Factors associated with prelacteal feeding practices in a rural northern Nigerian setting

Introduction: Prelacteal feeding practice contravenes the recommendation of World Health Organisation that breastfeeding be initiated within an hour of childbirth. Consequently, the health, social, emotional and economic benefits of optimal breastfeeding are limited. Therefore, to break this vicious cycle of prelacteal feeding and suboptimal breastfeeding, factors associated with the practice must be identified. Objective: To assess prelacteal feeding practices and its associated factors in a rural community with the view to generate data for community-level interventions that will promote optimal breastfeeding.Methods: Data was collected during a community-based surveillance for maternal, newborn and child health project in Tsibiri,a rural community in north-western Nigeria. The survey questionnaire was uploaded into mobile devices running on an android operating system. Trained female interviewers collected the data over a period of one week in 2011.Results: A total of 270 out of 309 interviewed women had experienced childbirth and were included in the analysis. Majority (85.2%) of respondents utilised prelacteal feeds for their newborns. Plain water was the most common prelacteal feed (44.7%).Prelacteal feeding was associated with births assisted by unskilled birth attendants (AOR 5.322, 95%CI 1.634-17.333); while operative delivery reduced the likelihood of the practice (AOR 0.168, 95%CI 0.060-0.470). No statistically significant association was found between use of prelacteal feed and women's age, education or access to income.Conclusion: The predominance of prelacteal feeding practices underscores the need for innovative strategies that create awareness among mothers and health care providers, with emphasis on health facility deliveries, advantages of breastfeeding and risks of prelacteal feeding

Prevalence of lupus anticoagulant in women with spontaneous abortion in Zaria.

INTRODUCTION: Spontaneous abortion (SA) is a common complication of pregnancy. Presence of lupus anticoagulant (LA), one of the antiphospholipid antibodies, has been associated with SA in many studies, especially in Caucasians. This study was carried out to determine the prevalence of LA in women with SA in ABUTH, Zaria. MATERIALS AND METHODS: A cohort of 100 consecutive women presenting with SA with no history of thrombotic episodes were enrolled into the study. Prothrombin time (PT), kaolin clotting time (KCT), and activated partial thromboplastin time (APTT) were conducted on samples of all the participants. Eight patients had prolonged APTT, and after a 50:50 mixture of their plasma with pooled control plasma, four (50%) had uncorrected APTT. Staclot® (a hexagonal-phase phospholipid) test and calculated Rosner index for prolonged KCT were used for the confirmation of LA in samples with uncorrected APTT after mixing studies. RESULTS: We analyzed 100 women with one or more SA with a mean age of 31.0 ± 3.8 years. Nearly 4% and 3% of the participants were LA positive with Staclot® and KCT tests, respectively. Patients with LA were more likely to have had a past history of preeclampsia/eclampsia, small for gestational age deliveries, and previous SA (prevalence odds ratio [95% confidence interval]) of 1.9 (0.2, 20.1), 3.2 (0.3, 34.3), and 1.4 (0.1-13.6), respectively. The PT, APTT, and KCT were significantly prolonged in patients with LA (P ≤ 0.001 for each, respectively). CONCLUSION: LA may be one of the causes of SA and other adverse pregnancy outcomes such as preeclampsia/eclampsia and small for date deliveries. It is recommended that patients with prolonged APTT, uncorrected with 50:50 mixing study with pooled control plasma, should be evaluated further for LA.

Establishing cause of maternal death in Malawi via facility-based review and application of the ICD-MM classification.

