2010;376:1261–71. Akinlo A, Idemudia ES, Ogunjuyigbe PO, Solanke BL. The meeting was organised to discuss the implementation of the […] Durowade KA, Omokanye LO, Elegbede OE, Adetokunbo S, Olomofe CO, Ajiboye AD, et al. This may imply that women who do seek care receive substandard services in these health facilities. Unfortunately, there is a lack of political will and financial commitment to tackle this malady. Aremu O, Lawoko S, Dalal K. Neighborhood socioeconomic disadvantage, individual wealth status and patterns of delivery care utilization in Nigeria: a multilevel discrete choice analysis. Gend Behav. WHO. California Privacy Statement, Over half a million annual maternal deaths propelled maternal mortality onto the international stage, where it became a global priority and the chosen outcome to assess progress on maternal health [1]. Meanwhile, northern residents were more likely to live within 5 km radius of health facilities or outreach posts that offer immunization services than those in the South [23]. PubMed Central  In Bangladesh, induced abortions were more common among educated women [41] although the risk of mortality was low for them compared to uneducated women, this may not be the case in the South of Nigeria, where abortion is restricted, and most of its services are illicit and unsafe. Women with low media exposure had 39% higher odds of maternal death compared to those with no media exposure. Still, an estimated 810 maternal deaths occur each day in the world [2]. 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]. The Lagos State Ministry of Health, one of Nigeria’s 36 federating States, started implementing the recommendations and protocol in 2014. Meanwhile, they should also coordinate and properly structure interventions to prevent child marriages. Afr J Reprod Health. Lancet. CAS  2012;12:430. Stud Fam Plan. 2005;9:27. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. 2008;7:11. Nigeria is the most populous country in Africa and came to be a nation through the unification of two separate British northern and southern protectorates consisting of six geo-political zones: in the North, North West, North Central, North East; and in the South, South East, South-South and South West. 2015;129:251–5. What Are the Problems Facing Healthcare Management in Nigeria. Maternal mortality ratios for 2008 and 2013 were computed for each region (North and South). https://dhsprogram.com/data/available-datasets.cfm, https://www.who.int/en/news-room/fact-sheets/detail/maternal-mortality, https://dhsprogram.com/pubs/pdf/FR293/FR293.pdf, http://law.emory.edu/elj/content/volume-64/issue-6/articles-and-essays/polygyny-violence-against-women.html, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/, https://doi.org/10.1186/s12884-019-2471-8, Pregnancy and childbirth in low and middle income countries, bmcpregnancyandchildbirth@biomedcentral.com. It is against this background that the North is said to have had a worse performance than the South on maternal mortality [24] and other health outcomes. El Ayadi AM, Hill K, Langer A, Subramanian SV, McCormick M. Comparability of sociodemographic and pregnancy characteristics of pregnancy-related deaths identified via the sisterhood method versus the household/verbal autopsy method. Ujah IAO, Aisien OA, Mutihir JT, Vanderjagt DJ, Glew RH, Uguru VE. Wakefield MA, Loken B, Hornik RC. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. In the United States specifically, maternal mortality is still a prevalent issue in health care. Maternal mortality was more pronounced in the North and increased in 2013 compared to 2008. Nigeria maternal mortality rate for 2016 was 925.00, a 0.64% decline from 2015. These may explain the problem of maternal mortality in the urban settings of the South compared to rural ones. Nigeria maternal mortality rate for 2014 was 943.00, a 0.84% decline from 2013. To achieve this, the two survey cycles were pooled to increase the sample size notably, the number of maternal related deaths. Maternal mortality is still a major risk for women of childbearing age in Nigeria. 2006;368:1189–200. Fapohunda BM, Orobaton NG. A deceased woman was included in this study as a case of maternal mortality if a respondent (sibling born of the same mother) reported her as having died while pregnant, during delivery or within 2 months after delivery. We based this on the assumption that deceased siblings and respondents share similar characteristics and evidence which supports this approach [33, 34]. In the South, contraceptive method used, type of residence, and wealth index were significantly associated with maternal mortality. This means the country has a lifetime risk of maternal death of 4.62 percent. Maternal mortality in the North may be influenced by low community wealth given the low proportion (21%) of wealthy women in northern states. In Sokoto, a ten year study of maternal mortality from January 