Faculty of Family Medicine

ASSESSING THE EFFECT OF COMPANIONSHIP DURING LABOUR ON LABOUR AND DELIVERY OUTCOMES AT MILE FOUR HOSPITAL, ISHIEKE ABAKALIKI, EBONYI STATE

UDOCHUKWU DANIEL AGHOR — 2019-04-20

There are few human experiences as profound as the physical, psychological, and social
intensity of labour and childbirth. Beyond the physiological aspects, childbirth is a socially
and historically shaped event, with wide cultural and geographical variability. Historical
evidence showed that women have been attended to by other women during labour, mostly
relatives and in some societies, traditional birth attendants.
Although, the adoption of modern obstetric practices has resulted in decrease in the incidence
of maternal morbidity and mortality, obstetric interventions have continued to increase.
Women give birth in hospitals where they are often left to labour alone as the midwives often
have too many women they care for at the same time. Health care providers tend to
underestimate the importance of the experience of childbirth and focus more on the outcomes,
such as morbidity and mortality. Though, some women reported the experience of labour and
childbirth to be empowering, ecstatic or even orgasmic event, most others report it as being
stressful and painful.
In the early twentieth century, with the emergence of evidence-based healthcare, a worldwide
movement started to document the emotional, health benefits and maternal satisfaction
associated with companionship and support during labour.
Aim: This study was undertaken to compare the birthing experiences and labour outcome
among parturients with and without companionship in labour at Mile 4 Hospital Ishieke
Abakaliki with a view to enhancing positive maternal experience and better foetal outcome.
Materials and methods: This was a hospital-based prospective cohort study involving 587
pregnant women recruited using systematic random sampling method and randomly allocated
into intervention and control groups. The study lasted for four months. Relevant data on
demographic features were obtained using a pre-tested interviewer-administered
questionnaire. Data was analysed using Statistical Package for Social Sciences version 20.
Main outcome measures: The main outcome measures in this study were pain perception
and anxiety among parturients and Apgar score of the babies at 1 and 5-minutes.
Results: More women in the control group had severe pain compared to the intervention
group (x2-51.201; p<0.001). Also majority of the parturients with companions had low
anxiety levels (56.8%); 39.0% had moderate anxiety and only about 4.1% had high anxiety
levels. But among the women without companions, the majority of them (56.3%) had high
anxiety levels; in 38.0% of the women, their anxiety level was moderate while only a small
proportion of them (5.8%) had low anxiety(x2-254.162; p<0.001).
There was no significant difference in the Apgar score at 1 and 5 minutes between the two
groups.
Conclusion: Companionship during childbirth is a safe and effective intervention in
improving maternal labour experience with regard to psychosocial variables and does not
worsen foetal outcome. However, there is need for clear guidelines to govern the practice for
health care professionals and labour support persons to avoid potential harm to the parturient.

ANAEMIA IN CHRONIC KIDNEY DISEASE IN LASUTH: IMPACT ON QUALITY OF LIFE AND LEFT VENTRICULAR MASS INDEX

OLUWASEYE MICHAEL OLADIMEJI — 2019-04-20

Anaemia is a common complication of chronic kidney disease(CKD), and has been shown to
worsen as CKD advances. It has also been identified as an independent predictor of left
ventricular hypertrophy (LVH) among CKD patients, and worsens their cardiovascular outcome,
and impacts negatively on their quality of life.
The aim of this study was to assess the prevalence and geometric pattern of LVH among anaemic
CKD patients, and the relationship between the severity of anaemia and its impact on the quality
of life of anaemic CKD patients attending nephrology clinic at Lagos State University Teaching
Hospital.
Methods: A cross sectional analytical study was carried out within a 10 month period (April
2016 to January 2017). A total of one hundred and sixty three subjects were recruited which
included one hundred and two anaemic CKD subjects and sixty one CKD subjects without
anaemia as controls. Karnofsky structured questionnaire was used to assess quality of life,
echocardiogram was used to determine the presence of LVH, the left ventricular geometric
pattern (L.V geometry) and the left ventricular systolic function, while the packed cell volume
was used to categories subjects into severity of anaemia.
Result: The mean age of anaemic CKD subjects was 54.04 ± 14.47 years, while those of controls
was 54.92 ± 15.67 years, with t = -0.364, p = 0.717. The duration of CKD among anaemic CKD
subjects was 3.41 ± 5.22 years and controls was 3.09 ± 2.57 years, with t = 0.442 and P = 0.659.
The prevalence of anaemia among CKD subjects was 102(62.6%), and it significantly worsens
as CKD advances, which ranged from 42.3% in stage 3 to 93% in stage 5 (X2 = 29.69, p <
0.001). The mean physical performance score was significantly lower among anaemic CKD
subjects than controls, which was 73.17 ± 12.95 and 84.59 ± 11.04 respectively, with t = -5.739
and P < 0.001. Furthermore, the mean physical performance score decreases significantly with
advancing CKD among both study groups. The prevalence of LVH among anaemic CKD
subjects was 64(68.8%), and was not significantly different among CKD subjects without
anaemia was 33(57.9%), X2 = 1.845, p = 0.174, O.R = 1.61, and 95% C.I was 0.81 – 3.17. The
most frequent pattern of LVH seen among both groups was concentric LVH which was 50
(53.8%), and 25(43.9%) among both anaemic CKD subjects and controls respectively, X2 =
2.385, and p = 0.497. The overall prevalence of left ventricular systolic dysfunction among
subjects was 68(45%), with significantly higher frequency among anaemic CKD subjects
58(61.7%), than controls 10(17.5%), with X2 = 27.952 and p < 0.001, O.R = 7.57, and 95% C.I =
3.43 – 16.73. Also there was a strong negative correlation between packed cell volume and left
ventricular mass index with correlation coefficient (r = -0.345, p = 0.001) among anaemic CKD
subjects, but weak positive correlation among controls (r = 0.001, p = 0.993).
Conclusion: This study showed that CKD patients with anaemia had significant impairment in
their physical ability than CKD patients without anaemia, and high prevalence of LVH and poor
left ventricular systolic function among them.