Trends in utilization of obstetric care at Wesley Guild Hospital, Ilesa, Nigeria: effects of a depressed economy

During 1981-1990 there were 12925 deliveries and 68668 mothers received prenatal care at Wesley Guild Hospital in Ilesa Nigeria. Physicians retrospectively analyzed data on these deliveries to determine trends in the perinatal mortality rate under harsh economic conditions. Rising economic hardship in Nigeria forced the hospital to introduce fees in late 1984 after which the number of mothers receiving prenatal care and the resultant number of deliveries at the hospital declined significantly (p < 0.001). In fact the percentage of deliveries where the mothers did not receive prenatal care increased as the total number of deliveries decreased (p < 0.001). The fees and the concurrent economic hardship decreased the purchasing power of the people thus more and more mothers could not afford to pay for prenatal care and delivery in the hospital. During the study period there were 747 perinatal deaths for a perinatal mortality rate of 57.8/1000 total births. The rate increased from 38.7 after introduction of fees and peaked at 110.5 in 1987. Leading obstetric complications were antepartum hemorrhage prolonged obstetric labor preeclampsia cord prolapse retained second twin severe anemia and maternal and fetal distress. The distribution of stillbirths early neonatal deaths and major obstetric complications was unequal during the study period. Stillbirths accounted for more than 75% of perinatal deaths. Factors related to stillbirth included prolonged obstructed labor antepartum hemorrhage multiple pregnancy and eclampsia. The two leading causes of early neonatal death were preterm delivery (low birth weight < 2500 g) (62.2%) and birth asphyxia (27.7%). More than 75% of these deaths occurred within the first 48 hours of life. More than 50% of the preterm infants weighed less than 1500 g at birth. These findings reflect the adverse effect of economic hardship and of the introduction of fees on perinatal health at Wesley Guild Hospital.