Highest Number Of Maternal Deaths Research Articles

Impact of COVID-19 pandemic in the Brazilian maternal mortality ratio: A comparative analysis of Neural Networks Autoregression, Holt-Winters exponential smoothing, and Autoregressive Integrated Moving Average models.

The acute respiratory infection caused by severe acute respiratory syndrome coronavirus disease (COVID-19) has resulted in increased mortality among pregnant, puerperal, and neonates. Brazil has the highest number of maternal deaths and a distressing fatality rate of 7.2%, more than double the country's current mortality rate of 2.8%. This study investigates the impact of the COVID-19 pandemic on the Brazilian Maternal Mortality Ratio (BMMR) and forecasts the BMMR up to 2025. To assess the impact of the COVID-19 pandemic on the BMMR, we employed Holt-Winters, Autoregressive Integrated Moving Average (ARIMA), and Neural Networks Autoregression (NNA). We utilized a retrospective time series spanning twenty-five years (1996-2021) to forecast the BMMR under both a COVID-19 pandemic scenario and a controlled COVID-19 scenario. Brazil consistently exhibited high maternal mortality values (mean BMMR [1996-2019] = 57.99 ±6.34/100,000 live births) according to World Health Organization criteria. The country experienced its highest mortality peak in the historical BMMR series in the second quarter of 2021 (197.75/100,000 live births), representing a more than 200% increase compared to the previous period. Holt-Winter and ARIMA models demonstrated better agreement with prediction results beyond the sample data, although NNA provided a better fit to previous data. Our study revealed an increase in BMMR and its temporal correlation with COVID-19 incidence. Additionally, it showed that Holt-Winter and ARIMA models can be employed for BMMR forecasting with lower errors. This information can assist governments and public health agencies in making timely and informed decisions.

Model-Based Small Area Estimation of Regional-Level Maternal Mortality Prevalence in Ghana

Abstract The study involved 1240 women covering the ten administrative regions of Ghana. The aim was to study the prevalence of maternal mortality and its distribution across the ten regions based on given demographic factors. Three main analytical methods were used: Direct estimation method, Fay-Herriot method and Binary Logistic regression. The study revealed that prevalence of maternal mortality in Ghana was high among women engaged in manual works, rural dwellers, women living without partners and women living in pro-poor families. The Northern region had the highest number of maternal deaths followed by the Western region whilst the Ashanti and the Upper East regions had the lowest number of maternal deaths. There is therefore the need for Ghana Health Service to engage all stakeholders in checking maternal mortality in the country.

Analisis Faktor yang Berhubungan dengan Kematian Maternal dalam Penguatan Pengetahuan dan Pengembangan Kebijakan Kesehatan: Studi Otopsi Verbal Maternal

Several factors that cause maternal death can be prevented. To get overview of maternal death caused, it is necessary to carry out in-depth investigations to family and various related parties. This study aims to determine the profile of maternal deaths, the factors that cause maternal deaths that can be prevented and the obstacles that cause maternal deaths. This study used mixed methods with sequential explanatory. The quantitative approach in the first stage was collecting data from data recapitulation and OVM of 254 maternal deaths in Banten Province in 2021. The second stage used a qualitative approach through in-depth interviews. The results showed that 97.6% of maternal deaths could be prevented. The high number of maternal deaths caused by the lack of ANC visits, the referral factor is especially late in deciding to refer.

Trends and patterns of maternal deaths from 2015 to 2019, associated factors and pregnancy outcomes in rural Lagos, Nigeria: a cross-sectional study.

maternal mortality is still a problem attracting global attention, with an estimate of 289,000 maternal deaths annually. Over half of these deaths occur in sub-Saharan Africa, with Nigeria accounting for 14% of the global maternal deaths. This study assessed the trends and patterns of maternal deaths, associated factors, and pregnancy outcomes in a rural area in Lagos, Nigeria. this study adopted a cross-sectional descriptive research design. A retrospective assessment of all maternal deaths that occurred at Epe Local Government Area (LGA) from 2015 to 2019 was done. A validated checklist was used to retrieve information from the records of 96 deceased. Ethical approval was obtained for the study. Data collected were analyzed using SPSS version 20.0. Analyses were done using descriptive and inferential statistics at a significance level of 0.05. highest number of maternal deaths 24 (23%) were recorded in the year 2015. The maternal mortality ratio was 1,645 per 100,000 live births. The highest direct cause of maternal death was eclampsia (27.1%), while the highest indirect cause was anemia (5.2%). Chances of maternal death increased with nonregistered pregnancy (71.9%), and non-institutional delivery (79.2%). Poor pregnancy outcomes include; stillbirth (60.4%), and preterm babies (62.5%). Statistical associations were found between maternal deaths and parity (p = 0.004). the maternal mortality ratio in rural areas is still very high and far from the proposed global target of 70 per 100,000. These maternal deaths are linked to direct and indirect causes. Maternal deaths could result in poor pregnancy outcomes.

