Neonatal mortality and perinatal risk factors in rural southwestern Nigeria: a community-based prospective study.

BACKGROUND: Reliable data on births and deaths particularly at the community level are scarce yet they are urgently needed to inform policy and assess the improvements which may have occurred with recent interventions. OBJECTIVE: To determine neonatal mortality rate and identify perinatal risk factors associated with neonatal deaths. METHODS: In a community based prospective study, baseline data on births and deaths were collected as they occurred in a rural community of Southwest Nigeria from 1993 to 1998. Data on births and deaths were collected for the period. RESULTS: There were 972 live births and 64 infant deaths giving an infant mortality rate of 65.8 per 1000. Neonatal deaths accounted for a half of all infant deaths (32) giving a neonatal mortality rate of 32.9 per 1000. Twelve (37.5%) of neonatal deaths occurred on the first day of life; half of all neonatal deaths occurred within two days of birth, 21(65.6%) occurred during the first seven days of life and only 11 (34.4%) occurred over the last three weeks of the first month. The commonest known cause of death was associated with low birth weight (LBW) which was responsible for eight (25%) of deaths, while sepsis and fever and maternal deaths and failure to thrive were responsible for four (12.5%) and three (9.4%) deaths respectively. Asphyxia accounted for 3(9.4%) deaths; neonatal tetanus, congenital abnormality and diarrhoea were responsible for one (3.1%) death each. Cause of death was unclassified in many early neonatal deaths particularly those which occurred at home. Predictors of neonatal death included LBW, RR of 4.7; delivery outside a health facility, RR of 3.6; lack of attendant at delivery, RR of 5.01; and Traditional Birth Attendant (TBA) delivering the baby, RR of 2.7. Effect of sex of the neonate, mother and fathers ages were not significant at the 5% level in the model. CONCLUSION: Neonatal deaths contribute significantly to the high infant mortality in this rural community. Services provided by TBAs are not optimal but appear to be better than having no one in attendance at delivery. TBAs therefore need to be trained to identify at risk neonates and refer. Obstetric and public health services have to be available and made more accessible at the grass root level.

Neonatal mortality and perinatal risk factors in rural south western Nigeria: a community-based prospective study

BACKGROUND: Reliable data on births and deaths particularly at the community level are scarce yet they are urgently needed to inform policy and assess the improvements which may haveoccurred with recent interventions. OBJECTIVE: To determine neonatal mortality rate and identify perinatal risk factors associated with neonatal deaths. METHODS: In a community-based prospective study, baseline data on births and deaths were collected as they occurred in a rural community of Southwest Nigeria from 1993 to 1998. Data on births and deaths were collected for the period. RESULTS: There were 972 live births and 64 infant deaths giving an infant mortality rate of 65.8 per 1000. Neonatal deaths accounted for a half of all infant deaths (N=32) giving a neonatal mortality rate of 32.9 per 1000. Twelve (37.5%) of neonatal deaths occurred on the first day of life; half of all neonatal deaths occurred within two days of birth, 21(65.6%) occurred during the first seven days of life and only 11 (34.4%) occurred over the last three weeks of the first month. The commonest known cause of death was associated with low birth weight (LBW) which was responsible for eight (25%) of deaths, while sepsis/fever and maternal deaths/failure to thrive were responsible for four (12.5%) and three (9.4%) deaths respectively. Asphyxia accounted for 3(9.4%) deaths; neonatal tetanus, congenital abnormality and diarrhoea were responsible for one (3.1%) death each. Cause of death was unclassified in many early neonatal deaths particularly those which occurred at home. Predictors of neonatal death included LBW {RR=4.7 (1.7-13.1) p=0.03},delivery outside a health facility {RR=3.6 (1.001-13.2) p=0.05},lack of attendant at delivery {RR=5.01 (1.3­19.1) p=0.018} and Traditional Birth Attendant (TBA) delivering the baby {RR=2.7 (1.1­6.4) p=0.03). Effect of sex of the neonate, mother and fathers' ages were not significant at the 5% level in the model. CONCLUSION: Neonatal deaths contribute significantly to the high infant mortality in this rural community. Services provided by TBAs are not optimal but appear to be better than having noone in attendance at delivery. TBAs therefore need to be trained to identify at risk neonates and refer. Obstetric and public health services have to be available and made more accessible at the grass root level

Contraceptive use among hairdressers in South-west Nigeria.