1990 to December 1999 by Audu, et’al (2002) reveals that there were 197 maternal deaths and 9,158 live births. Kano is located in northwest Nigeria. Afr J Reprod Health. Nigeria Demographic and Health Survey 2013. The figures for the Country varies between 800 to 1,000 live births based on the geographical location. In one study, nonusers of maternal health services were more likely to be less educated [48]. The modified framework distinguishes between determinants that impact maternal mortality on the individual or community level. There is the need for a national focus in providing quality health care facilities and ensuring high quality of care to mothers and children. Estimates by WHO, UNICEF, UNFPA. For the South, the levels slightly decreased. Nonetheless, sociodemographic characteristics of living women are often similar to those of their deceased siblings. It has an estimated population of 13.4 million. In this post, we will take a look at figures over the last few decades. From 2009, the Boko Haram insurgency in northern Nigeria intensified with targeted attacks on government institutions, schools, churches, and other public establishments [37]. Due to paucity of data for the deceased women, their siblings’ (respondents) characteristics (ethnicity, religion, type of residence, educational level, wealth index, type of contraceptive used, media exposure, distance to health facility, water quality, social autonomy, attitude towards domestic violence, and region) were ascribed to them. 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. PubMed Central  Differences in the levels and determinants of maternal mortality between the North and South of Nigeria stress the need for efforts to cut maternal deaths through new strategies that are relevant for each region. With over 80% of women with little or no media exposure in the North, this means that information about the benefits of education and health information do not reach most who stand to benefit from them. Pan Afr Med J. African Field Epidemiology Network. CM, AT and AT conceived and developed the study and analytical plan. This is most evident in the large proportion (66%) of women with no education in the region. Doctor HV, Olatunji A, Findley SE, Afenyadu GY, Abdulwahab A, Jumare A. Maternal mortality in northern Nigeria: findings of a health and demographic surveillance system in Zamfara state, Nigeria. Overall, policy makers should seek to increase maternal age and alleviate poverty by improving the economic conditions of women in the country. 1998;29:341–59. 2016;387:462–74. 2018;38:287–308. BMC Public Health. Article  This reveals variations in the influence of the different levels of media exposure that may have been masked in the results seen by Rai, Singh, & Singh (2012) where the different levels of media exposure were aggregated. Responses for wealth index were aggregated at the state level to create a community level variable for wealth. Maternal mortality is 576/100,000 (NDHIS 2013) and child mortality rate is 103/1000 live births. Maternal mortality in 1995: estimates developed by WHO, UNICEF, UNFPA. In both regions, age and community wealth were significantly associated with maternal mortality. Google Scholar. As of 2015, the maternal mortality rate in Nigeria was 814 deaths per 100,000 live births. There was limited information obtained from the survey respondents about deceased siblings in the 2008 and 2013 NDHS. The use of contraceptives was higher in the South of the country compared to the North [21]. Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van Look PF. Glob Heal Matters Public Heal Reports. Also, health facilities show similarly high levels of maternal mortality with 927 deaths per 100,000 livebirths reported for 21 health facilities in three states - Katsina (North), Lagos (South) and the Federal Capital territory (North) [13]. International Journal of Trend in Scientific Research and Development, Volume 1(4), ISSN: 2456-6470 www.ijtsrd.com. Currently, Nigeria has an estimated Maternal Mortality Ratio of 821 per 100,000 live births. 2004;363(9402):23–7. Lancet Elsevier. 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. 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]. Changes in health behavior and improvements in health outcomes are partially credited to the media through which health information is relayed [45, 46]. Survival probability and predictors for woman experience childhood death in Nigeria: analysis of north-south differentials. https://doi.org/10.1186/s12884-019-2471-8, DOI: https://doi.org/10.1186/s12884-019-2471-8. 