The impact of community midwives on maternal healthcare utilization.

Globally 800 women die every day from preventable causes related to pregnancy and childbirth. One of the major reasons for high maternal mortality ratios in many developing countries is the low proportion of births attended by Skilled Birth Attendants (SBA). To address the high number of maternal deaths, in 2008 the Government of Pakistan introduced the Community Midwives Program. Under the program, women from across the country were trained and deployed as Community Midwives. In this study, I use six rounds of Pakistan Social and Living Measurement Survey to estimate the impact of this program on maternal healthcare utilization. I find that women residing in districts with higher Community Midwives per capita were 9 percentage points more likely to be attended by a SBA at the time of delivery and were 8 percentage points more likely to give birth at a medical facility as opposed to birthing at home. I find no evidence of impact on take up of prenatal and post-natal check-ups. The use of Community Midwives may be a cost effective tool to reduce maternal deaths, especially for developing countries with low health budgets.

Maternal mortality and economic development in Sub-Saharan Africa

Globally, the highest number of maternal deaths is in Sub-Saharan African region with ratio of 546 maternal deaths per 100, 000 live births which is approximately 201,000 maternal deaths annually. This amounts to two-thirds of all maternal deaths per year worldwide. This fact calls for investigation to ascertain its effect(s) on economic development of the sub region. It is however hypothesized that maternal death generally is significant and has negative influence on economic growth (Gross Domestic product) both in under-developed, developing and developed nations. The objective of this study is to estimate the effect of maternal mortality on economic development in Sub-Sahara African region. Cross-sectional data analysis of selected member countries in the region under focus was employed using double-log econometric model. The source of data is from United Nations Development Programme and World Bank. The explanatory variables in the model were statistically significant at 5% level while other coefficients like maternal mortality, exports and imports conform to the apriori expectations and impacted negatively on the overall GDP. A necessary but not sufficient condition is investing on viable programmes and projects that reduce maternal deaths as well as spur significant economic returns and sustainability in sub-Saharan African economies are however recommended.

The COVID-19 pandemic in Brazilian pregnant and postpartum women: results from the REBRACO prospective cohort study

Brazil presented a very high number of maternal deaths and evident delays in healthcare. We aimed at evaluating the characteristics of SARS-CoV-2 infection and associated outcomes in the obstetric population. We conducted a prospective cohort study in 15 Brazilian centers including symptomatic pregnant or postpartum women with suspected COVID-19 from Feb/2020 to Feb/2021. Women were followed from suspected infection until the end of pregnancy. We analyzed maternal characteristics and pregnancy outcomes associated with confirmed COVID-19 infection and SARS, determining unadjusted risk ratios. In total, 729 symptomatic women with suspected COVID-19 were initially included. Among those investigated for COVID-19, 51.3% (n = 289) were confirmed COVID-19 and 48% (n = 270) were negative. Initially (before May 15th), only 52.9% of the suspected cases were tested and it was the period with the highest proportion of ICU admission and maternal deaths. Non-white ethnicity (RR 1.78 [1.04–3.04]), primary schooling or less (RR 2.16 [1.21–3.87]), being overweight (RR 4.34 [1.04–19.01]) or obese (RR 6.55 [1.57–27.37]), having public prenatal care (RR 2.16 [1.01–4.68]), planned pregnancies (RR 2.09 [1.15–3.78]), onset of infection in postpartum period (RR 6.00 [1.37–26.26]), chronic hypertension (RR 2.15 [1.37–4.10]), pre-existing diabetes (RR 3.20 [1.37–7.46]), asthma (RR 2.22 [1.14–4.34]), and anaemia (RR 3.15 [1.14–8.71]) were associated with higher risk for SARS. The availability of tests and maternal outcomes varied throughout the pandemic period of the study; the beginning was the most challenging period, with worse outcomes. Socially vulnerable, postpartum and previously ill women were more likely to present SARS related to COVID-19.

