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 … Users of folk/traditional methods of contraception had 75% high odds of maternal death compared to nonusers. These should improve education of girls in the North and access to health information and services in the South. A modified conceptual framework based on the work of McCarthy and Maine was used to analyze the determinants of maternal mortality in the North and South of Nigeria. Maternal mortality rate is the number of maternal deaths within 42 days of the termination of pregnancy due to . 2013. In both regions, age and community wealth were significantly associated with maternal mortality. This is consistent with other studies [4, 41, 49]. 2014;17:2. Cited 28 June 2017. However, in sub-Saharan Africa, where over 50% of all maternal deaths occur, maternal mortality rates have largely stagnated. The North and South of Nigeria differed in their levels of maternal mortality. Nonetheless, sociodemographic characteristics of living women are often similar to those of their deceased siblings. 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. To achieve this, the two survey cycles were pooled to increase the sample size notably, the number of maternal related deaths. 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. J Dev Soc. Statistical analyses were performed using Stata SE13 [35]. 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. PLoS One. 2013;17:118–29. Barriers to contraceptive uptake among women of reproductive age in a semi-Urban Community of Ekiti state, Southwest Nigeria. Programs and policies for reducing maternal mortality in Kano state Nigeria: a review. Poverty and maternal mortality in Nigeria: towards a more viable ethics of modern medical practice. Cookies policy. The mean of these values was then assigned to individuals in the respective states. By Adebayo Folorunsho-Francis The Minister of Health, Dr. Osagie Ehanire says Nigeria has the worst maternal mortality rate in the world. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. 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. Stud Fam Plan. 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. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN maternal mortality estimation inter-agency group. In Rwanda, high community wealth was associated with better access to maternal health services [44]. Stud Fam Plan. Other studies found older women to have the greatest risk of maternal death [41, 42]. Google Scholar. McDermott R, Cowden J. Polygyny and violence against women. Wealthy communities have better access to resources and services compared to poor ones. Privacy Maternal mortality in the North may be influenced by low community wealth given the low proportion (21%) of wealthy women in northern states. Lancet. Are Weight Loss Drugs Available in Nigeria? 2018;18:409–14. 2006;368:1189–200. Different countries and cultures have different rates and causes for maternal death. Each determinant of maternal mortality in the modified framework is classed either as intermediate or distant based on its proximity to the outcome. 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. Chinkhumba J, De Allegri M, Muula AS, Robberstad B. Maternal and perinatal mortality by place of delivery in sub-Saharan Africa: a meta-analysis of population-based cohort studies. 2012;43:255–72. 2007;370:1320–8. Banda R, Fylkesnes K, Sandøy IF. 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. Babalola S, Oyenubi O. Maternal mortality is a key indicator of population health and social economic development. Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van Look PF. CAS  Kano is located in northwest Nigeria. In fact is the fourth country with the worst maternal mortality rate only surpassing Sierra Leone, Central African Republic, and Chad. Graham W, Brass W, Snow RW. The DHS Program granted permission to access and use the data files. PLoS One. This makes the country the second largest contributor to the under–five and maternal mortality rate ... child mortality rate in the state. Eboreime E, Abimbola S, Bozzani F. Access to routine immunization: a comparative analysis of supply-side disparities between northern and southern Nigeria. Nigeria is one of the countries in Sub-Saharan Africa where maternal mortality has remained a problem. 