Year : 2009 | Volume
: 8 | Issue : 2 | Page : 81--84
A 5-year review of maternal mortality associated with eclampsia in a tertiary institution in northern Nigeria
Abubakar Ali Kullima1, Mohammed Bello Kawuwa1, Bala Mohammed Audu2, Hadiza Usman2, Ado Danazumi Geidam2,
1 Department of Obstetrics and Gynaecology, Federal Medical Centre Nguru, Nigeria
2 Department of Obstetrics and Gynaecology, University of Maiduguri Teaching Hospital, Nigeria
Abubakar Ali Kullima
Department of Obstetrics and Gynaecology, Federal Medical Centre, Nguru PMB 02, Nguru Yobe State
Objective : To determine the incidence of maternal mortality associated with eclampsia and to determine how socio-demographic and clinical characteristics of the women influence the deaths.
Methodology : Records of 52 eclampsia-related mortalities from January 2003 to December 2007 were reviewed, retrospectively. Their social demography, mode and place of delivery, time of eclampsia, and fetal outcome were extracted for analysis.
Results : Eclampsia accounted for 52 (46.4%) of the 112 total maternal deaths recorded within the 5-year period, with case fatality of 22.33%. Age group <20, 20-29 and above 30 all had similar case fatality rate of 22.1%, 23.8% and 26.7%, respectively. Those who were experiencing their first deliveries have the worst deaths recording 42.5% of the case fatality in that category. As expected, unbooked had higher case fatality of 24.0% compared to 15% among booked cases, while those with no formal education also had more death (22.3% case fatality) as compared to 3.3% among those who had some form of formal education. Antepartum eclampsia was the cause in 50% of the death, 11(21.2%) of the pregnancies were not delivered before their death, while 18 (34.6%) were stillbirth.
Conclusion : Eclampsia still remains the major cause of maternal mortality in this region resulting from unsupervised pregnancies and deliveries. There is need to educate and encourage the general public for antenatal care and hospital delivery.
|How to cite this article:|
Kullima AA, Kawuwa MB, Audu BM, Usman H, Geidam AD. A 5-year review of maternal mortality associated with eclampsia in a tertiary institution in northern Nigeria.Ann Afr Med 2009;8:81-84
|How to cite this URL:|
Kullima AA, Kawuwa MB, Audu BM, Usman H, Geidam AD. A 5-year review of maternal mortality associated with eclampsia in a tertiary institution in northern Nigeria. Ann Afr Med [serial online] 2009 [cited 2019 Sep 21 ];8:81-84
Available from: http://www.annalsafrmed.org/text.asp?2009/8/2/81/56233
Eclampsia remains a complication of pregnancy and a leading contributor to maternal and perinatal morbidity and mortality. , Worldwide  it accounts for 50,000 maternal deaths annually. In spite of the several global and regional interventions and initiatives from governments and other concerned agencies, maternal mortality continues to rise in sub-Saharan Africa with eclampsia as a major cause. , Over the last decade it remained the leading cause of maternal and perinatal mortality in Nigeria, ,, This picture could even be worse especially in the north-eastern part of Nigeria with so far, the worst case fatality rate of 11.6% (11,600/100,000) as reported in Gombe.  This study was undertaken to determine the incidence of eclampsia-related death in the study population, the socio-demographic characteristic of the women and pregnancy outcome.
Materials and Methods
This is a retrospective study of maternal deaths from eclampsia recorded in Federal Medical Centre Nguru over a 5-year period, from January 1, 2003 to December 31, 2007. Out of the 112 total maternal deaths recorded over the study period, records of 52 patients who suffered from eclampsia-related deaths were retrieved from the medical records library, and information pertaining to their age, parity level of education and booking status was obtained. Information on the mode of delivery, time of eclampsia, fit controlled and gestational age at delivery, place of delivery, and fetal outcome were also obtained from the records for analysis using SPSS version 11. The Chi-square test was used for test of significance.
During the period under review, a total of 3931 deliveries were recorded, 224 cases had eclampsia, giving a prevalence rate of 5.7% of the total deliveries. Diazepam is the sole anticonvulsant used for all the cases. Total deaths from eclampsia were 52 out of the 112 maternal death over the same period accounting for 46.4% of the total maternal death and a case fatality rate of 22.3% (22,300/100,000) and eclampsia-related maternal mortality ratio (MMR) of 1322/100,000 deliveries. As shown in [Table 1], age group  and other parts of Nigeria [Benin (10.7%),  Gombe (11.6%),  Ukpoma (15.4%)  and Jos (16.9%)  ]. The eclampsia-related maternal mortality ratio of 1322/100000 deliveries found was however lower than reported in Uyo (6800/100000).  There was no much significant difference in case fatality among the reported groups ,,,, Almost all the mothers not had any formal education that is not surprising, as there is apathy toward western education, particularly for girls' and children education with subsequent early marriage. The poor/lack antenatal supervision in majority, who were only rushed to the hospital at terminal stages of the emergency, may account for more deaths. This was similar to findings in the Niger Delta region of Nigeria. .
