Perinatal Mortality In Nigeria Research Articles

Determinants and outcomes of preterm births in Nigerian tertiary facilities.

To describe the incidence, and sociodemographic and clinical factors associated with preterm birth and perinatal mortality in Nigeria. Secondary analysis of data collected through the Maternal Perinatal Database for Quality, Equity and Dignity (MPD-4-QED) Programme. Data from births in 54 referral-level hospitals across Nigeria between 1 September 2019 and 31 August 2020. A total of 69 698 births. Multilevel modelling was used to determine the factors associated with preterm birth and perinatal mortality. Preterm birth and preterm perinatal mortality. Of 62 383 live births, 9547 were preterm (153 per 1000 live births). Maternal age (<20 years - adjusted odds ratio [aOR] 1.52, 95% CI 1.36-1.71; >35 years - aOR 1.23, 95% CI 1.16-1.30), no formal education (aOR 1.68, 95% CI 1.54-1.84), partner not gainfully employed (aOR 1.94, 95% CI 1.61-2.34) and no antenatal care (aOR 2.62, 95% CI 2.42-2.84) were associated with preterm births. Early neonatal mortality for preterm neonates was 47.2 per 1000 preterm live births (451/9547). Father's occupation (manual labour aOR 1.52, 95% CI 1.20-1.93), hypertensive disorders of pregnancy (aOR 1.37, 95% CI 1.02-1.83), no antenatal care (aOR 2.74, 95% CI 2.04-3.67), earlier gestation (28 to <32 weeks - aOR 2.94, 95% CI 2.15-4.10; 32 to <34 weeks - aOR 1.80, 95% CI 1.3-2.44) and birthweight <1000 g (aOR 21.35, 95% CI 12.54-36.33) were associated with preterm perinatal mortality. Preterm birth and perinatal mortality in Nigeria are high. Efforts should be made to enhance access to quality health care during pregnancy, delivery and the neonatal period, and improve the parental socio-economic status.

A five-year review of perinatal and maternal outcomes and their predisposing socio-demographic factors in a tertiary hospital in South-South Nigeria

Background: With a ‘Very High’ maternal mortality ratio (MMR) of 814 per 100,000 live births, Nigeria contributes the largest proportion of 19% to the global burden of maternal mortality. The causes of maternal and perinatal mortality in Nigeria are linked to the three levels of delay in accessing maternal healthcare. The objective of the study was to identify the sociodemographic contributors to adverse maternal and perinatal outcomes and mortalities in the facility and make appropriate recommendations that would improve maternal and perinatal outcomes/mortalities.Methods: This research was a retrospective study. It was conducted between January, 2016 and December, 2020. Relevant data was retrieved, entered into a pre-designed proforma, and analysed using Statistical Product and Service Solutions for windows® version 25, SPSS Inc.; Chicago, USA.Results: Age of the women (X2=12.94; p-0.005), marital status (X2=66.86; p-0.001), level of education (X2=8.77; p-0.033) and occupation of participants (X2=26.30; p-0.001) were sociodemographic characteristics that are significantly associated with the outcome of pregnancies in this centre. perinatal mortality was also associated with age of the women (X2=15.52; p-0.001), their marital status (X2=105.48; p-0.001), level of education (X2=223.15; p-0.005) and occupation (X2=229.6; p-0.001).Conclusions: Our study revealed that socio-demographic factors of the patients to a large extent contributes to maternal and perinatal morbidity and mortality, and not just the three delays.

Community-and proximate-level factors associated with perinatal mortality in Nigeria: evidence from a nationwide household survey

