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BMC Public Health
Published in: BMC Public Health 1/2012

Open Access 01-12-2012 | Research article

Assessing health and economic outcomes of interventions to reduce pregnancy-related mortality in Nigeria

Authors: Daniel O Erim, Stephen C Resch, Sue J Goldie

Published in: BMC Public Health | Issue 1/2012

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Abstract

Background

Women in Nigeria face some of the highest maternal mortality risks in the world. We explore the benefits and cost-effectiveness of individual and integrated packages of interventions to prevent pregnancy-related deaths.

Methods

We adapt a previously validated maternal mortality model to Nigeria. Model outcomes included clinical events, population measures, costs, and cost-effectiveness ratios. Separate models were adapted to Southwest and Northeast zones using survey-based data. Strategies consisted of improving coverage of effective interventions, and could include improved logistics.

Results

Increasing family planning was the most effective individual intervention to reduce pregnancy-related mortality, was cost saving in the Southwest zone and cost-effective elsewhere, and prevented nearly 1 in 5 abortion-related deaths. However, with a singular focus on family planning and safe abortion, mortality reduction would plateau below MDG 5. Strategies that could prevent 4 out of 5 maternal deaths included an integrated and stepwise approach that includes increased skilled deliveries, facility births, access to antenatal/postpartum care, improved recognition of referral need, transport, and availability quality of EmOC in addition to family planning and safe abortion. The economic benefits of these strategies ranged from being cost-saving to having incremental cost-effectiveness ratios less than $500 per YLS, well below Nigeria’s per capita GDP.

