APPRAISAL OF MATERNAL MORTALITY RATE IN THE GENERAL HOSPITAL BADAGRY-LAGOS STATE

CHAPTER ONE

INTRODUCTION

• Background of the study

Maternal mortality, also known as maternal death, continues to be the major cause of death among women of reproductive age in many countries and remains a serious public health issue especially in developing countries (WHO, 2007). As explained in Shah and Say (2007), a maternal death is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes. Globally, the estimated number of maternal deaths worldwide in 2005 was 536,000 up from 529,000 in 2000. According to the WHO Factsheet (2008), 1500 women die from pregnancy or pregnancy-related complications every day. Most of these deaths occur in developing countries, and most are avoidable. Of all the health statistics compiled by the World Health Organization, the largest discrepancy between developed and developing countries occurred in maternal mortality. Ujah et al. (2005) noted that while 25 percent of females of reproductive age lived in developed countries, they contributed only 1 percent to maternal deaths worldwide. A total of 99 percent of all maternal deaths occur in developing countries. More than half of these deaths occur in sub-Saharan Africa and one third in South Asia. The maternal mortality ratio in developing countries is 450 maternal deaths per 100,000 live births versus 9 in developed countries. Fifteen countries have maternal mortality ratios of at least 1000 per 100,000 live births, of which all but Afghanistan and India are in sub-Saharan Africa: Afghanistan, Angola, Burundi, Cameroon, Chad, the Democratic Republic of the Congo, Guinea-Bissau, India Liberia, Malawi, Niger, Nigeria, Rwanda, Sierra Leone and Somalia (WHO, 2008). Nigeria is one of the 187 countries that signed the Millennium Declaration in 2000 with the aim of reducing the 8 identified goals/targets substantially by 2015. With the deadline for the attainment of the Millennium Development Goals rapidly approaching, many Countries are developing strategies aimed at fast-tracking efforts being made towards the attainment of the MDGs.

Nigeria still has one of the highest maternal mortality rates in the World. The figures for the Country varies between 800 to 1,000 live births based on the geographical location. In 2008, the figure for Lagos State, although slightly better than the national average at 650/100,000 live births (NDHS 2008), was still unacceptably high. Although Nigeria is on track for some of its targets, it is showing slow progress especially with the health related ones. Nigeria is a major contributor to the global burden of maternal deaths and requires intensified efforts to rapidly reduce the high mortality indices. Neonatal mortality in recent years has increased in developing countries with Nigeria having the third highest neonatal mortality in the world. Presently with the integrated Maternal and Newborn and Child Health (IMNCH) strategy, rolled out by the Federal Government in 2011, to accelerate reduction in MDGs 4 and 5, there is an increase focus on the neonates, which account for 40 percent of children under five years of age, and have unfortunately been neglected in recent times. Newborn infants resuscitated during the golden hour i.e the first hour of birth, have a greater chance of surviving. Provision of basic resuscitation equipment at the primary health care centers can reduce death of the newborn during the first 2hours of birth. The resuscitation bag known generically as a manual resuscitator or “self-inflating bag” is a hand-held device commonly used to provide positive pressure ventilation to patients who are not breathing or not breathing adequately.

Nigeria has one of the highest maternal mortality rates in the world, second only to India whose population is eight times larger than that of Nigeria. Mairiga et al. (2008) expressed the view that the world’s maternal mortality ratio (the number of maternal deaths per 100,000 live births) is declining too slowly to meet Millennium Development Goal (MDG) 5 target, which aimed to reduce the number of women who die in pregnancy and childbirth by three quarters by the year 2015. While an annual decline of 5.5 per cent in maternal mortality ratios between 1990 and 2015 is required to achieve MDG 5, figures released by WHO, UNICEF, UNFPA and the World Bank show an annual decline of less than l per cent. Gains in reducing maternal mortality have been modest overall. While average global infant mortality and under five mortality have been reduced by more than half in the past 40 years, and average global life expectancy at birth has increased enormously during the same period there has been no visible progress in maternal mortality (MMR) reduction at the global level. Shah and Say (2007) noted that the trend in developing countries is much worse, as studies from various countries of sub-Saharan Africa indicate that maternal mortality has not only continued to be high, but is indeed increasing after the launch of the Safe Motherhood Initiative (SMI) in Nigeria