BackgroundThe perinatal mortality rate (PMR) in Nigeria rose by approximately 5% from 39 to 41 deaths per 1000 total births between 2008 and 2013, indicating a reversal in earlier gains. This study sought to identify factors associated with increased PMR.MethodsNationally representative data including 31,121 pregnancies of 7 months or longer obtained from the 2013 Nigeria Demographic and Health Survey were used to investigate the community-, socio-economic-, proximate- and environmental-level factors related to perinatal mortality (PM). Generalized linear latent and mixed models with the logit link and binomial family that adjusted for clustering and sampling weights was employed for the analyses.ResultsBabies born to obese women (adjusted odds ratio [aOR] = 1.46, 95% confidence interval [CI]: 1.13–1.89) and babies whose mothers perceived their body size after birth to be smaller than the average size (aOR = 1.92, 95% CI: 1.61–2.30) showed greater odds of PM. Babies delivered through caesarean section were more likely to die (aOR = 2.85, 95% CI: 2.02–4.02) than those born through vaginal delivery. Other factors that significantly increased PM included age of the women (≥40 years), living in rural areas, gender (being male) and a fourth or higher birth order with a birth interval ≤ 2 years.ConclusionsNewborn and maternal care interventions are needed, especially for rural communities, that aim at counselling women that are obese. Promoting well-timed caesarean delivery, Kangaroo mother care of small-for-gestational-age babies, child spacing, timely referral for ailing babies and adequate medical check-up for older pregnant women may substantially reduce PM in Nigeria.

Pregnancy-related acute kidney injury: Etiologies and short-term outcomes in a tertiary hospital in Southwest Nigeria.

Although the incidence of pregnancy-related acute kidney injury (PRAKI) is declining in developing countries, it still remains a major cause of maternal and fetal morbidity and mortality. The aim of this study was to determine the etiologies, short-term outcomes, and their predictors in patients with PRAKI managed in a tertiary health facility in Southwest Nigeria over a four-year period. This was a four-year retrospective review of clinical records of patients managed for PRAKI in University of Medical Sciences Teaching Hospital, Ondo State, Nigeria. Thirty-two women with a mean age of 31.09 ± 7.50 years had PRAKI during the period reviewed. Twenty-four (75%) patients were multiparous and PRAKI was most common in the postpartum period (56.3%). Twenty-three patients (71.9%) were in RIFLE Stage 3, 24 (75%) received blood transfusion, 5 (15.6%) required intensive care unit (ICU) care, 24 (75%) needed dialysis while 19 (59.4%) had hemodialysis. The common causes of PRAKI were obstetric hemorrhage in 16 (50%), sepsis in seven (21.9%), and eclampsia in six (18.8%). Maternal and fetal mortality were 34.4% and 50% respectively. Seventeen (53.1%) had full renal recovery and only one (3.1%) became dialysis dependent. Significant factors that were associated with maternal mortality were admission to ICU (P = 0.01), hypotension (P = 0.02), and impaired consciousness (P <0.001) PRAKI is still relatively common and significantly contributes to maternal and perinatal mortality in Nigeria. Obstetric hemorrhage which is the most common cause of PRAKI is preventable and treatable. There is a need for physicians to effectively prevent and manage obstetric hemorrhage.

68. Training of trainers of midwives and nurses as a strategy for the reduction of preeclampsia and eclampsia related maternal and perinatal mortality in Nigeria

Background Preeclampsia and eclampsia (PE/E) are major contributors to maternal and perinatal mortality in Nigeria. Despite the availability of current curriculum at Nigerian schools of nursing and midwifery, the knowledge on the management of PE/E among the students has remained poor. In order to reduce maternal and perinatal mortality in developing countries, pre service training of nurses and midwives is important. Methodology A total of 292 tutors from 171 schools of nursing and midwifery participated in the training of the trainers’ workshops on current management of PE/E across Nigeria. Pre and post test assessments were administered. Six months after the training, 29 schools and 84 tutors were randomly selected for follow-up to evaluate the impact of the training. Results Significant knowledge transfer occurred among the participants as the pretest/posttest analysis at the workshop showed knowledge transmission across all the 13 knowledge items assessed. The follow-up evaluation also showed that the trained tutors conducted 19 step-down trainings and trained 157 other tutors in their respective schools. Subsequently, 2382 nursing and midwifery students were trained. However, six of the monitored schools (24.2%) lacked essential kits for teaching PE/E. Conclusion Updating the knowledge of tutors leads to improved preservice training of the future generation of nurses and midwives. This will result in higher quality of care to patients and reduced PE/E-related maternal and perinatal mortality. However, there is need to provide essential training kits for teaching of student nurses and midwives.

