Quality and outcomes of maternal and perinatal care for 76,563 pregnancies reported in a nationwide network of Nigerian referral-level hospitals

The WHO in collaboration with the Nigeria Federal Ministry of Health, established a nationwide electronic data platform across referral-level hospitals. We report the burden of maternal, foetal and neonatal complications and quality and outcomes of care during the first year. Data were analysed from...

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Published in:	EClinicalMedicine Vol. 47; p. 101411
Main Authors:	Tukur, Jamilu, Lavin, Tina, Adanikin, Abiodun, Bankole, Kuti, Ekott, Mabel Ikpim, Godwin, Akaba, Ibrahim, Halima A, Ikechukwu, Okonkwo, Kadas, Saidu Abubakar, Ogunkunle, Taofik Oluwaseun, Tunau, Karima A., Bello, Musa, Ezekwe, Bosede, Aboyeji, Peter, Adesina, Olubukola A., Chama, Calvin, Etuk, Saturday, Galadanci, Hadiza, Ikechebelu, Joseph, Oladapo, Olufemi T., Adeniran, Abiodun S, Ocheke, Amaka, Joy, Fatimah Baba, Rais, Ibrahim, Mairami, Amsa B, Ozegya, Mohammed S., Pam, Samuel, Patricia, Medupin, Ochejele, Silas, Agada, Egwu, Nwachukwu, Duum, Abdurrahman, Aisha, Ibrahim, Lawal M, Adamu, Aisha Nana, Na'uzo, Aliyu, Ashimi, Adewale, Idris, Umma, Adebola, Owodunni A, Adamu, Asma'u, Labaran, Aliyu, Oguntayo, Adekunle, Ayuba, Andeyantso E, Farouk, Zubaida L, Daneji, Sulaiman Muhammad, Isa, Umar, Adelaiye, Samuel, Kalle, Ismail M, Bashir, Muhammad F, Bulus, Wasinda S, Yahaya, Usman R., Iliya, Jalo, Mairiga, Abdulkarim, Atterwahmie, Adamu, Hamza, Abdulhakeem, Ayegbusi, Wole, Ayodeji, Adefemi, Imam, Zainab, Akinajo, Opeyemi, Fajolu, Iretiola, Akinsanya, Olufemi, Agelebe, Efeturi, Oluwasola, Timothy, Tongo, Olukemi O, Jagun, Olusoji, Opeyemi, Kuponiyi, Kuku, Olumide, Awonuga, David O, Dedeke, Iyabode Olabisi F., Akinkunmi, Francis, Olofinbiyi, Babatunde, Olatunde, Ogundare E, Aworinde, Olufemi, Adeyanju, Olusoji, Ibijoke, Campbell, Ande, Adedapo B, Abbasiatai, Aniekan, Nyong, Eno Etim, Ochigbo, Sunny, Omo‐Aghoja, Lawrence, Ekpebe, Patrick, Njoku, Anthonia, Eigbedion, Andrew, Orazulike, Ngozi, Okechukwu, Chioma, Igbaruma, Solomon, Ebe, Idemudia, Ede-Edokpolor, Osahon, Ibeawuchi, Amarabia, Ibrahim, Isa Ayuba, Adeyemi, Oyedeji O, Mgbafulu, Chukwuemeka C, Ukamaka, Onubogu C, Anayochukwu, Ugwu, Ekwochi, Uchenna, Chioma, Obinna-Njoku, Obumneme-Anyim, Ijeoma, Ojiegbe, Nnabuike, Nwokeforo, Nathan U, Ezebialu, Ifeanyichukwu, Ejiofor, Obiora
Format:	Journal Article
Language:	English
Published:	England Elsevier Ltd 01-05-2022 Elsevier
Subjects:	Maternal morbidity Maternal mortality Neonatal mortality Quality of care Maternal mortality Maternal morbidity Neonatal mortality Quality of care
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Summary:	The WHO in collaboration with the Nigeria Federal Ministry of Health, established a nationwide electronic data platform across referral-level hospitals. We report the burden of maternal, foetal and neonatal complications and quality and outcomes of care during the first year. Data were analysed from 76,563 women who were admitted for delivery or on account of complications within 42 days of delivery or termination of pregnancy from September 2019 to August 2020 across the 54 hospitals included in the Maternal and Perinatal Database for Quality, Equity and Dignity programme. Participating hospitals reported 69,055 live births, 4,498 stillbirths and 1,090 early neonatal deaths. 44,614 women (58·3%) had at least one pregnancy complication, out of which 6,618 women (8·6%) met our criteria for potentially life-threatening complications, and 940 women (1·2%) died. Leading causes of maternal death were eclampsia (n = 187,20·6%), postpartum haemorrhage (PPH) (n = 103,11·4%), and sepsis (n = 99,10·8%). Antepartum hypoxia (n = 1455,31·1%) and acute intrapartum events (n = 913,19·6%) were the leading causes of perinatal death. Predictors of maternal and perinatal death were similar: low maternal education, lack of antenatal care, referral from other facility, previous caesarean section, latent-phase labour admission, operative vaginal birth, non-use of a labour monitoring tool, no labour companion, and non-use of uterotonic for PPH prevention. This nationwide programme for routine data aggregation shows that maternal and perinatal mortality reduction strategies in Nigeria require a multisectoral approach. Several lives could be saved in the short term by addressing key predictors of death, including gaps in the coverage of internationally recommended interventions such as companionship in labour and use of labour monitoring tool. This work was funded by MSD for Mothers; and UNDP/UNFPA/ UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a co-sponsored programme executed by the World Health Organization (WHO).
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 The full names and affiliations of the Maternal and Perinatal Database for Quality, Equity and Dignity Network are separately listed in Appendix I
ISSN:	2589-5370 2589-5370
DOI:	10.1016/j.eclinm.2022.101411