Because of the peculiarity of these patients (unbooked and illiterates in majority), gestational age was either estimated in months or extrapolated from the fundal height measurement at the time of examination, this often lead to problem of decision making at mode of delivery when fetal survival is to be considered. Maternal death is higher among those who experienced antepartum eclampsia compared to those who had intrapartum or post-partum eclampsia. This could be partly explained by the relatively longer duration or possibly repeated episodes of convulsion from the onset of the first fit that often increased the risk of mortality. The observed maternal mortality ratio in this study of 279.8/100,000 deliveries was much higher than reported from Kaduna Nigeria of 141/100,000.  However, there is no much significant difference between live births and stillbirths, but the stillbirth rate of 34.6% is similar to findings in Jos of 31.7%. ,,
Compared to those with other forms of eclampsia, neonatal outcome is relatively better among those with antepartum eclampsia; this might not be unconnected with the earlier recourse to caesarean section that might tend to minimiz further risks to both the mother and the fetus from repeated convulsions and its consequences.
Eclampsia no doubt contributes significantly to maternal mortality in Nigeria, more so in our geopolitical zone. Effort should be made by all concern to improve facilities and social infrastructures that will directly or otherwise minimize the occurrence of eclampsia. Skilled and prompt attendant of patient in emergency situations will help to curtail mortalities from preventable morbidities.
|1||Ogunbode O. Clinical aspects of eclampsia at Ibadan, Nigeria. Nigeria Med J 1997;7:162-6.|
|2||Obed SA, Wilson JB, Sakay A. Determinants of maternal mortality in eclampsia at Korle Bu Teaching Hospital Accra, Ghana. Ghana Med J 1999;33:86-9.|
|3|| Duley L. maternal mortality associated with hypertensive disorders of pregnancy in Africa, Asia, Latin America and the Caribbean. Br J Obstet Gynaecol 1992;99:547.|
|4||Fasubaa OB, Oguniyi SO, Ezechi OC. Maternal mortality in Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife: A Comparison of maternal Deaths in young and the older women. Niger J Med 1999;8:147-51.|
|5||Briggs ND. Maternal mortality in Sub Saharan Africa: The problems and prevention. Trop J Obstet Gynaecol 1994;11:8-11.|
|6||Igberase GO, Ebeigbe PN. Eclampsia: Ten years of experience in a rural tertiary hospital in Niger Delta, Nigeria. J Obstet Gynaecol 2006;26:414-7.|
|7||Ozumbia BC, Ibe AI. Eclampsia in Enugu eastern Nigeria. Acta Obstet Gynaecol Scand 1993;72:189-92|
|8||Yusuf MA, Hamisu MS, Nalini SK, Greg RA. Maternal mortality in northern Nigeria: A population based study. Eur J Obstet Gynaecol Reprod Biol 2003;109:153-7.|
|9||El- Nafaty AU, Melah GS, Massa AA, Audu BM, Madziga N. The analysis of Eclamptics morbidity and mortality in the Specialist Hospital Gombe, Nigeria. J Obstet Gynaecol 2004;24:142-7.|
|10||Raksha A, Gangul, RP, Swain S, Oumachiqul, Raja Ram P. Determinants of maternal mortality in eclampsia in India. Australian NZJ Obstet Gynaecol 1994;34:537-9.|
|11||Onuh SO, Aisien AO. Maternal and Fetal in eclamptics patients in Benin City, Nigeria. J Obstet Gynaecol 2004;24:765-8.|
|12||Ujah IA, Aisien OA, Mutihir JT, Vanderjagt DJ, Glew RH, Uguru VE. Maternal mortality among adolescent women in Jos, North Central, Nigeria. J Obstet Gynaecol 2005;25:3-6.|
|13||Bassey AE, Abasiatai AM, Umoiyoho AJ, Udoma EJ. Presentation and outcome of eclampsia in Uyo, South-South Nigeria. Trop J Med Res 2005;9:9-11.|
|14||Ikechebelu JI, Okoli CC. Review of eclampsia at the Nnamdi Azikiwe University Teaching Hospital, Nnewi. J Obstet Gynaecol 2002;22:287-90.|
|15||Ogunniyi SO. Eclampsia a continuing obstetrics catastrophe, the experience in Ile Ife, Nigeria. J Obstet Gynaecol 1999;19:26-9.|
|16||Onwuhafua PI, Onwuhafua A, Adze J, Mairami Z. Eclampsia in Kaduna state of Nigeria: A proposal for a better outcome. Niger J Med 2001;10:81-4.|
|17||Onwuhafua PI. Dying undelivered. J Obstet Gynaecol 2002;22:155-8.|
|18||Onwuhafua PI, Oguntayo A. Perinatal mortality associated with eclampsia in Kaduna, Northern Nigeria. Niger J Med 2006;15:397-400.|