Averting Maternal and Perinatal Mortality in Nigeria; Establishment of Obstetric Waiting Units; Targeting Uterine Rupture

Averting Maternal and Perinatal Mortality in Nigeria; Establishment of Obstetric Waiting Units; Targeting Uterine Rupture

Experiences with Universal Health Coverage of Maternal Health Care in Ondo State, Nigeria, 2009-2017.

I am pleased that the theme of this maiden conference of the Association of Feto-Maternal Medicine Specialists of Nigeria (AFEMSON) is the reduction of maternal and perinatal mortality. Practising in our setting can be particularly challenging due to the weak health system which leads to frustrating outcomes, with high rates of avoidable maternal and perinatal morbidity and mortality. For practitioners of fetomaternal medicine to deal with this as a major public health concern, the focus should not just be some cold statistics, but rather it must be addressed as a true everyday human story and societal tragedy. In a recent publication1, Elliot Main, a Stanford Professor of Obstetrics and Gynaecology, and founder of California Maternal Quality Care Collaborative was reported as saying: ―When you‘ve had a maternal death, you remember it for the rest of your life - all the details‖ Perhaps, practicing in our setting (like in most low and middle income countries) you may not remember ―all the details‖ because of regularity of occurrence. However, I am sure that each of you, frontline practitioners here gathered, has had a few unfortunate human angle stories - details of which get imprinted in your memory for the rest of your life. In my practice, I also had my own experiences, which were part of the reasons that I decided to temporarily set aside the practice of clinical medicine to get involved in top policy formulation for health and overall societal development. As reported by Olu Obafemi2 in his recent publication of my experiences: “Those days I will tell people that I could never forget the cry of a woman when she loses her child at night, because at a stage, I was living within my clinic. It was harrowing, especially at night, between 1-2am.” As Governor of Ondo State, southwest Nigeria for 8 years (2009-2017), working with other stakeholders, we proved that even in resource-restricted settings like Nigeria, it is possible to achieve positive outcomes in terms of systematic reduction in maternal and perinatal death mortality. The Centre for Strategic and International Studies (CSIS), in its publication on the first year of ABIYE3, succinctly encapsulated this by saying ―With leadership, progress is possible.‖ Specifically, under my leadership as Governor of Ondo State, we commenced a unique Abiye maternal health program that offered free maternal and child health services to pregnant mothers and children less than five years old (including sophisticated referral care) that brought maternal and child health care to the doorstep of every citizen in the state. The consequence was a significant reduction in maternal mortality in the state, enabling the state to achieve the target of Goal-5 of the Millennium Development Goals. But this was not achieved without some noteworthy challenges. The purpose of this presentation therefore is to describe the philosophy that led us to focus on the delivery of free maternal health care, to summarize the methods and challenges in its implementation and to make recommendations on ways to build political will for improved delivery of maternal health care and the reduction of maternal and perinatal mortality in Nigeria. I believe that the recommendations made will be useful for policymakers elsewhere to understand the social context of health care and to prioritize the delivery of maternal health care as a social justice and human rights requirement of citizens.

Training-of-trainers of nurses and midwives as a strategy for the reduction of eclampsia-related maternal mortality in Nigeria

Background: Preeclampsia and eclampsia (PE/E) are major contributors to maternal and perinatal mortality in Nigeria. Despite the availability of current curriculum at Nigerian schools of nursing and midwifery, the knowledge on the management of PE/E among the students has remained poor. In order to reduce maternal and perinatal mortality in developing countries, targeted training and supportive supervision of frontline health care providers have been recommended. Methodology: A total of 292 tutors from 171 schools of nursing and midwifery participated in the training of the trainers' workshops on current management of PE/E across the country. Pre- and post-test assessments were administered. Six months after the training, 29 schools and 84 tutors were randomly selected for follow-up to evaluate the impact of the training. Results: Significant knowledge transfer occurred among the participants as the pretest/posttest analysis showed knowledge transmission across all the 13 knowledge items assessed. The follow-up evaluation also showed that the trained tutors conducted 19 step-down trainings and trained 157 other tutors in their respective schools. Subsequently, 2382 nursing and midwifery students were properly trained. However, six of the monitored schools (24.2%) lacked all the essential kits for teaching on PE/E. Conclusion: Updating the knowledge of tutors leads to improved preservice training of the future generation of nurses and midwives. This will likely result in higher quality of care to patients and reduce PE/E-related maternal and perinatal mortality. However, there is need to provide essential training kits for teaching of student nurses and midwives.

