Prevalence and risk factors for maternal mortality in referral hospitals in Nigeria: a multicenter study

Abstract

IntroductionWhile reports from individual hospitals have helped to provide insights into the causes of maternal mortality in low-income countries, they are often limited for policymaking at national and subnational levels. This multisite study was designed to determine maternal mortality ratios (MMRs) and identify the risk factors for maternal deaths in referral health facilities in Nigeria.MethodsA pretested study protocol was used over a 6-month period (January 1–June 30, 2014) to obtain clinical data on pregnancies, births, and maternal deaths in eight referral hospitals across eight states and four geopolitical zones of Nigeria. Data were analyzed centrally using univariate, bivariate, and multivariate statistics.ResultsThe results show an MMR of 2,085 per 100,000 live births in the hospitals (range: 877–4,210 per 100,000 births). Several covariates were identified as increasing the odds for maternal mortality; however, after adjustment for confounding, five factors remained significant in the logistic regression model. These include delivery in a secondary health facility as opposed to delivery in a tertiary hospital, non-booking for antenatal and delivery care, referral as obstetric emergency from nonhospital sources of care, previous experience by women of early pregnancy complications, and grandmultiparity.ConclusionMMR remains high in referral health facilities in Nigeria due to institutional and patient-related factors. Efforts to reduce MMR in these health facilities should include the improvement of emergency obstetric care, public health education so that women can seek appropriate and immediate evidence-based pregnancy care, the socioeconomic empowerment of women, and the strengthening of the health care system.

Maternal mortality and factors affecting it, among pregnant women in Abeokuta South, Nigeria

“…This may be attributed to the socio-cultural beliefs of participants, as pregnant women in Abeokuta would rather consult religious leaders or traditional healers for information about their health. This agrees with the indings of Na iu, Kabir & Adiukwu, 2016; Ntoimo et al [10,11]. Respondents also agreed that grief and depression could lead to maternal mortality.…”

“…Risk of maternal mortality is increased in women who have had two children and above [9]. The higher the number of antenatal visits, the lower the likelihood of maternal mortality [10,11]. Azuh, Azuh, Iweala, Adeloye, Akanbi & Mordi [12] reported that place of delivery of last birth is signi icant to maternal mortality.…”

Non-Utilization of antenatal care services among women of reproductive age in the Niger delta region of Nigeria: Findings from 2595 women

“…The antenatal period provides ample opportunity for health workers to educate women, offer screening, diagnosis and treatment services for pregnancy-related conditions, and refer women for specialized interventions. It is therefore imperative that pregnant women take full advantage of antenatal care services [8][9][10][11][12].…”

Improving maternal health:Women’s attitude to antenatal care utilization is crucial

“…Available evidence reveal that Nigeria has not attained the expected success in antenatal coverage and reduction in maternal mortality ratio [5,6]. The poor maternal health outcome in Nigeria could be a result of poor ANC coverage and utilization [7,8].…”

“…The poor maternal health outcome in Nigeria could be a result of poor ANC coverage and utilization [7,8]. The importance of ANC services in enhancing maternal health during pregnancy and influencing the outcomes of pregnancy have been shown in previous studies [6,[9][10][11]. ANC allows for prevention, early identification and management of conditions that could be aggravated by pregnancy or threatening to the mother and/or her baby.…”