Informed Consent Practices and its Implication for Emergency Obstetrics Care in Azare, North-Eastern Nigeria

Abstract

Background: Consent practices can affect the institution of emergency obstetrics care in the health facility, and may indeed, determine the degree of maternal mortality and morbidity. Objectives: This study was aimed at determining informed consent practices and its implication for Emergency Obstetrics Care (EOC). Methods: A cross-sectional study involving 787 women who presented with obstetric emergencies at the FMC Azare from 1st January 2008 to 31st December 2009 was done. The sociodemographic characteristics and birth outcome were compared between those that gave early consent (EC) and those that gave delayed consent (DC). Data was analysed using SPSS version 11. Morbidities and mortalities were compared in the two groups and P < 0.05 was considered statistically significant. Results: EC for obstetric intervention was obtained in 260 (33.0%) of the cases, while 527 (66.0%) gave DC. The mean length of time for DC was 4.5 + 3.5 hours (Range 1.25 to 72 hours). In 62.9% of cases the consent was given by the husband while the patient consented in 5.6%. In-laws, relatives and others were responsible for 13.8%, 8.5%, 5.7% and 3.5% respectively. Consent was significantly delayed when given by the husbands, in-laws and relatives. Patients that gave consents for their own treatment were more likely to be gainfully employed (P=0.019), educated (P=0.004) and booked (P=0.001). Maternal mortality, intrauterine fetal death, low Apgar scores and early neonatal death were significantly increased in the DC group with P values of 0.016, 0.032 and 0.026 respectively. Conclusion: Delay in giving Consent contributes significantly to maternal and fetal morbidity and mortality in our environment because it increases the 3rd level of delay.

Key words: Informed Consent, Early consent, Delayed consent, Emergency obstetric care, Obstetric intervention, Azare.