Okonofua Friday, Imosemi Donald, Igboin Brian, Adeyemi Adegboyega, Chibuko Chioma, Idowu Adewale, Imongan Wilson
Program and Research Unit, Women's Health and Action Research Centre (WHARC), Benin City, Edo State, Nigeria.
University of Medical Sciences (UNIMED), Ondo, Ondo State, Nigeria.
PLoS One. 2017 Dec 14;12(12):e0188392. doi: 10.1371/journal.pone.0188392. eCollection 2017.
The objective of the study was to investigate the results of Maternal and Perinatal Death Surveillance and Response (MPDSR) conducted in three referral hospitals in Lagos State, Nigeria over a two-year period and to report the outcomes and the lessons learned. MPDRS panels were constituted in the three hospitals, and beginning from January 2015, we conducted monthly MPDSR in the three hospitals using a nationally approved protocol. Data on births and deaths and causes of deaths as identified by the MPDSR panels were collated in the hospitals. The results show that over a 21-month period (January 1, 2015 -September 30, 2016), maternal mortality ratio (MMR) remained high in the hospitals. Although there was a trend towards an increase in MMR in Lagos Island Maternity Hospital and Gbagada General Hospital, and a trend towards a decline in Ajeromi Hospital, none of these trends were statistically significant. Eclampsia, primary post-partum haemorrhage, obstructed labour and puerperal sepsis were the leading obstetric causes of death. By contrast, delay in arrival in hospital, the lack of antenatal care and patients' refusal to receive recommended treatment were the patients' associated causes of death, while delay in treatment, poor use of treatment protocols, lack of equipment and lack of skills by providers to use available equipment were the identified facility-related causes of death. Failure to address the patients and facility-related causes of maternal mortality possibly accounted for the persistently high maternal mortality ratio in the hospitals. We conclude that interventions aimed at redressing all causes of maternal deaths identified in the reviews will likely reduce the maternal mortality ratios in the hospitals.
该研究的目的是调查在尼日利亚拉各斯州的三家转诊医院进行的为期两年的孕产妇和围产期死亡监测与应对（MPDSR）的结果，并报告其成果和经验教训。在这三家医院成立了MPDRS小组，从2015年1月开始，我们使用国家批准的方案在这三家医院每月进行一次MPDSR。医院整理了MPDSR小组确定的出生、死亡及死亡原因的数据。结果显示，在21个月期间（2015年1月1日至2016年9月30日），这些医院的孕产妇死亡率（MMR）仍然很高。虽然拉各斯岛妇产医院和巴加达综合医院的MMR有上升趋势，而阿杰罗米医院有下降趋势，但这些趋势均无统计学意义。子痫、原发性产后出血、产程梗阻和产褥期败血症是主要的产科死亡原因。相比之下，入院延迟、缺乏产前护理以及患者拒绝接受推荐治疗是与患者相关的死亡原因，而治疗延迟、治疗方案使用不当、设备缺乏以及医护人员缺乏使用现有设备的技能是已确定的与医疗机构相关的死亡原因。未能解决与患者和医疗机构相关的孕产妇死亡原因可能是这些医院孕产妇死亡率持续居高不下的原因。我们得出结论，旨在纠正审查中确定的所有孕产妇死亡原因的干预措施可能会降低这些医院的孕产妇死亡率。
