Most developed societies have low maternal mortality rates — Dr. Farouk Jega
At the 2019 #HealthMeetsTechNG hackathon organised by EpiAFRIC, Dr. Farouk Jega, Senior Country Representative for Pathfinder International, mentioned that under the Saving Mothers Giving Life (SMGL) initiative, supported by Pathfinder and other stakeholders, Cross River State had experienced a 66% decrease in maternal mortality. I was particularly interested in the Maternal and Perinatal Death Surveillance and Response (MPDSR) part of the initiative.
Nigeria has one of the world’s highest maternal mortality ratios. The 2018 National Demographic and Health Survey data reports that the national maternal mortality ratio is 512 to every 100,000 live births while the national ratio for perinatal deaths is 49 to every 1,000 live births.
MPDSR examines the circumstances surrounding each death, including any preventable breakdown in care, whether from the household to the health facility. It is a continuous cycle that includes identifying when deaths take place, notifying the relevant authorities, and reviewing the causes of both maternal and perinatal deaths, after which actions to improve quality of care and prevent future deaths are instigated, all carried out in a no-blame environment. According to Dr. Yemis Femi-Pius, Programme Manager Pathfinder International, Cross River State, “MPDSR is important but it is also very sensitive because if people know that you are auditing deaths, they might want to cover up. So, it is important to sensitise the whole hospital, even down to the cleaner because everybody has a part to play in the quality of care that the woman receives”. In Nigeria, the Federal Ministry of Health adopted the MPDSR policy in 2016.
The SMGL initiative in Cross River State started in 2014/2015 with a state-wide assessment of health facilities that provide antenatal care (ANC) services; 812 health facilities were assessed for their readiness to deliver quality basic and comprehensive emergency obstetric and new-born care. The assessment revealed low recognition of danger signs and a lack of confidence in the health system among women and community members, and low capacity of facilities and providers to provide comprehensive and basic emergency obstetric and newborn care (EmONC). It also showed the irregular supply of essential medicines, poor use of registers, and infrequent performance of maternal and neonatal death audits.
Results showed that common causes of maternal deaths were obstructed labour, eclampsia, pre-eclampsia and postpartum hemorrhage (PPH) and the common causes of perinatal deaths were severe birth asphyxia, infection, and premature birth. The assessment also revealed a facility maternal mortality ratio of 876 maternal deaths per 100,000 live births.