ABSTRACT
Background: Although MMR has reduced over the last two decades from 380 to 210 deaths per 100,000 live births globally, there are still many challenges in achieving acceptable levels. According to the new sustainable development goals (SDGs), SDG 3.1 targets to reduce by 2030, the global MMR to <70 per 100,000 live births.
Objective: To determine causes of maternal mortality among women who received antenatal care at Yaba Primary Health Care facility between January 2010 and December 2020.
Method: This was unmatched case-control study in which medical records were reviewed to identify cases and appropriate controls. Cases comprised women who experienced maternal mortality and controls comprised women who attended the antenatal clinic but did not die during the study period. The data was collected by using a structured questionnaire. Data collected was coded and entered into statistical analysis software (SPSS) version 23. Data was presented in the form of tables and figures. Logistic regression was used to evaluate the strength of the association of each determinant and associations was considered statistically significant at P values of <0.05. Estimates were presented as OR using 95%confidence interval.
Result: Between January 2010 and December2016, a total of 200 files (50 cases and 150 controls) were identified. Cases had lower odds of having secondary education, OR 0.24 (95% CI 0.10-0.56), p<0.001or tertiary education, OR 0.32 (95% CI 0.14-0.71, p<0.001).
Cases had greater odds of preterm delivery, OR 2.81, 95% CI 1.43-5.03, p <0.001.Hypertensive disease (eclampsia and preeclampsia) were the leading direct cause of maternal mortality (39.3%) and HIV/AIDS was the leading cause of indirect maternal mortality (36.4%).Conditions significantly associated with maternal mortality included: preexisting medical conditions (OR 6.048, 95% CI 3.012-12.15; p < 0.01), cardiac disease OR 24.43 (95% 2.75-217.2) p<0.01, HIV OR 6.20 (95% CI 2.49-15.44) p<0.001 and Anemia OR 4.371, 95% CI 1.041-18.34; p < 0.004).
Conclusion: Among Yaba Health Care ANC clinic attendees, the risk factors for maternal mortality included a lower level of education, preexisting medical conditions especially cardiac disease and HIV/AIDS while hypertensive disorders and HIV/AIDs were the leading causes of maternal mortality.
Recommendations: Based on the study findings, (i) being poor (lack education and unemployed) is in itself a barrier to seeking adequate care, a multi-sectoral approach to fight poverty among women in the society is recommended; (ii) there is evidence that screening for pre-existing medical conditions during the antenatal period plays a significant role in reducing the risk of death to the mother. Thus, efforts for specialized consultation and care is highly recommended; (iii)periodic maternal mortality studies should be done to monitor emerging trends in maternal mortality causes, as well as evaluate the effectiveness of interventions aimed at reducing maternal mortality.
CHAPTER ONE
1.0 INTRODUCTION
1.1 Background of study
Globally, improving maternal health is one of the eight millennium development goals. In goal number five (MDGs) countries are committed to reducing mortality by 75% between 1990 -2020.According to UNFPA (2020), there has been an improvement in maternal health worldwide evidenced by a reduction in maternal mortality over the last two decades from 385to 216 deaths per 100,000 live births [3].
All regions have made progress but the challenge still persists especially in developing regions. In Eastern Asia, Northern Africa and Southern Asia maternal mortality have declined by around two-thirds [4].
According to the new sustainable development goals (SDGs), SDG 3.1 targets to reduce by 2030, the global MMR to <70 per 100,000 live births [5].
Preventable maternal mortality occurs where there is a failure to give effect to the right of women to health quality and nondiscrimination. Response to maternal mortality must be accompanied by improvements along the continuum of care, including commitments to sexual and reproductive health, and family planning.
Maternal Health issues in Nigeria are of National concern as maternal mortality remains unacceptably high. Efforts to reduce the maternal and perinatal mortality include the provision of free maternal services and advocacy (Beyond Zero Campaign, 2013).
