Place of birth or place of death: An evaluation of 1139 maternal deaths in Nigeria
Liverpool School of Tropical Medicine, Pembroke Place L3 5QA, United Kingdom; School of Nursing, Midwifery and Social Work, University of Manchester, Manchester M13 9PL, United Kingdom; Primary Health Care and Health Management Centre, Yemetu, Ibadan, Nig
Objective: to describe the incidence of maternal death by age, marital status, timing and place of death in Ibadan North and Ido Local Government Areas of Oyo State, Nigeria. Design: a retrospective study using multistage sampling with stratification and clustering to select local government areas, political wards and households. We included one eligible subject by household in the sample. Data on maternal mortality were collected using the principles of the indirect sisterhood method. Setting: Ibadan city of Oyo state, Nigeria. We included eight randomly selected political wards from Ibadan North LGA (urban) and Ido LGA (rural). Participants: 3028 participants were interviewed using the four questions of the indirect sisterhood method: How many sisters have you ever had who are ever married (or who survived until age 15)? How many are dead? How many are alive? How many died while they were pregnant, during childbirth, or within six weeks after childbirth (that is, died of maternal causes)? We also included other questions such as place and timing of death, age of women at death and number of pregnancies. Findings: 1139 deaths were reported to be related to pregnancy, childbirth or the puerperium. Almost half were aged between aged 25-34 years. More deaths occurred to women who were pregnant for the first time (33.4%, n=380) than for any other number of pregnancies, with 49.9% (n=521) dying within 24 hours after childbirth or abortion and 30.9% (n=322) dying after 24 hours but within 72 hours after childbirth or abortion. Only 71.5% (n=809) were reported to have been admitted to health-care facilities before their death, the percentage being higher in the urban LGA (72.4%, n=720) than the rural LGA (65.4%, n=89). The percentage being admitted varied from one political ward to another (from 42.9% to 80.4%), the difference being statistically significant (χ2=17.55, df=7, p=0.014). The majority of the deaths occurred after childbirth (63.5%, n=723). Most deaths were said to have occurred in the hospital (38.6%) or private clinic (28.2%), with 16.0% dying at home and 6.5% on the way to hospital. Key conclusions: maternal mortality in Nigeria is still unacceptably high. Implications for practice: ensure adequate training, recruitment and deployment of midwives and others with midwifery skills. Ensure midwives and other skilled birth attendants are backed up with functioning and well equipped health-care facilities. Provide health education and information to the public with regard to reproductive health and ensure the development and dissemination of a policy regarding attendance at birth by only health workers who have midwifery skills. © 2012 Elsevier Ltd.
adolescent; adult; article; cause of death; demography; developing country; epidemiology; female; health care delivery; human; marriage; maternal mortality; middle aged; midwife; Millennium development goal five; Nigeria; Place of maternal deaths; politics; pregnancy; reproductive history; retrospective study; socioeconomics; statistics; Developing countries; Maternal mortality; Millennium development goal five; Place of maternal deaths; Adolescent; Adult; Cause of Death; Female; Health Services Accessibility; Humans; Marital Status; Maternal Death; Maternal Mortality; Middle Aged; Midwifery; Nigeria; Politics; Pregnancy; Reproductive History; Residence Characteristics; Retrospective Studies; Sampling Studies; Socioeconomic Factors