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.

Background-There has been increased concern on human sexuality, especially with respect to contraception and the control of sexually transmissible infections. There is need to identify the sociodemographic characteristics that influence sexual behaviour and contraceptive use among young women. Methods-A descriptive cross sectional study that focused on the socio-demographic characteristics, sexuality, knowledge and use of modern contraceptive technology as well as interventions taken in the event of inadvertent pregnancy was conducted. A structured, close-ended questionnaire was randomly administered to 195 female nursing students with 60, 65 and 70 of them in their first, second and third year respectively. Results-Majority (76.7%) of the students were in the age bracket of 20-24years. While 65.6% of them were sexually active, only 54.9% had knowledge of family planning. Condom was the commonest contraceptive used (37.4%) and the main reasons were that of effectiveness (31.8%) and safety (30.3%). There was a significant relationship between respondents with multiple sexual partners and incidence of unwanted pregnancies (p=0.003). The majority (51.2%) of those with unwanted pregnancies resorted to induced abortion. Conclusion-In view of the high prevalence of induced abortion among the respondents, current nursing training programmes need to be reviewed to meet the peculiar reproductive health needs of female student nurses.

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This study examined the knowledge, attitude and practice of private medical practitioners in Calabar on abortion, postabortion care and post-abortion family planning. Forty eight private practitioners who were proprietors of private clinics in the city were interviewed using a structured questionnaire. The results showed that 22.9% of the doctors routinely terminate unwanted pregnancies when requested to do so by women, while 83.3% of them treat women who experience complications of unsafe abortion. The major reasons given by some of the doctors for not terminating unwanted pregnancies were religious, moral and ethical considerations rather than respect for the Nigerian abortion law. Only 18.2% of the doctors use standard procedures such as manual vacuum aspiration (MVA) for the management of patients with abortion and abortion complications. A good number of them did not routinely practice integrated post-abortion family planning and STDs management. There is need for a comprehensive programme of retraining of private medical practitioners in Calabar on the principles and practices of safe abortion, post-abortion care and family planning. These aspects of reproductive health need to be integrated into the medical training curricula in Nigeria. It is believed that this approach would help reduce the present high rate of abortion-related morbidity and mortality in Nigeria. Cette etude a examiné la connaissance, l'attitude et la pratique des praticiens médicaux privés à Calabar à l'égard de l'avortement, des soins de post-avortement et de la planifiction familiale du post-avortement. Nous avons interviewé 48 praticiens privés, propriétaires des cliniques privées dans la ville, à l'aide d'un questionnaire structuré. Les résultats ont montré que 22,9% des médecins interrompent systématiquement des grossesses non-désirées quand les femmes le demandent alors que 83,3% d'eux soignent les femmes qui ont des complications des avortements dangereux. Les raisons principales données par certains médecins pour lesquelles ils interrompent les grossesses non-desirées étaient plutôt plus pour des considerations religieuses et morales que pour le respect pour la loi nigériane sur l'avortement. Seuls 18,2% emploient des procedures normales telle l'aspiration pneumatique manuelle (APM) pour le traitement des patients qui ont des problèmes de l'avortement et des complications de l'avortement. Bon nombre d'eux ne pratiquent pas systématiquement la planification familiale du post-avortement intégré et du traitement des MSTs. Il faut un programme compréhensif du stage de recyclage des praticiens privés à Calabar sur les principes et les pratiques de l'avortement sans risque, les soins post-avortement et la planification familiale. Ces aspects de la santé reproductive doivent être intégrés dans le programme de la formation médicale au Nigéria. Nous espérons que cette approche aidera à réduire le présent taux élevé de la morbidité et de la mortalité lié à l'avortement au Nigéria. (Rev Afr Santé Reprod 2003; 7[3]: 55-64)