest risk of death within the first 72 hours.

Placental Site Trophoblastic Tumour Mimicking Placenta Previa.

ABSTRACT: We present a 42-year-old Nigerian woman who had three previous caesarean sections and is being managed conservatively for placenta previa. She underwent a caesarean hysterectomy on account of uncontrollable bleeding, and histopathology revealed a placental site trophoblastic tumour.

Characterisation and prevalence of community-associated MRSA among horses, dogs, cats and their human handlers: a cross-sectional study.

Methicillin-resistant Staphylococcus aureus (MRSA) as an infectious organism of public health significance has evolved to a genetically distinct community-acquired MRSA with extended resistance to other than ß-lactams. A cross-sectional study was conducted among 149 participants handling 446 animals (240 horses and 206 companion animals). The isolates were characterised as S. aureus and MRSA based on polymerase chain reaction detection of the nuc, mecA and mecC genes and the pvl gene for differentiation as community associated/livestock associated or hospital associated. The isolation rate of S. aureus from the human handlers' samples was 26 (17.4%) and 170 (38.1%) from the animal samples. The prevalence of MRSA among the isolates was 7 (4.7%) from the human handlers and 19 (4.3%) from the animals. Dogs and dog handlers had the highest isolation rates and were more likely to be colonized by S. aureus and MRSA compared with horses, cats and their handlers. The highest prevalence of MRSA was from horses (5.0%) and dog handlers (10.6%). This study has demonstrated a high prevalence of community associated MRSA in apparently healthy animals and their human handlers. This has important implications for antibiotic selection and use as well as infection control measures.

Prevalence and Pattern of Hearing Loss among Young Adults in Tertiary Institutions with Habitual Headphone/Earphone Usage in Kaduna Metropolis.

Background: World Health Organisation estimates that 1.1 billion young people worldwide could be at risk of hearing loss due to unsafe listening practises and nearly half of the teenagers and young adults are exposed to unsafe levels of sound from the use of personal audio devices. Aim: This study aimed to determine the prevalence and pattern of hearing loss among students with habitual use of headphone/earphone in tertiary institutions in Kaduna. Participants and Methods: This was a prospective cross-sectional study of young adults with prolonged headphone/earphone usage in Kaduna and a group of nonheadphone/earphone users matched for age and sex as controls. Ethical approvals were obtained from relevant bodies and informed consent was also obtained from all participants. Data were obtained by clinical interview and audiometric evaluation of the participants and the data obtained were descriptively analysed using SPSS version 20.0. Frequency tables were generated and chi-square test and Student's t test were used to test for a possible association of variables. The level of significance was set at P < 0.05. Results: Two hundred and seventy-two prolonged headphone/earphone users with same number of controls participated in this study. The mean age for subjects and controls was 22.6 ± 3.4 and 23.2 ± 4.2, respectively. Using the better hearing ear, 48 and 20 of the subjects and controls, respectively, had hearing loss, giving a prevalence of 17.6% and 7.4% among the subjects and controls, respectively. Of the 48 subjects with hearing loss, 89.6% had a mild hearing loss. Majority, 91.7% had sensorineural hearing loss and the hearing loss was bilateral in all the participants (both subjects and controls). High frequencies were the most affected (64.6%). Conclusion: This study revealed that hearing impairment was more common among prolonged headphone/earphone users. In the majority of the prolonged headphone/earphone users, the hearing impairment was bilateral, mild, sensorineural, and mostly affects higher frequencies.

Exploring the role and lived experiences of people with disabilities working in the agricultural sector in northern Nigeria

It is estimated that over 75.0% of households in sub-Saharan Africa are involved in agriculture, and the majority of the poor in rural areas rely on agriculture for their livelihoods. One billion people living with disabilities in low- and middle-income countries are argued to make up the poorest of the poor, yet to our knowledge, no literature has captured the livelihood of people living with disabilities in the context of farming in Nigeria, specifically northern Nigeria where most of the households are involved in agriculture and related activities. Objectives: This article reports on findings from a study that sought to understand disability in the context of northern Nigerian farming, with a particular focus on the role and lived experiences of people living with disabilities working in the agricultural sector. Method: A survey questionnaire was developed and captured the experiences of 1067 people living with disabilities working in the agricultural sector across five states (Adamawa, Bauchi, Jigawa, Kaduna and Yobe) in northern Nigeria. Results: Findings indicate that people with disabilities are actively participating in agricultural activities for several reasons, which specifically included 'forced to and for survival'. When participants reported needing care, this was predominantly provided by family members. Findings also showed that participants with disabilities experienced several economic and sociocultural challenges because of their impairments. Conclusion: This study adds to the very limited literature on farmers living with disabilities in sub-Saharan Africa and so highlights the need for more research to be conducted with farmers living with disabilities in Nigeria, particularly female farmers living with disabilities. These will provide more evidence pertaining to the experiences of farmers living with disabilities in order to provide effective disability- and gender-inclusive agricultural and entrepreneurship programs in Nigeria. Contribution: The results of this research reveal important insights relating to the experiences of farmers living with disabilities in northern Nigeria, which can contribute to informing future developmental projects to achieve effective inclusion and actively benefit people living with disabilities.