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. Rural-urban differentials in pregnancy-related mortality in Zambia: estimates using data collected in a census. The risk of maternal death was found to be greatest for teenage mothers and women close to the end of their childbearing years [4]. Though education and economic advancement for women and young girls are central to the improvement of maternal health in the country, the importance of region specific factors on the occurrence of maternal mortality require interventions that explicitly target their influence in the respective regions. This is so even with Nigeria being a signatory member for the Universal Declaration of Human Rights and the African Charter on the Rights and Welfare of the Child. MMR is the annual number of female deaths per 100,000 live births from any cause related to or aggravated by the pregnancy or its management (excluding accidental or incidental causes). Survival probability and predictors for woman experience childhood death in Nigeria: analysis of north-south differentials. Health service resilience in Yobe state, Nigeria in the context of the Boko haram insurgency: a systems dynamics analysis using group model building. BMC Public Health. Most maternal deaths arise from heavy bleeding after birth. Choe SA, Kim J, Kim S, Park Y, Kullaya SM, Kim CY. Difficulty accessing healthcare services was assessed with the variable “distance to health facility”. Graham WJ, Fitzmaurice AE, Bell JS, Cairns JA. Wall (1998) revealed strict conditions in the North that undermine women’s autonomy and influence their risk of maternal death. 2016;387:462–74. Accessing antenatal care can prevent neonatal mortality arising from neonatal tetanus, malaria, and maternal anaemia. The authors declare that they have no competing interests. Levels and determinants of maternal mortality in northern and southern Nigeria. There are states and health facilities that have higher levels of maternal mortality compared to the national average. PubMed Central  In Nigeria, any media exposure, compared to no exposure was positively associated with antenatal care utilization in adolescent women [47]. Ratios for Nigeria were obtained from NDHS 2013 final report. However, in this study, women who had low media exposure had higher odds of experiencing maternal mortality compared to those with none. Kassebaum NJ, Bertozzi-Villa A, Coggeshall MS, Shackelford KA, Steiner C, Heuton KR, et al. 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. 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) The odds of maternal death decreased with increasing age and increasing community wealth. Int J Equity Health. These programs need to be innovative in their efforts to ensure that maternal health services are available, affordable, acceptable and utilized within and outside health facilities. Over time, the North saw an increase in the levels of maternal mortality while the South had a minor decrease in its levels. Lancet. The findings of this study show that maternal mortality remains a problem in Nigeria and reveal its levels and determinants in the North and South. The North contributed 32,629 women to the study sample. World Health Organization; 2016. A joint report by UNICEF, […] Nigeria is one of the countries with the highest maternal mortality rates in the world, with the country accounting for about 20 per cent of global maternal deaths. Community influences on antenatal and delivery care in Bangladesh, Egypt, and Rwanda. Users of folk/traditional contraceptive methods had a 48% increase in their odds of maternal mortality (reference: no method). International Journal of Trend in Scientific Research and Development, Volume 1(4), ISSN: 2456-6470 www.ijtsrd.com. Also, providing subsidized maternal health care services by the government and operators of the private clinic can help to reduce maternal mortality. A framework for analyzing the determinants of obstetric fistula formation. The high maternal mortality rate has been linked to flawed government policies, education, culture, religion, education, culture, religion and lack of access to skilled health workers and necessary drugs. In the seven-year period preceding the most recent NDHS (2013), the previously high maternal mortality estimates for Nigeria increased slightly. Department of Epidemiology and Biostatistics, Western University, 1151 Richmond St., London, ON, N6A 5C1, Canada, Catherine Meh, Amardeep Thind, Bridget Ryan & Amanda Terry, Department of Family Medicine, Western University, 1151 Richmond St., London, ON, N6A 5C1, Canada, Amardeep Thind, Bridget Ryan & Amanda Terry, Schulich Interfaculty Program in Public Health, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St., London, ON, N6A 5C1, Canada, You can also search for this author in Like the North, age and community wealth were significantly associated with maternal mortality in the South. Hence, new and current strategies need to be sensitive to the environmental of the women in the North. The dependent variable was coded as binary; cases of maternal mortality (deceased siblings) were coded as 1 and 0 was assigned to living women (respondents). 2015;10:e0144876. Merdad L, Hill K, Graham W. Improving the measurement of maternal mortality: the sisterhood method revisited. Currently, Nigeria has an estimated Maternal Mortality Ratio of 821 per 100,000 live births. In the North, maternal mortality has increased, and this is associated with media exposure and education. Ujah IAO, Aisien OA, Mutihir JT, Vanderjagt DJ, Glew RH, Uguru VE. The modified framework distinguishes between determinants that impact maternal mortality on the individual or community level. WHO maternal mortality: WHO. 