Details
Category: Volume 06 Issue 12 December 2018
Hits: 989

Title: Exploring factors associated with maternal deaths in the University of Port Harcourt Teaching Hospital: the health workers’ perspective

Authors: Dr Sede Joy Chidinma*, Dr Daprim Samuel Ogaji

 DOI: https://dx.doi.org/10.18535/jmscr/v6i12.152

Abstract

Pregnancy or delivery-related maternal deaths occur every 10 minutes in Nigeria. This amounts to a whopping 53,000 maternal deaths every year and for every woman who dies, 30-50 more women suffer childbirth-related injuries, infections, or diseases. This research was conducted to explore the factors associated with maternal deaths from the perspectives of health workers in the University of Port Harcourt Teaching Hospital, Rivers State, Nigeria. A mixed method approach involving the extraction of data from medical folders associated with maternal deaths from January 2013 - December 2017 and qualitative interviews with health workers. The majority of maternal deaths at the study occurred in those aged 30 – 39 years, unbooked and these deaths were mostly due to hypertensive disorders (24%). The commonest clinical presentation was seizures (13.5%) and the common reported cause of death was organ failure (29.2%). Maternal mortality is still common although there have been decrease over the years. Recommendations included increasing public enlightenment campaigns and education of the communities especially the rural ones on the importance of antenatal care and delivery taken in health facilities by trained attendants. Social health insurance should also be strengthened to improve access to preventative care and reduce the burden of catastrophic health expenditures among households with pregnant women. The need for proper management of patients’ health records was also advocated.