Hairdressers and their apprentices are mostly women in their reproductive years. The social environment in hairdressing salons provides the opportunity to discuss sexual exploits among peers and may influence decisions on sexual behavior. This study was designed to assess the knowledge and use of contraceptives among hairdressers. A structured questionnaire was used to collect information on demographic characteristics and knowledge and use of contraceptive methods among hairdressers in Ibadan, South-west Nigeria. A total of 355 hairdressers were interviewed: 60 apprentices (17%) and 295 qualified hairdressers (83%); 110 (31%) single and 240 (67%) married. They were females aged 15 - 49 years (mean 29 +/- 6.9 years). Some 70% of single women had regular sexual partners. A total of 24 single women (21%) had been pregnant and 20 (18%) had abortions. Some 121 (34%) of the study population were currently using contraceptives: 27 single and 94 married respondents. The prevalence of contraceptive use among sexually active single women was 34%. The condom was the most known and used contraceptive method. The major reasons for non-use of contraceptives were fear of side-effects (23%); need for more children (16%); or respondents were not engaged in sexual activity (12%). Contraceptive use among sexually active single hairdressers is lower than the national average. Workplace educational intervention is needed to prevent unwanted pregnancies and sexually transmitted infections among these young women.

HIV as an additional risk factors for anaemia in pregnancy: evidence from primary care level in Ibadan, Southwestern Nigeria.

Anaemia in pregnancy has serious consequences including maternal morbidity and impairment of infant cognitive development. Several authors have however reported inconsistent findings on risk factors for anaemia in pregnancy. This study was carried out to determine risk factors for anaemia in pregnancy among women at primary care level and document the contribution of HIV/AIDS to anaemia in pregnancy in low risk pregnant women at primary care level. A prospective study carried out among pregnant women attending the booking clinics of primary health care centres in Ibadan, Nigeria. HIV positive and HIV negative mothers were followed throughout pregnancy till delivery of their babies. History of use of iron, folate, Vitamin B complex and daraprim were obtained. Haemoglobin, malaria parasitaemia, and HIV serostatus were determined. Use of iron (P < 0.006), folate (P = 0.032), vitamin B complex (P = 0.001) and treatment for malaria (P = 0.05) significantly reduced the risk for anaemia in pregnancy. Malaria parasitaemia (P = 0.0001) significantly increased the risk of anaemia. However, use of daraprim and HIV seropositivity increased the risk of anaemia in pregnancy but not significantly. In a logistic regression analysis, iron (P = 0.001) and folate supplementation (P = 0.015) significantly protected against anaemia in pregnancy while malaria parasitaemia (P = 0.006) and HIV seropositivity (P = 0.015) were significant adverse risk factors. HIV is an additional risk factor for anaemia in pregnancy. Voluntary counseling and testing of pregnant women for HIV is therefore also indicated at primary care level to detect asymptomatic anaemia in pregnancy that may be due to HIV.

Risk factors associated with neonatal tetanus in Ibadan, Nigeria--a revisit.