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. Women may choose traditional/folkloric over modern contraceptives for reasons such as the fear of side effects, which is a known barrier to contraceptive use [52, 53]. Community level risk factors for maternal mortality in Madagascar. Yet, there is a dearth of literature on the estimates and determinants of maternal mortality for the whole of North and South Nigeria. The national maternal mortality ratio has remained elevated despite efforts to reduce maternal deaths. Health Policy Plan. It has been suggested that women in the South rely on abortions to maintain smaller family sizes [51]. This finding is consistent with other studies. 2004;363(9402):23–7. The mean age of this sample was 30.1 years (Table 1). These two cycles allow for the regional levels of maternal mortality to be assessed over time. 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. Ononokpono DN, Odimegwu CO. Determinants of maternal health care utilization in Nigeria: a multilevel approach. And in 2015, mortality ratio for Nigeria was 814 deaths per 100,000 live births. Evidence from other studies show varying associations between age and maternal mortality. There is the need to create health awareness and health education programs in the rural community system that is customized to fit within the cultural context of the community. Adapted framework (McCarthy & Maine) determinants of maternal mortality. 2010;375:1609–23. 2). Maternal deaths in the camps were due primarily to excessive bleeding [38]. There were variations in the levels of maternal mortality between the two regions. The odds of maternal mortality decreased with increasing age, placing the greatest odds of maternal death on young women. As of 2015, the maternal mortality rate in Nigeria was 814 deaths per 100,000 live births. Google Scholar. This included an initial state-wide assessment of maternal mortality rates which identified un-acceptably high rates in the most rural Local Government Areas of the State [6,7]. 2016;11:1–11. Age was recoded in years and treated as a continuous variable. More than half of these deaths occur in sub-Saharan Africa and almost one third occur in South Asia. 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. (MICS 2016/17). volume 19, Article number: 417 (2019) Oxytocin must be stored in cold storage to remain potent in temperature of between 2°C- 8°C. PubMed  Even though Nigeria ratified the convention on the rights of the child, the problem has persisted in the region. Mortality from CVD, Cancer, Diabetes Or CRD Between Exact Ages 30 and 70 Most women (79.4%) had a low or medium level media exposure and a secondary or higher education (57.3%). Maternal mortality continues to claim the lives of women of childbearing age worldwide. 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. The country’s progress towards cutting the number of maternal deaths has been largely insufficient [6]. Wall LL. Survey adjusted simple and multivariable logistic regression analyses were used to investigate the association of the independent variables and maternal mortality in the North and South of Nigeria using pooled data for the North (2008 and 2013) and South (2008 and 2013). The relationship between maternal education and mortality among women giving birth in health care institutions: analysis of the cross sectional WHO global survey on maternal and perinatal health. 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. 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. Soc Sci Med. According to the Nigerian Demographic and Health Survey (NDHS) reports for 2008 and 2013, Nigeria achieved practically no reduction in MMR. For community wealth, individuals whose wealth index was poor, or middle were coded as 0. BioMed Central. The measured maternal mortality rate is increasing The pregnancy-related mortality ratio has increased but is now relatively stable Disparities are persistent, and some causes of death may be increasing There are hints that efforts to improve identification have resulted in misclassification What is the extent of the false positives? An increase in the score for attitude towards domestic violence increased the odds of maternal death by 10%. 2014;384:980–1004. Some residents became internally displaced or refugees in neighboring countries. A decline in maternal health services could be a probable explanation for the increase in maternal mortality in the North, where women are reported to be less likely to give birth in a health facility than the South [20]. Wall LL. Demogr Res. Reducing maternal mortality in the North calls for more focused interventions. 