Extended Spectrum Beta-Lactamase Escherichia coli in River Waters Collected from Two Cities in Ghana, 2018-2020.

Infections by Extended-Spectrum Beta-Lactamase producing Escherichia coli (ESBL-Ec) are on the increase in Ghana, but the level of environmental contamination with this organism, which may contribute to growing Antimicrobial Resistance (AMR), is unknown. Using the WHO OneHealth Tricycle Protocol, we investigated the contamination of E. coli (Ec) and ESBL-Ec in two rivers in Ghana (Odaw in Accra and Okurudu in Kasoa) that receive effluents from human and animal wastewater hotspots over a 12-month period. Concentrations of Ec, ESBL-Ec and percent ESBL-Ec/Ec were determined per 100 mL sample. Of 96 samples, 94 (98%) were positive for ESBL-Ec. concentrations per 100 mL (MCs100) of ESBL-Ec and %ESBL-Ec from both rivers were 4.2 × 104 (IQR, 3.1 × 103-2.3 × 105) and 2.79 (IQR, 0.96-6.03), respectively. MCs100 were significantly lower in upstream waters: 1.8 × 104 (IQR, 9.0 × 103-3.9 × 104) as compared to downstream waters: 1.9 × 106 (IQR, 3.7 × 105-5.4 × 106). Both human and animal wastewater effluents contributed to the increased contamination downstream. This study revealed high levels of ESBL-Ec in rivers flowing through two cities in Ghana. There is a need to manage the sources of contamination as they may contribute to the acquisition and spread of ESBL-Ec in humans and animals, thereby contributing to AMR.

Tympanometric findings among Nigerian prison inmates: A cross-sectional survey.

BACKGROUND: Prisoners, due to confinement, are isolated from contact with society and access to many of the facilities, including medical care. There is paucity of data on the middle ear function of prison inmates in the English literature globally. We aimed to assess the middle ear function of prison inmates in Kaduna, Nigeria. PARTICIPANTS AND METHODS: This was a cross-sectional comparative study of prison inmates at the Kaduna convict prison. Ethical approval was obtained from the Kaduna State Ministry of Health and the Nigerian Prison Service. Prison inmates aged 18-55 years in the Kaduna convict prison with an equal number of age and sex-matched controls from the community were enrolled. Consent was obtained from the participants. Data were collected using a structured pre-tested questionnaire. Participants had a thorough physical examination of the ears. Tympanometry was conducted on suitable participants to assess the middle ear function. Statistical Product and Service Solutions version 20.0 was used to analyse the data. RESULTS: Four hundred and thirty inmates with an equal number of controls were enrolled for the study. The mean age for the inmates and controls was 30.2 ± 7.51 and 30.4 ± 8.02 years, respectively. There were 47 female and 383 males, with a female: male of 1:8.1. Forty-six (46/397, 11.6%) of the inmates and 15 (15/423, 3.5%) of the controls had abnormal tympanograms on the right while on the left, it was 12.4% and 3.8%, respectively. The difference between the two groups was statistically significant (χ2 = 40.071, P = 0.0001). CONCLUSION: : Middle ear abnormalities are more prevalent among prison inmates than the general population. Middle ear effusion and ossicular chain disruption were the most common middle ear abnormalities affecting the prison inmates.

Stage of chronic kidney disease and cochlear function: A cross-sectional survey.

