Asian Journal of Pregnancy and Childbirth

Worldwide, Over 600,000 maternal deaths are recorded annually. Many women die due to pregnancy associated complications in Nigeria. Thus, this paper seeks to explore the application of poisson models in the study of incidence of pregnancy related death in Oyo state, Nigeria. The paper explores the application of poisson models in the study of maternal deaths. Understanding the incidence of maternal deaths may provide useful information to policy makers for the development of actionable plan to improve maternal health policies and its implementations. The analysis was based on data sourced from the records unit of the hospital for the period of 2009-2018. Within the 10 year period, a total of 1121 maternal death was observed, with the years 2016 and 2017 recording the highest deaths of 136 and 148 respectively. Also, the mean incidence of maternal deaths remained approximately the same over the period. Based on the result from our analysis, we recommend that management and government reevaluate all existing intervention programs for reducing maternal deaths since they seem not to have yielded the expected results over the past ten years (2009 - 2018) reference to this general hospital.

Introduction: This study was conducted for the purpose of determining the breastfeeding attitudes of pregnant women and factors which affect the breastfeeding.

Methods: This study is a cross-sectional and descriptive study. The study sample consisted of 152 pregnant monitored in obstetric clinics at a university hospital in Manisa. The study data were collected by using two forms “Pregnant Information Form” and “Breastfeeding Attrition Prediction Tool”.

Results: The mean age of pregnant women was 27.69±5.62 years. When the sub-scale score mean of the pregnant women are investigated, it has been determined that Positive Breastfeeding Attitudinal Scale (PBS) score averages 242.11±57.04, Negative Breastfeeding Attitudinal Scale (NBS) score averages 142.01 ± 52.07, Social and Professional Support Scale (SPS) score averages 209.49 ± 52.56  and Breastfeeding Control Scale (BFC) score averages 38.76 ± 6.78.

Conclusions: The results illustrated that with a university degree and from nuclear families and multipara and aged pregnant women had positive attitudes towards breastfeeding. It was also noted that multipara and aged pregnant women had higher control perceptions of breastfeeding.

Aims: To determine the factors influencing multiple antenatal care bookings among pregnant women in urban and rural communities of Ebonyi state, Nigeria.

Study Design: This was a community based cross-sectional comparative study design using a sequential mixed method exploratory approach.

Place and Duration of Study: The study was conducted in urban and rural communities of Ebonyi State, Nigeria between September and October 2017.

Methodology: A two stage sampling method was used to select 660 women who have been delivered of babies within one year preceding the study irrespective of place of antenatal care. Also the respondents were permanent residents of the selected communities for one year. Eight focus group discussions were conducted among women who delivered within one year preceding the study and those pregnant during the period of study. Twelve key informant interviews were also conducted among providers of antenatal care in health facilities in the selected communities. Chi square test of statistical significance and multivariate analysis using binary logistic regression were used in the analysis and level of statistical significance was determined by a p value of <0.05. QDA Miner Lite v2.0.6 was used in the analysis of qualitative data.

Results: The mean age of respondents were 29.6±6.2 and 28.6±5.1years in urban and rural communities respectively. A significantly higher proportion of respondents in urban area, 34.5% registered for antenatal care in more than one health facility when compared to those in rural, 25.8%. (p=0.014). The major reason for multiple antenatal care bookings in the urban was because of strike actions by health workers in the public health sector while in the rural, it was because of emergency which may occur during the period of pregnancy or labour. Predictor of multiple antenatal bookings among the respondents was the attainment of tertiary education. (A0R=1.7; 95%C1: 1.1-2.6).

Conclusion: More than a third of the respondents registered for antenatal care in more than one health facility. The reasons for this practice are a manifestation of the weaknesses of the health system and at a high cost to the women and the country especially as Nigeria bears the highest burden of maternal deaths globally. The Government of Nigeria should bring to an end the frequent industrial actions in the public health sector. There is also the need to train the health workers and enlighten the populace on referral system. These may serve as initial steps towards embracing quality maternal health services in Nigeria.

Aims: This study was to ascertain the barriers in PMTCT Services in private tertiary health facilities in Enugu state, South-east Nigeria

Study Design: This was a facility-based analytical cross-sectional study among HIV positive nursing mothers who were accessing PMTCT services.

