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Reproductive Health
Published in: Reproductive Health 1/2015

Open Access 01-12-2016 | Research

Maternal death and obstetric care audits in Nigeria: a systematic review of barriers and enabling factors in the provision of emergency care

Authors: Julia Hussein, Atsumi Hirose, Oluwatoyin Owolabi, Mari Imamura, Lovney Kanguru, Friday Okonofua

Published in: Reproductive Health | Issue 1/2015

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Abstract

Background

Maternal death reviews and obstetric audits identify causes and circumstances related to occurrence of a maternal death or serious complication and inform improvements in quality of care. Given Nigeria’s high maternal mortality, the lessons learned from past experiences can provide a good evidence base for informed decision making. We aimed to synthesise findings from maternal death reviews and other obstetric audits conducted in Nigeria through a systematic review, seeking to identify common barriers and enabling factors related to the provision of emergency obstetric care.

Methods

We searched for maternal death reviews and obstetric care audits reported in the published literature from 2000–2014. A ‘best-fit’ framework approach was used to extract data using a structured data extraction form. The articles that met the inclusion criteria were assessed using a nine point quality score.

Results

Of the 1,841 abstracts and titles at initial screening, 329 full text articles were reviewed and 43 papers fulfilled the inclusion criteria. Four types of barriers were reported related to: transport and referral; health workers; availability of services; and organisational factors. Three elements stand out in Nigeria as contributing to maternal mortality: delays in Caesarean section, unavailability of magnesium sulphate and lack of safe blood transfusion services.

