Study area
The study area was Ogun State in Southwestern Nigeria. The State hasan estimatedtotal population of 6,084,327 (with 3,078,669 males and 3,005,657females) derived from projections based on a 3.3% annual growth rate of the 2006 National Population Census figure for 2016. There has been a notable rise in the population and especially that of women of Reproductive Age (WRA) to an estimated 1,366,207 [5]. We obtained approval from the State Ministry of Health for this study.
Anecdotal review and analysis of 2007 to 2009 figures for Ogun Stateshowed a State level Maternal Mortality Ratio of 179 per 100,000 live births and Infant Mortality Ratio, Perinatal Mortality Ratio and Under-5 Mortality Ratio of 69/1000, 21/1000 and 27/1000 live births respectively. Modern contraceptive prevalence rate was 21.5 and 26.0% for all methods. Though most deliveries take place at health facilities (30.7% public and 44% private), the percentage of Traditional Birth Attendants (TBA)/Home delivery is still significant (24.8%) and in most situations,cases are often referred from this source to health facilities when it is already too late.
The study population
Constitutes all cases of maternal deaths that occurred in health facilities in Ogun Statein 2015 and 2016. The inclusion criterion is that such death should have been notified by the health facility where death occurred to the State MPDSR system which is a part of the national response.
Study design and scope of reviews
The study which was retrospective in design,covered an up-to-date epidemiological and programmatic review of maternal deaths data emanating from the MPDSR State response in 2015 and 2016. Quality, consistency, completeness and availability of data, and the investments needed to improve measurement of trends were also assessed. Observed trends in the surveillance and response systems were also assessed. Other activities carried out was a comprehensive desk review of documents, policies, guidelines, and reports, related to maternal mortality in Ogun State producedtill date.
Sampling methodology
A total sampling of all the MPDSR supported health facilities was carried out. In addition, a total sampling of all deaths notified within the period was made.
Research instruments
The national MPDSR tool (semi-structured, pretested and validated data collection questionnaire) was used by all the facilities for reporting or notification of deaths, and timely review of the same by designated facility staff. The existingStatedata-base was updated and validated by visiting some of the facilities at random and checking for consistency and availability of data.
MPDSR data collection methods
The State MPDSR response team went round the supported healthfacilities to ensure that no routine notification andreview forms were left behind, and that allforms got to the State Monitoring and Evaluation unit where the MPDSR database was being regularly updated. The State MPDSR data-base was a compendium of the responses in the data collection tool per Local Government Area (LGA) and per health facility. Secondary data analysis methodology only was deployed. MPDSR implementation efforts at health facility level were also assessed. A review of presentations made by the health facilities at the annual review meeting was also done.
Study variables
These include pattern of notification and review of maternal deaths, socio-demographic characteristics and some reproductive health history of the women who died within the period, includingthe causes and contributory factors to maternal mortality.
Ethical approval
Ethical Approval was obtained from Ogun state primary health care board ethical review committee. Written informed permission was obtained from the Medical directors of selected health facilities and the Executive Secretary of the Primary Health Care Board to use data.
TABLE OF CONTENT
Title page- – – – – – – – – i
Approval page – – – – – – – -ii
Dedication – – – – – – – – -iii
Acknowledgement – – – – – – – -iv
Abstract – – – – – – – – – -v
Table of content – – – – – – – -vi
CHAPTER ONE
INTRODUCTION – – – – – – – -1
1.0 Background of the study – – – – -1
1.1 Statement of the problem – – – – -5
1.2 Purpose of the study – – – – – -6
1.3 Significance of the study – – – – -8
1.4 Research questions – – – – – -9
1.5 Scope of the study – – – – – – -10
CHAPTER TWO
LITERATURE REVIEW – – – – – – -11
CHAPTER THREE
Research methodology – – – – – – -39
Design of study – – – – – – – -40
CHAPTER FOUR
Presentation, analysis and interpretation of data – -48
CHAPTER FIVE
Summary of findings – – – – – – -60
Conclusion – – – – – – – – -61
Recommendations – – – – – – – -62
Suggestions for further research – – – – -64
References – – – – – – – – -65
Appendix I – – – – — – – – -68
Questionnaire. – – – – – – – -69
THE FACTORS RESPONSIBLE FOR HIGH RATE OF MATERNAL MORTALITY IN BORNO STATE
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