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BackgroundMedical cannabis (MC) has been hypothesized as an alternative therapy for migraines, given the undesirable side effects of current migraine medications. The objective of this review was to assess the effectiveness and safety of MC in the treatment of migraine in adults.MethodsWe searched PubMed, EMBASE, PsycINFO, CINAHL, and Web of Science for eligible studies in adults aged 18 years and older. Two reviewers independently screened studies for eligibility. A narrative synthesis of the included studies was conducted.ResultsA total of 12 publications involving 1,980 participants in Italy and the United States of America were included.Medical cannabis significantly reduced nausea and vomiting associated with migraine attacks after 6 months of use. Also, MC reduced the number of days of migraine after 30 days, and the frequency of migraine headaches per month. MC was 51% more effective in reducing migraines than non-cannabis products. Compared to amitriptyline, MC aborted migraine headaches in some (11.6%) users and reduced migraine frequency. While the use of MC for migraines was associated with the occurrence of medication overuse headaches (MOH), and the adverse events were mostly mild and occurred in 43.75% of patients who used oral cannabinoid preparations.ConclusionsThere is promising evidence that MC may have a beneficial effect on the onset and duration of migraine headaches in adults. However, well-designed experimental studies that assess MC's effectiveness and safety for treating migraine in adults are needed to support this hypothesis.

ObjectivesTo describe changes in public risk perception and risky behaviours during the first wave (W1) and second wave (W2) of COVID-19 in Nigeria, associated factors and observed trend of the outbreak.DesignA secondary data analysis of cross-sectional telephone-based surveys conducted during the W1 and W2 of COVID-19 in Nigeria.SettingNigeria.ParticipantsData from participants randomly selected from all states in Nigeria.Primary outcomeRisk perception for COVID-19 infection categorised as risk perceived and risk not perceived.Secondary outcomeCompliance to public health and social measures (PHSMs) categorised as compliant; non-compliant and indifferent.AnalysisComparison of frequencies during both waves using χ2 statistic to test for associations. Univariate and multivariate logistic regression analyses helped estimate the unadjusted and adjusted odds of risk perception of oneself contracting COVID-19. Level of statistical significance was set at pResultsTriangulated datasets had a total of 6401 respondents, majority (49.5%) aged 25–35 years. Overall, 55.4% and 56.1% perceived themselves to be at risk of COVID-19 infection during the W1 and W2, respectively. A higher proportion of males than females perceived themselves to be at risk during the W1 (60.3% vs 50.3%, pConclusionRisk communication and community engagement geared towards increasing risk perception of COVID-19 should be implemented, particularly among the identified population groups. This could increase adherence to PHSMs and potentially reduce the burden of COVID-19 in Nigeria.

BackgroundThe in-service training of frontline health workers (FHWs) in primary health care facilities plays an important role in improving the standard of health care delivery. However, it is often expensive and requires FHWs to leave their posts in rural areas to attend courses in urban centers. This study reports the implementation of a digital health tool for providing video training (VTR) on maternal, newborn, and child health (MNCH) care to provide in-service training at scale without interrupting health services. The VTR intervention was supported by satellite communications technology and existing 3G mobile networks.ObjectiveThis study aims to determine the feasibility and acceptability of these digital health tools and their potential effectiveness in improving clinical knowledge, attitudes, and practices related to MNCH care.MethodsA mixed methods design, including an uncontrolled pre- and postquantitative evaluation, was adopted. From October 2017 to May 2018, a VTR mobile intervention was delivered to FHWs in 3 states of Nigeria. We examined changes in workers’ knowledge and confidence in delivering MNCH services through a pre- and posttest survey. Stakeholders’ experiences with the intervention were explored through semistructured interviews that drew on the technology acceptance model to frame contextual factors that shaped the intervention’s acceptability and usability in the work environment.ResultsIn total, 328 FHWs completed both pre- and posttests. FHWs achieved a mean pretest score of 51% (95% CI 48%-54%) and mean posttest score of 69% (95% CI 66%-72%), reflecting, after adjusting for key covariates, a mean increase between the pre- and posttest of 17 percentage points (95% CI 15-19; PConclusionsThis study found that VTR supported through a digital technology approach is a feasible and acceptable approach for supporting improvements in clinical knowledge, attitudes, and reported practices in MNCH. The determinants of technology acceptance included ease of use, perceived usefulness, access to technology and training contents, and the cost-effectiveness of VTR, whereas barriers to the adoption of VTR were poor electricity supply, poor internet connection, and FHWs’ workload. The evaluation also identified the mechanisms of the impact of delivering VTR Mobile at scale on the micro (individual), meso (organizational), and macro (policy) levels of the health system. Future research is required to explore the translation of this digital health approach for the VTR of FHWs and its impact across low-resource settings to ameliorate the financial and time costs of training and support high-quality MNCH care delivery.Trial RegistrationISRCTN Registry 32105372; https://www.isrctn.com/ISRCTN32105372

Objectives To identify and synthesise prevailing definitions and indices of vulnerability in maternal, new-born and child health (MNCH) research and health programs in low- and middle-income countries. Design and setting Scoping review using Arksey and O’Malley’s framework and a Delphi survey for consensus building. Participants Mothers, new-borns, and children living in low- and middle-income countries were selected as participants. Outcomes Vulnerability as defined by the authors was deduced from the studies. Results A total of 61 studies were included in this scoping review. Of this, 22 were publications on vulnerability in the context of maternal health and 40 were on new-born and child health. Definitions used in included studies can be broadly categorised into three domains: biological, socioeconomic, and environmental. Eleven studies defined vulnerability in the context of maternal health, five reported on the scales used to measure vulnerability in maternal health and only one study used a validated scale. Of the 40 included studies on vulnerability in child health, 19 defined vulnerability in the context of new-born and/or child health, 15 reported on the scales used to measure vulnerability in child health and nine reported on childhood vulnerability indices. As it was difficult to synthesise the definitions, their keywords were extracted to generate new candidate definitions for vulnerability in MNCH. Conclusion Included studies paid greater attention to new-born/ child vulnerability than maternal vulnerability, with authors defining the terms differently. A definition which helps in improving the description of vulnerability in MNCH across various programs and researchers was arrived at. This will further help in streamlining research and interventions which can influence the design of high impact MNCH programs. Scoping review registration The protocol for this review was registered in the open science framework at the registered address (https://osf.io/jt6nr).

