Anastasi Erin, Ekanem Ekanem, Hill Olivia, Adebayo Oluwakemi Agnes, Abayomi Oluwatosin, Bernasconi Andrea
United Nations Population Fund, New York, United States of America.
Operational Centre Barcelona, Médecins sans Frontières / Doctors without Borders, Barcelona, Spain.
PLoS One. 2017 May 10;12(5):e0177190. doi: 10.1371/journal.pone.0177190. eCollection 2017.
Nigeria has one of the highest maternal mortality ratios in the world as well as high perinatal mortality. Unfortunately, the country does not have the resources to assess this critical indicator with the conventional health information system and measuring its progress toward the goal of ending preventable maternal deaths is almost impossible. Médecins Sans Frontières (MSF) conducted a cross-sectional study to assess maternal and perinatal mortality in Makoko Riverine and Badia East, two of the most vulnerable slums of Lagos.
The study was a cross-sectional, community-based household survey. Nearly 4,000 households were surveyed. The sisterhood method was utilized to estimate maternal mortality and the preceding births technique was used to estimate newborn and child mortality. Questions regarding health seeking behavior were posed to female interviewees and self-reported data were collected.
Data was collected from 3963 respondents for a total of 7018 sisters ever married. The maternal mortality ratio was calculated at 1,050/100,000 live births (95% CI: 894-1215), and the lifetime risk of maternal death at 1:18. The neonatal mortality rate was extracted from 1967 pregnancies reported and was estimated at 28.4/1,000; infant mortality at 43.8/1,000 and under-five mortality at 103/1,000. Living in Badia, giving birth at home and belonging to the Egun ethnic group were associated with higher perinatal mortality. Half of the last pregnancies were reportedly delivered in private health facilities. Proximity to home was the main influencing factor (32.4%) associated with delivery at the health facility.
The maternal mortality ratio found in these urban slum populations within Lagos is extremely high, compared to the figure estimated for Lagos State of 545 per 100,000 live births. Urgent attention is required to address these neglected and vulnerable neighborhoods. Efforts should be invested in obtaining data from poor, marginalized, and hard-to-reach populations in order to identify pockets of marginalization needing additional resources and tailored approaches to guarantee equitable treatment and timely access to quality health services for vulnerable groups. This study demonstrates the importance of sub-regional, disaggregated data to identify and redress inequities that exist among poor, remote, vulnerable populations-as in the urban slums of Lagos.
尼日利亚是世界上孕产妇死亡率最高的国家之一，围产期死亡率也很高。不幸的是，该国没有资源通过传统的卫生信息系统来评估这一关键指标，而且几乎不可能衡量其在实现消除可预防孕产妇死亡目标方面的进展。无国界医生组织开展了一项横断面研究，以评估拉各斯最脆弱的两个贫民窟——马科科河滨区和巴迪亚东区的孕产妇和围产期死亡率。
该研究是一项基于社区的横断面家庭调查。共对近4000户家庭进行了调查。采用姐妹法估计孕产妇死亡率，采用前次生育技术估计新生儿和儿童死亡率。向女性受访者提出了有关寻求医疗行为的问题，并收集了自我报告的数据。
从3963名受访者那里收集了数据，这些受访者共有7018名已婚姐妹。计算得出孕产妇死亡率为每10万例活产1050例（95%置信区间：894 - 1215），孕产妇终身死亡风险为1:18。从报告的1967次怀孕中提取新生儿死亡率，估计为每1000例28.4例；婴儿死亡率为每1000例43.8例，五岁以下儿童死亡率为每1000例103例。居住在巴迪亚、在家分娩以及属于埃贡族与围产期死亡率较高有关。据报告，最后一次怀孕中有一半是在私立卫生机构分娩的。距离家近是与在卫生机构分娩相关的主要影响因素（32.4%）。
与拉各斯州估计的每10万例活产545例的数字相比，在拉各斯这些城市贫民窟人群中发现的孕产妇死亡率极高。需要紧急关注这些被忽视和脆弱的社区。应投入努力从贫困、边缘化和难以接触到的人群中获取数据，以便确定需要额外资源和量身定制方法的边缘化地区，从而保证为弱势群体提供公平的治疗并及时获得优质卫生服务。这项研究表明了次区域分类数据对于识别和纠正贫困、偏远、弱势群体（如拉各斯城市贫民窟人群）中存在的不平等现象的重要性。
