A retrospective study of the health profile of neonates of mothers with anemia in pregnancy and pregnancy induced hypertension in Lagos, Nigeria

  • Journal of Public Health in Africa, Volume 5, No. 2, Year 2014

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Study Justification:
– The study aimed to assess the health profile of neonates in relation to anemia in pregnancy and pregnancy induced hypertension (PIH).
– Anemia in pregnancy and PIH are common complications that can have negative effects on both the mother and the neonate.
– Understanding the relationship between these complications and neonatal health can help inform interventions and improve outcomes for both mothers and neonates.
Study Highlights:
– The study used a retrospective design and analyzed data from 1046 case records of pregnant women registered for ante-natal care at Lagos Island Maternity Hospital.
– The majority of the mothers (68.8%) had anemia and a small percentage (6.7%) had PIH.
– The neonatal health profile showed that the majority (97.12%) of the neonates were live births, while 2.88% were stillbirths.
– There was a positive correlation between the packed cell volume of the mother and the birth weight of the neonates.
– There was a negative correlation between the incidence of PIH and the birth weight, head circumference, and length of the neonates.
Study Recommendations:
– Intensify nutritional and health care intervention programs for pregnant women, especially during ante-natal visits to hospitals.
– Increase awareness and education about the risks and complications of anemia in pregnancy and PIH.
– Improve access to antenatal care and ensure early detection and management of anemia and PIH.
– Strengthen monitoring and evaluation systems to track the prevalence of anemia in pregnancy and PIH and their impact on neonatal health.
Key Role Players:
– Obstetricians and gynecologists
– Nurses and midwives
– Health educators
– Public health officials
– Policy makers
Cost Items for Planning Recommendations:
– Training and capacity building for healthcare providers
– Development and distribution of educational materials
– Antenatal care services and equipment
– Laboratory tests and diagnostic tools
– Monitoring and evaluation systems
– Research and data analysis
– Community outreach and awareness campaigns

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study design is a retrospective study, which may have limitations in terms of recall bias and data accuracy. However, the study used a systematic random sampling technique and gathered data from a large sample size of 1046 case records. The study also used both descriptive and inferential statistics for analysis. To improve the strength of the evidence, it would be beneficial to include information on the representativeness of the sample and any potential biases in the data collection process. Additionally, conducting a prospective study with a control group would provide stronger evidence.

Our study assessed the health profile of neonates in relation to anemia in pregnancy and pregnancy induced hypertension (PIH). This was a retrospective study where a systematic random sampling technique was used to select a total of 1046 case records of pregnant women registered for ante-natal care at Lagos Island Maternity Hospital, Lagos, Nigeria, between 2005 and 2009. Socio-demographic characteristics of the mothers, prevalence of anemia and PIH, and neonatal health profile were obtained from the case records and were analyzed using both descriptive and inferential statistics. Pearson product moment correlation was used to show the relationship (P≤0.05) between maternal complications and neonatal health profile. Majority (68.8%) of the mothers had anemia and 6.7 % had PIH. Majority (97.12%) of the neonates were live births and 2.88% of the neonates were still births, 65.4% of the women with still birth pregnancy outcome had anemia, and 34.6% had PIH. Majority (74%) of the neonates had birth weight within normal range (2.5-4.0 kg) and majority (68%) had normal Apgar score at 5 min of birth (7- 10). A positive correlation existed between the packed cell volume of the mother and the birth weight of the neonates (r=0.740, P≤0.05). A negative correlation existed between the incidence of PIH and the birth weight of the neonates neonates (r=0.781, P≤0.05), head circumference (r=-0.491, P≤0.05) and the length of the neonates(r=-0.480, P≤0.05). We conclude that nutritional and health care intervention programmes for pregnant women should be intensified especially during ante-natal visits to hospitals. © O.F. Sotunde et al., 2014.

