Epidemiology of death in the emergency department of a tertiary health centre south-south of Nigeria.

BACKGROUND: The emergency department (E.D) of any hospital is an important entry point of critically ill patients. The initial management of these patients is often challenging, and for valuable lives to be saved, the in fracture and manpower should be up to date. OBJECTIVE: To analyze the epidemiology of death in our Emergency Department within 72hours after admission, the death rate, and to establish any contributory factors. METHOD: Demographic data, time of arrival at the ED, physical finding, the Glasgow coma scale(GCS), the injury severity score(ISS), the diagnosis, investigations done, treatment offered, the time of death and the autopsy report, were entered into a Proforma. These data was analyzed using EPI-Info statistical programme version 3.4.3 of 2007. RESULTS: Four thousand and eleven (4,011) patients were seen in the E.D during the period. A total of three hundred and fifty five (355) mortalities were recorded. Their ages ranged from 4-87years, with an average of 34.5years. The male: female ratio was 2.1:1. The overall mortality in the hospital during the period was 859: the E.D mortality figure representing 41.3%. Fifteen patients were brought in dead. The 355 deaths fell into two categories: trauma and non-trauma. One hundred and forty-seven (41.4%) persons died from trauma; road traffic accidents (RTAs) accounting for 118 (80.3%). Two hundred and eight (58.6%) persons died from nontrauma related causes, with chronic cardiovascular disorders been the most frequent cause of death 52[25.0]. Majority of the mortalities were between 26-50 years age range. 86.2% of the mortalities presented late, greater than 6hours after the incidence. Within the 72 hours period, only 129(36.3%) were able to do the requested tests. Out of the 355 deaths, only 4[1.1%] were autopsied. An in-hospital 72hours death rate of 8.6 was recorded. CONCLUSION: Road traffic accidents and cardiovascular disorders are the common causes of emergency death in UCTH. A recorded death rate of 8.6% is high, suspected contributory factors include systemic deficiencies such as the lack of a trauma system, prehospital care; late presentation, the role of chemist operators, traditional healers, and delayed referral systems.

Awareness and acceptability of strategies for preventing mother to child transmission of HIV among antenatal clients in Calabar, Nigeria.

BACKGROUND: Mother to child transmission is the major route through which children below the age of 15 years acquire HIV infection. The most effective way to reduce childhood HIV infection is to prevent the infection in mothers and for already infected mothers use appropriate strategies to prevent transmission to their children. This study was conducted to determine the level of awareness and acceptability of strategies for preventing mother to child transmission of HIV. METHOD: Exploratory multi-centric descriptive study involving 400 antenatal attendees in Federal, State and a Private health facility was used. Interviewer-administered questionnaire was the tool for data collection. RESULT: Majority of the respondents (94.7%) were aware of transmission of HIV from an infected mother to her child. Respondents were more aware of the use of antiretroviral drugs in pregnancy (63.2%) than they were of avoiding breastfeeding (58.5%) and Cesarean delivery (22.8%) as strategies for preventing mother to child transmission. They were also more likely to accept the use of antiretroviral drugs (78.2%) than they would avoid breastfeeding (69.0%) and accept Cesarean delivery (38.0%) for preventing mother to child transmission of HIV High educational status was significantly associated with a positive attitude to these strategies. CONCLUSION: There is need for more educational programs and social support to bridge the gap between the levels of awareness and acceptability of strategies for preventing mother to child transmission of HIV among the populace.

Awareness and Acceptability of Strategies for Preventing Mother to Child Transmission of HIV among Antenatal Clients in Calabar; Nigeria

Background: Mother to child transmission is the major route through which children below the age of 15 years acquire HIV infection. The most effective way to reduce childhood HIV infection is to prevent the infection in mothers and for already infected mothers use appropriate strategies to prevent transmission to their children. This study was conducted to determine the level of awareness and acceptability of strategies for preventing mother to child transmission of HIV. Method: Exploratory multi-centric descriptive study involving 400 antenatal attendees in Federal; State and a Private health facility was used. Interviewer-administered questionnaire was the tool for data collection. Result: Majority of the respondents (94.7) were aware of transmission of HIV from an infected mother to her child. Respondents were more aware of the use of antiretroviral drugs in pregnancy (63.2) than they were of avoiding breastfeeding (58.5) and Cesarean delivery (22.8) as strategies for preventing mother to child transmission. They were also more likely to accept the use of antiretroviral drugs (78.2) than they would avoid breastfeeding (69.0) and accept Cesarean delivery (38.0) for preventing mother to child transmission of HIV. High educational status was significantly associated with a positive attitude to these strategies. Conclusion: There is need for more educational programs and social support to bridge the gap between the levels of awareness and acceptability of strategies for preventing mother to child transmission of HIV among the populace

Patients' perception of obstetric practice in Calabar, Nigeria.