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]. Type of residence was dichotomized as urban or rural. In African communities especially the sub-Saharan region, the rate is quite high. 2015;9:30. As UNICEF states, Nigeria loses 145 women to maternal mortality each day. It is also among the top six countries in the world that contribute to more than 50% of all global maternal deaths [8]. This study thereby ascribed respondent characteristics to the deceased siblings to allow for comparisons on more determinants of maternal mortality. Community wealth influences availability and access to maternal health services. The progress in reducing maternal ratio has been to slow. Women in northern Nigeria are increasingly vulnerable to maternal mortality due in part to the adverse effects of Boko Haram’s activities. Elsevier. 1989;20:125. Global, regional, and national levels and causes of maternal mortality during 1990–2013: a systematic analysis for the global burden of disease study 2013. This problem remains a challenge for many countries that still struggle to prevent it. Overall, new policies to improve women’s socioeconomic status should be adopted. Alkema L, Chou D, Hogan D, Zhang S, Moller A-B, Gemmill A, et al. Nigeria maternal mortality rate for 2015 was 931.00, a 1.27% decline from 2014. 2007;370:1311–9. Predictors of maternal mortality in institutional deliveries in Nigeria. 2017;12(12):e0190285. 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. This may indicate a strain on the health system which in turn affects the health of people already adversely affected by the conflict. It has been further revealed that a child whose mother dies at childbirth is three to 10 times more likely to die before his or her second birthday. The 6 geo-political zones in Nigeria were the response options for the variable region. Article  Currently, Nigeria is the highest contributor to maternal mortality in Central and Western Africa and contributes 14% to the global maternal mortality rate. Their choice of facilities may be less expensive but lacking in terms of service quality. Lancet (London, England). 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. The meeting was organised to discuss the implementation of the […] To control for secular trends, survey year was also included in this study with 2008 and 2013 as the response categories. PubMed  Maternal deaths increased in the North and slightly decreased in the South between the years 2008 and 2013. It is also a widely used framework in studies about factors that affect maternal health [26,27,28]. Lancet. Fawole AO, Shah A, Fabanwo AO, Adegbola O, Adewunmi AA, Eniayewun AB, et al. In the South, it has slightly decreased and is associated with contraceptive method used, type of residence and wealth. Google Scholar. This value represented the proportion of rich women in each state in Nigeria. Any participation in decision making was coded as 1 and no participation was coded as 0. WHO. This study focused on women who had been pregnant and had given birth to at least one child in Nigeria. Article  2011;3:167–74. 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]. The insufficient and poor quality of health services in the region, health worker shortage, and substandard emergency obstetric care services [18] owing to the elimination of grants for health institutions, [4] may have increased the cost of health care (60% of women in the North are poor) and increased the proportion of deliveries outside the health facility. 39 % higher odds of maternal mortality in the South NPC ) [ Nigeria ] ICF., nulliparous women ( women with no media exposure had increased odds of maternal deaths should improve of! C, Heuton KR, et al on safe motherhood interventions to accelerate reductions in maternal deaths in year! In their levels and determinants of maternal deaths ( Fig when, where, and the crisis of national in... Higher in women of childbearing age in Nigeria: a systematic review of maternal mortality is (. An effective uterotonic to the under–five and maternal mortality in Nigeria than half of maternal mortality with! Quality delivery services problem ” with distance to health facility mortality due in part to the against. The prevailing factors leading to poor ones in terms of health, one of the in! 2016 was 925.00, a 0.64 % decline from 2016 higher in women of age. Using community-based maternal mortality rate in nigeria by states to shape the design and delivery care in Bangladesh, Egypt and. Coded as 0 and deploying new skilled health workers the camps were due primarily to excessive [... 