title: Investigating maternal mortality in a public teaching hospital, abakaliki, ebonyi state, Nigeria.
abstract: BACKGROUND
  Maternal mortality in sub-Saharan Africa has remained high and this is a reflection of the poor quality of maternal services.
  
  
  OBJECTIVE
  To determine the causes, trends, and level of maternal mortality rate in Abakaliki, Ebonyi.
  
  
  METHODS
  This was a review of the records of all maternal deaths related to pregnancy over a ten-year period, that is, January 1999 to December 2008. Relevant information on number of deaths, booking status, age, parity, educational level of women, mode of delivery, and causes of death were extracted and analyzed.
  
  
  RESULTS
  During the study period, there were 12,587 deliveries and 171 maternal deaths. The maternal mortality ratio (MMR) was 1,359 per 100,000 live births. The trend over the period was lowest in 2008 and highest in 1999 with an MMR of 757 per 100,000 live births and 4,000 per 100,000 live births, respectively. There was a progressive decline in the MMR over the period of study except in the years 2003 and 2006, when the ratio spiked a little, giving an MMR of 1,510 per 100,000 live births and 1,290 per 100,000 live births, respectively. The progressive decline in maternal mortality corresponded with the time that free maternal services were introduced. Hemorrhage was the most important cause of maternal death, accounting for 23.0% (38/165), whereas diabetic ketoacidosis, congestive cardiac failure, and asthma in pregnancy were the least important causes of maternal deaths, each accounting for 0.6% (1/165). Majority of the maternal deaths occurred in unbooked patients (82.4% (136/165)), whereas 17.6% (29/165) of the deaths occurred in booked cases. Forty-seven (28.5% (47/165)) patients died following a cesarean section, 8.5% (14/165) died as a result of abortion complications, and 10.9% (18/165) died undelivered. Seventy-seven (46.7% (77/165)) of the maternal death patients had no formal education. Low socioeconomic status, poor educational level, and grand multiparity were some of the risk factors for maternal mortality.
  
  
  CONCLUSIONS
  There was a decline in MMR during the period of study. The free maternal health services and adequate staff recruitment, which may have contributed to the observed decline in maternal mortality, should be sustained in developing countries.
authors: Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Enugu, Nigeria.
authors: Hu
authors: H
authors: Ezegwui
authors: Rc
authors: R
authors: Onoh
authors: Lc
authors: L
authors: Ikeako
authors: A
authors: A
authors: Onyebuchi
authors: Ouj
authors: O
authors: Umeora
authors: P
authors: P
authors: Ezeonu
authors: P
authors: P
authors: Ibekwe
keywords: Causes; Maternal mortality; Nigeria; Removal of user fee
references: Int J Womens Health. 2010 Aug 10;2:249-54
references: 21151730
references: J Womens Health (Larchmt). 2010 Feb;19(2):323-7
references: 20092418
references: West Afr J Med. 2002 Jan-Mar;21(1):74-6
references: 12081352
references: J Obstet Gynaecol. 2005 Aug;25(6):569-74
references: 16234142
references: Trop Doct. 2010 Jan;40(1):13-7
references: 20008058
references: Bull World Health Organ. 2009 Jan;87(1):30-8
references: 19197402
references: Afr J Reprod Health. 2001 Aug;5(2):90-7
references: 12471917
references: Br Med Bull. 2003;67:127-35
references: 14711759
references: Eur J Obstet Gynecol Reprod Biol. 2003 Aug 15;109(2):153-9
references: 12860333
references: Obstet Gynecol. 1997 Jul;90(1):78-82
references: 9207818
references: Lancet. 2006 Sep 30;368(9542):1189-200
references: 17011946
references: Cochrane Database Syst Rev. 2009 Jul 08;(3):CD000007
references: 19588315
references: BMC Pregnancy Childbirth. 2009 Sep 15;9:43
references: 19754941