The effect of improving maternity services in a secondary facility, Zaria, Nigeria. The Zaria PMM Team.

PRELIMINARY STUDIES: Facility review at the secondary hospital in Makarfi revealed a lack of drugs and skilled personnel and delays in treating and referring women with obstetric complications. INTERVENTIONS: In 1994, maternity facilities were renovated, a revolving drug fund was introduced, midwives were trained and an ambulance was restored to service. Attempts to secure a physician with skills in treating obstetric emergencies were unsuccessful. Prior to these activities, obstetric services at the referral hospital were improved. Community interventions focused on improving utilization by women with complications. RESULTS: Between 1990 and 1995, substantial increases occurred in antenatal attendance (2517 to 5565 per year) and deliveries (325 to 1952 per year). The number of women with complications seeking care at this facility, however, dropped from 85 in 1990 to 28 in 1995. Referrals to higher level facilities increased from four in 1990 to 17 in 1995. COSTS: The cost of the interventions was approximately US $32,000. Ninety-eight percent was paid by the government and 2% by PMM. CONCLUSIONS: Improving the quality of maternity services can increase utilization by women with uncomplicated pregnancies. However, utilization of emergency services appears to be influenced by other factors, such as the ability to treat obstetric complications and prevailing economic conditions.

A simple mass-closure technique compared with layered technique in the closure of high-risk abdominal wounds.

A retrospective comparison of the outcome of patients with ruptured gravid uterus following obstructed labour who had abdominal closure by a simple mass-closure technique (using non-absorbable Nylon suture) with their counterparts who had the more popularly used layered technique. The clinical features on admission, operation details and wound complications were compared. Thirty-one patients who had mass-closure were compared with 103 that had the layered technique. Nineteen percent of the former had wound infections or partial dehiscences while none had complete dehiscence or hernias. On the other hand these respective complications occurred in 32%, 9.7% and 1.9% of the layered group. This mass-closure technique has the advantages of low-cost, speed and safety. We advocate that it be used on all high-risk abdominal wounds.