Avoidable maternal mortality in Enugu, Nigeria

Ozumba, Benjamin C.; Nwogu-Ikojo, E. E.

doi:10.1016/j.puhe.2007.04.018

Cited by 34 publications

(33 citation statements)

References 17 publications

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“…Patient factors accounted for about one third of substandard care factors, similar to other studies from sub-Saharan Africa [22, 23]. This reflects the importance of interventions which address the first two delay components: recognizing complications and making decision to seek medical attention and also delay in reaching care due to poor infrastructure.…”

Section: Discussionsupporting

confidence: 78%

Maternal mortality at muhimbili national hospital in Dar-es-Salaam, Tanzania in the year 2011

Pembe

Paulo

Dmello³

et al. 2014

BMC Pregnancy Childbirth

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BackgroundImproving maternal health is one of the eight millennium development goals adopted at the millennium summit in the year 2000. Within this frame work, the international community is committed to reduce the maternal mortality ratio by 75% between 1990 and 2015. The objective of this study was to determine the maternal mortality ratio, classify causes of maternal deaths and assess substandard care factors at Muhimbili National Hospital (MNH), Dar-es-Salaam in Tanzania.MethodsA retrospective review of all maternal death records of cases that occurred from 1st January to 31st December 2011 was done.ResultsThere were 10,057 live births, 155 maternal deaths and hence MMR of 1,541 per 100,000 live births. Direct causes of maternal deaths were classified in 69.5% of the maternal deaths. Of the direct causes, preeclampsia/eclampsia was the major cause (19.9% of all deaths), followed by post partum haemorrhage (14.9%), abortion complications (9.9%) and sepsis (9.2%). Among the indirect causes anaemia was the leading cause (11.3%) of all deaths, followed by HIV/AIDS (9.9%). Substandard care factors contributing to deaths were identified in 116 (82.3%) of all cases. Among these 28 had patient factors only, 71 medical service factors while 17 had both patient and medical service substandard care factors. The common factors from the woman’s side included delay in seeking care (73.3%) and complete lack of antenatal care (11.1%). Of the medical service factors, inadequate (26.1%) or no blood for transfusion (19.3%), delay in receiving treatment (18.3%) and mismanagement (17%) were the common factors.ConclusionThere is a high maternal mortality ratio at MNH. Hypertensive disorders of pregnancy, post partum haemorrhage and anaemia are the leading causes of maternal deaths in this institution. Multiple substandard care factors identified both at individual and health care service levels that contributed to maternal deaths. There is a need for increasing efforts in the fight to reduce maternal deaths at the institution. A more pro-active role from the referring facilities in the region is needed.

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Section: Discussionsupporting

confidence: 78%

Maternal mortality at muhimbili national hospital in Dar-es-Salaam, Tanzania in the year 2011

Pembe

Paulo

Dmello³

et al. 2014

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

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“…Ogunjuyigbe (2004) combine Samoza method and univariate and bivariate analysis to calculate mortality indices for each woman in Ondo and Ekiti state. Ozumba and Nwogu-Ikojo (2008) applied multiple regressions with autocorrelation adjustment to estimate mortality. Antai et al (2010) employ the multilevel logistic regression while Doctor (2011) uses multivariate logistic regression.…”

Section: Literature Reviewmentioning

confidence: 99%

Environmental Determinants of Child Mortality in Nigeria

Godson¹,

Nnamdi²

2011

JSD

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Globally, childhood mortality rates have decline over the years due majorly to various action plans and interventions targeted at various communicable diseases and other immunizable childhood infections which have been major causes of child mortality, but the situation seems to remain unchanged in sub-Saharan African countries, as approximately half of these deaths occur in sub-Saharan Africa despite the region having only one fifth of the world's children population. Many covariates associated with variations in infant and child mortality are interrelated, and it is important to attempt to isolate the effects of individual variables for proper and effective interventions. This study examined the environmental determinants of child mortality using principal component analysis as a data reduction technique with varimax rotation to assess the underlying structure for sixty-five measured variables, explaining the covariance relationships amongst the large correlated variables in a more parsimonious way and simultaneous multiple regression for child mortality modelling in Nigeria. For purpose of robustness, a model selection technique procedure was implemented. Estimation from the stepwise regression model shows that household environmental characteristics do have significant impact on mortality.

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“…Several studies have applied this model to local contexts,14–17 stressing the importance of eliminating delays occurring before and after the woman in labour arrives at the health facility settings,13 15 16 and suggesting interventions addressing identified local gaps in various components of the referral process 14 18 19. Recognising the importance of local provider and consumer inputs to the identification of barriers and ownership of solutions to overcome those barrier,20 21 we present a contextual application of Thaddeus and Maine's model in a rural setting in Ghana.…”

Section: Introductionmentioning

confidence: 99%

Quality improvement in emergency obstetric referrals: qualitative study of provider perspectives in Assin North district, Ghana

et al. 2014

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ObjectiveTo describe healthcare worker (HCW)-identified system-based bottlenecks and the value of local engagement in designing strategies to improve referral processes related to emergency obstetric care in rural Ghana.DesignQualitative study using semistructured interviews of participants to obtain provider narratives.SettingReferral systems in obstetrics in Assin North Municipal Assembly, a rural district in Ghana. This included one district hospital, six health centres and four local health posts. This work was embedded in an ongoing quality improvement project in the district addressing barriers to existing referral protocols to lessen delays.Participants18 HCWs (8 midwives, 4 community health officers, 3 medical assistants, 2 emergency room nurses, 1 doctor) at different facility levels within the district.ResultsWe identified important gaps in referral processes in Assin North, with the most commonly noted including recognising danger signs, alerting receiving units, accompanying critically ill patients, documenting referral cases and giving and obtaining feedback on referred cases. Main root causes identified by providers were in four domains: (1) transportation, (2) communication, (3) clinical skills and management and (4) standards of care and monitoring, and suggested interventions that target these barriers. Mapping these challenges allowed for better understanding of next steps for developing comprehensive, evidence-based solutions to identified referral gaps within the district.ConclusionsProviders are an important source of information on local referral delays and in the development of approaches to improvement responsive to these gaps. Better engagement of HCWs can help to identify and evaluate high-impact holistic interventions to address faulty referral systems which result in poor maternal outcomes in resource-poor settings. These perspectives need to be integrated with patient and community perspectives.

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Avoidable maternal mortality in Enugu, Nigeria

Cited by 34 publications

References 17 publications

Maternal mortality at muhimbili national hospital in Dar-es-Salaam, Tanzania in the year 2011

Maternal mortality at muhimbili national hospital in Dar-es-Salaam, Tanzania in the year 2011

Environmental Determinants of Child Mortality in Nigeria

Quality improvement in emergency obstetric referrals: qualitative study of provider perspectives in Assin North district, Ghana

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