Abiodun M.T.,University of Benin |
Oluwafemi R.O.,Mother and Child Hospital
Nigerian Journal of Clinical Practice | Year: 2017
Background: Neonatal emergencies contribute significantly to under-five morbidity and mortality in developing countries, partly due to poverty and limited access to quality healthcare in rural communities. Aims: The aim is to evaluate the spectrum, outcome, case fatality rates (CFRs), and prognostic factors of neonatal emergencies seen in the two free health-care facilities in Ondo State. Methods: This was a cross-sectional descriptive study of neonatal emergencies. Data were collected on eligible consecutive infants using a self-designed questionnaire. Neonatal emergencies were classified based on systemic involvement and underlying causes. Categorized data were expressed as percentages. Outcome and CFRs were presented pictorially. Inferential analysis was performed. The value of P < 0.05 was considered statistically significant. Results: Altogether, 425 infants with neonatal emergencies were recruited, constituting 21.3% of the under-five medical emergencies managed during September 2014 to February 2015. The most frequent emergencies were neonatal sepsis (45.2%) and neurological emergencies, especially hypoxic ischemic encephalopathy (22.1%) and acute bilirubin encephalopathy (14.6%). Furthermore, 6.1% of the infants presented with disseminated intravascular coagulopathy. The outcome of the emergencies was as follows: 88.6% were discharged, 7.4% died, and 3.7% left against medical advice whereas 0.3% were referred for subspecialty services. The leading causes of death among the 32 mortalities in this survey were sepsis (39.5%), hypoxic ischemic encephalopathy (36.9%), and hypothermia (13.2%). Hypothermia, perinatal asphyxia, and hypoglycemia had the highest CFRs, 22.7%, 12.6%, and 11.8%, respectively. Conclusion: Neonatal encephalopathy and sepsis were the most common emergencies seen in the free health-care program. Furthermore, they accounted for a majority of the neonatal deaths. This should be taken into cognizance while designing local interventions for neonatal emergencies.
News Article | March 3, 2017
Carmela Torres was 18 when she became pregnant for the first time. It was 1987 and she and her now-husband, Pablo Hernández had just moved to Colombia’s capital, Bogotá, in search of a better life. One December afternoon, suddenly out of nowhere, her body began to convulse with sharp contractions. It was more than two months before her due date. She rushed to the Instituto Materno Infantil (Mother and Child Hospital) in the east of the city. Not long after arriving she gave birth naturally to a baby boy weighing just 1,650 grams (3lb 10oz). Before she had a chance to hold him, her baby was whisked off to a neo-natal intensive care unit. Torres was simply told to get dressed and go home. “I didn’t even get to touch him,” she says. “They said I could come back and see him but the visiting times were very restricted – just a couple of hours a day. When I did visit I was allowed to look but not touch.” On the third day she was at home preparing for her next visit when the phone rang. “It was the hospital,” she says. “They called to say my baby was dead. They didn’t tell me the cause of death or give me any diagnosis. Just that he was dead. I hadn’t even named him yet.” A decade passed before Torres was ready to become pregnant again. A couple of months before her due date those familiar, severe contractions ripped through her body, stopping her in her tracks. “I was petrified,” she says. “I didn’t want another premature baby. I was taken to the exact same ward where I had my baby which died. I was extremely stressed.” At one o’clock the next morning Torres gave birth to another boy. She named him immediately, calling him Julian. He weighed almost the same as her firstborn and just like then, he was whisked straight into intensive care. “I spent a very frightening night panicking that I was about to lose another baby,” she says. “But the next morning a doctor came to see me. She told me about a thing called Kangaroo Mother Care – how I could act as a human incubator and carry my own baby and take it home with me.” That day Torres was taught how to hold her baby under her clothing, upright between her breasts with his airways clear. She was taught how even the finest layer of fabric between her and her baby wasn’t allowed – it had to be continuous and direct skin-to-skin contact. She was taught how to breastfeed, how to sleep on her back propped up by cushions, and strictly never to bathe him as this would waste his precious energy. Remarkably, the very next afternoon, with her tiny baby strapped to her chest under a blanket, Torres walked out of hospital. “Julian was very small and fragile but I was much happier taking him home with me than leaving him there, where my other baby had died,” she says. “Feeding him wasn’t easy, but I had a lot of help. I carried him for a month, 24 hours a day, sharing shifts with my husband, until he hit his target weight of 2,500g. Once he’d reached that we didn’t have to do it any more and finally he got his first bath.” Kangaroo Mother Care (KMC) is the brainchild of Colombian paediatrician Edgar Rey, who introduced it to the Instituto Materno Infantil in 1978. It was an idea born out of desperation. The institute served the city’s poorest people. At the time this was the biggest neonatal unit in Colombia, responsible for delivering 30,000 babies a year. Overcrowding was so bad that three babies would have to share an incubator at a time, and the rate of cross-infection was high. Death rates were spiralling and so too was the level of abandonment as young, impoverished mothers, who never even got to touch their babies, found it easier