Postnatal care services use by mothers: A comparative study of defaulters versus attendees of postnatal clinics in Enugu.

INTRODUCTION: Despite much emphasis on the reproductive health of women, maternal mortality is still high, especially in postnatal period. OBJECTIVE: To assess the prevalence of postnatal care use and reasons for defaults among mothers attending the child immunization clinics in Enugu, Nigeria. METHODS: This was a cross-sectional comparative study of 400 consecutive nursing mothers who presented at the Institute of Child Health of UNTH and ESUTH, Enugu for Second dose of the Oral Polio Vaccine (OPV2) for their babies at 10 weeks postpartum. Data was collected using Interviewer-administered questionnaire and subsequently analyzed with version 22.0 IBM SPSS software, Chicago, Illinois. A p-value of less than 0.05 was considered as statistically significant. RESULT: The prevalence of the 6th week postnatal clinic attendance among the mothers was 59%. The majority of the women (60.6%) who had antenatal care by skilled birth attendants attended postnatal clinic. Unawareness and being healthy were the main reasons for not attending postnatal clinic. Following multivariate analysis, place of antenatal (OR = 2.870, 95% C.I = 1.590-5.180, p < 0.001) and mode of delivery (OR = 0.452, 95% C.I = 0.280-0.728, p = 0.001) were the only significant predictors of postnatal clinic attendance (p < 0.05). CONCLUSION: Postnatal clinic attendance by women in Enugu is still suboptimal. The main reason for non-attendance of the 6th week postnatal clinic was lack of awareness. There is need for healthcare professionals to create awareness about the importance of postnatal care and encourage mothers to attend.

Comparison of Placenta Previa and Placenta Accreta Spectrum Disorder Following Previous Cesarean Section between Women with a Short and Normal Interpregnancy Interval.

Objectives: The aim of this study is to determine the effect of interpregnancy interval (IPI) on the incidence of placenta previa and placenta accreta spectrum disorders in women with a previous cesarean section. Methods: A prospective cohort three-center study involving parturients who had previous cesarean section was conducted. Participants were included if pregnancy has lasted up to 34 weeks. Parturients with co-existing uterine fibroids, multiple gestations, premature rupture of membranes, and those with prior postcesarean delivery wound infection were excluded. The eligible women recruited were distributed into two groups, namely, short (<18 months) and normal (18-36 months) IPI. The outcome measures were incidences of placenta previa and placenta accreta spectrum disorder and factors associated with the occurrence of placenta previa. A univariate analysis was performed using the chi-square test or Mann-Whitney U test, wherever appropriate, to examine the significance of the differences in clinical variables. Results: A total of 248 women met the inclusion criteria. The incidence of placenta previa by ultrasound was 8.9% and 4.0% for short and normal IPI (odds ratios = 2.32; 95% confidence intervals = 0.78-6.88; p = 0.13), respectively. The incidence of placenta accreta spectrum disorder was 1.6% and 0.8% for short and normal IPI (odds ratios = 2.02; 95% confidence intervals = 0.18-22.13; p = 0.57), respectively. The only observed significant difference between the clinical variables and placenta previa is the number of cesarean sections (p = 0.02) in women with short IPI. Conclusion: A short interpregnancy interval does not significantly affect the incidence of placenta previa and placenta accreta spectrum disorder following a cesarean section. There is a need for further study with large numbers to corroborate these findings in low- and middle-income settings.

Effectiveness of antenatal perineal massage in reducing perineal trauma and post-partum morbidities: A randomized controlled trial.

AIM: The study aimed to evaluate the effectiveness of antenatal perineal massage (APM) in reducing perineal trauma and post-partum morbidities. METHODS: A randomized controlled trial of 108 primigravidae at the University of Nigeria Teaching Hospital, Enugu, Nigeria, was conducted from January 2013 to May 2014. The intervention group received APM, while the control group did not receive APM. RESULTS: Women who received APM were significantly more likely to have an intact perineum after childbirth [27/53 (50.9%) vs 16/55 (29.1%); RR: 1.75; 95% CI: 1.07-2.86; P = 0.02]. The incidence of episiotomy was lower in the intervention group [20/53 (37.7%) vs 32/55 (58.2%); RR: 0.65; 95% CI: 0.43-0.98; P = 0.03; NNT = 5]. Women who received APM were significantly less likely to develop flatus incontinence [4/53 (8.3%) vs 13/55 (26.0%); RR: 0.32; 95% CI: 0.11-0.91; P = 0.03]. However, the incidences of premature rupture of membranes, preterm labor and birth asphyxia were similar between the two groups (P > 0.05). CONCLUSION: APM reduces the incidence of episiotomy and increases the incidence of women with an intact perineum after vaginal delivery. It also reduces the risk of flatus incontinence after childbirth without increased maternal or neonatal complications. Women should therefore be counseled on the likely benefits of APM and the information provided during antenatal care. Obstetricians should consider the technique as routine prenatal care for nulliparous women so as to reduce the incidence of perineal trauma during vaginal birth.

Prevalence and predictors of urinary/anal incontinence after vaginal delivery: prospective study of Nigerian women.

