Fawole AO, Shah A, Fabanwo AO, Adegbola O, Adewunmi AA, Eniayewun AB, et al. El Ayadi AM, Hill K, Langer A, Subramanian SV, McCormick M. Comparability of sociodemographic and pregnancy characteristics of pregnancy-related deaths identified via the sisterhood method versus the household/verbal autopsy method. The 2015 figure indicates that Nigeria recorded 58,000 women in that year. 2003;109:153–9. What Are the Problems Facing Healthcare Management in Nigeria. Nigeria still has one of the highest maternal mortality rates in the World. Hogan MC, Foreman KJ, Naghavi M, Ahn SY, Wang M, Makela SM, et al. Wall (1998) revealed strict conditions in the North that undermine women’s autonomy and influence their risk of maternal death. The values for this composite variable ranged from 0 to 4, where 0 was no participation and a score of 4 meant participation in all four individual measures of decision making. Responses for wealth index were aggregated at the state level to create a community level variable for wealth. CM acquired and analyzed the data. Similarly, studies show that factors such as age [14], education, antenatal care, parity [13], domestic violence and social autonomy [16] (which have been established as determinants of maternal mortality) are associated with this outcome in Nigeria. Trop Dr. 2012;42:140–3. With over 80% of women with little or no media exposure in the North, this means that information about the benefits of education and health information do not reach most who stand to benefit from them. 1) have a more direct influence on maternal mortality while distant determinants impact the outcome by way of their influence on the intermediate factors. The likelihood of dying was significantly higher in women who used folkloric or traditional methods compared to nonusers. Neonatal mortality rate is the number of neonates dying before reaching 28 days of age, per 1,000 live births in a given year. Additionally, women can be empowered in order to improve their status and access to quality health care. Elsevier. The 6 geo-political zones in Nigeria were the response options for the variable region. Rural-urban differentials in pregnancy-related mortality in Zambia: estimates using data collected in a census. 2011;11:606. This gap in contraceptive use between the North and South is attributed to socioeconomic and ideational (ideal number of children, awareness of contraceptive method, and self-efficacy) factors [22]. Maternal mortality was more pronounced in the North and increased in 2013 compared to 2008. Meh, C., Thind, A., Ryan, B. et al. PubMed  This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. WHO. A total of 18,863 women were from the South with 24% of the reported maternal deaths (Fig. The North contributed 32,629 women to the study sample. CM, AT, BR and AT contributed to the interpretation of data, and revision of the draft. Massachusetts’s maternal mortality rate of 8.4 per 100,000 births makes it the state with the … Over time, the North saw an increase in the levels of maternal mortality while the South had a minor decrease in its levels. The government must intensify its efforts towards providing maternal health services in a conflict zone using alternate strategies that do not impinge on the already fragile healthcare institution. The Millennium Development Goal (MDG) 5 to reduce the global burden of maternal death by 75% by 2015, and the recent Sustainable Development Goal (SDG) 3, which seeks to significantly cut the number of deaths to 70 per 100,000 livebirths by 2030, led to the implementation of interventions to reduce the global burden of maternal mortality. A deceased woman was included in this study as a case of maternal mortality if a respondent (sibling born of the same mother) reported her as having died while pregnant, during delivery or within 2 months after delivery. Use of mass media campaigns to change health behaviour. PubMed  However, studies have shown that the levels of maternal mortality vary within the country. 2012;127:96–106. While countries like Rwanda - which once had the highest level of maternal deaths in the world (in 1995, maternal mortality ratio (MMR) was 2300/100,00 livebirths) [4, 5] – have met their MDG 5 target of reducing maternal deaths [6] to 320/100,000 livebirths [7], other countries in Sub-Saharan Africa either had no significant change or experienced an increase in their levels of maternal mortality, even with implementation of evidence-based interventions. Higher community income was linked with fewer maternal deaths in Madagascar [43]. Unwanted pregnancies expose women to unsafe abortions that are linked to maternal deaths. Adamu PI, Adamu MO, Okagbue HI. 1992;23:23. PubMed  This may imply that women who do seek care receive substandard services in these health facilities. 2015;385:941. WHO maternal mortality: WHO. As UNICEF states, Nigeria loses 145 women to maternal mortality each day. In one study, nonusers of maternal health services were more likely to be less educated [48]. 