just to take off. Rey happened upon a paper on the physiology of the kangaroo. It mentioned how at birth kangaroos are bald and roughly the size of a peanut – very immature, just like a human pre-term baby. Once in its mother’s pouch the kangaroo receives thermal regulation from the direct skin-to-skin contact afforded by its lack of hair. It then latches onto its mother’s nipple, where it remains until it has grown to roughly a quarter of its mother’s weight, when finally it is ready to emerge into the world. This struck a chord with Rey. He went back to the institute and decided to test it out. He trained mothers of premature babies to carry them just as kangaroos do. The results were remarkable. Death rates and infection levels dropped immediately. Overcrowding was reduced because hospital stays were much shorter, incubators were freed up, and the number of abandoned babies fell. It’s 8am and already the shiny new KMC unit at the San Ignacio University Hospital in central Bogotá is packed to the rafters. Rows of women, and a surprisingly high number of men, too, squeeze together – a sea of colourful knitted hats and chunky coats, protection against the city’s unpredictable cycle of hail, rain and heat. They sit on narrow pews with the tiniest little heads peeping skyward on their chests. It’s warm, there is a buzz, and it is a million miles away from the sterile atmosphere of a typical neonatal intensive care unit. Many seem to have settled in for the day – one woman has her knitting out and another has her extended family in tow. Five paediatricians stand in a row behind a bench examining baby after baby. “Traditional units are closed and have very restrictive visiting hours,” says Nathalie Charpak, the French paediatrician who heads the unit. “An important element of KMC is that the unit is open and parents have access so they can sit with their infants, connect with each other and gain confidence seeing others with very small babies doing the same thing.” In 1989 Charpak did a study on a sample of babies from two of the very poorest hospitals in the city and proved that KMC was safe. In 1994, with funding from a Swiss NGO, a larger randomised trial proved conclusively that not only were babies dying less, but breastfeeding rates were up, hospital stays were shorter and infection was down. Charpak is also director of an NGO that researches and promotes KMC, the Fundación Canguro – the Kangaroo Foundation. “It is clear KMC is about much more than just saving the baby’s life,” says Charpak. “I have fought all my life to show that KMC has nothing to do with comfort or massage or anything fluffy like that. It is difficult to do and each baby is carefully followed up every six weeks for the first year, but the benefits are extraordinary.” One of the very first countries to investigate what was going on in Bogotá was Venezuela. In 1994 a small team came to witness KMC for themselves. Others came too: Brazil in 1995, Ethiopia in 1996, followed shortly by Madagascar, India, Cameroon and many more. Many of the resulting KMC programmes are very successful. In Malawi, which has the highest rate of premature births in the world (181 babies out of 1,000), there is now a KMC centre in every district. Over the 10 years to 2015, the number of babies dying before their first birthday fell from 72 out of 1,000 to 43. “I have seen a significant drop in mortality,” says Indira, a midwife at Zomba Central Hospital in southern Malawi. “It has also helped reduce congestion in the ward as babies are cared for at home. And it has helped reduce costs, because electricity is being saved as the mother is a perfect heat source for the baby.” The World Health Organisation has estimated that KMC has the potential to save as many as 450,000 lives a year. Resistance, however, has come from where you might least expect it. For some health professionals, nurses and even paediatricians, Charpak says, it can be difficult to accept that care by mothers is better than anything they can offer themselves, especially if they have fought hard to bring shiny rows of incubators to their hospitals. There is also the prevailing idea that things are done better in westernised countries. Charpak and colleague Julieta Villegas now struggle to convince the world that it isn’t just an option for poor women. “It’s not something just to be done in poor countries,” says Charpak. “There is a cost to it. It’s a proper neonatal care with advantages that are clinically proven.” Undeniably, though, it is cheaper. The estimated cost of neonatal care for premature babies in the US is up to $5,000 (£4,000) a day. In low-income countries, a KMC programme can cost as little as $4.60 a day. Last November Charpak unveiled the most ambitious study yet into KMC aiming to track down the 716 families who took part in the original 1994 study. The original kangaroo babies were subjected to a series of rigorous checks including MRIs, neuroimaging, blood tests, psychosocial tests and physical evaluations. Each was measured for self-esteem, depression, hyperactivity, aggressiveness and more. So were the grown-up babies from the original control group, who had received traditional care. The full results were published in Pediatrics journal at the end of last year. “The findings are groundbreaking,” says Villegas. “We found the kangaroo babies were less hyperactive, less antisocial, and they even earned higher wages. This is especially significant because these were babies who were the most fragile to begin with and who came from a lower socioeconomic background ... This is why we say with kangaroo care, we fight inequality. We don’t just save lives, we change lives.” This article first appeared on Mosaic Science and is republished here under a Creative Commons licence.
