Watching the Grand Ethiopian Renaissance Dam from a distance: Implications for sustainable water management of the Nile water.

Increased demands for sustainable water and energy resources in densely populated basins have led to the construction of dams, which impound waters in artificial reservoirs. In many cases, scarce field data led to the development of models that underestimated the seepage losses from reservoirs and ignored the role of extensive fault networks as preferred pathways for groundwater flow. We adopt an integrated approach (remote sensing, hydrologic modeling, and field observations) to assess the magnitude and nature of seepage from such systems using the Grand Ethiopian Renaissance Dam (GERD), Africa's largest hydropower project, as a test site. The dam was constructed on the Blue Nile within steep, highly fractured, and weathered terrain in the western Ethiopian Highlands. The GERD Gravity Recovery and Climate Experiment Terrestrial Water Storage (GRACETWS), seasonal peak difference product, reveals significant mass accumulation (43 ± 5 BCM) in the reservoir and seepage in its surroundings with progressive south-southwest mass migration along mapped structures between 2019 and 2022. Seepage, but not a decrease in inflow or increase in outflow, could explain, at least in part, the observed drop in the reservoir's water level and volume following each of the three fillings. Using mass balance calculations and GRACETWS observations, we estimate significant seepage (19.8 ± 6 BCM) comparable to the reservoir's impounded waters (19.9 ± 1.2 BCM). Investigating and addressing the seepage from the GERD will ensure sustainable development and promote regional cooperation; overlooking the seepage would compromise hydrological modeling efforts on the Nile Basin and misinform ongoing negotiations on the Nile water management.

Emerging mercury and methylmercury contamination from new artisanal and small-scale gold mining along the Nile Valley, Egypt.

The past decade witnessed the initiation and boom of the Artisanal and Small-scale Gold Mining (ASGM) activities in the hyper-arid southern Egypt. The ores are mined in the Eastern Desert and then transported to the densely populated farming communities in the Nile Valley, where the river provides the water resources needed for ore processing. In search for economic benefits, the poorly educated farmers with limited technical resources transformed their cultivated lands into ASGM operations, exposing themselves, their families, the residents, and the Nile ecosystems to several environmental and occupational health problems. Using integrated remote sensing, field, geochemical, and isotopic analyses, we report the first inventory of ASGM-related total mercury (THg) and methylmercury (MeHg) levels in tailings, amalgamation-tailing ponds, and surface and groundwater with emphasis on the Edfu city and its surroundings. The field and remote sensing-based mapping of ASGM activities reveals clustering around the Nile waterways and suggests interaction of Hg contamination sources with their surrounding receptors. Common ASGM practices include release of contaminated water from unlined amalgamation-tailing ponds into irrigation and drainage canals, and spreading of tailings over cultivated soils. In a short period (10 years), the released Hg contaminated multiple media, including the surface water, the shallow and deep aquifers, and possibly the soil, crops, and livestock. THg levels in amalgamation-tailing ponds (1200-8470 ng/L) are fourfold higher than US EPA and eightfold the WHO thresholds. The contaminated waters released from amalgamation-tailing ponds raised THg levels in surface water (irrigation canals: 50-100 ng/L; drainage canals: THg: > 200 ng/L) and groundwater (shallow and deep aquifers: 80-500 ng/L). Our findings highlight the need to extend the adopted approach to cover the entire length of the Nile River and its valley and the importance of conducting awareness campaigns to educate residents and health care providers about potential ASGM-related environmental and health hazards.

Advances on concrete strength properties after adding polypropylene fibers from health personal protective equipment (PPE) of COVID-19: Implication on waste management and sustainable environment.

Using Health personal protective equipment (PPE) such as face masks, safety foot shoes and protective suits has expanded dramatically due to COVID-19 pandemic leading to a widespread distribution of the PPE, particularly the face masks, in the environments including streets, dump sites, seashores and other risky locations. The environmental degradation of polypropylene, the essential plastic component in single-use face masks (SUM), takes between 20 and 30 years and thus it is essential to develop experimental approaches to recycle the polypropylene or to reuse it in different ways. This paper explores the integration of SUM into concrete structures to improve its mechanical properties. We first to cut the inner nose wire and ear loops, then distribute the PPE material among five different mixed styles. The PPE were applied by volume at 0%, 1%, 1.5%, 2.0%, and 2.5%, with tests focusing on UCS, STS, FS, and PV to determine the concrete's overall consistency and assess the improvement in its mechanical properties. The results showed that adding PPE improves the strength properties and general performance of the concrete specimens. The pattern of rising intensity started to fade after 2%. The findings demonstrated that adding PPE fibers enhanced the UCS by 9.4% at the optimum 2% PPE. The PPE fibers, on the other side, are crucial in calculating the STS and FS of the reinforcement concrete.