BACKGROUND: Studies have shown that hearing loss increases in patients with chronic kidney disease (CKD) with decreasing glomerular filtration rate. The hearing loss in CKD patients may worsen over time which in turn will negatively affect the patient's ability to effectively communicate with people, resulting in low self-esteem, social isolation, anger and depression. We aimed to assess the relationship between stage of CKD and hearing threshold in patients with CKD in Kaduna. PATIENTS AND METHODS: A cross-sectional study of patients with CKD in Kaduna. Individuals were selected consecutively using convenience sampling. Ethical approval and informed consent were obtained. The patients were grouped based on the stage of the disease. The pure tone audiometry was carried out using a Diagnostic Audiometer (Graphic Digi-IS, USA). The hearing threshold of the patients was then compared based on stage of the disease. The data collected was analysed using Statistical Product and Service Solutions, version 20. RESULTS: Sixty CKD patients (120 ears) were assessed. Their mean age was 43.2 ± 13.4 years and 70% were males. Of the 120 ears studied, 51 (42.5%) had normal hearing thresholds and 69 (57.5%) had hearing loss. Of the 69 ears with hearing loss, 11 (15.9%), 22 (31.9%) and 36 (52.2%) were in Stage III, IV and V, respectively, and the difference was statistically significant (P = 0.006). All those with Stage III CKD had mild hearing loss and the hearing loss worsen with advancing stage. Stage III CKD had significantly better hearing than those with stage IV and V (P < 0.001). CONCLUSION: Our study showed a statistically significant relationship between advancing stage of CKD and hearing loss. The hearing loss worsen with advancing stage of CKD.

Reducing maternal and newborn mortality in Nigeria-a qualitative study of stakeholders' perceptions about the performance of community health workers and the introduction of community midwifery at primary healthcare level.

BACKGROUND: Rural communities in Nigeria account for high maternal and newborn mortality rates in the country. Thus, there is a need for innovative models of service delivery, possibly with greater community engagement. Introducing and strengthening community midwifery practice within the Nigerian primary healthcare system is a clear policy option. The potential of community midwifery to increase the availability of skilled care during pregnancy, at birth and within postpartum periods in the health systems of developing countries has not been fully explored. This study was designed to assess stakeholders' perceptions about the performance of community health workers and the feasibility of introducing and using community midwifery to address the high maternal and newborn mortality within the Nigerian healthcare system. METHODS: This study was undertaken in two human resources for health (HRH) project focal states (Bauchi and Cross River States) in Nigeria, utilizing a qualitative research design. Interviews were conducted with 44 purposively selected key informants. Key informants were selected based on their knowledge and experience working with different cadres of frontline health workers at primary healthcare level. The qualitative data were audio-recorded, transcribed and then thematically analysed. RESULTS: Some study participants felt that introducing community midwifery will increase access to maternal and newborn healthcare services, especially in rural communities. Others felt that applying community midwifery at the primary healthcare level may lead to duplication of duties among the health worker cadres, possibly creating disharmony. Some key informants suggested that there should be concerted efforts to train and retrain the existing cadres of community health workers via the effective implementation of the task shifting policy in Nigeria, in addition to possibly revising the existing training curricula, instead of introducing community midwifery. CONCLUSION: Applying community midwifery within the Nigerian healthcare system has the potential to increase the availability of skilled care during pregnancy, at birth and within postpartum periods, especially in rural communities. However, there needs to be broader stakeholder engagement, more awareness creation and the careful consideration of modalities for introducing and strengthening community midwifery training and practice within the Nigerian health system as well as within the health systems of other developing countries.

Hearing threshold of deaf pupils in Kaduna metropolis, Kaduna, Nigeria: A cross-sectional survey.

BACKGROUND: Hearing loss in paediatric age group may be inherited, developmental or caused by maternal rubella. It may also be due to complications at birth or certain infections such as meningitis and measles. Ototoxicity and exposure to excessive noise also contribute significantly. Majority of hearing loss in children can be prevented primarily. We aimed to share our findings on assessing the hearing thresholds of pupils in deaf schools in Northwestern Nigeria. PARTICIPANTS AND METHODS: This was a cross-sectional study which assessed the hearing threshold of pupils in deaf schools in Kaduna metropolis, Kaduna, Nigeria. Approval was obtained from the State Ministry of Health Ethics Committee. Multi-staged sampling method was used to enrol 430 deaf pupils. Consent was obtained and a structured pre-tested questionnaire was used to generate data on the participant's biodata, history and detailed examination findings as well as pure-tone audiometry. Collated data were documented and entered into Statistical Product and Service Solutions version 20 for windows then analysed. RESULTS: Mean pure-tone average of the right ear was 103.4 ± 8.3 and the left ear was 104.3 ± 8.9. Majority had bilateral profound hearing loss (99.0%). Severe hearing loss was seen in 0.9%, whereas the remaining 0.1% had moderate hearing loss. The hearing loss sensorineural in majority (97.6%) and the remaining 2.4% had mixed hearing loss. High-frequency hearing loss predominated (98.6%). CONCLUSION: Majority of the deaf pupils had bilateral, profound, sensorineural hearing loss, involving higher frequencies.

