Analysis Effect Of Mortality Death Rate On Women Age Group

Introduction

1.1 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 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 Kenya in 1987.

According to the WHO, over 800 women die globally each day from preventable maternal deaths. Ninety-nine percent of these deaths have been found to occur within developing nations with about half of these deaths happening in sub Saharan Africa alone and nearly one-third occurring in South Asia (World Health Organization, 2018a).

The causes of maternal mortality have been put into 2 groups, direct and indirect causes. Direct causes of maternal deaths result from abortion, haemorrhage, sepsis, hypertensive disorders, obstructed labour, and ruptured uterus. Indirect causes of maternal mortality on the other hand result from HIV, malaria, severe anaemia, sickle cell disease, and embolism (World Health Organization, 2018a). Regional variations in the causes of maternal deaths have been found to exist. Additionally, variations in the timing of maternal mortality with respect to the 3 partum periods have also been identified amongst different regions (Merdad & Ali, 2018).

Maternal mortality is the principal cause of death amongst females within the age ranges of 15-49 all over the world. Maternal mortality was not globally accepted as an issue of public health concern until the latter part of the 20th century. In 1985, a thought provoking article published by Allan Rosenfield and Deborah Maine revealed that although attention had been given to maternal and child health in general, little attention had been given to the issue of maternal mortality by politicians, policy makers and health care professionals hence, little had been done to reduce maternal mortality in developing nations (Allan & Maine, 1985).

1.2 Statement of the Problem

In spite of all the policies, declarations, conferences and other efforts aimed at reducing the scourge of maternal deaths across the globe, only modest gains in maternal mortality reduction appear to have been achieved in many countries in the past 20 years (Shah and Say, 2007). Countries in Africa may have actually lost ground while many developing countries have fallen far short of the standards set by the World Health Organisation’s initiative on Safe Motherhood. In Nigeria, the Federal Ministry of Health had set Year 2006 as the target year that maternal mortality would have been reduced by 50 percent. However, not only were these targets not achieved but also the maternal health situation in Nigeria is now much worse than in previous years (Ujah et al, 2005).

Past efforts to reduce maternal mortality ratio in Nigeria were concentrated on making direct improvements to the health system. These efforts have not involved enough resources to successfully reduce maternal mortality in the country.

In view of this lack of success, Shiffman and Okonofua(2007) noted that the high maternal mortality in the country will have to be tackled by generating sufficient political priority to make governments deploy enough resources to successfully reduce maternal mortality in Nigeria.

This study brings together some of the factors responsible for the high maternal mortality in the country, and uses stepwise regression to select the ones that appear to have more effect on maternal mortality ratio in Nigeria.

Narrowing down the range of factors to be considered by political office holders should help bring focus to the challenge of generating political priority, since maternal mortality is just one among hundreds of issues competing for the attention of political leaders at any given point in time.

1.3 Objective of the Study

The objective of this study is to:

Bring together some of the risk factors mentioned in the past as responsible for high maternal mortality in Nigeria.

Identify the factors that seem to have more effect than the others on maternal mortality in Nigeria.

1.4 Research Question

What is the trend of maternal mortality rate in Nigeria?

What are the risk factors mentioned in the past as responsible for high maternal mortality in Nigeria ?

What are the factors that seem to have more effect than the others on maternal mortality in Nigeria ?

1.5 Hypothesis of the Study

The following hypotheses were formulated and tested by the study

Ho: There is no relationship between some demographic/socioeconomic factors and maternal mortality in Nigeria

Hi: There is relationship between some demographic/socioeconomic factors and maternal mortality in Nigeria

1.6 Significance of the Study

Nigeria could not achieve the Millennium Development Goal (MDG) 5A objective of three quarter reduction of maternal deaths by 2015. In 2016, For Nigeria to achieve the Sustainable Development Goal (SDG) objective of at most 70 per 100,000 live births by 2030, the current intervention strategies must be reviewed and some new recommendations be made.

This study would provide a conceptual framework outline for risk factor management and a risk factor classification for modeling. The results would be valuable to the Nation in managing risk factors associated with maternal mortality so as to reduce maternal deaths drastically.

1.7 Scope / Limitation of the Study

This study would be restricted to the records on maternal mortality. The secondary data obtained from Health Information Systems were across 50 hospitals in the country. Special attention would be given to the data on ascription of cause of maternal death from the National Hospital Abuja, since it is the major referral hospital in the FCT. This hospital often treats cases that place pregnant women in high risk group for death. The data collection procedure also limits one’s capacity to assign an exact cause of death.