Keywords: Maternal, deaths, mortality records, related factors, causes

References

  1. Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van Look PF. WHO analysis of causes of maternal death: a systematic review. The Lancet,2006 ;367(9516):1066-74..
  2. World Health Organisation (WHO). Maternal mortality in 2005. Estimates developed by WHO, UNICEF, UNFPA, and the World Bank. World Health Organisation, 2007.
  3. Olusegun OL, Ibe RT, Micheal IM. Curbing maternal and child mortality: The Nigerian experience. International Journal of Nursing and Midwifery, 2012;4(3):33-9..
  4. Iloh GU, Ofoedu JN, Njoku PU, Amadi AN, Godswill-Uko EU. The Magnitude of Under-five Emergencies in a Resource-poor Environment of a Rural Hospital in Eastern Nigeria: Implication for Strengthening the House-hold and Community-integrated Management of Childhood Illnesses. North American journal of medical sciences, 2012;4(8):344 - 49.
  5. Masmas TN, Jensen H, da Silva D, Høj L, Sandström A, Aaby P. The social situation of motherless children in rural and urban areas of Guinea-Bissau. Social Science & Medicine, 2004;59(6):1231-9..
  6. Ujah IA, Aisien OA, Mutihir JT, Vanderjagt DJ, Glew RH, Uguru V. Factors contributing to maternal mortality in north-central Nigeria: a seventeen-year review. African journal of reproductive health, 2005:27-40.
  7. WHO U. UNFPA, World Bank Group and the United Nations Population Division. Trends in Maternal Mortality: 1990 to 2015. Estimates by WHO, UNICEF, UNFPA, World Bank and UN Population Division, Geneva: World Health Organization, 2015.
  8. Hill K, Thomas K, AbouZahr C, Walker N, Say L, Inoue M, & Suzuki E. Estimates of maternal mortality worldwide between 1990 and 2005: an assessment of available data. Lancet, 2007; 370: 9595:1311–1319.
  9. World Health Organization. Factsheet, Maternal Mortality: Fact sheet. Department of making pregnancy safer, 2008. Available fromhttp://www.who.intLast accessed 23/4/18.
  10. Mojekwu JN, Ibekwe U. Maternal mortality in Nigeria: Examination of intervention methods. International Journal of Humanities and Social Science, 2012;2(20):135-49.
  11. World Health Organization. Global Health Observatory (GHO) data. Maternal mortality country profiles, World Health Organisation, 2013.
  12. Olaitan T, Okafor IP, Onajole AT, &Abosede OA. Ending preventable maternal and child deaths in western Nigeria: Do women utilize the life lines? PLoSone, 2017:12(5):1-3.
  13. Anastasi E, Ekanem E, Hill O, Oluwakemi AA, Abayomi O, Bernasconi A. Unmasking inequalities: Sub-national maternal and child mortality data from two urban slums in Lagos, Nigeria tells the story. PloS one, 2017;12(5):e0177190.
  14. Tobin, E. A., Ofili, A. N., Enebeli, N., &Enueze, O. Assessment of birth preparedness and complication readiness among pregnant women attending Primary Health Care Centres in Edo State, Nigeria. Annuals of Nigerian Medicine, 2014; 8(2): 76-81
  15. Hunt Paul, & Bueno de Mezquita, J. Reducing maternal mortality. the contribution of the right to the highest attainable standard of health, 2007. Monograph available at http://repository.essex.ac.uk/9719/. Accessed 6/04/2018.
  16. Alkema L, Chou D, Hogan D, Zhang S, Moller AB, Gemmill A, Fat DM, Boerma T, Temmerman M, Mathers C, Say L. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. The Lancet, 2016;387(10017):462-74.
  17. Cross, S., Bell, J. S., & Graham, W. J.. What you count is what you target: the implications of maternal death classification for tracking progress towards reducing maternal mortality in developing countries. Bulletin of the World Health Organization, 2010; 88(2), 147–153.
  18. Ordinioha B, Sawyer W. The environmental health condition of the new UPTH. The Nigerian Health Journal,2011; 11(4), 117-119.
  19. Marshall MN. Sampling for qualitative research. Family practice, 1996; 13(6):522-6.
  20. Rees, D.G. Essential Statistics (4th). London, United Kingdom: Chapman & Hall/CRC, 2000.
  21. Mason, M. Sample size and saturation in PhD studies using qualitative interviews. In Forum qualitative Sozialforschung/Forum: qualitative social research, 2010; 11(3).
  22. Orazulike NC, Alegbeleye JO, Obiorah CC, Nyengidiki TK, &Uzoigwe SA. A 3-year Retrospective review of Mortality in women of reproductive age in a Tertiary health facility in Port Harcourt, Nigeria. International Journal of Women’s Health, 2017; 9,769–775.
  23. Agan, T.U., Archibong, E., Ekabua, J.E., Ekanem, E., Abeshi, S.E., Edentekhe, T., Bassey, E.E. Trends in maternal mortality at the University of Calabar Teaching Hospital, Nigeria, 1999-2009. International Journal of Women’s Health, 2010; 2:249-54.
