CHAPTER ONE

1.1 Background of Study

The world health organization (W.H.O,1993) defined maternal mortality as the

death of a woman while pregnant or within forty-two (42) days after termination of

pregnancy, from any cause related to or aggravated by the pregnancy or its

management but not from accidental or incidental causes. Late maternal mortality

is defined as the death of woman from direct or indirect obstetric causes occurring

more than 42days but less than one year after termination of the pregnancy

(W.H.O, 1993).

The issue of maternal death emerged as a world health organization concern

through the United Nations call for "Safe motherhood" in the 1980's. Despite such

early advocacy, there appear to be little important in maternal health care delivery

in Nigeria.

The Millennium Development Goals (MDGs) target 5; which aimed to reduce the

number of women who die in pregnancy and child birth by three quarters by 2015

recommends an annual decline of 5.5% in maternal mortality ratios between 1990

and 2015 in order to achieve MDG5, unfortunately figures related by WHO,

UNICEF UNFPA and world Bank show annual decline of less than 1% (United

Nations, 1990).

1
Approximately 529,000 women die from pregnant related causes annually and

almost all (99%) of these maternal deaths occur in developing nations (including

Nigeria) (W.H.O, 2009).

Considering the devastating effect of maternal mortality on health, United Nation

aims to reduce maternal mortality rate by 75% by 2015 as contained in one of its

millennium developments goals

Maternal mortality is the vital indicator with the greatest disparity between

developed and developing countries. The figures have remained unacceptably high

in developing countries especially Nigeria.

More worrisome is the face that pregnant women die from treatable causes.

The direct observation causes of maternal mortality are attributable to pregnancy

itself and they account for approximately 80% of maternal death.

These direct causes include hemorrhage (25%), sepsis (15%), unsafe abortion

(13%), eclampsia (12%) and obstructed labour (8%). However observes have

pointed to unsafe abortion and pre-eclampsia as commonest causes of maternal

mortality in Dingyadi town, Bodinga local government of sokoto state Nigeria.

Indirect obstetric causes account for about 20% of maternal mortality and include

causes that complicate pregnancy or are aggravated by pregnancy, such as malaria,

2
anaemia and HIV/AIDS it is worthy to note that women also die because of poor

health at conception and lack of pregnancy for themselves and their babies.

Preventing maternal mortality has remained the bane of world health organization

(W.H.O) and other United Nations agencies. In February 1987 the first

international safe motherhood conference took place in Nairobi, Kenya, it set a

goal of a 50% reduction in the 1990 levels maternal mortality by 2000 and further

reduction by 75% by 2015.

Maternal mortality in resource poor nations has been attributed to the "3 delays":

delay in deciding to seek care, delay in reaching care in time and delay in receiving

adequate treatment. Preventing and reducing maternal mortality will depends so

much on effective these delays are tackle. In Dingyadi, maternal mortality is a

serious problem and little is known about it relative to infant and child mortality.

However research to identify causes, risk factors and preventive measure to take to

reduce maternal mortality are needed to help contain this problem.

1.2 Statement of the Problems

Maternal mortality is worst in northern Nigeria an average staggering figure of

2,420 (ranging between 1,373 and 4,477) per 100,000 live births was recorded in

Kano state (Kapadia Shah &Sikri , 1997). In addition, another cause of concern is

woman apathetic attitude towards their own health and its management during

3
illness. Women were found to seek treatment only when their health problem

caused great physical discomfort or when it affected their work performance

(Kapadia Shah &Sikri, 1997).

The north East zone has highest maternal mortality rate (1,549 per 100,000 live

births) which is almost ten times higher than in the South East. The ratio in the

North West is (1,549 per 100,000 live births) is ten times higher than in the South

West. The North West (1,025 per 100, 000 live births) is six times higher than in

the South West (NPC, UNICEF, 2001; citied in June 2011). The manifestation of

maternal mortality in sokoto state where however not explained.

Most Africa cultures value children highly, but few people including woman

themselves understand the risk involved in bearing children. About on a third of

the total disease burden among woman age 14-44 years in Africa is linked to health

problems arising out of pregnancy, child birth, abortion and reproductive infectious

diseases. (Aruku, 1995; Olusola, 2016). For instance Aruku(1995) observed

woman in Africa die much more frequently from the complications of pregnancy

and childbirth than woman in Europe and North America. This view has been

similarly expressed by various stakeholders in sokoto state, where cases of

maternal mortality and morbidity are high. The maternal mortality ratio of sokoto

was reported to be 10%.

