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Maternal Mortality – Prevalence and Causes

The Prevalence and Causes of Maternal Mortality in Federal Teaching Hospital

 

ABSTRACT

This research surveyed the prevalence and causes of maternal mortality among patient managed at the maternity unit of Federal Teaching Hospital. Maternal mortality in sub-saharan African has remained high and this is a relation of the poor quality of maternal services. A retrospective research designed was the review of the all maternal death related to pregnancy over a 4 year period that is January 2005 to December 2009. Relevant information on number of deaths, booking status, age, parity, educational level of women, mode of delivery and causes of death were extracted and analyzed using tables, frequencies and percentages. The result show that of six thousand, four hundred and forty six samples studied and 146 deaths was recorded. Majority of women were within the age of 36-40 and 26-30 in age distribution table. The progress decline in maternal mortality corresponded with the time that free maternal services where introduced. Hemorrhage was the most important causes of maternal death, accounting for 23% indirect cause and 26% direct cause where as obstructed labour, ruptured uterine, unsafe abortion, hypertensive disorder, malaria, anemia, sepsis and other pregnancy or delivery related causes were the least important causes of maternal deaths. Majority of the maternal death occurred in unbooked patients (82.4%) where as 17.6% of the maternal deaths occurred in booked cases. There was a decline in mmR during the period study of the free was maternal health services and adequate staff recruitment, which may have contributed to the observed decline in maternal mortality. The researcher therefore recommends increased public health awareness on the affect of this maternal mortality as well as the need for early detectation and prevention of this problem.   

CHAPTER ONE

Introduction

Background of the Study

        Pregnancy is a normal physiological process which is the goal of every marriage. Pregnancy is also a very joyful development especially when the mother had delivered without complications. Unfortunately this seemingly joyful event has brought disability, pain, and sorrow, loss of family member and loss of body function in some people. The implication is that some women died or develop some disability in the course of pregnancy, and labour and post pueperium delivery resulting in maternal mortality.

Maternal mortality is the death of a woman while pregnant or within 42 days of termination of pregnancy from any cause related to or aggravated by the pregnancy or its management (Lucas 2003). High maternal mortality in developing countries can be attributed to the wide spread poverty, social inequality, ignorance, illiteracy, poor transportation and communication facilities, shortage and misdistribution of trained medical personnel of termination of pregnancy from any cause related to or aggravated by the pregnancy or its management (Lucas 2003). High maternal mortality in developing countries can be attributed to the wide spread poverty, social inequality, ignorance, illiteracy, poor transportation and communication facilities, shortage and misdistribution of trained medical personnel. Expensive or inconsistent, poorly formulated and managed health policies.

United Nations report in 2009 “Global maternal mortality” states that 52, 900 Nigeria women die annually from pregnancy related complications out of a global total of 529,000 maternal deaths. A woman chance of dying from pregnancy and child birth is 1:13. This is unacceptably high by European standard.

The Nigerian maternal mortality rate is one of the highest in the world, making Nigeria one of the unsafe place for a woman to be pregnant and go into labour (Asuike, 2006).

According to world health organization (2000) Maternal deaths have been subdivided into direct obstetric deaths usually occur due to post partum hemorrhage, puepural sepsis, eclampsia, obstructed labour and complications of unsafe abortion while the indirect obstetric is mainly due to existing diseases or from disease arising during pregnancy like malaria, anaemia, cardiovascular disease, HIV/AIDS and other infections such as typhoid fever, hepatitis and tuberculosis (Sawger, 2004).

About 1,100 women die during pregnancy or child birth for every 100,000 live births, hence Nigeria Government embarked on reducing maternal mortality by signing on to the programme of action at the international conference on the population and development in Cairo. According to India and china, may 2013 new analysis finds that while the government has adopted policies aimed at reducing maternal mortality by 2015, those policies have not been implemented effectively and are seriously under funded.

Globally, there is a substantial difference in maternal mortality in 21st century. According to Worner’s international network news, ‘the number of maternal deaths world wide per 100,000 live births is 430 with sharp division between developing countries. The highest maternal mortality rate are found in eastern and western African WHO, 2001).