Background Intermittent preventive treatment (IPT) with sulphadoxine-pyrimethamine (SP) is recommended for preventing maternal and fetal effects of malaria in pregnancy. Increasing parasite resistance to SP has necessitated the search for an alternative medication. Objective To compare dihydroartemisinin-piperaquine (DP) and sulphadoxine-pyrimethamine in preventing malaria during pregnancy. Search strategy Databases including CENTRAL, MEDLINE, and ICTRP were searched until August 2018. Selection criteria Randomized and quasi-randomized controlled trials that compared DP with SP given to pregnant women to prevent adverse maternal or fetal effects of malaria were included. Data collection and analysis Quality of evidence was determined with GRADE criteria. Effectiveness measures were calculated using odds ratios at 95% confidence intervals. Results Three randomized controlled trials were included. Compared with IPT-SP, moderate certainty evidence indicated that women who received IPT-DP had significantly lower risks of clinical malaria during pregnancy. High certainty evidence showed intermittent screening and treatment with DP did not reduce placental malaria or maternal parasitemia at delivery. Effect of DP on low birth weight and adverse birth outcomes was minimal. Conclusions Moderate certainty evidence suggests that IPT-DP may reduce maternal and placental malaria compared with IPT-SP, and monthly DP is more effective than SP in reducing placental malaria. Prospero id CRD42018084651.

Background: Strengthening health systems to improve access to maternity services remains challenging for Nigeria due partly to weak and irregular in-service training and deficient data management. This paper reports the implementation of digital health tools for video training (VTR) of health workers and digitization of health data at scale, supported by satellite communications (SatCom) technology and existing 3G mobile networks.Objective: To understand whether, and under what circumstances using digital interventions to extend maternal, newborn and child health (MNCH) services to remote areas of Nigeria improved standards of healthcare delivery.Methods: From March 2017 to March 2019, VTR and data digitization interventions were delivered in 126 facilities across three states of Nigeria. Data collection combined documents review with 294 semi-structured interviews of stakeholders across four phases (baseline, midline, endline, and 12-months post-project closedown) to assess acceptability and impacts of digital interventions. Data was analyzed using a framework approach, drawing on a modified Technology Acceptance Model to identify factors that shaped technology adoption and use.Results: Analysis of documents and interview transcripts revealed that a supportive policy environment, and track record of private-public partnerships facilitated adoption of technology. The determinants of technology acceptance among health workers included ease of use, perceived usefulness, and prior familiarity with technology. Perceptions of impact suggested that at the micro (individual) level, repeated engagement with clinical videos increased staff knowledge, motivation and confidence to perform healthcare roles. At meso (organizational) level, better-trained staff felt supported and empowered to provide respectful healthcare and improved management of obstetric complications, triggering increased use of MNCH services. The macro level saw greater use of reliable and accurate data for policymaking.Conclusions: Simultaneous and sustained implementation of VTR and data digitization at scale enabled through SatCom and 3G mobile networks are feasible approaches for supporting improvements in staff confidence and motivation and reported MNCH practices. By identifying mechanisms of impact of digital interventions on micro, meso, and macro levels of the health system, the study extends the evidence base for effectiveness of digital health and theoretical underpinnings to guide further technology use for improving MNCH services in low resource settings.Trial Registration: ISRCTN32105372.

Objective: To assess the effect of emergency transportation interventions on the outcome of labor and delivery in low- and middle-income countries (LMICs). Methods: Eleven databases were searched through December 2019: Medline/PubMed, EMBASE, Web of Science, EBSCO (PsycINFO and CINAHL), SCIELO, LILACS, JSTOR, POPLINE, Google Scholar, the Cochrane Pregnancy and Childbirth Group’s Specialized Register, and the Cochrane Central Register of Controlled Trials. Methodological quality of included studies was assessed using the ROBINS-I tool. Results: Nine studies (three in Asia and six in Africa) were included: one cluster randomized controlled trial, three controlled before-and-after (CBA) studies, four uncontrolled before and after studies, and one case-control study. The means of emergency obstetric transportation evaluated by the studies included bicycle (n = 1) or motorcycle ambulances (n = 3), 4-wheel drive vehicles (n = 3), and formal motor-vehicle ambulances (n = 2). Transportation support was offered within multi-component interventions including financial incentives (n = 1), improved communication (n = 7), and community mobilization (n = 2). Two controlled before-and-after studies that implemented interventions including financial support, three-wheeled motorcycles, and use of mobile phones reported reduction of maternal mortality. One cluster-randomized study which involved community mobilization and strengthening of referral, and transportation, and one controlled before-and-after that implemented free-of-charge, 24-hour, 4 × 4 wheel ambulance and a mobile phone showed reductions in stillbirth, perinatal, and neonatal mortality. Six studies reported increases in facility delivery ranging from 12–50%, and one study showed a 19% reduction in home delivery. There was a significant increase of caesarian sections in two studies; use of motorcycle ambulances compared to car ambulance resulted in reduction in referral delay by 2 to 4.5 hours. Only three included studies had low risk of bias on all domains. Conclusion: Integrating emergency obstetric transportation with complimentary maternal health interventions may reduce adverse pregnancy outcomes and increase access to skilled obstetric services for women in LMICs. The strength of evidence is limited by the paucity of high-quality studies.

The global threat which continues to accompany SARS‐CoV‐2 has led to a global response which adopts lockdown and stays home policy as means of curtailing its spread. This study investigates compliance with the Stay Home policy and exposure to COVID‐19 in Nigeria. A survey was conducted from April 4 to May 8, 2020 using a cross‐sectional mixed‐methods approach to elicit responses from 879 participants across six geopolitical zones of Nigeria. Descriptive, χ 2, and multiple regression tests were used to analyze survey data using SPSS, whereas NVivo v12 was used for thematic analysis of qualitative data. States with complete lockdown had 72.4% of respondents complying fully with the policy compared with 44.2% of respondents in zones with the partial lockdown. Market places, classified as high‐risk zones, were the most visited (n = 505; 71.0%). Though compliance was influenced by the nature of lockdown enforced (χ 2 = 70.385, df = 2; p, Key Points Exposure to risk of COVID‐19 infection was conditioned by social and economic realities.The nature of lockdown (partial or complete) influenced compliance with stay Home Policy.Visits among family members was higher in areas with complete lockdown compared to area with partial lockdown.Places classified as high‐risk zones (market and religious centres) were the most patronised.Fear, anxiety and misperception play significant roles in compliance with Stay Home Policy.