2012;22:407–14. Wealthy communities have better access to resources and services compared to poor ones. A review study of place of delivery in sub-Saharan Africa revealed that women who gave birth at health facilities had a higher risk of maternal death than women who gave birth at home [55]. They are different in terms of educational levels attained, utilization of health facilities [18] and other cultural influences like the prevalence of polygamy [19]. To date, maternal mortality data for the North and South have been extrapolated from individual states’ community and facility data. BMC Public Health. Kassebaum NJ, Bertozzi-Villa A, Coggeshall MS, Shackelford KA, Steiner C, Heuton KR, et al. 2016;387:462–74. Statistical analyses were performed using Stata SE13 [35]. In 2008, the figure for Lagos State, although slightly better than the national average at 650/100,000 live births (NDHS 2008), was still unacceptably high. Springer Nature. Maternal mortality refers to deaths due to complications from pregnancy or childbirth. Int J Gynecol Obstet. Though estimates of maternal mortality levels can be derived with the Sisterhood method, these estimates are not current in terms of representing the survey year in which the data were collected. The population of interest in these surveys are men and women between the ages of 15 to 49 years. Currently, Nigeria has the second highest burden of maternal mortality in the world and contributes about 15 percent of the annual total global deaths which represent two percent of the global population. BMC Public Health. In fact is the fourth country with the worst maternal mortality rate only surpassing Sierra Leone, Central African Republic, and Chad. Karlsen S, Say L, Souza J-P, Hogue CJ, Calles DL, Gülmezoglu AM, et al. The response options included two categories - “small problem”, and “big problem” with distance to health facility. Meanwhile, northern residents were more likely to live within 5 km radius of health facilities or outreach posts that offer immunization services than those in the South [23]. Diarrhea and malnutrition were commonly recorded among displaced persons living in poor conditions with restricted access to health and other basic services. Gend Behav. PubMed  2). BMC Public Health. Rich women had 20% lower odds of maternal death compared to those who were poor. Kano is located in northwest Nigeria. The Maternal Mortality Rate (MMR) in Nigeria was 560 per 100,000 live births in 2013. In 2019, neonatal mortality rate for Nigeria was 35.9 deaths per 1,000 live births. Survival probability and predictors for woman experience childhood death in Nigeria: analysis of north-south differentials. 2014;384:980–1004. Currently, Nigeria has an estimated Maternal Mortality Ratio of 821 per 100,000 live births. Previous findings in the northern state of Kebbi show that after community education on emergency health services, their use did not increase even though awareness about them improved [36]. Hemorrhage, abortions, sepsis and obstructed labor are some of the leading causes of maternal death in this region [3]. 2013. PubMed Central  Lancet. This value represented the proportion of rich women in each state in Nigeria. Choe SA, Kim J, Kim S, Park Y, Kullaya SM, Kim CY. It is also a widely used framework in studies about factors that affect maternal health [26,27,28]. In the South, being a rural resident was protective against maternal mortality with a 32% reduction in the odds of maternal death. This was on the assumption that deceased siblings share similar characteristics as the respondents. PubMed Google Scholar. NCHS has identified instances where application of the checkbox information according to coding rules led to misclassification of maternal deaths, and NCHS is making changes in coding rules and reporting to make data more accurate. The South saw a slight decline in its MMR but there remains a need for the government to ensure that there are appropriate family planning services and education available in the South. This was unlike other studies that show an increased risk of maternal mortality for women living in rural areas compared to those in urban settings [4]. Lancet (London, England). Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Aremu O, Lawoko S, Dalal K. Neighborhood socioeconomic disadvantage, individual wealth status and patterns of delivery care utilization in Nigeria: a multilevel discrete choice analysis. Maternal Mortality Ratio in the North, South, and Nigeria Overall - 2008 & 2013. More than half of maternal deaths occur in fragile and humanitarian settings. The risk of maternal death may be higher in women with less education because of factors such as early marriage and other cultural practices that restrict their access and participation in the labor force. Child marriage, which is commonplace in the North, promotes early childbearing, exposes young women to birth complications due to the immature nature of their bodies and prevents the education of girls. To achieve this, the two survey cycles were pooled to increase the sample size notably, the number of maternal related deaths. Maternal mortality adversely affects women, their families and communities. The national maternal mortality ratio has remained elevated despite efforts to reduce maternal deaths. Over half a million annual maternal deaths propelled maternal mortality onto the international stage, where it became a global priority and the chosen outcome to assess progress on maternal health [1]. Given the rarity of the outcome for this study, it was necessary to increase the study power to detect associations between maternal mortality and the independent variables at the regional level. Geneva: The World Bank and the United Nations Population Division; 2014. Estimates of maternal mortality worldwide between 1990 and 2005: an assessment of available data. 2013. Nigeria presently has about 512 maternal mortality per 100,000 live births, making it the worst in the world, according to the Health Minister, Prof. Osagie Ehanire. In the North, early marriages expose young girls to early childbearing and pregnancies that are prone to complications and may lead to maternal death. National Population Commission (NPC) [Nigeria] and ICF International. We would like to thank the Measure DHS Program for making the data used for this study publicly available. Among the southern ethnic groups, being Yoruba and others ethnic group