Conclusions

Early intensive efforts to improve family planning and control of fertility choices, accompanied by a stepwise effort to scale-up capacity for integrated maternal health services over several years, will save lives and provide equal or greater value than many public health interventions we consider among the most cost-effective (e.g., childhood immunization).
Appendix
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Literature
1.
Hogan MC, et al: Maternal mortality for 181 countries, 1980: a systematic analysis of progress towards Millennium Development Goal 5. Lancet. 2008, 375 (9726): p 1609-p 1623.CrossRef
2.
3.
4.
5.
Onyebuchi-Chukwu CO: Nigeria and the millennium development goals: progress towards 2015. A speech presented at the 65th Session of the United Nations General Assembly to review the Millennium Development Goals. 2010, New York, Available at http://​goo.​gl/​DZ4s9. Accessed January 2011,
6.
Onyebuchi Chukwu CO: The action push agenda for the transformation of the health sector: recent development and the road ahead. 2011, Federal Ministry of Health, p 4-p 5.
7.
Asuzu M: The necessity for a health systems reform in Nigeria. Journal of Community Medicine & Primary Health Care. 2004, 16 (1): 1-3.
8.
Abdullahi MJ: Update/Progress Report on the Implementation of the Midwives Service Scheme. 2010, Abuja: National Primary Healthcare Development Agency, p 32-p 37.
9.
Kale O, et al: Nigerian Health Review. 2006, Abuja, Nigeria: Health Reform Foundation Of Nigeria (HERFON)
10.
11.
12.
Hulme D: Reproductive Health and the Millennium Development Goals: Politics, Ethics. 2009, Evidence and an Unholy Alliance, Brooks World Poverty Institute Working Paper Series
13.
14.
Goldie SJ, Goldhaber-Fiebert JD, Garnett GP: Chapter 18: public health policy for cervical cancer prevention: The role of decision science, economic evaluation, and mathematical modeling. Vaccine. 2006, 24 (3): 155-CrossRef
15.
WHO Commission on Macroeconomics and Health: Macroeconomics and health: investing in health for economic development. 2001, Geneva: World Health Organization, 200 p-
16.
Goldie SJ, et al: Alternative strategies to reduce maternal mortality in India: a cost-effectiveness analysis. PLoS Med. 2010, 7 (4): p e1000264-CrossRef
17.
UNICEF, WHO, & UNFPA: Guidelines for monitoring the availability and use of obstetric services. 1997, New York, NY 10017, USA: United Nations Children's Fund, 3 UN Plaza
18.
19.
National Primary Healthcare Development Agency, Government of Nigeria: The Midwives Service Scheme (MSS) Baseline Survey Report. 2010, Abuja, Nigeria, Available at http://​nphcda.​org/​,
20.
21.
Weissman E, Saltner J: Reproductive Health Costing Model, Part 1: Cost per case. Version 1.1 (Millenuim Project Version). 2005, New York NY: UNFPA
22.
Hutubessy R, WHO-CHOICE, et al: Choosing interventions that are cost-effective. Health systems performance assessment: debates, methods and empiricism. 2003, Geneva: WHO Editions, 823-835.
23.
Borghi JO, et al: Mobilising financial resources for maternal health. Lancet. 2006, 368 (9545): 1457-1465. 10.1016/S0140-6736(06)69383-5.CrossRefPubMed
24.
Henshaw SK, et al: The incidence of induced abortion in Nigeria. Int Fam Plan Perspect. 1998, 24 (4): p 156-p 164.CrossRef
25.
Khan KS, et al: WHO analysis of causes of maternal death: a systematic review. Lancet. 2006, 367 (9516): 1066-1074. 10.1016/S0140-6736(06)68397-9.CrossRefPubMed
26.
Johns B, et al: Estimated global resources needed to attain universal coverage of maternal and newborn health services. Bull World Health Organ. 2007, 85 (4): 256-263. 10.2471/BLT.06.032037.CrossRefPubMedPubMedCentral
27.
Murray CJL, et al: Estimating causes of death: new methods and global and regional applications for 1990. The global burden of disease. 1996, 1: 117-200.
28.
Ahman E, Dolea C, Shah I: The global burden of unsafe abortion in the year 2000. 2005, Geneva: World Health Organization (WHO), draft working paper
29.
Singh S: Hospital admissions resulting from unsafe abortion: estimates from 13 developing countries. Lancet. 2006, 368 (9550): 1887-1892. 10.1016/S0140-6736(06)69778-X.CrossRefPubMed
30.
Graham WJ, et al: Maternal and Perinatal Conditions. Disease Control Priorities in Developing Countries. 2006, New York: Oxford University Press, 2
31.
Regional Estimates of the Incidence of Unsafe Abortion and Associated Mortality in 2003. 2004, Geneva: World Health Organization
32.
Shah I, Ahman E: Unsafe abortion: global and regional incidence, trends, consequences, and challenges. J Obstet Gynaecol Can. 2009, 31 (12): 1149-1158.CrossRefPubMed
33.
Dolea C, AbouZahr C, Stein C, Global Burden of Maternal Hemorrhage in the Year 2000: Evidence and Information for Policy (EIP). 2003, Geneva: World Health Organization, 460-
34.
Dolea C, Stein C, Global burden of maternal sepsis in the year: Evidence and information for policy. 2000, Geneva: World Health Organization
35.
Gulmezoglu AM, et al: WHO multicentre randomised trial of misoprostol in the management of the third stage of labour. Lancet. 2001, 358 (9283): 689-695. 10.1016/S0140-6736(01)05835-4.CrossRefPubMed
36.
Hofmeyr GJ, Kulier R: External cephalic version for breech presentation at term. Cochrane Database Syst Rev (Online). 2000, CD000083-2
37.
Hofmeyr GJ, Hannah ME: Planned caesarean section for term breech delivery. Cochrane database of systematic reviews (Online). 2001, p. CD000166-1
38.
Schuitemaker N, et al: Maternal mortality after cesarean section in The Netherlands. Acta Obstet Gynecol Scand. 1997, 76 (4): 332-334. 10.1111/j.1600-0412.1997.tb07987.x.CrossRefPubMed
39.
Altman D, et al: Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie trial: a randomised placebo-controlled trial. Lancet. 2002, 359 (9321): 1877-CrossRefPubMed
40.
Duley L, Gulmezoglu AM, Henderson-Smart DJ: Magnesium sulphate and other anticonvulsants for women with pre-eclampsia. Cochrane database of systematic reviews (Online). 2003, p CD000025-2
41.
French L: Prevention and treatment of postpartum endometritis. Curr Womens Health Rep. 2003, 3 (4): 274-PubMed
42.
Brabin BJ, Hakimi M, Pelletier D: An analysis of anemia and pregnancy-related maternal mortality. J Nutr. 2001, 131 (2): 604S-PubMed
43.
Hu D, et al: The costs, benefits, and cost-effectiveness of interventions to reduce maternal morbidity and mortality in Mexico. PLoS One. 2007, 2 (8): e750-10.1371/journal.pone.0000750.CrossRefPubMedPubMedCentral
44.
Cahuana-Hurtado L, Sosa-Rubi S, Bertozzi S: The application of the mother baby package reproductive health costing spreadsheet in Morelos: National Institute of Public Health. 2004, Mexico: Division of Health Economics and Policy
45.
Solagberu B, et al: Pre-hospital care in Nigeria: a country without emergency medical services. Niger J Clin Pract. 2009, 12 (1): 29-PubMed
46.
Adesiji G, Dada S, Komolafe S: Problems faced by rural people in accessing health care facilities in Akure north and Akure south local government areas of Ondo State, Nigeria. J Appl Sci Res. 2012, 8 (4): 2260-2266.
47.
48.
Okaro J, Iyoke C: The Society of Gynaecology and Obstetrics of Nigeria (SOGON) Plan for Sustainable Reduction in Maternal Mortality: A Review. Afr J Reprod Health. 2010, 14 (2): 139-147.PubMed
49.
Erim DO, Kolapo UM, Resch SC: A rapid assessment of the availability and use of obstetric care in Nigerian healthcare facilities. PLoS One. 2012, 7 (6): e39555-10.1371/journal.pone.0039555.CrossRefPubMedPubMedCentral
50.
51.
52.
53.
54.
55.
McFayden JE: International drug price indicator guide. 2005, Management Sciences for Health, Boston
56.
UN, World Population Prospects: The 2008 Revision. Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat. 2009, New York: United Nations
57.
Ahmed S, et al: Maternal deaths averted by contraceptive use: an analysis of 172 countries. Lancet. 2012, 380 (9837): 111-125. 10.1016/S0140-6736(12)60478-4. ISSN: 0140-6736CrossRefPubMed
Metadata
Title
Assessing health and economic outcomes of interventions to reduce pregnancy-related mortality in Nigeria
Authors
Daniel O Erim
Stephen C Resch
Sue J Goldie
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2012
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-12-786

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