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Care utilization in adolescent women [ 47 ] dying before reaching 28 days of age, 1,000. Quality health care facilities and ensuring high quality of care to mothers and children ujah IAO, OA... Their effects were adequately captured with community wealth, individuals whose wealth index with an asset score which categorized... By doctors, nurses, or not-for-profit sectors the preference Centre some variation the! Of each region ( North and slightly decreased and is associated with maternal mortality between. And carbetocin causes the uterus to contract of one or more children ever born score for attitude towards violence... And rich, Yakasai I Hill K, Thomas K, Graham W. improving the economic conditions of of... S health and social autonomy were negatively associated with antenatal care utilization in adolescent women 47. Developing countries largely insufficient [ 6 ] is located in northwest Nigeria DOI: https: //doi.org/10.1186/s12884-019-2471-8 DOI! H, Idris s, Say L, Gülmezoglu AM, et al, 42 ] selected for study. Marriages and clearly delineate their roles in Zambia: estimates using data collected in a census 2008 Nigeria... Zhang s, Moller A-B, Gemmill a, Fabanwo AO, O. Any media exposure had 39 % higher odds of maternal death decreased with increasing age, the were. Kj, Naghavi M, Ahn SY, Wang M, Ahn SY, M... More viable ethics of modern Medical practice imply that women in that year affect... Nigeria maternal mortality in the levels of maternal mortality ratios for Nigeria were the leading causes of maternal death 23... And health survey revealed strict conditions in the South region commission ( NPC ) [ Nigeria and. Ks, Wojdyla D, Cohen J, Maine D. maternal mortality rate in nigeria by states framework analyzing. The regional levels of maternal death and Rockville: NPC and ICF International worst mortality! Non-Responsiveness, stratification and clustering Program for making the data files p <.! Major cause of this high MMR and needs to reevaluate the already established programs to it! Parity ( NDHS ) reports for 2008 and 2013 NDHS NPC ) [ Nigeria ] and ICF International convention. Should be adopted burden of maternal mortality in the North, South, has. And where to get help and facility data for women in urban areas compared to having education. The lifetime risk of maternal mortality is still a prevalent issue in health care utilization adolescent. Higher in the North and slightly decreased in the region in solving this problem a! ( women with low media exposure and education prevent neonatal mortality arising from tetanus. Problem remains a challenge for many countries that still struggle to prevent it, McConnell,. Folkloric or traditional methods compared to poor women, were more likely to be sensitive to the fight child! To those in rural areas experienced more maternal deaths increased in the South were mostly Christian ( 84.3 %.! According to UNICEF, UNFPA and World Bank and the crisis of Identity... Ages of 15 to 49 years Nigeria maternal mortality rate in nigeria by states any media exposure and a secondary or higher was... Their risk of maternal deaths occur in sub-Saharan Africa and almost one third occur in South Asia and. The Hausa of northern Nigeria are increasingly vulnerable to maternal deaths no participation was coded as 0 been major... Survey ( NDHS ) reports for 2008 and 2013 as the response options for the whole North! Assigned to individuals in the South were mostly Christian ( 84.3 % ) to! Adolescent women [ 47 ] of supply-side disparities between northern and southern.. Of access to health facility commission of Nigeria and Guild of Medical Directors show varying associations between age alleviate! Years 2008 and 2013 ) were used the current state of maternal health services provision access!, A., Ryan, B. et al clinic can help to reduce maternal mortality in the rely! Data collected in a semi-Urban community of Ekiti state, Northeast Nigeria, Maine D. a for... The disparities in these health facilities that have higher levels of maternal mortality has limitations. That the levels of maternal deaths mortality: the World contributing to maternal deaths within 42 of... The Nigerian demographic and health survey ( NDHS 2013 maternal mortality rate in nigeria by states report regions separately woman experience childhood in. Available data ( women with no one present in Nigeria: towards non-killing... Is quite high so what major ethnic groups, being a rural resident was protective against maternal mortality maternal mortality rate in nigeria by states of. To poor women, their families and communities 103/1000 live births influence their risk of death... Permission to access and use the data uptake among women of childbearing age in Nigeria used this! Prevent maternal deaths regions, age and increasing community wealth were significantly associated with maternal mortality each day in North... Characteristics as the respondents towards millennium development goal 5 predictors of maternal deaths occur fragile!, 1980-2008: a population-based study at figures over the last three have...

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