Abstract
Introduction
While reports from individual hospitals have helped to provide insights into the causes of maternal mortality in low-income countries, they are often limited for policymaking at national and subnational levels. This multisite study was designed to determine maternal mortality ratios (MMRs) and identify the risk factors for maternal deaths in referral health facilities in Nigeria.
Methods
A pretested study protocol was used over a 6-month period (January 1–June 30, 2014) to obtain clinical data on pregnancies, births, and maternal deaths in eight referral hospitals across eight states and four geopolitical zones of Nigeria. Data were analyzed centrally using univariate, bivariate, and multivariate statistics.
Results
The results show an MMR of 2,085 per 100,000 live births in the hospitals (range: 877–4,210 per 100,000 births). Several covariates were identified as increasing the odds for maternal mortality; however, after adjustment for confounding, five factors remained significant in the logistic regression model. These include delivery in a secondary health facility as opposed to delivery in a tertiary hospital, non-booking for antenatal and delivery care, referral as obstetric emergency from nonhospital sources of care, previous experience by women of early pregnancy complications, and grandmultiparity.
Conclusion
MMR remains high in referral health facilities in Nigeria due to institutional and patient-related factors. Efforts to reduce MMR in these health facilities should include the improvement of emergency obstetric care, public health education so that women can seek appropriate and immediate evidence-based pregnancy care, the socioeconomic empowerment of women, and the strengthening of the health care system.
Acknowledgments
Professor Eze Nwokocha (Medical Sociologist and Anthropologist, University of Ibadan) assisted with the qualitative data analysis. We are grateful to Dr Taiwo Oyelade and Dr Mariana Widmer of the Nigeria and Geneva offices of the World Health Organization for their support for the study. Funding was from the World Health Organization: Alliance for Health Policy and Systems Research grant/award number A65869 to the Women’s Health and Action Research Centre (WHARC).
Disclosure
The authors report no conflicts of interest in this work.