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Nigeria make up 2% of the world's population, but it account for 10% of it's

maternal deaths in report by (W.H.O, 2013), Nigeria was identified having the

world's second highest number of maternal mortality with approximately (59,000)

of such deaths take place annually. Similarly, (Obadaki, 2014) observed that a

woman in Nigeria has 1 in 8 risk of dying in childbirth or from pregnancy- related

causes during her lifetime, which is higher than the overall 1in 22 risks of woman

throughout sub Saharan Africa. The risk of maternal mortality are even greaefor

certain Nigeria women such as those in the Northern region of the country, rural

women and low income women without formed education. He further opined that

early pregnancy and early child bearing which in most result from early marriage

(a custom that is prevalent in Northern Nigeria) present a much high risk of

complication during pregnancy and delivery as well as maternal mortality and

morbidity. Early child bearing and limited access to the highest attainable standard

of health, including sexual and reproductive health, causes high level of obstetric

fisula and other maternal morbidities as well as maternal mortality. The socio-

cultural determinants of high risk pregnancies have not been investigated.

Furthermore, most studies on maternal morbidity and mortality have concentrated

on other causes of maternal mortality and morbidity, ignoring high risk

pregnancies, such as early bearing, late child bearing, poor child spacing, large

number of children, and non-attendance of ante-natal care, poor nutrition and

5
poverty. According to World health organization (W.H.O, 2015) one out every 22

women in Africa dies from pregnancy-related complications. For every women

suffer from an illness or disability caused by childbearing. This means that every

year more than 150,000 Africa women die and millions of women suffer a serious

illness, because of pregnancy and childbirth (Arkutu, 1995) reported that more than

67.68% of all pregnancies in Nigeria (from 1985 - 1990) where high risk

pregnancies. The report also revealed that a total of 21% of married women in

Nigeria have an “unmet need" for family planning.

The desire to space births is highest among women within 20-29 years of age while

older women's need is to limit births.

It was therefore important to known the contributory percentage of high-risk

pregnancies to the issue of maternal mortality using Sokoto state as a reference

point.

1.3 Objectives of the Research

The major objective of the research is to identify the major causes of maternal

mortality as well as preventive measure of maternal mortality in Dingyadi from

2002-2018.

However the specific objectives ara as follows:-

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i. To determine the causes of maternal mortality in Dingyadi town, Bodinga local

government of sokoto state.

ii. To know the maternal mortality ratio as seen in Dingyadi town

iii. To determine the strategies that help to prevent maternal death among woman of

childbearing age in Dingyadi town

1.4 Significance of Study

The research is aimed to estimate maternal death overtime critically. In that it helps

in planning of sexual and reproductive health programs and advocacy. More

specifically it is very important because it provided written and theoretical

information which can be use by government for coherent, maternal welfare policy.

This research also helps to identify the causes of maternal mortality in Dingyadi

town of sokoto state. In addition, this research will serve a source of material for

students who may have the interest in the study of maternal mortality, High risk

pregnancies and related issues. Finally the result of this study can be use as basis

for developing new and refined maternal welfare programs, services and strategies,

including those aimed at the prevention of maternal mortality among women of

childbearing age.

1.5 Research Questions

This study is predicated upon the following research questions:-

i. What the causes of maternal mortality are as observed in Dingyaditown?

7
ii. What are the factors that contribute to maternal mortality in Dingyaditown?

iii. What are the strategies for reducing maternal mortality in Dingyaditown?

1.6 Scope and Limitation of the Study

The research is aimed in finding out the causes and how to reduce maternal

mortality among women of childbearing age in Dingyadi town, Bodinga local

government of sokoto state Nigeria.

The study will limited to the General hospital Bodinga, General hospital Binji, and

Primary health center as well Nasiha clinic Dingyadi due to researcher ability to go

beyond above mentioned health centers. Also due to short period time allocated to

this study will limit the research from going in to extensive study.

CHAPTER TWO

2.0 Review of the Related Literature

In this chapter; literature on:- definition of maternal mortality, causes of maternal

mortality, factors contribute to maternal mortality, strategies of reducing maternal

mortality, roles of midwife & Chew in preventing maternal mortality,

8
implications/consequences of maternal mortality and reduction of maternal

mortality as role of the midwife & Chews.

2.1 Definition

Maternal mortality is defined as the death of a woman while pregnant or within

42days of termination of pregnancy, irrespective of the pregnancy duration and site

of the pregnancy, from any cause related or aggravated by the pregnancy or its

management but not from accidental or incidental causes (W.H.O., 2012).

