CHAPTER ONE

Introduction

Background to the study

           Maternal mortality is a serious public health problem especially in African countries including Nigeria and Birnin Kebbi in particular. Maternal mortality rates in many countries have remained essentially a public health challenge. Worldwide, over 500,000 women of childbearing age die of complications related to pregnancy and childbirth each year. Over 99 per cent of these deaths occur in developing countries such as Nigeria (World Health Organization-WHO 2007). At least 150,000 African women die of pregnancy related complications each year and the number of maternal deaths continues to rise each year in many countries (WHO 2001). Maternal mortality has generated great concern among United Nations (UN) and International Agencies as well as National Governments in 3^rd world countries like Nigeria (Onuzulike, 2006).

          WHO estimates that at least 600,000 women worldwide die every year from pregnancy related causes, though the rate is difficult to calculate with accuracy (Clark, 2002). Partnership for Transforming Health Systems-PATHS(2005), stated that everyday, at least 1,450 women worldwide die from  complications of pregnancy and childbirth, that is a minimum of 600,000 women dying every year .The majority of these deaths (almost 99%) occur in  Asia and Sub-Sahara Africa and less than one per cent in the developed world. PATHS further stated that life time risk of maternal death is1 in75, indeveloped country like America  it is 1 in 2,500, while in West Africa it is1 in13  (Khalid 2006). This alarming situation of the maternal deaths in the world may not exclude Nigeria.

Nigeria’s maternal mortality rate continues at unacceptably high rate. Royston and Armstrong (1989), reported that maternal mortality ratio in Nigeria is800 in100,000 live births. Audu (2010) estimated Nigeria maternal mortality ratio at 1,500 per 100,000 live births. With this figure, Nigeria accounts for 10 per cent of the world’s maternal deaths. According to State Economic Empowerment and Development Strategy-Seeds (2004), in Enugu State, the maternal mortality rate for the South East zone was 286 per 100,000 live births, North West 1549 per 100,000 live births in the year 2000. Maternal mortality rates are twice as high as in rural setting as they are in urban settings. It has been estimated that 1:18 women of childbearing age in Nigeria face a life time risk of dying from pregnancy related causes compared to 1:2400 in Europe, 1:5100 in U.K and 1:7,700 in Canada (PATHS, 2005). From record, it has been shown that Nigeria is one of the countries with highest maternal mortality ratios in the world.

           Maternal death has been defined as the death of a woman while pregnant or within 42 days of delivery, miscarriage or termination of pregnancy, from any cause related to or aggravated by pregnancy or its management, but not from accidental or incidental causes (Lewis & Drife, 2001).The complications of pregnancy may be experienced during pregnancy or delivery itself or may occur up to 42 days following childbirth. Maternal mortality in the context of the present study is defined as the death of a woman during pregnancy, in labour or first six weeks after delivery or termination of pregnancy from causes directly due to pregnancy or to conditions aggravated by pregnancy.

           The Nigerian Demographic and Health Survey-NDHS (2008) posited that Nigeria ranks second globally (next to India) in number of maternal deaths. The data also suggest that the ratios are different in the six geopolitical zones of the country. A population-based study indicated that maternal mortality ratio is worst in Northern Nigeria; an average staggering figure of 2,420 (ranging between 1,373 and 4,477) per 100,000 live births was recorded in Kano State (Chama, 2004). In the North Eastern region, Borno State has an estimated maternal mortality ratio of 1,549 per live births, while 1,732 per 100,000 live births was reported from Bauch State in the same North East region (Glew & Uguru, 2005).These ratios are the worst in the world. In Plateau State, maternal mortality ratio of 740 per 100,000 live births was reported (Uja, Aisien, Mutihir & Vander 2005). A ratio of 1700 per 100,000 live births was reported from Lagos, and that of Sagamu was 1,930 per 100,000 live births, all in South Western Nigeria (Agboghoroma & Emuveyam. 1997). Enugu State as one of the states in Nigeria is not left out of this ugly situation.

      Kebbi State, one of the states with the highest rates of new-born mortality (under the age of five) in the country, has been rated as one of the states with the highest rates in the world.

The state records 32,514 deaths of children under the age of 5 annually. Following this, the state has been rated fourth by the United Nations’ International Education Fund (UNICEF) on the index of places with the highest infant mortality rates.

The Chief of Health ,UNICEF, Dr.Sanjana Bhardwaj stated that “The state is one of the highest in Nigeria, with a record of 32,514 children under the age of 5 dying yearly,” she said. She said, considering the steady drop in Nigeria’s mortality rate, the issue of Kebbi was worrisome and affects the country’s mortality rate.Graham (2001) grouped maternal deaths into direct and indirect obstetric deaths Direct obstetric deaths are deaths resulting from obstetric complications during pregnancy, labour or puerperium, or from interventions, omissions or incorrect treatments or from a chain of events resulting from eclampsia, postpartum haemorrhage or sepsis. Indirect obstetric deaths are those deaths resulting from a previously existing disease or a disease that developed during the pregnancy. Examples are anemia, HIV and AIDS, malaria or heart disease. These deaths accruing from pregnancy related complications have some causes.