Study objective-To understand community based or socio-cultural factors that determine maternal morbidity and mortality in a semi-urban setting. Design-The study is an exploratory multidisciplinary operations research and the instruments were focus groups and interviews. Setting-Ekpoma, a semi-urban community with a population of 70 000 in central part of Edo state in southern Nigeria. Participants-Thirteen groups of women, two groups of men, and two groups of traditional birth attendants. Results-There is a fairly good knowledge of haemorrhage but this is circumscibed by attitudes, practices, and situations that keep women away from or delay the decision to seek modern obstetric care. Conclusions-For a fuller understanding of maternal morbidity and mortality, it is important to consider factors outside the hospital and formal medical practice. Furthermore, a change of existing knowledge, attitudes, practices, and situations can be enhanced through modelling on them. (J Epidemiol Community Health 1998;52:293-297) The level of maternal mortality in Africa, estimated at 100-fold to 200-fold that of the industrialised countries, is unacceptably high. 1Because of its very high fertility and death rates, Nigeria is said to account for 10 per cent of the world's maternal mortality.2 Moreover, most of these women suVer permanent disabilities.The most common medical causes of maternal deaths are haemorrhage, toxaemia, infection, obstructed labour, and unsafe abortion. Deaths from most of these complications can be prevented if promptly and eVectively managed. But in sub-Saharan Africa, the problem stems not only from inadequate health services, but is also the result of the interplay of many antecedent factors that could be social, cultural, economic and logistic, coupled with very high fertility. Such sex specific health problems ramify into the well known sociocultural diYculties and discriminations endured by women in Third World countries. 3Most of these women would have been neglected as children, overworked and underfed, espoused as adolescents, are quite often poor and illiterate, usually subjected to harmful traditional practices, denied equal social status in the society, and denied adequate family planning and maternal health services.Although the limitations of health care delivery facilities and, therefore, personnel in Third World countries are quite well known, nonmedical factors, which are no less important have turned out to be intractable problems and are often conveniently ignored by confounded oYcials. Even in situations where modern health care facilities and personnel are available, many routine traditional or normative practices may prevent or delay the decision to seek proper and more eVective care.The objective of this study is to highlight these community based factors and their implications in maternal mortality and morbidity. Methods EKPOMAEkpoma was chosen as the study site because the social and political situation were conducive to working with the community. It is also an area b...

In a 13-year review of maternal deaths at the University of Benin Teaching Hospital, Benin City, abortion was one of the three major causes of death, accounting for 37 (22.4%) out of the 165 deaths. Induced abortion was responsible for 34 (91.9%) of these deaths. The usual victim is the teenage, inexperienced school girl who has no ready access to contraceptive practice. Death was mainly due to sepsis (including tetanus), hemorrhage and trauma to vital organs, complications directly attributable to faulty techniques by unskilled abortion providers, a by-product of the present restrictive abortion laws. Total overhaul of maternal child health services and the family health education system, as well as integration of planned parenthood at primary health care level into the health care delivery system, are suggested. Contraceptive practice should be made available to all categories of women at risk, and the cost subsidised by governmental and institutional bodies. Where unwanted pregnancies occur, the authors advocate termination in appropriate health institutions where lethal and sometimes fatal complications are unlikely to occur. In effect, from the results of this study and a review of studies on abortion deaths in Nigeria and other developing countries, it is obvious that a revision of abortion laws as they operate, notably in the African continent, is overdue.

From July 1973 to December 1980, 6942 patients were admitted to the Gynaecology unit of the University of Benin Teaching Hospital, Benin City, Nigeria. Fifty-nine patients presented with gynatresia (vaginal atresia and stenosis), an incidence of 8.5 1000. The most common causes of this condition were caustic vaginitis, secondary to local herb pessary insertion, and circumcision. The resulting vaginal adhesions were effectively treated surgically by simple adhesiolysis . There was a low incidence of congenital gynatresia . As the large proportion of cases of acquired gynatresia were preventable, improvement in health education should further reduce incidence of this condition in our community.

Five hundred sixty grandmultiparous women were interviewed as to their contraceptive awareness, desirability and use in the three major hospitals in Benin City, Nigeria, between October 1, 1980 and September, 1981. Their parity ranged from 5 to 14 with a mean of 6.7. There was high level of awareness of contraceptive availability and usefulness (65%), but low level of practice (27.1%). The main causes of the low practice level included opposition from husband and other relatives, complications of previous methods used and the desire to have a large family. Oral contraceptives were the preferred method, followed by intrauterine devices. Educational attainment had a positive relationship to acceptance of contraceptive practice. We believe that with more concerted effort at family planning counseling, the community will be rid of the hazards and menace of grandmultiparity.

Fifty cases of umbilical cord prolapse in a nine‐year period is analysed. The incidence was 0.21% and foetal mortality rate 28%. The Caesarian section rate was 86% and all live babies were delivered by Caesarian section. Analysis of the foetal mortalities revealed the following trend. Of the 18 patients who ruptured membranes spontaneously at home, foetal mortality was 66.6% as against 6.3% for those rupturing membranes in hospital. Of the 20 patients arriving hospital over two hours after the cord prolapse, 65% foetal mortality occurred. When the diagnosis delivery interval was beyond 30 minutes the foetal mortality for the 19 cases was 68.4%. Of the 19 cases where cord prolapse occurred with the Os uteri 8–10 centimeters dilated and had attempted vaginal delivery before Caesarian section, the foetal mortality was 57.9% as against 9.7% for the 31 cases where cord prolapse occurred with the Os uteri less than seven centimeters dilated and had a straight Caesarian section. Other contributing factors to foetal mortality were missed diagnosis of cord prolapse on admission, wrong judgement of the safest mode of delivery and undue delay of patient arrival in labour ward after cord prolapse.