To identify major risk factors associated with recent occurrence of neonatal tetanus (NNT) in Ibadan Nigeria, 140 cases matched 1:1 with controls were recruited into the study from the major referral hospitals. Maternal age (<20 years), low paternal education, low socio-economic status, primiparity and delivery outside health facilities were associated with significantly increased risk for NNT. Lack of trained attendant at delivery, the type of instrument used to cut the cord and the presence of livestock within the family compound also significantly increased the risk for NNT. Antenatal clinic (ANC) was attended by 86.4% of mothers of cases but only 25.6% of these mothers received full immunization. Three out of four mothers of cases who attended ANC did so with a frequency of 5 to 20 times indicating missed opportunities for immunization. Data also suggest that the main reason for failure to receive full immunization was ignorance on the mothers' part, which reflects inadequate health education by the health system. The study case fatality rate was 79.4 percent. Risk factors observed in this population are generally known, indicating that the problem has not yet received adequate attention. Effort needs to be made towards providing the masses with formal education as well as health education, targeting the population at grass root level. Improving access to antenatal care services as well as improving the quality of these services; outreach efforts on immunization would contribute in no small measure to reducing the incidence of neonatal tetanus in this community.

The pattern of stillbirth in a secondary and a tertiary hospital in Ibadan, Nigeria.

Stillbirths contribute a remarkable proportion to perinatal mortality in developing countries. Perinatal mortality rate (PMR) is still very high in these countries, ranging from 60 to 120 per 1000 total births, compared with 10 to 20 per 1000 total births in Europe. A descriptive review epidemiological study was carried out over a 3 year period, 1978-1980 inclusive, in two major hospitals in Ibadan city, capital of Oyo State in the South Western part of Nigeria, using structured questionnaires. The study revealed an overall prevalence rate of stillbirths of 63/1000 total births. Fresh stillbirths with no visible congenital malformations predominate. Some of the risk factors observed from this study to be associated with stillbirths in Nigeria include teenage and advanced maternal age (< or = 19 years and > or = 35 years), high party and past history of spontaneous abortions. As preventive measures, efforts should be made to improve antenatal and obstetric services. The data collected serves as a baseline for further research on this topic.

Problems of widowhood: a study of widows in a tertiary institution in Ibadan, south west Nigeria.

This study is part of a larger multi-centre survey on widowhood in Nigeria. Information was gathered using a structured self-administered questionnaire from 42 widows who are working at the University College Hospital and the College of Medicine, in Ibadan, capital of Oyo State in the southwest of Nigeria. The findings reveal that the majority of these widows are middle aged, between 35 and 55 years of age, with little or no prospect of remarriage. Almost half of them had only primary education and are of low professional status; 48% of them earn very low salary, and had a high parity, having 5 or more children. The problems identified by these widows in order of priority include financial/economic hardship (69%), absence of husband's will resulting in the loss of properties to husband's relations (55%), loneliness and depression (41%), poor relationship with in-laws (41%), difficulty in social interaction (21%), and poor housing (17%). Recommendation for alleviating the hardships of widows suggested include encouragement of female education, enhancement of women, economic empowerment, improving availability and effective utilization of family planning services and encouraging men to write their wills early in marriage. Also, through advocacy and public health awareness campaigns, to enlighten the masses about the plight of the widows, in order to eliminate the dehumanizing traditional practices to which Nigerian widows are often subjected.

Knowledge and management of malaria in under five children by primary health care workers in Ibadan South-east local government area.

The results of a survey of the knowledge and management practices of 61 health workers in five primary health care facilities in Ibadan South-east LGA are presented. In addition, 30 health workers were observed as they managed children with fever and the parasite status of 92 children diagnosed to have malaria was determined. Results revealed that 62(67.4%) children had the malaria parasite. Knowledge of some basic concepts was fairly adequate as the majority 46(75.4%) knew the cause of malaria. Treatment practices were poor as only 34(55.7010) and 39(63.9%) health workers respectively prescribed chloroquine and paracetamol correctly. Observation revealed that history taking and physical examinations were rudimentary. Scores out of 100 on correct prescriptions of chloroquine and paracetamol were 60.1 and 76.8 respectively. There is an urgent need for periodic education programmes, especially for health workers with many years of experience to help them maintain clinical skills and refresh their knowledge.

