Magnitude, Trends and Causes of Maternal Mortality: A 7-year Review at a Tertiary Hospital in Rivers State, Nigeria

Main Article Content

P. A. Awoyesuku
D. A. MacPepple
B. O. Altraide

Abstract

Background: Maternal mortality ratios (MMR) are still unacceptably high in many low- and middle-income countries especially in sub-Saharan Africa. Background Data for the causes of maternal deaths are needed to inform policies to improve maternal healthcare and reduce maternal mortality.

Objective: This study sought to determine the magnitude and trend in maternal mortality and the causes at a tertiary hospital over a seven-year study period.

Methodology: This was a retrospective review of maternal mortality and causes from 2012 to 2018. Data on number of maternal deaths, deliveries and causes of death were retrieved from the departmental annual reports and hospital records and entered into Microsoft Excel 2013. Data were presented as line graphs, charts and frequency tables.

Results: One hundred and ten (110) maternal deaths occurred out of 17,080 total births during the study period giving an overall MMR of 644. The MMR increased progressively from 580 in 2012 to 785 in 2018 with a sharp rise to the highest and subsequent decline to the lowest, values at the midpoint. The commonest causes of maternal deaths were Pre-eclampsia (PET) and Eclampsia 44(40%), Postpartum Haemorrhage (PPH) 25(22.7%) and Ruptured Uterus 13(11.8%).

Conclusion: The maternal mortality ratio is high and the trend is worsening. The leading causes of maternal deaths were PET/Eclampsia and Postpartum haemorrhage accounting for about two-thirds of all deaths. Efforts must be geared towards improvements in the management of these cases, if this trend is to be reversed.

Keywords:
Maternal mortality, magnitude, trends, causes, tertiary hospital, Rivers State.

Article Details

How to Cite
Awoyesuku, P. A., MacPepple, D. A., & Altraide, B. O. (2020). Magnitude, Trends and Causes of Maternal Mortality: A 7-year Review at a Tertiary Hospital in Rivers State, Nigeria. Journal of Advances in Medicine and Medical Research, 32(1), 103-109. https://doi.org/10.9734/jammr/2020/v32i130357
Section
Original Research Article

References

World Health Organization (WHO). Trends in maternal mortality: 1990-2015. Estimates by WHO, UNICEF, UNFPA, World Bank and United Nations Population Division. Geneva, Switzerland: WHO; 2015.
Available:http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/
(Accessed 24 Dec 2019)

Hogan C. Maternal mortality for 181 countries, 1980-2008: A systematic analysis of progress towards MDG5. Lancet. 2010;375(9726):14.

World Health Organization (WHO). Working together for health. The World Health Report 2006. Switzerland: WHO; 2006.

Federal Ministry of Health FMOH/NPC. National Demographic and Health Survey. Abuja: National Population Commission; 2004.

Doctor HV, Olatunji A, Findly SE, Afenyadu GY, Abdulwahab A, Jumare A. Maternal mortality in Northern Nigeria: Findings of a health and demographic surveillance system in Zamfara State, Nigeria. Tropical Doctor. 2012;42(3):140-3.
DOI:https://dx.doi.org/10.1258/td.2012.120062

Nwagha UI, Nwachukwu D, Dim C, Ibekwe PC, Onyebuchi A. Maternal mortality trend in South East Nigeria: Less than a decade to the millennium development goals. Journal of Women’s Health. 2010;19(2): 323-7.
DOI:https://dx.doi.org/10.1089/jwh.2008.1028

Adegoke AA, Campbell M, Ogundeji MO, Lawoyin TO, Thomson AM. Community study of maternal mortality in South West Nigeria: How applicable is the sisterhood method. Maternal and Child Health Journal. 2013;17(2):319-29.
DOI:https://dx.doi.org/10.1007/s10995-012-0977-z

Agan T, Archibong E, Ekabua J, Ekanem E, Abeshi S, Edentekhe T, et al. Trends in maternal mortality at the University of Calabar Teaching Hospital, Nigeria, 1999-2009. International Journal of Women’s Health. 2010;2:249.
DOI:https://dx.doi.org/10.2147/ijwh.s11971

United Nations. United Nations Millennium Development Goals; 2013.
Available:http://www.un.org/millenniumgoals/maternal.shtml
(Accessed Dec 28, 2019)

United Nations’ Secretary General. Global Strategy for Women’s and Children’s Health. New York: United Nations; 2010.

Say L, Chou D, Gemmill A, Tuncalp O, Moller A, Daniels J, et al. Global causes of maternal death: A WHO systematic analy-sis. Lancet Glob Health. 2014;2:e323–33.
Available:http://dx.doi.org/10.1016/S2214-109X(14)70227-X

Okonofua F, Imosemi D, Igboin B, Adeyemi A, Chibuko C, Idowu A, et at. Maternal death review and outcomes: An assessment in Lagos State, Nigeria. PLoS ONE. 2017;12(12):e0188392.
Available:https://dx.doi.org/10.1371/journal.pone.0188392

Saager R, Kongnyuy E, Adebimpe WO, Omosehin O, Ogunsola EA, Sanni B. Causes and contributory factors of maternal mortality: Evidence from maternal and perinatal death surveillance and response in Ogun State, Southwest Nigeria. BMC Pregnancy and Childbirth. 2019;19:63.
DOI:https://dx.doi.org/10.1186/s12884-019-2202-1

Tesfaye G, Loxton D, Chojenta C, Assefa N, Smith R. Magnitude, trends and causes of maternal mortality among reproductive aged women in Kersa health and demographic surveillance system, Eastern Ethiopia. BMC Women’s Health. 2018;18:198.
DOI:https://dx.doi.org/10.1186/s12905-018-0690-1

Agan TU, Monjok E, Akpan UB, Omoronyia OE, Ekabua JE. Trend and causes of maternal mortality in a Nigerian Tertiary Hospital: A 5-year retrospective study (2010-2014) at the University of Calabar Teaching Hospital, Calabar, Nigeria. Open Access Macedonian Journal of Medical Sciences. 2018;6(6):1153-8.
DOI:https://dx.doi.org/10.3889/oamjms.2018.220

Pattison R, Say L, Souza JP, Broek Nvd, Rooney C. WHO maternal death and near-miss classification. Bulletin of the World Health Organization. 2009;87(10):734-A.

Oladipo TO, Lamina MA, Fakoya TA. Maternal deaths in Shagamu in the new millennium: A facility-based retrospective analysis. BMC Pregnancy Childbirth. 2006;6:6.
DOI:https://dx.doi.org/10.1186/1471-2393-6-6

Uzoigwe SA, John CT. Maternal mortality in the University of Port Harcourt Teaching Hospital: PH in the last year before the New Millennium. Niger J Med. 2004;13:32-35.

Audu LR, Ekele BA. A ten-year review of maternal mortality in Sokoto, Northern Nigeria. West Afr J Med. 2002;21:74-76.

World Health Organization (WHO). Strategies towards ending preventable maternal mortality (EPMM); 2015.

Shakar H, Elbourme D, Gulmezoglu M, Alfrevic Z, Ronsmas C, Allen E. The Woman Trial (World Maternal Antifibrinolytic Trial): Tranexamic acid for treatment of postpartum haemorrhage: An international randomized, double-blind placebo-controlled trial. Trials. 2010;11: 40.
DOI:https://dx.doi.org/10.1186/1745-6215-11-40

The Magpie Trial Collaborative Group. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: A randomized placebo-controlled trial. Lancet. 2002;359(9321): P1877-1890.
DOI:https://dx.doi.org/10.1016/S0140-6736(02)08778-0