OBJECTIVE: To determine the influence of patients' perception of obstetric practice in Calabar on the low utilization of health facilities for delivery. METHODS: The University of Calabar Teaching Hospital, the general hospital and eight private clinics in Calabar were visited daily for a period of one month to interview postnatal mothers. This was to ascertain the mothers' perception of obstetric care in these facilities and their attitude towards some selected birth practices. RESULTS: All the interviewed mothers had some formal education, and 133 (92.4%) were aged 20 years and above. One hundred and forty (97.2%) of the mothers were satisfied with at least one aspect of care received. Areas of satisfaction mentioned by the mothers include attitude of health staff 114 (81.4%), clinical care received 85 (60.7%), sanitation of the facility 61 (43.6%), and basic amenities 47 (33.6%), poor sanitary condition of the health facility and lack of basic amenities were the major causes of dissatisfaction. Few mothers, 31 (22%) disagreed with dorsal position during second stage of labor. Most mothers, 92 (63.9%) would want pain relief in labor; 19 (13.2%) did not appreciate shaving of pubic hair and 50 (34.7%) felt episiotomy was not necessary for safe delivery. CONCLUSION: To improve the utilization of obstetric services in Calabar, basic amenities such as water and sanitation should be provided; and there should be restriction of routine birth practices that have no evidence of effectiveness.

KAP of HIV prevention and screening among pregnant women attending specialist antenatal clinics in Calabar, Nigeria.

BACKGROUND: There is a growing concern globally to reverse the growing incidence of HIV especially in Sub-Saharan Africa. This study was conducted to determine the level of awareness, attitude and practice of antenatal HIV screening in Calabar. METHOD: Descriptive multi-centric study of 400 antenatal attendees in Calabar, carried out in October 2005 using pre-tested, semi-structured and interviewer-administered questionnaire for data collection. RESULT: Of the 96.7% women with knowledge of HIV infection, 41.2% were assessed to have excellent knowledge of the mode of transmission. Awareness of antenatal HIV screening was observed in 96.2% women; while 93.7% approved of antenatal HIV screening. Awareness and approval of antenatal HIV screening was significantly related to age and educational status. The proportion of women who had HIV test in current pregnancy was 70.2%. Pre-test counseling was done in 65.8% of women. Most women (78.2%) who had not been screened were willing to undergo HIV testing. Spousal disapproval (23.1%) was the main reason for unwillingness to undergo HIV testing. CONCLUSION: The study revealed high levels of awareness, approval and practice of antenatal HIV screening. However, pre test counseling was not consistently given in cases tested.

Quality of child health services in primary health care facilities in south-east Nigeria.

BACKGROUND: To assess the quality of child health services in primary health care (PHC) facilities in Calabar, south-east Nigeria. DESIGN: Cross-sectional, descriptive design. METHODS: Key informant interviews, structured observation, self-administered questionnaire and focus group discussion. SETTING: Calabar, south-east Nigeria. Participants All 10 PHC facilities in Calabar, 252 PHC workers serving in the facilities, and 76 mothers whose children received care in the facilities. OUTCOME MEASURES: Adequacy of structure (equipment and personnel); process (diagnosis, training and knowledge, use of national case-management algorithm, and supervision), and output (clients' satisfaction). MAIN RESULTS: PHC facilities were adequately equipped to the extent of providing immunization services and management of diarrhoea but not for other aspects of care expected of a PHC centre, including management of acute respiratory infections (ARI), a common problem in children in the region. Supply of essential drugs was inadequate in all centres and facilities for emergency care were lacking. Many of the health care workers (68.3%) had adequate training in immunization, and their knowledge scores on immunization issues (62%) was higher than in other aspect of PHC. Use of the national case management algorithm was low among PHC workers. Results of the focus group discussions with mothers showed that a few perceived quality of care to be poor. The main concerns were long waiting time, lack of essential drugs, and attitude of the health workers. CONCLUSIONS: Inadequacy in the quality of child health services in PHC facilities is a product of failures in a range of quality measures -- structural (lack of equipment and essential drugs), process failings (non-use of the national case management algorithm and lack of a protocol of systematic supervision of health workers). Efforts to improve the quality of child health services provided by PHC workers in the study setting and similar locales in less developed countries should focus not only on resource-intensive structural improvements, but also on cheap, cost-effective measures that address actual delivery of services (process), especially the proper use of national guidelines for case management, and meaningful supervision.

