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

Acknowledgements We would like to thank Yutaka Osakabe for co-ordinating the retrieval of full text articles. The John D. and Catherine T. MacArthur Foundation supported this study, grant number 12-100074-000-INPPeer reviewedPublisher PD

Maternal and child health interventions in Nigeria: a systematic review of published studies from 1990 to 2014

BACKGROUND: Poor maternal and child health indicators have been reported in Nigeria since the 1990s. Many interventions have been instituted to reverse the trend and ensure that Nigeria is on track to achieve the Millennium Development Goals. This systematic review aims at describing and indirectly measuring the effect of the Maternal, Newborn, and Child Health (MNCH) interventions implemented in Nigeria from 1990 to 2014. METHODS: PubMed and ISI Web of Knowledge were searched from 1990 to April 2014 whereas POPLINE® was searched until 16 February 2015 to identify reports of interventions targeting Maternal, Newborn, and Child Health in Nigeria. Narrative and graphical synthesis was done by integrating the results of extracted studies with trends of maternal mortality ratio (MMR) and under five mortality (U5MR) derived from a joint point regression analysis using Nigeria Demographic and Health Survey data (1990-2013). This was supplemented by document analysis of policies, guidelines and strategies of the Federal Ministry of Health developed for Nigeria during the same period. RESULTS: We identified 66 eligible studies from 2,662 studies. Three interventions were deployed nationwide and the remainder at the regional level. Multiple study designs were employed in the enrolled studies: pre- and post-intervention or quasi-experimental (n = 40; 61%); clinical trials (n = 6;9%); cohort study or longitudinal evaluation (n = 3;5%); process/output/outcome evaluation (n = 17;26%). The national MMR shows a consistent reduction (Annual Percentage Change (APC) = -3.10%, 95% CI: -5.20 to -1.00 %) with marked decrease in the slope observed in the period with a cluster of published studies (2004-2014). Fifteen intervention studies specifically targeting under-five children were published during the 24 years of observation. A statistically insignificant downward trend in the U5MR was observed (APC = -1.25%, 95% CI: -4.70 to 2.40%) coinciding with publication of most of the studies and development of MNCH policies. CONCLUSIONS: The development of MNCH policies, implementation and publication of interventions corresponds with the downward trend of maternal and child mortality in Nigeria. This systematic review has also shown that more MNCH intervention research and publications of findings is required to generate local and relevant evidence

Maternal Mortality at the University of Nigeria Teaching Hospital, Enugu, Before and After Kenya

