Reducing maternal deaths in a low resource setting in Nigeria

Ezugwu, E.C.; Agu, PU; Nwoke, Mo O.; Ezugwu, Frank Okechukwu

doi:10.4103/1119-3077.122842

Cited by 39 publications

(31 citation statements)

References 20 publications

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“…About 94.7% of women in Enugu received ante natal care from a skilled provider, while skill birth attendance is about 93% [34]. However, the maternal mortality rate in Enugu is 645/100, 000 live births [35], higher than the national rate of 512/100, 000 live births [34].…”

Section: Study Settingmentioning

confidence: 99%

Person-Centred Maternity Care in a Poor-Resource Setting: Evidence from a Cross-Sectional Study in Enugu State, Nigeria

Ogbuabor

Nwankwor

2020

Preprint

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Background Women are not getting adequate person-centred maternity care (PCMC) in low-income and middle-income countries despite being important in reducing maternal morbidity and mortality. This study assessed perceptions and predictors of PCMC among childbearing women in Enugu State, South-east Nigeria.Methods The study was conducted in two health districts in Enugu State using a descriptive, cross-sectional survey design. We conveniently selected 450 childbearing women, within 9 weeks post-partum, from 11 health facilities purposively selected based on high maternal and child health attendance. Data was collected from women using an interviewer administered 30-item PCMC scale (scores 0–90) consisting of: dignity and respect (6 items, scores 0–18), communication and autonomy (9 items, scores 0–27), and supportive care (15 items, scores 0–45). We categorized full PCMC and each sub-scale into “low, medium and high” using 25th and 75th percentile of the summative scores. The questionnaire also collected data on women characteristics, facility characteristics and service type. Data were analysed using descriptive statistics, t- tests, analysis of variance and Generalized Linear Models.Results Women had medium scores on full PCMC scale and sub-scales. The lowest score was in communication and autonomy. A quarter of women perceived PCMC as high. Marrying at age 20–29 years (β = 5.83, ρ = 0.002), self-employed women (β = -10.23, ρ = 0.004), starting antenatal care in the third trimester (β = -7.93, ρ = 0.008), high participation in household decisions (β = -4.98, ρ = 0.011), domestic violence experience (β = 5.41, ρ = 0.002), delivery at health centre (β = 7.09, ρ = 0.000), delivery at private/mission hospital (β = 17.47, ρ = 0.000), delivery by non-skilled attendant (β = -9.61, ρ = 0.001); delivery by community health workers (β = -7.65, ρ = 0.001), and experience of pregnancy complication (β = 6.20, ρ = 0.028) predicted PCMC.Conclusions Person-centred maternity care was generally inadequate. Improving PCMC would entail sustaining dignified care, enhancing provider-patient communication, addressing facility-level drivers, increasing women’s personal empowerment and self-employment, timely initiation of antenatal care, and paying attention to women with pregnancy complication.

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Section: Study Settingmentioning

confidence: 99%

Person-Centred Maternity Care in a Poor-Resource Setting: Evidence from a Cross-Sectional Study in Enugu State, Nigeria

Ogbuabor

Nwankwor

2020

Preprint

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“…The maternal mortality rate in Enugu is 645/100,000 live births [43], higher than the national rate of 576/100,000 live births [44]. Under-five mortality rate in South-east Nigeria, including Enugu State, is 131/1000 live births; slightly higher than national average of 128/100,000 live births [44].…”

Section: Introductionmentioning

confidence: 99%

Implementation of free maternal and child healthcare policies: assessment of influence of context and institutional capacity of health facilities in South-east Nigeria

Ogbuabor

Onwujekwe

2018

Global Health Action

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Background: Studies examining how the capacity of health facilities affect implementation of free healthcare policies in low and middle-income countries are limited.Objective: This study describes how the context and institutional capacity of health facilities influenced implementation of the free maternal and child health programme (FMCHP) in Enugu state, South-east Nigeria.Methods: We conducted a qualitative case study at the state level and in two health districts (Isi-Uzo and Enugu Metropolis) in Enugu State. Data were collected through document review and semi-structured, in-depth interviews with policymakers (n = 16), healthcare providers (n = 16) and health facility committee leaders (n = 12) guided by an existing capacity framework and analysed using a thematic framework approach.Results: The findings reveal that active health facility committees, changes in provider payment process, supportive supervision, drug revolving fund, availability of medical equipment, electronic data transmission and staff sanction system enhanced the capacity of health facilities to offer free healthcare. However, ineffective decentralisation, irregular supervision and weak citizen participation limited this capacity. Uncertain provider payment, evidence of tax payment policy and a co-existing fee-exempt scheme constrained health facilities in following the FMCHP guidelines. Poor recording and reporting skills and lack of support from district officials constrained providers’ adherence to claims’ submission timeline. Poor funding, weak drug supply system, inadequate infrastructure and lack of participatory decision-making constrained delivery of free healthcare. Insufficient trained workforce, mission-inconsistent postings and transfers, and weak staff disciplinary system limited the human resource capacity.Conclusions: Effectiveness of FMCHP at the health facility level depends on the extent of decentralisation, citizen participation, concurrent and conflictive policies, timely payment of providers, organisation of service delivery and human resources practices. Attention to these contextual and institutional factors will enhance responsiveness of health facilities, sustainability of free healthcare policies and progress towards universal health coverage.

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“…6 The MMR for this unit has not been documented before in the literature. In a similar low-resource setting in a Nigerian hospital it was found to be 645 maternal deaths per 1,00,000 live births 7 and 438 maternal deaths per 10,000 live births in a Ugandan hospital. 8 The global causes of maternal mortality are haemorrhage, hypertensive disorders and sepsis, which account for more than half of the global deaths.…”

Section: Introductionmentioning

confidence: 95%

The Effect of the Introduction of Emergency Obstetric Drills on Maternal Mortality Trends in a Low-Resource Setting: A 5-Year Review at Mpilo Central Hospital, Bulawayo, Zimbabwe

Ngwenya¹

2017

Gynecol Obstet Res Open J

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CitationNgwenya S. The effect of the introduction of emergency obstetric drills on maternal mortality trends in a low-resource setting: A 5-year review at Mpilo Central Hospital, Bulawayo, Zimbabwe. Maternal deaths are very distressing to the healthcare givers and devastating to surviving family members. They decimate young, healthy women at the peak of their reproductive lives. The deaths result in orphaned children. Globally maternal deaths remain high on the agenda of the World Health Organisation (WHO) and the United Nations (UN) with the aim to reduce them. Developing nations with low/middle incomes contribute the majority of global deaths. Pregnant women in these settings face far greater risks of dying in pregnancy compared to their counterparts in rich-resourced countries. In this unit, there was an introduction of emergency obstetric drills (PROPMT

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Reducing maternal deaths in a low resource setting in Nigeria

Abstract: Administration of evidence based intervention is possible in low resource settings and could contribute to a significant reduction in the maternal deaths.

Cited by 39 publications

References 20 publications

Person-Centred Maternity Care in a Poor-Resource Setting: Evidence from a Cross-Sectional Study in Enugu State, Nigeria

Person-Centred Maternity Care in a Poor-Resource Setting: Evidence from a Cross-Sectional Study in Enugu State, Nigeria

Implementation of free maternal and child healthcare policies: assessment of influence of context and institutional capacity of health facilities in South-east Nigeria

The Effect of the Introduction of Emergency Obstetric Drills on Maternal Mortality Trends in a Low-Resource Setting: A 5-Year Review at Mpilo Central Hospital, Bulawayo, Zimbabwe

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