Factors Influencing the Incidence of Pre-term Birth in Calabar, Nigeria.

Women who had pre-term birth in the University of Calabar Teaching Hospital, Calabar, over a two and a half year period were studied. The aim was to establish the factors influencing the incidence of pre-term birth in Calabar. Factors which significantly increase the incidence of pre-term delivery included: previous induced abortion [P < 0.0001], nulliparity [P < 0.001], out of wedlock birth [P < 0.05] and lack of antenatal care [P < 0.01]. Women with multiple pregnancy [P < 0.001] or previous pre-term delivery [P < 0.01], have a significantly high risk for pre-term birth. Antenatal complications [P < 0.0001] particularly anaemia [P < 0.001] or malaria [P < 0.05] in the index pregnancy constitute risk factors for pre-term delivery. However, educational status, social class and previous spontaneous abortion did not seem to significantly influence the incidence of pre-term birth in this study [P < 0.05]. Wider use of family planning, less restrictive abortion laws and training of doctors and nurses on the use of manual vacuum aspiration in the management of post-abortion complications may help reduce the incidence of pre-term birth in Calabar. Replacing pyrimethamine chemoprophylaxis for malaria in pregnancy by intermittent treatment of malaria with sulphadoxine-pyrimethamine and deworming our women during antenatal care may also help reduce the incidence of pre-term birth in our community.

Factors associated with missed opportunities to immunise with tetanus toxoid at a tertiary health institution in Nigeria.

OBJECTIVE: To determine the magnitude of and the reasons for missed opportunities to immunise with tetanus toxoid at a tertiary health institution in Nigeria. The information obtained would be used in developing an intervention strategy for eliminating missed opportunities in the future. DESIGN: Missed opportunity was assessed by using the Revised WHO/EPI protocol (WHO/EPI/MLM/91.7). Exit interviews were carried out on pregnant women visiting the antenatal (prenatal) clinic to register the present pregnancy. SETTING: A tertiary health institution in Nigeria. SUBJECTS: Pregnant women who attended the antenatal clinic for the purpose of registering the present pregnancy during the last two booking days in February, 1997 and the first booking day in March, 1997. MAIN OUTCOME MEASURES: Missed opportunities and contributory factors. RESULTS: The prevalence of missed opportunity was 66%. The factors responsible for missed opportunity were poor history taking, lack of knowledge of the current schedule of immunisation, dependence on physician referral for immunisation and inefficient immunisation record keeping system. CONCLUSION: The findings establish the need for providing physicians in antenatal settings with an update on current immunisation policy and practice and for improved documentation of immunisation histories.

PIP: This report presents the magnitude of the problem and the reason for missed opportunities for tetanus toxoid (TT) immunization at the University of Calabar Teaching Hospital (UCTH) in Nigeria. The information obtained will be used in developing a strategy for eliminating missed opportunities in the future. The subjects were all pregnant women who attended the antenatal clinic for the purpose of registering pregnancy during the last two booking days in February 1997 and the first booking day in March 1997. Information were collected from 54 pregnant women by means of exit interview conducted by trained by data collectors. Information obtained includes: dose(s) of TT received and when; record of offer of TT; and acceptance or decline of TT offered. Results of the exit interview showed a 66% prevalence rate of missed opportunity. Factors contributing to this high prevalence of missed opportunity were poor history taking, lack of knowledge of current schedule of immunization, dependence on physician referral for immunization, and an inefficient immunization record keeping system. The findings point out the need to provide physicians in antenatal settings with an update on current immunization policy and practice and for improved documentation of immunization histories.