According to recent internal audits at Yaba Primary Health Care facility (Yaba Health Care), there were about 120 deaths in 2013 and 116 deaths in 2014 giving an estimated maternal mortality ratio to be 1,024 and 800 per live birth for 2013 and 2014 respectively. Although there is no systematic evaluation of the contribution of Yaba Health Care to these mortalities, similar internal data estimated 5 and 7 deaths for 2013 and 2014 are from Yaba Health Care while 115 and 109 deaths from other facilities.
As a referral facility, some of the maternal mortality that occurs at Yaba Health Care may occur among patient referred from other facilities with severe complications and appropriate interventions to address such complications may avert the maternal mortality. On the other hand, maternal mortality may occur among patients who initiate or referred for and receive antenatal care at Yaba Health Care. These Yaba Health Care antenatal clinic attendees should have risk factors for maternal death identified early and appropriate interventions implemented to reduce the mortality since they can benefit from increased contact and availability of highly skilled human resource and allied services.
Thus, there is a need to understand the determinants of mortality and whether its pre-existing conditions (which may be largely unpreventable) are the main causes of death among women who receive antenatal care at Yaba Primary Health Care facility.
It is expected that the study finding will contribute toward strategies to improve care for pregnant women attending form strategies to improve the care of pregnant women attending ANC at Yaba Health Care as well as intrapartum and post-partum care at the hospital, especially among the preexisting medical conditions.
1.2 Statement of Problem
Maternal mortality in sub-Saharan Africa remains high despite improved antenatal and intrapartum care. The quality of maternal care can be measured by its impact on maternal mortality. As a referral institution, maternal mortality may arise from patients who receive and those who do not receive ANC at Yaba Primary Health Care facility (Yaba Health Care). Women with pre- existing conditions are more likely to be referred early in pregnancy and therefore more likely to have better outcomes. Patients who are referred after developing complications during the intrapartum and postpartum period may not benefit from risk stratification and optimum care, compared to those who receive ANC at Yaba Health Care.
It is therefore expected that ANC should go a long way in reducing MMR and influencing the use of skilled delivery care among women. Recent findings show that Yaba Health Care ANC attendance is relatively high, meaning that women are willing to present themselves for care. In addition, Nigeria has adopted the WHO recommended focused ANC (FANC) model known to improve quality. Despite this, the MMR of 362 per 100,000 live births estimated by NDHS in 2014 is still high and the recent estimates of WHO, UNICEF, UNFPA, the World Bank Group and UN Population Division also highlight insufficient progress.
In order to develop effective interventions and to guide priority for use of limited resources in this setting, it is important to understand the factors that are associated with maternal mortality among those patients who received care at Yaba Health Care. Findings of this study should inform policy, resource allocation and quality of care received by Yaba Health Care ANC attendees.
• Research Question
What are the causes of maternal mortality among women who received antenatal care at Yaba Primary Health Care facility between January 2010 and December 2020?
• Hypothesis
Null: There are no specific causes of maternal mortality among women who received antenatal care at Yaba Primary Health Care facility.
Alternative: There are specific causes of maternal mortality among women who received antenatal care at Yaba Primary Health Care facility.
• OBJECTIVES
Broad Objective
To determine the causes of maternal mortality among women who received antenatal care at Yaba Primary Health Care facility between January 2010and December 2020.
Specific Objectives
• To determine socio-demographic and obstetric causes of maternal mortality among women who received antenatal care at Yaba Primary Health Care facility between January 2010 and December 2020.
• To determine the role of obstetric and non-obstetric conditions among women who received antenatal care at Yaba Health Care between January 2010 and December 2020.
• To evaluate the association between the preexisting medical conditions and maternal mortality among women who received antenatal care at Yaba Health Care between January 2010 and December 2020.
• Study Limitation
This was a hospital-based study and it may not be generalized to the whole population. It only includes deaths that occurred during the hospital admission and therefore the risk factors identified here were specifically associated with in-hospital mortality.
Bias may have resulted from the misclassification of causes of death data and missing information in some fields. For instance, pregnancy-related mortality that occurs outside hospital may have other risk factors that were not identified here.
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===================================================================Item Type: Project Material | Size: 51 pages | Chapters: 1-5
Format: MS Word | Delivery: Within 30Mins.
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