Trends of Maternal Mortality in Damaturu, Yobe State, Nigeria

Yobe state is one of the core state in the north east geopolitical zone of Nigeria, a zone that is characterized by second highest maternal mortality in the country, after north-west. This study aimed to examine trends of maternal mortality in Yobe State, a case study of General Sani Abatcha Specialist Hospital Damaturu. One consultant gynecologist, three midwives, and forty women of child bearing age participated in the study. An Ex-post factor research design was adopted using maternity attendance record and structured interview. The data was analyzed using descriptive statistic and presented on graphs/tables. It was identified that maternal mortality decline steadily from 2010 to 2013, but there was relative increase in 2014, both of which were associated with ante-natal care coverage and hospital deliveries. The study further identified ways of improving maternal health using provision of adequate trained health personal, and provision of essential facilities in hospitals among others. Based on these findings, it was concluded that maternal mortality decreases in yobe over the years, but the figure still remain unacceptably high. It is thus recommended that Government, Non – governmental organization and philanthropist to be more committed in providing modern equipments in hospitals and primary health care centers.


INTRODUCTION
Achieving the Millennium Development Goals (MDGs) of reducing maternal mortality ratio by three quarter between 1990 and 2015, is far from target, particularly in Sub-Saharan Africa countries, where access to basic obstetric services is very poor (Hofman and  WHO 2014). It has been a challenge to observe the exact progress made over the years, due to lack of reliable and accurate maternal mortality data (WHO and UNICEF, 2014).
Globally, there was an estimated 289,000 maternal deaths in 2013 with a decline of 45 percent from 1990 (WHO 2014). The global Maternal Mortality Rate (MMR) in 2013 was 210 maternal deaths per 100,000 live births in comparison to 380 maternal deaths per 100,000 live births in 1990. However, hidden within these figures are enormous inequalities for instance; the MMR in developing regions was 14 times higher than developed regions (WHO, UNICEF, UNFPA, World Bank and UN, 2014). Every region has advanced to a certain level, although level of maternal mortality remains unacceptable high in sub-Saharan Africa despite the little advances made in some of the countries. Almost all maternal deaths can be preventable with reasonable investment, considering the huge disparities found between the richest and poorest countries, for instance, the lifetime risk of maternal death in industrialized countries is 1 in 400 versus 1 in 51 in countries classified as "least developed," (UNICEF, 2013).
Nigeria has 630 maternal deaths in 2010 as compared to Kenya 360, South Africa 300, United State 21, United Kingdom 12 and Belgium 8, all these deaths per 100,000 live births. The profile of maternal mortality trends in Nigeria as published by the United Nations based on the estimates for 1990-2013 was gradually reducing. The report "Trends in Maternal Mortality: 1990-2013" presents internationally comparable maternal mortality ratio (MMR) estimates, whereby Nigeria is said to have declined in maternal mortality by 52% between 1990 and 2013, (Mamaye, 2015;Ager et al., 2015;WHO, 2014). Despite these progress, the country accounts for 13% global maternal mortality rates with an estimated 36,000 women dying in pregnancy or child birth each year, out of which 5500 of these deaths are among teenage mothers. These figures were reflected in Nigerian Demographic & Health Survey (2013), confidential and purely academic. The interaction helps in finding silent issues. The interview took two consecutive weeks. The researcher used pen and paper in writing the responses of the respondents. The introductory letter helped in collecting data on maternity record in General Sani Abatcha Specialist Hospital Damaturu.
Ethical Consideration -The fact this is a primary study, a number of ethical considerations were observed before conduct of the study. Firstly, a formal ethical approval was obtained from University of Maiduguri research and ethical committee after filling the appropriate ethical forms. Similarly, permission was sought from the Chief Medical Director (CMD) of General Sani Abatcha Specialist Hospital Damaturu to conduct the study in the institution. After gaining approval by the CMD, another permission was obtained from the Head of the Maternity Unit, to conduct the study in the Unity after explaining in detail the purpose of the study. Finally, only participants who voluntarily agreed to participate in the study were included. The participants (Doctor, Midwives and Women) were given a consent form that they read and sign before they were enrolled for the study. Confidentiality and anonymity of information was ensured throughout the study.

RESULTS
The graph is used to present the data obtained from General Sani Abatcha Specialist Hospital Damaturu (GSASH) Damaturu i.e. the maternity attendance record from year 2010 to 2014. This graph is used because it clearly project the ante -natal care attendance, Hospital delivery and maternal death. The information volunteered from health workers and women was used in discussing the graphs.    (2015), who stated that globally there is declined in maternal death and Nigeria is not exempted. However, the year 2014 as indicated on the graph shows a slightly increase in maternal death above the previous three years. The situation in the prevalence rate can be described as low because out of 3,978 deliveries in the year 2013, only 242 lost their lives. This is significant because the nation itself (Nigeria) has made significant progress in reducing the maternal mortality ratio. On the other hand, the finding of the study also shows a steady increase in the number of women attending antenatal care services in the hospital over the four year period. This is to say that decrease in the mortality rate coincide with increase in antenatal care coverage; hence a number of the predisposing factors to maternal deaths were taken care of during the ante-natal services. This is supported by the findings of Hofman and Mohammed (2014) in selected northern Nigerian states, which shown a maternal mortality decline in the study areas with corresponding increase in antenatal care coverage. However, finding of this study indicated a dramatic decrease in the number of hospital deliveries, particularly in the year 2014. This was indicated to be associated with the insurgency and civil unrest affecting the state during that time, thus a number of women migrated out of the state.
The finding of this study further shows from the opinion of the health personals (consultant gynecologist and midwives), that availability of drugs

CONCLUSION
Based on the findings of this study, it was concluded that Yobe state of Nigeria is still far from reaching its target of reducing maternal mortalities in the state, despite the advances and progress made over the years. Therefore, Government, Non -governmental organizations and philanthropists should help in providing modern equipments, recruitment of more staff and enhancing primary health care services.

ACKNOWLEGEMENT
The researcher sincerely the Chief Medical Director as well as the head of maternity unit of General Sani Abatcha Specialist Hospital Damaturu for cooperation and granting permission to conduct this study. Our appreciation also goes to the respondents, who voluntarily participated in this study.