A comparative retrospective analysis of maternal deaths at the University of Nigeria Teaching Hospital, Enugu, Nigeria, was carried out for two ten-year periods ? 1976-1985 and 1991-2000 ? in order to evaluate the effect of Safe Motherhood Initiative on maternal mortality in the hospital. Variables for the two periods were compared by means of the t-test at 95% confidence level. Maternal mortality ratio was significantly higher in Period II than in Period I (1406 versus 270 per 100,000; p = 0.00). The leading causes of maternal death were uterine rupture for Period I and septicaemia for Period II. Although from the first to the second ten-year period there was a significant decrease in the number of midwives, physicians and nurse anaesthetists, there was more than a proportionate decrease in the number of deliveries. There was also increase in the incidence of anaemia due to diminished standards of living and in the mean decision-intervention interval (1.5 ± 0.5 versus 5.8 ± 1.2 hours; p = 0.000) as a result of worker dissatisfaction and changes in hospital policies. We conclude that since the launching of the Safe Motherhood Initiative, MMR at the University of Nigeria Teaching Hospital, Enugu, Nigeria, has increased five-fold as a result of institutional delays and a deterioration in the living standards of Nigerians, both consequences of a depressed economy. To halt this trend, we recommend that the living standard of all Nigerians should be improved. Furthermore, healthcare personnel should be motivated through enhanced salaries and provision of working materials including efficient mobile telephone services. (Afr J Reprod Health 2001; 5[2]: 90-97) RÉSUMÉ Mortalité matrenelle au Centre Hospitalier Universitaire à Enugu, Nigéria: Avant et après le Kenya. Une analyse retrospective comparée des décès maternels au Centre Hospitalier Universitaire à Enugu au Nigeria a été faite au cours de deux périodes de dix ans chacune, 1976-1985 et 1991-2000. Le but de l'analyse était d'évaluer l'effet de la Safe Motherhood Initiative sur la mortalité maternelle dans l'hôpital. Des variables pour les deux périodes ont été comprarés à l'aide du test de t à un niveau de confiance de 95%. Le rapport de mortalité maternelle était, de manière significative, plus élevé dans la période II que dans la Période I (1406 par opposition à 270 par 100,000, p = 0,00). Les causes principales du décès maternel étaient la rupture de l'utérine pour la Période I et la septicémie pour la Période II. Bien que depuis la première jusqu'à la deuxième période de dix ans il y ait une baisse significative dans le nombre de sages-femmes, de médecins et d'infirmières anesthésistes, il y avait plus qu'une baisse proportionnelle dans le nombre d'accouchements. Il y avait également une augmentation de l'incidence d'anémie à cause du niveau de vie baissé et dans l'espace de la moyenne décision-intervention (1,5 ± 0,5 par opposition à 5,8 ± 1,2 heures; p = 0,000) à cause du mécontentement chez les salariés et des changements dans la politique de l'hôpital. Nous concluons que depuis qu'on a lancé la Safe Motherhood Initiative, le taux de mortalité maternelle a augmenté cinq fois au Centre Hospitalier Universitaire à Enugu, Nigéria, a cause des délais institutionnels et à cause de la déterioration du niveau de vie des Nigérians, deux conséquences d'une économie en déclin. Pour mettre fin à cette tendance, nous recommandons que le niveau de vie de tous les Nigérians soit amélioré. En plus, les membres du personnel du service de santé doivent être motivés à travers les salaires augmenté et en mettant à la disposition des membres du personnel tous les matériels du travail y compris les services du téléphone portable. (Rev Afr Santé Reprod 2001; 5[2]: 90-97 ) KEY WORDS: Increasing, maternal mortality ratio, Enugu, Nigeria, Keny

Determinants of low birth weight in India: An investigation from the National Family Health Survey

Objective: This study aimed to estimate the change in prevalence of low birth weight (LBW) over the last decade in India and to identify its associated factors—biological, demographic, socio‐economic, and programmatic. Methods: We used the data from the National Family Health Survey of 2005‐2006 (NFHS‐3) and 2015‐2016 (NFHS‐4). The sample of this study included 11 300 children from NFHS‐3 and 99 894 from NFHS‐4 data; all these children were the last full‐term singleton live‐births, born within the last 3 years prior to the survey. Results: In India, the prevalence of LBW has significantly declined from 20.4% (95%CI 19.4‐21.4) to 16.4% (95% CI 16.1‐16.8) in the last decade. The prevalence of LBW remained high in girl children (OR = 1.2, 95% CI 1.2‐1.3; P \u3c .001), whose mothers were adolescent (OR = 1.2, 95% CI 1.1‐1.3; P \u3c .001), and were stunted (OR = 1.3, 95% CI 1.3‐1.3; P \u3c .001). Prevalence of LBW declined among second or higher birth order child (OR = 0.8, 95% CI 0.8‐0.9; P \u3c .001), whose mothers educated up to secondary level and above (OR = 0.6 to 0.8), belonged to rich wealth quintiles (OR = 0.9 to 0.8), were from rural area (OR = 0.9, 95% CI 0.9‐1.0; P \u3c .001), received better nutrition and adequate antenatal care (OR = 0.8, 95% CI 0.8‐0.8; P \u3c .001), and were from eastern, northeastern, and southern regions of India (OR = 0.9 to 0.5). Conclusion: Although the prevalence of LBW in India has declined over the past decade, the extent of the decline is modest. In the coming years, health programs in India need to gear up with greater convergence between maternal health services and maternal nutrition to reduce LBW