Place and Duration of Study: The study was at Ante natal clinic and post natal Clinics of Annunciation and Mother of Christ health facilities in Enugu state. The study was between February and July 2015.

Methodology: Questionnaires were used. Chi-square test was used for association between socio-demographic variables and experience of any access barrier. Multivariate analysis in form of logistic regression was done to for determinants of experience of any access barrier.  Level of significance was determined at a p-value of ≤ 0.05

Results: Majority were aged 30-34 years 144(52.4%), attained secondary education 121(44.0%), were unemployed 108(39.3%), and had 1-2 babies 128(46.5%). The major barriers experienced were; cost of registration/transport 198(72.0%), Stigma and discrimination from friends/neighbours 123(44.7%) and being too busy with household chores 137(49.8%). There were statistically significant association between experience of barriers with educational level (χ2=8.572, p =0.036) and parity (χ2=6.451, p=0.040)

Conclusion: Almost all the study participants in this study experienced a form of barrier with major barriers. Parity and educational level influenced barriers to PMTCT care. There is need for educational empowerment and family planning for the desired goals of PMTCT services to be achieved.

Aims: This study aimed at investigating maternal malaria and its impact on red cell indices of pregnant women in rural Nigeria.

Study Design: Case-control study.

Place and Duration of Study: This study was carried out in rural Cross River State of Nigeria between May and November, 2018.

Methodology: This study was carried out among consenting pregnant women at Akpet central, Biase Local Government Area of Cross River State. A total of three hundred and eighty pregnant women and three hundred and eighty non-pregnant women were enrolled. Blood samples were collected into ethylene diamine tetra-acetic acid bottles and plain bottles for analysis of red cell indices by automation and to obtain serum for iron tests respectively. Serum iron and TIBC were analyzed by standard colorimetric methods while serum ferritin was assayed by enzyme-linked immunosorbent assay technique. Malaria microcopy was carried out on stained thick and thin blood films.

Results: The red cell indices and iron levels of pregnant women were significantly lower (p≤ 0.05) compared to non-pregnant women. These parameters were also significantly lower (p≤ 0.05) among malaria-infected pregnant women compared to their counterparts who did not have malaria.

Conclusion: Malaria and anaemia remain important health challenges for pregnant women in rural communities of Nigeria. 

Introduction: This study assessed birth preparedness and complication readiness (BP/CR) and its associated factors among pregnant woman attending selected health care facilities in Ado-Ekiti, Ekiti state, Nigeria.

Methods: A cross-sectional study design was employed. Two hundred and six pregnant women were randomly selected from four health care facilities. Data were analysed using descriptive, binary and multiple logistic regression analysis. The level of significance was set at P <0.05. Results: The overall prevalence of BP/CR was 70.6% (n = 125). About 149 (81%) already identified a place of delivery, 114 (62%) identified skilled birth attendant, and 160 (87%) saved money for delivery. However only 30 (16.3%) of the respondents made arrangement for blood donor in case of emergency. Religion, parity, and knowledge of at least two obstetric danger signs were significantly associated with the extent of BP/CR practice. Being a Christian (AOR = 6.15, 95% CI: 1.65 – 22.97) and having knowledge of at least two obstetric danger signs (AOR = 5.80, 95% CI: 1.81 – 18.56) were significant predictors of good BP/CR practices.

Conclusions: Health care providers should stress the importance of identifying blood donor in case of emergency and antenatal clinics should be goal - and client-oriented and time effective. BP/CR should be made an integral part of maternal and child health services as the occurrences of complications during the process of childbirth are unpredictable.

Background: TORCH infection is responsible for the major of maternal and fetal morbidity and mortality in the pregnancy because of their ability to generate congenital defects. It transmits to foetus from the mother during gestation or delivery time and leads to serious complication to the foetus. It can lead to abortion, congenital anomalies and intrauterine fetal death. In fact, the most effective way to prevent the infection is a regular hand washing, particularly when caring for infected women and babies. The aim of this study is to assess the relationship between the rate of abortion and foetus death and TORCH infection as a major cause.

