Advancing Survival in Nigeria: A Pre-post Evaluation of an Integrated Maternal and Neonatal Health Program - PubMed (original) (raw)

Advancing Survival in Nigeria: A Pre-post Evaluation of an Integrated Maternal and Neonatal Health Program

Nancy L Sloan et al. Matern Child Health J. 2018 Jul.

Abstract

Introduction Nigeria contributes more obstetric, postpartum and neonatal deaths and stillbirths globally than any other country. The Clinton Health Access Initiative in partnership with the Nigerian Federal Ministry of Health and the state Governments of Kano, Katsina, and Kaduna implemented an integrated Maternal and Neonatal Health program from July 2014. Up to 90% women deliver at home in Northern Nigeria, where maternal mortality ratio and neonatal mortality rates (MMR and NMR) are high and severe challenges to improving survival exist. Methods Community-based leaders ("key informants") reported monthly vital events. Pre-post comparisons of later (months 16-18) with conservative baseline (months 7-9) rates were used to assess change in MMR, NMR, perinatal mortality (PMR) and stillbirth. Two-tailed cross-tabulations and unadjusted and adjusted logistic regression analyses were conducted. Results Data on 147,455 births (144,641 livebirths and 4275 stillbirths) were analyzed. At endline (months 16-18), MMR declined 37% (OR 0.629, 95% CI 0.490-0.806, p ≤ 0.0003) vs. baseline 440/100,000 births (months 7-9). NMR declined 43% (OR 0.574, 95% CI 0.503-0.655, p < 0.0001 vs. baseline 15.2/1000 livebirths. Stillbirth rates declined 15% (OR 0.850, 95% CI 0.768-0.941, p = 0.0018) vs. baseline 21.1/1000 births. PMR declined 27% (OR 0.733, 95% CI 0.676-0.795, p < 0.0001) vs. baseline 36.0/1000 births. Adjusted results were similar. Discussion The findings are similar to the Cochrane Review effects of community-based interventions and indicate large survival improvements compared to much slower global and flat national trends. Key informant data have limitations, however, their limitations would have little effect on the results magnitude or significance.

Keywords: Maternal mortality ratio; Neonatal mortality rate; Nigeria; Perinatal mortality rate; Stillbirth rate.

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Conflict of interest statement

Dr. Sloan was engaged to conduct an independent evaluation of the MNH Nigeria program. Authors Storey, Fasawe, Yakubu, Wiwa and McCrystal are CHAI staff. Lene Jeanette Lothe and Mari Grepstad are Norad staff. All authors have interpreted the study findings with objectivity and report no conflicts of interest.

Figures

Fig. 1

Fig. 1

The three state MNH integrated approach to ensure a continuum of care from the community through to the hospital level

Fig. 2

Fig. 2

Implementation of the integrated three state MNH integrated approach establishing and reinforcing linkages across levels of care

Fig. 3

Fig. 3

Flow diagram and process used to merge and analyze event registry files

Fig. 4

Fig. 4

Maternal mortality ratios per 100,000 births by quarter

Fig. 5

Fig. 5

Neonatal mortality (Per 1000 livebirths), stillbirth (Per 1000 births) and perinatal (Per 1000 births) mortality rates by quarter

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