Causes and contributory factors of maternal mortality: evidence from maternal and perinatal death surveillance and response in Ogun state, Southwest Nigeria

Abstract

BackgroundNigeria still ranks second globally in the number of maternal deaths. Most maternal death reviews in Nigeria are isolated research based reports from a single health facility. This study determined causes and contributory factors of maternal mortality in Ogun statefollowing a periodic State-widematernal and perinatal deaths surveillance and response (MPDSR) review.MethodsWe carried out a retrospective analysis of cases of maternal deaths notified (n = 77) and reviewed (n = 45) in health facilities in Ogun State from 2015 to 2016selected using total sampling method. Using the national MPDSR structured and validated data collection tools or questionnaire, collected data was extracted from existing MPDSR data base, andanalyzed using the Statistical Package for Social Sciences (SPSS) software 20.0. We obtained approval from the State Ministry of Health for this study.ResultsAverage age at maternal death was 30.8 ± 5.7 years. Haemorrhageand pre-eclampsia or eclampsia account for 43.4 and 36.9% of causes respectively. Leading contributory factors ofmaternal deaths include inadequate human resource for health, delay in seeking care, inadequate equipment, lack of ambulance transportation, and delay in referrals services. 51.1%of the women had antenatal care while a significant proportion of the women were referred from Traditional Births Attendants (TBAs) and mission houses.ConclusionWe concluded that many of the contributory factors of maternal mortality could be avoided if preventive measures were taken and adequate care available. MPDSR provides a platform for critical evidence of where the main problems lie, and can provide valuable information on strategies which maternal mortality prevention programs should focus on. The implementation and institutionalization of MPDSR programme is on course in Ogun State. MPDSR is feasible and should be institutionalized in all states of Nigeria. A commitment to act upon the findings of MPDSR is a key prerequisite for success.

Causes and contributing factors of maternal mortality in Bosaso District of Somalia. A retrospective study of 30 cases using a Verbal Autopsy approach

“…The majority of the deaths were direct obstetric deaths due to haemorrhage, followed by eclampsia, obstructed labour and sepsis. This is consistent with findings of other studies including a WHO global estimate [1,6,[14][15][16]. One study from Mozambique and some other African countries identified sepsis as the second leading direct cause of death and HIV/AIDS was the most common indirect cause of death [17].…”

Community-Based Health Planning and Services Plus programme in Ghana: A qualitative study with stakeholders in two Systems Learning Districts on improving the implementation of primary health care

“…An implication of this finding was that the community members, especially pregnant women mainly resorted to the utilisation of Traditional Birth Attendants (TBAs) during delivery. This comes at the backdrop that home deliveries with TBAs usually come with high maternal and neonatal mortality especially when they are untrained [27][28][29][30] which the participants in our study strongly alluded to. What makes the situation worse is that due to improper community entry, TBAs in our study were usually unwilling to refer cases they were unable to handle for skilled orthodox care and thereby increasing the chances of maternal deaths.…”

Magnitude, Trends and Causes of Maternal Mortality: A 7-year Review at a Tertiary Hospital in Rivers State, Nigeria

“…In the study by Okonofua et al [12], they found delay in arrival in hospital, the lack of antenatal care and patient's refusal to receive recommended treatment as the patient's associated causes of death, while delay in treatment, poor use of treatment protocols, lack of equipment and lack of skills by providers to use available equipment were the identified facility-related causes of death. In another study, by Sageer et al [13], the leading contributory factors of maternal deaths were inadequate human resource for health, delay in seeking care, inadequate equipment, lack of ambulance transportation, and delay in referral services.…”

“…Other studies have also found haemorrhage and pre-eclampsia and eclampsia as the leading causes of maternal deaths. Sageer et al [13] found figures of 43.4% and 36.9% of causes respectively in South-west Nigeria; Agan et al [8] found figures of 33.4% and 21.2% of causes respectively in South-south Nigeria; Tesfaye et al [14] found figures of 46.5% and 16.3% of causes respectively in Eastern Ethiopia. Nwagha et al [6] found sepsis as the commonest cause 25.8% before haemorrhage (23.7%) and pre-eclampsia/ eclampsia (12.4%).…”