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" c linica l assessment and lIlanaqelllent wore again dire cted and co nvinced t o a t tend the nex t c l inic . Care was taken to e nsure t hat a l l t h e s e assessments were done in t he best po s s i b l e enviro nmental se tti ng which was qu i et a nd also private. 4.10 : LABORATORY I NVESTIG AT I ONS Haemoglobi n a na l ys i s t he onl y laborat ory i nv e s t i g a t i on r nu t i nely car r i e d out on a l l stud y SUb j e c ts. Two mi llilitre v e no u s b loo d samp l es we r e t a ken from the f ore arms o f SUbj ects usi ng EDTA v ecuce tnee tubes. Bl ood samp l es were ob tained on two occasions ; the f irst in t he pre-pa r t um period whe n s Ubj ects were admitt e d i n l a bour, and t he second during mo r b i d i t y ll.sseSSGent. All s amples were collecte d f rom study cent ers at t he sallle time once ea ch d ay an d transported t o the u n i ve r s i t y ot Science and Technology (UST) Hospital laboratory where analysis ....a s carried out by one technician. All blood samples wer e analyz ed within 24 hours o f collect i o n . Haemoglob i n l evels wer e an alyzed by t he cynmothaema globin conc e nt r at i on m'ethod ....i th s pect ro phot omet ry. The haemoglobin s t a nda r d preparation u s ed co ntormed t o 6 .S 3985, wi t h a concentration o f 14.3 9 pe r dec ilitre . The i nstr ume nt us ed was spectronic 20 (Baus c h & Lomb) , a nd mea surements we r e t aken at a ....av elength o f 54 0 nano metr e s .
.. When the results 0 :£ haemoglobi n analysis were found to be less than 7 .0 q per de c ilitre the principal i nv e s tigat o r was notified immediatelY so t ha t the subject could be further f o l l owed u p. Ho....ever i n mos t cases t he s evere anaemia cases we r-e often diagnosed c l i nical ly. Other l abor a t or y i nve s t i g a t i ons r eq uested were undertaken only as pa rt of pa t ient managem ent and i nc luded mostly urine, stool, and s i c k l i n g electr ophoresis . The s e were u s ually done i n t he hospital ' 5 routine l aboratory. .. • 11 : DATA MANAGEMENT AND ANALYSIS Th e data generated by the study could b e c lassified into t wo ma jor c a t eg or i es: - t he baselin e data [accLo-edemoqz-aph Lo , antenatal and l abour va r Lab Les ] , - morb i d ity assessment da ta ( i nt erv i e w and examination f indings) . The EPI INFO Dat abase a nd s tatist ical package was used to s t o r e data on the compu ter and to carry out primary descript ive a na l yses . More sophisticat ed da ta a na lyses were do ne wi t h t he SPSS-X progr a m, and gra ph ical pre s entati ons p r e pa r e d wi t h HAVARD GRAPHICS software .
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A PROSPECTIVE STUDY OF EARLY PUERPE
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dysuria (26%). Nearly 60% of the st
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on l y greatl y enri ch ed the s ub
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5.4 De t e r mi na nt s o f morbidi
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Ta ble 2 .1 1 Di ag nos es in t rea
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CHAPTER 1 IN T RODU CTI ON As mor e
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impair mater nal health [ 13 ] . Th
Page 20 and 21:
Many African countries l ike Ghan a
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Sex ratio (M/F) (1 989) 0 . 98 Rura
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growt h r ate of 2 .5% [ 21] . I t
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Sex ratio (M as a % o f F) Crude bi
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hours in t he h o s p i t ll;l. Nor
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irths ( 19 ) . Although no communit
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It i s ob vious froID. the above in
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The need for adequate puerperal car
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for )0% and 20% respectivel y (33]
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The Za r i a s t ud y ( a}, also re
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embolism coul d be classified a s a
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serious h e alth consequences becau
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o ne known pat hoge n [54] _ Candid
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a de qua t e trr ea tinerrc fo r th
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3 6 Three of the 31 bacteriuric cas
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sinc e direct bladd er s ampling h
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developing world countries have i n
Page 58 and 59: Unlike t he developed world, breast
Page 60 and 61: i n t h e puerper ium will occur i
Page 62 and 63: ED; siotomy wou nd inf ection: I n
Page 64 and 65: 4' The incidence o f deep vein thro
Page 66 and 67: percent in Bali, Indonesia [37]. Th
Page 68 and 69: Pos t p a r t um Anaemia: Anaemia i
Page 70 and 71: study situat ions and ma y be up t
Page 72 and 73: wome n with caesarean deliveries (-
Page 74: deficien t , 50% f o l a t e defici
Page 77 and 78: days {178, 179] . In a study of pre
Page 79 and 80: 22,774 births s t udied were 6 .1%,
Page 81 and 82: ca r d i a c failure, a ssoc iated
Page 84 and 85: of the disease in zaria has been at
Page 86 and 87: Africa. and the incidence is still
Page 88 and 89: i ncreased occu rrenC:2 of psychiat
Page 90 and 91: African studies respectively h a d
Page 92 and 93: about the i r mari t a l s tat us,
Page 94 and 95: CHAP TE R 4 M!ill!Q.!2S 4 .1 : THE
Page 97 and 98: Bearing in mind t he fact t ha t th
Page 99 and 100: - Fre e medical consultation for ..
