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Experiences of 6 years quality assurance in obstetrics in Nigeria – a critical review of results and obstacles

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Published/Copyright: January 17, 2015
Journal of Perinatal Medicine
From the journal Journal of Perinatal Medicine Volume 44 Issue 3

Abstract

Objective: The objective of this study was to monitor the maternal mortality ratio (MMR) in 19 general hospitals after introducing quality assurance in four states in Nigeria.

Methods: Data collection with a structured maternity record book started in 2008 in ten rural hospitals in Kano and Kaduna State. In 2011, five hospitals from Federal Capital Territory Abuja were added, whilst in 2013 four hospitals were added from Ondo State. The routine data collection was conducted by experienced midwives and supervised by obstetricians from each of the states. However, the data from all four states were collated centrally at Aminu Kano Teaching Hospital for analysis.

Results: From 2008 to 2013, 121,808 deliveries were evaluated; MMR fell from 1380 to 360/100,000 in Kaduna State, whilst for Kano State there was a gradual reduction of MMR from 2100/100,000 in 2008 to 1070/100,000 in 2011, and then it increased to 2150/100,000 in 2013. Ondo state had the lowest MMR of 180/100,000 in 2013 followed by Abuja with 240/100,000. The median cesarean section rate was 8.19%, (range 0.97–22.53%), eclampsia/preeclampsia was 4.43% (range 0–56.55%), and postpartum hemorrhage was 3.36% (range 0.81–11.4%).

Conclusions: Quality assurance in rural hospitals generates the awareness necessary to improve maternal health and lead to reduction of MMR.

Keywords: Cesarean section; fetal mortality; hospital profile; maternal mortality; obstetrics; postpartum hemorrhage; quality assurance

Acknowledgments

We thank the Ministry of Health of the State Governments of Kano, Kaduna, FCT Abuja and Ondo for their support in data collection in the respective hospitals. We thank The Rotary Foundation (TRF), the Rotary District 9120 Northern Nigeria, German Ministry for Economic Cooperation and Development (BMZ), Aventis Foundation, IAMANEH German section, the Rotarian Action Group for Population and Development (RFPD), Rotary Clubs from Germany and Rotaract Clubs and Inner Wheel Clubs from Germany and Austria for their generous support. We thank the midwives from Kano State, Kaduna State, FCT Abuja and Ondo State for supervising the hospitals, collecting the data and discussing the results of the evaluation with the hospital management. Special thanks go to the statistical office in Kano State for entering and evaluating the data and for the preparation of the review meetings.

Limitations of the investigation: The limitation of this investigation is that the described maternal mortality ratio (MMR) and fetal mortality ratio (FMR) are mainly mortalities described in a hospital. It does not take into account all the maternal and fetal deaths that occur outside the health facility within the communities. The balance between both is not known and is hard to estimate. Also, our MMR is in relation to total deliveries instead of total live births.

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The authors stated that there are no conflicts of interest regarding the publication of this article.

Received: 2014-9-8
Accepted: 2014-12-3
Published Online: 2015-1-17
Published in Print: 2016-4-1

©2016 by De Gruyter

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. The emergence of obstetric medicine
  4. Mini review
  5. Folate status and health: challenges and opportunities
  6. Original articles - Obstetrics
  7. Increased levels of serum clusterin is associated with intrauterine growth restriction and adverse pregnancy outcomes in preeclampsia
  8. The utility of clinical findings to predict laboratory values in hypertensive disorders of pregnancy
  9. Association between decreased plasma levels of soluble human leukocyte antigen-G and severe pre-eclampsia
  10. Umbilical cord plasma interferon-induced protein 10 (IP-10) and interferon-induced T-cell alpha chemoattractant (ITAC) levels are lower in women with severe preeclampsia
  11. The prognostic value of first-trimester cystatin C levels for gestational complications
  12. Experiences of 6 years quality assurance in obstetrics in Nigeria – a critical review of results and obstacles
  13. Are there anamnestic risk factors for iron deficiency in pregnancy? Results from a feasibility study
  14. Is there any relationship between serum sirtuin-1 level and neutrophil-lymphocyte ratio in hyperemesis gravidarum?
  15. Pregnancy outcomes among renal transplant recipients and patients with end-stage renal disease on dialysis
  16. Are pregnant women safer in motor vehicle accidents?
  17. Amniotic fluid as a source of multipotent cells for clinical use
  18. Original articles - Newborn
  19. Antenatal risk factors for symptomatic congenital CMV disease following primary maternal CMV infection
  20. Effects of preeclampsia on the amplitude integrated electroencephalography activity in preterm infants
  21. Short communication
  22. The impact of uterine curettage postpartum on maternal sFlt-1 concentration
  23. Letter to the Editor
  24. Fetal cerebroplacental ratio and adverse perinatal outcome
  25. Letter to the Editor – Reply
  26. Reply to: Fetal cerebroplacental ratio and adverse perinatal outcome
  27. Congress Calendar
  28. Congress Calendar
https://doi.org/10.1515/jpm-2014-0302
Keywords for this article
Cesarean section; fetal mortality; hospital profile; maternal mortality; obstetrics; postpartum hemorrhage; quality assurance

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. The emergence of obstetric medicine
  4. Mini review
  5. Folate status and health: challenges and opportunities
  6. Original articles - Obstetrics
  7. Increased levels of serum clusterin is associated with intrauterine growth restriction and adverse pregnancy outcomes in preeclampsia
  8. The utility of clinical findings to predict laboratory values in hypertensive disorders of pregnancy
  9. Association between decreased plasma levels of soluble human leukocyte antigen-G and severe pre-eclampsia
  10. Umbilical cord plasma interferon-induced protein 10 (IP-10) and interferon-induced T-cell alpha chemoattractant (ITAC) levels are lower in women with severe preeclampsia
  11. The prognostic value of first-trimester cystatin C levels for gestational complications
  12. Experiences of 6 years quality assurance in obstetrics in Nigeria – a critical review of results and obstacles
  13. Are there anamnestic risk factors for iron deficiency in pregnancy? Results from a feasibility study
  14. Is there any relationship between serum sirtuin-1 level and neutrophil-lymphocyte ratio in hyperemesis gravidarum?
  15. Pregnancy outcomes among renal transplant recipients and patients with end-stage renal disease on dialysis
  16. Are pregnant women safer in motor vehicle accidents?
  17. Amniotic fluid as a source of multipotent cells for clinical use
  18. Original articles - Newborn
  19. Antenatal risk factors for symptomatic congenital CMV disease following primary maternal CMV infection
  20. Effects of preeclampsia on the amplitude integrated electroencephalography activity in preterm infants
  21. Short communication
  22. The impact of uterine curettage postpartum on maternal sFlt-1 concentration
  23. Letter to the Editor
  24. Fetal cerebroplacental ratio and adverse perinatal outcome
  25. Letter to the Editor – Reply
  26. Reply to: Fetal cerebroplacental ratio and adverse perinatal outcome
  27. Congress Calendar
  28. Congress Calendar
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