Browsing by Author "Adegbola, O"
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Item The burden of severe maternal outcomes and indicators of quality of maternal care in Nigerian hospitals: a secondary analysis comparing two large facility-based surveys.(Royal College of Obstetricians and gynaecologists, 2019-05-14) Vogel, Joshua; Fawole, Bukola; Adeniran, Abiodun; Adegbola, O; Oladapo, OlufemiObjective To compare severe maternal outcomes (SMOs) from two multi-centre surveys in Nigerian hospitals, and to evaluate how the SMO burden affects quality of secondary and tertiary hospital care. Design Two facility-based surveys of women experiencing SMO (maternal near-miss or maternal deaths). Setting Sixteen secondary and five tertiary facilities in Nigeria [WHO Multi-Country Survey on Maternal and Newborn Health (WHOMCS)] and 42 public tertiary facilities in Nigeria (Nigeria Near-Miss and Maternal Death Survey). Population 371 women in WHOMCS-Nigeria and 2449 women in Nigeria Near-Miss and Maternal Death Survey who experienced SMO. Methods Secondary analysis and comparison of SMO data from two surveys, stratified by facility level. Main outcome measures Maternal mortality ratio (MMR) per 100 000 livebirths (LB), maternal near-miss (MNM) ratio per 1000 LB, SMO ratio per 1000 LB and mortality index (deaths/ SMO). Results Maternal mortality ratio and mortality indices were highest in tertiary facilities of the WHOMCS-Nigeria (706 per 100 000; 26.7%) and the Nigeria Near-Miss and Maternal Death Survey (1088 per 100 000; 40.8%), and lower in secondary facilities of the WHOMCS-Nigeria (593 per 100 000; 17.9%). The MNM ratio and SMO ratio were highest in secondary WHOMCS- Nigeria facilities (27.2 per 1000 LB; 33.1 per 1000 LB). Conclusions Tertiary-level facilities in Nigeria experience unacceptably high maternal mortality rates, but secondary-level facilities had a proportionately higher burden of severe maternal outcomes. Common conditions with a high mortality index (postpartum haemorrhage, eclampsia, and infectious morbidities) should be prioritised for action. Surveillance using SMO indicators can guide quality improvement efforts and assess changes over time. Keywords Maternal death, maternal health, maternal near-miss, quality of care, severe maternal outcome.Item When getting there is not enough: a nationwide cross-sectional study of 99 maternal deaths and 1451 near-misses in public tertiary hospitals in a low-income country(Royal College of Obstetricians and Gynaecologists, 2015-05-14) Oladapo, Olufemi; Adetoro, O.O; Ekele, Bisalla; Chama, Calvin; Etuk, Saturday; Aboyeji, Peter; Onah, H.E; Abasiattai, A.M; Adamu, A.N; Adegbola, O; Adeniran, Abiodun; Aimakhu, C.O; Akinsanya, O; Aliyu, L.D; Ande, A.B; Ashimi, A; Bwala, M; Fabanwo, A; Giedam, A.D; Ikechebelu, J.I.; Imaralu, J.O; Kuti, O; Nwachukwu, D; Omo-Aghoja, L; Tunau, K; Tukur, J; Umeora, O.U.J; Umezulike, A.C; Dada, O.A; Tuncalp, O; Vogel, Joshua; Gulmezoglu, A.MObjective To investigate the burden and causes of life-threatening maternal complications and the quality of emergency obstetric care in Nigerian public tertiary hospitals. Design Nationwide cross-sectional study. Setting Forty-two tertiary hospitals. Population Women admitted for pregnancy, childbirth and puerperal complications. Methods All cases of severe maternal outcome (SMO: maternal near-miss or maternal death) were prospectively identified using the WHO criteria over a 1-year period. Main outcome measures Incidence and causes of SMO, health service events, case fatality rate, and mortality index (% of maternal death/SMO). Results Participating hospitals recorded 91 724 live births and 5910 stillbirths. A total of 2449 women had an SMO, including 1451 near-misses and 998 maternal deaths (2.7, 1.6 and 1.1% of live births, respectively). The majority (91.8%) of SMO cases were admitted in critical condition. Leading causes of SMO were preeclampsia/eclampsia (23.4%) and postpartum haemorrhage (14.4%). The overall mortality index for life-threatening conditions was 40.8%. For all SMOs, the median time between diagnosis and critical intervention was 60 minutes (IQR: 21–215 minutes) but in 21.9% of cases, it was over 4 hours. Late presentation (35.3%), lack of health insurance (17.5%) and nonavailability of blood/blood products (12.7%) were the most frequent problems associated with deficiencies in care. Conclusions Improving the chances of maternal survival would not only require timely application of life-saving interventions but also their safe, efficient and equitable use. Maternal mortality reduction strategies in Nigeria should address the deficiencies identified in tertiary hospital care and prioritise the prevention of severe complications at lower levels of care.