Predictors of maternal mortality in institutional deliveries in Nigeria.

BACKGROUND: Maternal mortality in poor countries reflects the under-development in these societies. Global recognition of the burden of maternal mortality and the urgency for a reversal of the trend underpin the Millenium Development Goals (MDGs). OBJECTIVE: To determine risk factors for maternal mortality in institutional births in Nigeria. METHOD: Twenty one health facilities in three states were selected using stratified multi-stage cluster sampling strategy. Information on all delivered mothers and their newborn infants within a three-month period was culled from medical records. RESULTS: A total of 9 208 deliveries were recorded. About one-fifth (20.5%) of women had no antenatal care while 79.5% had at least one antenatal visit during pregnancy. Four-fifths (80.5%) of all deliveries were normal deliveries. Elective and emergency caesarean section rates were 3.1% and 11.5% respectively. There were 79 maternal deaths and 8 526 live births, giving a maternal mortality ratio of 927 maternal deaths per 100 000 live births. No antenatal care, parity, level of education, and mode of delivery were significantly associated with maternal mortality. Low maternal education, high parity, emergency caesarean delivery, and high risk patients risk independently predicted maternal mortality. CONCLUSION: Meeting goal five of the MDGs remains a major challenge in Nigeria. Multi-sectoral approaches and focused political will are needed to revert the high maternal mortality.

Pregnancy performance of Nigerian women aged 16 years and below, as seen in Ibadan, Nigeria.

A review of eighty-four women aged 16 years and below who gave birth at the University College Hospital, Ibadan during the period 1978-1982 has shown the majority of the patients to be unemployed women from a low socio-economic class. There is a strong tendency to lack of antenatal care in this group of women. Pregnancy and delivery were complicated by a higher than usual incidence of pregnancy-induced hypertension (PIH) and foeto-pelvic disproportion. A high perinatal mortality rate is noted and this poor result is related to the deficit in perinatal care the women received. Maternal mortality showed no significant difference compared with that obtained for all other maternity patients but a high morbidity rate, related mainly to PIH and foeto-pelvic disproportion, was found. Despite the undesirable social effects of teenage pregnancies, apart from the immature pelvic size, no definite biological reason could be adduced for the noted differences in their performance when compared to the total hospital maternity patients. We believe that differences in reports on teenage pregnancies may be due to differences in socio-cultural and educational standards of the various groups studied.