The study is a retrospective study where data were gathered from case records of 1046 patients who registered for Antenatal care at Lagos Island Maternity Hospital, Campbell Street, Lagos between July 2005 and December 2009. The hospital which is one of the foremost maternity hospitals in Nigeria and in sub-Saharan Africa is owned by Lagos State Government. It is a specialist hospital that caters for all aspects of obstetric and gynecological problems and also a referral secondary centre for many private hospitals, other Lagos State Government Hospitals, and also from tertiary institutions from Lagos environs and other states. Data on age, occupation, marital status, religion, parity, hemoglobin/packed cell volume (PCV) values at registration, and incidence of PIH for the mothers; and birth weight, Apgar score at 5 min after birth, length and head circumference for the neonates were all gathered from the case records. Permission was sought from the hospital authority for access into patients’ case records which are in the care of the head of health information and record department of the Hospital. The antenatal department of the hospital keeps a register which has a total of 9695 pregnant women registered for ante natal care at the Hospital within July 2005 and December 2009. The systematic random sampling method with sampling interval of 9 calculated using the Kth element,15 random starting point is between 0 and 9 where 6 was randomly picked which became the first number and every 9th number was used. A total number of 1046 case records were selected for the study, excluding case records of women with multiple birth pregnancies as infants of multiple birth pregnancies have a much greater risk of being born premature with intra uterine growth retardation (IUGR) or LBW than do infants of single births.11 The case records selected from the register were extracted from the records department. Information gathered from the case records were immediately imputed into Excel work sheet with the help of trained research assistants. The Statistical Package for Social Sciences version 16 (SPSS; IBM Corp., Armonk, NY, USA) computer program was used to analyze the data. Descriptive statistics such as frequency and percentage tables were used to describe the distribution of pregnancy complications recorded for the period under consideration and the personal characteristics of the women. Pearson product moment correlation was used to determine the level of relationship and their significance at 5% probability level (P≤0.05).

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Based on the information provided, here are some potential innovations that could improve access to maternal health:

1. Mobile Antenatal Care: Develop a mobile application that allows pregnant women to access antenatal care information, schedule appointments, and receive reminders for important check-ups and tests. This would help improve access to healthcare services and ensure timely and regular antenatal care.

2. Telemedicine Services: Implement telemedicine services that enable pregnant women in remote or underserved areas to consult with healthcare professionals remotely. This would allow them to receive medical advice, monitor their health, and address any concerns without the need for physical travel.

3. Community Health Workers: Train and deploy community health workers to provide education, support, and basic healthcare services to pregnant women in their communities. These workers can conduct regular check-ups, provide health information, and refer women to healthcare facilities when necessary, improving access to maternal health services at the grassroots level.

4. Health Information Systems: Implement electronic health information systems that enable healthcare providers to easily access and share patient records, ensuring continuity of care and reducing the risk of missing important information. This would improve coordination and communication among healthcare providers, leading to better maternal health outcomes.

5. Health Education Programs: Develop and implement comprehensive health education programs that target pregnant women and their families. These programs can provide information on nutrition, prenatal care, and the importance of regular check-ups, empowering women to make informed decisions about their health and improving access to maternal health services.

6. Maternal Health Vouchers: Introduce a voucher system that provides pregnant women with financial assistance to access maternal health services. This would help reduce financial barriers and ensure that women can afford the necessary care during pregnancy and childbirth.

7. Maternal Transport Services: Establish transportation services specifically designed to transport pregnant women to healthcare facilities for antenatal care, delivery, and postnatal care. This would address the issue of transportation barriers, particularly in rural areas, and improve access to timely and appropriate maternal healthcare.

These innovations have the potential to improve access to maternal health by addressing various barriers such as geographical distance, financial constraints, lack of information, and limited healthcare resources.
AI Innovations Description
The recommendation that can be developed into an innovation to improve access to maternal health based on the study is to intensify nutritional and healthcare intervention programs for pregnant women, especially during antenatal visits to hospitals. This recommendation is based on the findings that a majority of the mothers in the study had anemia and a significant correlation was found between maternal complications (such as anemia and pregnancy-induced hypertension) and neonatal health outcomes.