Conclusions

Obstetric care reviews and audits are useful activities to undertake and should be promoted by improving the processes used to conduct them, as well as extending their implementation to rural and basic level health facilities and to the community. Urgent areas for quality improvement in obstetric care, even in tertiary and teaching hospitals should focus on organisational factors to reduce delays in conducting Caesarean section and making blood and magnesium sulphate available for all who need these interventions.
Literature
1.
Merali HS, Lipsitz S, Hevelone N, Gawande AA, Lashoher A, Agrawal P, Spector J. Audit-identified avoidable factors in maternal and perinatal deaths in low resource settings: a systematic review. BMC Pregnancy Childb. 2014;14:280.CrossRef
2.
Hounton S, De Bernis L, Hussein J, Graham W, Danel I, Byass P. Mason EM Towards elimination of maternal deaths: maternal deaths surveillance and response. Reprod Health. 2013;10:1.CrossRefPubMedPubMedCentral
3.
World Health Organization. Maternal death surveillance and response: technical guidance information for action to prevent maternal death. Geneva: WHO; 2013.
4.
Power M. The Audit Society: Rituals of verification. New York: Oxford University Press Inc; 1997.
5.
Mayne J. Audit and evaluation in public management: challenges, reforms and different roles. Can J Program Eval. 2006;21(1):11–45.
6.
National Population Commission (NPC) [Nigeria] and ICF Internationa. Nigeria Demographic and Health Survey 2013. Abuja, Nigeria, and Rockville, Maryland, USA: NPC and ICF Internationa; 2014.
7.
World Health Organization. Trends in maternal mortality: 1990 to 2013. Estimates by WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division. 2014.
8.
Federal Republic of Nigeria. Countdown strategy 2010 to 2015, Millennium Development Goals (MDGs). Abuja: Government of the Federal Republic of Nigeria; 2010.
9.
Gomez GB, Foster N, Brals D, Nelissen HE, Bolarinwa OA, Hendriks ME, Boers AC, van Eck D, Rosendaal N, Adenusi P, Agbede K, Akande TM, Boele van Hensbroek M, Wit FW, Hankins CA, Schultsz C.. Improving Maternal Care through a State-Wide Health Insurance Program: A Cost and Cost-Effectiveness Study in Rural Nigeria. PLoS One. 2015;10(9):e0139048.CrossRefPubMedPubMedCentral
10.
Haver J, Brieger W, Zoungrana J, Ansari N, Kagoma J. Experiences engaging community health workers to provide maternal and newborn health services: implementation of four programs. Int J Gynaecol Obstet. 2015;Suppl 2:S32–9. doi:10.​1016/​j.​ijgo.​2015.​03.​006.CrossRef
11.
12.
13.
World Health Organization. Beyond the numbers. Geneva: WHO; 2004.
14.
Pattinson R, Kerber K, Waiswa P, Day LT, Mussell F, Asiruddin SK, Blencowe H, Lawn JE. Perinatal mortality audit: counting, accountability, and overcoming challenges in scaling up in low- and middle-income countries. Int J Gynaecol Obstet. 2009;107 Suppl 1:S113–21.CrossRefPubMed
15.
Dumont A, Fournier P, Abrahamowicz M, Traore M, Haddad S, Fraser WD. Quality of care, risk management, and technology in obstetrics to reduce hospital-based maternal mortality in Senegal and Mali (QUARITE): a cluster-randomised trial. Lancet. 2013;382(9887):146–57.CrossRefPubMed
16.
Achem FF, Agboghoroma CO. Setting up facility-based maternal deaths reviews in Nigeria. BJOG. 2014;121 Suppl 4:75–80.CrossRefPubMed
17.
Hussein J, Okonofua F. Time for Action: Audit, accountability and confidential enquiries into maternal deaths in Nigeria. Afr J Reprod Health. 2012;16(1):9–14.PubMed
18.
Ritchie J, Spencer L. Qualitative data analysis for applied policy research. In: Bryman A, Burgess R, editors. Analyzing qualitative data. London: Sage; 1993. p. 173–94.
19.
20.
National Committee for Confidential Enquiry into Maternal Deaths (NCCEMD). Fifth report on the Confidential Enquiries into Maternal Deaths in South Africa: Comprehensive Report. Appendix 2: Process and method of assessment. Department of Health, Republic of South Africa; 2012.
21.
D’Ambruoso L, Achadi E, Adisasmita A, Izati Y, Makowiecka K, Hussein J. Assessing quality of care provided by Indonesian village midwives with a confidential enquiry. Midwifery. 2009;25(5):528–39.CrossRefPubMed
22.
Pirkle CM, Dumont A, Zunzunegui MV. Criterion-based clinical audit to assess quality of obstetrical care in low- and middle-income countries: a systematic review. Int J Qual Health Care. 2011;23(4):456–63.CrossRefPubMed
23.
Ande A, Olagbuji B, Ezeanochie M. An Audit of Maternal deaths from a referral University Teaching Hospital in Nigeria: The Emergence of HIV/AIDS as a leading cause. Niger Postgrad Med J. 2012;19(2):83–7.PubMed
24.