COVID-19 and Pregnancy

Abstract Objectives: reviewing the available literature on COVID-19 infection and the maternal and perinatal outcomes. Methods: this is a narrative review of the literature carried out from March to September 2020, usingthe MESH: coronavirus, Covid 19, SARS-CoV-2, pregnancy, gravidity, pregnancy complications and pregnancy complications infectius. All study designs, reviews, recommendations and technical notes were included, without distinction of language and that would bring the approach of the new coronavirus in the gestational and perinatal scenario. Results: the COVID-19 pandemic has had devastating effects, affecting millions of people and claiming almost a million lives worldwide. Initially, pregnant women were not seen as a risk group for the disease, however as the proportion of women affected during the pregnancy-puerperal cycle increased, several studies were published showing an increased risk of complications. Brazilian studies have also warned of a high number of maternal deaths, associated with the presence of comorbidities but, above all, with the social determinants of the disease and serious failures in care. Conclusion: the need for new studies with an adequate research design was observed, as many studies are only letters or small series of cases, in addition expert recommendations, without the necessary scientific rigor.

Quality of Visit and Fulfillment Needs after Childbirth: Study on Postpartum Maternal Mortality

Most maternal deaths occur during the postpartum period so that childbirth health services play an important role in reducing maternal mortality rates from 6 hours to 42 days after giving birth. It is estimated that 69% of maternal deaths due to pregnancy occur after childbirth, and 50% of postpartum deaths occurred in the first 24 hours. The highest number of maternal deaths was found in East Sumba Regency which was 19 maternal deaths, 12 of which were maternal deaths during the puerperium. Maternal deaths in 2017 out of 9, there were 5 postpartum mothers whereas the 3rd postpartum visit was 91%. The objective of this study is to determine the quality of puerperal visits and the fulfillment of the needs of puerperal women in East Sumba Regency in 2015-2018. This type of research is qualitative research with a phenomenological study. Participants or informants in this study were the husband or family of all mothers who died postpartum in 2015-2018 and midwives who deal with these mothers during antenatal care, childbirth, and postpartum as well as data analysis which is content analysis. The results showed that the quality of puerperal visits was still irregular, systematic, and unfocused so that it was unable to detect postpartum problems early. Meeting the needs of mothers during childbirth is still incomplete, not detailed, and does not routinely conduct head-to-toe examinations during postpartum visits. The conclusion of the study shows that the quality of the visit and the fulfillment of the needs of the postpartum mothers are related to maternal mortality during the postpartum period in East Sumba Regency.

Kepatuhan Petugas Kesehatan Terhadap Standar Pelayanan Antenatal Yang Berkualitas Di Puskesmas Kabupaten Karawang

Selama tahun 2014 - 2016, cakupan pelayanan antenatal (ANC) kabupaten Karawang selain melampaui dari target, cakupan ini juga diatas cakupan provinsi dan nasional. Meskipun cakupan ANC mengalami peningkatan, namun kabupaten Karawang menempati rangking kedua kabupaten di Jawa Barat yang jumlah kematian ibu terbanyak. Tingginya hasil cakupan ANC (kuantitatif), namun masih tingginya jumlah kematian ibu, hal ini menunjukkan masih rendahnya kualitas ANC di kabupaten Karawang. Penelitian ini bertujuan mengetahui gambaran kepatuhan petugas kesehatan dalam melaksanakan standar pelayanan antenatal. Lokasi penelitian di Puskesmas Rengasdengklok, Puskesmas Ciampel, dan Puskesmas Jatisari Kabupaten Karawang. Penelitian ini merupakan jenis penelitian kualitatif dengan pendekatan etnografi. Pengumpulan data dilakukan melalui observasi, dokumentasi, dan wawancara mendalam. Analisis data menggunakan cara interaktif yang terdiri atas: reduksi data, penyajian data dan penarikan simpulan. Keabsahan data menggunakan teknik triangulasi, analisis kasus negatif, member check, dan low inference descriptor (verbatim), dan diskusi teman sejawat. Hasil penelitian menunjukkan bahwa petugas kesehatan pada tiga puskesmas lokus penelitian lebih berfokus pada kebijakan, sarana dan prasarana, standar operasional prosedur, dan koordinasi tim. Kepatuhan petugas kesehatan akan lebih baik jika ada kebijakan yang lebih memadai, kelengkapan sarana dan prasarana, standar operasional prosedur yang jelas, dan koordinasi tim yang lebih serta kepemimpinan yang kuat.

The impact of a nurse mentoring program on the quality of labour and delivery care at primary health care facilities in Bihar, India

IntroductionAlthough the number of women who deliver with a skilled birth attendant in India has almost doubled between 2006 and 2016, the country still has the second highest number of...

