Stefanie Adams.
University Ulm, Germany
Title: Maternal and neonatal Mortality and Morbidity in 20 Hospitals in Nigeria – Reduction of MMR by Quality assurance in Obstetrics
Biography
Biography: Stefanie Adams.
Abstract
Objective: Introduction of Quality Assurance in Obstetrics including continuous collection of obstetrical data in rural hospitals is aimed at reducing maternal and neonatal morbidity and mortality. Method: Since January 2008 data on maternal and neonatal mortality and morbidity were aggregated on a monthly basis for ten hospitals in Kano and Kaduna State in northern Nigeria. In 2011 the project was extended to five hospitals in Abuja and in 2013 in Ondo State. Audits were used to assess these hospitals in terms of equipment status and hygiene conditions and condensed into a rating score. All data were centrally collated in tables and graphs not revealing individual hospital‘s identity by the Institute of Quality Assurance in Kano State. Results: 151,738 deliveries were analysed between 2008 and 2014. Kano and Kaduna State initially showed a continuous fall in MMR from 2008 to 2011, followed by a gradual increase in 2013 and finally a decrease in 2014. Hospitals in FCT Abuja and Ondo State showed lower MMR. Overall MMR was roughly related to the total number of deliveries increasing in hospitals with fewer deliveries. Conclusion: Obstetric quality assurance involves continuous processing, analysis and discussion of MMR and FMR administered by the Institute of Quality Assurance. Seven years of data collection in 4 Nigerian states showed that a comprehensive quality assurance for improving maternal and child health in low-income countries extends well beyond the focus of maternal and fetal mortality. In order to achieve persistent improvement of maternal and child health, improvements in infrastructure and hygiene, continuous improvements in obstetrical practise, regular training of health care professionals, conduction of community dialogues and regular discussion of the results at bi-annual review meetings is of essential importance. This embracing approach which proves successful in Nigeria may also be seen as a model for reduction of unacceptable high MMR and FMR in other low income countries.