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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 6  |  Issue : 3  |  Page : 134-137

Prevalence of postpartum morbidities in a tertiary care center in Northern Nigeria


Department of Obstetrics & Gynaecology, Bayero University, Aminu Kano Teaching Hospital, Kano, Nigeria

Date of Submission13-Aug-2019
Date of Decision11-Nov-2019
Date of Acceptance02-Dec-2019
Date of Web Publication04-Feb-2020

Correspondence Address:
Dr. Usman Aliyu Umar
Consultant Obstetrician & Gynaecologist/Senior Lecturer, Department of Obstetrics & Gynaecology, Bayero University, /Aminu Kano Teaching Hospital, Kano
Nigeria
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DOI: 10.4103/ssajm.ssajm_27_19

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  Abstract 


Background: Complications can arise during the postpartum period and if unrecognized can lead to physical discomfort, psychological distress, and a poor quality of life for the mothers. The true burden of postpartum maternal morbidity is still not known. It is estimated to be highest in low- and middle-income countries. Objective: This study was aimed at determining the pattern of postpartum morbidities at Aminu Kano Teaching Hospital and their possible determinants. Methodology: It was a cross-sectional study of women admitted into postnatal ward of Aminu Kano Teaching Hospital, Kano, Nigeria, on account of postpartum morbidities from January 1to December 31, 2016. The admission register of antenatal/postnatal ward was retrieved and only women admitted within the postpartum period were included in the study. Result: There were 3933 deliveries over the studied period and 141 women were admitted for postpartum morbidities. The most common morbidities were anaemia (35.5%), hypertensive disorders (19.6%), and puerperal sepsis (19.6%). Nearly 70% of the patients were unbooked and had spontaneous vaginal delivery. There was a significant association between postpartum morbidities and booking status, level of educational, and mode of delivery. Conclusion: Anaemia, hypertension, and sepsis are the common postpartum morbidities in Kano, north-west Nigeria. Health education on the importance of quality antenatal and intrapartum care will go a long way in reducing these morbidities.

Keywords: Maternal morbidity, postpartum morbidity


How to cite this article:
Adamou N, Mohammed FL, Umar UA. Prevalence of postpartum morbidities in a tertiary care center in Northern Nigeria. Sub-Saharan Afr J Med 2019;6:134-7

How to cite this URL:
Adamou N, Mohammed FL, Umar UA. Prevalence of postpartum morbidities in a tertiary care center in Northern Nigeria. Sub-Saharan Afr J Med [serial online] 2019 [cited 2020 Dec 2];6:134-7. Available from: https://www.ssajm.org/text.asp?2019/6/3/134/277783




  Introduction Top


Maternal morbidity refers to the problems borne by women during pregnancy and the postpartum period. The Maternal Morbidity Working Group (MMWG) defined maternal morbidity as any health condition attributed to and/or aggravated by pregnancy and childbirth that has a negative impact on the woman’s wellbeing.[1] Maternal morbidity can be conceptualized as a spectrum ranging, at its most severe, from a “maternal near miss”—defined by the World Health Organization (WHO) as the near death of a woman who has survived a complication occurring during pregnancy or childbirth or within 42 days of the termination of pregnancy—to non-life-threatening morbidity, which is more common by far.[1]

The WHO defines the postpartum period or puerperium as beginning one hour after the delivery of the placenta and continuing until 6 weeks (42 days) after the birth of the infant.[2] It is a very important but the most neglected part in obstetric care.[3],[4]

Most of the postpartum maternal complications leading to maternal morbidities arise during labour and delivery and within the first 1–2 weeks of delivery.[2],[3] Major acute obstetric morbidities include haemorrhage, sepsis, and pregnancy-related hypertension. Others include post-caesarean section wound breakdown, puerperal psychosis, and mastitis. Long-term morbidities include uterine prolapse, vesicovaginal fistula, urinary incontinence, dyspareunia, and infertility.

A study conducted in Lusaka, Zambia, identified puerperal sepsis (34.8%) and malaria (14.6%) as the leading direct and indirect causes of postpartum morbidity.[5] In the United State, William et al.[6] found substantial increase in severe complications for delivery and postpartum hospitalization which was indicated by the growing rates for blood transfusions, acute renal failure, shock, acute myocardial infarction, respiratory distress syndrome, aneurysms, and cardiac surgery during delivery hospitalizations.