Highlights • Nine studies intervened on vaccination in racial/ethnic and sexual and gender minorities. • Education and reminders increased HPV vaccine series initiation and completion. • Lack of high-quality, adequately powered studies warrants further investigation., Minority youth represent a unique population for public health interventions given the social, economic, and cultural barriers they often face in accessing health services. Interventions to increase uptake of Human Papillomavirus (HPV) vaccination in minority youth have the potential to reduce disparities in HPV infection and HPV-related cancers. This systematic review assesses the effectiveness of interventions to increase HPV vaccine uptake, measured as vaccine series initiation and series completion, among adolescents and young adults, aged 9–26 years old, identifying as a racial and ethnic minority or sexual and gender minority (SGM) group in high-income countries. Of the 3013 citations produced by a systematic search of three electronic databases (PubMed, Embase, and Web of Science) in November 2018, nine studies involving 9749 participants were selected for inclusion. All studies were conducted in the United States and were published from 2015 to 2018. Interventions utilized education, vaccine appointment reminders, and negotiated interviewing to increase vaccination. Participants were Black or African American (44.4%), Asian (33.3%), Hispanic or Latinx (22.2%), American Indian or Alaska Native (11.1%), and SGM (22.2%). Studies enrolled parent–child dyads (33.3%), parents alone (11.1%), and youth alone (55.6%). Vaccine series initiation ranged from 11.1% to 84% and series completion ranged from 5.6% to 74.2% post-intervention. Educational and appointment reminder interventions may improve HPV vaccine series initiation and completion in minority youth in the U.S. Given the lack of high quality, adequately powered studies, further research is warranted to identify effective strategies for improving HPV vaccine uptake for minority populations.

BACKGROUND: Advance community distribution of misoprostol for preventing or treating postpartum haemorrhage (PPH) has become an attractive strategy to expand uterotonic coverage to places where conventional uterotonic use is not feasible. However, the value and safety of this strategy remain contentious. This is an update of a Cochrane Review first published in 2012. OBJECTIVES: To assess the effectiveness and safety of the strategy of advance misoprostol distribution to pregnant women for the prevention or treatment of PPH in non‐facility births. SEARCH METHODS: For this update, we searched the Cochrane Pregnancy and Childbirth Trial Register, ClinicalTrials.gov, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (19 December 2019), and reference lists of retrieved studies. SELECTION CRITERIA: We included randomised, cluster‐randomised or quasi‐randomised controlled trials of advance misoprostol distribution to pregnant women compared with usual (or standard) care for the prevention or treatment of PPH in non‐facility births. We excluded studies without any form of random design and those that were available in abstract form only. DATA COLLECTION AND ANALYSIS: At least two review authors independently assessed trials for inclusion, extracted data and assessed the risk of bias in included studies. Two review authors independently assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS: Two studies conducted in rural Uganda met the inclusion criteria for this review. One was a stepped‐wedge cluster‐randomised trial (involving 2466 women) which assessed the effectiveness and safety of misoprostol distribution to pregnant women compared with standard care for PPH prevention during non‐facility births. The other study (involving 748 women) was a pilot individually randomised placebo‐controlled trial which assessed the logistics and feasibility of community antenatal distribution of misoprostol, as well as the effectiveness and safety of self‐administration of misoprostol for PPH prevention. Only 271 (11%) of women in the cluster‐randomised trial and 299 (40%) of the women in the individually randomised trial had non‐facility births. Data from the two studies could not be meta‐analysed as the data available from the stepped‐wedge trial were not adjusted for the study design. Therefore, the analysed effects of advance misoprostol distribution on PPH prevention largely reflect the findings of the placebo‐controlled trial. Neither of the included studies addressed advance misoprostol distribution for the treatment of PPH. Primary outcomes Severe PPH was not reported in the studies. In both the intervention and standard care arms of the two studies, no cases of severe maternal morbidity or death were recorded among women who had a non‐facility birth. Secondary outcomes Compared with standard care, it is uncertain whether advance misoprostol distribution has any effect on blood transfusion (no events, 1 study, 299 women), the number of women not using misoprostol (2% in the advance distribution group versus 4% in the usual care group; risk ratio (RR) 0.50, 95% confidence interval (CI) 0.13 to 1.95, 1 study, 299 women), the number of women not using misoprostol correctly (RR 4.86, 95% CI 0.24 to 100.46, 1 study, 290 women), inappropriate use of misoprostol (RR 4.97, 95% CI 0.24 to 102.59, 1 study, 299 women) or maternal transfer or referral to a health facility (RR 0.66, 95% CI 0.11 to 3.91, 1 study, 299 women). Compared with standard care, it is uncertain whether advance misoprostol provision increases the number of women experiencing minor adverse effects: shivering/chills (RR 1.84, CI 95% 1.35 to 2.50, 1 study, 299 women), fever (RR 1.87, 95% CI 1.16 to 3.00, 1 study, 299 women), or diarrhoea (RR 3.92, 95% CI 0.44 to 34.64, 1 study, 299 women); major adverse effects: placenta retention (RR 1.49, 95% CI 0.25 to 8.79, 1 study, 299 women) or hospital admission for longer than 24 hours (RR 0.99, 95% CI 0.66 to 15.73, 1 study, 299 women) after non‐facility birth. For all the outcomes included in the 'Summary of findings' table, we assessed the certainty of the evidence as very low, according to GRADE criteria. AUTHORS' CONCLUSIONS: Whilst it might be considered reasonable and feasible to provide advance misoprostol to pregnant women where there are no suitable alternative options for the prevention or treatment of PPH, the evidence on the benefits and harms of this approach remains uncertain. Expansion of uterotonic coverage through this strategy should be cautiously implemented either in the context of rigorous research or with targeted monitoring and evaluation of its impact.

Background Medical cannabis (MC) is currently being used as an adjunct to opiates given its analgesic effects and potential to reduce opiate addiction. This review assessed if MC used in combination with opioids to treat non-cancer chronic pain would reduce opioid dosage. Methods Four databases—Ovid (Medline), Psyc-INFO, PubMed, Web of Science, and grey literature—were searched to identify original research that assessed the effects of MC on non-cancer chronic pain in humans. Study eligibility included randomized controlled trials, controlled before-and-after studies, cohort studies, cross-sectional studies, and case reports. All databases were searched for articles published from inception to October 31, 2019. Cochrane’s ROBINS-I tool and the AXIS tool were used for risk of bias assessment. PRISMA guidelines were followed in reporting the systematic review. Results Nine studies involving 7222 participants were included. There was a 64–75% reduction in opioid dosage when used in combination with MC. Use of MC for opioid substitution was reported by 32–59.3% of patients with non-cancer chronic pain. One study reported a slight decrease in mean hospital admissions in the past calendar year (P = .53) and decreased mean emergency department visits in the past calendar year (P = .39) for patients who received MC as an adjunct to opioids in the treatment of non-cancer chronic pain compared to those who did not receive MC. All included studies had high risk of bias, which was mainly due to their methods. Conclusions While this review indicated the likelihood of reducing opioid dosage when used in combination with MC, we cannot make a causal inference. Although medical cannabis’ recognized analgesic properties make it a viable option to achieve opioid dosage reduction, the evidence from this review cannot be relied upon to promote MC as an adjunct to opioids in treating non-cancer chronic pain. More so, the optimal MC dosage to achieve opioid dosage reduction remains unknown. Therefore, more research is needed to elucidate whether MC used in combination with opioids in the treatment of non-cancer chronic pain is associated with health consequences that are yet unknown. Systematic review registration This systematic review was not registered.

