Maternal mortality at the University of Nigeria Teaching Hospital, Enugu, 1999-2003

Abstract

In order to assess the current maternal mortality ratio (MMR) at the University of Nigeria Teaching Hospital, Enugu, Nigeria, a retrospective analysis of maternal deaths for the years 1999-2003 was carried out. Data abstracted from the case notes included the socio-demographic characteristics of the women who died; their referral sources, type of delay (if any), medical causes of death and whether each death could have been prevented by appropriate interventions. Compared to the 1980s, there was a decline in the yearly mean number of deliveries with an increased proportion of unbooked emergencies. During the 5-year period, there were 88 maternal deaths and 3854 live births giving a MMR of 2283 per 100 000 live births. MMR was much higher in this study than in two previous reviews from the same hospital (2283 per 100 000 in the current study compared to 1406 per 100 000 for the period 1991-2000 and 270 per 100 000 for the period 1976-1985, respectively). The leading causes of maternal death were obstetric haemorrhage, sepsis, prolonged obstructed labour/ruptured uterus and preeclampsia/eclampsia. Most of the deaths were due to obstetric emergencies referred from private hospitals and maternity homes. Referral and institutional delays were the main causes of delay in tackling obstetric emergencies within the 5-year period. It was concluded that the MMR at the UNTH, Enugu has remained high due to a combination of factors. Reducing maternal mortality ratio in the hospital would involve provision of functional blood banking services and training of private health care providers and those in government hospitals and primary health centers on emergency obstetric care land early referral. Other measures include subsidized health care for the benefit of poor patients, provision of necessary equipment and a drug-revolving fund system.