A study done in Jos, Nigeria, showed the most common morbidity to be postpartum haemorrhage, accounting for 35.4% of cases, followed by hypertensive disorders (24.8% of cases) and genital tract sepsis accounted for 16.7% of cases.[2] Another study done in Akwa Ibom, South Nigeria, also showed similar pattern of morbidities with postpartum haemorrhage accounting for 22.6%, genital sepsis 16.1%, and hypertensive disorders 11.8%.[3] In India, a similar study also showed similar pattern of postpartum morbidities.[7]

The true burden of postpartum maternal morbidity is still not known, but not surprisingly, is estimated to be highest in low- and middle-income countries.[1],[3],[8] In developing countries, pregnancy and complications from childbirth account for 18% of the diseases among females.[5] Every year, about 303,000 maternal deaths are recorded worldwide, 99% of which occur in developing regions with sub-Saharan Africa accounting for about 66%.[9] It has been suggested that for each maternal death, 20–30 women suffer from morbidity, acute or chronic.[1],[8],[10]

Quality health care during pregnancy in the form of antenatal care attendance and the presence of skilled attendants at delivery can reduce postpartum morbidities and prevent a lot of maternal deaths.[2],[3],[11],[12] The quality of medical care and socio-environmental factors are important determinants of maternal outcomes in life-threatening situations.[8]

There are limited data on postpartum morbidities in Nigeria especially in the northern part of the country. This study was therefore aimed at determining the patterns of maternal morbidities in Aminu Kano Teaching Hospital.


  Materials and method Top


This was a cross-sectional study of women admitted into the postnatal ward of Aminu Kano Teaching Hospital from January 1 to December 31, 2016 on account of postpartum morbidities. The admission register of antenatal/postnatal ward was retrieved and only women admitted within the postpartum period were included in the study. Their folders were retrieved from the medical records. Information regarding their age, religion, ethnicity, occupation, parity, booking status, mode of delivery, accoutre at delivery, nature of morbidity were extracted using a predesigned (designed for the study) pro forma.

Microsoft Excel 2013 was used for data entry and analysis done using SPSS version 21. Descriptive statistics were computed for relevant variables. Comparative analysis was done with the chi-square test and level of significance was set at P < 0.05. Ethical approval for the study was granted by Research and Ethics Committee of the hospital.


  Results Top


There were 3933 deliveries during the studied period and 141 women were admitted for postpartum morbidities. This gives a prevalence rate of 3.6%. 107 files were retrieved and analysed, giving a retrieval rate of 75.9%.

[Table 1] shows the sociodemographic characteristics of the study population. Majority, 43(40.2%), of the women were in the age group of 21–30 years. They were mostly Hausas, 89 (83.2%), and housewives, 90 (84.1%). Only 19 (17.8%) of the women had tertiary education. Majority were primiparous, 38 (35.5%), and grand multiparous, 38 (35.5%). Most of the pregnancies were unbooked, 74 (69.2%), and mode of delivery was mostly via spontaneous vaginal deliveries (SVD), 70 (65.5%). The pattern of postpartum morbidities is shown in [Figure 1]. The common postpartum morbidities were found to be anaemia, 38 (35.5%), hypertensive disorders, 21 (19.6%), and puerperal sepsis, 21 (19.6%).
Table 1 Sociodemographic and reproductive characteristics

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Figure 1 Pattern of post-partum morbidities

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Postpartum morbidities were found to be significantly associated with booking status (P-value = 0.031). There was a significant association between postpartum morbidities and educational status (P-value = 0.003). Those with the morbidities were mostly women with secondary education and below. Significant association exists between morbidities and delivery via SVD (P-value = 0.03). There was no association between parity and the postpartum morbidities (0.354). There was no significant association between the morbidities and accoutre. These are as shown in [Table 2].
Table 2 Factors associated with post-partum morbidities

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  Discussion Top


The result of this study shows that the majority of the patients (72%) are within the age groups 21–40 years, which is expected as this is the reproductive age group. Most of them are Hausa by tribe (83.2%), Muslims (88.8%), housewives (84.1%), and with no more than secondary school education (82.2%).This could be explained by the fact that the study area was in Northern Nigeria where customs and social conventions limit women’s exposure to Western education and most women stay at home as full term housewives.

Most of the women delivered via spontaneous vaginal delivery (SVD) rather than caesarean section. This may not be unconnected with home deliveries in unclean environment thus prone to sepsis and other complications such as PPH.

