Pregnancy outcome in booked and unbooked mothers in Southeastern Nigeria
AbstractBackground: In order for individual health institutions in Nigeria to contribute towards the achievement of the Millennium Development Goals (MDG) with regards to maternal health, there is need for research on the local causes of and factors influencing adverse maternal outcomes. This would enable care providers and policy makers appreciate the burden of the problem and know where to focus as they distribute resources.
Objectives: To compare the socio-demographical characteristics, obstetrical complications and foetal outcome in booked verses unbooked mothers who delivered at this hospital.
Design: A hospital based retrospective study.
Setting: The Abia State University Teaching Hospital (ABSUTH), Aba in South Eastern Nigeria.
Subjects: Three thousand, seven hundred and thirty four mothers who delivered in the hospital between 1st January 2005 and 31st December 2007.
Results: Unbooked mothers constituted 17.0% of the 3734 deliveries in the studied period. Compared to booked mothers, unbooked mothers were younger in age (28.2 ± 5.80 vs. 29.3 ± 6.04; p < 0.001) and had a lower educational status (P <0.001). Majority of the unbooked were of lower social class; p<0.001. Unbooked mothers had a statistically significant higher incidence of pre-eclampsia/eclampsia (OR 3.88; 95%CI 2.61-5.77; p< 0.001) and were 13 times more likely to die in the hospital than booked patients (OR: 13.54; 95%CI: 6.89-27.03); p <0.0001). Unbooked mothers were about half as likely to deliver by spontaneous vaginal delivery compared to booked mothers (OR 0.64; 95%CI 0.55-0.73; P< 0.001) and eight times more likely to be delivered by emergency laparotomy due to uterine rupture than booked mothers (OR 8.80; 95%CI 3.84-20.55; P < 0.001). Unbooked mothers were nine times more likely to have babies with birth asphyxia.
Conclusion: The study showed a positive correlation between lack of proper antenatal care and adverse pregnancy outcome with poorer outcomes in unbooked than booked patients. Improving the availability and accessibility of quality antenatal and delivery care services in our environment will improve pregnancy outcome.