Eclampsia and seasonal variation in the tropics - a study in Nigeria

Abstract

Background:A retrospective observational study on the seasonal variation in the admission of eclampsia patients to the multi-disciplinary intensive care unit (ICU) of National Hospital, Abuja, Nigeria over a five-year span (March 2000 – March 2005) was carried out.Method:The patient’s case files and ICU records were used to extract the needed data. The diagnosis of eclampsia was based on clinical and laboratory findings by the obstetricians.Results:There were a total of 5,987 deliveries during the study period. Forty-six eclamptics were admitted to the ICU during the study period giving an ICU admission rate of 7.6/1000 deliveries. The average age of the patients was 28.6 years. Six patients (13%) were booked for antenatal care in the hospital, while forty patients (87%) were referred. Average duration of stay in the ICU was 4.6 days (range 1–42 days).Thirty-one eclamptics (67.4%) were admitted to the ICU during the rainy season (April to October) and fifteen (32.6%) during the dry season (November to April). The rainy season is associated with a lower average high temperature and a higher humidity than the dry season. There is a view that holds that increasing humidity and a lower temperature is associated with increased incidence of eclampsia. There were thirteen deaths giving a case fatality rate of 28.2%. The causes of death were HELLP (haemolysis, elevated liver enzymes, low platelet count) syndrome in six patients, disseminated intravascular coagulation in two patients, and acute renal failure (ARF) in two patients. Septicemia, lobar pneumonia/heart failure and cerebrovascular accident accounted for one death each.Conclusion:In this study, we found an association between the rainy season and the incidence of eclampsia to our intensive care unit. This association should be further explored.

Study of serum lactate dehydrogenase level and seasonal variation in preeclampsia and eclampsia with its obstetric outcome

“…Raised LDH level is known to be associated with HELLP syndrome, DIC and also heart disease, thus long term follow up of these young women for cardiac diseases like myocarditis, myocardial infarction, ect, is necessary. 8 There was no association between seasonal variation and occurrence of the disease observed in this study as opposed to a study by Magnus et al, in which there was a peak in occurrence of preeclampsia during winter.…”

Association of anemia, pre-eclampsia and eclampsia with seasonality: A realist systematic review

“…Thirteen of the studies found a statistically significant relationship between season and temperature on maternal outcomes. Some studies did not examine statistical significance entirely or measure the significance between maternal outcomes and seasonal variation (Bondevik et al, 2000;Hammerich et al, 2002;Crowther, 1985;Okafor et al, 2009;Halimi et al, 2010), while other studies found no statistical significance (Jamelle, 1998;Wacker et al, 1998;Soroori et al, 2007). It is important to note that seasonal patterns differ between countries based on climatology (e.g.…”

“…Contrarily, Immink et al (2008) found a significant correlation (p o0.032) in Tygerberg, South Africa, between the number of patients admitted with pre-eclampsia and low minimum temperatures; June had the lowest temperature of 7 1C compared to a maximum of 16.3 1C in February. Okafor et al (2009) documented a significant number of women admitted during the rainy seasons and suggested a link between the seasonality of eclampsia to the seasonality of malaria. This was confirmed in Anya's (2004) research, which established a 5.4 fold increase in eclampsia (p ¼0.008) during the malarial season.…”

“…Sixteen of the studies used retrospective analyses through the examination of hospitals records (Fleming, 1970;Hoestermann et al, 1996;Granja et al, 1998;Ndyomugyenyi and Magnussen, 2001;Hammerich et al, 2002;Anya, 2004;Hounton et al, 2008;Agobe et al, 1981;Crowther, 1985;Jamelle, 1998;Wacker et al, 1998;Subramaniam, 2007;Immink et al, 2008;Okafor et al, 2009;Halimi et al, 2010;Elongi et al, 2011). The common use of retrospective analyses made it easier to compare the findings using a systematic realist approach.…”

“…To investigate this issue, twelve articles focused on preeclampsia and eclampsia with regard to seasonal variation (see Table 2). Five studies found that eclampsia corresponded with the rainy season in Sub-Saharan Africa and the monsoonal season in India (Agobe et al, 1981;Wacker et al, 1998;Subramaniam, 2007;Okafor et al, 2009;Immink et al, 2008).…”