ABSTRACT
Lagos State, Nigeria, Africa's largest city with an estimaed 21 million population, continues to face challenges in its attempts to reduce maternal mortality (555 deaths per 100,000 live births) and deaths of children under five (59 per 1,000 live births). These deaths are more common among women and children living in poverty, many of whom rarely utilize health services. This paper describes the trend in the use of maternal, neonatal and child health (MNCH) services in the State in the past decade and shows barriers to the use of the services. Significant improvement in the coverage of the services were not observed. We identified the following five types of barriers to the use of MNCH services: i) financial barriers, ii) physical barriers, iii) cognitive barriers, iv) organizational barriers, and v) psychological and socio-cultural barriers. To address these interrelated barriers, the Lagos State Ministry of Health should prioritize regular outreach health services including health promotion, and realize the current initiative for massive recruitment of health personnel and appropriate deployment of them.
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.
