Ntoimo Lorretta F, Okonofua Friday E, Ogu Rosemary N, Galadanci Hadiza S, Gana Mohammed, Okike Ola N, Agholor Kingsley N, Abdus-Salam Rukiyat A, Durodola Adetoye, Abe Eghe, Randawa Abdullahi J
WHO Implementation Research Group, The Women's Health and Action Research Centre, Benin City, Edo State.
Department of Demography and Social Statistics, Federal University Oye-Ekiti, Ekiti State.
Int J Womens Health. 2018 Feb 1;10:69-76. doi: 10.2147/IJWH.S151784. eCollection 2018.
While reports from individual hospitals have helped to provide insights into the causes of maternal mortality in low-income countries, they are often limited for policymaking at national and subnational levels. This multisite study was designed to determine maternal mortality ratios (MMRs) and identify the risk factors for maternal deaths in referral health facilities in Nigeria.
A pretested study protocol was used over a 6-month period (January 1-June 30, 2014) to obtain clinical data on pregnancies, births, and maternal deaths in eight referral hospitals across eight states and four geopolitical zones of Nigeria. Data were analyzed centrally using univariate, bivariate, and multivariate statistics.
The results show an MMR of 2,085 per 100,000 live births in the hospitals (range: 877-4,210 per 100,000 births). Several covariates were identified as increasing the odds for maternal mortality; however, after adjustment for confounding, five factors remained significant in the logistic regression model. These include delivery in a secondary health facility as opposed to delivery in a tertiary hospital, non-booking for antenatal and delivery care, referral as obstetric emergency from nonhospital sources of care, previous experience by women of early pregnancy complications, and grandmultiparity.
MMR remains high in referral health facilities in Nigeria due to institutional and patient-related factors. Efforts to reduce MMR in these health facilities should include the improvement of emergency obstetric care, public health education so that women can seek appropriate and immediate evidence-based pregnancy care, the socioeconomic empowerment of women, and the strengthening of the health care system.
虽然来自个别医院的报告有助于深入了解低收入国家孕产妇死亡的原因，但这些报告往往在国家和次国家层面的政策制定方面存在局限性。这项多地点研究旨在确定尼日利亚转诊医疗机构的孕产妇死亡率（MMR），并确定孕产妇死亡的风险因素。
在2014年1月1日至6月30日的6个月期间，使用经过预测试的研究方案，获取尼日利亚八个州和四个地缘政治区的八家转诊医院的妊娠、分娩和孕产妇死亡的临床数据。使用单变量、双变量和多变量统计方法对数据进行集中分析。
结果显示，医院的孕产妇死亡率为每10万活产2085例（范围：每10万例分娩877 - 4210例）。确定了几个协变量会增加孕产妇死亡的几率；然而，在对混杂因素进行调整后，五个因素在逻辑回归模型中仍然显著。这些因素包括在二级医疗机构分娩而非在三级医院分娩、未进行产前和分娩护理预约、从非医院护理来源作为产科急诊转诊、妇女既往有早孕并发症经历以及多产。
由于机构和患者相关因素，尼日利亚转诊医疗机构的孕产妇死亡率仍然很高。在这些医疗机构降低孕产妇死亡率的努力应包括改善产科急诊护理、开展公共健康教育以使妇女能够寻求适当且即时的循证孕期护理、增强妇女的社会经济权能以及加强医疗保健系统。
