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OBJECTIVE: To determine the incidence, risk factors and outcomes of babies with neonatal jaundice in a network of referral-level hospitals in Nigeria. DESIGN: A cross-sectional analysis of perinatal data collected over a 1-year period. SETTING: Fifty-four referral-level hospitals (48 public and 6 private) across the six geopolitical zones of Nigeria. POPULATION: A total of 77 026 babies born at or admitted to the participating facilities (67 697 hospital live births; plus 9329 out-born babies), with information on jaundice between 1 September 2019 and 31 August 2020. METHODS: Data were extracted and analysed to calculate incidence and sociodemographic and clinical risk factors for neonatal jaundice. MAIN OUTCOME MEASURES: Incidence and risk factors of neonatal jaundice in the 54-referral hospitals in Nigeria. RESULTS: Of 77 026 babies born in or admitted to the participating facilities, 3228 had jaundice (41.92 per 1000 live births). Of the 67 697 hospital live births, 845 babies had jaundice (12.48 per 1000 live births). The risk factors associated with neonatal jaundice were no formal education (adjusted odds ratio [aOR] 1.68, 95% CI 1.11-2.52) or post-secondary education (aOR 1.17, 95% CI 0.99-1.38), previous caesarean section (aOR 1.68, 95% CI 1.40-2.03), booked antenatal care at <13 weeks or 13-26 weeks of gestation (aOR 1.58, 95% CI 1.20-2.08; aOR 1.15, 95% CI 0.93-1.42, respectively), preterm birth (aOR 1.43, 95% CI 1.14-1.78) and labour more than 18 hours (aOR 2.14, 95% CI 1.74-2.63). CONCLUSIONS: Hospital-level and regional-level strategies are needed to address newborn jaundice, which include a focus on management and discharge counselling on signs of jaundice.
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OBJECTIVE: To evaluate whether treatment of slow labor progress among term nulliparous women using a 2-hour partograph action line reduces the incidence of prolonged labor versus a 4-hour action line. METHODS: Randomized controlled trial of nulliparous women with a term singleton, non-macrosomic, cephalic fetus in labor attending a university hospital in Nigeria (2008-2015). For labor supervision, women were randomly assigned to the 2-hour (n=320) or 4-hour (n=320) partograph action line group. slow labor progress was treated with oxytocin augmentation The primary outcome was incidence of prolonged labor (>12 hours). Delivery mode, neonatal outcomes, and maternal satisfaction with treatment were secondary outcomes. RESULTS: Prolonged labor rate did not significantly differ between the 2-hour (7/320, 2.2%) and 4-hour (8/320, 2.5%) action line groups. Secondary outcomes did not differ significantly. Oxytocin augmentation to treat slow labor progress was needed for 87 (27.2%) and 61 (19.1%) women in the respective 2- and 4-hour groups (P=0.025). Mean duration of first and second labor stages differed significantly between the groups (P<0.05). CONCLUSION: The 2-hour partograph action line did not reduce incidence of prolonged labor relative to the 4-hour action line. Partograph with a 4-hour action line is recommended for labor supervision in all facilities. CLINICAL TRIAL REGISTRATION: Registered at ClinicalTrials.gov as (https://clinicaltrialsgov/show/NCT02911272).