was protective against maternal mortality (reference: Ekoi/Ibibio). Correspondence to The influence of the social and cultural environment on maternal mortality in Nigeria: evidence from the 2013 demographic and health survey. Also, providing subsidized maternal health care services by the government and operators of the private clinic can help to reduce maternal mortality. The majority of women (83.4%) had no or low media exposure, no education (66.1%) and were Muslim (75.4%). Also, the lack of trained health care attendants in births and the fact that only six in ten mothers receive antenatal care from a trained medical professional are other causes of the high MMR in Nigeria. These workers can offer basic services to pregnant women in their homes and provide information on safe motherhood practices and where to get help. Key demographic indicators for Nigeria: Under-Five Mortality Rate, Population. Other studies found older women to have the greatest risk of maternal death [41, 42]. CAS  2010;375:1609–23. The Multiple Cluster Indicator Survey of 1999 revealed some variation in the levels of maternal mortality between zones in the North and South. This is further aggravated by cultural practices in the region that prevent pregnant women from seeking care or showing signs of distress from the pregnancy [24]. The incidence of abortion in Nigeria. In the South, contraceptive method used, type of residence, and wealth index were significantly associated with maternal mortality. In 2008, Nigeria bore 14% of the global burden of maternal mortality. This means the country has a lifetime risk of maternal death of 4.62 percent. There is the need for a national focus in providing quality health care facilities and ensuring high quality of care to mothers and children. In the South, hemorrhage and illegal abortions were the leading causes of maternal death [4]. CAS  When women deliver with no one present in Nigeria: who, what, where and so what? In fact, Africa has the highest maternal mortality rate in the world and Nigeria is one of the countries with the highest rate in the region. Google Scholar. 2014;17:2. In Bangladesh, induced abortions were more common among educated women [41] although the risk of mortality was low for them compared to uneducated women, this may not be the case in the South of Nigeria, where abortion is restricted, and most of its services are illicit and unsafe. In terms of the probability of childhood mortality, women in the North experience higher levels and have a higher likelihood of having experienced previous childhood mortality than their southern counterparts [17]. This rate of maternal mortality in Nigeria is highest in northwest geopolitical zone which comprised Sokoto state. 2016;14:7085–99. The principal inhabitants of the state are the Hausa/Fulani people. PLoS One. Reports show that non-indigenous health workers fled from conflict zones to safer states while insurgents destroyed and removed medical supplies from health facilities [39]. BioMed Central. Lancet. BMC Pregnancy Childbirth. Maternal mortality rate is the number of maternal deaths within 42 days of the termination of pregnancy due to . Community education and parity were excluded from this study because they were highly correlated with community wealth and age respectively, and parity was not reported in NDHS 2008. Most maternal deaths arise from heavy bleeding after birth. Factors contributing to maternal mortality in North-Central Nigeria: A seventeen-year review. In 2015, Nigeria’s estimated maternal mortality ratio was over 800 maternal deaths per 100 000 live births, with approximately 58 000 maternal deaths during that year. From the foregoing, it is obvious that Nigeria has one of the highest maternal mortality rates in the world, second only to India whose population is eight times larger than that of Nigeria. Maternal mortality persists in Nigeria despite strategies like the promotion of institutional deliveries, training and deploying new skilled health workers. And in 2015, mortality ratio for Nigeria was 814 deaths per 100,000 live births. Maternal mortality ratio (national estimate, per 100,000 live births) Mortality rate attributed to household and ambient air pollution, age-standardized, male (per 100,000 male population) Prevalence of stunting, height for age, male (% of children under 5) 2013;45:57–77. Maternal mortality in the North may be influenced by low community wealth given the low proportion (21%) of wealthy women in northern states. Google Scholar. Article  BMC Public Health. Oluwole E, Kuyinu Y, Goodman O, Odugbemi B, Akinyinka M. Factors influencing the uptake of modern family planning methods among women of reproductive age in a rural Community in Lagos State. One of the major contributing factors to this prevalence is the slow progress being made in the region in solving this problem. Nigeria maternal mortality rate for 2014 was 943.00, a 0.84% decline from 2013. Hernandez JC, Moser CM. It is preventable through the administration of an effective uterotonic to the mother immediately after the birth of her baby. https://doi.org/10.1186/s12884-019-2471-8, DOI: https://doi.org/10.1186/s12884-019-2471-8. Meanwhile, highly educated women tend to use and demand maternal health services [50]. Manage cookies/Do not sell my data we use in the preference centre. While the North and South had similarities in terms of determinants of maternal mortality (age and community wealth), in the North, there were significant associations between media exposure, level of education, and maternal mortality. Graham WJ, Fitzmaurice AE, Bell JS, Cairns JA. 2015;9:30. 