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  • Title: Trends in utilization of obstetric care at Wesley Guild Hospital, Ilesa, Nigeria. Effects of a depressed economy.
    Author: Owa JA, Osinaike AI, Makinde OO.
    Journal: Trop Geogr Med; 1995; 47(2):86-8. PubMed ID: 8592770.
    Abstract:
    Perinatal mortality rate (PNMR) at Wesley Guild Hospital (WGH), Ilesa, Nigeria, over a ten-year period was retrospectively analysed. The main objective was to determine the trends in the utilization of obstetric care and PNMR in the face of current economic difficulties in Nigeria and to make suggestions for improvement. The average PNMR over the period was 57.8/1000 births. There was a sharp rise in PNMR in 1985 to a peak of 110/1000 in 1987 (p < 0.0001). This was associated with a decline in utilization of maternity services, probably as a result of the introduction of fees for maternity services late in 1984 and increase in economic hardship in Nigeria. Actions are needed to improve enhanced access to obstetric care for the poor. These actions include: improvement in the economic conditions of the people, emphasis on primary health care (PHC) and early referral of high-risk pregnant women to tertiary units. During 1981-1990, there were 12,925 deliveries and 68,668 mothers received prenatal care at Wesley Guild Hospital in Ilesa, Nigeria. Physicians retrospectively analyzed data on these deliveries to determine trends in the perinatal mortality rate under harsh economic conditions. Rising economic hardship in Nigeria forced the hospital to introduce fees in late 1984, after which, the number of mothers receiving prenatal care and the resultant number of deliveries at the hospital declined significantly (p 0.001). In fact, the percentage of deliveries where the mothers did not receive prenatal care increased as the total number of deliveries decreased (p 0.001). The fees and the concurrent economic hardship decreased the purchasing power of the people, thus more and more mothers could not afford to pay for prenatal care and delivery in the hospital. During the study period, there were 747 perinatal deaths for a perinatal mortality rate of 57.8/1000 total births. The rate increased from 38.7 after introduction of fees and peaked at 110.5 in 1987. Leading obstetric complications were antepartum hemorrhage, prolonged obstetric labor, preeclampsia, cord prolapse, retained second twin, severe anemia, and maternal and fetal distress. The distribution of stillbirths, early neonatal deaths, and major obstetric complications was unequal during the study period. Stillbirths accounted for more than 75% of perinatal deaths. Factors related to stillbirth included prolonged obstructed labor, antepartum hemorrhage, multiple pregnancy, and eclampsia. The two leading causes of early neonatal death were preterm delivery (low birth weight 2500 g) (62.2%) and birth asphyxia (27.7%). More than 75% of these deaths occurred within the first 48 hours of life. More than 50% of the preterm infants weighed less than 1500 g at birth. These findings reflect the adverse effect of economic hardship and of the introduction of fees on perinatal health at Wesley Guild Hospital.
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