Determinants Of Maternal Mortality In General Hospital
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Determinants Of Maternal Mortality In General Hospital
Chapter one
INTRODUCTION
1.1 Background of the Study
The expanding global concern for improving reproductive health has produced a demand for research, particularly in the field of maternal health. Maternal health, defined as a woman’s physical well-being during pregnancy, childbirth, and the postpartum period (WHO, 2011; Fadeyi, 2007), has been a significant focus of various worldwide summits and conferences since the late 1980s, culminating in the Millennium Summit in 2000 (WHO).
It is evident that maternal mortality is an important aspect of maternal health. The World Health Organisation defines maternal mortality as the death of a woman while pregnant or within 42 days of the termination of a pregnancy
irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental and incidental causes (WHO 2007; Ogunjuyigbe and Liasu, 2007; Khama, 2006).
Within this conceptual framework, Millennium Development Goal 5A aims for a three-quarters reduction in maternal mortality by 2015. At its current rate, however, the world would fall short of the aim for maternal mortality reduction since the statistics so far gathered indicate that to meet the target, the worldwide Maternal Mortality Rate (MMR) would have had to be decreased by an average of 5.5% per year between 1990 and 2015.
Although Nigeria has only 2% of the worldwide population, it is responsible for nearly 10% of maternal mortality, ranking second only to India (Okonofua, 2007; Abdul-Aziz, 2008).
Maternal health in Nigeria is dismal, with 59,000 women dying each year from pregnancy-related reasons. This has been identified as the top cause of death among Nigerian women of reproductive age (Idris, 2010).
Although opinions on the determinants of maternal mortality differ, Herfon (2006) noted that the cause of maternal mortality is the result of a nexus interaction of a variety of factors, namely: distant factors (socio-economic, cultural) such as occupation, income level, and illiteracy act through proximate or intermediate factors (health and reproductive behaviour, access to health services) and influence outcome (pregnancy complication mortality).
Idris (2010) found other sociology-cultural elements that contribute to maternal mortality, including traditional practices, norms, beliefs, education, and religion.
Several attempts have been made in the past to reduce maternal mortality in Nigeria; but, such efforts, particularly by the federal and state governments, have typically failed to provide the intended outcomes.
However, some positive results have lately been reported as a result of legislative efforts implemented by a few state governments. In 2007, the Cross River state house of assembly passed a bill ensuring that pregnant women receive free maternal health services. The state commissioner of health, an obstetrician and gynaecologist, had a key role in its conception and implementation.
The introduction of the safe motherhood programme in 1995, the midwife service scheme (MSS) in 2011, and the subsidy reinvestment program (SURE-P) in 2012 introduced a range of interventions, including antenatal care, labour and delivery care, postnatal care, family planning, the prevention and management of unsafe abortions, and health education, but MMR has not been encouraging over the years, and progress has been slow.
The former state commissioner of health, together with certain top obstetricians and gynaecologists, played key roles in developing this favourable atmosphere for maternal healthcare.
As a result, pregnant women in Cross River now have access to free medical treatments at General Hospital in Calabar as part of the state government’s efforts to lower maternal death rates (Media Global, 2010).
Other states, such as Jigawa, have provided funds to upgrade obstetric care facilities in hospitals, recruit obstetricians and gynaecologists, and provide ambulances at the local level to transport pregnant women experiencing delivery complications to health facilities as part of efforts to reduce maternal mortality. The former executive secretary for primary health care, who later became state commissioner of health, supported these approaches.
1.2 Statement of Problem
Maternal mortality is the most important measure of maternal health and well-being in every country (Herfon, 2006). Maternal mortality is a tragedy; many children are left without a mother, depriving them of maternal care
which has a negative impact on both their physiological and psychological development. The bulk of these pitiful conditions are caused by maternal mortality.
According to recent estimates, the number of deaths from maternal causes globally has declined from 536,000 in 2005 to 358,000 in 2008 and 273,500 in 2011. For every woman who dies during pregnancy or childbirth, nearly 20 more sustain injuries, infections, or disabilities (IHME, 2012; UNICEF 2008; WHO, 2007).
Nigeria’s position is far more frightening. For example, in 2000, the maternal death rate per 100,000 live births was 800, compared to 540 in Ghana and 240 in South Africa.
As a result, the chance of a Nigerian woman dying from reproductive health disorders and complications was put at 1 in 10 in 2002 (Population Reference Bureau, 2002), 1 in 18 in 2005, and 1 in 23 in 2008, putting the Nigerian woman at far greater risk than her counterpart in the developed world, where the risk is estimated to be 1 in 17,800 and 1 in 10,000 in countries such as the Republic of Ireland and Singapore, respectively (World Bank, 2011; UNICEF, 2010; Media Glob These estimates may lead to a decline in the country’s workforce and hinder quick development.
This study focusses on the factors that contribute to maternal mortality in General Hospital Calabar, Cross River State. The researcher was prompted to conduct this study based on observations and clinical experience on the rate at which pregnant women die following childbirth as a result of postpartum haemorrhage or eclampsia. The question is, what are the causes of women’s deaths? This can only be answered once this study is completed.
1.3 The purpose of the study
The study’s goal is to better understand the factors that contribute to maternal mortality at General Hospital Calabar, Cross River.
1.4 Objectives of the Study
(i) Evaluate the impact of inadequate maternal health care on maternal mortality.
(ii) To determine the impact of schooling on maternal mortality.
(iii) Determine the impact of profession on maternal mortality.
1.5 Research questions.
To help the researcher fulfil the study’s aims, the following research questions were developed:
To what extent does poor maternal health affect maternal mortality?
How do educational characteristics affect maternal mortality?
Can one’s career effect maternal mortality?
1.6 Research Hypothesis
There is no significant link between maternal level of education and the causes of maternal death in General Hospital, Calabar.
1.7 Scope of the Study
The study is limited to all pregnant women with pregnancy-related disorders that result in maternal death at General Hospital Calabar.
1.8 Significance of the Study
The study’s findings will assist health workers in identifying the factors that contribute to maternal death, allowing them to implement more effective interventions to ensure that women have an uncomplicated pregnancy, delivery, and puerperium.
It will assist women of childbearing age in preventing maternal mortality during future pregnancies by providing sufficient prenatal care.
Similarly, the findings will be useful for state and federal governments, policymakers, and researchers conducting future research.
1.9 Limitations.
The biggest restriction found during this investigation was the health record official’s attitude towards providing important information to the researcher. Furthermore, some information retrieval was difficult due to the manual nature of data storage.
1.10 Operational Definition of Terms
A hospital is a facility or building where individuals who are unwell, sick, or injured receive medical treatment and care.
Primary health care refers to the first medical treatment obtained when sick.
Pregnancy is the period during which a woman’s baby develops inside her.
Maternal mortality refers to the death of a woman during or after delivery.
Maternal health refers to a woman’s physical well-being during pregnancy, childbirth, and the postpartum period.
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