Risk Factors Associated with the Occurrence of Gastrointestinal Helminths among Indigenous Donkeys (Equus asinus) in Northeastern Nigeria.

Aim. This survey study was conducted from April 2014 through March 2015 in Bauchi, Yobe, and Gombe states, northeastern Nigeria, to explore the risk factors associated with the occurrence of gastrointestinal helminthosis among indigenous donkeys (Equus asinus). Materials and Methods. A total of six hundred fresh faecal samples were randomly collected from indigenous donkeys of varying age, sex, and settlements. Simple flotation and sedimentation techniques were used for the detection of helminths eggs. Results. Three gastrointestinal nematode parasites were encountered including Strongyle, Parascaris equorum, and Oxyuris equi. An overall prevalence of 98.3% was obtained, of which 78.3%, 40.3%, and 17.5% were, respectively, from Strongyle, Parascaris equorum, and Oxyuris equi. Age, sex, and season were not statistically associated with the risk of helminth infection as were the different study areas (p > 0.05). However, body condition score, settlement, anthelminthic medication history, and management practices were significantly associated with the risk of gastrointestinal helminthosis. Statistically high prevalence of helminthic infections was observed in donkeys, with poor (thin) body condition, from rural settlements, that were not dewormed and raised under poor management systems (p < 0.001). Conclusion. It is concluded from the study that gastrointestinal helminths particularly Strongyle were endemic among the indigenous donkeys in northeastern Nigeria. Further control and preventive measures were discussed.

Ultrastructure of the thyroid gland in adult West African dwarf goat (Capra hircus) / Ultraestructura de la glándula tiroides en la cabra enana africana occidental (Capra hircus)

The present study examined ultrastructure of the thyroid gland of adult West African Dwarf (WAD) goat in order to further understand the ultrastructural morphology and some of the changes in the components of the thyroid gland in goat with age. Thyroids glands obtained from fifteen adult WAD goats of different ages and sexes slaughtered at the local abattoirs were used in this study. Electron microscopic techniques were used to study the fixed tissue with emphasis on the follicular and parafollicular cells. The results showed that the ultrastructure is generally similar to that of some domestic animals. Follicular cells were cuboidal in young adult goats thyroids but were flattened in older goat thyroids of 5­7 years. These cells remarkably showed highly dilated cisternae of rough endoplasmic reticulum which decreased in frequency the older goats. Microvilli were short and sparse on the follicular cells and the number decreased in the older goats. Different sizes of apical vesicles of varying electron density were encountered that included colloid droplets, secretory vesicles and lysosome-like bodies and the appearance of these vesicles changed with age. Parafollicular cells were encountered in the basal position between follicular cells in all thyroids examined. Numerous dense cytoplasmic granules were observed and they were not apparently different from that described in several mammals.

El presente estudio examinó la ultraestructura de la glándula tiroides en cabra enana de África occidental adulta con el objetivo de tener un mejor conocimiento de la morfología y algunos de los cambios en los componentes de esta glándula en cabras de mayor edad. Se estudiaron glándulas tiroides obtenidas de quince cabras adultas de diferentes edades y sexos, sacrificadas en los mataderos locales. Se utilizaron técnicas de microscopía electrónica para estudiar el tejido con énfasis en las células foliculares y para foliculares. Los resultados mostraron que la ultraestructura generalmente era similar a la de algunos animales domésticos. Las células foliculares en la tiroides de cabras adultas jóvenes eran cúbicas, no obstante en cabras adultas de mayor edad (5 a 7 años) se observaron células aplanadas en las tiroides. Estas células mostraron cisternas de retículo endoplasmático rugoso muy dilatadas que disminuyeron en frecuencia en las cabras de más edad. Las microvellosidades eran cortas y escasas en las células foliculares, y el número disminuyó en las cabras de más edad. Se encontraron diferentes tamaños de vesículas apicales y se observaron gotitas coloidales, vesículas secretoras y organismos similares a los lisosomas; la aparición de estas vesículas fue cambiando en cabras de mayor edad. Se encontraron células parafoliculares en posición basal en todas las células foliculares examinadas. Se observaron numerosos gránulos citoplasmáticos densos sin aparente diferencia de aquellos descritos en otros mamíferos.

