ObjectiveTo investigate the burden and causes of life‐threatening maternal complications and the quality of emergency obstetric care in Nigerian public tertiary hospitals.DesignNationwide cross‐sectional study.SettingForty‐two tertiary hospitals.PopulationWomen admitted for pregnancy, childbirth and puerperal complications.MethodsAll cases of severe maternal outcome (SMO: maternal near‐miss or maternal death) were prospectively identified using the WHO criteria over a 1‐year period.Main outcome measuresIncidence and causes of SMO, health service events, case fatality rate, and mortality index (% of maternal death/SMO).ResultsParticipating hospitals recorded 91 724 live births and 5910 stillbirths. A total of 2449 women had an SMO, including 1451 near‐misses and 998 maternal deaths (2.7, 1.6 and 1.1% of live births, respectively). The majority (91.8%) of SMO cases were admitted in critical condition. Leading causes of SMO were pre‐eclampsia/eclampsia (23.4%) and postpartum haemorrhage (14.4%). The overall mortality index for life‐threatening conditions was 40.8%. For all SMOs, the median time between diagnosis and critical intervention was 60 minutes (IQR: 21–215 minutes) but in 21.9% of cases, it was over 4 hours. Late presentation (35.3%), lack of health insurance (17.5%) and non‐availability of blood/blood products (12.7%) were the most frequent problems associated with deficiencies in care.ConclusionsImproving the chances of maternal survival would not only require timely application of life‐saving interventions but also their safe, efficient and equitable use. Maternal mortality reduction strategies in Nigeria should address the deficiencies identified in tertiary hospital care and prioritise the prevention of severe complications at lower levels of care.Tweetable abstractOf 998 maternal deaths and 1451 near‐misses reported in a network of 42 Nigerian tertiary hospitals in 1 year.

The exposure to conditions that predispose women to cervical cancer was high, and the levels of awareness of cervical cancer and cervical screening uptake were low. Continued awareness creation, local provision of cheap and affordable services and poverty alleviation are needed to improve cervical screening uptake with the hope of reducing the incidence of cervical cancer in the long term.

BackgroundUrinary tract infection (UTI) is a common bacterial infection during pregnancy and a significant cause of perinatal and maternal morbidity and mortality. The causative bacteria have remained virtually the same although with variations in individual prevalence. There has been an increasing resistance by these bacteria to the commonly available antibiotics.ObjectivesTo determine the prevalence of UTI, the common causative bacteria, and their antibiotic sensitivity pattern among pregnant women with UTI.MethodologyThis is a descriptive study that was carried out at the Obstetrics Department of two tertiary institutions in Abakaliki, Ebonyi State, Nigeria (Federal Medical Center and Ebonyi State University Teaching Hospital) over a period of 12 months. Midstream urine specimens from selected pregnant women with clinical features of UTI were collected for microscopy, culture, and sensitivity. The results were analyzed with the 2008 Epi Info™ software.ResultsA total of 542 pregnant women presented with symptoms of UTI and were recruited for the study over the study period. Of the 542 pregnant women, 252 (46.5%) had significant bacteriuria with positive urine culture and varying antibiotic sensitivity pattern. The prevalence of symptomatic UTI was 3%. Escherichia coli was the most common bacteria isolated with a percentage of 50.8%. Other isolated micro organisms included Stapylococcus aereus (52 cultures, 20.6%), Proteus mirabilis (24 cultures, 9.5%), S. saprophyticus (18 cultures, 7.1%), Streptococcus spp. (14 cultures, 5.6%), Citrobacter spp. (5 cultures, 2.0%), Klebsiella spp. (4 cultures, 1.6%), Enterobacter spp. (4 cultures, 1.6%), and Pseudomonas spp. (3 cultures, 1.2%). Levofloxacin had the highest overall antibiotic sensitivity of 92.5%. Others with overall antibiotic sensitivity pattern greater than 50% included cefpodoxime (87.3%), ofloxacin (77.4%), ciprofloxacin (66.7%), ceftriaxone (66.7%), and gentamicin (50.8%).ConclusionE. coli was the most common etiological agent of UTI in pregnancy with Enterococcus (Staphylococcus) gaining prominence. Cephalosporin and quinolones were shown to be very effective against the organisms causing UTI in these pregnant women.

Background:Intimate partner violence (IPV) is the most common type of violence against women. It is a major public health problem and violates the fundamental human rights of women.Aim:To determine the prevalence, pattern and consequences of IPV during pregnancy in Abakaliki, Southeast Nigeria.Subjects and Methods:A semi-structured questionnaire was designed for cross-sectional survey of pregnant women attending antenatal clinic between April and June 2011 at the Federal Medical Centre Abakaliki. A total of 321 questionnaires were correctly filled and then analyzed using Epi info software 2008 (Atlanta Georgia, USA).Results:Out of the 321 booked pregnant women, 44.6% (143/321) reported having been abused in the index pregnancy. Age of woman, family setting, religion, educational level of couples, parity and social habits of their husbands significantly influenced IPV (P < 0.05). The common causes of IPV were no identifiable cause (20.1%) 29/144, domestic issues (19.4%) 28/144, keeping late nights (12.5%) 18/144 and financial problem (11.8%) 17/144. Verbal abuse (60.1%) 86/143 was the most common type of abuse and most pregnant women resorted to praying (31.5%) 46/146, crying (24.7%) 36/146, and begging (22.6%) 33/146 as their major reactions to IPV. Eleven (7.7%) 11/143 pregnant women were hospitalized while (21%) 30/143 sustained emotional and physical injury. Apologies were tendered after IPV by 84.6% (121/143) of husband. Majority (83.9%) 120/143 of the abused did not support reporting IPV.Conclusion:Various types of IPV are still practiced commonly in our environment. IPV poses great threat to the reproductive health of all women especially during pregnancy.

