Reducing Maternal Mortality by Strengthening Community Maternal Support Systems: Findings from a Qualitative Baseline Study in Northern Nigeria

Ekechi Okereke, Susan B. Aradeon, Ibrahim Yisa

Abstract

The “three delays model” illustrates how issues around obstetric emergency can lead to maternal deaths. This study applied indepth interviews of key community gatekeepers in 16 rural communities across two states in northern Nigeria to evaluate the presence and functionality of key community maternal support systems for reducing maternal mortality. Findings show that only one out of the 16 communities had all the key support systems. Five rural communities reported that pregnant women have standing permission to visit health facilities during obstetric emergencies. A quarter of the communities reported the presence of transport for maternal emergencies. One rural community each reported the existence of community savings for obstetric emergencies and the presence of blood donor groups. Establishing and/or strengthening community support systems, ensuring citizens are well-informed about maternal danger signs and preparing for safe pregnancies can enable communities overcome the delays and reduce maternal mortality especially in low resource settings. (Afr J Reprod Health 2016 (Special Edition); 20[3]: 159-167).

Full Text:

PDF

References

Mbonye AK, Asimwe JB, Kabarangira J, Nanda G, Orinda V. Emergency obstetric care as the priority intervention to reduce maternal mortality in Uganda. Int J Gynaecol Obstet. 2007 Mar; 96(3): 220-5. 2. Aradeon, SB and Doctor, HV. Reducing rural maternal mortality and the equity gap in northern Nigeria: the public health evidence for the Community Communication Emergency Referral Strategy. International Journal of Women‟s Health 2016, 8: 7792; http://dx.doi.org/10.2147/IJWH .S94823. 3. Idris SH, Gwarzo UM, Shehu AU. Determinants of place of delivery among women in a semiurban settlement in Zaria, northern Nigeria. Ann Afr Med 2006; 5: 68-72. 4. Idris SH, Sambo MN, Ibrahim MS. Barriers to utilization of maternal health services in a semiurban community in northern Nigeria: The clients‟ perspective. Niger Med J 2013; 54: 27-32. 5. Thaddeus S, Maine D. Too far to walk: maternal mortality in context. Soc Sci Med. 1994 Apr; 38(8):1091-110. 6. Barnes-Josiah D, Myntti C, Augustin A. The “three delays” as a framework for examining maternal mortality in Haiti. Social Science & Medicine 1998, 46(8): 981-993. 7. Combs Thorsen V, Sundby J, Malata A. Piecing together the maternal death puzzle through narratives: the three delays model revisited. PLoS One 2012; 7:12. 8. Okusanya BO, Okogbo FO, Momoh MM, Okogbenin SA and Abebe JO. Maternal mortality and delay: sociodemographic characteristics of maternal deaths with delay in Irrua, Nigeria. Niger J Med. 2007 Jan-Mar; 16(1):38-41. 9. Shah N, Hossain N, Shoaib R, Hussain A, Gillani R and

Okereke et al. Strengthening Community to Reduce Maternal Mortality

African Journal of Reproductive Health September 2016 (Special Edition); 20(3): 167

Khan NH. Socio-demographic characteristics and the three delays of maternal mortality. J Coll Physicians Surg Pak. 2009 Feb; 19(2): 95 – 8. 10. National Population Commission (NPC) (2014) ICF Macro. Nigeria demographic and health survey 2013. Abuja, Nigeria: National Population Commission and ICF Macro. 11. Abimbola S, Okoli U, Olubajo O, Abdullahi MJ, Pate MA (2012) The Midwives Service Scheme in Nigeria. PLoS Med 9(5): e1001211. doi:10.1371/ journal.pmed.1001211. 12. Hogan M.C., Foreman K.J., Naghavi M., Ahn S.Y., Wang M., Makela S.M., Lopez A.D., Lozano R, Murray C. Maternal mortality for 181 countries, 1980- 2008: a systematic analysis of progress towards Millennium Development Goal 5. Lancet 2010, 375: 1609 -1623. 13. Adegoke AA, Lawoyin TO, Ogundeji MO, Thomson AM. A community based investigation of avoidable factors of maternal mortality in Nigeria: the pilot experience. Afr Health Sci. 2007;7(3):176–181. 14. Stephenson R, Tsui AO: Contextual influences on reproductive health service use in Uttar Pradesh, India. Stud Fam Plann 2002, 33(4):309-320. 15. Lassi ZS, Haider BA, Bhutta ZA. Community-based intervention packages for reducing maternal and neonatal morbidity and mortality and improving neonatal outcomes. Cochrane Database Syst Rev. 2010 Nov 10;(11): CD007754. doi: 10.1002/1465 1858. CD0 0775 4.pub2. 16. Costello A. Reducing maternal and neonatal mortality in the poorest communities. BMJ 2004; 329: 1166. 17. Okereke E, Aradeon S, Akerele A, Tanko M, Yisa I, Obonyo B. . Knowledge of safe motherhood among women in rural communities in northern Nigeria: implications for maternal mortality reduction. Reproductive Health 2013 10:57. 18. National Population Commission (NPC) [Nigeria]: Final Results of the 2006 National Population and Housing Census of Nigeria. Abuja, Nigeria: National Population Commission; 2009. 19. National Population Commission (NPC) [Nigeria]: Nigeria Demographic and Health Survey 2008. Abuja, Nigeria: National Population Commission

and ICT Macro; 2009. 20. Wolf M, Abubakar A, Tsui S, Williamson NE: Child spacing attitudes in Northern Nigeria. Arlington, VI: FHI; 2008. 21. Mbaruku G, Roosmalen J, Kimondo I, Bilango F, and Bergstr¨om S, “Perinatal audit using the 3-delays model in western Tanzania,” International Journal of Gynecology & Obstetrics, vol. 106, no. 6, pp. 85– 88, 2009. 22. Crowe S, Utley M, Costello A, Page C. How many births in sub-Saharan Africa and South Asia will not be attended by a skilled birth attendant between 2011 and 2015? BMC Pregnancy Childbirth. 2012; 12: 4. 23. The Prevention of Maternal Mortality Network, “Barriers to treatment of obstetric emergencies in rural communities of West Africa,” Studies in Family Planning, vol. 23, pp. 279–291, 1992. 24. Ensor T and Cooper S, “Overcoming barriers to health service access: influencing the demand side,” Health Policy and Planning, vol. 19, no. 2, pp. 69– 79, 2004. 25. Shehu D, Ikeh A, and Kuna M, “Mobilizing transport for obstetric emergencies in North-west Nigeria,” International Journal of Gynecology & Obstetrics, vol. 59, pp. S173–S180, 1997. 26. Jammeh A, Sundby J, Vangen S. Barriers to emergency obstetric care services in perinatal deaths in rural gambia: a qualitative in-depth interview study. ISRN Obstet Gynecol. 2011; 2011:981096. 27. WHO, Universal Access to Safe Blood Transfusion, World Health Organization, Geneva, Switzerland, 2008. 28. Sundby J, Vangen S and Cham M. “Maternal mortality in the rural Gambia, a qualitative study on access to emergency obstetric care,” Reproductive Health, vol. 2, no. 1, 2005. 29. JHPIEGO and MNH Programme, Monitoring Birth Preparedness and Complication Readiness: Tools and Indicators for Maternal and Newborn Health, JHPIEGO, Baltimore, Md, USA, 4th edition, 2004. 30. Gage A.J, “Barriers to the utilization of maternal health care in rural Mali,” Social Science and Medicine, vol. 65, no. 8, pp. 1666–1682, 2007.

Refbacks

  • There are currently no refbacks.