Our findings show an extremely high maternal mortality ratio of 1,012 maternal deaths per 100,000 live births (95% CI: 898–1,126) in Jigawa State, Northern Nigeria. Like the North, age and community wealth were significantly associated with maternal mortality in the South. Meh, C., Thind, A., Ryan, B. et al. CAS  Maternal mortality adversely affects women, their families and communities. Notify me of follow-up comments by email. Lancet. Statistical analyses were performed using Stata SE13 [35]. Chowdhury ME, Botlero R, Koblinsky M, Saha SK, Dieltiens G, Ronsmans C. Determinants of reduction in maternal mortality in Matlab, Bangladesh: a 30-year cohort study. 2003;109:153–9. Department of Epidemiology and Biostatistics, Western University, 1151 Richmond St., London, ON, N6A 5C1, Canada, Catherine Meh, Amardeep Thind, Bridget Ryan & Amanda Terry, Department of Family Medicine, Western University, 1151 Richmond St., London, ON, N6A 5C1, Canada, Amardeep Thind, Bridget Ryan & Amanda Terry, Schulich Interfaculty Program in Public Health, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St., London, ON, N6A 5C1, Canada, You can also search for this author in NCHS has identified instances where application of the checkbox information according to coding rules led to misclassification of maternal deaths, and NCHS is making changes in coding rules and reporting to make data more accurate. Still, an estimated 810 maternal deaths occur each day in the world [2]. Hernandez JC, Moser CM. Article  This may imply that women who do seek care receive substandard services in these health facilities. Ujah IAO, Aisien OA, Mutihir JT, Vanderjagt DJ, Glew RH, Uguru VE. Nonetheless, sociodemographic characteristics of living women are often similar to those of their deceased siblings. The major cause of this high MMR has been linked to the lack of access to quality delivery services. Correspondence to The government must intensify its efforts towards providing maternal health services in a conflict zone using alternate strategies that do not impinge on the already fragile healthcare institution. The method of contraceptive used had 3 categories: “no method”, “folk/traditional”, and “modern”. Hence, the aim of this study was to assess the levels and determinants of maternal mortality in the Northern and Southern regions of Nigeria among women of childbearing age using Nigeria Demographic Health Surveys. The modified framework distinguishes between determinants that impact maternal mortality on the individual or community level. Adapted framework (McCarthy & Maine) determinants of maternal mortality. Community wealth influences availability and access to maternal health services. The women from the South were mostly Christian (84.3%). This method identifies deceased siblings through select questions asked of the respondents and is widely used by the Demographic and Health Survey Program [30] and maternal health studies [31, 32] to obtain periodic estimates of maternal mortality. CAS  Since the ethnic composition of the North and South were different, two variables for ethnicity were created and used only for the separate regional analyses. Postpartum hemorrhage is severe bleeding experienced by women following the birth of a baby. A total of 18,863 women were from the South with 24% of the reported maternal deaths (Fig. 2013;17:118–29. BMC Pregnancy and Childbirth Almost all maternal deaths (99%) occur in developing countries. PubMed  Gend Behav. Alkema L, Chou D, Hogan D, Zhang S, Moller A-B, Gemmill A, et al. 2001. This means the country has a lifetime risk of maternal death of 4.62 percent. In one study, nonusers of maternal health services were more likely to be less educated [48]. The risk of maternal death may be high among the middle class because they are more likely to seek care at health facilities compared to the poor. In fact is the fourth country with the worst maternal mortality rate only surpassing Sierra Leone, Central African Republic, and Chad. Rai RK, Singh PK, Singh L. Utilization of maternal health care services among married adolescent women: insights from the Nigeria demographic and health survey, 2008. 1) have a more direct influence on maternal mortality while distant determinants impact the outcome by way of their influence on the intermediate factors. The modified framework retained some determinants of maternal mortality from the McCarthy and Maine framework. Unwanted pregnancies expose women to unsafe abortions that are linked to maternal deaths. The South saw a slight decline in its MMR but there remains a need for the government to ensure that there are appropriate family planning services and education available in the South. Other North-South differentials exist in Nigeria. Int J Equity Health. The disparities in these regions influence their levels and determinants of maternal mortality. To control for secular trends, survey year was also included in this study with 2008 and 2013 as the response categories. The progress in reducing maternal ratio has been to slow. BMC Public Health. PLoS One. An ethics waiver was granted by the Research