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Item Burden and outcomes of postpartum haemorrhage in Nigerian referral-level hospitals.(2024) Adebayo, T.; Adefemi, A.; Adewumi, I.; Akinajo, O.; Akinkunmi, B.; Awonuga, D.; Aworinde, O.; Ayegbusi, E.; Dedeke, I.; Fajolu, I.; Imam, Z.; Jagun, O.; Kuku, O.; Ogundare, E.; Oluwasola, T.; Oyeneyin, L.; Adebanjo-Aina, D.; Adenuga, E.; Adeyanju, A.; Akinsanya, O.; Campbell, I.; Kuti, B.; Olofinbiyi, B.; Salau, Q.; Tongo, O.; Ezekwe, B.; Lavin, T.; Oladapo, O. T.; Tukur, J.; Adesina, O.Objective: To determine the prevalence of primary postpartum haemorrhage (PPH), risk factors, and maternal and neonatal outcomes in a multicentre study across Nigeria. Design: A secondary data analysis using a cross-sectional design. Setting: Referral-level hospitals (48 public and six private facilities). Population: Women admitted for birth between 1 September 2019 and 31 August 2020. Methods: Data collected over a 1-year period from the Maternal and Perinatal Database for Quality, Equity and Dignity programme in Nigeria were analysed, stratified by mode of delivery (vaginal or caesarean), using a mixed-effects logistic regression model. Main outcome measures: Prevalence of PPH and maternal and neonatal outcomes. Results: Of 68 754 women, 2169 (3.2%, 95% CI 3.07%–3.30%) had PPH, with a prevalence of 2.7% (95% CI 2.55%–2.85%) and 4.0% (95% CI 3.75%–4.25%) for vaginal and caesarean deliveries, respectively. Factors associated with PPH following vaginal delivery were: no formal education (aOR 2.2, 95% CI 1.8–2.6, P < 0.001); multiple pregnancy (aOR 2.7, 95% CI 2.1–3.5, P < 0.001); and antepartum haemorrhage (aOR 11.7, 95% CI 9.4–14.7, P < 0.001). Factors associated with PPH in a caesarean delivery were: maternal age of >35 years (aOR 1.7, 95% CI 1.5–2.0, P < 0.001); eferral from informal setting (aOR 2.4, 95% CI 1.4–4.0, P = 0.002); and antepartum haemorrhage (aOR 3.7, 95% CI 2.8–4.7, P < 0.001). Maternal mortality occurred in 4.8% (104/2169) of deliveries overall, and in 8.5% (101/1182) of intensive care unit admissions. One-quarter of all infants were stillborn (570/2307), representing 23.9% (429/1796) of neonatal intensive care unit admissions. Conclusions: A PPH prevalence of 3.2% can be reduced with improved access to skilled birth attendants.Item Maternal near-miss due to unsafe abortion and associated short-term health and socio-economic consequences in Nigeria(2015) Prada, E.; Bankole, A.; Oladapo, O. T.; Awolude, O. A.; Adewole, I. F.; Adewole, I. F.; Onda, T.Little is known about maternal near-miss (MNM) due to unsafe abortion in Nigeria. We used the WHO criteria to identify near-miss events and the proportion due to unsafe abortion among women of childbearing age in eight large secondary and tertiary hospitals across the six geo-political zones. We also explored the characteristics of women with these events, delays in seeking care and the short-term socioeconomic and health impacts on women and their families. Between July 2011 and January 2012, 137 MNM cases were identified of which 13 or 9.5% were due to unsafe abortions. Severe bleeding, pain and fever were the most common immediate abortion complications. On average, treatment of MNM due to abortion costs six times more than induced abortion procedures. Unsafe abortion and delays in care seeking are important contributors to MNM. Programs to prevent unsafe abortion and delays in seeking postabortion care are urgently needed to reduce abortion related MNM in Nigeria.