ABSTRACT
Background: Delivery by caesarean section has been reported as the single most important risk factor for maternal wound infection. Wound infection is not only a leading cause of prolonged hospital stay but a major cause of widespread aversion to caesarean delivery in developing countries. Despite all these, the determinants of post-caesarean wound infection in Nnewi have remained largely uninvestigated. Objective: This study was to determine the factors that predispose to post- caesarean wound infection at a tertiary institution in a developing country. Design: This was a cross sectional study. Place and Duration of Study: Labour ward, Theatre and Post natal ward of NAUTH Nnewi between April to November 2012. Methodology: All women who had caesarean section, met the inclusion criteria and gave consent were included in the study. They were divided into two groups (Group A and Group B) each comprising 60 women. Group A comprised women who had emergency caesarean section, while those in group B had elective caesarean section. The outcome of their post-caesarean wound was assessed. Statistical analysis (Logistic regression) of identified risk factors in patients who developed wound infection was performed at a 95% confidence interval. Results: The incidence of post caesarean wound infection was 12.5%. While the infection rate was twelve (20.0%) among women who had emergency caesarean section, it was 3 (5.0%) among those who had elective caesarean section. The identified independent risk factors for wound infections were the duration of membrane rupture more than 24 hours (OR=0.11: 95% CI 0.03- 0.47: P =0.003), labour duration more than 12 hours (OR =0.07: 95% CI 0.01-0.32: P =0.001) and the use of subumbilical, midline incision (OR=0.21: 95% CI 0.05-0.91). Conclusion: The post caesarean wound infection rate in NAUTH was high. Efforts should be geared towards the prevention of prolonged labour by health education, early intervention and use of partograph. Timely intervention for prolonged rupture of membranes would drastically reduce the incidence of wound infection in our area.
ABSTRACT
Background: Placental malaria constitutes a risk for both the pregnant women and their unborn child hence there is need to demonstrate the adverse associations between placental malaria and pregnancy outcome. Aim: To demonstrate the adverse maternal and fetal associations with placental malaria Study Design and Setting: This is a cross sectional study carried out at Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, South East, Nigeria between 1st August, 2012 and 31st January, 2013. Result: Two hundred placentae were analyzed, 141(70.5%) were positive for malaria, Placental malaria was associated with lower maternal pcv (30.67±1.60 vs 32.51±2.82, p-value < 0.001), preterm delivery (OR=4.99, C.I=1.15 – 45.08, p- value=0.020), and low birth weight (OR = 4.71, C.I=1.08 – 42.71, p-value=0.027) but not associated with maternal anaemia (OR=2.27, C.I= 0.90-6.47, p-value=0.063) and perinatal deaths (OR=Infinity, C.I =0.38 – infinity, p-value = 0.143). Conclusion: Placental malaria was associated with low birth weight, lower pcv and preterm delivery but associated neither with maternal anaemia nor perinatal deaths.
ABSTRACT
Background: Placental malaria is one of the complications of malaria in pregnancy and is associated with poor pregnancy outcome. Demonstration of its prevalence and risk factors will help in modifying the measures in the prevention of malaria in pregnancy and strengthens the effective pre-existing preventive measures in our community. More so, there is paucity of studies of placental malaria in our environment using histology which is the gold standard. Aim: To determine the prevalence and the risk factors for placental malaria. Study Design and Setting: This is a cross sectional study carried out at Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, South East, Nigeria between 1st August, 2012 and 31st January, 2013. Materials and Methods: A cross section of pregnant women who delivered in the labour ward was recruited for the study. The following data were obtained from those who met the inclusion criteria: age, parity, gestational age, the booking status, educational level and husband’s occupation. The history of Intermittent preventive therapy (IPT), Insecticide treated net (ITN), HIV status, Blood group and Haemoglobin genotype were also obtained. Descriptive analysis of the results was done using the statistical package for social sciences (SPSS) version 16. Univariate analysis and logistic regression were used and the results expressed in Odd ratios (OR) and Confidence interval (C.I). P-value <0.05 was taken as significant level. Result: Out of 200 placentae analyzed, 141 were positive for malaria, giving a prevalence of 70.5%. The commonest form of parasitisation was chronic infection (68.09%) followed by past infection (19.14%) and acute infection (12.77%). Using univariate analysis, the potential risk factors were young age, primigrividity, unbooked status and non use of IPT, non use of ITN, low social class, HIV positivity and haemoglobin genotype AA. However when these were subjected to logistic regression, the independent risk factors identified were young age, primigrividity, unbooked status, non use of IPT and non use of ITN. Conclusion: This study highlighted high prevalence of placental malaria in our environment. The independent risk factors noted were young age, primigrividity, unbooked status, non use of IPT and non use of ITN.