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Ceni tal I n f ecti o ns 249 It is difficult to c linically distinguish accurately between the various types of up per genital infection such as sa l pingitis , e ndometritis, myometrit is or parametri tis. For the purposes o f this study, t h e r e fo r e , genital sepsis will be divided i n t o Upper genital t ract infec t ion and Lower genital tract i n f ecti on wi th the fol lowing diagnostic criteria: Upper genital tract infection (UGTI ): 1) Fever a t examination and/or reported by SUbject 2) Lower abdominal tenderness o n palpation o f a bdome n i ndicated by wincing a nd/or abdominal wall guarding . J) Fou l lochia with or wi thout associated colour change . 4) uteri ne t ende r ne s s wi t h or wi t hout en largemen t and/or cervical mot ion pain examination. bimanual The presence of thr ee or more o f the s e s i gns/symptoms wi ll be considered diagnost ic. Lower genital tract i nfection (LGTI): 1) Local oedema and r edn e s s greater t ha n O.S cm on wound sides. 2) A discharge of pus.
3) Gaped wound/Delayed wound healing 4) Exqu i s ite local t e nde r ness 5) Fe ver 250 Th e presence of t hree or mare of t he above l i sted signs 10'111 be con s idered d i a gnostic. LGTI wi ll a lso be f urther subd i vi de d i nto the following t wo groups o f : (I) Episiotomy infection and (II) other infected Lecere b.ions o r perineal l esions . Secondary pos t - partum h aem orrhage ' 1) Bright red lochia observed at t he t i me of ex amination wi t h or without clots, is consider ed diagnostic . Breast d isorders Mastitis: Th e p r e s ence of t he fo llowing t h r e e clinical signs wil l be a c cept e d as evidence of mastitis. 1) Fever at examination or reported by SUbj ect 2) Swolle n , tender, a nd r edden ed breast 3) Crac ked s ore/t ender nip p l es 3) Absence of a fluct ua t ing mas s Breast Abc cess : All t he above c-riteria with t he add i t i on a l presence t o of a fluc t uan t mass and/or pus discharge will classify t he l esion as a brea s t abcess. Nip ple disor de r : The presen c e only of a chaffed , cracked, and inflammed n ipples wi t hout the above listed signs or s ymptoms .
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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
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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
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Unlike t he developed world, breast
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i n t h e puerper ium will occur i
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ED; siotomy wou nd inf ection: I n
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4' The incidence o f deep vein thro
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percent in Bali, Indonesia [37]. Th
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Pos t p a r t um Anaemia: Anaemia i
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study situat ions and ma y be up t
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wome n with caesarean deliveries (-
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deficien t , 50% f o l a t e defici
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days {178, 179] . In a study of pre
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22,774 births s t udied were 6 .1%,
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ca r d i a c failure, a ssoc iated
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of the disease in zaria has been at
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Africa. and the incidence is still
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i ncreased occu rrenC:2 of psychiat
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African studies respectively h a d
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about the i r mari t a l s tat us,
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CHAP TE R 4 M!ill!Q.!2S 4 .1 : THE
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Bearing in mind t he fact t ha t th
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- Fre e medical consultation for ..
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Examination : SUbjects wer e examin
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•• Lowe r genita l t ract i nte
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" c linica l assessment and lIlanaq
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sample cJ9scr ipt i on ; The charac
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Further mUltivariate logistic regre
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discharge s i n c e they were aa s
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104 ETHNIC ORIGINS: The majority of
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106 ap prenticeship- trained occupa
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YES 1l6'l\ FIG. 1.4 ANTENATAL CARE
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Labour e ve nts , c omplications a
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n . OTHER IMMEDI ATE COMPL.ICATIONS
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5 .2 : FOLLOW-UP AND MORBIDI'I'Y FI
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5 .2 . 1 Comparinq clinic a t t e n
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200 ,eo 100 FIG. 2.1 :HOW SUBJECTS
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FIG.2.3: THE DAY OF FEVER ONSET REP
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13 . I n a l l 21 2 ( 59 . 1\> s Ub
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133 sUbjects said they did. A wide
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136 Diastolic blood pressure readin
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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
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 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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