The study, by Guttmacher institute on 28 May 2009 carriers to safe motherhood released by the New York based Guttmacher institute and women’s health and action research centre Benin city Nigeria compared nationally represented data from 1990 to 2003 and found that the provision of pre natal care critical in reducing maternal mortality has not improved overtime. More than 40% Nigeria women still do not visit a trained health care provider during pregnancy. In the year 2000, the largest gathering of world leaders adopted the millennium development goals which they hope to achieve by the year 2015, and this reduction in maternal deaths is the fifth goal. In order to achieve this, the Governor of Ebonyi state has given free maternal health care services in the state. It is dishearting to know that after all the effort yet the number of maternal deaths is still on the increase.

Statement of problem

The researcher, during the course of his clinical postings in Ebonyi State. Teaching Hospital observed with dismay that some mothers lost their live before, during or after pregnancy. The research has then moved to study the prevalence of these maternal deaths in FETHA and find out what could be the cause of these deaths at this hospital hence necessitating this study.

Purpose of the study

The main purpose of this study was to determine the prevalence of maternal mortality in Federal Teaching Hospital, Abakaliki from 2005 to 2009.

Objectives of the Study

  1. To determine the number of women that of pregnancy related causes in the hospital from January 2005 to December 2009.
  2. To determine the number of women that died of direct causes of maternal mortality.
  3. To identify the number of women that died of indirect causes of maternal complications.
  4. To ascertain the age distribution of the women that died of maternal complications between January 2005/December 2009.
  5. To identify the parity distribution of the women that died of maternal complications.

 Significance of the study

The study will provide insight to maternal mortality situation in well established tertiary health institutions. Its findings will provide insight to the picture of problem in primary and secondary healthy care institutions, it will help provide solutions to provide solutions to problems of maternal mortality in Ebonyi and assist in the planning and implementation of maternal health policies in the state. It will also add to the existing literature on maternal mortality.

Scope of the study

This study is limited to the number of women that died from 2005 to 2009 in Federal Teaching Hospital Abakaliki.

Operational definitions

Maternal mortality: This is the number of women who died from pregnancy, child birth and pueperium.

Maternal mortality: The number of maternal deaths per 1000 live births.

Direct causes: These are deaths from complication of the pregnant state either during pregnancy, labour or puerperium or also from wrong interventions e.g. ectopic pregnancy ante partum hemorrhage.

Indirect causes: These are deaths resulting from the previously existing disease or a pregnancy related disease e.g. diabetes mellitus, hypertension etc.

Age distribution

Women of child bearing: Any female from adolescent to other women adult from 15 to 45years.

Parity distribution on maternal mortality, this is the number of pregnancies a woman has had that have each resulted in the birth of an infant capable of survival.

CHAPTER FIVE

DISCUSSION OF FINDINGS

SUMMARY, CONCLUSION AND RECOMMENDATIONS

This chapter is concerned with the discussion of major findings, implications for nursing, summary, conclusion and recommendations. Suggestion for further studies and limitations of the study are also pointed out. The discussion of findings is presented questions by question for clarity.

Discussion of major findings:

Objective one

Maternal Mortality is frequently undiagnosed in the health care settings. However the findings disagree with the result of a 7- year study conducted by patrizic et al (2009) that recoded a high rate of 31% of the maternal mortality rate among 103 non child bearing ages. Some of the deaths may have been attended to and had their babies delivered by unskilled health personnel as a result to cultural beliefs, ignorance, poverty and lack of qualified midwives in the clinics and health centers within their communities.

Objective two

        To determine the number of women that died from direct causes of maternal mortality, Post-partum haemorrhage 26, puerperal sepsis 20 and obstructed labour, uterine inertia and rupture of uterus 15 and ante partum  hemorrhage 14 eclampsia 28. With a total cause of 103 deaths between 2005 to 2009 puerperal sepsis can be caused by use of unsterile technique during labour.

Post Partum haemorrhage can be caused by uterine retention of tissue or placenta. Ante partum haemorrhage can be caused by rupture of the uterine tissue. Obstructed labour comes in where there was no pelvic assessment.

Objective three

        To determine the indirect causes of maternal Mortality. It was observed that other infections (15) diseases (11) diabetes mellitus (5), anemia in pregnancy (12) are the indirect causes of maternal mortality causing a total of 43 deaths between  2005 and 2009. Other infection like tetanus, typhoid fever, HIV/AIDS, proper health education during antenatal clinic reduces that. Most Nigerian women are not educated and well informed. Some are very poor that they cannot even afford the so called “pure water” to avoid typhoid fever. Immunization, HIV/AIDS and prevention.