Methods: The data was collected from neonatal death certificates from the departments of gynaecology, obstetrics and neonates at Benghazi Medical Centre, which includes age groups, and causes of death, the data included all certificates from October 2014 to December 2018.

Results: The current study had showed that there was a significant elevation in the fetal and infant mortality rates from 2014 to 2018, and these numbers were increasing throughout the years without any medical reasons. High foetus death was observed at gestational period 33 -40 weeks, while the neonatal death was higher at age 1 to 30 days. Furthermore, this study reported that head and brain congenital anomalies were the most common between foetus and neonates and these findings were assumed that the death of the foetus and neonate could be caused by any of TORCH infections when compared to the previous studies.

Conclusion: Elevation rates of neonates and foetus were an obvious issue that must be of major concern, so that, the findings of this study emphasizing on the demand for doing TORCH test for all pregnant women at the first of pregnancy to early recognizing the infection. In addition, it is ensuring the demands of doing the TORCH test with the required HIV and hepatitis C tests before delivery to guide the staff take further attention. In addition, it emphasizes the need to focus on the effectiveness of hand hygiene, cleaning and disinfection in the department to reduce the rate of infection.

Aim: To highlight the potential for benign lesions of the cervix uteri to present in bizarre unexpected ways during late pregnancy and the need for cautious evaluation to ensure optimal treatment is given, especially when life-altering decisions need to be made.

Presentation of Case: We present here a literature review and a case of 25 year old primigravida with twin gestation and antepartum hemorrhage (APH) initially thought to be due to cervical cancer but which turned out to be caused by chronic cervicitis.

Discussion: Obstetric hemorrhage remains the commonest cause of maternal mortality and morbidity in Nigeria. The occurrence of APH portends grave risks to the fetus and mother. A high risk of prematurity exists when bleeding occurs before term; a further risk of caesarean hysterectomy exists when a diagnosis of cervical cancer is suspected in women with APH. Infective cervical lesions such as cervicitis have been reported as causes of antepartum hemorrhage, but they are not significant enough to determine or affect obstetric outcome. Chronic cervicitis presenting as heavy antepartum hemorrhage leading to preterm delivery is a rare occurrence.

Conclusion: Infective lesions of the cervix are important benign causes of antepartum hemorrhage; the ability of chronic cervicitis to mimic exophytic cervical cancer is a consequence of physiologic changes in pregnancy which should be considered during patient evaluation. Cautious patient assessment should be done to ensure optimal care is given without undue risk to the fetus or mother.

Aims: Some women in the developing world use abortion to regulate fertility and space childbearing. However, repeat induced abortion has become common and it’s linked to increased risk of adverse outcomes in future pregnancies. The aim of this study was to determine the relationship between repeat induced abortion and current use of contraception among women in Ghana.

Study Design: A secondary analysis of cross-sectional survey data.

Place and Duration of Study: The study was conducted in Ghana between July 2019 and August 2019.

Methodology: Data on a weighted sample of 4595 women aged 15-49 years with a lifetime history of induced abortion from the 2017 Ghana Maternal Health Survey were analysed using Chi-square (χ²) test and multivariable survey logistic regression in STATA/IC 15.0. Statistical significance was set at the 5% level. The adjusted odds ratio was estimated.

Results: Out of 4595 women, 1591 (34.6%) experienced repeat-induced abortion. Current use of contraception was 36.7% (CI: 34.7-38.7). The majority used modern contraceptives (78%). The commonly used methods were injectables (20.3%), implants (19.7%), pills (16.6%) and rhythm (16.2%). After adjusting for potential confounding, repeat induced abortion was not significantly associated with current use of contraception. However, age, marital status, place of residence and ecological zone of residence were associated with current use of contraception. For instance, rural women with a history of repeat induced abortion were 1.3 times (AOR=1.27, 95% CI: 1.02-1.59, p=0.036) more likely to be on contraception compared to urban women.

Conclusion: Women’s previous abortion experience was not independently associated with their current use of contraception. Other factors were significantly associated with women’s use of contraception post-abortion. Further research is recommended to clearly understand this phenomenon among Ghanaian women in the reproductive age group.

Aims: To assess the quality of antenatal care and determine factors influencing access to quality care at the Holy Family Hospital, Nkawkaw in the Kwahu West Municipality of Ghana.

