ABSTRACT: A survey of 452 pregnant women accessing care at first level public health facilities in a local government area in southwest Nigeria was conducted to assess their perspectives on the quality of antenatal care received. Majority of the women expressed satisfaction with the level of expertise and basic technical competence of their careproviders. Less than 30% were pleased with the existing patients' referral mechanisms. At least two-thirds received as much information as desired in salient aspects of antenatal health information needs. Frequency of antenatal visits was "about the same as expected" for 93.6% of the women. The mean reported waiting time before antenatal consultation was 131.1 minutes although 106 (43.3 %) women expected to be attended within 30 minutes of arrival. Approximately two-thirds of women were unhappy about their involvement in decision-making with respect to birth planning and postpartum contraception. Compared to other elements of quality, women were least pleased with constellation of services especially sanitary facilities and number of skilled healthcare providers. On the whole, respondents expressed a high level of overall satisfaction (81.4%) with the care received. The survey indicates that antenatal women may generally express satisfaction with the quality of services despite some inconsistencies between received care and their expectations of the facilities.
African Journal of Reproductive Health 01/2009; 12(3):71-92.
ABSTRACT: Data about maternal outcomes of elective Caesarean section in low-income countries are limited.
To estimate the maternal morbidity and mortality associated with elective Caesarean delivery at a Nigerian University hospital.
Retrospective analysis of all elective Caesarean deliveries at the Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria (1990-2005). For each case of elective Caesarean delivery, four parturients who achieved non-operative vaginal delivery following spontaneous onset of labour were selected to serve as a referent group. Morbidity outcomes and mortality among women who had elective Caesarean delivery were compared with those of the referent group to estimate their comparative risks. Level of significance was put at P<0.05.
A total of 164 elective Caesarean sections were performed out of 6882 deliveries (2.4%). All morbidities were more frequent among women who had elective Caesarean section compared to those who had vaginal delivery but only peripartum blood transfusion (11.6 vs 5.6%), puerperal febrile morbidity (11.0 vs 4.7%), unplanned readmission (4.3 vs 1.4%), mean fall in haemoglobin concentration (1.5 +/- 0.6 vs 0.5 +/- 0.7 g/dL) and mean hospital stay (13.3 +/- 8.8 vs 6.2 +/- 5.4 days) showed statistically significant differences. There was one maternal death among the elective Caesarean section group, giving a maternal mortality ratio of 6.1:1000 deliveries, which was not significantly different from 3.0:1000 deliveries in the referent group.
Elective Caesarean delivery in this hospital is certainly accompanied by considerable maternal risks and should be offered to pregnant women with extreme caution. Efforts should be made to improve its safety by investigating and rectifying the factors responsible for the associated severe maternal complications.
Australian and New Zealand Journal of Obstetrics and Gynaecology 04/2007; 47(2):110-4. · 1.24 Impact Factor
ABSTRACT: To determine the frequency of near-miss (severe acute maternal morbidity) and the nature of near-miss events, and comparatively analysed near-miss morbidities and maternal deaths among pregnant women managed over a 3-year period in a Nigerian tertiary centre.
Retrospective facility-based review of cases of near-miss and maternal death which occurred between 1 January 2002 and 31 December 2004. Near-miss case definition was based on validated disease-specific criteria, comprising of five diagnostic categories: haemorrhage, hypertensive disorders in pregnancy, dystocia, infection and anaemia. The near-miss morbidities were compared with maternal deaths with respect to demographic features and disease profiles. Mortality indices were determined for various disease processes to appreciate the standard of care provided for life-threatening obstetric conditions. The maternal death to near-miss ratios for the three years were compared to assess the trend in the quality of obstetric care.
There were 1501 deliveries, 211 near-miss cases and 44 maternal deaths. The total near-miss events were 242 with a decreasing trend from 2002 to 2004. Demographic features of cases of near-miss and maternal death were comparable. Besides infectious morbidity, the categories of complications responsible for near-misses and maternal deaths followed the same order of decreasing frequency. Hypertensive disorders in pregnancy and haemorrhage were responsible for 61.1% of near-miss cases and 50.0% of maternal deaths. More women died after developing severe morbidity due to uterine rupture and infection, with mortality indices of 37.5% and 28.6%, respectively. Early pregnancy complications and antepartum haemorrhage had the lowest mortality indices. Majority of the cases of near-miss (82.5%) and maternal death (88.6%) were unbooked for antenatal care and delivery in this hospital. Maternal mortality ratio for the period was 2931.4 per 100,000 deliveries. The overall maternal death to near-miss ratio was 1: 4.8 and this remained relatively constant over the 3-year period.
The quality of care received by critically ill obstetric patients in this centre is suboptimal with no evident changes between 2002 and 2004. Reduction of the present maternal mortality ratio may best be achieved by developing evidence-based protocols and improving the resources for managing severe morbidities due to hypertension and haemorrhage especially in critically ill unbooked patients. Tertiary care hospitals in Nigeria could also benefit from evaluation of their standard of obstetric care by including near-miss investigations in their maternal death enquiries.
Reproductive Health 12/2005; 2:9.