PubMed | Luang Prabang Provincial Hospital, Centers for Disease Control and Prevention, Ministry of Health, Mother and Child Hospital and 4 more.
Type: Journal Article | Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America | Year: 2016
Some studies suggest that maternal influenza vaccination can improve birth outcomes. However, there are limited data from tropical settings, particularly Southeast Asia. We conducted an observational study in Laos to assess the effect of influenza vaccination in pregnant women on birth outcomes.We consented and enrolled a cohort of pregnant woman who delivered babies at 3 hospitals during April 2014-February 2015. We collected demographic and clinical information on mother and child. Influenza vaccination status was ascertained by vaccine card. Primary outcomes were the proportion of live births born small for gestational age (SGA) or preterm and mean birth weight. Multivariate models controlled for differences between vaccinated and unvaccinated women and influenza virus circulation.We enrolled 5103 women (2172 [43%] were vaccinated). Among the 4854 who had a live birth, vaccinated women were statistically significantly less likely than unvaccinated women to have an infant born preterm during the period of high influenza virus circulation (risk ratio [RR] = 0.56, 95% confidence interval [CI], .45-.70), and the effect remained after adjusting for covariates (adjusted RR, 0.69; 95% CI, .55-.87). There was no effect of vaccine on SGA or mean birth weight. The population-prevented fraction was 18.0%.In this observational study, we found indirect evidence of influenza vaccine safety during pregnancy, and women who received vaccine had a reduced risk of delivering a preterm infant during times of high influenza virus circulation. Vaccination may prevent 1 in 5 preterm births that occur during periods of high influenza circulation.
Oluwafemi R.O.,Mother and Child Hospital |
Abiodun M.T.,University of Benin
Sri Lanka Journalof Child Health | Year: 2016
Background: Preterm birth contributes significantly to neonatal deaths. Its burden should be defined to enhance interventions especially in resource-limited settings with poor neonatal health indices. Objectives: To determine the incidence of preterm delivery in the Mother and Child Hospital, Akure, to investigate the outcome and explore the relationship between birth weight and neonatal survival. Method: Demographic and clinical features (gestational age, birth weight and outcome) of consecutive preterm infants were documented for one and a half years. Incidence of preterm birth was computed, using total birth as the denominator. Quarterly incidence of preterm birth was presented graphically. Univariate logistic regression analysis of birth weight as a predictor of preterm death was done. P value < 0.05 was considered significant. Results: Of 10,432 births during study period, 1,606 were preterm giving an incidence of preterm births of 15.4%. Among preterm infants, 1,449 (90.2%) had low birth weight (LBW), 123 (7.7%) very low birth weight (VLBW) and 34 (2.1%) extremely low birth weight (ELBW). Most (92.8%) preterm babies were discharged. Prematurity had a case fatality rate (CFR) of 5.6%. Compared to normal birth weight infants, ELBW babies were 250 times and VLBW infants 47.6 times more likely to die. Conclusions: Incidence of preterm delivery in the Mother and Child Hospital, Akure was 15.4%. The CFR of prematurity was 5.6%. ELBW had the highest percentage of deaths (70.6%).