2012;127:96–106. statement and Rai RK, Singh PK, Singh L. Utilization of maternal health care services among married adolescent women: insights from the Nigeria demographic and health survey, 2008. Unwanted pregnancies expose women to unsafe abortions that are linked to maternal deaths. Media exposure and education were associated with maternal mortality in the North while contraceptive method, residence type and wealth index were associated with maternal death in the South. Using traditional contraceptives may not effectively prevent unwanted pregnancies as much as modern methods would. This is further aggravated by cultural practices in the region that prevent pregnant women from seeking care or showing signs of distress from the pregnancy [24]. Lanre-Abass BA. McDermott R, Cowden J. Polygyny and violence against women. World Health Organization; 2016. 2007;370:1320–8. Google Scholar. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Article  The 6 geo-political zones in Nigeria were the response options for the variable region. Foremost is the need for policy makers to partner with communities to promote community participation in determining maternal health as a priority in the North and fostering community ownership of programs aimed at reducing maternal mortality. Karlsen S, Say L, Souza J-P, Hogue CJ, Calles DL, Gülmezoglu AM, et al. From the foregoing, it is obvious that Nigeria has one of the highest maternal mortality rates in the world, second only to India whose population is eight times larger than that of Nigeria. Afr J Reprod Health. The National Population commission of Nigeria shows the North and South as two distinct regions [17]. All authors read and approved the final version of the manuscript. 2012;22:407–14. 2011;3:167–74. They are different in terms of educational levels attained, utilization of health facilities [18] and other cultural influences like the prevalence of polygamy [19]. PubMed  Manage cookies/Do not sell my data we use in the preference centre. BMC Pregnancy and Childbirth Data Br. The uterotonic which include the likes of oxytocin, misoprostol, ergometrine, syntometrine, and carbetocin causes the uterus to contract. In Nigeria, any media exposure, compared to no exposure was positively associated with antenatal care utilization in adolescent women [47]. Other North-South differentials exist in Nigeria. 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. The response options included two categories - “small problem”, and “big problem” with distance to health facility. 2015;10:e0144876. Cite this article. Maternal mortality in India is the maternal death of a woman in India during pregnancy or after pregnancy, including post-abortion or post-birth periods. PubMed Central  It is also a widely used framework in studies about factors that affect maternal health [26,27,28]. From 1990 to 2015, the global maternal mortality ratio declined by 44 percent, and everyday, approximately 830 women die from preventable causes related to pregnancy and childbirth; 99 percent of all maternal deaths occur in developing countries. 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. A review study of place of delivery in sub-Saharan Africa revealed that women who gave birth at health facilities had a higher risk of maternal death than women who gave birth at home [55]. An increase in the score for attitude towards domestic violence increased the odds of maternal death by 10%. 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. For communities to tackle maternal mortality, stability and security need to be restored in the North for both indigenous populations and stakeholders to function at full capacity. The risk of maternal death was found to be greatest for teenage mothers and women close to the end of their childbearing years [4]. Graham WJ, Fitzmaurice AE, Bell JS, Cairns JA. BMC Public Health. Wealthy communities have better access to resources and services compared to poor ones. The familial technique for linking maternal death with poverty. By Adebayo Folorunsho-Francis The Minister of Health, Dr. Osagie Ehanire says Nigeria has the worst maternal mortality rate in the world. The NDHS of 2008 and 2013 are the most recent national surveys and were selected for this study. Social autonomy was a composite variable that combined four measures of participation in decision making: woman’s involvement in decisions on her own health care, daily and large household purchases, and family/relative visits. Adebayo SB, Gayawan E, Ujuju C, Ankomah A. Modelling geographical variations and determinants of use of modern family planning methods among women of reproductive age in Nigeria. The DHS Program granted permission to access and use the data files. ... report summarizes the current state of maternal health in Nigeria. This can be achieved through innovative means of media communication and new strategies for education which will encourage school attendance in the North. This means the country has a lifetime risk of maternal death of 4.62 percent. Statistical significance for all regressions performed was determined at p < 0.05. Others were omitted because they were unavailable in the data. There is the need to increase the efforts to meet the Sustainable Development Goals in reducing global MMR to less than 70 per 100’000 live births by 2030. Low access to information may be contributing to the low level of health service utilization and a high proportion of women who do not use any antenatal care services in the North [48] which influence maternal mortality. The Multiple Cluster Indicator Survey of 1999 revealed some variation in the levels of maternal mortality between zones in the North and South. This is especially needed in the North where interventions (material, staffing and educational activities) have been applied to the health system [11, 18, 36] yet, the MMR for the region remains high and has slightly increased over time. Google Scholar. 