Maternal mortality is also defined as death of woman during pregnancy, labour

(childbirth) postpartum period (42days after birth) with the exception of accidental

or incidental causes. (Reaction, 2004)

Maternal mortality is also defined as death of woman during pregnancy, childbirth

and postpartum period either direct or indirect cause but not accidental or

incidental causes. (Through verbal communication with P.N.O Zakir GH Dogon

daji 2017).

2.2 Causes of Maternal Mortality

The causes of maternal mortality are classified into two as Direct and Indirect.

Direct causes are those related to obstetric complications of pregnancy, labour

(childbirth) and postpartum period or resulting from any treatment received.

9
Indirect causes are those relating to pre-existing by medical conditions that may be

aggravated by the physiologic demands of pregnancy.

2.3 Factors that Contribute to Maternal Mortality

1. Harmful cultural practices

2. Low/absent of contraceptives use

3. High rate of unsafe abortion among teenage

4. Pre-existing of health conditions

5. Lower access to ante-natal care

6. Poor access to mass media

7. Poor nutrition

8. Parity

9. Age of the mother

10.Availability of the health facility

11.Manpower, working hours

12.Habits, custom, superstition & others

13.Repeated pregnancies

14.Interval between two consecutive pregnancies

15.Illiteracy

And also started about three delay factors that also contribute.

10
 The three delays factors that have been recognized and documents as obstruct to

EOC.

 DELAY ONE IS THE HOME

This delay comes from home in deciding to seek of appropriate care.

a. This is the mobility of the woman and her family to decide it and when to seek

necessary care due to

b. Lack of information (inadequate knowledge) about pregnancy and labour

complication signals.

c. Lack of preparedness for child birth within the family and community.

 DELAY TWO

Is inability to access health facility in this delay the problem is in reaching the

appropriate facilities? This can be as a result of:-

a. Poor setting of health facility

b. Poor road and communication networks

c. Poor community support

d. Lack of transportation

e. Inadequate financial resources

 DELAY THREE

This is a delay between the arrival and accessing services at health facility.

The facility response in providing appropriate quality care:-

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a. Inadequate skilled attendants

b. Inadequate equipment and supplies

c. Functional preparedness to respond to the obstetric emergency e.g. CS, Power

failure etc.

d. Blood transfusion service etc.

2.4 Strategies For Reducing Maternal Mortality

The safe motherhood initiative was launched in 1987 as an inter-agency

international partnership intended to raise awareness of the scope and

consequences of poor maternal health in developing countries and provoke action

to address the issue of maternal mortality. Through these efforts, access to safe

pregnancy and childbirth is beginning to be viewed not just a public health

concern, but as a human right ( Thompson, 2011).

To reduce the maternal mortality may include the following:-

 Intervention involved behavioral changes

Reducing risk of maternal mortality frequently involves behavioral changes for

women. While such changes are often difficult to achieve, they can facilitated with

information about pregnancy, risk and heathy behavior (Harrison, 1997).

Some examples of behavioral changes in women that are discussed in this

report include the following:-

1. Not to reproduce after 35years of age

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2. Eating healthy diet

3. Limiting or avoiding alcohol

4. Stooping smoking

5. Using bed net (insecticidal treated net) to protect malaria

6. Arranging skilled birth attendant at labour and delivery

7. Recognizing and acting promptly on signs of a complicated delivery

However the strategies that improve birth outcome is monitored clinical trials may

fail when introduced into large, unmonitored populations of compliance with the

intervention is inadequate. As a result, the recommendations in this report focus on

strategies that have been proven effective in both clinical trials and in large

comparable population.

Research that identifies additional strategies for encouraging heathy behavior can

contributes, significantly to the success of heathy interventions that rely on

patient’s compliance over time. Such efforts might involve education of women

through campaigns and advice or counselling during ante-natal care. The might

also involve the development and showing of movies that initiate changes in social

behaviors.

 ANTE-NATAL CARE

Many ante-natal interventions have been shown to reduce neonatal morbidity and

mortality (Bergsjo and villar, 2010); however evidence for the effectiveness of

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 ante-natal care in reducing maternal mortality (and a lesser extent, morbidity) is

less compelling (Mc Donagh, 2004). Therefore it is widely accepted that screening

pregnant women to identify those at risk for obstetric complications is not a

replacement for skilled care during labour and delivery. More maternal deaths

occur in the much larger group of low risk women. As a result Ante-natal care will

not necessarily prevent complications from occurring (Maine and Rosenfield,

2003). This was demonstrated in a study in Gambia in the early 1980s in which a

relatively high standard of antenatal care was not able was not able to identify the

specific risk factors that could predict which women were more likely to

experience fatal complications (Greewood et 2000).