Ezugwu EC, Onah HE, Ezugwu FO, Okafor II. Maternal Mortality in a Transitional Hospital in Enugu, South East Nigeria. Afr J Reprod Health. 2009;13(4):67–72.PubMed
25.
Ozumba BC, Nwogu-Ikojo EE. Avoidable maternal mortality in Enugu, Nigeria. J Royal Inst Public Health. 2008;122:354–60.
26.
Omo-Aghoja LO, Aisien OA, Akuse JT, Bergstrom S, Okonofua FE. Maternal mortality and emergency obstetric care in Benin City, South-south Nigeria. J Clin Med Res. 2010;2(4):55–60.
27.
Oladapo OT, Sule-Odu AO, Olatunji AO, Daniel OJ. “Near-miss” obstetric events and maternal deaths in Sagamu, Nigeria: a retrospective study. Reproductive Health. 2005;2:9.CrossRefPubMedPubMedCentral
28.
Oladapo OT, Ariba AJ, Odusoga OL. Changing patterns of emergency obstetric care at a Nigerian University hospital. Int J Gynec Obstet. 2007;98:278–84.CrossRef
29.
Hunyinbo KI, Fawole AO, Sotiloye OS, Otolorin EO. Evaluation of criteria-based clinical audit in improving quality of obstetric care in developing country hospital. Afr J Reprod Health. 2008;12(3):59–70.PubMed
30.
Adeoye IA, Onayade AA, Futusi AO. Incidence, determinants and perinatal outcomes of near miss maternal morbidity in Ile-Ife Nigeria: a prospective case control study. BMC Pregnancy Childb. 2013;13:93.CrossRef
31.
Olagbuji BN, Ezeanochie MC, Igbaruma S, Okoigi SO, Ande AB. Stillbirth in cases of severe acute maternal morbidity. Int J Gynec Obstet. 2012;119:53–6.CrossRef
32.
Ezugwu EC, Ona HE, Ezugwui HC. Nnanji. Stillbirth rate at an emerging tertiary health institution in Enugu, Southeast Nigeria. Int J Gynec Obstet. 2011;115:164–6.CrossRef
33.
Olusanya BO, Solanke OA. Predictors of term stillbirths in an inner-city maternity hospital in Lagos, Nigeria. Acta Obstet Gynecol. 2009;88:1243–51.CrossRef
34.
Ibrahim IA, Onwudiegwu U. Sociodemographic determinants of complicated unsafe abortions in a semi-urban Nigerian town: a four-year review. West Indian Med J. 2012;61(2):163–7.PubMed
35.
Raibu KA, Omolulu OM, Ojo TO, Adewunmi AA, Alugo BG. Unsafe abortion in Lagos Nigeria: a continuing tragedy. Niger Postgrad Med J. 2009;16(4):251–5.
36.
Nwogu-Ikojo EE, Ezegwui HU. Abortion-related mortality in a tertiary medical centre in Enugu, Nigeria. J Obstet Gynaecol. 2007;27(8):835–7.CrossRefPubMed
37.
Ekanem EI, Etuk SJ, Ekabua JE, Iklaki C. Clinical presentation and complications in patients with unsafe abortions in University of Calabar Teaching Hospital, Calabar, Nigeria. Niger J Med. 2009;18(4):370–4.PubMed
38.
Adinma ED. Maternal and perinatal outcome of eclampsia in tertiary health institution in Southeast Nigeria. J Mater-fetal Neonatal Med 2013; 26(2): 211–214.CrossRef
39.
Eke AC, Ezebialu IU, Okafor C. Presentation and outcome of eclampsia at a tertiary center in Southeast Nigeria - a 6-year review. Hypertens Pregnancy. 2011;30:125–32.CrossRefPubMed
40.
Agida ET, Adeka BI, Jibril KA. Pregnancy outcome in eclamptics at the University of Abuja Teaching Hospital, Gwagwalada, Abuja: a 3 year review. Niger J Clin Pract. 2010;13(4):394–8.PubMed
41.
Kullima AA, Kawuwa MB, Audu BM, Usman H, Geidam AD. A 5-year review of maternal mortality associated with eclampsia in a tertiary institution in northern Nigeria. Ann Afr M. 2009;8(2):81–4.CrossRef
42.
Okafor UV, Efetie RE. Critical care management of eclamptics: challenges in an African setting. Trop Dr. 2008;38:11–3.CrossRef
43.
Makinde ON, Adegoke OA, Adediran IA, Ndububa DA, Adeyemi AB, Owolabi AT, Kuti O, Orji EO, Salawu L. HELLP syndrome: the experience at Ile-Ife, Nigeria. J Obstet Gynaec. 2009;29(3):195–199.CrossRef
44.
Nyengidiki TK, Allagoa DO. Rupture of the gravid uterus in a tertiary health facility in the Niger deltaregion of Nigeria: A 5-year review. Niger Med J. 2011;52(4):230–4.CrossRefPubMedPubMedCentral
45.
Esike COU, Umeora OUJ, Eze JN, Igberase GO. Ruptured uterus: the unabating obstetric catastrophe in South eastern Nigeria. Arch Gynecol Obstet. 2011;283:993–7.CrossRefPubMed
46.
Osaikhuwuomwan JA, Ande AB. Reappraisal of ruptured uterus in an urban tertiary center in the Niger-delta region of Nigeria. J Mater-Fetal Neonatal Med. 2011;24(4):559–63.CrossRef
47.
Okafor UV, Aniebue U. Anaesthesia for uterine rupture in a Nigerian teaching hospital: maternal and fetaloutcome. Int J Obstet Anaesth. 2006;15:124–8.CrossRef
48.
Mbamara SU, Obiechina NJA, Elije GU. An analysis of uterine rupture at the Nnamdi Asikiwi University Teaching Hospital Nnewi, Southeast Nigeria. Niger J Clin Pract. 2012;15(4):448–452.CrossRefPubMed
49.
Onankpa B, Ekele B. Fetal outcome following cesarean section in a university teaching hospital. J Natl Med Assoc. 2009;101(6):578–81.CrossRefPubMed
50.