Aderoba A.K.,Mother and Child Hospital |
Iribhogbe O.I.,University of Benin |
Olagbuji B.N.,Ekiti State University, Ado Ekiti |
Olokor O.E.,University of Benin |
And 2 more authors.
International Journal of Gynecology and Obstetrics | Year: 2015
Objective To determine the prevalence of helminth infestation during pregnancy and the associated risks of adverse maternal and infant outcomes. Methods A cross-sectional study of women with a singleton pregnancy of at least 34 weeks was conducted at a teaching hospital in Benin City, Nigeria, between April 1 and September 30, 2010. Socioeconomic and clinical data were obtained. Stool samples were used to determine helminth infection. Birth weight was recorded at delivery. Multivariable analysis was used to assess the link between helminth infestation and maternal and perinatal outcomes. Results Among 178 women, 31 (17.4%) had a helminth infestation (15 [8.4%] had ascariasis, 8 [4.5%] trichuriasis, and 25 [14.0%] hookworm infestation). Multivariate analysis found that helminth infestations was associated with maternal anemia (adjusted odds ratio 12.4; 95% confidence interval 4.2-36.3) and low birth weight (adjusted odds ratio 6.8; 95% confidence interval 2.1-21.9). Conclusion Approximately one in five women had a helminth infestation in the third trimester of pregnancy. Maternal helminth infestation significantly increased the risks of maternal anemia and low birth weight, indicating that routine administration of anthelminthic drugs during early pregnancy might improve perinatal outcomes. © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
PubMed | University of Benin and Mother and Child Hospital
Type: Journal Article | Journal: Nigerian medical journal : journal of the Nigeria Medical Association | Year: 2016
To determine the incidence and risk factors of fetal macrosomia and maternal and perinatal outcome.This was a 1-year prospective case-control study of singleton pregnancies in a Nigerian tertiary hospital. Only women who gave consent were recruited for the study. The maternal and perinatal outcomes in women who delivered macrosomic infants (birth weight 4000 g) were compared with the next consecutive delivery of normal birth weight (2500-3999 g) infants.The total deliveries for the study period were 2437, of which 135 were macrosomic babies. The incidence of fetal macrosomia was 5.5%. The mean birth weights of macrosomic and nonmacrosomic babies were 4.26 0.29 kg and 3.20 0.38 kg, respectively, P = 0.000. Mothers with macrosomic babies were more likely to be older (P = 0.047), of higher parity (0.001), taller (P = 0.007), and weighed more at delivery (P = 0.000). Previous history of fetal macrosomia (P = 0.000) and maternal diabetes (P = 0.007) were factors strongly associated with the delivery of macrosomic infants. Pregnancies associated with fetal macrosomia had increased duration of labor (P = 0.007), interventional deliveries (P = 0.000), shoulder dystocia, and genital laceration (P = 0.000). There was no significant difference in the incidence of primary postpartum hemorrhage (P = 0.790), birth asphyxia, and perinatal mortality (P = 0.197).Fetal macrosomia is associated with maternal and fetal morbidities. The presence of the observed risk factors should elicit the suspicion of a macrosomic fetus and the need for appropriate management to reduce maternal and fetal morbidities.
PubMed | University of Maryland Baltimore County, National Hospital Abuja, Mother and Child Hospital, University Of Abuja and 2 more.
Type: Journal Article | Journal: BMJ open | Year: 2016
To explore the barriers to cervical cancer screening, focusing on religious and cultural factors, in order to inform group-specific interventions that may improve uptake of cervical cancer screening programmes.We conducted four focus group discussions among Muslim and Christian women in Nigeria.Discussions were conducted in two hospitals, one in the South West and the other in the North Central region of Nigeria.27 Christian and 22 Muslim women over the age of 18, with no diagnosis of cancer.Most participants in the focus group discussions had heard about cervical cancer except Muslim women in the South Western region who had never heard about cervical cancer. Participants believed that wizardry, multiple sexual partners and inserting herbs into the vagina cause cervical cancer. Only one participant knew about the human papillomavirus. Among the Christian women, the majority of respondents had heard about cervical cancer screening and believed that it could be used to prevent cervical cancer. Participants mentioned religious and cultural obligations of modesty, gender of healthcare providers, fear of disclosure of results, fear of nosocomial infections, lack of awareness, discrimination at hospitals, and need for spousal approval as barriers to uptake of screening. These barriers varied by religion across the geographical regions.Barriers to cervical cancer screening vary by religious affiliations. Interventions to increase cervical cancer awareness and screening uptake in multicultural and multireligious communities need to take into consideration the varying cultural and religious beliefs in order to design and implement effective cervical cancer screening intervention programmes.
