Socio-cultural factors in maternal morbidity and mortality: a study of a semi-urban community in southern Nigeria.

STUDY OBJECTIVE: To understand community based or socio-cultural factors that determine maternal morbidity and mortality in a semi-urban setting. DESIGN: The study is an exploratory multidisciplinary operations research and the instruments were focus groups and interviews. SETTING: Ekpoma, a semi-urban community with a population of 70,000 in central part of Edo state in southern Nigeria. PARTICIPANTS: Thirteen groups of women, two groups of men, and two groups of traditional birth attendants. RESULTS: There is a fairly good knowledge of haemorrhage but this is circumscibed by attitudes, practices, and situations that keep women away from or delay the decision to seek modern obstetric care. CONCLUSIONS: For a fuller understanding of maternal morbidity and mortality, it is important to consider factors outside the hospital and formal medical practice. Furthermore, a change of existing knowledge, attitudes, practices, and situations can be enhanced through modelling on them.

Causes of maternal mortality in a semi-urban Nigerian setting.

Focus group discussions with people in Ekpoma, Nigeria, revealed them to be quite knowledgeable about haemorrhage in pregnancy and delivery. However, because of their inability to recognize early warning signs they continued traditional treatment even when clear evidence of danger existed. Furthermore, they tended not to seek help in clinics and hospitals because of sociocultural conditioning and a negative perception of the quality of care available. There were shortages of materials and adequately trained and committed personnel in the modern health institutions serving the community. An outline is given of the kinds of intervention needed in order to overcome these deficiencies.

PIP: Fifteen focus groups were conducted among a sample of persons, who were from the semi-urban community of Ekpoma, Nigeria. One focus group involved only traditional birth attendants. The aim was to examine the factors responsible for delaying or preventing effective care and treatment for women with pregnancy-related complications. In general, this population had a degree of knowledge about the dangers of hemorrhage during pregnancy and delivery and about the risk of mortality. However, knowledge was lacking about the warning signs for hemorrhage and the potential danger for bleeding after delivery. Women did not know about when to seek help from modern obstetric services. Some practices such as food taboos put pregnant women at risk. Some believed that supernatural forces caused some forms of hemorrhage in pregnancy and delivery. Use of modern facilities for treatment of hemorrhage was constrained by continued use of traditional birth attendants, transportation difficulties, and negative perceptions of quality of care in modern obstetric institutions. There was a lack of coordination between different levels of care. The study area contained 14 modern health institutions. The two state controlled hospitals at Iruekpen and Ubiaja were too far from where patients lived, and transportation was expensive and inadequate. Obstetric staffing was inadequate at Iruekpen hospital and the primary centers. Only the zonal tertiary hospital at Ubiaja had an obstetrician on staff for handling emergencies. Supplies were inadequate at all institutions. The private health institutions were evenly distributed throughout the community, but the quality of equipment and staff was difficult to evaluate. It was assumed that quality of care was the same at the secondary referral hospital. Women need to be educated about the warning signs of hemorrhage during pregnancy and delivery and the importance of seeking care early. Obstetric institutions must improve equipment, drug availability, and sufficiency of supplies. Staff need to receive training including training that enhances awareness about the importance of a friendly attitude toward patients. Evaluations are needed in order to assure improvement in care. Village chiefs and other opinion leaders should be informed about the changes.