Background Supportive psychotherapy, in individual or group settings, may help improve surgical outcomes for women and girls living with female genital mutilation (FGM). Objectives To assess whether supportive psychotherapy given alongside surgical procedures to correct complications of FGM improves clinical outcomes. Search strategy We searched major databases including CENTRAL, Medline, African Index Medicus, SCOPUS, PsycINFO, and others. There were no language restrictions. We checked the reference lists of retrieved studies for additional reports of relevant studies. Selection criteria We included studies of girls and women living with any type of FGM who received supportive psychotherapy or client education sessions alongside any surgical procedure to correct health complications from FGM. Data collection and analysis Two team members independently screened studies for eligibility. Main results There were no eligible studies identified. Conclusions There is no direct evidence for the benefits or harms of supportive psychotherapy alongside surgical procedures for women and girls living with FGM. Research evidence is urgently needed to guide clinical practice. PROSPERO registration 42015024639.

BACKGROUND: In many low- and middle-income countries, data on the prevalence of surgical diseases have been derived primarily from hospital-based studies, which may lead to an underestimation of disease burden within the community. Community-based prevalence studies may provide better estimates of surgical need to enable proper resource allocation and prioritization of needs. This study aims to assess the prevalence of common surgical conditions among children in a diverse rural and urban population in Nigeria.METHODS: Descriptive cross-sectional, community-based study to determine the prevalence of congenital and acquired surgical conditions among children in a diverse rural-urban area of Nigeria was conducted. Households, defined as one or more persons 'who eat from the same pot' or slept under the same roof the night before the interview, were randomized for inclusion in the study. Data was collected using an adapted and modified version of the interviewer-administered questionnaire-Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey tool and analysed using the REDCap web-based analytic application.MAIN RESULTS: Eight-hundred-and-fifty-six households were surveyed, comprising 1,883 children. Eighty-one conditions were identified, the most common being umbilical hernias (20), inguinal hernias (13), and wound injuries to the extremities (9). The prevalence per 10,000 children was 85 for umbilical hernias (95% CI: 47, 123), and 61 for inguinal hernias (95% CI: 34, 88). The prevalence of hydroceles and undescended testes was comparable at 22 and 26 per 10,000 children, respectively. Children with surgical conditions had similar sociodemographic characteristics to healthy children in the study population.CONCLUSION: The most common congenital surgical conditions in our setting were umbilical hernias, while injuries were the most common acquired conditions. From our study, it is estimated that there will be about 2.9 million children with surgically correctable conditions in the nation. This suggests an acute need for training more paediatric surgeons.

IntroductioneHealth solutions that use internet and related technologies to deliver and enhance health services and information are emerging as novel approaches to support healthcare delivery in sub-Saharan Africa. Using digital technology in this way can support cost-effectiveness of care delivery and extend the reach of services to remote locations. Despite the burgeoning literature on eHealth approaches, little is known about the effectiveness of eHealth tools for improving the quality and efficiency of health systems functions or client outcomes in resource-limited countries. eHealth tools including satellite communications are currently being implemented at scale, to extend health services to rural areas of Nigeria, in Ondo and Kano States and the Federal Capital Territory. This paper shares the protocol for a 2-year project (‘EXTEND’) that aims to evaluate the impact of eHealth tools on health system functions and health outcomes.Methodology and analysisThis multisite, mixed-method evaluation includes a non-randomised, cluster trial design. The study comprises three phases—baseline, midline and endline evaluations—that involve: (1) process evaluation of video training and digitisation of health data interventions; (2) evaluation of contextual influences on the implementation of interventions; and (3) impact evaluation of results of the project. A convergent mixed-method model will be adopted to allow integration of quantitative and qualitative findings to achieve study objectives. Multiple quantitative and qualitative datasets will be repeatedly analysed and triangulated to facilitate better understanding of impact of eHealth tools on health worker knowledge, quality and efficiency of health systems and client outcomes.Ethics and disseminationEthics approvals were obtained from the University of Leeds and three States’ Ministries of Health in Nigeria. All data collected for this study will be anonymised and reports will not contain information that could identify respondents. Study findings will be presented to Ministries of Health at scientific conferences and published in peer-reviewed journals.Trial registration numberISRCTN32105372; Pre-results.

Objective: This was to determine the serum lipid profile of preeclamptic women and their association with severity of preeclampsia.Methods: This was a case control study conducted at the Lagos Univ...

Objective To investigate life-threatening maternal complications related to hypertensive disorders of pregnancy (HDP) in Nigerian public tertiary hospitals. Design Secondary analysis of a nationwide cross-sectional study. Setting Forty-two tertiary hospitals. Population Women admitted for pregnancy, childbirth or puerperal complications. Method All cases of severe maternal outcome (SMO: maternal near-miss or maternal death) due to HDP were prospectively identified using the WHO criteria over a 1-year period. Main outcome measures Incidence of SMO, health service events, case fatality rate, and mortality index (% of maternal death/SMO). Results Out of 100 107 admissions for maternal complications, 6753 (6.8%) women had HDP. Pre-eclampsia (PE) (54.5%) and eclampsia (E) (30.4%) were the most common HDP recorded. SMO occurred in 587 women with HDP: 298 maternal near-misses and 289 maternal deaths. The majority (93%) of the women with SMO due to HDP were admitted in a critical condition. The median diagnosis-definitive intervention interval was over 4 hours in a quarter of women who died from HDP. For PE and E, case fatality rates were 1.9 and 10.4%, respectively, although both conditions had a similar mortality index of 49.3%. Lack of antenatal care and place of residence further than 5 km from the hospital were associated with maternal death. Conclusions Severe maternal outcomes from HDP were due to late presentations and health system challenges. To reduce maternal deaths from HDP, health system strengthening that would engender early hospital presentation and prompt treatment is recommended. Funding The original research that generated the data for this secondary analysis was funded by the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a co-sponsored programme executed by the World Health Organization (WHO). We have no other funding issue to declare for our study. Tweetable abstract Eclampsia is the leading cause of maternal death in Nigerian hospitals.