To implement this recommendation, healthcare facilities and providers can focus on the following strategies:

1. Antenatal education and counseling: Provide comprehensive information to pregnant women about the importance of proper nutrition, including iron-rich foods, and the potential risks and complications associated with anemia and pregnancy-induced hypertension. This can be done through individual counseling sessions, group education classes, or the use of educational materials.

2. Regular monitoring and screening: Implement routine screening for anemia and pregnancy-induced hypertension during antenatal visits. This can help identify high-risk pregnancies early on and allow for timely interventions and management.

3. Nutritional supplementation: Provide pregnant women with iron and other necessary nutritional supplements to prevent and treat anemia. This can be done through the distribution of prenatal vitamins or iron supplements during antenatal visits.

4. Access to healthcare services: Ensure that pregnant women have easy access to healthcare facilities and services, including antenatal care, delivery, and postnatal care. This can be achieved by improving the availability and affordability of healthcare services, especially in rural and underserved areas.

5. Collaboration and coordination: Foster collaboration between healthcare providers, government agencies, and community organizations to develop and implement comprehensive maternal health programs. This can include partnerships with local clinics, hospitals, and community health workers to ensure a coordinated approach to maternal healthcare.

By implementing these recommendations, it is expected that access to maternal health services will be improved, leading to better maternal and neonatal health outcomes.
AI Innovations Methodology
To improve access to maternal health, here are some potential recommendations:

1. Mobile Clinics: Implementing mobile clinics that can travel to remote areas or underserved communities to provide prenatal care, screenings, and education to pregnant women who may not have easy access to healthcare facilities.

2. Telemedicine: Utilizing telemedicine technology to connect pregnant women with healthcare providers remotely, allowing them to receive prenatal care and consultations without the need for in-person visits.

3. Community Health Workers: Training and deploying community health workers who can provide basic prenatal care, education, and support to pregnant women in their own communities, bridging the gap between healthcare facilities and remote areas.

4. Health Education Programs: Developing and implementing comprehensive health education programs that focus on maternal health, covering topics such as nutrition, prenatal care, breastfeeding, and postpartum care. These programs can be conducted in schools, community centers, and through digital platforms.

5. Transportation Support: Providing transportation support for pregnant women in remote areas to access healthcare facilities for prenatal visits, delivery, and postpartum care.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define the variables: Identify the key variables that will be measured to assess the impact, such as the number of prenatal visits, the rate of complications during pregnancy and childbirth, the percentage of women receiving adequate prenatal care, and the overall maternal and neonatal health outcomes.

2. Data collection: Gather data on the current state of maternal health access and outcomes in the target population. This can include information from healthcare facilities, surveys, and interviews with healthcare providers and pregnant women.

3. Modeling: Use statistical modeling techniques to simulate the impact of the recommendations on the identified variables. This can involve creating different scenarios based on the implementation of each recommendation and estimating the potential changes in the variables of interest.

4. Sensitivity analysis: Conduct sensitivity analysis to assess the robustness of the results and identify the key factors that may influence the impact of the recommendations. This can help in understanding the potential limitations and uncertainties associated with the simulation.

5. Evaluation: Evaluate the simulated impact of the recommendations and compare it to the baseline data. Assess the potential benefits, challenges, and feasibility of implementing the recommendations based on the simulation results.

6. Refinement and implementation: Based on the evaluation, refine the recommendations and develop an implementation plan that takes into account the resources, infrastructure, and cultural context of the target population. Monitor and evaluate the implementation to measure the actual impact on improving access to maternal health.


Statistics:
Citations: 1
Identifiers:
DOI: 10.4081/jphia.2014.286
ISSN: 20389922
Research Areas:
Community Interventions, Health System and Policy, Maternal Access, Maternal and Child Health, Noncommunicable Diseases, Quality of Care, Sexual and Reproductive Health
Study Countries:
Nigeria
Study Design:
Cohort Study, Cross Sectional Study, randomised-control-trial
Study Approach:
Quantitative
Participants Gender:
Female
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