Assessment of supplied water quality during mass gatherings in arid environments.

Mass gathering events commonly encounter environmental challenges that necessitate assurance of water quality and food security. The current outbreak of the coronavirus disease 2019 (COVID-19) call for maintaining safe drinking water supply and providing assessment tools of drinking water quality to avoid contamination in water sources or distribution networks. Arid environmental conditions also add more stress on supplied water to mass gathering events. Herein, we assess the quality of the water supply (desalinated 95% and groundwater 5%) in Makkah city, Saudi Arabia during a mass gathering event in 2019 (9.6 million people) for religious purposes. Fifty five samples were randomly collected from nine different districts of Makkah city, analyzed for TDS, turbidity, pH, EC, free Cl2, Al, Cd, Pb, Cr, F, major ions, coliform and E.coli bacteria and were finally used to estimate the water quality index (WQI). Major ions, trace elements and heavy metals analyses show values below permissible limits in most of the samples, while a few samples show slightly higher values. No bacterial count found in any sample. WQI values of all fifty-five samples were below 50 and were identified as "excellent water". The WQI variations could be attributed to the distribution network conditions rather than a direct impact of adding groundwater with uncontrolled chemical composition. The use of WQI to report the quality of water during mass gathering events to governmental authorities has been proved to be beneficial and should be applied for further mass gathering events worldwide.

Buffering the impacts of extreme climate variability in the highly engineered Tigris Euphrates river system.

More extreme and prolonged floods and droughts, commonly attributed to global warming, are affecting the livelihood of major sectors of the world's population in many basins worldwide. While these events could introduce devastating socioeconomic impacts, highly engineered systems are better prepared for modulating these extreme climatic variabilities. Herein, we provide methodologies to assess the effectiveness of reservoirs in managing extreme floods and droughts and modulating their impacts in data-scarce river basins. Our analysis of multiple satellite missions and global land surface models over the Tigris-Euphrates Watershed (TEW; 30 dams; storage capacity: 250 km3), showed a prolonged (2007-2018) and intense drought (Average Annual Precipitation [AAP]: < 400 km3) with no parallels in the past 100 years (AAP during 1920-2020: 538 km3) followed by 1-in-100-year extensive precipitation event (726 km3) and an impressive recovery (113 ± 11 km3) in 2019 amounting to 50% of losses endured during drought years. Dam reservoirs captured water equivalent to 40% of those losses in that year. Additional studies are required to investigate whether similar highly engineered watersheds with multi-year, high storage capacity can potentially modulate the impact of projected global warming-related increases in the frequency and intensity of extreme rainfall and drought events in the twenty-first century.

Groundwater mounding: A diagnostic feature for mapping aquifer connectivity in hyper-arid deserts.

Shallow aquifer mapping and large-scale characterization of groundwater dynamics in the Saharan-Arabian Desert is largely impeded by the limited hydrological datasets from sparse and unevenly distributed well logs. Today, as these aquifers are depleting at alarming rates in response to climatic and anthropogenic stresses, accurate knowledge of their dynamical characteristics is not only essential for understanding the water deficit in these increasingly populated areas but also to understand the regional and global environmental impacts of such changes. Herein, we suggest that groundwater mounding can be used for assessing aquifer connectivity in hyper-arid deserts. Using the shallow Post Nubian Aquifer System (PNAS) in Egypt as a test site, we integrate remote sensing, isotopic, hydrochemical and geoelectrical methods to characterize the Saharan groundwater mounds, examine the structural control on groundwater dynamics and discuss the potential of future satellite missions to characterize aquifer connectivity. The results suggest that groundwater mounding in the PNAS is attributed to artesian discharge of the deep Nubian Aquifer System (NAS) along the intersection of WNW and E-W major faults. This is evident by the dominant isotopic signature (δ18O: -9.93‰; δ2H: -79.05) of the deep NAS in the shallow PNAS with a percentage of up to 85% in the faulted zone. The 2D-Electrical Restively Imaging (ERI) delineate multiple small-scale mounds, atop of faults, that can attain 37 m height above average water table creating a relatively steep hydraulic gradient and deviating the groundwater flow direction. Future orbital radar sounding missions can benefit from characterizing the geometry of these mounds to define the measurement requirements of such hydrological features. The large-scale time-coherent subsurface mapping of the Saharan-Arabian aquifers can provide unique insights to examine the aquifer connectivity and the response of aquifers to climatic and anthropogenic stresses in desert areas that otherwise cannot be addressed using existing sporadic well-logs.

