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POSTNATAL CARE IN ENUGU: A COMPARISON BETWEEN TRADITIONAL CARE AND A PROPOSED NEW MODEL

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Supervisor: Prof U.U. Aniebue, Prof B.C Ozumba
Faculty: OBSTETRICS AND GYNAECOLOGY
Year: 2013

Abstract

1.1 BACKGROUND Maternal and infant mortality are a major health concern world over. Approximately 287,000 maternal deaths occur annually, of which more than half (56%) occur in sub-Saharan Africa.1 Africa has the highest burden of maternal mortality in the world and sub-Saharan Africa is largely responsible for the dismal maternal death figure in Africa, contributing approximately 98% of the maternal deaths in the continent.2 The lifetime risk of maternal death in sub-Saharan Africa is 1 in 22 mothers compared to 1 in 210 in Northern Africa, 1 in 62 for Oceania, 1 in 120 for Asia, and 1 in 290 for Latin America and the Caribbean.2 Nigeria is a leading contributor to the maternal death figure in sub-Saharan Africa. From available data on maternal mortality rates in 2010, Nigeria had 630/100,000 live births compared to other African countries such as Ghana with 350/100,000, Benin with 350/100,000, Togo with 300/100,000, Gabon with 230/100,000, Egypt with 66/100,000 and Tunisia with 56/100,000 live births.3 Nigeria which has approximately two per cent of the world’s population contributes almost 10% of the world’s maternal deaths.4 Most maternal deaths - approximately two thirds, occur in the postnatal period.5,6 Similarly, an estimated 4 million babies die worldwide in the first 4 weeks of life (the neonatal period) annually. Of these, 99% occur in low and middle income countries, where a large proportion of births take place and home and where postnatal care is either not available or is of poor quality.1,7 Three-quarters of neonatal deaths happen in the first week of life - the highest risk of death however is on the first day of life.7 13 The postnatal period is the time from just after delivery through the first six weeks of life.8,9 Some other authors have suggested it could extend up till 8 weeks after delivery.10 However, 6weeks appears more generally accepted. Postnatal care services enable health professionals identify post-delivery problems, and their associated risk factors as well as provide prompt treatment.11 While the postpartum period is uncomplicated for most women, approximately 3% of women who have a vaginal delivery and 9% of women who have a caesarean section will experience a complication that either requires prolonged hospitalization after delivery or readmission to the hospital.12 Outpatient postpartum visits allow clinicians to address problems with bowel and bladder function, pain, and vaginal bleeding. They also allow clinicians to assess breastfeeding, postpartum depression, infant bonding, resumption of sexual intercourse, and contraception.13 Attendance however to outpatient postnatal clinics has consistently been reported to be lower than attendance to antenatal clinics and even delivery by skilled birth attendants.5,14 Considering global and national interests in the Millennium Development Goal and Nigeria's high level of maternal mortality,14 it is essential that Policies and programs are focused on this critical period, which may hinder efforts to achieve the Millennium Development Goals (MDGs) for maternal and child survival.15 Particularly as Nigeria is yet to be among African countries experiencing an acceleration in decline in their neonatal mortality figures, hence not well on their way to achieve the Millennium Development Goals.1

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