29 January 2013

Nigeria: Strategic Action On Maternal Death Review


I was elated when I read the report of a maternal death review that was conducted for the year 2012 in one of the northern states in a big secondary health center which also serves as a comprehensive emergency obstetric and newborn center.

It was an event within the premises of the hospital that the commissioner of health of the state and his team were in attendance to listen to findings and respond to issues accordingly.

This indeed is a welcome development worth pointing out and it is a practice that should be encouraged in all the 36 states of Nigeria. We are all aware that the 1st instinct of any government agency in Nigeria is to deny any bad figure or wrong doing associated with health matters especially maternal death, but for a state to come out and organize a maternal death review exercise, I believe is a proactive move which should replicated all over the place.

What they did was actually in line with the work of the Commission on Information and Accountability for Women and Children's Health that is built on the fundamental human right of every woman and child to the highest attainable standard of health and on the critical importance of achieving equity in health. It fits into the accountability mechanisms which should be effective, transparent and inclusive of all stakeholders.

The Commission's framework

The accountability framework's three interconnected processes are ;

1. Monitor means providing critical and valid information on what is happening, where and to whom (results) and how much is spent, where, on what and on whom (resources).

2. Review means analysing data to determine whether reproductive, maternal, newborn and child health has improved, and whether pledges, promises and commitments have been kept by countries, donors and non-state actors.

3. Act means using the information and evidence that emerge from the review process and doing what has been identified as necessary to accelerate progress towards improving health outcomes, meeting commitments, and reallocating resources for maximum health benefit.

The MDR Findings

Coming back to the MDR finding; aimed at reviewing the maternal death and intended to provide evidence on where the main problems exist and produce analysis of what could be done in practical terms and highlight the key areas requiring recommendations for health sector and community action as well as guidelines for improving clinical outcome.

It was a retrospective analysis of maternal mortality records covering all maternal deaths between 1st January 2012 to 31st December 2012 and some of the indicators analyzed were; age, parity, causes and time of death and total number of live births during the period also recorded.

Looking at the findings, it showed that in 2012 Eclampsia, Hemorrage and Sepsis had accounted for 40%, 19% and 17% of all maternal death in that hospital respectively and in comparison with year 2010 Eclampsia, Haemorrhage and Sepsis had accounted for 47%, 6.7% and 13% respectively.

For Eclampsia in the 2 years experience the changes wasn't much and it shows that the state need to do a lot in containing this menace. Prompt action as well as adequate provision of Magnesium Sulphate could actually bring down the mortality.

For Haemorrhage, the state need to review its blood donation and blood bank policies, if there are gaps, as well as ambulances availability that could transport women and improve referral system.

For Sepsis, also the state should investigate safety procedure, disposal and sanitary system whether they contribute to sepsis within the maternity.

For the months of February and May in 2012, they recorded the highest maternal death. What can we learn from that? Was there fewer staff then? Or there were more patients? The un-booked patients recorded 64% of all the maternal death.

This shows that the state needs to intensify awareness campaign on the importance of Antenatal care and early booking. It also recorded maternal deaths more for those women coming from rural areas up to 86%.

It is also an indication that peripheral hospitals should be empowered to respond to emergencies. One interesting finding which could be seen also in all public hospitals was the highest maternal death was recorded in the night which accounted for 65%.

This is a question of human resources which could be inadequate during the night as well as less supervision in the night. If the state could strengthen human resources at night and supervision, I guess the figures will improve remarkably.


I am hoping that by 2014 when another MDR will be conducted in the same facility, the figures will shows improvement as I expect the government to take necessary proactive steps to address the gaps in management and maternity services not only in one facility but all over the state.

I will conclude by a quotation that's says "the right to health does not mean the right to be healthy... But it does require ... policies and action plans which will lead to available and accessible health care for all...this is the challenge facing both the human rights community and public health professionals."

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