Inferencing the land subsidence in the Nile Delta using Sentinel-1 satellites and GPS between 2015 and 2019.

The Nile Delta is home to half of Egypt's population and has ample agricultural, industrial, and cultural resources, yet the land subsides in response to many natural and anthropogenic impacts. We report the recent subsidence rate and patterns in the Nile Delta using the synthetic aperture radar Sentinel-1 data of 144 images obtained between 2015 and 2019, based on coherence small baseline subset interferometry of ~2900 interferograms. We distinguished three patterns of deformation due to three different physical mechanisms: 1) The land subsides with rates ranging from -12 to -20 mm/year in major cities (such as Zagazig, Mit Ghamr, Tanta, Mansoura and Mahla) due to urban-induced loading; 2) A subsidence rate ranges between -3 and -8 mm/year along the coastal margins due to natural sediment dewatering and compaction. This rate is consistent with the global positioning system rate of -3.5 mm/year and 3) A subsidence rate ranges from -20 to -16 mm/year and -6 to -12 mm/year in newly reclaimed lands on the west and east of the delta's flood plains, respectively, due to groundwater overexploitation. Our findings, in contrast with results from previous studies of regional deformation mainly felt to be controlled by natural processes, demonstrate a localized subsidence and predominant anthropogenic control on the land deformation and call for revisiting sea level rise-related flooding models in the Nile Delta. In light of the new findings, the authorities should take necessary measures to reduce the ongoing land subsidence through enforcement of urban planning policies in the delta's flood plain and development of a sustainable management strategy for groundwater extraction.

The respective roles of modern and paleo recharge to alluvium aquifers in continental rift basins: A case study from El Qaa plain, Sinai, Egypt.

Even though assessment of aquifer characterization and recharge mechanisms in rift-related basins, especially in arid environments, is essential for developing sustainable management strategies and food security assurance, a little attention has been paid to understand these parameters. In this manuscript, we utilize an integrated remote sensing, hydrological and isotopic approach together with previously published data to better understand the aquifer characteristics and the respective roles of modern and paleo recharge to the post-Miocene alluvium aquifer in El Qaa plain, which represents the eastern margin of the Gulf of Suez continental rift basin. Our findings indicate that: (1) the alluvium aquifer is largely formed of sand and gravels intercalated with silt and clay lenses and exceeds 500 m thick, (2) the groundwater salinity gradually increases towards the Gulf of Suez (from 402 to 5613 mg/l) with increasing the distance from the crystalline rocks bounding the alluvium-dominated plain, (3) isotopic analysis reveals that all of the groundwater samples show mixed isotopic signature between modern and paleo waters (δ18O: -6.79 to -4.433‰, and δ2H: -46.36 to -21.99‰). Basin-scale hydrological parameters show that the aquifer receives an annual modern recharge of 39 × 106 m3 and isotopic mass balance calculations indicate that the modern water ranges between 20 and 70% of the total volume of water in the aquifer. We suggest three dam locations along the southernmost basins in El Qaa plain to enhance the modern recharge to the aquifer and to harvest surface runoff of an annual volume of 737 × 103 m3 sufficient to supply freshwater to 13 thousands of the residents of south Sinai. The present study suggests that topographically-driven modern recharge to rift-related basins is taking place with significant amounts even under hyper-arid conditions and calls for paying special attention to investigate the response of these aquifers to climate variability.

Response of deep aquifers to climate variability.

