Maternal death review and surveillance: The case of Central Hospital, Benin City, Nigeria

• Published in: PloS one 2019-12, Vol.14 (12), p.e0226075-e0226075
• Main Authors: Aikpitanyi, Josephine, Ohenhen, Victor, Ugbodaga, Philip, Ojemhen, Best, Omo-Omorodion, Blessing I, Ntoimo, Lorretta Fc, Imongan, Wilson, Balogun, Joseph A, Okonofua, Friday E
• Format: Article
• Language: English
• Subjects: Biology and Life Sciences; Blood; Blood donation; Blood transfusion; Cause of Death; Congestive heart failure; Databases, Factual; Delivery of Health Care; Delivery, Obstetric - adverse effects; Eclampsia; Embolism; Fatalities; Female; Health aspects; Health education; Health facilities; Health Policy; Health surveillance; Heart Failure - etiology; Heart Failure - mortality; Hemorrhage; Hemorrhage - etiology; Hemorrhage - mortality; Hospitals; Humans; Infant mortality; Intelligence gathering; Low income groups; Maternal & child health; Maternal Mortality; Medical personnel training; Medicine and Health Sciences; Mortality; Nigeria; Obstetrics; Parent death; People and Places; Pregnancy; Pregnant women; Public health; Pulmonary embolism; Pulmonary Embolism - etiology; Pulmonary Embolism - mortality; Refurbishment; Reproductive health; Sepsis; Sepsis - etiology; Sepsis - mortality; Strategic planning; Strategic planning (Business); Surveillance; Transfusion; Uterus; Womens health; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0226075

Despite the adoption of Maternal and Perinatal Death Surveillance and Response (MPDSR) by Nigeria's Federal Ministry of Health to track and rectify the causes of maternal mortality, very limited documentation exists on experiences with the method and its outcomes at institutional and policy levels. The objective of this study was to identify through the MPDSR process, the medical causes and contributory factors of maternal mortality, and to elucidate the policy response that took place after the dissemination of the results. The study was conducted at the Central Hospital, Benin between October 1, 2017, and May 31, 2019. We first developed a strategic plan with the objective to reduce maternal mortality by 50% in the hospital in two years. An MPDSR committee was established and the members and all staff of the Maternity Department of the hospital were trained to use the nationally approved protocol. All consecutive cases of maternal deaths in the hospital were then reviewed using the MPDSR protocol. The results were submitted to the hospital Management and its supporting agencies for administrative action to correct the identified deficiencies. There were 18 maternal deaths in the hospital during the period, and 4,557 deliveries giving a maternal mortality ratio (MMR) of 395/100,000 deliveries. This amounted to a seven-fold reduction in MMR in the hospital at the onset of the project. The main medical causes identified were obstetric hemorrhage (n = 10), pulmonary embolism (n = 2), ruptured uterus (n = 2), eclampsia (n = 1), anemic heart failure (n = 1) and post-partum sepsis (n = 2). Several facility-based and patient contributory factors were identified such as lack of blood in the hospital and late reporting with severe obstetric complication among others. Response to the recommendations from the committee include increased commitment of hospital managers to immediately rectify the attributable causes of deaths, the establishment of a couples health education program, mobilization and sensitization of staff to handle pregnant women with great sensitivity, promptness and care, the refurbishing of an intensive care unit, and the increased availability of blood for transfusion through the intensification of blood donation drive in the hospital. We conclude that the results of MPDSR, when acted upon by hospital managers and policymakers can lead to an improvement in quality of care and a consequent decline in maternal mortality ratio in referral hospitals.