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

A community-based investigation of the avoidable factors of maternal mortality in Nigeria: the pilot experience

"Background: Reduction of maternal mortality is one of the major goals of several recent international conferences and has been included within the Millennium Development Goals. However; because measuring maternal mortality is difficult and complex; reliable estimates of the dimensions of the problem are not generally available and assessing progress towards the goal is difficult in some countries. Reliable baseline data are crucial to effectively track progress and measure that targets or goals of reducing maternal mortality have been met. Objectives:The objectives of this pilot study were: to test adequacy of research instruments; to improve research techniques; to determine an appro- priate workload; to determine the time required for interviews; and to assess the feasibility of a (full-scale) study/ survey. Methods:This pilot study was conducted between 11th April and 22nd April 2005. 420 houses were visited and interviews of 420 respondents between the ages of 15-49 were conducted in a randomly pre-selected Local Government Area of Oyo state using a structured instrument developed using the principles of the Sisterhood Method. Results:There was willingness of the public to participate in the study. The response rate was 100.There was no issue raised as regards the structure;wording and translation of the question- naire.This pilot study uncovered local political problems and other issues that may be encountered during the main study. Conclusions:The pilot raised a number of fundamental issues related to the process of designing the research instrument; identifying and recruiting Data Collectors; training and supervision of Data Collectors and the research project; gaining access to respondents and obtaining support and approval from ""gate- keepers"".This paper highlights the lessons learned and reports practical issues that occurred during pilot study."

A Four-year analysis of manuscripts submitted for publication in West African Journal of Medicine (June 2001 to May 2005) (A brief report)

There are various criteria that could be used to rate a tertiary institution. One of these is the productivity of the members of staff which is shown by the research conducted; publications submitted and manuscripts published in indexed journals. Manuscripts submitted and published in one of the highly rated indexed journals in our locality were analysed with a view to identifying how the institutions add to knowledge by their contributions. Our findings show that the four top-rated institutions in terms of manuscripts published in West African Journal of Medicine (WAJM) are University College Hospital (UCH); lbadan; University of Ilorin Teaching Hospital (UITH); Obafemi Awolowo University Teaching Hospital (OAUTH); and Jos University Teaching Hospital (JUTH)

The relationship between maternal weight gain in pregnancy, hemoglobin level, stature, antenatal attendance and low birth weight.

Low birth weight (birth weight less 2,500 g) remains a major public health problem in many communities. Five hundred and twenty-eight (528) consecutive singleton maternities delivered at the Armed Forces Hospital Tabuk, northwest Saudi Arabia were studied to identify the relationship between prenatal weight gain, maternal hemoglobin at delivery, maternal stature, antenatal clinic attendance and low birth weight (LBW). Of the total number, 9.5% (50/528) babies were of low birth weight, 56% of which were preterm while 44% were term and small for gestational age, resembling the pattern observed in developed countries rather than developing countries. Mothers who delivered LBW babies gained significantly less weight in the 3rd trimester and last 4 weeks of term pregnancy when compared with controls who had normal weight babies (NW > or = 2,500 g) who were delivered in the study period (t = 4.06, p < 0.0001, t = 3.7, p < 0.001). There was no significant difference in the prenatal weight gain in the second trimester for the two groups of mothers (p = 0.53). Mothers with LBW babies also had significantly lower Body Mass Index (BMI) at onset of pregnancy (t = 3.8, p = 0.001) and were shorter in height (t = 2.12, p < 0.03). Mothers who delivered preterm LBW babies had significantly lower hemoglobin levels at delivery when compared with those who had NW deliveries (p < 0.002). There was no difference in hemoglobin levels of mothers who had LBW babies at term and those with NW at term (p = 0.72). For this community, it is suggested that to reduce the LBW baby rate and improve birth weight, anemia must be prevented in pregnancy; attention needs to be paid to weight gained in the third trimester and the last 4 weeks of pregnancy encouraging antenatal clinic attendance, and improving the nutritional status of female children so that optimal height is achieved by the age of reproduction.