There is a general agreement that deep aquifers experience significant lag time in their response to climatic variations. Analysis of Temporal Gravity Recovery and Climate Experiment (GRACE), Soil Moisture and Ocean Salinity mission (SMOS), satellite altimetry, stable isotopic composition of groundwater, and precipitation and static global geopotential models over the Nubian Sandstone Aquifer System (NSAS) revealed rapid aquifer response to climate variability. Findings include: (1) The recharge areas of the NSAS (Northern Sudan Platform subbasin) witnessed a dry period (2002-2012), where average annual precipitation (AAP) was modest (85 mm) followed by a wet period (2013-2016; AAP: 107 mm), and during both periods the AAP remained negligible (<10 mm) over the northern parts of the NSAS (Dakhla subbasin); (2) the secular trends in terrestrial water storage (TWS) over the Dakhla subbasin were estimated at -3.8 ±â€¯1.3 mm/yr and + 7.8 ±â€¯1 mm/yr for the dry and wet periods, respectively; (3) spatial variations in TWS values and phase are consistent with rapid groundwater flow from the Northern Sudan Platform subbasin and Lake Nasser towards the Dakhla subbasin during the wet period and from the lake during the dry period; and (4) networks of densely fractured and karstified bedrocks provide preferential pathways for groundwater flow. The proposed model is supported by (1) rapid response in groundwater levels in distant wells (>280 km from source areas) and in soil moisture content in areas with shallow (<2 m) groundwater levels to fluctuations in Lake Nasser surface water, and (2) the isotopic composition (O, H) of groundwater along the preferred pathways, consistent with mixing of enriched (Lake Nasser water or precipitation over Sudan) and depleted (NSAS fossil water) endmembers. Findings provide new insights into the response of large, deep aquifers to climate variability and address the sustainability of the NSAS and similar fossil aquifers worldwide.

Sex differences in regional specialisation across the placental surface.

There may be regional specialisation in structure and function across the placental surface. In Riyadh, Saudi Arabia, the length and the breadth of the placental surface at birth were highly correlated, but the breadth was more closely associated with the size of the baby. To replicate this we studied 321 pregnant Saudi women in the town of Baish. We measured the size of the newborn babies and their placentas. The association of the length and breadth of the placental surface on the baby's body size differed in boys and girls. Among boys the breadth had a stronger association with all birth measurements except crown-heel length. This was similar to the findings in Riyadh. Placental surface length was related to crown-heel length. For each centimetre in surface length, crown-heel length increased by 0.27 cm (95% CI 0.09-0.44, p = 0.004). Among girls placental surface breadth was related to crown-heel length, whereas surface length was related to birth weight, head and thigh circumferences. For each centimetre in surface breadth, crown-heel length increased by 0.33 cm (0.13-0.53, p = 0.001). We conclude that, within Saudi Arabia, there are both geographical and sex differences in regional specialisation across the placental surface. In the adverse circumstances of Baish, linked to the mothers' short stature, boys were smaller at birth than girls. Boys may have compensated for under-nutrition by increasing the depth of spiral artery invasion rather than by recruiting additional spiral arteries. Girls may have had more effective regional specialisation across the placental surface.

Intergenerational effects of in utero exposure to Ramadan in Tunisia.

UNLABELLED: We have reported that changes in the lifestyle of pregnant women during Ramadan affect more than one generation. In a series of newborn babies in Saudi Arabia, those whose mothers had been in utero during Ramadan differed from those whose mothers had not been in utero during Ramadan. These were unexpected findings and require replication. METHODS: We examined body size at birth in 1,321 babies (682 boys and 639 girls) born in Gafsa, a small city in Tunisia. RESULTS: Babies whose mothers had been in utero during Ramadan were smaller and thinner, and had smaller placentas, than those whose mothers had not been in utero during Ramadan. After adjustment for sex, the babies were 93 g lighter (95% confidence interval, 32-153, P=0.003) than those whose mother had not been in utero during Ramadan, their mean ponderal index was 0.52 kg/m(3) lower (0.24-0.79, P<0.001) and their placental weight was 21 g lower (5-37, P=0.01). The findings did not differ by trimester of maternal exposure to Ramadan. They were similar in boys and girls and in primiparous and multiparous mothers CONCLUSION: This study provides further evidence that changes in lifestyle during Ramadan have intergenerational effects.

The breadth of the placental surface but not the length is associated with body size at birth.