Ability of shock index and heart rate to predict the percentage of body blood volume lost after vaginal delivery as an indicator of severity: results from a prospective cohort study.

BackgroundPostpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide, but it mainly affects women from low- and middle-income countries. Despite being a treatable condition, the high number of maternal deaths resulting from PPH is outstanding for at least 25 years. Late diagnosis and difficulties in identifying women who will develop severe postpartum bleeding can, in part, explain the high incidence of PPH. Over the past few years, researchers have focused on identifying a simple, accessible and low-cost diagnostic tool that could be applied to avoid maternal deaths. In particular, it has been suggested that vital signs and shock index (SI) could be useful. The objective of this study was to evaluate whether vital signs are correlated with the percentage of body blood volume (BBVp) lost after vaginal delivery.MethodsA prospective cohort study was performed at the Women’s Hospital of UNICAMP, Brazil. The inclusion criteria were women delivering vaginally who did not suffer from hypertension, hyper- or hypothyroidism, cardiac disease, infections or coagulopathy. Blood loss was measured over 24 hours using a calibrated drape and by weighing compresses, gauzes and pads. Vital signs were measured up to 24 hours after delivery. We evaluated the BBVp lost, and generated a Receiver operating characteristics (ROC) curve with area under the curve (AUC) analysis to determine the cut-off values for vital signs to determine the likelihood of postpartum bleeding above the 90th percentile within 24 hours of delivery.ResultsA total of 270 women were included. The mean blood loss within 24 hours of vaginal delivery was 570.66 ± 360.04 mL. In the first 40 minutes, 73% of the total blood loss over the 24-hour period had occurred, and within 2 hours, 91% of women had bled 90% of the total blood loss. Changes in SI and heart rate (HR) were statistically significant in predicting postpartum bleeding (P ≤ 0.05). Higher values for likelihood ratio (LR) to identify BBVp loss above the 90th percentile within 2 hours were a SI above 1.04 at 41-60 minutes after birth (LR = +11.84) and a HR above 105.2 bpm at 21-40 minutes after birth (LR = +4.96). Both measures showed high specificity but low sensitivity.ConclusionValues of SI and HR are statistically significant in predicting postpartum bleeding with high specificity but low sensitivity. The cut-off points were 1.04 for SI and 105 bpm for HR.

Joyce Banda and Ellen Johnson Sirleaf – confronting the neglect of maternal health and women’s rights in Malawi and Liberia

abstractSub-Saharan Africa accounts for the majority of maternal deaths in the world. The death of girls and women during childbirth as a result of pregnancy-related complications, or maternal deaths is termed unwanted or avoidable deaths due to the fact that we have the medical expertise to deal with them. A major factor that pushes up maternal deaths is the absence of or the poor state of sexual and reproductive health rights and services (SRHRS). Gender inequality, women’s lower social, political and economic status are recognised as contributing significantly to the neglect of universal access to and provision of reproductive health services for women. Africa as a continent has identified maternal deaths as a health policy priority. Reversing the trend has been dependent on a number of variables, not least country level attention to women’s health. In this article I place the spotlight on two examples of leaders who as women used the positional power of office as head of state to address the neglect of rural women’s health and access to services. Presidents Joyce Banda and Ellen Johnson Sirleaf introduced measures and committed government resources to maternal health services delivery to bring down the high number of maternal deaths of women in their respective countries, Malawi and Liberia. These measures offered women maternal care and a safe environment in which to give birth. The different initiatives taken by two presidential leaders to reduce maternal mortality are profiled against the growing pressure on Africa’s nations to take action to provide universal access to sexual and reproductive health services to women and girls.

Prevalence and Associated Factors of Induced Abortion Among Women of Reproductive Age Group in Gondar Town, Northwest Ethiopia

