Prevalence and risk factors for maternal mortality in referral hospitals in Nigeria: a multicenter study

Abstract

Lorretta F Ntoimo,1,2 Friday E Okonofua,1,3,4 Rosemary N Ogu,1,3,5 Hadiza S Galadanci,6 Mohammed Gana,7 Ola N Okike,8 Kingsley N Agholor,9 Rukiyat A Abdus-Salam,10 Adetoye Durodola,11 Eghe Abe,12 Abdullahi J Randawa13 On behalf of the WHARC WHO FMOH MNCH Implementation Research Study Team 1WHO Implementation Research Group, The Women’s Health and Action Research Centre, Benin City, Edo State, 2Department of Demography and Social Statistics, Federal University Oye-Ekiti, Ekiti State, 3Centre of Excellence in Reproductive Health Innovation, University of Benin, Benin City, Edo State, 4Vice Chancellors Office, University of Medical Sciences, Ondo City, Ondo State, 5Department of Obstetrics and Gynaecology, University of Port Harcourt, Port Harcourt, Rivers State, 6Aminu Kano Teaching Hospital, Kano, Kano State, 7General Hospital, Minna, Niger State, 8Karshi General Hospital, Federal Capital Territory, Abuja, 9Central Hospital, Warri, Delta State, 10Adeoyo Maternity Hospital, Ibadan, Oyo State, 11General Hospital, Ijaye, Abeokuta, Ogun State, 12Central Hospital, Benin City, Edo State, 13Department of Obstetrics and Gynaecology, Ahmadu Bello University, Zaria, Kaduna State, Nigeria 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. Keywords: maternal death, maternal mortality ratio, emergency obstetric care, pregnancy care, tertiary hospital

Keywords

• Mortality
• Pregnancy
• High risk pregnancy
• Women health issues
• midwifery