  24. Nove A, Matthews Z, Neal S, Camacho AV. Maternal mortality in adolescents compared with women of other ages: evidence from 144 countries. The Lancet Global Health, 2014;2(3):e155-64..
  25. SirikulIsaranurug M, Mo-Suwan L, Choprapawon C. Differences in socio-economic status, service utilization, and pregnancy outcomes between teenage and adult mothers. J Med Assoc Thai. 2006;89(2):51-145.
  26. Weitoft GR, Haglund B, Rosén M. Mortality among lone mothers in Sweden: a population study. The Lancet, 2000;355(9211):1215-9..
  27. Razum O, Jahn A. Marital status and maternal mortality. The Lancet, 2000;355(9221):2169..
  28. Karlsen S, Say L, Souza JP, Hogue CJ, Calles DL, Gülmezoglu AM, Raine R. The relationship between maternal education and mortality among women giving birth in health care institutions: analysis of the cross sectional WHO Global Survey on Maternal and Perinatal Health. BMC public health, 2011;11(1):606.
  29. Babalola S, Fatusi A. Determinants of use of maternal health services in Nigeria-looking beyond individual and household factors. BMC pregnancy and childbirth, 2009;9(1):43-44.
  30. National Population Commission (NPC) [Nigeria] and ORC Macro. Nigeria Demographic and Health Survey 2003. Calverton, Maryland: NPC and ORC Macro; 2004.
  31. National Population Commission. Nigeria Demographic and Health Survey 2008. Abuja, Nigeria: National Population Commission and ICF Macro.2009.
  32. Restrepo-Méndez MC, Victora CG. Maternal mortality by age: who is most at risk? The Lancet Global Health, 2014;2(3):e120-21.
  33. Sonneveldt E, Plosky WD, Stover J. Linking high parity and maternal and child mortality: what is the impact of lower health services coverage among higher order births? BMC Public Health, 2013;13(3):S7.
  34. Simkhada, B., Teijlingen, E.R., Porte, R.M., &Simkhada, P.J. Factors affecting the utilization of antenatal care in developing countries: systematic review of the literature Advanced Nursing Journal, 2008; 61(3):244-260.
  35. Obiechina NJ, Okolie VE, Okechukwu ZC, Oguejiofor CF, Udegbunam OI, Nwajiaku LS, Ogbuokiri C, Egeonu R. Maternal mortality at Nnamdi Azikiwe University Teaching Hospital, Southeast Nigeria: a 10-year review (2003–2012). International Journal of Women's Health. 2013;5:431-432.
  36. Murthy, B.K., Murthy, M.B., &Prabhu, P.M. Maternal Mortality in a Tertiary Care Hospital: A 10-year Review. International Journal of Preventive Medicine, 2013;4(1):105–109.
  37. Oladapo, O.T., Lamina, M.A., &Fakoya, T.A. Maternal deaths in Sagamu in the new millennium: a facility-based retrospective analysis. BMC Pregnancy Childbirth, 2006;6:6-8.
  38. Kullima, A.A., Kawuwa, M.B., Audu, B.M., Geidam, A.D., &Mairiga, A.G. Trends in maternal mortality in a tertiary institution in Northern Nigeria. Annuals of African Medicine, 2009; 8: 221-224.
  39. Bello, F.A., Adesina, O.A., Morhason-Bello, I.O. &Adekunle, A.O. Maternal Mortality Audit in a Tertiary Health Institution in Nigeria: Lessons from Direct Causes and its drivers. Niger J Med, 2015; 24(4): 300-6.
  40. Say L, Chou D, Gemmill A., Tuncalp O, Moller AB, Daniels J. Global causes of maternal death: A WHO systematic analysis. Lancet Global Health, 2014; 2, 323–333.
  41. Pacagnella RC, Cecatti JG, Parpinelli MA, Sousa MH, Haddad SM, Costa ML, Souza JP, Pattinson RC. Delays in receiving obstetric care and poor maternal outcomes: results from a national multicentre cross-sectional study. BMC pregnancy and childbirth, 2014;14(1):159-160.
  42. Mgawadere F, Unkels R, Kazembe A, & van den Broek N. Factors associated with maternal mortality in Malawi: application of the three delays model. BMC Pregnancy Childbirth, 2017; 17(1):219-220
  43. Okonofua F, Imosemi D, Igboin B, Adeyemi A, Chibuko C, Idowu A, Imongan W. Maternal death review and outcomes: An assessment in Lagos State, Nigeria. PloS one, 2017;12(12):e0188392.
  44. Audu BM, Takai UI, Bukar M. Trends in maternal mortality at University of Maiduguri teaching hospital, Maiduguri, Nigeria-A five-year review. Nigerian Medical Journal, 2010;51(4):147-151
  45. Mrisho M, Obrist B, Schellenberg JA, Haws RA, Mushi AK, Mshinda H, Tanner M, Schellenberg D. The use of antenatal and postnatal care: perspectives and experiences of women and health care providers in rural southern Tanzania. BMC pregnancy and childbirth, 2009;9(1):10.
  46. Onah HE, Okaro JM, Umeh U, Chigbu CO. Maternal mortality in health institutions with emergency obstetric care facilities in Enugu State, Nigeria. Journal of obstetrics and gynaecology, 2005;25(6):569-74.

Corresponding Author

Dr Sede Joy Chidinma

Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Phone: +2348131011153