The most common postpartum morbidity was found to be anaemia occurring in 38 (35.5%) patients which was secondary to postpartum haemorrhage in nearly all the anaemic cases admitted. This was followed by hypertensive disorders and puerperal sepsis seen in 19.6% each respectively. This is similar to the studies done in Jos by Mutihir and Utoo,[2] Ile Ife by Adeoye et al.,[8] Akwa Ibom by Ekanem et al.,[3] and India reported by Iyengar et al.[7] Poor antenatal care, home delivery, and lack of skilled birth attendants at some health facilities may be the possible explanation for this finding.

Most of the morbidities occurred in primiparas and grandmultips, accounting for 71% of all morbidities compared to the multiparas, although no statistically significant association was found. In our locality, both primigravidas and grandmultiparous women have poor health seeking behaviour for both reproductive and maternal health services.

The majority (69.2%) of morbidities occurred in unbooked patients and this was statistically significant when compared with the booked antenatal clients. This is similar to study done in Ile Ife by Adeoye et al.[9] where antenatal attendance was found to protect against near miss maternal morbidities. This is anticipated since booked patients will benefit from interventions during antenatal care and are more likely going to deliver in facility with skilled birth attendants.

Surgical site infection was recorded in 8.4% of the patients. This is higher than the 4.5% recorded in Jos[2] where most of their patients were booked. Differences in hygienic status of the patients and factors such as use of prophylactic antibiotics and surgical techniques may have accounted for this. Puerperal psychosis was identified in 4.7% of our study group. This is similar to the findings by Mutihir and Utoo in Jos.[2] Both centres are tertiary referring hospital where psychiatric services are available.

Morbidities were found to be commoner in women with lower education. This was significant. Higher level of education may translate to higher socioeconomic status and hence better health seeking behaviour which will prevent serious morbidities.

Anaemia, hypertension, and sepsis are the common postpartum morbidities in Kano, north-west Nigeria. Health education on the importance of quality antenatal and intrapartum care will go a long way in reducing these morbidities.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Firoz T, Chou D, Dadelszen P, Agrawal P, Vanderkruik R, Tuncalp O et al. Measuring maternal health: focus on maternal morbidity. Bull World Health Organ 2013;91:794-6.  Back to cited text no. 1
    
2.
Mutihir JT, Utoo BT. Postpatum maternal morbidity in Jos, North-Central Nigeria. Niger J Clin Pract 2011;14:38-42.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Ekanem EI, Efiok EE, Udoh AE, Anaikot EC. Trends in postpartum maternal morbidity in Ikot Ekpene a rural community in Southern Nigeria. Open J Obstet Gynecol 2013;3:493-9.  Back to cited text no. 3
    
4.
Okeke TC, Ugwu EO, Ezenyeaku CCT, Ikeako LC, Okezie OA. Postpartum practices in parturient women in Enugu, South East Nigeria. Ann Med Health Sci Res 2013;3:47-50.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Vallely L, Ahmed Y, Murray SF. Postpartum maternal morbidity requiring hospital admission in Lusaka, Zambia − a descriptive study. BMC Pregnancy and Childbirth 2005;5:1 Available from: http://www.biomedcentral.com/1471-2393/5/  Back to cited text no. 5
    
6.
Callaghan WM, Creanga AA, Kuklina EV. Severe maternal morbidity among delivery and postpartum hospitalizations in the United States. Obstet Gynecol 2012;120:1029-36.  Back to cited text no. 6
    
7.
Iyengar K. Early postpartum maternal morbidity among rural women of Rajasthan, India: a community-based study. J Health Popul Nutr 2012;30:213-25.  Back to cited text no. 7
    
8.
Adeoye AI, Onayade AA, Fatusi AO. Incidence, determinants and perinatal outcomes of near miss maternal morbidity in Ile-Ife Nigeria: a prospective case control study. BMC Pregnancy and Childbirth 2013;13:93.  Back to cited text no. 8
    
9.
Trends in Maternal Mortality: 1990-2015: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division.  Back to cited text no. 9
    
10.
Say L, Barreix M, Chou D, Tuncalp O, Cottler S, McCaw-Binns A et al. Maternal morbidity measurement tool pilot: study protocol. Reproductive Health 2016;13:69.  Back to cited text no. 10
    
11.
World Health Organization. WHO recommendations on antenatal care for a positive pregnancy experience: executive summary. World Health Organization, 2016. http://www.who.int/iris/handle/10665/250800  Back to cited text no. 11
    
12.
Adamu YM, Salihu HM. Barriers to the use of antenatal and obstetric care services in rural Kano, Nigeria. J Obstet Gynaecol 2002;22:600-3.  Back to cited text no. 12
    


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    Tables

  [Table 1], [Table 2]



 

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