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CHAPTER 1 IN T RODU CTI ON As mor e i nformation on the high mat ernal death r a t es i n t he de veloping world ha s become a vailable, wor l d att ention has been drawn to the ne gl ected tragedy o f mater na l i ll-he a l t h and death in t hese disadva ntaged coun tries ( 1 ] . It is estimated t ha t half u mi lli on women die f r om pregna ncy- rel ated causes each year world wi de; 99% o f the s e occur i n t he d ev eloping co untries at' Af ric a , Asia a nd South Amer ica ( 1). I n Africa, t he c urrently e s t i mate d mat e r nal death r ate is 6.4 p er 1000 , as com pa red wi t h rate s o f less than 0.1 p e r 10 00 i n Europe a nd North America [ 2, 3 , 4] . In f act acme studies hav e even recorded rates of 20 per 1 0 0 0 i n some parts of t h e African c o ntine nt [5]. I n today 's world, thes e horrifi c mate r na l dea t h rates a re reminiscent of rates in pre- nt ne eeeen c entur y Eur ope [6,7], a nd ch ild bea r ing rightly desc ribed by some as still a da ngero us qarabje f or these unfortunate wome n (8 ] . Deaths are jus t the tip of the ice berg of maternal suffering . It i s e st i ma ted that, f or ev ery woman who dies another 10 t o 15 mor e s uffe r se vere he alth con s e qu e nc es from their preg nancies [9] . In Africa an estimated t wo to thre e million women are belie ved t o be disabled o r in capacitated t o va r ying degrees b y pa s t ; pregna ncies [1]. Some of the s e women described as t he livi ng dead, only co ntinue t o live at t h e
fringes of health and silently bear bitter social and pc e-eonc f consequences. The actual extent of the problem of maternal ill-health in Africa is stil l not known however, because data
Page 5: A PROSPECTIVE STUDY OF EARLY PUERPE
Page 8 and 9: dysuria (26%). Nearly 60% of the st
Page 10 and 11: on l y greatl y enri ch ed the s ub
Page 12 and 13: 5.4 De t e r mi na nt s o f morbidi
Page 14 and 15: Ta ble 2 .1 1 Di ag nos es in t rea
Page 18 and 19: impair mater nal health [ 13 ] . Th
Page 20 and 21: Many African countries l ike Ghan a
Page 22 and 23: Sex ratio (M/F) (1 989) 0 . 98 Rura
Page 24 and 25: growt h r ate of 2 .5% [ 21] . I t
Page 26 and 27: Sex ratio (M as a % o f F) Crude bi
Page 28 and 29: hours in t he h o s p i t ll;l. Nor
Page 30 and 31: irths ( 19 ) . Although no communit
Page 32 and 33: It i s ob vious froID. the above in
Page 34: The need for adequate puerperal car
Page 37 and 38: for )0% and 20% respectivel y (33]
Page 39 and 40: The Za r i a s t ud y ( a}, also re
Page 41 and 42: embolism coul d be classified a s a
Page 43: serious h e alth consequences becau
Page 47 and 48: o ne known pat hoge n [54] _ Candid
Page 49 and 50: a de qua t e trr ea tinerrc fo r th
Page 51 and 52: 3 6 Three of the 31 bacteriuric cas
Page 53 and 54: sinc e direct bladd er s ampling h
Page 56 and 57: 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 108 and 109:
" c linica l assessment and lIlanaq
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
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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
Page 159 and 160:
144 FOLLOW-UP OUTCOMES: At the end
Page 161:
5. 3 : I NCI DENCE OF MORBI DITY 5
Page 165 and 166:
150 LOWER GENITAL TRACT I NFECTIO N
Page 167 and 168:
152 ACUTE URIN ARY TRACT I NFECTION
Page 169:
154 !i\!m.!!!Ari. : The occurrence
Page 172 and 173:
15 7 regr ession was performed, t o
Page 174 and 175:
15. The s tat i stically significan
Page 176 and 177:
161 s t atistically !li gnifica nt
Page 178 and 179:
16 3 t.o de t ermi ne t hose wi th
Page 180 and 181:
165 was 280 nr (SO ± 166 ml.) and
Page 182 and 183:
1 6 7 The results o f multiva riate
Page 184 and 185:
169 The s atur a t ed rnode I of th
Page 188 and 189:
CHAPTER 6 !l!SQJ.SSI ON AND RECOMME
Page 190 and 191:
175 higher ed ucation levels a nd l
Page 192:
177 a bout half of t he women who h
Page 195 and 196:
180 ranked t he i r health as satis
Page 197:
1 8 2 I nformal i nf ormat ion obta
Page 201:
1 8 6 bact eriur ia r ates often r-
Page 205 and 206:
190 lacerations or i ncisions which
Page 207 and 208:
The non-infectiolIs morbid!ties : P
Page 209 and 210:
194 About 60 % of the su b j ec t.s
Page 212 and 213:
197 for preventing postpartum infec
Page 214 and 215:
'" comparable to t h e high 57% rep
Page 216 and 217:
201 p ostpartum pe r Lcd and also f
Page 218 and 219:
203 bcv ev e r , a bou t 3 to 10 t
Page 220:
205 The ve ry small number of patie
Page 225 and 226:
210 i n f orm ation on t he ea rly
Page 227 and 228:
212 depend o n the type of mo r b i
Page 229:
one d id not fUlly escape t he l i
Page 232 and 233:
3 . What i s the ex tent o f pos t
Page 236:
2 21 38 . Kah n AR, Jahan FA ( 1 98
Page 240 and 241:
225 85 . Ph ill i p s I , ' Ba s s
Page 243 and 244:
22. 122. Thacker 58, Banta HD (1982
Page 247 and 248:
232 17 1. Hype r tensive di s o rde
Page 249 and 250:
234 191. Cox ML ( J.963) . Incidenc
Page 251:
'" 223 . Pugb TF , J erat h BK, Sch
Page 254:
APPENDIZ A MAP OF GHANA AND STUDY "
Page 257 and 258:
STUDY FORM A: Pa g e 2. PREGNANCY/l
Page 259:
STUD Y FORM B : Page 2 IF YES, Did
Page 262:
STUDY FORM B: Page 5 Bima nual Pa l
Page 265 and 266:
3) Gaped wound/Delayed wound healin
Page 267 and 268:
APPENDI X F R.ESULTS OF MUTI VARI A
Page 270:
APPENDI X r II THE PREDICTORS OF PO
Page 273 and 274:
APPENDIX L DETERMINANTS or POSTPART
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