Abstract
Nigeria has one of the highest maternal mortality ratios in the world. Poor health outcomes are linked to weak health infrastructure, barriers to service access, and consequent low rates of service utilization. In the northern state of Jigawa, a pilot study was conducted to explore the feasibility of deploying resident female Community Health Extension Workers (CHEWs) to rural areas to provide essential maternal, newborn, and child health services. Between February and August 2011, a quasi-experimental design compared service utilization in the pilot community of Kadawawa, which deployed female resident CHEWs to provide health post services, 24/7 emergency access, and home visits, with the control community of Kafin Baka. In addition, we analyzed data from the preceding year in Kadawawa, and also compared service utilization data in Kadawawa from 2008-2010 (before introduction of the pilot) with data from 2011-2013 (during and after the pilot) to gauge sustainability of the model. Following deployment of female CHEWs to Kadawawa in 2011, there was more than a 500% increase in rates of health post visits compared with 2010, from about 1.5 monthly visits per 100 population to about 8 monthly visits per 100. Health post visit rates were between 1.4 and 5.5 times higher in the intervention community than in the control community. Monthly antenatal care coverage in Kadawawa during the pilot period ranged from 11.9% to 21.3%, up from 0.9% to 5.8% in the preceding year. Coverage in Kafin Baka ranged from 0% to 3%. Facility-based deliveries by a skilled birth attendant more than doubled in Kadawawa compared with the preceding year (105 vs. 43 deliveries total, respectively). There was evidence of sustainability of these changes over the 2 subsequent years. Community-based service delivery through a resident female community health worker can increase health service utilization in rural, hard-to-reach areas.
Highlights
Nigeria has one of the highest maternal mortality ratios in the world
In contrast to many countries where the maternal mortality ratios (MMRs) has declined over recent decades, Nigeria is one of the few countries in the world where maternal mortality has shown no substantial reduction (516 per 100,000 live births in 1980 compared with 576 per 100,000 live births in 2013).[2]
The country has for some time been signaled as one that will fail to meet the Millennium Development Goal (MDG) of reducing maternal mortality by 75% by 2015.3 The situation is of Community MNCH Service Delivery in Nigeria www.ghspjournal.org
Summary
Nigeria has one of the highest maternal mortality ratios in the world. Poor health outcomes are linked to weak health infrastructure, barriers to service access, and consequent low rates of service utilization. In contrast to many countries where the MMR has declined over recent decades, Nigeria is one of the few countries in the world where maternal mortality has shown no substantial reduction (516 per 100,000 live births in 1980 compared with 576 per 100,000 live births in 2013).[2] the country has for some time been signaled as one that will fail to meet the Millennium Development Goal (MDG) of reducing maternal mortality by 75% by 2015.3 The situation is of Community MNCH Service Delivery in Nigeria www.ghspjournal.org. Maternal mortality particular concern in northern Nigeria, where the in northern Nigeria MMR is estimated to be significantly higher than is significantly the national average. Only 21.5% of women had reported having their last baby in a health facility, and 21.2% of children between
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