Study Design: A facility-based cross-sectional study.

Place and Duration of Study: Postnatal clinic of Holy Family Hospital, Nkawkaw, from July to September 2016.

Methodology: Four hundred postnatal clinic attendants age 15-49 years were selected consecutively for the study. Quality of antenatal care was classified according to the Content and Timing of care in Pregnancy (CTP) tool developed by Beekman et al (2011). Logistic regression was used to determine predictors of acceptable quality care. Results were presented as adjusted odds ratio at 95% confidence level.

Results: Approximately 66% of respondents received acceptable quality of care. Being a trader (AOR=4.1, 95%CI: 1.7-10.0); having had three or four births (AOR=2.0, 95%CI: 1.1-3.6) and having a partner with secondary education (AOR=4.6, 95%CI: 1.9-11.0) were significantly associated with receiving acceptable quality of care.

Conclusion: Although 66% of the respondents accessed acceptable quality of care, the hospital has the capacity to provide quality care to all women attending its antenatal clinic. Community-based Health Planning and Services; mobile phone text messaging to remind pregnant women of appointments; and domiciliary midwifery services could be part of effective strategies to address gaps in quality antenatal care.

Malaria and HIV are important challenging infections in Nigeria. Co-infections of this duo in pregnancy has been associated with various adverse pregnancy outcomes including anaemia, low birth weight, premature birth, maternal and neonatal death. This study was carried out to determine the prevalence of malaria infection among HIV infected pregnant mothers reporting for routine antenatal checkup in two major state owned hospitals in Ondo city. The cross-sectional study conducted between May and September 2018 had 93 HIV infected pregnant women as participants. The overall prevalence rate of malaria was 52.6% and the highest rate was recorded among separated/divorced participants (83.3%). Malaria infection was found to be statistically significant in relative to CD₄⁺ cell counts where malaria infection prevalence ranges from 22.2% to 71.4% ( χ² =9.22, P=0.03). This study has found that the prevalence of malaria was high among HIV infected pregnant women in Ondo city and that factors such as gravidity, reported fever and residence do not vary significantly on the univariate analysis employed in this study.

Background: Antenatal care is one of the pillars of the SAFE Motherhood Initiative aimed at preventing adverse pregnancy outcome. Early initiation provides an opportunity for optimum utilization of this care with improved maternal and fetal outcomes.

Objective: To determine the pattern and Socio-demographic determinants of gestational age at antenatal booking at the Rivers State University Teaching Hospital (RSUTH) over a two-year period.

Methodology: A retrospective review of hospital records of all pregnant women booked for antenatal care (ANC) at RSUTH in a two-year period, from 1^ST May 2017 to 30^TH April 2019, was carried out. Data on patients’ age, parity and educational level, and gestational age at booking were retrieved using structured pro-forma and analyzed using Epi Info Version 7. Test for significance using Chi-square was set at significant level of P<0.05.

Results: There were 3560 cases, with a mean age of 31.5±4.7 years and a mean gestational age at booking of 22.1±6.8 weeks. Majority of the women (53.9%) booked in the second trimester. Only about a quarter (26.5%) booked early, with 73.5% booking late. Majority of the women (62.2%) fall within the 30-39 age group, are Multiparous (65.3%) and had tertiary education (72.5%). There was no statistically significant relationship between their ages and gestational age at booking (χ2 = 3.372, p-value=0.761). However, parity (χ2 = 50.015, p-value=0.000) and educational qualification (χ2 = 18.358, p-value=0.001) were statistically significant.

Conclusion: The majority of ANC attendees booked late for antenatal care in this study, and only about a quarter booked early. There was a statistically significant difference in parity and educational status as determinants of gestational age at booking, with the nullipara and primary education group booking earlier.

Background:  There are several complications of pregnancy that confer significant ongoing risk to the mother or fetus. For these conditions, induction of labour is as an artificial termination of pregnancy utilized to decrease both maternal and neonatal morbidity and mortality. The process of inducing labour is not always successful and sometimes fails to achieve a safe vaginal delivery.

