Socio-cultural factors in maternal morbidity and mortality: a study of a semi-urban community in southern Nigeria

Abstract

Study objective-To understand community based or socio-cultural factors that determine maternal morbidity and mortality in a semi-urban setting. Design-The study is an exploratory multidisciplinary operations research and the instruments were focus groups and interviews. Setting-Ekpoma, a semi-urban community with a population of 70 000 in central part of Edo state in southern Nigeria. Participants-Thirteen groups of women, two groups of men, and two groups of traditional birth attendants. Results-There is a fairly good knowledge of haemorrhage but this is circumscibed by attitudes, practices, and situations that keep women away from or delay the decision to seek modern obstetric care. Conclusions-For a fuller understanding of maternal morbidity and mortality, it is important to consider factors outside the hospital and formal medical practice. Furthermore, a change of existing knowledge, attitudes, practices, and situations can be enhanced through modelling on them. (J Epidemiol Community Health 1998;52:293-297) The level of maternal mortality in Africa, estimated at 100-fold to 200-fold that of the industrialised countries, is unacceptably high. 1Because of its very high fertility and death rates, Nigeria is said to account for 10 per cent of the world's maternal mortality.2 Moreover, most of these women suVer permanent disabilities.The most common medical causes of maternal deaths are haemorrhage, toxaemia, infection, obstructed labour, and unsafe abortion. Deaths from most of these complications can be prevented if promptly and eVectively managed. But in sub-Saharan Africa, the problem stems not only from inadequate health services, but is also the result of the interplay of many antecedent factors that could be social, cultural, economic and logistic, coupled with very high fertility. Such sex specific health problems ramify into the well known sociocultural diYculties and discriminations endured by women in Third World countries. 3Most of these women would have been neglected as children, overworked and underfed, espoused as adolescents, are quite often poor and illiterate, usually subjected to harmful traditional practices, denied equal social status in the society, and denied adequate family planning and maternal health services.Although the limitations of health care delivery facilities and, therefore, personnel in Third World countries are quite well known, nonmedical factors, which are no less important have turned out to be intractable problems and are often conveniently ignored by confounded oYcials. Even in situations where modern health care facilities and personnel are available, many routine traditional or normative practices may prevent or delay the decision to seek proper and more eVective care.The objective of this study is to highlight these community based factors and their implications in maternal mortality and morbidity. Methods EKPOMAEkpoma was chosen as the study site because the social and political situation were conducive to working with the community. It is also an area b...

Awareness and perception of maternal mortality among women in a semi-urban community in the Niger Delta of Nigeria

“…Similar observations have been noted in previous studies. [7,8] Surprisingly, this high level of awareness even among some sections of the populace does not translate to reduced maternal mortality rates, as Nigeria still has one of the worst statistics in the world with regard to maternal mortality.…”

“…[2,3,5,10] Okolocha et al found that women in southern Nigeria had fairly good knowledge of obstetric hemorrhage as a cause of maternal mortality but yet their attitudes, practices and situations kept them away from, or delayed the decision to seek, modern obstetric care. [7] Causes such as infidelity, witchcraft/evil forces and disobedience surprisingly constituted 8.3% of the causes of death mentioned by the subjects. This may be due to the fact that majority of the study population were educated.…”

“…Sociocultural factors have been highlighted as significant contributors to maternal mortality in Sub-Saharan Africa. [7] Okolocha et al concluded that for a fuller understanding of maternal morbidity and mortality, it is important to consider factors outside the hospital and formal medical practice. [7] A study in Konduga, Bornu State of Nigeria, showed that their community members had a good understanding of obstetric complications leading to maternal death.…”

“…[7] Okolocha et al concluded that for a fuller understanding of maternal morbidity and mortality, it is important to consider factors outside the hospital and formal medical practice. [7] A study in Konduga, Bornu State of Nigeria, showed that their community members had a good understanding of obstetric complications leading to maternal death. [8] Another study among the Annang in southeastern Nigeria showed that most of the participants felt hospitals generally connote sickness and were places reserved for sick people only.…”

Improving maternal nutrition for better pregnancy outcomes

“…Pregnancy outcomes rank among the pressing reproductive health problems in the world. Globally, an annual estimate of 600 000 women aged 15-49 die of pregnancy related causes, with 99 % coming from the developing world (1)(2)(3) and Nigeria alone accounting for 10 % of this total (4) . The status of maternal and fetal mortality may be threatening and calls for serious attention.…”