Background:Abortion is the termination of pregnancy by the expulsion of a fetus or embryo from the uterus before viability. An estimated 56 million induced abortions occurred worldwide each year. Ethiopia has the fifth highest number of maternal deaths in the world: one in twenty-seven women die from complications of pregnancy and childbirth annually. Objective:To assess the prevalence of induced abortion and associated factors among women of reproductive age group in Gondar Town, Northwest Ethiopia. Methods:A descriptive cross sectional study design was conducted in450 reproductive age women, using a pre-tested and structured questionnaire with face-to-face interview, from January 01 to August 07, 2018. Respondents were randomly selected using systematic random sampling method. Descriptive analysis, binary and multivariable logistic regression analysis were used to analyze the data. Results:In this study, the prevalence rate of induced abortion was 40 per 1000 women, making it higher from the previous national rate of abortion for Ethiopia (28/1000 women aged 15-44). Among respondents those are committing induced abortions, 83.33% was safe abortion. Factors like women’s age at first pregnancy (15-19 years [AOR (Adjusted Odds Ratio) = 4.38, 95% CI (1.21, 15.81)];single marital status [AOR =45.05, 95% CI (12.02, 168.85)];unwanted pregnancy [AOR=3.21, 95% CI (1.16, 8.90)] and attending school at the time of interfered abortion [AOR=5.28, 95% CI (1.80, 15.49)]were significantly associated with committing induced abortion. Conclusions:The study revealed a medium level of prevalence rateof induced abortionamong women of reproductive age group in Gondar Town. Factors like women’s ageat first pregnancy, single marital status, unwanted pregnancy and attending school at the time of interfered induced abortion were independently and significantly associated with committing induced abortion.

Desk review of maternal death in Liberia, epidemiological week 1-52, 2016

Introduction : maternal death is the death of a woman while pregnant or within 42 days after delivery or termination of pregnancy, irrespective of site and duration of pregnancy and not from incidental causes. Globally, about 830 women die daily from pregnancy-related complications with postpartum hemorrhage being the leading cause. Liberia maternal mortality is one of the highest in the world with 1072 per 100,000 live births. A descriptive analysis of maternal death data was conducted to inform interventions. Methods : Liberia is located in West-Africa with an estimated population of 4.1 million. It has 15 counties with 745 health facilities. A significant proportion of its communities are hard to reach. The Ebola outbreak in 2014 almost led to the collapse of the health system. We reviewed all maternal surveillance data and maternal deaths audit forms submitted to Ministry of Health from the Counties for Epidemiological week 1-52, 2016. Descriptive analyses were done using excel spread sheet. Results : a total of 302 maternal deaths were recorded in 2016. Age 16 -19 years accounted for the highest number of maternal deaths with 64 (21%). Montserrado County had the highest number of maternal deaths with 73 (24%). Most maternal deaths occurred at the health facility, 204 (81%) with postpartum hemorrhage, 93 (31%) being the leading cause followed by postpartum sepsis, 53 (18%). Highest number 34(12%) of maternal deaths was recorded in April and June. Conclusion : teenagers are at high risk of dying from pregnancy-related complications. Postpartum hemorrhage being the leading cause of deaths was probably due to lack of access to high quality care and specialized emergency services (Surgery, Blood Transfusion etc.). Maternal deaths in health facilities are probably due to the poor healthcare and late referral. Analytic studies need to be conducted to access the actual risk factors for maternal deaths in Liberia.

The proposed legislation on termination of pregnancy does not protect women or children in Malawi and is not fit for the intended purpose: Christian Medical and Dental Fellowship position.

This legislation represents a significant move towards liberalisation of abortion in Malawi. Those supporting the legislation have founded their arguments mainly on the premise that it will protect women and reduce maternal mortality. We join with them to express our concern with the high number of maternal deaths in the country and firmly assert our commitment and role to ensure that no woman dies from pregnancy-related complications. Aside from the maternal mortality arguments, many of those supporting this legislation take a “pro-choice” position, insisting that the rights of a woman who is pregnant supersede any rights of her unborn child, sidelining both male (parental) responsibility and the responsibility of society to take charge of the wider societal issues raised by “unwanted” pregnancies.

Trends in reproductive health indicators in Nigeria using demographic and health surveys (1990–2013)

ABSTRACTThere is an urgent need to improve reproductive health (RH) in Nigeria – the most populous country in Africa. In 2015, Nigeria had the highest number of maternal deaths in the world. This study assessed the trends in select RH indicators in Nigeria over two decades. Data used were from Nigeria Demographic and Health Surveys (NDHS) conducted between 1990 and 2013. The NDHS uses a two-stage cluster sampling design to select nationally representative samples of reproductive-age women. The study sample ranged from 7620 to 38,948 women aged 15–49 across the five surveys. Trends in modern contraceptive prevalence rate, skilled antenatal care, skilled birth attendance, and adolescent birth were assessed. The results show increasing trends in modern contraceptive prevalence rate from 4% in 1990 to 11% in 2013 (p < .001); in skilled antenatal care from 57% in 1990 to 61% in 2013 (p < .001); and in skilled birth attendance from 31% in 1990 to 40% in 2013 (p < .001). The trend in adolescent birth decreased from 24% in 1990 to 17% in 2013 (p < .001). Marked disparities exist as rural, poor, and less educated women bear the greatest burden. Interventions should target the at-risk populations to improve their access and use of RH services.

