Professor Atiene Solomon Sagay - University of Jos Institutional ...

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espectively. Lack of antenatal care (Unbooked status) and illiteracy were the significant determinants of maternal mortality. When we compare these maternal mortality figures with 3/100,000 deliveries in Sweden, 4/100,000 deliveries in Spain, 5/100,000 deliveries in Switzerland and 8/100,000 deliveries in the United Kingdom (WHO 2005), they become terribly disturbing. These staggering maternal mortality figures are a reflection of the premium placed on the lives of women in this country. These women do not die of diseases that can’t be treated or complications that can’t be prevented. To quote Mahmoud Fathalla, former president of the International Federation of Obstetricians and Gynecologists, “they die because societies have yet to determine that their lives are worth saving”. Sadly, if a woman does not survive, her child has little chance of survival. Vesico-Vaginal Fistula (VVF) For every woman who dies at childbirth, 15 to 30 live but suffer chronic disabilities, the worst of which is obstetric fistula. Each year some 50,000-100,000 women sustain an obstetric fistula in the act of trying to bring forth new life. Fistula is a preventable and treatable condition, one that no woman should have to endure. Yet more than two million women remain untreated in developing countries. Obstetric fistula is the most devastating of all pregnancy-related disabilities. It usually occurs when a young, poor woman has an obstructed labour and cannot get a Caesarean section when needed. The obstruction can occur because the woman‘s pelvis is too small, the baby‘s head is too big, or the baby is badly positioned. The woman can be in labour for three days or more without medical help. The baby usually dies. If the mother survives, she is left with extensive tissue damage to her birth canal that renders her incontinent. The results are life shattering. The woman is unable to stay dry and the smell of urine or faeces is constant and humiliating. Nerve damage to her legs can also make it difficult to walk. Rather than being comforted for the loss of her child, she is often rejected by her husband, shunned by her community and blamed for her condition. Women who remain untreated not only face a life of shame and isolation, but may also face a slow, premature death from infection and kidney failure. While some women receive support from their families, others are forced to beg or turn to sex work for a living. During obstructed labour, the prolonged pressure of the baby‘s head against the mother‘s bony pelvis cuts off the blood supply to the soft tissues of her vagina, bladder and rectum that are trapped between the harder (bony) structures. The injured soft tissue soon rots away, leaving a hole, or fistula. If the hole is between the woman‘s vagina and bladder, she loses control over her urination, and if it is between her vagina and rectum, she loses control of her bowels. Reconstructive surgery can mend this injury, but most women are either unaware that treatment is available or cannot access or afford it. Fistula surgical repair has up to 90 per cent success rates and costs between N20, 000 to N60, 000. In supported VVF repair and rehabilitation centres, most services are provided free of charge. ECWA Evangel Hospital is one such centre in Jos, Nigeria. In the words of DR. ANDREW ARKUTU ―An obstetric fistula is more than a hole. For those afflicted, it is a comprehensive social and psychological disaster, resulting from a dramatic failure in obstetric care.‖ 10
The tragedy of an obstetric fistula is that it touches a young girl at the very essence of her being - her childbearing capabilities. It touches her when she is too young to understand what has happened. . . If not operated on or helped, recurrent urinary tract infections can lead to kidney problems and eventual renal failure and death. So, though the girl with obstetric fistula is a survivor of maternal mortality statistics in the first light, is she really, if she dies later, unwanted, humiliated and lonely in some remote village hut? Clinical Audit of Primary Health Centres in Jos, Nigeria In 1978 at Alma Ata, the United Nations adopted primary health care, as a global strategy for promoting health for all by the year 2000, a policy that was adopted by Nigeria in 1988. The emphasis was on preventive rather than curative medicine. The federal ministry of health through the states and local governments established Primary Health Centres (PHCs) in all local government areas in this country. One of the aims was to improve access to affordable antenatal care for pregnant women in order to achieve a substantial reduction in maternal and perinatal deaths. Despite these efforts by government, maternal and perinatal death rates did not decline. Pregnant women are frequently referred late from PHCs to tertiary institutions, resulting in adverse obstetric outcomes (Kuti et al 2001). The high proportion of avoidable maternal deaths in the maternity unit of JUTH resulting from late referrals from PHCs around Jos prompted us to conduct a clinical audit of these centres (Sagay et al 2005). The study evaluated the quality of antenatal care services in 12 randomly selected PHCs in the Jos/Bukuru metropolis. The findings indicated that: High risk obstetric cases (previous caesarean section, hypertension, and previous post partum haemorrhage) were being booked and seen at the PHCs. Over two-thirds of pregnant women receiving antenatal care at PHCs did not have blood pressure surveillance through pregnancy. Routine malaria prophylaxis during pregnancy was not given in any of the PHCs. About two-thirds of pregnant women receiving antenatal care did not have any documented attempt to ascertain the gestational age. No pregnant woman was screened for sickle cell disease (sickling test or genotype). The principal examination that almost all patients had was weighing which has been shown to have little impact on obstetric outcome. Undoubtedly, we considered antenatal care provided at the PHCs in the Jos area substandard and capable of putting the health of pregnant women at unacceptable risk. We made the following recommendations: 1. A periodic exchange of staff between primary, secondary and tertiary health institutions should be encouraged as a way of improving the knowledge base and skills of healthcare providers in these facilities. 2. Healthcare workers in PHCs should be encouraged to attend periodic update courses. 3. Regular internal and periodic external audit of the clinical activities at PHCs should be considered. 11
Page 1 and 2: FACING THE CHALLENGES OF MOTHERHOOD
Page 3 and 4: meant to make fun of them. This is
Page 5 and 6: estimates, more than 3,000 women di
Page 7 and 8: For every woman who dies, 15 to 30
Page 9: Table 1: Nursing personnel gaps in
Page 13 and 14: Figure 1: Diagram shows rising tren
Page 15 and 16: ankers or accountants. Table 2b. Th
Page 17 and 18: Table 2d. The associations between
Page 19 and 20: Figure 3: Health Facility Deliverie
Page 21 and 22: Figure 7: Hub and Spoke Illustratio
Page 23 and 24: The study documented a high prevale
Page 25 and 26: Evidence of declining prevalence Th
Page 27 and 28: 9. Henshaw SK, Adewole I, Singh S,
Page 29: 34. Sagay AS, Adisa OJ, Ekwempu CC,

Professor Atiene Solomon Sagay - University of Jos Institutional ...

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