In additional where adequate medical care is available, however certain ante-natal

interventions appear to be effective in reducing adverse maternal outcomes (Carroli

et all 2017; Villar and Bergso; 2015)

More controversial are ante-natal itervention to prevent maternal anemia and other

form of nutritional supplement.

In addition to the potential for reducing specific causes of maternal morbidity and

mortality, ante-natal care can also encourage birth preparedness and the use of

skilled assistance in labour and delivery.

 DETECTION AND TREATMENT OF ASYMPTOMATIC BACTERIURIA

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 Routine screening for and treatment of asymptomatic bacteriuria has been shown

to be cost effective (Rouse, 1995). Antibiotics treatment prevent pyelonephritis and

many also reduce the risk of preterm delivery (Email, 2016).

 PREVENTION AND TREATMENT OF MALARIA

Pregnant women who live in malaria endemic areas need access to prevention

and/or treatment of malaria and associated anemia. The Cochrane library has

reviewed trials on the effectiveness of prompt treatment of malaria infection,

prophylaxis with antimalarial drugs to prevent parasitemia, and reduced exposure

to infection by using insecticide treated net (ITN) (Garner and Gulmezoglu,2000).

Prophylaxis with antimalarial drugs is clearly associated with reduce frequently of

disease, lower ante-natal parasitemia, lower malarial infection, less anemia and

fewer low birth weight infants and preterm births. A recent study in Gambia

(Okoko, 2016).

The 20th WHO expert committee report recommends on effective one-dose regime

for women in malaria- endemic areas who are in their first and second pregnancies

(skeketee, 2009).

Sulfadoxine-pyrimethamine is effective in a single dose to semi-immune women,

is not bitter, and is relatively well tolerated. In non-Africa setting where malaria

transmission is lower and plasmodium vivax multidrug resist p.falciparum co-exist,

finding an appropriate drug regimen is more difficult (steketee, 2017).

15
 Although insecticide treated net (ITN) have been shown to reduce malaria

infection and death among pregnant women and children (Binka, 1997; Lengeler

2000). And are provider free of charge to pregnant women in Nigeria (Guyatt,

2002).Their effectiveness in preventing malaria among pregnant women has been

established.

Further studies of net use requires considerable effort to maintain good adherence

and requires resources, yet has significant potential for pregnant women

 VITAMIN A SUPPLEMENTATIONS

Studies conducted in Nepal indicate that vitamin supplement may reduce morbidity

and mortality in pregnant women related to night blindness, nausea and length of

labour (Christian, 2000).

 NUTRITIONAL INTERVENTION

Widespread maternal malnutrition in developing countries has created a demand

for nutritional intervention.

Malnourished mothers are at increased risk for complications and deaths during

pregnancy and childbirth. In addition their children tend to have low birth weight,

fail to grow at a normal rate, and have higher rates of disease and early death

(Tinker, 2000). There is some concern that nutritional programs divert resources

from intervention that could be more effective in reducing maternal morbidity and

16
 mortality (Rush, 2000). While it has been noted that past improvement in nutrition

in Western Europe had little effect on maternal mortality, these women were not as

malnourished as the target population for contemporary nutritional programs

(loundon, 2000).

 SKILLED ATTENDANCE AT BIRTH

There are two important challenges to achieve a significant reduction in services

from the birth attendant at labour and delivery and access to higher level obstetric

care in the event of complications (Weil and Fernandez,1999). Meeting these

challenges requires competent health professional as well as an environment in

which that can perform effectively (Graham, 2011). This section discusses the

evidence for the use of a skilled birth attendant during child birth.

According to a comprehensive definition of the "skilled birth attendant" given

1999 joint statement by WHO, the united Nations Fund for population activities

(UNFPA), UNICEF and the world bank a skilled birth attendant is person with

midwifery skills, such as midwife, nurse or physician, who has been trained to

proficiency in the skills necessary to manage normal labour and delivery. A skilled

attendant recognizes the onset of complications, performs essential intervention,

starts treatment and supervises the referral of mother and baby for interventions

that are beyond their competence or not possible in the particular setting.

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 Therefore are major difference worldwide and among developing countries in the

proportion of deliveries that take place in health facilities there are also important

differences in the risk for maternal mortality in different setting. In some urban

areas of developing countries, most childbirth take place in a hospital attendant by

a physician or midwife. In developing countries urban areas childbirth may also

take place in home with or without medically trained attendants or in a health

clinic with a nurse or physician. Rural areas of developing countries most

childbirth take place at home, generally without skilled birth attendant and often

with poor access to medical care (W.H.O, 1999).

