title: Assessment of the risk approach in the reduction of maternal mortality in north-central Nigeria.
abstract: BACKGROUND
  Risk screening during antenatal care has been traditionally believed to be impactful in maternal and newborn mortality reduction. Relative risk of death is commonly used as a guide for clinical practice. To inform good decision-making in planning maternal mortality reduction programs, the number of maternal deaths as well as the relative risk should be considered. The objective of this study was to predict the risk of death using the age distribution, parity and booking status of women who had maternal deaths in the four facilities during the 6 months study period.
  
  
  METHODS
  This was a 6 month prospective, cross sectional study of maternal deaths from 1(st) January, 2011 to 30(th) June, 2011 using the emergency obstetric care register in four health facilities in Makurdi North-central Nigeria.
  
  
  RESULTS
  Women aged 20-34 years accounted for 82% of deliveries and contributed 74% of maternal deaths. Primigravidae and grand multigravidae made up 569 (41%) of all deliveries but contributed 58% of all maternal deaths. Most (53%) maternal deaths occurred in booked women. This is contrary to conventional knowledge where primigravidae, grand multipara, women who are unbooked, less than 20 years, 35 years and above, were expected to have high risk of maternal mortality.
  
  
  CONCLUSIONS
  This study shows that most maternal deaths occurred in the standard low risk women. Therefore age, parity and booking status do not predict maternal mortality accurately in this environment. All pregnant women should therefore be viewed as being at risk of maternal death all through pregnancy, delivery and puerperium.
authors.affiliation: Federal Medical Centre, Makurdi, Benue State, Nigeria.
authors.forename: S
authors.initials: S
authors.lastname: Ochejele
authors.affiliation: Federal Medical Centre, Makurdi, Benue State, Nigeria.
authors.forename: Eb
authors.initials: E
authors.lastname: Ijiko
authors.affiliation: Federal Medical Centre, Makurdi, Benue State, Nigeria.
authors.forename: Ma
authors.initials: M
authors.lastname: Obulu
keywords: Maternal mortality; Nigeria; Risk approach