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wome n with caesarean deliveries (-3 .46 g/dl) , a nd in sUbjects with difficult vaginal deliveries (-1. 5 9 g/dl) and sl'lalle.c;t in those with easy vaginal deliveries (-0.87 g/dll ( 164 ). The well-nourished women i n t he Western world will probably adjust to t hes e reduc tions i n haemoglobin level with ease a nd a lso quickly correct the deficiency in t he ne xt few days after delivery . For the already anaemic fema les in t he poor 'ieveloping world communities, t hese blood losses can u r-ed i epoee to l o ng - t e r m chrcnfc a naemia with resul ting poor health b e c a u s e many of the f
anaemia [8J . Of the 391 cases admit.ted with s ev e r e pcsnparuue haemorrhage, 6 . n died and the others su rv i ve d probably with seve r e anaemia [ 8) . 58 Many other studies on anaemia in lactating mot hers in Africa , have reported prevalence rates r anging from ] 0 to 99\ , further emphasis ing the higher occurrence rates o f pos t partum anaem i a in t hese regions [146}. After pregnancy the anaase l c new mother in these countries is still faced with the e xtr a dema nd s of l a c t a t i o n , at a time when her reserves a re at their lowest . I t should a lso be remembered that breast-feeding i s done a l mos t universally i n the develplng world, for longer periods and r epeatedly as fertility ra tes are h ig h , a nd therefore the d ep leti ng effects of lactat i on on ea t erna I resources can be quite marked in these pop ulations . Anaelllia i n the puerperal pe r ic:xt is associat e d with a n i nc r ea s e d risk of puerperal i n f e c t ive ccepj I cetIcns (7,8,)0 l which could i n t urn a l s o aggravate the an aem i a . t n Za ria, for i ns t a nc e, ma ny of the puerperal an aemi a pa t ient s seen als o presented with infec tive cond i t i o ns {8 l . Controll ing puerpera l anaemia can, therefore, contribute significantly to reduc ing morbidi ty a nd mortality from puerperal seps is i n thes e commun i t i e s . A study of the nutritional rect.oz-e i n 100 puerperal anaemic SUbjects ....ith haemoglobin level s less than 10 gm/dl in Johannesbu rg , South Af rica , found gOt o r them to be iron
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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
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 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
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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
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-
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
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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
Page 227 and 228:
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
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
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APPENDIZ A MAP OF GHANA AND STUDY "
Page 257 and 258:
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
Page 265 and 266:
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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