PubMed | Federal Medical Center, University of Maryland Baltimore County, Mother and Child Hospital, Garki Hospital and 3 more.
Type: | Journal: BMC women's health | Year: 2016
The burden of cervical cancer remains huge globally, more so in sub-Saharan Africa. Effectiveness of screening, rates of recurrence following treatment and factors driving these in Africans have not been sufficiently studied. The purpose of this study therefore was to investigate factors associated with recurrence of cervical intraepithelial lesions following thermo-coagulation in HIV-positive and HIV-negative Nigerian women using Visual Inspection with Acetic Acid (VIA) or Lugols Iodine (VILI) for diagnosis.A retrospective cohort study was conducted, recruiting participants from the cervical cancer see and treat program of IHVN. Data from 6 sites collected over a 4-year period was used. Inclusion criteria were: age 18years, baseline HIV status known, VIA or VILI positive and thermo-coagulation done. Logistic regression was performed to examine the proportion of women with recurrence and to examine factors associated with recurrence.Out of 177 women included in study, 67.8% (120/177) were HIV-positive and 32.2% (57/177) were HIV-negative. Recurrence occurred in 16.4% (29/177) of participants; this was 18.3% (22/120) in HIV-positive women compared to 12.3% (7/57) in HIV-negative women but this difference was not statistically significant (p-value 0.31). Women aged 30years were much less likely to develop recurrence, adjusted OR=0.34 (95% CI=0.13, 0.92). Among HIV-positive women, CD4 count <200cells/mm(3) was associated with recurrence, adjusted OR=5.47 (95 % CI=1.24, 24.18).Recurrence of VIA or VILI positive lesions after thermo-coagulation occurs in a significant proportion of women. HIV-positive women with low CD4 counts are at increased risk of recurrent lesions and may be related to immunosuppression.
Mahajan N.,Mother and Child Hospital
International Journal of Infertility and Fetal Medicine | Year: 2013
ART is proven of great help to all the infertile couples anxious to get pregnant, but is not free of side effects and complications. OHSS one of the most important complication especially in cases of PCOS. Ovarian hyperstimulation syndrome (OHSS) is a potentially fatal complication of ovarian stimulation. The incidence has been estimated at 3 to 6% for moderate and 0.1 to 2% for severe OHSS. The trigger for initiation of OHSS appears to be human chorionic gonadotropin (hCG). In conception cycles symptoms may persist longer due to endogenous hCG stimulus.Vascular endothelial growth factor (VEGF), a member of the transforming growth factor superfamily, has emerged as one of the factors most likely involved in the pathophysiology of OHSS. There are various risk factors which increases the risk of developing OHSS during the stimulation like PCOS, low body weight, previous history of OHSS, etc. Primary and secondary preventive measures are been tried to reduce the risk of developing OHSS. GnRHa trigger in patients at risk revealed that incidence OHSS was reduced or totally eliminated. Use of antagonist cycle with an agonist trigger and elective vitrification of all embryos allows us to aim for an 'OHSS Free' clinic today.
Mahajan N.,Mother and Child Hospital |
Gupta I.,Mother and Child Hospital
Journal of Human Reproductive Sciences | Year: 2011
Background: Smooth atraumatic embryo transfer is paramount for the success of in-vitro fertilization (IVF). In difficult cases, cervical canal manipulation may be required. Aim: To see if surgical correction of the cervical canal or cervical canal refashioning could improve ease of embryo transfer. Setting: Private infertility and IVF hospital. Design: Prospective study. Materials and Methods: Patients: 11 women with failed 1-3 IVF cycles with history of extremely difficult embryo transfers (ETs) despite undergoing cervical dilatation in the cycle prior to IVF. Interventions: Operative hysteroscopy using Versapoint for refashioning of the cervical canal. Main Outcome Measures: Ease of ET in the subsequent IVF cycle. Secondary outcome measure was to assess reproductive outcome. Results: Easy and atraumatic ET in the IVF cycle after procedure in 100% patients. PR was 46.5%. Conclusions: Use of Versapoint for refashioning the cervical canal can improve the quality of ET and PR.