Maternal death review and surveillance: The case of Central Hospital, Benin City, Nigeria


Autoři: Josephine Aikpitanyi aff001;  Victor Ohenhen aff002;  Philip Ugbodaga aff003;  Best Ojemhen aff001;  Blessing I. Omo-Omorodion aff001;  Lorretta FC Ntoimo aff001;  Wilson Imongan aff001;  Joseph A. Balogun aff005;  Friday E. Okonofua aff001
Působiště autorů: The Women’s Health and Action Research Centre (WHARC), Benin City, Nigeria aff001;  The Centre of Excellence in Reproductive Health Innovation (CERHI), University of Benin, Benin City, Nigeria aff002;  The Central Hospital, Benin City, Nigeria aff003;  The Federal University, Oye-Ekiti, Nigeria aff004;  The University of Medical Sciences, Ondo City, Ondo State, Nigeria aff005;  Chicago State University, Chicago, United States of America aff006
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: 10.1371/journal.pone.0226075

Souhrn

Background

Despite the adoption of Maternal and Perinatal Death Surveillance and Response (MPDSR) by Nigeria’s Federal Ministry of Health to track and rectify the causes of maternal mortality, very limited documentation exists on experiences with the method and its outcomes at institutional and policy levels.

Objective

The objective of this study was to identify through the MPDSR process, the medical causes and contributory factors of maternal mortality, and to elucidate the policy response that took place after the dissemination of the results.

Methods

The study was conducted at the Central Hospital, Benin between October 1, 2017, and May 31, 2019. We first developed a strategic plan with the objective to reduce maternal mortality by 50% in the hospital in two years. An MPDSR committee was established and the members and all staff of the Maternity Department of the hospital were trained to use the nationally approved protocol. All consecutive cases of maternal deaths in the hospital were then reviewed using the MPDSR protocol. The results were submitted to the hospital Management and its supporting agencies for administrative action to correct the identified deficiencies.

Results

There were 18 maternal deaths in the hospital during the period, and 4,557 deliveries giving a maternal mortality ratio (MMR) of 395/100,000 deliveries. This amounted to a seven-fold reduction in MMR in the hospital at the onset of the project. The main medical causes identified were obstetric hemorrhage (n = 10), pulmonary embolism (n = 2), ruptured uterus (n = 2), eclampsia (n = 1), anemic heart failure (n = 1) and post-partum sepsis (n = 2). Several facility-based and patient contributory factors were identified such as lack of blood in the hospital and late reporting with severe obstetric complication among others. Response to the recommendations from the committee include increased commitment of hospital managers to immediately rectify the attributable causes of deaths, the establishment of a couples health education program, mobilization and sensitization of staff to handle pregnant women with great sensitivity, promptness and care, the refurbishing of an intensive care unit, and the increased availability of blood for transfusion through the intensification of blood donation drive in the hospital.

Conclusion

We conclude that the results of MPDSR, when acted upon by hospital managers and policymakers can lead to an improvement in quality of care and a consequent decline in maternal mortality ratio in referral hospitals.

Klíčová slova:

Benin – Blood – Critical care and emergency medicine – Death rates – Hospitals – Labor and delivery – Obstetrics and gynecology – Pregnancy


Zdroje

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Článek vyšel v časopise

PLOS One


2019 Číslo 12