INTRODUCTION AND HYPOTHESIS: Urinary and anal incontinence are major public health problems impacting on the quality of life of affected women, with resultant loss of self-esteem. Despite the anticipated magnitude of this public health problem in sub-Saharan Africa, there is paucity of data on the prevalence of urinary and/or anal incontinence after childbirth in the region. This study determined the prevalence and predictors of urinary and anal incontinence after vaginal delivery among women in Enugu, southeastern Nigeria. METHODS: This was a longitudinal study of 230 consecutive parturients at the University of Nigeria Teaching Hospital, Enugu, Nigeria. Eligible women were followed up immediately, 6 weeks, and 3 months postpartum to assess the development of urinary and/or anal incontinence using validated questionnaires. RESULTS: Overall, 28 women had urinary incontinence, giving a cumulative prevalence rate of 12.2 %. The cumulative prevalence rate was 13.5 % for anal incontinence and 3 % for combined urinary and anal incontinence. Age, social class, parity, prolonged second stage of labor, and neonatal birth weight were significantly associated with postpartum urinary incontinence (P < 0.05). On the other hand, age, parity, prolonged second stage of labor, episiotomy, and instrumental vaginal delivery were significantly associated with postpartum anal incontinence (P < 0.05). CONCLUSION: Urinary and anal incontinence are common after vaginal delivery in Enugu, Nigeria. Modification of obstetric care and discouraging preventable predisposing factors for incontinence, such as prolonged second stage of labor and vaginal delivery of macrosomic babies, are measures that may reduce the prevalence of postpartum incontinence in our population.

Oral versus vaginal misoprostol for induction of labor in Enugu, Nigeria: a randomized controlled trial.

OBJECTIVE: The study aimed at comparing the effectiveness and maternal satisfaction of oral misoprostol with vaginal misoprostol for induction of labor at term. MATERIALS AND METHODS: A randomized controlled trial of 140 term pregnant women at the University of Nigeria Teaching Hospital Enugu, Nigeria, was conducted from April 2011 to May 2012. The women were equally randomized into two groups (A and B) to receive oral and vaginal misoprostol, respectively. RESULTS: The vaginal route reduced the mean induction-vaginal delivery interval by four-and-half hours (20.7 ± 12.1 vs. 16.2 ± 10.4; mean difference: 4.50, 95% CI 0.63-0.82; p = 0.02). Furthermore, the mean dose of misoprostol required to achieve induction of labor and the mean duration of oxytocin augmentation when indicated were significantly less in the vaginal group than in the oral group (2.5 ± 1.3 vs. 2.0 ± 1.1; mean difference: 0.50, 95% CI 0.10-0.90; p = 0.02 and 4.6 ± 3.2 vs. 3.4 ± 3.1; mean difference: 1.20, 95% CI 0.15-0.23; p = 0.03 respectively). However, neonatal complications and maternal satisfaction were similar between the two groups. CONCLUSION: Both routes of administration are effective in the induction of labor at term and have comparable maternal satisfaction. However, the vaginal route has the added advantage of shorter induction-delivery interval among others, and thus should be highly considered when induction of labor is indicated at term.

Membrane stripping to prevent post-term pregnancy in Enugu, Nigeria: a randomized controlled trial.

OBJECTIVES: This study aimed at evaluating the effectiveness and safety of membrane stripping at 40-41 weeks of gestation as a means of preventing post-term pregnancy and the need for formal induction of labor in Enugu, Nigeria. METHODOLOGY: A randomized controlled trial of 134 post-date pregnant women at the University of Nigeria Teaching Hospital, Enugu, Nigeria, from February to November 2012. The intervention group received membrane stripping while the control group did not receive membrane stripping. RESULTS: The incidence of post-term pregnancy in the membrane stripping group was 16.1% (10/62) versus 39.3% (24/61) in the control group (RR 0.41; 95% CI 0.22-0.78; P = 0.004; NNT = 4). Membrane stripping reduced the duration of pregnancy by 3 days (P < 0.001). The procedure also significantly reduced the need for 'formal' labor induction [7/62 (11.3%) vs. 23/61 (37.7%); RR 0.30; 95 CI 0.14-0.65; P = 0.002]. However, maternal and neonatal complications were similar between the two groups. CONCLUSION: Membrane stripping reduces the incidence of post-term pregnancy and need for formal induction of labor in post-date pregnant women, without increased maternal or neonatal complications.

Nutritional status of HIV-positive individuals on free HAART treatment in a developing nation.

INTRODUCTION: HIV positive individuals are prone to malnutrition due to inadequate dietary intake. Additionally, in low-income countries, including Nigeria, stigmatization and discrimination result in a lack of support for HIV-positive individuals ultimately contributing to even further reduced food availability and inadequate dietary intake. This study aimed to determine the nutrirional status of HIV-positive individuals on free, highly active antiretroviral therapy (HAART) in Abakaliki, southeast Nigeria. METHODOLOGY: Subjective global assessment (SGA) technique was used to survey the nutritional status of 120 HIV-positive individuals and a control group over a one-year period. RESULTS: All the HIV-positive individuals and their control group were physically active, with a third of them belonging to the lower socioeconomic status. There were significantly more malnourished individuals among the HIV-positive group than in the control group (P < 0.05). CONCLUSION: Malnutrition is common among HIV-positive patients in southeast Nigeria.