An innovation for improving maternal, newborn and child health (MNCH) service delivery in Jigawa State, northern Nigeria: a qualitative study of stakeholders' perceptions about clinical mentoring.

BACKGROUND: An effective capacity building process for healthcare workers is required for the delivery of quality health care services. Work-based training can be applied for the capacity building of health care workers while causing minimum disruption to service delivery within health facilities. In 2012, clinical mentoring was introduced into the Jigawa State Health System through collaboration between the Jigawa State Ministry of Health and the Partnership for Transforming Health Systems Phase 2 (PATHS2). This study evaluates the perceptions of different stakeholders about clinical mentoring as a strategy for improving maternal, newborn and child health service delivery in Jigawa State, northern Nigeria. METHODS: Interviews were conducted in February 2013 with different stakeholders within Jigawa State in Northern Nigeria. There were semi-structured interviews with 33 mentored health care workers as well as the health facility departmental heads for Obstetrics and Pediatrics in the selected clinical mentoring health facilities. In-depth interviews were also conducted with the clinical mentors and two senior government health officials working within the Jigawa State Ministry of Health. The qualitative data were audio-recorded; transcribed and thematically analysed. RESULTS: The study findings suggest that clinical mentoring improved service delivery within the clinical mentoring health facilities. Significant improvements in the professional capacity of mentored health workers were observed by clinical mentors, heads of departments and the mentored health workers. Best practices were introduced with the support of the clinical mentors such as appropriate baseline investigations for pediatric patients, the use of magnesium sulphate and misoprostol for the management of eclampsia and post-partum hemorrhage respectively. Government health officials indicate that clinical mentoring has led to more emphasis on the need for the provision of better quality health services. CONCLUSION: Stakeholders report that the introduction of clinical mentoring into the Jigawa State health system gave rise to an improved capacity of the mentored health care workers to deliver better quality maternal, newborn and child health services. It is anticipated that with a scale up of clinical mentoring, health outcomes will also significantly improve across northern Nigeria.

Perinatal Mortality in a Northwestern Nigerian City: A Wake up Call.

BACKGROUND: In Nigeria, of the over 900,000 children under the age of 5 years that die every year, perinatal mortality is responsible for a little over 20%. Previous reports are largely from the southern part of the country. This is the first report of perinatal data from the northwest of Nigeria. METHODS: A case control study of perinatal deaths in the three major public hospitals in Katsina metropolis was carried out to determine the pattern of perinatal deaths in the metropolis. Data were collected over a 6 week period on maternal socio-demographic, antenatal, and delivery variables. Data were similarly obtained on neonatal profile and morbidities. RESULTS: There were 143 perinatal deaths (94 stillbirths and 49 early neonatal deaths) out of 1104 live and stillbirths during the study period. The perinatal mortality rate was thus 130 per 1000 births with a stillbirth rate of 85 per 1000 births and an early neonatal mortality rate of 49 per 1000 live births. Stillbirths during the intrapartum period were twice as frequent as macerated stillbirths (2:1). Maternal factors significantly associated with perinatal deaths included chorioamnionitis, ruptured uterus, multiple gestation, medically induced delivery, prolonged labor, unbooked pregnancies, antepartum hemorrhage, and prolonged rupture of membranes. Antepartum hemorrhage was the strongest determinant of perinatal death. Significant neonatal determinants were multiple gestation, severe birth asphyxia, apnea, and necrotizing enterocolitis. Apnea was the strongest neonatal determinant. The majority (83.2%) of perinatal deaths were due to severe perinatal asphyxia (SPA) (54.5%), normally formed macerated stillbirths (20.3%), and immaturity (8.4%). CONCLUSION: In conclusion, Perinatal Mortality in Katsina metropolis in northwest Nigeria is unacceptably high as we approach the timeline for the millennium development goals. Antepartum hemorrhage and SPA are major determinants.

Sexual assault against female Nigerian students.