• STATEMENT OF THE PROBLEM

The problem of poor organization and access to maternal health services has always been a major challenge in Nigeria. Omo-Aghoja et al (2008) asserted that maternity care in Nigeria is organized around three tiers: primary, secondary and tertiary care levels. Primary health centres are located in all the 774 local government councils in the country. Pregnant women are to receive antenatal care, delivery and postnatal care in the primary health centres nearest to them. In case of complications they are referred to secondary care centres, managed by states, or tertiary centres, managed by the federal government. It is in view of this short coming that the researcher intends to appraise the maternal mortality rate in the general hospital in Lagos state.

• OBJECTIVE OF THE STUDY

The main objective of this study is an appraisal of maternal mortality rate in Lagos state general hospitals, specific objective includes:

1. To appraise the causes of maternal mortality rate in Lagos state general hospital
2. To investigate the effect or maternal mortality rate on the population growth of Lagos state

• To investigate the relationship between maternal mortality and the psychological well-being of the children

1. To proffer suggested solution to the identified problem

1.4 RESEARCH HYPOTHESES

To aid the completion of the study, the following research hypotheses were formulated by the researcher;

H₀: there are no causes of maternal mortality rate in Lagos state general hospital

H₁: there are causes of maternal mortality rate in Lagos state general hospital

H₀²: maternal mortality rate has no effect on the population growth of Lagos state

H₂: maternal mortality rate has effect on the population growth of Lagos state.

• SIGNIFICANCE OF THE STUDY

It is believed that at the completion of the study, the findings will be of great importance to the to the mid-wives and nurses in the general hospital, as the study seek to investigate the proximate causes of maternal mortality rate in the Lagos state general hospital, the study will also be of great importance to pregnant women as the study seek to ascertain the major cause of maternal mortality rate in Badagary and Lagos state metropolis at large. The study will also be beneficial to researchers who intends to embark on study in similar topic as the study will serve as a guide to their study. Finally the study will be beneficial to academia’s students and the general public.

• SCOPE AND LIMITATION OF THE STUDY

The scope of the study covers appraisal of maternal mortality rate in the general hospital in Lagos state. In the cause of the study, there were some factors which limited the scope of the study;

(a)Availability of research material: The research material available to the researcher is insufficient, thereby limiting the study.

(b)Time: The time frame allocated to the study does not enhance wider coverage as the researcher has to combine other academic activities and examinations with the study.

(c)Finance: The finance available for the research work does not allow for wider coverage as resources are very limited as the researcher has other academic bills to cover.

1.7 OPERATIONAL DEFINITION OF TERMS

Maternal

Relating to a mother, especially during pregnancy or shortly after childbirth

Mortality

Mortality data indicate numbers of deaths by place, time and cause. WHO’s mortality data reflect deaths registered by national civil registration systems of deaths, with the underlying cause of death coded by the national authority.

Maternal mortality

Maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.

Mortality rate

Mortality rate, or death rate,^[1] is a measure of the number of deaths (in general, or due to a specific cause) in a particular population, scaled to the size of that population, per unit of time. Mortality rate is typically expressed in units of deaths per 1,000 individuals per year; thus, a mortality rate of 9.5 (out of 1,000) in a population of 1,000 would mean 9.5 deaths per year in that entire population, or 0.95% out of the total.

1.8 ORGANIZATION OF THE STUDY

This research work is organized in five chapters, for easy understanding, as follows. Chapter one is concern with the introduction, which consist of the (background of the study), statement of the problem, objectives of the study, research questions, research hypotheses, significance of the study, scope of the study etc. Chapter two being the review of the related literature presents the theoretical framework, conceptual framework and other areas concerning the subject matter.     Chapter three is a research methodology covers deals on the research design and methods adopted in the study. Chapter four concentrate on the data collection and analysis and presentation of finding.  Chapter five gives summary, conclusion, and recommendations made of the study.

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