Trend and Causes of Maternal Mortality in a Nigerian Tertiary Hospital: A 5-year Retrospective Study (2010-2014) at the University of Calabar Teaching Hospital, Calabar, Nigeria

Abstract

BACKGROUND:Maternal mortality ratios (MMR) are still unacceptably high in many low-income countries especially in sub-Saharan Africa. MMR had been reported to have improved from an initial 3,026 per 100,000 live births in 1999 to 941 in 2009, at the University of Calabar Teaching Hospital (UCTH), Calabar, a tertiary health facility in Nigeria. Post-partum haemorrhage and hypertensive diseases of pregnancy have been the common causes of maternal deaths in the facility.AIM:This study was aimed at determining the trend in maternal mortality in the same facility, following institution of some facility-based intervention measures.METHODOLOGY:A retrospective study design was utilised with extraction and review of medical records of pregnancy-related deaths in UCTH, Calabar, from January 2010 to December 2014. The beginning of the review period coincided with the period the “Woman Intervention Trial” was set up to reduce maternal mortality in the facility. This trial consists of the use of Tranexamic acid for prevention of post-partum haemorrhage, as well as more proactive attendance to parturition.RESULTS:There were 13,605 live births and sixty-one (61) pregnancy-related deaths in UCTH during the study period. This yielded a facility Maternal Mortality Ratio of 448 per 100,000 live births. In the previous 11-year period of review, there was sustained the decline in MMR by 72.9% in the initial four years (from 793 in 2010 to 215 in 2013), with the onset of resurgence to 366 in the last year (2014). Mean age at maternal death was 27 ± 6.5 years, with most subjects (45, 73.8%) being within 20-34 years age group. Forty-eight (78.7%) were married, 26 (42.6%) were unemployed, and 33 (55.7%) had at least secondary level of education. Septic abortion (13, 21.3%) and hypertensive diseases of pregnancy (10, 16.4%) were the leading causes of death. Over three quarters (47, 77.0%) had not received care from any health facility. Most deaths (46, 75.5%) occurred between 24 and 97 hours of admission.CONCLUSION:Compared with previous trends, there has been a significant improvement in maternal mortality ratio in the study setting. There is also a significant change in the leading cause of maternal deaths, with septic abortion and hypertensive disease of pregnancy now replacing post-partum haemorrhage and puerperal sepsis that was previously reported. This success may be attributable to the institution of the Woman trial intervention which is still ongoing in other parts of the world. There is, however, need to sustain effort at a further reduction in MMR towards the attainment of set sustainable development goals (SDGs), through improvement in the provision of maternal health services in low-income countries.

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

“…This is however lower than The Nigerian national MMR of 814 in 2015 recorded by WHO [1] and the 903.7 recorded by Nwagha et al [6] and much higher figures from other studies in Nigeria [17,18,19]. This is however higher than the findings of a similar study in the South-South region of Nigeria by Agan et al 2018 [15] of 448, but lower than their earlier finding of 1,513 at the same center in 2010 [8]. The success in reduction of MMR in their study was attributed to the free maternal care services to all categories of pregnant women in their state, as well as the Although the MMR of 644 in this study is lower than the current WHO estimate for Nigeria, it is abysmal when compared with the estimates for developed nations, such as 3 for Denmark, 8 for the UK, and 14 for Singapore [1].…”

“…Nwagha et al [6] in their study also recorded consistent increase in the MMR over the 3-year period of 2003(756.8), 2004(897.6) and 2005(1052.2). However, Agan et al [15] reported a consistently decreasing MMR over their 5-year study period.…”

“…Other studies have reported these two culprits as the main causes but with postpartum haemorrhage as the major offender [11,12,13,14]. Agan et al [8] in their earlier study reported the leading causes as postpartum haemorrhage (33.4%) and preeclampsia / eclampsia (21.2%) but in their later study, Agan et al [15], it was sepsis (21.3%) and hypertensive disorders in pregnancy (16.4%). They deduced that the significant reduction in MMR might have been as a result of reduction in deaths from postpartum haemorrhage following the dedicated implementation of the Woman Trial.…”

“…Nwagha et al [6] found sepsis as the commonest cause 25.8% before haemorrhage (23.7%) and pre-eclampsia/ eclampsia (12.4%). In a recent review of causes at their Centre, Agan et al [15] found sepsis (21.3%) and hypertensive diseases (16.4%) as the leading causes of death.…”

Maternal near‐miss and death associated with abortive pregnancy outcome: a secondary analysis of the Nigeria Near‐miss and Maternal Death Survey

“…At present, there are few studies in Nigeria reporting maternal deaths from pregnancies with an abortive outcome, and none is nationally representative . Likewise, institutional‐based reports on maternal near‐miss and deaths from ectopic pregnancy in the country are random and scarce .…”