ANALYSIS ON DETERMINANTS OF MATERNAL MORTALITY IN GENERAL HOSPITAL
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BACKGROUND OF STUDY
The ever-increasing focus on enhancing women's reproductive health on a worldwide scale has resulted in an increased need for research, particularly in the field of maternal health. Since the late 1980s, the issue of maternal health, which is defined as the physical well-being of a woman during pregnancy, childbirth, and the postpartum period. According to Audu, Tukai,& Bukar (2017), opined that mortality has been a primary focus of a number of international summits and conferences, culminating in the Millennium Summit in the year 2000. It should come as no surprise that the rate of maternal mortality is an essential component of maternal health. The World Health Organization has defined maternal mortality in the international statistical classification of diseases and related health problems (ICD) as the death of a woman while she is pregnant or within 42 days of a termination of a pregnancy, regardless of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but excluding accidental and incidental causes. This definition does not include deaths that occur as a result of unintentional and incidental causes (Enyi & Nworgu 2016). Within the context of this overarching theoretical structure, the Millennium Development Goal Target 5A asks for a decrease in the ratio of maternal mortality by three-quarters by the year 2015. However, if things continue as they are, the world will fail to meet the target for the reduction of maternal mortality. This is due to the fact that the data that has been collected up to this point suggests that in order to meet the target, the global Maternal Mortality Rate (MMR) would have needed to be reduced by an average of 5.5% each year between the years 1990 and 2015.
Nigerians make up just two percent of the world's population, yet the country is responsible for more than ten percent of all maternal fatalities and ranks only second internationally, behind India (Okonofua, 2007; Abdul'Aziz, 2008). The maternal mortality rate in Nigeria is 59,000 per year, which indicates that the country has a low maternal health status. These deaths are caused by pregnancy-related issues. It has been determined that this is the primary factor or cause of mortality among women of reproductive age in Nigeria (Idris, 2010).
Glew & Uguru (2015) noted that the cause of maternal mortality is an outcome of the nexus interaction of a variety of factors, namely: the distant factors (socio-economic, cultural), which include; occupation, income level, and illiteracy act through the proximate or intermediate factors (health and reproductive behaviour, access to health services), and in turn influence outcome. Although opinions differ on the determinants of maternal mortality, Herfon (2006) noted that the cause of maternal mortality is an outcome of the nex (pregnancy complication mortality). Idris (2010) found that traditional practises, norms, beliefs, education, and religion are all sociology-cultural elements that contribute to maternal mortality. Other sociology-cultural contributors to maternal mortality include traditional practices.
There have been a number of measures undertaken in the past with the intention of lowering the maternal mortality rate in Nigeria; however, such efforts, particularly those made by the Federal and state governments, have typically not been very effective in obtaining the outcomes that were wanted. However, just recently, several state governments have begun to record some encouraging outcomes as a result of various policy efforts that they have undertaken. In 2007, the house of assembly of Cross River state voted in favour of a measure that would make it mandatory for all pregnant women to get free maternal health services (Shiffman and Okonofua, 2007). The state commissioner of health, who is both an obstetrician and gynaecologist, was instrumental in the creation and implementation of this policy, playing a key role in both processes. Even with the implementation of numerous interventions such as antenatal care, labour and delivery care, postnatal care, family planning, prevention and management of unsafe abortions, and health education, the maternal mortality ratio (MMR) has not been encouraging over the years, and improvements are moving at such a snail's pace. The introduction of the safe motherhood programme in 1995, the midwife service scheme (MSS) in 2011, and the subsidy reinvestment programme (SURE-P) in 2012 all contributed to the introduction of these
It was the previous state commissioner of health, together with other prominent obstetricians and gynaecologists, who were instrumental in the formation of this favourable atmosphere for maternal health. As a result, pregnant women in Cross River may now take use of free medical treatments at the General hospital in Calabar. This is one of the steps that the state government has put in place as part of an effort to lower the maternal mortality rate in the state (Media Global,2010). However, other states like Jigawa have provided funds for the improvement of obstetric care facilities in hospitals, the recruitment of obstetricians and gynaecologists, and the provision of ambulances at the local level in order to transport pregnant women who are experiencing delivery complications to health facilities. These are all measures that are being taken as part of an effort to reduce the rate of maternal mortality. These measures had the support of the individual who had previously served as executive secretary for primary health care and afterwards became state commissioner for health.
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