Ekanem AD, Udoma EJ, Etuk SJ, Eshiet AI. Outcome of emergency caesarean sections in Calabara, Nigeria: Impact of the seniority of the medical team. J Obstet Gynaecol. 2008;28(2):198–201.CrossRefPubMed
51.
Ozumba BC, Ezegwui HU. Blood transfusion and caesarean section in a developing country. J Obstet Gynaecol. 2006;26(8):746–8.CrossRefPubMed
52.
Ojiyi E, Dike E, Anolue F, Chukwulebe A. Appraisal Of Caesarean Section At The Imo State University Teaching Hospital, Orlu, Southeastern Nigeria. Internet J Gynecol Obstet. 2012;16(2):1–6.
53.
Onah HE, Ibeziako N, Umezulike AC, Effetie ER, Ogbuokiri CM. Decision-delivery interval and perinatal outcome in emergency caesarean sections. J Obstet Gynaecol. 2005;25(4):342–6.CrossRefPubMed
54.
Faponle AF, Makinde ON. Caesarean section: intra-operative blood loss and its restitution. East Afr Med J. 2007;84(1):31–4.CrossRefPubMed
55.
Abasiattai AM, Umoiyoho AJ, Utuk NM, Inyang-Etoh EC, Asuquo OP. Emergency peripartum hysterectomy in a tertiary hospital in southern Nigeria. Pan Afr Med J. 2013;15:60–6.CrossRefPubMedPubMedCentral
56.
57.
Rabiu KA, Akinlusi FM, Adewunmi AA, Akinola OI. Emergency peripartum hysterectomy in a tertiary hospital in Lagos, Nigeria: a five-year review. Trop Dr. 2010;40(1):1–4.CrossRef
58.
Badejoko OO, Awowole IO, Ijarotimi AO, Badejoko BO, Loto OM, Ogunniyi SO. Obstetric hysterectomy: Trend and outcome in Ile-Ife, Nigeria. J Obstet Gynaecol. 2013;33:581–4.CrossRefPubMed
59.
Omole-Ohonsi A, Olayinka HT. Emergency Peripartum Hysterectomy in a Developing Country. J Obstet Gynaecol. 2012;34(10):954–60.
60.
Mutihir JT, Utoo BT. Postpartum maternal morbidity in Jos, north-central Nigeria. Niger J Clin Pract. 2011;14(1):38–42.CrossRefPubMed
61.
Ajenifuja KO, Adepiti CA, Ogunniyi SO. Post partum haemorrhage in a teaching hospital in Nigeria: a 5-year experience. Afr Health Sci. 2010;10(1):71–4.PubMedPubMedCentral
62.
Agwu UM, Umeora OUJ, Ejikeme BN, Egwuatu VE. Retained placenta aspect of clinical management in a tertiary health institution in Nigeria. Niger J Med. 2008;17(2):146–9.CrossRefPubMed
63.
Adelaja LM, Taiwo OO. Maternal and Fetal Outcome of Obstetric Emergencies in a Tertiary Health Institution in South-Western Nigeria. ISRN Obstet Gynecol. 2011. doi:10.​5402/​2011/​160932.
64.
Kalu CA, Umeora OUJ. Risk factors and perinatal outcome of umbilical cord prolapse in Ebonyi State University Teaching Hospital, Abakaliki, Nigeria. Niger J Clin Pract. 2011;14(4):413–7.CrossRefPubMed
65.
Lawani O, Anozie OB, Ezeonu PO. Ectopic pregnancy: a life-threatening gynaecological emergency. Int J Women's Health. 2013;5:515–21.CrossRef
66.
Owens L, Semrau K, Mbewe R, Musokotwane K, Grogan C, Maine D, Hamer DH. The state of routine and emergency obstetric and neonatal care in Southern Province, Zambia. Int J Gynaecol Obstet. 2015;128(1):53–7.CrossRefPubMed
67.
Mirkuzie AH, Sisay MM, Reta AT, Bedane MM. Current evidence on basic emergency obstetric and newborn care services in Addis Ababa, Ethiopia; a cross sectional study. BMC Pregnancy Childb. 2014;14:354.CrossRef
68.
Ameh C, Msuya S, Hofman J, Raven J, Mathai M, van den Broek N. Status of emergency obstetric care in six developing countries five years before the MDG targets for maternal and newborn health. PLoS One. 2012;7(12):e49938.CrossRefPubMedPubMedCentral
69.
Lumbiganon P, Gülmezoglu AM, Piaggio G, Langer A, Grimshaw J. Magnesium sulfate is not used for pre-eclampsia and eclampsia in Mexico and Thailand as much as it should be. Bull World Health Organiz. 2007;85(10):733–820.CrossRef
70.
World Health Organization. Monitoring emergency obstetric care: a handbook. Geneva: WHO; 2009.
71.
Osaro E, Charles AT. The challenges of meeting the blood transfusion requirements in Sub-Saharan Africa: the need for the development of alternatives to allogenic blood. Blood Med. 2011;2:7–21.CrossRef
72.
Glenton C, Colvin CJ, Carlsen B, Swartz A, Lewin S, Noyes J, Rashidian A. Barriers and facilitators to the implementation of lay health worker programmes to improve access to maternal and child health: qualitative evidence synthesis. Cochrane Database Syst Rev. 2013; Issue 10 Art. No.: CD010414. doi: 10.​1002/​14651858.​CD010414.​pub2.
Metadata
Title
Maternal death and obstetric care audits in Nigeria: a systematic review of barriers and enabling factors in the provision of emergency care
Authors
Julia Hussein
Atsumi Hirose
Oluwatoyin Owolabi
Mari Imamura
Lovney Kanguru
Friday Okonofua
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Reproductive Health / Issue 1/2015
Electronic ISSN: 1742-4755
DOI
https://doi.org/10.1186/s12978-016-0158-4

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