title: MATERNAL MORTALITY AUDIT IN A TERTIARY HEALTH INSTITUTION IN NIGERIA: LESSONS FROM DIRECT CAUSES AND ITS DRIVERS.
abstract: BACKGROUND
  Nigeria has the second highest number of maternal deaths in the world.The study aimed at determining the causes of and non-obstetric contributors to maternal mortality at a tertiary referral hospital.
  
  
  METHODS
  It was a prospective audit of all consecutive maternal deaths in the hospital over a three-year period. Immediately after the death, information wvas retrieved via a data collection form. Data were analysed with SPSS-20.
  
  
  RESULTS
  Seventy deaths were examined over the study period. Maternal mortality ratio was 1,265/100,000 live births. The annual ratio decreased steadily over the study period. Most of the deaths were of multiparous women who had not received any antenatal care, and were mostly postpartum,within 24 hours of delivery. Most of them were critically ill on admission to the hospital. Major causes of death were haemorrhage (36%), sepsis (17%) and hypertensive disorders (16%).Delays were identified in 34.3% of cases; most (70.1%) were Phase III delays.
  
  
  CONCLUSIONS
  Direct causes of maternal mortality are consistent with those found in literature. Steps which the centre has been taken to counter direct and non-obstetric causes are discussed. Possible strategies to improve health financing and referral system are proffered.
authors.forename: F A
authors.initials: FA
authors.lastname: Bello
authors.forename: O A
authors.initials: OA
authors.lastname: Adesina
authors.forename: I O
authors.initials: IO
authors.lastname: Morhason-Bello
authors.forename: A O
authors.initials: AO
authors.lastname: Adekunle
mesh_terms: D000328:Adult; D002423:Cause of Death / Q000639:trends; D036861:Delivery, Obstetric / Q000401:mortality*; D005260:Female; D006801:Humans; D008428:Maternal Mortality / Q000639:trends*; D009549:Nigeria / Q000453:epidemiology; D006473:Postpartum Hemorrhage / Q000401:mortality; D011225:Pre-Eclampsia / Q000401:mortality; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data; D011446:Prospective Studies; D011645:Puerperal Infection / Q000401:mortality; D018805:Sepsis / Q000401:mortality; D062606:Tertiary Care Centers