Background Deinfibulation is a surgical procedure carried out to re-open the vaginal introitus of women living with type III female genital mutilation (FGM). Objectives To assess the impact of deinfibulation on gynecologic or obstetric outcomes by comparing women who were deinfibulated with women with type III FGM or women without FGM. Search strategy Major databases including CENTRAL, MEDLINE, and Scopus were searched until August 2015. Selection criteria We included nonrandomized studies that compared obstetric outcomes of women with deinfibulation, type III FGM (not deinfibulated during labor), and no FGM. Data collection and analysis Quality of evidence was determined following the GRADE methodology. Summary measures were calculated using odds ratios at 95% confidence intervals. Results We found no randomized controlled trials. We included four case–control studies. The quality of evidence was very low. Compared with women with type III FGM at delivery, deinfibulated women had a significant reduction in the risk of having a cesarean delivery or postpartum hemorrhage. Compared with women without FGM, deinfibulated women had a similar risk of episiotomy, cesarean delivery, vaginal lacerations, postpartum hemorrhage, and blood loss at vaginal delivery. The length of second stage of labor, mean maternal hospital stay, and Apgar scores less than 7 were also comparable. Conclusions Low-quality evidence suggests deinfibulation improves birth outcomes for women with type III FGM. PROSPERO registration CRD42015024466.

Background There remains no consensus on the best timing of deinfibulation in women with type III female genital mutilation (FGM). Objectives To conduct a systematic review of the effects of antepartum or intrapartum deinfibulation on childbirth outcomes in women with type III FGM. Search strategy The following major databases were searched: Cochrane Central Register for Controlled Trials (CENTRAL), MEDLINE, Scopus, Web of Science, and ClinicalTrials.gov, from inception until August 2015 without any language restrictions. Selection criteria Studies of pregnant women or girls with type III FGM who were deinfibulated antepartum or intrapartum were included. Data collection and analysis Two team members independently screened and collected data. Quality of evidence was assessed using GRADE. Summary odds ratios and proportions were calculated when possible. Results There is no evidence of a significant difference between antepartum and intrapartum deinfibulation for obstetric outcomes such as duration of labor, perineal lacerations, episiotomies, postpartum hemorrhage, and cesarean deliveries. Outcomes in women living with type III FGM and those who have undergone deinfibulation were not statistically different; however, trends show a benefit for deinfibulation. All studies were underpowered to detect statistical differences. Conclusion Larger studies are required to have full confidence in these findings. PROSPERO registration CRD42015024464.

Clinical practice guidelines have been developed by professional societies globally. Each guideline although based on published scientific evidence reflected each country’s socioeconomic peculiarities and unique medical environment. The Society of Obstetrics and Gynaecology of Nigerian has published guidelines in other clinical areas; however, this is the first edition of practice guidelines for the prevention of cervical cancer. The Guidelines Committee was established in 2015 and decided to develop the first edition of this guideline following Delphi pool conducted among members which selected cervical cancer prevention as the subject that guideline is urgently needed. These guidelines cover strategies for cervical cancer prevention, screening, and management of test results. The committee developed the draft guideline during a 2‑day workshop with technical input from Cochrane Nigeria and Dr. Chris Maske, Lancet Laboratories, South Africa. The recommendations for each specific area were developed by the consensus, and they are summarized here, along with the details. The objective of these practice guidelines is to establish standard policies on issues in clinical practice related to the prevention of cervical cancer.Keywords: Cervical cancer; guideline; management; prevention; screening; Society of Obstetrics and Gynecology of Nigerian

This was to determine the sero-prevalence of hepatitis C viral (HCV) antibodies in pregnant women attending the first antenatal clinic and assess the epidemiologic correlates of women anti-HCV positive. This was a prospective observational study which used in vitro diagnostic test kits to detect anti-HCV antibodies. Women attending their first antenatal clinic were recruited at the antenatal clinic of Irrua Specialist Teaching Hospital, Edo State, Nigeria. Seropositive women had liver enzymes assessed, and screening for hepatitis B surface antigen and Human Immuno-deficiency Virus (HIV) was done. Eight out of 205 women were anti-HCV positive. The prevalence of hepatitis C infection was 3.9 %. The mean age of the women was 28.9 ± 2.1 years. Most (50 %) anti-HCV positive women had tertiary level education. Though health workers made up 3.5 % of the participants, they constituted 25 % women with anti-HCV antibody. Awareness of HCV infection had no impact on the rate of infection. Multiple sexual partners (P = 0.71), blood transfusion (0.64) and female circumcision (P = 1.00) were not significant risks of infection. 2 (1 %) women had hepatitis B co-infection and 1 (12.5 %) woman had both HCV antibody and HIV co-infection. Despite the 3.9 % prevalence, routine screening for hepatitis C virus infection in pregnancy is unjustified. Risk-based screening using locally prevailing risk factors with antenatal monitoring and postpartum treatment of women with hepatitis C antibodies is recommended.

To assess the maternal mortality ratio (MMR) from data collected as maternal deaths occurred over a 4-year period.A Departmental database established in 2008 was used to keep data on deliveries and maternal deaths as they occurred. The causes of death were decided after a meeting reviewed the case. Analysis was done using Microsoft Excel software and results presented in means and frequencies.Eight thousand two hundred and twenty live deliveries that occurred were complicated by 68 maternal deaths. The MMR was 827/100 000 live births. The MMR for unbooked women was four times higher than for booked women. Obstetric haemorrhage was the main (21.6%) direct cause of death followed by preeclampsia/eclampsia (18.9%). While anaemia was the leading (8.1%) indirect cause of death, tetanus in the puerperium reared its head as an emerging (5.4%) indirect cause of maternal death. None of the women ever used contraceptives. Most deaths occurred in teenage mothers (23.5%), unbooked women (86%) and in the postpartum period (69%).The MMR was high and tetanus in puerperium emerged as an indirect cause of maternal deaths. There is a need to curb the emergence of tetanus in the puerperium as a cause of maternal death.