Maternal death review (MDR) is an accepted process that is implemented across Malawi and 'underlying cause of death' is assigned by healthcare providers using a standard MDR form. Mixed-methods approach. Key informant interviews with eight stakeholders involved in MDR. Secondary analysis of MDR forms for 54 maternal deaths. Comparison of assigned cause of death by healthcare providers conducting MDR at health facility level with cause assigned by researchers using the International Classification of Diseases Maternal Mortality (ICD-MM) classification. MDR teams, analysts and policymakers reported facing challenges in completing the forms, analysing and using information. The concepts of underlying (primary) and contributing (secondary) causes of death are often misunderstood. Healthcare providers using only MDR forms reported cause of death as non-obstetric complications in 39.6% and pregnancy-related infection in 11.3% of cases. For 30.2% of cases, no clear clinical cause of death was recorded. The most commonly assigned underlying cause of death using ICD-MM was obstetric haemorrhage (32.1%), non-obstetric complications (24.5%) and pregnancy-related infection (22.6%). There was poor agreement between cause(s) of maternal death assigned by healthcare providers in the field and trained researchers using the new ICD-MM classification (κ statistic; 0.219). The majority of cases could be reclassified using the ICD-MM and this provided a more specific cause of death. A more structured and user-friendly MDR form is required. Accurate classification of cause of death is important. Dissemination of, and training in the use of the new ICD-MM classification system will be helpful to healthcare providers conducting MDR in Malawi.

Causes of and factors associated with stillbirth in low- and middle-income countries: a systematic literature review.

BACKGROUND: Annually, 2.6 million stillbirths occur worldwide, 98% in developing countries. It is crucial that we understand causes and contributing factors. METHODS: We conducted a systematic review of studies reporting factors associated with and cause(s) of stillbirth in low- and middle-income countries (2000-13). Narrative synthesis to compare similarities and differences between studies with similar outcome categories. MAIN RESULTS: A total of 142 studies with 2.1% from low-income settings were investigated; most report on stillbirths occurring at health facility level. Definition of stillbirth varied; 10.6% of studies (mainly upper middle-income countries) used a cut-off point of ≥22 weeks of gestation and 32.4% (mainly lower income countries) used ≥28 weeks of gestation. Factors reported to be associated with stillbirth include poverty and lack of education, maternal age (>35 or <20 years), parity (1, ≥5), lack of antenatal care, prematurity, low birthweight, and previous stillbirth. The most frequently reported cause of stillbirth was maternal factors (8-50%) including syphilis, positive HIV status with low CD4 count, malaria and diabetes. Congenital anomalies are reported to account for 2.1-33.3% of stillbirths, placental causes (7.4-42%), asphyxia and birth trauma (3.1-25%), umbilical problems (2.9-33.3%), and amniotic and uterine factors (6.5-10.7%). Seven different classification systems were identified but applied in only 22% of studies that could have used a classification system. A high percentage of stillbirths remain 'unclassified' (3.8-57.4%). CONCLUSION: To build capacity for perinatal death audit, clear guidelines and a suitable classification system to assign cause of death must be developed. Existing classification systems may need to be adapted. Better data and more data are urgently needed.

Vaginally inserted herbs causing vesico-vaginal fistula and vaginal stenosis.

A 32-year-old woman developed a vesico-vaginal fistula and vaginal stenosis following insertion of herbs into her vagina by a traditional doctor to "melt" her uterine myomata. She underwent successful trans-abdominal repair of her fistula and passive dilatation of her vagina was recommended for the vaginal stenosis. The emerging importance of traditional treatments as a cause of vesico-vaginal fistula is highlighted. The role of quality improvement through research and strict regulation to maximise the benefits of traditional treatment and minimise complications is also emphasised.

Bothersome lower urinary symptoms during pregnancy: a preliminary study using the International Consultation on Incontinence Questionnaire.