Knowledge and home management of malaria fever by mothers and care givers of under five children.

This study documents the knowledge and home management practices of 376 mothers and care givers of under five children on malaria fever. Results revealed that both the knowledge and case management practices were poor as only 179 (46.8%) knew how malaria was transmitted. Of those who knew malaria could be prevented, clearing of bushes and gutters was the commonly stated method (78 or 21.8%), followed by the use of traditional herbs. 'Agbo' by 75(20.9%) mothers. The elders and friends were stated to be the major source of knowledge about malaria by 141(37.5%) mothers. Knowledge scores was significantly higher in older mothers, among the educated, and skilled mothers (P<0.05). As regards practices, self-medication with modern drugs was common, these drugs had been given in the home by 265(70.5%) mothers while "Agbo", had been used by 95(25.5%) mothers before presenting at the clinic. Paracetamol was the modern drug often used (217 or 81.8%). Followed by chloroquine (57 or 21.5%). However, drug treatment practice were often incorrect. Chloroquine was prescribed correctly by 15(26.3%) mothers, while 109(50.2%) gave the correct dose of paracetamol. Only 16(4.3%) of the children received anti-malarial on the day the illness began. There is the need for education programmes on malaria for mothers, especially for young, illiterate and unskilled mothers, including the family elders.

Factors associated with exclusive breastfeeding in Ibadan, Nigeria.

Although nationwide efforts to promote exclusive breastfeeding began in Nigeria in 1992, data on this type of infant feeding are still generally scarce. Current status breastfeeding data were obtained from 2794 mothers, enrolled from randomly selected infant welfare clinics in Ibadan, Nigeria, to evaluate factors that are associated with exclusive breastfeeding. The exclusive breastfeeding rate dropped from 57.4% at 1 month to 23.4% at 6 months. Using multiple regression analysis, younger age of infant (P < .0001), higher maternal occupation (P < .05), and delivery in tertiary (P < .0001) or secondary (P < .0001) health facility were predictive of exclusive breastfeeding. Mothers 24 years or younger and primiparous mothers were less likely to breastfeed their babies exclusively (P < .01 and P < .05, respectively). Additional programs are needed to meet the needs of at-risk mothers, who should be identified and counseled.

Outbreak of cholera in Ibadan, Nigeria.

The changing epidemiology of cholera in Ibadan, Nigeria, has become a public health challenge, and outbreaks of the disease have been occurring with increasing frequency since the first outbreak in modern times in 1970. In this outbreak, 1384 persons were seen, diagnosed and treated for the disease at the cholera unit, Ibadan from January to December 1996. The outbreak lasted for a whole year. No child under one year was seen. The age adjusted case fatality rate was 5.3%. Diarrhoea and vomiting were the most common combination of symptoms present in 97.3% of all cases, followed by diarrhoea, vomiting and dehydration (84.3%). The median number of days spent on admission was only 2 days. Cholera cases were clustered within the densely populated and poorly planned areas of the city. Though significantly more cases were seen during the rainy season than during the dry season (p<0.01), the deaths were not seasonally related (p = 0.67). Contamination of otherwise potable sources of water, late presentation to the cholera treatment unit and low levels of knowledge about diseases need to be addressed in order to effectively control this disease in the community. Progress should also be made towards developing a suitable vaccine for the control of this internationally important public health disease so that the responsibility of its control is not left entirely to individuals and communities, particularly in developing countries.

Fertility and childbearing practices in rural African community.