Uterine anomalies are generally rare and are usually asymptomatic. When present, these anomalies are implicated in complications such as recurrent miscarriages, preterm labor, malpresentation, intrauterine growth restriction, uterine rupture, and a variety of menstrual disturbances. We report a case of a pregnancy carried to term in a unicornuate uterus with an accessory horn, diagnosed intraoperatively during an emergency cesarean section with favorable outcome to the mother and baby. Keywords: Cesarean section; successful pregnancy; unicornuate uterus; uterine anomaly

We evaluated birth plans and health insurance enrolment of pregnant women at secondary health care level as a strategy for post-2015 goals.This was a cross-sectional study at two secondary health facilities in Lagos state, Nigeria. A pre-tested questionnaire was used to collect data that were analysed and results presented with frequencies. An overall estimate with 95% confidence interval was used at significant p values of less than 0.05.Five hundred and twenty-four women, with a mean age of 3 0 ± 4.1 years, participated. Most women chose hospital delivery (84%) and had plan for transportation (86.3%) during labour. Few women were well prepared for birth (9.7%) and had health insurance (10.1%). Compared with women without insurance, more health-insured women had plans for transport in labour (p = 0.1383) and identified a place of birth (p = 0.2294), but did not have as much plan for someone to accompany them in the case of an emergency (p = 0.3855) and donate blood (p = 0.5065). Few health insured women saved money for delivery (p = 0.7439).Health insured women did not have better birth plans and expanding pregnant women's access to health insurance may be an insufficient strategy to achieve post MDG 2015 goals.

Background The pharmacokinetic basis of magnesium sulphate (MgSO 4) dosing regimens for eclampsia prophylaxis and treatment is not clearly established. Objectives To review available data on clinical pharmacokinetic properties of MgSO 4 when used for women with pre‐eclampsia and/or eclampsia. Search strategy MEDLINE, EMBASE, CINAHL, POPLINE, Global Health Library and reference lists of eligible studies. Selection criteria All study types investigating pharmacokinetic properties of MgSO 4 in women with pre‐eclampsia and/or eclampsia. Data collection and analysis Two authors extracted data on basic pharmacokinetic parameters reflecting the different aspects of absorption, bioavailability, distribution and excretion of MgSO 4 according to identified dosing regimens. Main results Twenty‐eight studies investigating pharmacokinetic properties of 17 MgSO 4 regimens met our inclusion criteria. Most women (91.5%) in the studies had pre‐eclampsia. Baseline serum magnesium concentrations were consistently, Tweetable abstract Minimum effective serum magnesium concentration for eclampsia prophylaxis is lower than the generally accepted therapeutic level.

History-indicated cervical cerclage insertion is required when factors in a woman's history could predispose to spontaneous miscarriage or preterm birth. This retrospective study determined the pregnancy outcome after insertion of history-indicated cervical cerclage for at least one previous mid-trimester spontaneous abortion over a 10-year period in a low-resource setting.This was a retrospective analysis of hospital data. Data was retrieved on biosocial and obstetrics parameters and analysed. The outcome measures were recurrence of spontaneous miscarriage, preterm delivery rate and fetal salvage rate. Descriptive frequencies were used to present results. The test of statistical significance was with Yates' coefficient correlation at 95% confidence interval.Cervical cerclage rate was 7 per 1000 births. Diagnosis was clinical and cerclage was inserted at a mean gestational age of 15 ± 3.6 weeks. Hospital admission greater than five days after cerclage insertion had no statistically significant difference on preterm delivery (CI 95%; p value = 0.98). Repeat spontaneous miscarriage occurred less (5.6%) after cerclage insertion, fetal salvage rate was 75% and the preterm birth rate was 30%.The limitations of the study notwithstanding, use of history-indicated cervical cerclage in pregnancy resulted in better fetal salvage rate and reduced recurrence of spontaneous miscarriage.

Nigeria is scaling up prevention of mother-to-child transmission (PMTCT) of HIV interventions to primary health care centres (PHCs). This retrospective study of PMTCT was at two PHCs in Northwest Nigeria with the main outcome measure being HIV infection rate of exposed infants at 6 weeks of life. Of 10,289 women who had antenatal HIV test, 74 had positive results. This gave a prevalence of 0.7%. The uptake of antenatal (99.8%) and intrapartum (97.3%) tests was high at both centres. 30% of HIV infected mothers and 25% of exposed infants were lost to follow-up (LFU). Most women (85.7%) had highly active antiretroviral therapy (HAART) and vaginal delivery (98%). Perinatal mortality rate was 66/1000 births and 95.3% of exposed infants had negative HIV-DNA polymerase reaction test at 6 weeks of life. Despite a high LFU, a new vista has been opened to attaining a zero infection rate.

Detection of asymptomatic bacteriuria (ASB) in pregnancy is important to avert the attendant morbidities. Therefore, we assessed the use of chlorhexidine reaction to detect ASB in pregnancy. This was a prospective study, which compared chlorhexidine reaction with dipstick tests and urine culture in 150 asymptomatic pregnant women. Urine cultures detected bacteriuria in seven women (4.7%). Chlorhexidine detected ASB in 72 women (48%) and had sensitivity, specificity and accuracy of 100%, 54% and 56%, respectively. Leucocyte esterase (LE) and nitrite detected bacteriuria in 31 (20.7%) women and 12 (8.0%) women, respectively. Singly, LE had a sensitivity and specificity of 14.3% and 79%, respectively, while nitrite's sensitivity and specificity was 42.9% and 93.7%, respectively. Combined, LE and nitrite had better sensitivity (97.9%) and accuracy (94%). Since the accuracy of chlorhexidine is low, other than urine culture, combined dipstick urinalysis of leucocyte esterase and nitrite tests is good to detect asymptomatic bacteriuria in pregnancy.

To assess the practice of provider-initiated counseling and testing (PICT) for HIV infection by Nigerian Obstetricians and estimate missed opportunities at the gynecological and family planning clinics.Online cross-sectional survey of members of the Society of Gynaecology and Obstetrics of Nigeria (SOGON) over a 4-week period using SurveyMonkey®. Frequencies were used to present responses of participants.There were 201 (29%) respondents. Participants' mean age was 46 ± 7.2 (SD) years and majority (93.3%) held consultant positions. Most respondents (92.2%) cared for HIV-infected pregnant women with dedicated HIV counselors (77.4%), and in dedicated counseling rooms (71%). Majority (75.7%) had been trained on HIV management in pregnancy and 95.3% routinely counseled and tested women attending the booking antenatal clinic. Fourteen per cent (14%) and 16% of respondents conducted routine counseling and testing for women attending the gynecological and family planning clinics, respectively, for the first time. For every 100 women tested at the antenatal clinic, 317 women were missed at each of the two clinics.PICT of HIV infection in Nigeria has focused on pregnancy. To eliminate new HIV infections in children, PICT should be routine at the gynecological and family planning clinics.