Anaemia in pregnancy is usually due to unbalanced nutrition, malaria attack and sickle cell anemia. According to Onah 2009. Both direct and indirect causes of maternal mortality are cited in his study but his work had no record of HIV/AIDS. Ezugwu (2009) in his study, hypertension (cause 16 deaths) was the leading cause of death as have been reported by Nigeria 8, 9. This was followed by eclampsia coupled with non availability of magnesium sulfate in the hospital within the study period, a drug that has shown to be very effective in management of severe eclampsia. According to him haemorrhage was also a common cause of death (cause 10 deaths), sepsis, severe anaemia and unsafe abortion.

Objective four

        To determine the age distribution of the women who died of maternal complications. Majority of the deaths occurred among those less than 16 years old and those above 40 years of age. This is partly due to the prematurely reproductive organs as some  of the women are given out for marriage at the age of 13 years.

Objective five

To determine the parity distribution of the women who died of maternal completion.

Multiparty of the women as well as lack of child spacing might have contributed to the mortality rate because some of them may not have replaced the blood and tissue loss before carrying another pregnancy. At 40 years old some of the women might have had more than 10 pregnancies and may have delivered more than 2 times under poor care, poor feeding and lack of health monitoring. From the findings, obvious that majority of the deaths (38/1) were recorded among those in the para 6-10 and the para 0-1 31.5 categories. This could be the result of underdevelopment of the reproductive; organs and the various complications associated with multi-parity such as eclampsia, ante partum/post partum haemorrhage as well as uterine inertia.

Conclusion

        Although there is free maternity care in Ebonyi State and Ebonyi State Federal Teaching Hospital is expected to provide qualitiative and specialized health care services to the South Eastern State, maternal modality is still a problem, this is despite the availability of trained and qualified health personnel in the hospital, the death: are often recorded, as a result of external factors like ignorance, cultural practices, poverty and delay in seeking medical care by the patients.

Summary

The study is a review of maternal mortality at (FETHA 1) Federal Teaching Hospital Abakaliki from 2005-2009. The objectives were:

  • To determine the number of women that died of pregnant related causes within the study period.
  • To determine the number of women that died from direct causes of maternal modality.
  • To determine the number of women that died from direct cause of maternal complication.
  • To determine the age distribution of the women that died of maternal complications between January 2005/December 2009.
  • To identify the parity distribution of the women that died of maternal complications.

Review of related literature was discussed under the heading conceptual framework, concept of maternal mortality in developed and developing countries. Prevalence of maternal mortality in developed and developed and developing countries, causes of maternal mortality, prevention of maternal mortality. It was retrospective study and information was obtained from the medical records department of obstetrics and gynecology of the hospital.

During the collection of data, a master list of all the deaths that occurred was compiled and groups according to the objectives of the study. Analysis of data was done and presented in tables. Based on the major findings, conclusions were made; recommendation & suggestion for further studies were made.

Recommendations

        From the above findings, the following are therefore recommended:

  • Intensive health education programmed and public enlightenment should be embarked upon on the dangers of early marriage to reduce teenage pregnancy and its complications.
  • The women should be encouraged to attend maternal clinic through health education with free or subsidized antenatal services and improved access to the clinics.
  • More clinics and adequate qualified mid-wives as well as other health personnel should be provided in the communities to provide regular pre natal and ante-natal care to the women. Family planning services should be made available to the women to improve the high parity level among the women. To improve compliance of family to the planning, its important to get men fully involved by making it a law that all men must witness the child delivery of their babies. This will prepare them body, soul and psychologically for family planning,
  • The women should be encouraged to deliver their babies in the clinic and to attend antenatal clinics regularly.
  • The traditional birth attendants should be adequately trained especially on the danger signs of pregnancy. High risk cases to the clinic hospitals and to reduce the risk of complications that could lead to death. Girl child education should be encouraged to reduce early marriage and to improve awareness about maternal health services among the women.

Limitations of the study

        Delay in signing of the letter of request for data collection by hospital authorities almost infringed on my study. The reason was because the chief ward charge and ward matron traveled for a workshop and the staff nurse claimed the letter wasn’t directed to any specific person or to her of whom to hold responsible in case of any misconduct.

In some folders, the patients demographic data were not properly recorded for instance, the column for age were  written adult and the column for data of birth were written in some only the year of birth.

Suggestion for further studies

        By way of improving this study, the researcher suggests that a larger population involving two or more Hospital be used. The research also suggest the need for further research on the causes and pregnancy related causes of maternal mortality.

 

The Prevalence and Causes of Maternal Mortality in Federal Teaching Hospital

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