MATERNAL AND PERINATAL HEALTH IN MALI, TOGO AND NIGERIA

Objective: The health care system in many developing countries is less efficient compared with that in the industrialized world. The aim of the present study was to investigate the differences of the efficiency of the health care in obstetrics in Nigeria, Mali and Togo. Study des ign: The data were collected in African district hospitals from Lome/T ogo (n=1002), Bamako/Mali (n=1462) and Kaduna/Nigeria (n=1055) with a routinely applied questionnaire analyzed at the University Giessen and compared with the data from the Department of Obstetrics and Gynaecol ogy Giessen (Germany) (referral hospital) (n=1313) and the total data pool of the perinatal survey 1993 in Hesse (n=58 430). Results: The me dical history indicates important differences: the incidence of young mothers below 18 is highest in Mali (9.8%) compared with Nigeria (2.7% ) and Togo (2.6%) (Hesse 0.6%). In general there is an increased rate of previous pregnancies of more than five: 13-28% (Hesse 2.1%). The ra te of prenatal visits is also reduced: more than ten visits have 2% in Togo, 10.6% in Mali and 15.5% in Nigeria (Hesse 72%). Ultrasound exam inations are very rare (1-12%) and tocolysis is nearly unknown. As a r esult the incidence of dead infants in the medical history is high: Ma li 28%, Togo 18%, Nigeria 10.8% (Hesse 1.7%), as well as the rate of l ow birth weight infants. This is also reflected in the perinatal morta lity which ranged from 115 parts per thousand in Mali, 77 parts per th ousand in Togo and 68 parts per thousand in Nigeria (Hesse 5.3 parts p er thousand, Ob/Gyn Giessen 16.4 parts per thousand). Conclusion: The improvement of perinatal and maternal health in the developing world c an only be achieved if family planning, prenatal care, selection of hi gh risk pregnancies goes in parallel with a sound organization impleme nted and supported by the government.