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Gender-based violence, though deeply entrenched in some cultures and religions, has remained a neglected area in health research in South-east Nigeria. This study assessed the prevalence, pattern and background factors precipitating domestic violence in a population of prenatal clinic attendees. This was a cross-sectional questionnaire-based study. Booked antenatal women were recruited into the study after informed consent. Trained research assistants administered the questionnaires in the local dialects of the women. Analysis was by the Epi Info Statistical Software package version 3.2.2 of 2005. A total of 500 women were involved in the study that spanned 3 months. Of these, 68 were exposed to gender-based violence. Verbal abuse/insult was the commonest form of male engendered violence. Others were sexual abuse, financial deprivation, threats and physical harm. Financial and domestic issues were the major sources of disagreements. Some 17.6% sustained physical injury, while all admitted to some degree of psychological trauma. Routine assessment in a non-judgemental way of antenatal population for gender-based violence is advocated. This will determine the true prevalence and pattern of domestic violence, and form a rational basis for the formulation of interventional strategies.

Background:Breast cancer is the most common female malignancy and commonly associated with high levels of morbidity and mortality in developing countries due to late presentation. Breast self-examination (BSE) can help in early detection of the disease.Aims:This study aims to determine the awareness and practice of BSE among market women in Abakailiki, Southeast Nigeria.Subjects and Methods:This cross-sectional descriptive study involved the use of questionnaire among market women in Abakaliki. Inclusion criteria were women from the age of 18 years and above who own or sell in a shop, while females less than 18 years of age and women who came to the market to buy products were excluded. Questionnaires were distributed randomly among women who met the criteria in every shop visited based on willingness to participate. Analysis was done using Epi info version 3:5:3 (Atlanta Geogia USA.2008). The association between variables was tested using Chi square for trend statistics. Significance was set at P < 0.05. Binomial logistic regression analysis was used to test for relationship between the age group categories against ever heard of BSE.Results:The age range of participants was between 20 and 65 years, with a mean age of 34.3 (10.8) years. The age range between 20 and 29 years constituted the highest age group 35.3% (84/238). Majority 54.2% (129/238) had a maximum of secondary education. Of the 238 participants, 77.7% have heard of breast cancer, of which 73.9% thought that early detection would aid treatment. Only 38.9% (6/195), 13% and 13.4% have heard of BSE, clinical breast examination and mammography, respectively. Just 23.9% have been taught how to perform BSE, while 21.8% had done it in the past. One person 0.4% knew the correct frequency of BSE, and also did it regularly. There was a statistically significant difference between the level of education and awareness of BSE. However, there was no statistical significant difference between participants age and awareness of BSE.Conclusion:There was a low level of awareness of BSE among market women in Abakiliki, and there is a need to increase the level of awareness through campaigns.

Availability of blood for transfusion is of utmost importance in the fight against maternal morbidity and mortality. This study was conducted to identify the socio-demographic characteristics and reasons of persons declining voluntary blood donation. Patients' relatives declining blood donation in rural Ebonyi State were randomly recruited and interviewed using standardised questionnaire after obtaining informed consent from each of them. Responses were ranked according to frequency of positive respondents. Illiteracy was prevalent among the population: over 76% had no formal education. 'Not being strong enough' and 'not having enough blood' were the two major reasons for declining blood donation, while loss of manhood/libido and exposure of blood to witchcraft were the other reasons given. Respondents' level of awareness of HIV/AIDS was appreciable. Socio-cultural barriers to voluntary blood donation exist in predominantly illiterate rural communities of the country. Most of the reasons given were based on misconception, misinformation and ignorance about the effect and safety of blood donation. RÉSUMÉObstacles socio-culturels au don volontaire du sang destiné à l'usage obstétrical dans un village Nigérian rural La disponibilité du sang destiné à la transfusion est d'une importance capitale dans le combat contre la morbidité et la mortalité maternelles. Cette étude a été menée afin d'identifier les caractéristiques socio-démographiques et les raisons pour lesquelles les gens ne veulent pas faire le don volontaire du sang. Les parents des patients qui ne veulent pas faire le don volontaire du sang dans l'état d'Ebonyi rural ont été recrutés et interviewés au hasard à l'aide d'un questionnaire standardisé, suite à l'obtentionn du consentement éclairé de chacun d'eux. Nous avons classifié les réponses selon la fréquence des repondants positifs. L'analphabétisme était prévalent auprès de la population; plus de 76% n'avaient pas reçu une instruction formelle. Les deux principales raisons pour lesquelles ils ne donnaient pas du sang étaient "n'est pas assez en bonne santé" et" on n'a pas assez de sang", alors que la perte de sa virilité, ainsi que le fait d'exposer le sang à la sorcellerie étaient les deux autres raisons avancées. Le niveau de la conscience du VIH/SIDA était considérable. Les obstacles socio-culturels au don volontaire de sang existent dans les communautés essentiellement illetrées et rurales du pays. La plupart des raisons données ont été fondées sur des opinions fausses, des désinformations et l'ignorance au sujet de l'effet et de la sécurité du don de sang. (Rev Afr Santé Reprod 2005; 9[3]:72-76)