Maternal mortality in northern Nigeria: findings of a health and demographic surveillance system in Zamfara State, Nigeria

Abstract

The aim of this study was to estimate: (1) the lifetime risk (LTR) of maternal death; and (2) the maternal mortality ratio (MMR) in the Zamfara State of northern Nigeria. Data from the Nahuche Health and Demographic Surveillance System were utilized using the 'sisterhood method' for estimating maternal mortality. Female respondents (15-49 years) from six districts in the surveillance area were interviewed, creating a retrospective cohort of their sisters who had reached the reproductive age of 15 years. Based on population and fertility estimates, we calculated the LTR of maternal death and the MMR. A total of 17,087 respondents reported 38,761 maternal sisters of whom 3592 had died and of whom 1261 were maternal-related deaths. This corresponded to an LTR of maternal death of 8% (referring to a period of about 10.5 years prior to the survey) and an MMR of 1049 deaths per 100,000 live births (95% confidence interval, 1021-1136). The study provides documented evidence of high maternal mortality in the study area and the state as a whole. Thus, there is a need to improve the health system with an emphasis on interventions that will accelerate reduction in MMR such as the availability of skilled birth attendants and emergency obstetric care, promotion of facility delivery and antenatal care attendance. This can be achieved through a holistic approach and is critical in order to accelerate progress in meeting the Millennium Development Goal of maternal mortality reduction.

When Women Deliver with No One Present in Nigeria: Who, What, Where and So What?

“…The persistently high rates of maternal mortality in Nigeria are even more stark when the rates are disaggregated by political zone [2], [3]. Estimates from several studies were collated and are presented in Table 2, to illustrate variations in the picture of mortality patterns in the country [4], [5], [6], [7], [8], [9], [10]. For example, the rate is 1049 per 100,000 live births in Zamfara State [8] and 1500/100,000 live births in Sokoto State [7].…”

“…Estimates from several studies were collated and are presented in Table 2, to illustrate variations in the picture of mortality patterns in the country [4], [5], [6], [7], [8], [9], [10]. For example, the rate is 1049 per 100,000 live births in Zamfara State [8] and 1500/100,000 live births in Sokoto State [7]. Some locality estimates based on hospital records showed a rate as high as 2,397 per 100,000 live births for the South East, Nigeria, although hospital-based rates are typically higher than population-based rates [4].…”

“…Lawoyin and Onadeko et al [8] contrasted the likelihood of neonates to die with skilled delivery assistance and other scenarios: neonates were five times more likely to die if they had no attendance at birth, three times more likely to die if their births were attended by Traditional Birth Attendants (TBA), and four times more likely to die if they were delivered outside the health facility. A matched case control study of 56 infants with permanent congenital and early hearing loss (PCEHL) and 280 normal hearing controls also found that infants delivered with unskilled attendance were four times more likely to develop PCEHL than their peers who were delivered with skilled attendance [16].…”

Choice of place of Delivery amongst Women in a Rural Community in northeastern Nigeria

“…The 2008 Nigeria Demographic and Health Survey (NDHS) reported that of all home deliveries, one in five pregnant women delivered alone with no one present [16] . Similar studies have also documented that newborns were five times more likely to die if they had no attendance at birth, three times more likely to die if their births were attended by Traditional Birth Attendants (TBA), and four times more likely to die if they were delivered outside the health facility [17] .…”

Countdown to 2015: Tracking Maternal and Child Health Intervention Targets Using Lot Quality Assurance Sampling in Bauchi State Nigeria

“…Evidence has shown that neonates were five times more likely to die without a birth attendant, three times more likely to die from births attended by Traditional Birth Attendants (TBA). Births that were delivered outside the health facilities were four times more likely to die [11]. Infants delivered with unskilled birth attendants were four times more likely to develop permanent congenital and early hearing loss (PCEHL) than those delivered with skilled attendance [12].…”