title: Impact assessment of a maternal health project in a megacity, Nigeria: toward a future with more demand for maternal health services.
abstract: To improve the quantity and quality of maternal health services in Lagos State, Nigeria having a maternal mortality ratio of 555 per 100 000 live births, a four-year project was implemented since February 2010. The major activity of the project was training for both the service supply and demand sides. This study aimed to examine the impact of the project on coverages and quality of the services in target areas, and guide statewide policies. The Cochran-Armitage test for trend was applied to understand trends in the service coverages during 2009-2013. The same test was performed to analyse trends in the proportions of perineal conditions (i.e. intact or tear) and to evaluate variations in midwives' snkill during 2011-2013. The paired t-test was used to analyse changes in midwives' knowledge. The project interventions contributed to a significant increase in the overall service coverages, including improvements in midwifery knowledge and possibly in their skills. However, the service coverage was still limited as of the termination of the project. To instal the interventions and maximise the effect of them state-wide, it is recommended to undertake five tasks: (i) establishment of public primary health centres offering 24-h maternal health services; (ii) redeployment and recruitment of public health personnel; (iii) expansion of midwifery trainings and continuous education by the local trainers; (iv) review of grass-roots level activities; and (v) scrutiny of barriers to maternal health services. Copyright © 2016 John Wiley & Sons, Ltd.
authors.affiliation: JICA Project for Strengthening Pro-poor Community Health Services in Lagos State, Lagos, Nigeria.
authors.forename: Sadatoshi
authors.initials: S
authors.lastname: Matsuoka
authors.affiliation: JICA Project for Strengthening Pro-poor Community Health Services in Lagos State, Lagos, Nigeria.
authors.forename: Sumiko
authors.initials: S
authors.lastname: Koga
authors.affiliation: Hyogo University of Health Sciences, School of Nursing, Department of Family Health Nursing, Hyogo, Japan.
authors.forename: Emiko
authors.initials: E
authors.lastname: Suzui
authors.affiliation: The Japanese Red Cross College of Nursing, School of Nursing, Tokyo, Japan.
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Tsukada
authors.affiliation: Department of Children's and Women's Health, Area of Nursing Science, Division of Health Sciences, Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: Kazutomo
authors.initials: K
authors.lastname: Ohashi
authors.affiliation: Lagos State Ministry of Health, Department of Family Health and Nutrition, Lagos, Nigeria.
authors.forename: Taiwo
authors.initials: T
authors.lastname: Johnson
mesh_terms: D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D005260:Female; D005544:Forecasting; D062489:Health Impact Assessment; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D000068097:Maternal Health / Q000639:trends; D008427:Maternal Health Services / Q000458:organization & administration* / Q000592:standards / Q000639:trends; D009549:Nigeria; D011247:Pregnancy; D011787:Quality of Health Care / Q000458:organization & administration; D019037:Urban Health Services / Q000458:organization & administration* / Q000592:standards / Q000639:trends
keywords: Nigeria; demand creation; impact assessment; maternal health; midwifery care