Page 102 and 103: Examination : SUbjects wer e examin
Page 105: •• Lowe r genita l t ract i nte
Page 110 and 111: sample cJ9scr ipt i on ; The charac
Page 112: Further mUltivariate logistic regre
Page 116 and 117: discharge s i n c e they were aa s
Page 119 and 120: 104 ETHNIC ORIGINS: The majority of
Page 121: 106 ap prenticeship- trained occupa
Page 124: YES 1l6'l\ FIG. 1.4 ANTENATAL CARE
Page 129 and 130: Labour e ve nts , c omplications a
Page 131 and 132: n . OTHER IMMEDI ATE COMPL.ICATIONS
Page 133: 5 .2 : FOLLOW-UP AND MORBIDI'I'Y FI
Page 136: 5 .2 . 1 Comparinq clinic a t t e n
Page 140 and 141: 200 ,eo 100 FIG. 2.1 :HOW SUBJECTS
Page 142 and 143: FIG.2.3: THE DAY OF FEVER ONSET REP
Page 145: 13 . I n a l l 21 2 ( 59 . 1\> s Ub
Page 148 and 149: 133 sUbjects said they did. A wide
Page 151: 136 Diastolic blood pressure readin
Page 156 and 157: 141 OTHER PATHOLOGI CAL FI NDI NGS
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144 FOLLOW-UP OUTCOMES: At the end
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5. 3 : I NCI DENCE OF MORBI DITY 5
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150 LOWER GENITAL TRACT I NFECTIO N
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152 ACUTE URIN ARY TRACT I NFECTION
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154 !i\!m.!!!Ari. : The occurrence
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15 7 regr ession was performed, t o
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15. The s tat i stically significan
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161 s t atistically !li gnifica nt
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16 3 t.o de t ermi ne t hose wi th
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165 was 280 nr (SO ± 166 ml.) and
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1 6 7 The results o f multiva riate
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169 The s atur a t ed rnode I of th
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CHAPTER 6 !l!SQJ.SSI ON AND RECOMME
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175 higher ed ucation levels a nd l
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177 a bout half of t he women who h
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180 ranked t he i r health as satis
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1 8 2 I nformal i nf ormat ion obta
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1 8 6 bact eriur ia r ates often r-
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190 lacerations or i ncisions which
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The non-infectiolIs morbid!ties : P
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194 About 60 % of the su b j ec t.s
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197 for preventing postpartum infec
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'" comparable to t h e high 57% rep
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201 p ostpartum pe r Lcd and also f
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203 bcv ev e r , a bou t 3 to 10 t
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205 The ve ry small number of patie
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210 i n f orm ation on t he ea rly
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212 depend o n the type of mo r b i
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one d id not fUlly escape t he l i
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3 . What i s the ex tent o f pos t
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2 21 38 . Kah n AR, Jahan FA ( 1 98
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225 85 . Ph ill i p s I , ' Ba s s
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22. 122. Thacker 58, Banta HD (1982
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232 17 1. Hype r tensive di s o rde
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234 191. Cox ML ( J.963) . Incidenc
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'" 223 . Pugb TF , J erat h BK, Sch
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APPENDIZ A MAP OF GHANA AND STUDY "
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STUDY FORM A: Pa g e 2. PREGNANCY/l
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STUD Y FORM B : Page 2 IF YES, Did
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STUDY FORM B: Page 5 Bima nual Pa l
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3) Gaped wound/Delayed wound healin
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APPENDI X F R.ESULTS OF MUTI VARI A
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APPENDI X r II THE PREDICTORS OF PO
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APPENDIX L DETERMINANTS or POSTPART
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