Background
Objectives
General
Primary Specific Objectives
Secondary Specific Objective
Methods
General outline
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This will be a nationwide cohort study that will ascertain all women who experience MNM and those who die from pregnancy, childbirth and puerperal complications according to the WHO criteria for MNM and maternal mortality among women admitted in tertiary healthcare facilities within the six geopolitical zones in Nigeria.
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Over a period of one year, women admitted for delivery or within 42 days of delivery or termination of pregnancy will be studied at all public hospitals of tertiary institution status (University hospitals and Federal Medical Centres).
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Cases of MNM and maternal deaths during the period that the women remain on admission in the facility will be identified using pre-defined criteria amongst the cohort.
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For every woman enrolled, the health service events (care pathways) within the facility will be evaluated to identify areas of substandard care/avoidable factors through clinical audit by the local research team.
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Health service events will be compared between women who experience MNM and those who die to identify institutional factors contributing to maternal death in each facility.
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Frequencies of MNM and maternal deaths among parturients will be compared between institutions across six geo-political zones and between those with less institutional capacity versus those with appropriate institutional capacity.
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A summary estimate of the frequencies of MNM and maternal deaths will be determined at intervals. Indicators of quality of care (case fatality rate, both total and cause-specific and mortality index) will be evaluated at facility, regional and country levels.
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This data system will undergo modification based on the experience gained from the pilot phase in the initial three months and publish report quarterly through the newsletter of NNRHRT.
Setting
ZONE | STATE | INSTITUTION |
---|---|---|
SOUTH WEST
| Ekiti | • Federal Medical Centre, Ido-Ekiti |
Lagos | • Federal Medical Centre, Ebute Metta | |
• Lagos State University Teaching Hospital, Ikeja | ||
• Lagos University Teaching Hospital, Idi-Araba | ||
Osun | • Ladoke Akintola University Teaching Hospital, Osogbo | |
• Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife | ||
Ondo | • Federal Medical Centre, Owo | |
Ogun | • Federal Medical Centre, Abeokuta | |
• Olabisi Onabanjo University Teaching Hospital, Sagamu | ||
Oyo | • University College Hospital, Ibadan | |
SOUTH EAST
| Abia | • Abia State University Teaching Hospital, Aba |
• Federal Medical Centre, Umuahia | ||
Anambra | • Nnamdi Azikiwe University Teaching Hospital, Nnewi | |
Ebonyi | • Ebonyi State University Teaching Hospital, Abakaliki | |
• Federal Medical Centre, Abakaliki | ||
Enugu | • University of Nigeria Teaching Hospital, Enugu | |
• Enugu State University Teaching Hospital, Enugu | ||
Imo | • Federal Medical Centre, Owerri | |
• Imo State University Teaching Hospital, Orlu | ||
SOUTH-SOUTH
| Akwa-Ibom | • University of Uyo Teaching Hospital, Uyo |
Bayelsa | • Federal Medical Centre, Yenegoa | |
Cross-Rivers | • University of Calabar Teaching Hospital, Calabar | |
Delta | • Federal Medical Centre, Asaba | |
• Federal Medical Centre, Onicha-Olona | ||
• Federal Medical Centre, Agbor | ||
• Delta State University Teaching Hospital, Abraka | ||
Edo | • University of Benin Teaching Hospital, Benin-city | |
• Irrua Specialist Teaching Hospital, Irrua | ||
Rivers | • University of Port Harcourt Teaching Hospital, Port-Harcourt | |
NORTH -CENTRAL
| Benue | • Federal Medical Centre, Markurdi |
Abuja (Federal Capital Territory) | • National Hospital, Abuja | |
• University of Abuja Teaching Hospital, Gwagwalada | ||
Kogi | • Federal Medical Centre, Lokoja | |
Kwara | • University of Ilorin Teaching Hospital, Ilorin | |
Niger | • Federal Medical Centre, Bida | |
Plateau | • Jos University Teaching Hospital, Jos | |
Bauchi | • Federal Medical Centre, Azare | |
NORTH-EAST
| Borno | • University of Maiduguri Teaching Hospital, Maiduguri |
Gombe | • Federal Medical Centre, Gombe | |
Yobe | • Federal Medical Centre, Nguru | |
Kaduna | • Ahmadu Bello University Teaching Hospital, Kaduna | |
NORTH WEST
| Katsina | • Federal Medical Centre, Katsina |
Kano | • Aminu Kano Teaching Hospital, Kano | |
Kebbi | • Federal Medical Centre, Birnin Kebbi | |
Sokoto | • Usmanu Danfodiyo University Teaching Hospital, Sokoto | |
Jigawa | • Federal Medical Centre, Birnin Kudu | |
Zamfara | • Federal Medical Centre, Zamfara | |
• Federal Medical Centre, Gusau |
Selection of subjects
Inclusion criteria
Exclusion criteria
Data Collection
Individual level data (Additional file 1)
1. Maternal characteristics
2. Information on maternal outcomes
Dysfunctional system | Clinical criteria | Laboratory markers | Management based proxies |
---|---|---|---|
Cardiovascular
| • Shock (a) | • pH<7.1 | • Use of continuous vasoactive drugs (i) |
• Cardiac arrest (b) | • Lactate>5 mEq/mL | • Cardio-pulmonary resuscitation (CPR) | |
Respiratory
| • Acute cyanosis | • Oxygen saturation < 90% for ≥ 60 minutes | • Intubation and ventilation not related to anaesthesia |
• Gasping (c) | • PaO2/FiO2<200 mmHg | ||
• Respiratory rate >40 or <6 bpm | |||
Renal
| • Oliguria non responsive to fluids or diuretics (d) | • Creatinine ≥ 300 μmol/l or ≥ 3.5 mg/dL | • Dialysis for acute renal failure |
Haematologic/
Coagulation
| • Failure to form clots(e) | • Acute severe thrombocytopa-enia (<50,000 platelets/ml) | • Transfusion of ≥ 5 units of blood/red cells |
Hepatic
| • Jaundice in the presence of preeclampsia (h) | • Bilirubin >100 μmol/l or >6.0 mg/dL | |
Neurologic
| • Any loss of consciousness lasting >12 h (f) | ||
• Stroke (g) | |||
• Uncontrollable fit/status epilepticus | |||
• Total paralysis | |||
Alternative severity proxy
| • Hysterectomy following infection or haemorrhage |