Sexual assault is a common social disorder among students in our tertiary institutions. This study ascertains the extent and effect of sexual assault among Nigerian students. Two hundred and Sixty Eight structured questionnaires were distributed to randomly selected students in 4 tertiary institutions, information on socio demography, sexual history and consequences of their exposure were obtained for analysis and interpretation. Thirty seven (13.8%) of the respondents were sexually assaulted as a student and 19 (7.1%) were assaulted by their lecturers and fellow students, Younger age at coitarche, history of forced coitarche, marriage, coitarche with relations and unknown persons, significantly influenced subsequent risks of sexual assault. Improve security, moral behaviours enforcing dress code and stiffer penalties were suggested ways to prevent sexual assault among the students. Sexual assault is still a common finding in our institutions; effort should be made by all stake holders to prevent this social embarrassment.

Sexual assault against female nigerian students

Sexual assault is a common social disorder among students in our tertiary institutions. This study ascertains the extent and effect of sexual assault among Nigerian students. Two hundred and Sixty Eight structured questionnaires were distributed to randomly selected students in 4 tertiary institutions, information on socio demography, sexual history and consequences of their exposure were obtained for analysis and interpretation. Thirty seven (13.8%) of the respondents were sexually assaulted as a student and 19 (7.1%) were assaulted by their lecturers and fellow students, Younger age at coitarche, history of forced coitarche, marriage, coitarche with relations and unknown persons, significantly influenced subsequent risks of sexual assault. Improve security, moral behaviours enforcing dress code and stiffer penalties were suggested ways to prevent sexual assault among the students. Sexual assault is still a common finding in our institutions; effort should be made by all stake holders to prevent this social embarrassment (Afr. J. Reprod. Health 2010; 14[3]: 189-193)

A 5-year review of maternal mortality associated with eclampsia in a tertiary institution in northern Nigeria.

OBJECTIVE: To determine the incidence of maternal mortality associated with eclampsia and to determine how socio-demographic and clinical characteristics of the women influence the deaths. METHODOLOGY: Records of 52 eclampsia-related mortalities from January 2003 to December 2007 were reviewed, retrospectively. Their social demography, mode and place of delivery, time of eclampsia, and fetal outcome were extracted for analysis. RESULTS: Eclampsia accounted for 52 (46.4%) of the 112 total maternal deaths recorded within the 5-year period, with case fatality of 22.33%. Age group <20, 20-29 and above 30 all had similar case fatality rate of 22.1%, 23.8% and 26.7%, respectively. Those who were experiencing their first deliveries have the worst deaths recording 42.5% of the case fatality in that category. As expected, unbooked had a higher case fatality of 24.0% compared to 15% among book cases, while those with formal education also had more death (22.3% case fatality) as compared to 3.3% among those who had some form of formal education. Antepartum eclampsia was the cause in 50% of the death, 11 (21.2%) of the pregnancies were not delivered before their death, while 18 (34.6%) were stillbirth. CONCLUSION: Eclampsia still remains the major cause of maternal mortality in this region resulting from unsupervised pregnancies and deliveries. There is need to educate and encourage the general public for antenatal care and hospital delivery.

Trends in maternal mortality in a tertiary institution in Northern Nigeria.

OBJECTIVE: To look at the trends in maternal mortality in our institution over 5 years. METHODS: Records of 112 maternal deaths were retrospectively reviewed to determine the trends and the likely direct cause of each death over the study period. RESULTS: There were a total of 112 maternal deaths, while 3931 deliveries were conducted over the 5-year period. The maternal mortality ratio (MMR) was 2849/100,000 deliveries. The highest MMR of 6234/100,000 was observed in 2003, with remarkable decline to 1837/100,000 in 2007. Eclampsia consistently remained the leading cause, accounting for 46.4% of the maternal deaths, followed by sepsis and postpartum hemorrhage (PPH) contributing 17% and 14.3%, respectively. There were no statistically significant differences in the corresponding percentages of maternal deaths between various age groups (chi2=6.68; P =0.083). Grandmultiparas accounted for a significant proportion of maternal deaths as compared to low parity, with chi2=10.43; P =0.00054. Lack of seeking antenatal care (unbooked) and illiteracy were observed to be significant determinants of maternal mortality (chi2=64.69, P =0.00000; and chi2=18.52, P =0.0000168, respectively). CONCLUSION: In spite of decrease in the maternal mortality ratio over the years, it still remains high, with eclampsia persistently contributing most significantly. Community enlightenment on the need to avail of antenatal care and hospital delivery services, and improvement in the quality of skilled maternity care will, among other factors, drastically curtail these preventable causes of maternal death and reduce MMR.