Methods: Retrospective cross-sectional study was conducted on medical records of 319 registered women who undergo labour induction at Dessie referral hospital from January 01 to February 2017.  Systematic sampling techniques were used to select the samples. The data was cleaned, edited, coded, and entered into EPI INFO version 3.5 and exported and analyzed by SPSS with windows version 20.0. Bivariate and multivariate logistic regression statistical model was used to identify factors associated with the outcome variable. Adjusted odds ratio with 95% CI was computed to see the strength of association.

Results: The proportion of failed induction of labour was 19.7 %. Multivariable logistic regression analysis showed that women live in a rural area [4.171(1.358-12.807)], primipara [AOR=1.72(1.67-4.415)] and women whose Bishop score is unfavourable [0.147(0.066-0.327)] were significantly associated with failed induction of labour.

Conclusion: The proportion of failed induction of labour was relatively high in the study area. Variables which increased the likelihood of failed induction were living rural area, primigravidity and unfavourable bishop score before induction of labour.

Aims: To determine prevalence and factors influencing stillbirth among deliveries.

Study Design: A facility-based cross-sectional analytical study.

Place and Duration of Study: Sunyani Municipal and Seventh Day Adventist (SDA) Hospitals in Bono Region, Ghana from January, 2014 and December, 2015.  

Methodology: Two thousand and twelve deliveries were analyzed. Outcome variable was stillbirth, explanatory variables were the sociodemographic, obstetric and clinical characteristics. Logistic regression (bivariate and multivariate) analysis reporting odds ratio at 95% confidence interval were calculated to identify factors associated with stillbirth. 

Results Stillbirth rate was 15/1000 births.  Mean age of mothers was 28.2 ±5.9 years and majority (75.1%) were aged 20-34 years. Prevalence of stillbirth was higher among women with no formal education (2.1%). Odds of stillbirth decreased with additional antenatal care (ANC) visits; 2-3times ANC visits (AOR=0.16, 95% CI:0.06 - 0.48), ANC 4+ times (AOR=0.017, 95% CI: 0.006 - 0.052). Women who received 3+ doses of intermittent prophylactic treatment (IPT) for malaria had 68% reduction in odds of stillbirth compared with those who had one (AOR=0.32, 95% CI: 0.009-0.103). Women with haemoglobin greater than 11.0 g/dl were more than 70% less likely of stillbirth outcome (AOR = 0.29, 95% CI: 0.11-0.73).

Conclusion: High number of ANC visits, optimal maternal haemoglobin (>11.0 g/dl) and 3+ IPT are associated with lower risk of stillbirth among deliveries.  Premium should be placed on quality of ANC to suit the specific needs of pregnant women whiles encouraging more visits.

Background: The need for fertility stimulation in men and women cannot be overemphasized especially when a marriage is childless in some communities in Nigeria. While chemical methods for fertility stimulation may have some side effects and are not readily available, remedy from natural sources can be used.

Aim: This present study is aimed to evaluate the effect of coconut water on fertility in male Wistar rats.

Materials and Methods: Coconuts of about 8 months old were harvested from Apata area of Ibadan in Oyo State, Nigeria. The coconuts were dehusked, broken carefully and the liquid endosperm was collected and preserved in the refrigerator. Thirty male Wistar rats weighing between 180 and 200 g were used for the experiment. They were acclimatized for 7 days during which they were fed ad libitum with standard feed and drinking water. They were randomly divided into 6 groups of 5 rats each. Animals in groups A, B and C were administered normal saline for 10, 20 and 30 days respectively via oral route. Those in groups D, E and F were similarly treated (for 10, 20 and 30 days respectively via oral route) but with 3 mL of undiluted coconut water. At the end of treatment, the animals were sacrificed by the cervical dislocation. The internal organs were exposed. Testes and cauda epididymis were removed and kept in sterilized watched glass. Male fertility parameters were determined using standard methods.

Results: Coconut water caused increased sperm count and sperm motility while mortality and abnormality of spermatozoa decreased significantly after 10, 20 and 30 days of treatment respectively. However, coconut water had no significant difference on seminal pH at P<0.05.

Conclusion: The results of this present study showed that coconut water increased fertility in male Wistar rats. Men with fertility challenges are encouraged to consume coconut water as often as possible.