Determinants of utilization of antenatal care services among adolescent girls and young women in Indonesia

ABSTRACTDue to the high number of maternal deaths, provision of antenatal care services (ANC) in Indonesia is one of the key aims of the post-Millennium Development Goals agenda. This study aimed to assess the key factors determining use of ANC by adolescent girls and young women in Indonesia. Data from the Indonesia Demographic and Health Survey 2012 were used, with a focus on married adolescent girls (aged 15–19 years, n = 543) and young women (20–24 years, n = 2,916) who were mothers. Bivariate and multiple logistic regression analyses were performed to determine the factors associated with ANC use. The findings indicated that adolescents were less likely to make ANC visits than young women. Richer women were more likely to make four ANC visits in both groups compared to the poorer women. Living in urban areas, higher educational attainment, and lower birth order were also all associated with higher levels of receiving ANC among young women. The results showed that socio-economic factors were related to the use of ANC among adolescent girls and young women. Ongoing health-care interventions should thus put a priority on adolescent mothers coming from poor socio-economic backgrounds.

Institutional Delivery Service Utilization among Women from Rural Districts of Wolaita and Dawro Zones, Southern Ethiopia; a Community Based Cross-Sectional Study

IntroductionThe highest number of maternal deaths occur during labour, delivery and the first day after delivery highlighting the critical need for good quality care during this period. Therefore, for the strategies of institutional delivery to be effective, it is essential to understand the factors that influence individual and household factors to utilize skilled birth attendance and institutions for delivery. This study was aimed to assess factors affecting the utilization of institutional delivery service of women in rural districts of Wolaita and Dawro Zones.MethodsA community based cross-sectional study was done among mothers who gave birth within the past one year preceding the survey in Wolaita and Dawro Zones, from February 01 –April 30, 2015 by using a three stage sampling technique. Initially, 6 districts were selected randomly from the total of 17 eligible districts. Then, 2 kebele from each district was selected randomly cumulating a total of 12 clusters. Finally, study participants were selected from each cluster by using systematic sampling technique. Accordingly, 957 mothers were included in the survey. Data was collected by using a pretested interviewer administered structured questionnaire. The questionnaire was prepared by including socio-demographic variables and variables of maternal health service utilization factors. Data was entered using Epi-data version 1.4.4.0 and exported to SPSS version 20 for analysis. Bivariate and multiple logistic regressions were applied to identify candidate and predictor variables respectively.ResultOnly 38% of study participants delivered the index child at health facility. Husband’s educational status, wealth index, average distance from nearest health facility, wanted pregnancy, agreement to follow post-natal care, problem faced during delivery, birth order, preference of health professional for ante-natal care and maternity care were predictors of institutional delivery.ConclusionThe use of institutional delivery service is low in the study community. Eventhough antenatal care service is high; nearly two in every three mothers delivered their index child out of health facility. Improving socio-economic status of mothers as well as availing modern health facilities to the nearest locality will have a good impact to improve institutional delivery service utilization. Similarly, education is also a tool to improve awareness of mothers and their husbands for the improvement of health care service utilization.

Maternal mortality audit in a tertiary health institution in Nigeria: Lessons from direct causes and its drivers

Nigeria has the second highest number of maternal deaths in the world.The study aimed at determining the causes of and non-obstetric contributors to maternal mortality at a tertiary referral hospital.It was a prospective audit of all consecutive maternal deaths in the hospital over a three-year period. Immediately after the death, information wvas retrieved via a data collection form. Data were analysed with SPSS-20.Seventy deaths were examined over the study period. Maternal mortality ratio was 1,265/100,000 live births. The annual ratio decreased steadily over the study period. Most of the deaths were of multiparous women who had not received any antenatal care, and were mostly postpartum,within 24 hours of delivery. Most of them were critically ill on admission to the hospital. Major causes of death were haemorrhage (36%), sepsis (17%) and hypertensive disorders (16%).Delays were identified in 34.3% of cases; most (70.1%) were Phase III delays.Direct causes of maternal mortality are consistent with those found in literature. Steps which the centre has been taken to counter direct and non-obstetric causes are discussed. Possible strategies to improve health financing and referral system are proffered.