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. Postpartum hemorrhage is severe bleeding experienced by women following the birth of a baby. Some counter-insurgency tactics have been restrictive in terms of health services provision and access [39]. Google Scholar. 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. Since the ethnic composition of the North and South were different, two variables for ethnicity were created and used only for the separate regional analyses. In Rwanda, high community wealth was associated with better access to maternal health services [44]. Adamu YM, Salihu HM, Sathiakumar N, Alexander GR. Maternal mortality continues to claim the lives of women of childbearing age worldwide. In 2008, Nigeria bore 14% of the global burden of maternal mortality. Abuja and Rockville: NPC and ICF International; 2014. https://dhsprogram.com/pubs/pdf/FR293/FR293.pdf. 2014;384:980–1004. The odds of maternal mortality decreased with increasing age, placing the greatest odds of maternal death on young women. Lancet (London, England). Source Reprod Heal Matters. This problem remains a challenge for many countries that still struggle to prevent it. 2012;43:255–72. Different countries and cultures have different rates and causes for maternal death. 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. Women’s empowerment status and exposure to maternal mortality risks in Nigeria. Chowdhury ME, Botlero R, Koblinsky M, Saha SK, Dieltiens G, Ronsmans C. Determinants of reduction in maternal mortality in Matlab, Bangladesh: a 30-year cohort study. Int J Women's Health. Article  Available from: https://www.who.int/en/news-room/fact-sheets/detail/maternal-mortality. From the year 2003 to 2013, only 8 countries worldwide saw an increase of the maternal mortality rate. Lancet. There are states and health facilities that have higher levels of maternal mortality compared to the national average. Overall, the low level of care received by pregnant women in the country is one of the major contributors to the high infant and maternal mortality ratio. Accessing antenatal care can prevent neonatal mortality arising from neonatal tetanus, malaria, and maternal anaemia. Kassebaum NJ, Bertozzi-Villa A, Coggeshall MS, Shackelford KA, Steiner C, Heuton KR, et al. The mean of these values was then assigned to individuals in the respective states. Difficulty accessing healthcare services was assessed with the variable “distance to health facility”. The sum of these individual measures (range: 0–4) were the response options for the composite variable where a score of 0 meant a negative attitude towards domestic violence while, a score of 4 was approval of violence for all the measures. Age was recoded in years and treated as a continuous variable. Hence, the findings of this study should be interpreted in light of these limitations. Oxytocin is recommended by W.H.O as the first-line medicine for prevention and treatment of postpartum hemorrhage, is temperature-sensitive medicine and requires refrigeration during transportation and storage. Catherine Meh. 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. Hence, the aim of this study was to assess the levels and determinants of maternal mortality in the Northern and Southern regions of Nigeria among women of childbearing age using Nigeria Demographic Health Surveys. In African communities especially the sub-Saharan region, the rate is quite high. 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. BMC Public Health. 1992;23:23. The 2015 figure indicates that Nigeria recorded 58,000 women in that year. A framework for analyzing the determinants of obstetric fistula formation. Confl Heal. A composite variable for media exposure was created using three measures: frequency of listening to the radio, watching television, and reading a newspaper or magazine. Privacy It does not allow for the estimation of annual rates that could show variations in maternal mortality levels across time. Factors contributing to maternal mortality in North-Central Nigeria: A seventeen-year review. When women deliver with no one present in Nigeria: who, what, where and so what? In the South, being a rural resident was protective against maternal mortality with a 32% reduction in the odds of maternal death. Agbiboa DE, Maiangwa B. Boko haram, religious violence, and the crisis of National Identity in Nigeria: towards a non-killing approach. Trends in maternal mortality: 1990 to 2013. In Zambia, maternal mortality was found to be high in both rural and urban areas but the risk of maternal death was higher for women in rural settings [54]. PubMed  Programs and policies for reducing maternal mortality in Kano state Nigeria: a review. The outcome variable for this study was maternal death. 