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Prioritizing Maternal Death Reviews in Health systems.

Maternal death has been one of the major health care challenges in Nigeria and it’s no longer news that Nigeria is the second country with the high rate of maternal death in the world second to India. Nigeria is also a part of a group of six countries in 2008 that collectively accounted for over 50% of all maternal deaths globally and in terms of the maternal mortality ratio, Nigeria is ranked eighth in Sub-Sahara Africa.  And just like cancer it keeps spreading despite efforts to curb these deaths.  One of the goals of the MDGs was to reduce these deaths by 75% between 1990 and 2015 however Nigeria is still 28.5% away from this goal. 

Although Statistics has been made available on the rate of maternal death but one continues to wonder on the accuracy of such figures as there are no effective mechanism for the registration of number of maternal deaths not to mention the causes.  The medical Obstetrics and Gynecology professionals tell us that maternal deaths are medical or social causes. These causes can be attributed to either one or more of the 3 Maternal delays categorized into 3 levels: delay in making decision for seeking care, delay in arrival at a health facility and delay in receiving adequate treatment which has been named first, second and third delays respectively. However, it would be worthy to note the percentage of women dying from any of these delays as it will provide a more direct approach in tackling this menace of Maternal Death. 

WHO, FIGO and SOGON recommended a frame work for improving maternal and child health which includes strengthening of Health sector review mechanism which ensures that all maternal deaths are recorded, the deaths are reviewed to identify all attributed causes and that recommendations are made from the reviews to prevent avoidable reoccurrences. The Federal Ministry of Health adopted and announced that such reviews should be implemented in all health care systems.  In 2013 Lagos State commenced implementation of this health system review on maternal death in collaboration with The Women’s Health and Action Research Centre (WHARC), a Non-Governmental Organization located in Benin City. This pilot program from Lagos State proffered positive lessons and examples for other States to adapt, presently about six other States has taken up this initiative. Also WHARC continued to support this initiative by piloting the reviews of maternal and Perinatal deaths in Niger and Edo States.  This program features selected members of different units in the hospital and the community to constitute a Maternal and Perinatal Death Review committee who were trained to review maternal and Perinatal deaths occurring in the hospital with a guideline.

According to a report collated from May 2013 to December 2014 from 18 facilities conducting MDR in Lagos State, 340 maternal deaths were recorded while 322 cases were reviewed.  The leading medical cause of these deaths was Eclampsia, greater percentage of these deaths were not registered for antenatal in the hospital where they died, they were either referred from private clinics or from Traditional birthing homes and about 48% died in less than 24 hours of admission. It is worthy to note that the recommendations from the audit so far has helped to improve the quality of maternal care and services thus resulting to increased antenatal registration and attendance.

Interestingly, this program has pointed out the contributions of private clinics in the maternal deaths and the urgent need to clamp down unregistered and sub-standard clinics to save women from becoming victims of maternal death.

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