Ethics Board at Western University in accordance with regulations pertaining to the use of anonymous secondary data. A secondary/higher education significantly reduced the odds of maternal mortality by 47% (reference: no education). Women may choose traditional/folkloric over modern contraceptives for reasons such as the fear of side effects, which is a known barrier to contraceptive use [52, 53]. Maternal Mortality Ratio in the North, South, and Nigeria Overall - 2008 & 2013. BMC Pregnancy Childbirth. Currently, Nigeria is the highest contributor to maternal mortality in Central and Western Africa and contributes 14% to the global maternal mortality rate. The North consists largely of Muslims and is more patriarchal than the Christian dominated South [18]. A joint report by UNICEF, […] In 2019, neonatal mortality rate for Nigeria was 35.9 deaths per 1,000 live births. Nigeria is one of the countries with the highest maternal mortality rates in the world, with the country accounting for about 20 per cent of global maternal deaths. A response of “no” was coded as 0 and meant disapproval of domestic violence while “yes/don’t know” was coded as 1 and represented approval or lack of knowledge on whether domestic violence was justified. The dependent variable was coded as binary; cases of maternal mortality (deceased siblings) were coded as 1 and 0 was assigned to living women (respondents). The principal inhabitants of the state are the Hausa/Fulani people. Maternal mortality refers to deaths due to complications from pregnancy or childbirth. Choe SA, Kim J, Kim S, Park Y, Kullaya SM, Kim CY. Population Council. Water source was classified as improved or unimproved depending on whether there was a natural construction or a deliberate intervention to protect it from outside contamination. The problem of poor organization and access to maternal health services has always been a major challenge in Nigeria. The influence of the social and cultural environment on maternal mortality in Nigeria: evidence from the 2013 demographic and health survey. Secondary or higher education was protective against maternal mortality in the North compared to having no education. Three percent of the sample consisted of maternal mortality cases of which, 751 and 810 maternal deaths were reported in 2008 and 2013 respectively. Article  CM acquired and analyzed the data. 2015;64(6):1767-814. http://law.emory.edu/elj/content/volume-64/issue-6/articles-and-essays/polygyny-violence-against-women.html. They were an average age of 33.6 years. In both regions, age and community wealth were significantly associated with maternal mortality. Maternal Mortality Rate in Nigeria: Past & Present Figures, Weight Loss: How to Lose Weight Using Dumbbells, Common Yoruba Herbs, their English Name & Uses. Different countries and cultures have different rates and causes for maternal death. In Bangladesh, induced abortions were more common among educated women [41] although the risk of mortality was low for them compared to uneducated women, this may not be the case in the South of Nigeria, where abortion is restricted, and most of its services are illicit and unsafe. Factors contributing to maternal mortality in North-Central Nigeria: A seventeen-year review. Hemorrhage, abortions, sepsis and obstructed labor are some of the leading causes of maternal death in this region [3]. The majority of women (83.4%) had no or low media exposure, no education (66.1%) and were Muslim (75.4%). Survey adjusted simple and multivariable logistic regression analyses were used to investigate the association of the independent variables and maternal mortality in the North and South of Nigeria using pooled data for the North (2008 and 2013) and South (2008 and 2013). Intermediate determinants (Fig. These should improve education of girls in the North and access to health information and services in the South. Estimating maternal mortality: the sisterhood method. Most women (79.4%) had a low or medium level media exposure and a secondary or higher education (57.3%). Adebowale AS, Yusuf BO, Fagbamigbe AF. World Health Organization; 2016. BMC Public Health. Meanwhile, northern residents were more likely to live within 5 km radius of health facilities or outreach posts that offer immunization services than those in the South [23]. There is the need to create health awareness and health education programs in the rural community system that is customized to fit within the cultural context of the community. United States Agency for International Development. Lancet. Nigeria maternal mortality rate for 2014 was 943.00, a 0.84% decline from 2013. Afr J Reprod Health. To achieve this, the two survey cycles were pooled to increase the sample size notably, the number of maternal related deaths. The Nigeria Demographic and Health Surveys (NDHS) revealed a national MMR of 576 deaths per 100,000 livebirths and 545 deaths per 100,000 in 2013 and 2008 respectively [10]. Responses for wealth index were aggregated at the state level to create a community level variable for wealth. 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