Background Pregnant women with sickle cell disease (HbSS, HbSC and HbSβThal) may require blood transfusion to prevent severe anaemia or to manage potential medical complications. Preventive blood transfusion in the absence of complications starting from the early weeks of pregnancy or blood transfusion only for medical or obstetric indications have been used as management policies. There is currently no consensus on the blood transfusion policy that guarantees optimal clinical benefits with minimal risks for such women and their babies. This is an update of a Cochrane review that was published in 2013. Objectives To assess the benefits and harms of a policy of prophylactic versus selective blood transfusion in pregnant women with sickle cell disease. Search methods We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 May 2016) and reference lists of retrieved studies. We did not apply any language or date restrictions. Selection criteria Randomised controlled trials evaluating the effects of prophylactic versus selective (emergency) blood transfusion in pregnant women with sickle cell disease (SCD). Quasi-randomised trials and trials using a cluster-randomised design were eligible for inclusion but none were identified. Data collection and analysis Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. Two review authors independently assessed the quality of the evidence using the GRADE approach. Main results Out of six relevant reports identified by the search strategy, one trial involving 72 women with sickle cell anaemia (HbSS) met our inclusion criteria. The trial was at unclear risk of bias. Overall, there were few events for most of the reported outcomes and the results were generally imprecise. The included trial reported no maternal mortality occurring in women who received either prophylactic or selective blood transfusion. Very low-quality evidence indicated no clear differences in maternal mortality, perinatal mortality (risk ratio (RR) 2.85, 95% confidence interval (CI) 0.61 to 13.22; very low-quality evidence) or markers of severe maternal morbidity (pulmonary embolism (no events); congestive cardiac failure (RR 1.00, 95% CI 0.07 to 15.38; very low-quality evidence); acute chest syndrome (RR 0.67, 95% CI 0.12 to 3.75)) between the treatment groups (prophylactic blood transfusion versus selective blood transfusion). Low-quality evidence indicated that prophylactic blood transfusion reduced the risk of pain crisis compared with selective blood transfusion (RR 0.28, 95% CI 0.12 to 0.67, one trial, 72 women; low-quality evidence), and no differences in the occurrence of acute splenic sequestration (RR 0.33, 95% CI 0.01 to 7.92; low-quality evidence), haemolytic crises (RR 0.33, 95% CI 0.04 to 3.06) or delayed blood transfusion reaction (RR 2.00, 95% CI 0.54 to 7.39; very low-quality evidence) between the comparison groups. Other relevant maternal outcomes pre-specified for this review such as cumulative duration of hospital stay, postpartum haemorrhage and iron overload, and infant outcomes, admission to neonatal intensive care unit (NICU) and haemolytic disease of the newborn, were not reported by the trial. Authors' conclusions Evidence from one small trial of very low quality suggests that prophylactic blood transfusion to pregnant women with sickle cell anaemia (HbSS) confers no clear clinical benefits when compared with selective transfusion. Currently, there is no evidence from randomised or quasi-randomised trials to provide reliable advice on the optimal blood transfusion policy for women with other variants of sickle cell disease (i.e. HbSC and HbSβThal). The available data and quality of evidence on this subject are insufficient to advocate for a change in existing clinical practice and policy.

BACKGROUND: There is general agreement that oxytocin given either through the intravenous or intramuscular route is effective in reducing postpartum blood loss. However, it is unclear whether the subtle differences between the mode of action of these routes have any effect on maternal and infant outcomes. This review was first published in 2012 and last updated in 2018. OBJECTIVES: To determine the comparative effectiveness and safety of oxytocin administered intravenously or intramuscularly for prophylactic management of the third stage of labour after vaginal birth. SEARCH METHODS: We searched Cochrane Pregnancy and Childbirth’s Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (19 December 2019), and reference lists of retrieved studies. SELECTION CRITERIA: Eligible studies were randomised trials comparing intravenous with intramuscular oxytocin for prophylactic management of the third stage of labour after vaginal birth. We excluded quasi‐randomised trials. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed studies for inclusion and risk of bias, extracted data and checked them for accuracy. We assessed the certainty of the evidence with the GRADE approach. MAIN RESULTS: Seven trials, involving 7817 women, met the inclusion criteria for this review. The trials compared intravenous versus intramuscular administration of oxytocin just after the birth of the anterior shoulder or soon after the birth of the baby. All trials were conducted in hospital settings, mainly in middle‐ and high‐income countries, and included women with term pregnancies, undergoing a vaginal birth. Overall, the included studies were at moderate or low risk of bias, with two trials providing clear information on allocation concealment and blinding. High‐certainty evidence suggests that intravenous administration of oxytocin in the third stage of labour compared with intramuscular administration carries a lower risk for postpartum haemorrhage (PPH) ≥ 500 mL (average risk ratio (RR) 0.78, 95% confidence interval (CI) 0.66 to 0.92; six trials; 7731 women) and blood transfusion (average RR 0.44, 95% CI 0.26 to 0.77; four trials; 6684 women). Intravenous administration of oxytocin probably reduces the risk of PPH ≥ 1000 mL, although the 95% CI crosses the line of no‐effect (average RR 0.65, 95% CI 0.39 to 1.08; four trials; 6681 women; moderate‐certainty evidence). In all studies but one, there was a reduction in the risk of PPH ≥ 1000 mL with intravenous oxytocin. The study that found a large increase with intravenous administration was small (256 women), and contributed only 3% of total events. Once this small study was removed from the meta‐analysis, heterogeneity was eliminated and the treatment effect favoured intravenous oxytocin (average RR 0.61, 95% CI 0.42 to 0.88; three trials; 6425 women; high‐certainty evidence). Additionally, a sensitivity analysis, exploring the effect of risk of bias by restricting analysis to those studies rated as 'low risk of bias' for random sequence generation and allocation concealment, found that the prophylactic administration of intravenous oxytocin reduces the risk for PPH ≥ 1000 mL, compared with intramuscular oxytocin (average RR 0.64, 95% CI 0.43 to 0.94; two trials; 1512 women). There may be little to no difference between the two routes of oxytocin administration in terms of additional uterotonic use (average RR 0.78, 95% CI 0.49 to 1.25; six trials; 7327 women; low‐certainty evidence). Although intravenous compared with intramuscular administration of oxytocin probably results in a lower risk for serious maternal morbidity (e.g. hysterectomy, organ failure, coma, intensive care unit admissions), the size of the effect is uncertain as the confidence interval is wide, including a substantial reduction, but also touches the line of no‐effect (average RR 0.47, 95% CI 0.22 to 1.00; four trials; 7028 women; moderate‐certainty evidence). Most events occurred in one study from Ireland reporting high dependency unit admissions, whereas in the remaining three studies there was only one case of uvular oedema. There were no maternal deaths reported in any of the included studies (very low‐certainty evidence). There is probably little or no difference in the risk of hypotension between intravenous and intramuscular administration of oxytocin (RR 1.01, 95% CI 0.88 to 1.15; four trials; 6468 women; moderate‐certainty evidence). Subgroup analyses based on the mode of administration of intravenous oxytocin (bolus injection or infusion) versus intramuscular oxytocin did not show any evidence of substantial differences on the primary outcomes. Similarly, additional subgroup analyses based on whether oxytocin was used alone or as part of active management of the third stage of labour (AMTSL) did not show any evidence of substantial differences between the two routes of administration. AUTHORS' CONCLUSIONS: Intravenous administration of oxytocin is more effective than its intramuscular administration in preventing PPH during vaginal birth. Intravenous oxytocin administration presents no evidence of additional safety concerns and has a comparable side effects profile with its intramuscular administration. Future studies should consider the acceptability, feasibility and resource use for the intervention, especially in low‐resource settings.

