Determinants
of maternal mortality in General hospital Calabar, Cross River State.
CHAPTER ONE
INTRODUCTION
1.1 Background of the study
The growing concern on
improving reproductive health at the global level has created a demand for research especially in the area of maternal health.
Maternal health, which is the physical well being of a woman during pregnancy,
childbirth, and postpartum period (WHO, 2011; Fadeyi, 2007), has been a major
concern of several international summits and conferences since the late 1980s,
which culminated to the Millennium Summit in 2000 (WHO, 2007).
It
is obvious that maternal mortality is a key constituent of maternal health. The
World Health Organization in the international statistical classification of
diseases and related health problems (ICD), has defined maternal mortality as
the death of a woman while pregnant or within 42 days of a termination of a
pregnancy, irrespective of the duration and site of the pregnancy, from any
cause related to or aggravated by the pregnancy or its management but not from
accidental and incidental causes (WHO 2007; Ogunjuyigbe and Liasu, 2007; Khama,
2006). It is within this conceptual
framework that the Millennium Development Goal Target 5A, calls for a reduction
in maternal mortality ratio by three-quarters by 2015. At its present rate,
however, the world will fall short of the target for maternal mortality
reduction because the data so far collated suggest that to reach the target,
the global Maternal Mortality Rate (MMR) would have had to be reduced by an
average of 5.5% a year between 1990 and 2015.
Nigerian
constitutes only two percent of the world‟s population, but Nigeria accounts
for over 10% of the world maternal deaths, and ranks second globally only to
India (Okonofua, 2007; Abdul‟Aziz, 2008). The status of maternal health is poor in
Nigeria, defined by maternal mortality of 59,000 per annum due to
pregnancy-related causes. This has been identified as the leading cause or
determinant of death among women of reproductive age in Nigeria (Idris, 2010).
Although opinion differ on
the determinants of maternal mortality, Herfon, (2006), noted that the cause of maternal mortality is an
outcome of nexus interaction of a variety of factors namely: the distant
factors (socio-economic, cultural) which include; occupation, income level and
illiteracy act through the proximate or intermediate factors (health and
reproductive behavior, access to health services) and in turn influence outcome
(pregnancy complication mortality).Idris, (2010) further identified other
factors responsible for maternal mortality
as socio-cultural factors which include; traditional practices, norms,
believes, education and religion.
Several attempts have been made in the past
aimed at reducing maternal mortality in Nigeria, such attempts, especially by
the Federal and state governments, have generally not proved very successful in
achieving the desired results. Some promising results however have recently
begun to be recorded through some policy
initiatives by a few state governments. In Cross River state, the state house
of assembly approved a bill in 2007, guaranteeing free maternal health services
to pregnant women (Shiffman and Okonofua, 2007). The state commissioner of
health, who is an obstetrician and gynaecologist, played a central role in its
development and adoption.
The introduction of the safe
motherhood programme in 1995,midwife service scheme (MSS) in (2011) and subsidy
reinvestment program (SURE-P) IN 2012 introduced a range of interventions which
included antenatal care, labour and delivery care, postnatal care, family
planning, prevention and management of unsafe abortions, and health education
but still MMR has not been encouraging over the years and improvements are so
slow.
The former state commissioner of health
together with some senior obstetrician and gynaecologist, played central roles
in creating this positive environment for maternal health. Hence , today pregnant women in Cross River now assess free
medical services in General hospital, Calabar as part of measures put in place
by the state government to reduce maternal mortality rate in the state (Media Global,2010).
However, other states like Jigawa, as part of measure in checking
maternal mortality, have provided funds
for the upgrading of obstetric care facilities in hospitals, the recruitment of
obstetricians and gynaecologists and the provision of ambulances at the local
level to transport pregnant women experiencing delivery complications to health
facilities. The former executive secretary for primary health care, who subsequently
became state commissioner for health, stood behind these initiatives.
1.2 Statement of the Problem
Maternal mortality is the
most important indicator of maternal health and well being in any country
(Herfon, 2006). Maternal mortality is a tragedy, many children are
rendered motherless, such children are
deprived of maternal care which goes a long way to affect adversely both their
physiological and psychological development. The majority of these pitiable
situations are due to maternal mortality.
From
recent estimates, the number of deaths each year from maternal causes worldwide decreased from
536,000 in 2005 to an estimated 358,000 in 2008 and 273,500 in 2011. For every
woman that dies, approximately 20 more suffer injuries, infection and
disabilities in pregnancy or childbirth (IHME, 2012; UNICEF 2008; WHO, 2007).
The situation is even more alarming in Nigeria. For example, in the year 2000,
the maternal mortality ratio per 100,000 live births was 800 compared to 540
for Ghana and 240 for South Africa.
Consequently, the chance of a Nigerian woman
dying from reproductive health disorders and complications was put at 1 in 10
in 2002 (Population Reference Bureau, 2002), 1 in 18 in 2005, and 1 in 23 in
2008, placing the Nigerian woman at far
greater risk than her counterpart in the developed world, where the risk is
estimated to be 1 in 17,800 and 1 in 10000 in countries such as the Republic of
Ireland and Singapore respectively (World Bank, 2011; UNICEF, 2010; Media
Global, 2010; UNICEF, 2008; UNFPA, 2005). Some of the implications of these estimates are the depletion of the
country‟s
workforce and the overall stifling of rapid development.
This study focuses on determinants
of maternal mortality in General hospital Calabar, Cross River State. The
researcher was motivated to carry out
this study based observation and experience while on clinical posting
towards the rate at which pregnant women die during childbirth as a result of
post partum hemorrhage or eclampsia. The poser is what are the causes of women
death?: thus this question can only be answered when this study is concluded.
1.3 Purpose of the study
The purpose
of the study is to understand the determinants of maternal mortality in General
Hospital Calabar, Cross River.
1.4 Objectives of the
study
(i) To assess the influence of
poor maternal health care on maternal mortality
(ii)
To identify the influence of education on maternal mortality
(iii) To determine the influence of occupation
on maternal mortality
1.5 Research Questions
In order for the researcher to
achieve the objectives of the study, the following research questions were
developed to guide the study;
(i)
To what extent does poor maternal
health influence maternal mortality?
(ii)
How does education factors influence maternal mortality?
(iii)
Can occupation influence maternal mortality?
1.6 Research hypothesis
There is no
significant relationship between maternal level of education and causes of maternal
mortality in General Hospital, Calabar
1.7 Scope of the
study
The study is narrowed to all pregnant women with pregnancy
related issues resulting to maternal mortality in General Hospital Calabar.
1.8 Significance
of the study
The findings of this study will help health workers to
identify factors responsible for maternal mortality, this will guide them on adopting
more effective measures to ensure that women experience uneventful pregnancy,
labour and peuperium. It will help women of child bearing age in the prevention
of maternal mortality even in future pregnancies by obtaining adequate prenatal
care.
Similarly, the study will
also be of value to government both state and federal, policy makers as well as
researchers for further research.
1.9 Limitations
The major limitation encountered during this study was the
attitude of health record official in providing relevant information for the
researcher. Also some retrieval of information was very cumbersome due to the
manual nature of keeping information.
1.10 Operational definition of terms
Hospital: Is a place or building where people who are
ill/sick or injured are giving medical treatment and care.
Primary Health Care: Is the medical treatment one received first
when sick.
Pregnacy:
Is a period where a woman is having a baby developing inside her.
Maternal Mortality: Is the death of a
woman during or after delivery.
Maternal
health:
Is the physical well being of a woman during pregnancy, childbirth, and
postpartum period