2013;17:118–29. The country’s progress towards cutting the number of maternal deaths has been largely insufficient [6]. In contrast, some factors were only significantly associated with maternal mortality in the South. Though health disparities exist between the North and South of Nigeria, there is a dearth of evidence on the estimates and determinants of maternal mortality for these regions. For community wealth, individuals whose wealth index was poor, or middle were coded as 0. This method identifies deceased siblings through select questions asked of the respondents and is widely used by the Demographic and Health Survey Program [30] and maternal health studies [31, 32] to obtain periodic estimates of maternal mortality. Currently, Nigeria has an estimated Maternal Mortality Ratio of 821 per 100,000 live births. Wall LL. The risk of maternal death may be high among the middle class because they are more likely to seek care at health facilities compared to the poor. A secondary/higher education significantly reduced the odds of maternal mortality by 47% (reference: no education). Number of births: 63,178 Death rate: 58.1 per 100,000 births How the state handles it: Louisiana has had a maternal mortality review program since … Community influences on antenatal and delivery care in Bangladesh, Egypt, and Rwanda. These factors are linked with health outcomes such as maternal mortality. 2015;13:32. Notify me of follow-up comments by email. Article  It is also among the top six countries in the world that contribute to more than 50% of all global maternal deaths [8]. Currently, Nigeria is the highest contributor to maternal mortality in Central and Western Africa and contributes 14% to the global maternal mortality rate. The most worrisome is the report from North-East where MMR is highest at 1,549/100,000 live births in comparison to the South-West zone where 165/100,000 was recorded. Google Scholar. In this post, we will take a look at figures over the last few decades. 2016;31:277–84. This can be achieved through innovative means of media communication and new strategies for education which will encourage school attendance in the North. In African communities especially the sub-Saharan region, the rate is quite high. Fapohunda BM, Orobaton NG. Int J Women's Health. 2010;376:1261–71. According to UNICEF, a woman’s chance of dying from pregnancy and childbirth in Nigeria is 1 in 13. Akinlo A, Idemudia ES, Ogunjuyigbe PO, Solanke BL. Overall, new policies to improve women’s socioeconomic status should be adopted. This study aimed to assess differences in the levels and determinants of maternal mortality in women of childbearing age (15–49 years) in the North and South of Nigeria. Lancet. Those who were rich were coded as 1. Eboreime E, Abimbola S, Bozzani F. Access to routine immunization: a comparative analysis of supply-side disparities between northern and southern Nigeria. PubMed Central  These differences between the North and South of Nigeria have implications for maternal health programs to prevent maternal deaths. This status was assigned to a deceased woman if a respondent indicated “yes” to whether her female sibling died while pregnant, during child birth, or within 2 months of delivery. This means the country has a lifetime risk of maternal death of 4.62 percent. To control for secular trends, survey year was also included in this study with 2008 and 2013 as the response categories. It is possible that some deceased siblings had different characteristics compared to those ascribed to them which may lead to the misclassification of their own attributes. 2017;27:121–8. This conflict possibly influenced the level of maternal mortality in the North in 2013 compared to that of 2008 due to its devastating impact on the health system. Alkema L, Chou D, Hogan D, Zhang S, Moller A-B, Gemmill A, et al. The association between maternal mortality (outcome) and relevant sociocultural, economic and health factors was tested using multivariable logistic regression in a sample of 51,492 living or deceased women who had given birth. Short of that, the drug will not work. The maternal mortality rate for women aged 40 and over (81.9 per 100,000 live births) is nearly 8 times that for women under age 25 (10.6). 2011;3:167–74. Women in the North are less likely to give birth at health facilities [20] and many in some northern states, live far from health centers which are plagued by severe shortages of health workers [18] compared to the South of Nigeria. Dove Press. A joint report by UNICEF, […] PubMed Central  In Nigeria, any media exposure, compared to no exposure was positively associated with antenatal care utilization in adolescent women [47]. According to the Nigerian Demographic and Health Survey (NDHS) reports for 2008 and 2013, Nigeria achieved practically no reduction in MMR. Stud Fam Plan. The high number of maternal deaths in some areas of the world reflects inequities in access to health services, and highlights the gap between rich and poor. Cookies policy. But the problem is the quality and effectiveness of these uterotonics in developing countries is quite low which has led to the inability of the uterotonic to prevent PPH due to the poor state of medicines. Our findings show an extremely high maternal mortality ratio of 1,012 maternal deaths per 100,000 live births (95% CI: 898–1,126) in Jigawa State, Northern Nigeria. Article  Source Reprod Heal Matters. 2015;41:170–81. Educational level was defined as “no education”, “primary”, and “secondary/higher”. Using community-based research to shape the design and delivery of maternal health services in northern Nigeria. 2015;64(6):1767-814. http://law.emory.edu/elj/content/volume-64/issue-6/articles-and-essays/polygyny-violence-against-women.html. 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