Neural Tube Defects (NTDs) are congenital structural abnormalities of the brain (anencephaly) and vertebral column (spina bifida) that represented as one of the most common congenital malformations of neonates worldwide. A fouryear and eight months (January 1 st , 2007 to August 31 st , 2011) retrospective record review study on prevalence, trend, and associated demographic factors of NTD was conducted at Orotta National Referral Maternity Hospital, Asmara, Eritrea. The prevalence, trend and associated demographic factors were assessed by data extraction from hospital delivery register and patient cards. Associations between variables of maternal age, parity, and infant gender and primary outcomes were determined using χ 2 analyses and Poisson regression modeled cumulative incidence and controlled for confounders. Out of 39, 803 total deliveries 185 neonates were found to have NTDs related abnormalities, but 156 neonates identified with complete and welldocumented registers, medical records and charts showing a prevalence of 3.9 per 1000 deliveries. The most commonly identified NTDs were Anencephaly 75(48.1%), Hydrocephalus 29 (18.6%), Spina bifida 27 (17.3%), and Multiple NTDs 25 (16.0%). Marital status, ethnicity, religion, and maternal history of abortion were found to have no enough evidence, but women who delivered neonates with NTDs who had parity less than four 125 (80.1%) and age below 30 years 108 (69.2%)were observed to have higher chances. All the Anencephalic neonates were delivered by vaginal delivery, Majority (66 (88%)) with a weight of less than 2000 grams and were female by sex 55(74.3%); whereas 13(44.8%) Hydrocephalic neonates were delivered by Caesarian section and 26 (92.9%) had a weight greater than 2000 grams. The Appearance Pulse Grimace Activity Respiration(APGAR) score results were founded to be zero for all anencephalic neonates and for 17 (74%) of multiple NTD; while 40 percent of and 46 percent of neonates with spina bifida and hydrocephalus, respectively, had no APGAR at five minutes. Over the years of the study a significant increase in the trend of NTDs were observed, mainly that of anencephaly. The increase was 1.5 percent (p < 0.05). The results of Poisson analysis indicated an exceptional statistically significant increase of anencephaly only. The trend of NTDs in neonates was observed to increase significantly, mainly anencephaly. The study findings noted younger women (less than 30 years) and with parity less than four were at higher risk than those of older age and higher parity. NTDs can be prevented and reduced with folic acid supplementation and fortification of principal foods.

Education and training can improve the quality of health care. We evaluated a course taught by Obstetrics/Gynaecology residents on the work environment and maternal/neonatal outcomes at Orotta Maternity Hospital. Participants were given a Standardised Safety Attitudes Questionnaire (SAQ) to measure work environment before and after training. Maternal/neonatal outcomes were extracted from hospital logbooks. Neonatal quality indicators were: adverse score index, weighted score index and severity score index. SAQ response rate was 77.6% (45/58) pre-training and 95.6% (43/45) post-training. Mean total SAQ score increased from 3.07 to 3.32 out of 5 points (p < 0.05). Changes in relative risk (RR) were not statistically significant for maternal [maternal death ratio of RR (RRR) =1.08, 95% CI: 0.20-5.84 and blood transfusion RRR = 0.90, 95% CI: 0.74 -1.09] or neonatal outcomes (intrapartum death RRR = 1.24, 95% CI: 0.57-2.75, neonatal death RRR = 0.93, 95% CI: 0.26-3.24, neonatal transfer RRR = 1.02, 95% CI: 0.81-1.27, and Apgar < 7 at 5 minutes RRR = 1.20, 95% CI: 0.83-1.73). Neonatal quality indicators did not change significantly. Utilising residents to teach staff-developed training within a hospital setting was feasible and may improve the work environment. Impact on maternal/neonatal outcomes is not evident but continued follow-up is important.

Background: obstetric fistula is a devastating childbirth injury as a result of obstructed labor. It leads to chronic urinary incontinence and, in most cases, significant physical and emotional suffering. Its prevalence is high in Sab-Sahara African and South Asian countries. The objective of this study is to determine the incidence and describe the characteristics of women with obstetric Vesico-vaginal fistula. Methods: A retrospective cross-sectional study was conducted in all obstetric vesico-vaginal fistula patients. Patient identification performed through review of prerecorded logbook and patient card describing each patient admitted to fistula ward over a period of five years from January 1 st 2014 to December 31, 2018. Medical records were reviewed to obtain data on socio-demographic and obstetric characteristics, clinical details, and treatment. Statistical analysis was performed using STATA-9. Results: There were 146 women with Vesico-vaginal fistula (VVF) admitted to the fistula hospital over the study period; of which 144 of them were obstetric fistula. During the study period the total number of health facility deliveries in Eritrea was 217,119 giving an estimated rate of obstetric VVF of 0.7/1000 facility deliveries. The median age, parity, and number of live births was 30, 3, and 2, respectively. One quarter (n=37) of the cases being in the age group of 20years or younger. The highest incidence of VVF (38%) was observed in Primiparous. 75% gave birth in a health facility, 54% of deliveries were by caesarean section, and 80% of babies were stillborn. 77% of repairs were successful. Conclusion: The incidence of fistula in Eritrea is relatively low as compared to other sub-Saharan African countries. In this study, age at fistula development was older than usually found, which might be due to poor access to emergency obstetric care (EmOC) that contributed more to this problem.

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