Objective : This qualitative study was conducted to assess and compare the attitude of teachers in two geopolitical zones of Nigeria to family life education. Methods : Multi stage sample selection was used to pick 6 public secondary schools (3 junior, 3 senior) in each zone. All teachers (221) in the selected schools were surveyed. Pre-tested questionnaires were self administered, responses analyzed and results presented using descriptive frequencies. Where appropriate statistical evaluation was done with Yates corrected Chi square at 95% confidence interval. Results : Katsina respondents were mostly Muslims (92.4%), married (64.8%) and had the National Certificate of Education (62.9%). Ekpoma teachers were mostly Christians (97.4%), married (93.1%) and 67.2% had a University degree. Attendance at a seminar on family life education was by 19% and 25.9% of respondents from Katsina and Ekpoma respectively. Teachers‘ knowledge of family life education was very good and most teachers in both regions considered it useful but there were geographical disparities in perception and attitude. While teachers in Katsina discussed HIV/AIDS twice more with their students than sexuality (54.3% vs 28%) those in Ekpoma discussed sexuality more than HIV/AIDS (80.2% vs 72.4%). Respondents in Katsina reported three times (60% vs 19.8%) more that parents would object to FLE in schools than those in Ekpoma and also that its introduction would encourage promiscuity amongst the students (53.3% vs 21.6%). While being married positively influenced respondents‘ perception, their attitude was influenced positively by having university degree and teaching at the senior secondary school. Christians significantly discussed sexuality (Chi square 58.60; RR: 3.03) and HIV/AIDS (Chi square 15.01; RR: 1.50) with students than Muslims. Conclusion :Policy makers need to be aware of the regional differences in teachers‘ attitude to family life education as this may hinder the implementation of curriculum.

Background We determined the prevalence of dysmenorrhoea and associated factors amongst undergraduates in a Nigerian university. Information on dysmenorrhoea amongst Nigerian populace is limited as it is seen as a norm and hence unreported. This is in spite of its consequences on women's socio-economic lives. Method This was a prospective questionnaire-based study. Cluster sampling technique was used and tests of statistical significance were done using Yates corrected Chi square. Results The prevalence of dysmenorrhoea in this study was 76.3%. The mean age at menarche was 13.8 years. Dysmenorrhoea occurred at menarche in 36.9% respondents. Primary and secondary dysmenorrhoea was reported by 40.6% and 16.3% respondents respectively. Fifty one point nine per cent (51.9%) had painful expectation of dysmenorrhoea. Having a sister with dysmenorrhoea did not have a statistically significant influence on expectation of dysmenorrhoea (CI 95%; P value: 0.76). Normal activity was affected by dysmenorrhoea in 35% of respondents while 68% of those with dysmenorrhoea did not seek help. Hospital admission solely for dysmenorrhoea was reported by 6.9% of respondents. Commonly associated symptoms with dysmenorrhoea were mood changes (59.4%) and pimples (53.1%). Conclusion The high proportion of women not seeking help for dysmenorrhoea in this study may reflect the attitude of the larger society to the condition. Education to improve women's knowledge of and attitude to dysmenorrhoea is recommended.

The presence of protein in hypertensive disorders of pregnancy is a sign of a worsening condition and thus requires early intervention to prevent adverse consequences. Accurate assessment of proteinuria in patients with pre-eclampsia will ensure prompt and timely intervention to reduce or prevent the maternal and perinatal morbidity and mortality associated with pre-eclampsia. This study compared the reliability and validity of the more rapid diagnostic tests, such as the dipstick, 2-h and 12-h protein estimations with the 24-h protein. The result of the dipstick, 2-h and 12-h urine were also compared with the 24-h urine results using confidence interval (CI) for proportions with a value of p < 0.05 considered significant (CI 95%). When compared with the gold standard, there was a high degree of correlation between the 2-h (p = 0.244, CI 95%) and 12-h (p < 0.0255, CI 95%) with the 24-h sample in the quantification of proteinuria in women with pre-eclampsia. The most sensitive and specific test was the 12-h protein estimation, (89%) and (93%), respectively. The least sensitive and specific test was the dipstick test; (81%) and (47%), respectively. The 12-h protein estimation test had the highest positive predictive value (84%). The 12-h protein test also had the lowest false positive rate (12%) and false negative rates (11%), respectively. The most accurate test was the 12-h protein estimation (88%). The dipstick tests were however much cheaper and the results were faster. It is recommended that routine rapid quantisation of proteinuria in patients with pre-eclampsia be done using either the 2-h or 12-h urine sample.

Background: Maternal mortality ratio of Nigeria is one of the highest globally. The delay in getting prompt and appropriate treatment in the event of a complication during pregnancy is one of the identified factors in maternal deaths. This study assessed the contribution of delay to maternal deaths and also determined the socio¬demographic characteristics of patients with maternal deaths with associated delay. Methods: This is a cross-sectional descriptive study of all maternal deaths in Irrua specialist Teaching Hospital, Nigeria between January 1999 and December 2003. Statistical analysis was done using 1 tailed Fisher's exact test. The level of significance was inferred at p< 0.05 Results: The mortality ratio in the study period is 1747/100,000 live births. Delay was associated with 77.8% of all maternal deaths. Type I delay was the major problem contributing 57.1%. Identified risk factors for delay in this study are; unbooked status, low socio¬economic status and marital status. Conclusion: The recent launch of the National Health Insurance Scheme in Nigeria may improve access to health care of patients with pregnancy complications. Better living standards with improved social infrastructures as well as retraining of health personnel are also suggested. Nigerian Journal of Medicine Vol. 16 (1) 2007: pp. 38-41