Studies of pregnancies complicated by preeclampsia led to the suggestion that the surface of the placenta is aligned along two axes, measured by its breadth and length. It was hypothesised that tissue along the breadth serves as a nutrient sensor, responding to the mother's nutritional state and fetal nutritional demands, while tissue along the length has different functions. To develop this hypothesis we measured the breadth and length of the placental surface in 401 neonates born in the King Khalid Hospital, Riyadh, Saudi Arabia, and related these measurements to the baby's body size. The breadth and length of the placental surface were highly correlated (coefficient = 0.7). Nevertheless, in a simultaneous regression with both measurements, only the breadth was associated with neonatal body size. There were strong trends of increasing birth weight, ponderal index, and the circumferences of the head, chest, abdomen and thigh with increasing placental breadth. In contrast no measurement of baby's body size was related to placental length. Birth weight increased by 125 g per cm increase in placental breadth (95% confidence interval 88 to 162, p < 0.001) but only by 20 g per cm increase in placental length (-13 to 53, p = 0.2). The corresponding figures for head circumference were 0.28 cm (0.17-0.39, p < 0.001) and 0.03 (-0.07 to 0.14, p = 0.5). The associations between placental breadth and neonatal body size were strongest if the mother's height was below the median (157 cm). The associations between a larger breadth of the placental surface and a larger baby are consistent with the hypothesis that tissue along the breadth plays a key role in nutrient transfer from mother to baby. Mothers who are short in stature are known to have lower rates of protein turnover in pregnancy. In these circumstances the ability of the placenta to transfer amino acids to the fetus may be critical.

Sex differences in birth size and intergenerational effects of intrauterine exposure to Ramadan in Saudi Arabia.

OBJECTIVES: In Europe, boys and girls have different body proportions at birth. We examined newborn babies in Saudi Arabia to determine the sex differences and whether fetal growth differed if the mother was in utero during Ramadan. METHODS: We examined body size at birth among 967 babies (479 boys and 488 girls) born in Unizah, a small city in Saudi Arabia. RESULTS: Large head circumference was the strongest single predictor of male sex. In a simultaneous regression, female sex was predicted by small head circumference (P < 0.001), low birth weight (P = 0.002), and large chest circumference (P = 0.008). The mothers of boys were heavier in pregnancy than the mothers of girls and had a higher body mass index, 31.7 kg/m(2) compared to 30.2 (P < 0.001). The mothers of girls, however, were taller than the mothers of boys, 158.6 cm compared to 157.4 (P = 0.001). Compared to babies whose mothers were not in utero during Ramadan boys whose mothers were in mid gestation during Ramadan were 1.2 cm longer (P = 0.005) while girls had a 0.4 week shorter gestation period (P = 0.04). CONCLUSION: Our findings are consistent with other evidence that boys are more ready than girls to trade off visceral development in utero to protect somatic and brain growth. They also support the hypothesis that boys are more responsive to their mother's current diet than girls, who respond more to their mother's life time nutrition and metabolism. They provide the first evidence that changes in the life style of pregnant women during Ramadan affect more than one generation.

Secular increase in placental weight in Saudi Arabia.

BACKGROUND: Ramadan is an annual period of day-time fasting during which people in Saudi Arabia, including pregnant women, change their diets and physical activity. We recently reported that among babies who were in the second or third trimester of gestation during Ramadan placental growth slowed. We also found that, over the four years of the study, placental weight increased by 29 g per year. We have now extended our data collection in order to examine this trend in more detail. METHODS: We studied the birth records of 17 660 singletons born in King Saud Hospital, Unizah, Saudi Arabia, over a ten year period. The records included birth weight, placental weight and gestational age. RESULTS: During the first six years of the study period mean placental weight rose by more than 100 g while mean birth weight was unchanged. This secular increase in placental weight was accompanied by a change in the placenta's response to Ramadan. During the first half of the study period babies who were in their second or third trimester of gestation during Ramadan had reduced placental weight (475 g and 476 g compared with 484 g, p < 0.001 for both). During the second half of the study period babies who were in their first trimester of gestation during Ramadan had reduced placental weight (533 g compared with 539 g, p = 0.03). CONCLUSIONS: We suggest that the secular increase in placental weight reflects changes in maternal body composition. These have altered placental responses to the dietary changes during Ramadan. The biological processes underlying these responses are not known.

Changes in placental size during Ramadan.