This longitudinal, community based study was carried out to gain insight into factors which influence child bearing practices and fertility in a typical Yoruba village in S.W. Nigeria. Although fertility is shown to be on the decline in most developing countries, a relatively high fertility is still sustained in the rural areas of this country. Women start child bearing early and continue into advanced reproductive ages. Median age of the women who delivered in the 2 year study period was 24 years with peak fertility seen between ages 20-24 years. Seasonality of births was observed due to religion and the agricultural cycle. Unadjusted Total Fertility Rate (TFR) for 1993 was 8.83 and for 1994 was 8.47. This small decline in TFR was not significant (Paired t-test t = 1.3, p = 0.28). Traditional attitudes which favour high fertility are maintained because of ignorance about modern family planning methods, low child survival rates and the ingrained custom of using children as a source of help on the farms. In addition, children are still the major source of support in old age. It is recommended that in order to reduce National total fertility rate, attention be paid to the rural areas where the majority of the people reside. Potential modifiable factors include improving child survival rates, increasing contraceptive awareness and education and a general improvement in the socio-economic conditions of the rural areas of this country.

The prevalence of toxoplasma antibodies in pregnant Nigerian women and the occurrence of stillbirth and congenital malformation.

Toxoplasma antibody serological tests were carried out using the Dye test on sera of pregnant and postpartum Nigerian women to investigate whether there was any association between the levels of antibody titres and the occurrence of stillbirths and congenital malformations. There was a high prevalence of toxoplasma antibodies in the sera of both pregnant and postpartum women. The prevalence rates for the pregnant women ranged from 72.5% to 88.8% with an overall rate of 75.4%; whilst for the postpartum women, the prevalence rates ranged from 75.0% to 94.4% with an overall rate of 80.5%. The toxoplasma antibody titres of the sera from the live-born babies as well as stillbirths and congenitally malformed babies ranged from 1:16 to 1:1024. The exact role played by toxoplasma in the occurrence of stillbirths and congenital malformation in our area of study is, however, not clear. For future research, it is suggested that larger samples be studied in order to enhance the validity of the findings of the present study.

Ectodermal dysplasia with hypodontia in a set of Nigerian twins--a case report.

A set of Nigerian male twins with features of ectodermal dysplasia born to apparently normal parents are presented. The main findings in both children were hypodontia, abnormally shaped teeth and hypotrichosis. The general treatment modalities of the condition, especially in a tropical environment, are discussed.

Observations of stillbirths, birthweight and maternal haemoglobin in teenage pregnancy in Ibadan, Nigeria.

Teenage pregnancy has become a serious public health problem, particularly in developing countries with limited obstetric facilities. The condition has often been associated with obstetric and gynaecological risks. The present study which attempts to identify such risks has revealed teenage pregnancy an an important public health problem in Nigeria. Out of 4,649 pregnant mothers followed up in an antenatal clinic of a general hospital, 704 (15.1%) were teenagers. The highest frequency of low birth weight babies was recorded amongst these teenage mothers; so also was anaemia. In addition, the number of stillbirths and the incidence of low birth-weight babies were found to increased with decreasing maternal haemoglobin level. As a result of the identified risk factors associated with teenage pregnancy, it is suggested that teenage pregnant mothers be given more specialised supervision during antenatal period and at delivery; while efforts should be made to reduce the incidence of teenage pregnancy through scholarship programs for the education of girls.

A nomogram for screening low birth weight and large for gestational age babies for use in primary health care centres.

In this prospective study, maternal weights per gestational age were recorded on 600 randomly selected gravid women attending regular antenatal clinics until delivery of their babies. This paper explains how the knowledge of these weights were used to produce a pregnancy nomogram for prenatally screening mothers who are likely to deliver term (37-41 weeks). Low birth weight (< or = 2500g) and large for gestational age (> or = 3800g) babies in the community. The nomogram gave a sensitivity of 80.1%, a specificity of 97.9%; a predictive value of a positive test of 87.9% and a predictive value of a negative test of 96.3%. The lower cadre workers were able to successfully utilize the nomogram.

The prevalence of Toxoplasma infection among pregnant women in Ibadan, Nigeria.