BACKGROUND: During pregnancy, many women suffer from lower urinary tract symptoms which they hardly report to their care providers. Measuring the prevalence of these symptoms has been difficult because of lack of uniform nomenclature and standardized tool. The updated nomenclature and the new ICIQ-FLUTS questionnaire offer an opportunity for assessment of these symptoms especially in developing countries. OBJECTIVE: This study aimed to establish the prevalence of bothersome lower urinary symptoms among pregnant women in Zaria, Nigeria. METHODS: This was a cross-sectional study in which the International Consultation on Incontinence Questionnaire on Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) was administered by trained interviewers to 204 consenting pregnant women aged 15 to 42 years who were attending Antenatal care (ANC) at a tertiary health facility in Zaria, Nigeria. RESULTS: Storage phase symptoms (nocturia, urgency, daytime frequency and painful bladder) were common among respondents. Of these, nocturia was the commonest with 94.1% of the respondents reporting it. Voiding symptoms (hesitancy, straining to pass urine and interrupted stream) were also found. Interrupted stream was the commonest of these, occurring in 8.3% of respondents. Incontinence; stress (13.7%), urge (9.8%) and enuresis (1%) were found among the respondents. CONCLUSIONS: These findings show that diverse, bothersome forms of lower urinary tract symptoms are experienced by pregnant women in this environment and the ICIQ-FLUTS questionnaire is a helpful tool in identifying these symptoms.

Introduction of an innovation for the reduction of maternal mortality in Kano State, northern Nigeria: a case study of magnesium sulphate.

In this project, sponsored by the McArthur Foundation and the Population Council, magnesium sulphate was introduced in February 2007 to 10 general hospitals in Kano State, northern Nigeria. Changes were monitored via data collected at the hospital. At an initial training of the trainers' workshop, 25 master trainers were trained. They then conducted step down trainings and trained 160 clinical providers. Within 12 months, 1045 patients were treated with magnesium sulphate. The attributable deaths from eclampsia fell by 42.4%. The community became aware of an improved outcome for eclampsia. The providers expressed satisfaction with the outcome of the treated patients. Four of the master trainers trained 30 clinical providers from the other 25 general hospitals. Initiatives for the reduction of maternal mortality should be evidence-based.

Operative vaginal deliveries in Zaria, Nigeria.

BACKGROUND: Operative vaginal deliveries are frequent features of obstetrics practice in tertiary levels of care even in developing countries. It is essential to review these practices in order to assess their benefits or otherwise to safe motherhood in resource limited settings. STUDY DESIGN: Labor records on operative vaginal delivery cases and matched controls who had spontaneous vaginal deliveries between January 1997 and December 2001 at the Ahmadu Bello University Teaching Hospital, Zaria, Nigeria, were analyzed with respect to mode of delivery, indication for operative vaginal delivery, anesthesia use, fetal 5-min Apgar score, birth weight, fetal, and maternal complications. RESULTS: Of 7,327 deliveries at the center in the study period, 262 (3.6%) were by operative vaginal deliveries. Forceps delivery was most frequently performed (55.7%), while vacuum delivery was found to be in increased use (38.2%). Embryotomy procedures were performed selectively (6.1%). Operative vaginal deliveries were more commonly employed on primigravida (78.6%) compared to multiparas and the most common indication was delayed second stage of labor. Forcep- and vacuum-assisted deliveries were both associated with maternal and newborn complications. There was no significant difference in the use of anesthesia between forceps and vacuum deliveries. CONCLUSION: Operative vaginal delivery rates in this center are comparable to other centers as are the possible complications. Making these procedures safer will improve safe motherhood in settings where there are performed.

Unplanned births before arrival at the hospital in a low resource setting: a case series.

BACKGROUND: Unplanned births before arrival at the hospital have significant impacts on maternal and neonatal outcomes all over the world. This is more so in low income countries like Nigeria. Yet, little information is available from low income countries about experiences in cases of unplanned births before arrival at the hospital. METHOD: An observational study of 24 consecutive parturients, the case notes were retrieved and necessary information obtained. Literature search was done using PubMed, texts on relevant topic and review of journals. RESULTS: Twenty-four cases of unplanned births before arrival at the hospital and the consequences are presented. The cases reviewed here were parturients seen at the labour ward of the Ahmadu Bello University Teaching Hospital in Zaria Nigeria over a six month period who had unplanned births before arrival at the hospital. CONCLUSION: Unplanned births before arrival at the hospital remain a threat to maternal and neonatal health, especially in low income countries like Nigeria. Safe birth planning can substantially address most of the reasons for delays that could lead to unplanned births before arrival and should be a key component of strategies to improve maternal and neonatal health in the community.