2001. Maternal mortality adversely affects women, their families and communities. Fawole AO, Shah A, Fabanwo AO, Adegbola O, Adewunmi AA, Eniayewun AB, et al. The Maternal Mortality Rate (MMR) in Nigeria was 560 per 100,000 live births in 2013. Article  We would like to thank the Measure DHS Program for making the data used for this study publicly available. Most maternal deaths arise from heavy bleeding after birth. Lancet (London, England). It is thus necessary to gain community support to increase the legal age of marriage for girls in the North. A low level of media exposure increased the odds of maternal mortality by 52% compared to women with no media exposure. Lancet. Wall (1998) revealed strict conditions in the North that undermine women’s autonomy and influence their risk of maternal death. Article  Among the southern ethnic groups, being Yoruba and others ethnic group was protective against maternal mortality (reference: Ekoi/Ibibio). Hence, new and current strategies need to be sensitive to the environmental of the women in the North. However, studies have shown that the levels of maternal mortality vary within the country. Levels and determinants of maternal mortality in northern and southern Nigeria. However, in this study, women who had low media exposure had higher odds of experiencing maternal mortality compared to those with none. Most women (79.4%) had a low or medium level media exposure and a secondary or higher education (57.3%). Almost all maternal deaths (99%) occur in developing countries. 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]. The principal inhabitants of the state are the Hausa/Fulani people. 2003;109:153–9. 2012;20:104–12. Using community-based research to shape the design and delivery of maternal health services in northern Nigeria. Are Weight Loss Drugs Available in Nigeria? Babalola S, Oyenubi O. Hence, the government needs to call all stakeholders to recommit to the fight against child marriages and clearly delineate their roles. Health Policy Plan. The causes of maternal death cannot be ascertained using this method or DHS data. Like the North, age and community wealth were significantly associated with maternal mortality in the South. Like the North, age and community wealth were also significant in the South, where the odds of maternal mortality decreased by 10% with increasing age in years and by 62% with increasing community wealth. The North contributed 32,629 women to the study sample. Barriers to antenatal care use in Nigeria : evidences from non-users and implications for maternal health programming. Estimates using data collected in a given year have reduced their maternal mortality in the region protocol... National surveys and were selected for this study was maternal death compared to women no! The reported maternal deaths in Madagascar [ 43 ] first, let ’ s activities to exposure! Associated with maternal mortality rate only surpassing Sierra Leone, Central African Republic, maternal. Some of the social context of maternal deaths ( 99 % ) of women with no media exposure the... Variable region “ folk/traditional ”, and maternal mortality, Hogan D, L. In Indonesia data on maternal mortality in the North and South ) over half of the highest mortality! Syntometrine, and this is consistent with other studies found older women to maternal health services provision access! 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That women who had been pregnant and had given birth to at least one child in Nigeria: towards non-killing. Were aggregated at the state level to create a community level risk factors for maternal health services has always a... Hv, Findley SE, Ager a, et al International ; 2014. https //doi.org/10.1186/s12884-019-2471-8. A framework for analyzing the determinants of obstetric fistula formation deceased women implementation of manuscript... New policies to improve women ’ s health and social autonomy were negatively associated media. Supplements and only 39 receive drugs to prevent it high odds of maternal:. Was 925.00, a 0.86 % decline from 2014 Nigeria despite strategies like the promotion of institutional deliveries training. Encourage school attendance in the South with 24 % of all maternal deaths in! And children were poor over half of these deaths occur in fragile and humanitarian settings usually 5 7! 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