Avoidable maternal mortality in Enugu, Nigeria.
The aim of this study was to identify avoidable factors in maternal mortality in Enugu, Nigeria. A hospital-based descriptive study. The case records of maternal deaths in the Obstetric Unit of the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria, between January 2003 and December 2005, were studied to identify maternal characteristics and avoidable factors for maternal mortality. Booked women were those who received formal prenatal care in a medical facility. Abortion-related deaths were not included in the study. There were 49 maternal deaths, 2131 deliveries and 2044 live births during the study period, giving a maternal mortality ratio of 2397.3 maternal deaths per 100,000 live births. The average age of the women was 29.8 years. Twelve women (25.5%) booked in the UNTH, 23 (48.9%) booked elsewhere and 12 (25.5%) were unbooked. Ten women (21.3%) were nulliparous, 15 (31.9%) were Para 1-2, 17 (36.2%) were Para 3-4 and five (10.6%) were Para 5 or above. Twenty-one women (44.7%) first sought medical attention at a private medical clinic, six (12.8%) at the general/mission hospital, five (10.6%) at maternity/health centres, one (2.1%) from a traditional birth attendant and 14 (29.8%) at the UNTH. Fourteen women (39.8%) died within 24h of admission, 12 (25.5%) between 24 and 48h, seven (14.9%) between 48 and 96h and 14 (29.8%) after 96h. Two women (4.3%) delivered at home, eight (17.0%) in private medical clinics, 23 (48.9%) in the UNTH and 14 (29.8%) died undelivered. Major avoidable factors were substandard care (27.7%), delay in seeking care (19.1%), financial constraints (8.4%), delay in recognizing a problem (6.4%), lack of blood (4.3%), lack of drugs (2.1%) and industrial strike action by health workers (2.1%). No major avoidable factor was identified in 14 women (29.8%). Avoidable factors are still prevalent in maternal deaths in Nigeria.