BACKGROUND: Placental growth responds to maternal influences. Ramadan is an annual period of day-time fasting during which people in Saudi Arabia, including pregnant women, change their diets and physical activity. Little is known about the effects of this altered lifestyle on placental development. METHODS: We studied the birth records of 7083 babies born over a four-year period to Saudi nationals in Unizah, a small city 350km to the north of Riyadh, the capital city of Saudi Arabia. The records included birth weight, placental weight and gestational age. RESULTS: Mean birth weight was similar to European values but the mean placental weight and ratio of placental weight to birth weight were lower. Among babies who were in the second or third trimester of gestation during Ramadan the mean placental weight and ratio were below those of babies who were not in utero during Ramadan. Among boys the mean placental ratios were 14.4 percent (second trimester) and 14.5 percent (third trimester) compared with 14.9 percent (p=<0.001 and 0.002). The corresponding figures for girls were 14.8 and 14.6 percent compared with 15.1 percent (p=0.02 and <0.001). CONCLUSIONS: In Saudi Arabia placentas respond to mothers' limited ability to deliver nutrients to them. Placental growth slows but efficiency is increased so that fetal growth is sustained, albeit with a reduced reserve capacity. The lifestyle changes associated with Ramadan further slow placental growth. Ramadan may influence placental growth through dietary changes other than day-time fasting. Changes in placental growth during Ramadan could be associated with altered fetal programming, and may therefore have long-term implications for the health of the next generation.

Socio-demographic characteristics of the "unbooked mother".

In a study to investigate the characteristics of the "Unbooked mother", the medical records of 467 patients who presented for delivery with no prenatal care at the obstetric unit of the King Khalid University Hospital (KKUH), Riyadh, during the period 1991 to 1995 were evaluated. For controls, the records of 415 mothers who had pre-natal care in the Unit over the same period were also evaluated. Data pertaining to their socio-demographic characteristics, previous obstetric history, prevalence of pregnancy-related and familial diseases, gestation age at delivery and weights of the babies, were extracted and analysed using odds ratios and 95% confidence intervals (C.I.). The unbooked mother tended to be young (< or = 24 years), unskilled worker, or student. On the other hand, the booked ones tended to be primigravid, with pregnancy-related (PET) and familial diseases (hypertension and diabetes). However, the level of parity, gestation age and birth weights did not appear to significantly influence the tendency to be booked or unbooked. These findings highlight the group of women who should be targeted for health education counselling regarding the value of prenatal care. This way, one can avoid some of the catastrophes often said to be associated with deliveries in the unbooked mother.

Abdomino-pelvic packing to control severe haemorrhage following caesarean hysterectomy.

Surgically uncontrollable peri-operative obstetric haemorrhage associated with coagulopathy, developed in five women who were managed by emergency caesarean hysterectomy. All women had a morbidly adherent anterior placenta praevia and a previous lower segment caesarean section scar. Conventional medical and surgical therapy to control bleeding from pelvic and abdominal raw surfaces were unsuccessful. Abdomino-pelvic packing was performed with 10-12 dry laparotomy pads applied firmly over bleeding sites. The abdomen was closed after observation of the cessation of bleeding for 5-10 minutes. Following correction of coagulation and haemodynamic disorders relaparotomy for pack removal was performed 34-48 hours later. One patient developed small bowel obstruction on the 5th post-operative day, however, there was no long term gynaecological morbidity in any of the cases. Abdomino-pelvic packing achieved complete haemostasis in all of the five women which we believe may have been impossible using alternative measures.

Elective induction of labor at term doing a lot to gain a little?

Full text is available as a scanned copy of the original print version.

Obstetric outcome in the unbooked mother.

This study aimed at determining the outcome of pregnancy in unbooked mothers with regard to maternal complications and foetal outcome. This retrospective study was based on investigations of medical records of 467 unbooked mothers who presented for delivery at the Obstetrics Unit at King Khalid University Hospital, Riyadh, during the period 1991 and 1992, and 415 booked mothers with regular clinic attendance selected as controls. Data collected from the records included patients' socio-demographic characteristics, past obstetric history, prevalence of pregnancy-related diseases, and data relating to labour, delivery, and foetal outcome. Chi-square test and Fisher's exact test were used for assessing the statistical significance of the association between the various factors which were investigated. The tendency for mothers to be booked was found to be significantly associated with their age, occupation, parity, and gestational age at delivery. Booked and unbooked mothers did not differ significantly in relation to the mode of delivery and foetal outcome, although the prevalence of previous complications of pregnancy was generally lower among unbooked mothers. There was no statistically significant association between the absence of antenatal care and outcome of pregnancies, unbooked mothers had a higher proportion of MICU admissions and dead babies compared with the controls. Educating the community about the benefits of receiving regular antenatal care, even if at primary care level, may be of great importance in improving the pregnancy outcome.