Perinatal Mortality in Nigeria: Do Place of Delivery and Delivery Assistants Matter?

Background: Studies in developed countries have shown that deliveries which occur at home and under the supervision of unskilled attendants present a high risk of perinatal death. However, it is unclear, especially in sub- Saharan Africa (SSA) where studies are limited, on precisely how these factors may influence perinatal mortality. This is particularly of interest considering that majority of births in SSA occur at home under the supervision of unskilled attendants and perinatal mortality in the sub-region is about five times that of the developed world. This study aims to determine the extent to which these factors influence perinatal mortality in Nigeria in order to inform maternal and child health policy decisions. Methods: This study uses secondary data from the 2003 Nigerian Demographic and Health Survey. Logistic regression analysis was used to determine the association of place of delivery and delivery assistants with perinatal mortality while controlling for other known risk factors. Results: Of the 5783 live singleton births that were analyzed, 194 were perinatal deaths giving an estimated perinatal mortality rate (PNMR) of 72.4 per 1000 live births. However, the results show that place of delivery and delivery assistants were not significantly associated with perinatal mortality in Nigeria. Conclusions: In this study, place of delivery and delivery assistants are not critical predictors of perinatal mortality in Nigeria. However in view of the high PNMR found in this study, we recommend improved skilled attendance and institutional delivery rates as part of efforts for better maternal and child health in developing countries.

Perinatal Outcome of Babies Delivered to Eclamptic Mothers: A Prospective Study from a Nigerian Tertiary Hospital

Background: Eclampsia is a leading cause of maternal and perinatal mortality in Nigeria. Preventive and interventional measures have been shown to reduce maternal mortality and morbidity with no significant beneficial effect on neonatal outcomes. The aim of this study is to assess the perinatal outcome of eclampsia at the University of Port-Harcourt Teaching Hospital (UPTH). Materials and methods: This prospective, cross-sectional study was conducted on 88 consecutive patients presenting with antepartum eclampsia at the UPTH between 1st January 2007 and 31st December 2008. A protocol was developed and used to collect information about socio-demographic characteristics, mode of delivery, perinatal complications and outcome. Data collected was entered into a spread sheet using SPSS 15.0 for Windows® statistical software which was also used for analysis. Chi square was used to test relationship between variables. P value&lt;0.05 was considered statistically significant. Results: There were a total of 5488 deliveries at the University of Port-Harcourt Teaching Hospital from January 2007 to December 2008. Of these, 5,310 were live births while 404 were perinatal deaths giving perinatal mortality rate of 73.6 per 1000 live births. Eighty eight (1.6%) of the mothers were eclamptic. Eight (9.1%) were booked, 80 (90.1%) were unbooked. The mean gestational age at delivery was 35.1 ± 4.2 weeks. The main mode of delivery was by emergency caesarian section in 49 (55.7%) of the patients. Others were spontaneous vertex delivery (34.1%), assisted vaginal breech delivery (6.8%) and instrumental vaginal delivery (3.4%). Fifty four babies (61.4%) were admitted into the Special Care Baby Unit. Indications for admission include prematurity (n=23), low birth weight (n=10), severe birth asphyxia (n=12), neonatal jaundice (n=4) and neonatal sepsis (n=5). There were 37 perinatal deaths giving a perinatal mortality rate of 411 per 1000 live births. Of the mortalities, 19 were intrauterine foetal deaths, while 18 were early neonatal deaths. Causes of death include severe birth asphyxia (n=6), respiratory distress syndrome (n=4), prematurity (n=4), neonatal jaundice (n=1) and sepsis (n=3). Conclusion: Eclampsia is a major contributor of perinatal mortality and morbidity in Nigeria. Detection and appropriate management of preeclampsia is critical to reduce the risk of eclampsia.