The seroprevalence of toxoplasmosis in pregnant women from the inner area of Ibadan was determined by the dye test. Two hundred and seventy-three of the 352 women (78%) had dye test titres of 1/16 or greater with 165 (47%) having titres of 1/128 or greater. In contrast, 42 of 192 pregnant women (22%) from the Swansea area of the UK were dye test positive with only six (3%) having titres of 1/128. The possibility that reinfection or recrudescence is responsible for maintaining high antibody levels in African women and the consequence of this high level of infection in relation to potential human immune deficiency virus (HIV) infections are discussed. Social and environmental conditions indicate that the source of infection is contact with cat faeces.

PIP: A health practitioner took blood samples from 352 pregnant women who attended the antenatal clinic at either the University College Teaching Hospital or St. May's Catholic Hospital in Ibadan City, Nigeria to determine the prevalence of toxoplasma infection among these women. The practitioner also took 241 samples from both women and newborns just after delivery. The samples were flown to the Toxoplasma Reference Unit of the Public Health Laboratory in Swansea, Wales to be tested by the toxoplasma dye test (DT) and ELISA IgM method. The DTs showed that 78% of the Nigerian women had titres of =or1/16. Further 47% had titres of =or1/128. On the other hand, these corresponding figures for pregnant women in Swansea, Wales were only 22% and 3%. Yet only 1 DT titre positive sample among those from the Nigerian women tested positive using the ELISA IgM method. The infant of the women who had a detectable toxoplasma specific IgM exhibited polydactylism, a common congenital abnormality in Ibadan. The researchers suggested that reinfections or recrudescence may account for the high antibody levels. The inner area of Ibadan, where 98% of these pregnant women lived, was overcrowded with poor environmental sanitation conditions including considerable contamination of cat feces. This situation most likely explains the higher prevalence of toxoplasma infection among pregnant women in Ibadan than among those in Swansea, Wales. This high rate of chronic toxoplasmosis poses a considerable potential risk as HIV spreads in Africa since cerebral toxoplasmosis is an opportunistic infection of AIDS.

Socio-psychological factors affecting emergency obstetric deliveries at the University College Hospital, Ibadan, Nigeria.

PIP: This study was designed to determine the influence of socio- psychological characteristics on reproductive outcomes among emergency cases admitted into the Labor Ward of the University College Hospital in Ibadan City, Nigeria. The study took place between May 1, 1984 and February 28, 1985 and included all emergency cases admitted (EA) into the hospital. 144 matched pairs of patients (emergency and booked cases) were admitted into the study making a total of 228 patients. Results of the study showed no observed differences in the educational or occupational status of the spouses of booked patients compared with EA. However, there were more uneducated women among the EA than the booked. IN both groups younger patients (15-34) had format education compared with the older patients (35+), strengthening the hypothesis that education is the most influential factor in patient's acceptance of modern maternity care. Polygamy and Islam were more prevalent among the EA than the booked. It is believed that the economic affects of polygamy exercise more direct adverse effects on reproduction than religion. The purdah system, practiced by Moslems confines women to their homes, interfering with their ability to get pre-natal care. Fewer number of EA lived with their spouses compared with booked patients. Lower social class is associated with larger numbers of adverse factors in reproductive outcomes such as increased rates of low birth weight babies, multiple pregnancies and fetal abnormalities. (Author's modified).^ieng

Prematurely erupted deciduous teeth in a Nigerian baby--a case report.

This paper reports the case of a thirteen-day-old male child who was brought to the clinic with lower central incisors which had been erupted into the oral cavity from birth. The teeth, which resembled the normal deciduous series, were mobile. A striking observation was the anxious behaviour of the mother which prompted further probing. History taking revealed that the mother's anxiety was caused by societal unpleasant reaction to her baby's prematurely erupted teeth. The pressure was so intense that she had to seek medical help. At this tender age of the baby, it is advisable to preserve prematurely erupted teeth in order to prevent malocclusion resulting from premature loss of the deciduous teeth. Therefore, it is highly essential that people in this society be enlightened about such cases in order to reduce the psychological stress on parents of children with a similar condition.