 OTHERS STRATEGIES FOR REDUCING MATERNAL MORTALITY

INCLUDE THE FOLLOWING:-

1. Recognition of hypertensive disease in pregnancy

2. Prevention of Anaemia

3. Prenatal counselling to recognize signs of complications

4. Prenatal counselling to use a skilled birth attendant

5. Prompt referral of complicated conditions

2.5 The roles of the midwife & chews in preventing maternal mortality

(according to lecture note of malama khadija who is a college lecturer of nursing

and midwifery sokoto, 2014).

 Home(family) ,community level

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a. Work with the TBAs, women & other community member

b. Provides information to increase understanding on nutrition, personal hygiene,

family planning recognition of danger signs, the need seek medical attention

promptly etc.

c. Influence decision making in the family & community

d. Motivate, show love & concern to everyone

e. Organized the community into group for self-help programmes e.g.

transportation committee in case of emergency.

f. Encourage empowerment of women

g. In birth preparedness, she plans with the community members in readiness for

any emergency or complicated case.

 Health Facility Level:-

a. Work in collaboration with other member of the health

b. Train, supervise other midwife & any other ladies under her

c. Develop emergency plans & delegate to the team member and when necessary

d. Plan with the community member in readiness for any emergency or

complication

e. Seek, organizes, continuity education programs to vote her knowledge and that

of other staff

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f. Uses data in maternal health to analyze, evaluate, and seek ways to improve her

services and care.

 National Level:-

a. Influence policies that affect her practices

b. Keep data in her facility and submit the same for the government to use in

identifying need.

2.6 Implications of maternal mortality (according to rauindram, 2013).

 To The Family: - women who die as a result of obstetric complication or after

delivery leave behind orphans.

a. Loss of caretaker of the house

b. Children left behind will suffer poor growth and development

c. About 66% infant left by this mother have higher risk of dying before 2years of

age.

 To The Community:-

a. Loss of leaders

b. Loss of an activities

c. Community take extra responsibility

d. Less educated youth to the society

e. Increase crime rate/truancy

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f. Reduce productivity

2.7 Reductions of maternal mortality as role of the midwife & chews (Malama

Khadija Hassan, 2014).

Midwife and Chews in the community:-

a. Familiarity with religion/culture, taboos etc.

b. Know who is decision maker in the community

c. Who is a teacher or instructor in the community and health facility levelcare?

 The Roles are as follows:-

1. Explain and advice (Health Education)

2. Provide information to increase understanding

3. Influence community to take action that will improve the lives of women and

their children.

4. Teach good nutritional practices

5. Help community to understand the need for obstetric complications i.e. danger

sign, transportetc.

6. Encourage, improve education for girl child/ mother

7. Encourage, changes a lot will improve woman status

8. Promptly identifies and refer all identified of risk or complicated case

9. As a professional takes lifesaving action in emergencies

10. Help increase respect and value for all Chews and midwives

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11. Acknowledge that technical knowledge changes continuously so is always up to

date with correct changes in midwifery practices documents and keep record of all

action taken.

12. Provide quality care to women in their reproductive years i.e.

a. Family planning

b. Post abortion care

c. Ante-natal care

d. Intra-partum care

e. Post-partum care.

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 CHAPTER THREE

3.0 Methodology

This chapter present the method used in carrying out this research under the

following sub heading: - research design, area of study, population, instruments for

data collection, validity of the instruments, reliability of the instruments, method of

data collection, method of data analysis and decision rule. All in this chapter.

3.1 Research Design

This study is descriptive community based cross-sectional research which collected

primary data on woman's indulgence in high risk of pregnancies, causes of

maternal mortality, factor contributed to maternal mortality and strategies in

reducing maternal mortality among others. Through survey, in depth interview

(IDIs) and focus group discussion (FGDs) with women within reproductive age

(15-45years) and maternal health care providers, which included chews,

midwives/nurses, doctors, as well as men in the community.

3.2 Area of Study

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This study was carryout in Dingyadi town of Bodinga local government in Sokoto

State, which serve as head quarter of the local government. The local government

secretariat and local government education authority secretariat were there in

Dingyadi town. Dingyadi has two health centres government and private which are

primary health centre and Nasiha clinic Dingyadi. The major ethnic groups found

in Dingyadi are Hausa Fulani.

The Dingyadi town is district which have two Wards as follows: - Badawa and

Dingyadi itself.

The Dingyadi town mainly inhabited by traders, civil servants and farmers.

Institutions located in Dingyadi are Government day secondary school,

Muhammad Mai Gero Institute for qur’anic and general studies and two primary

school within the Town.

The people of Dingyadi are mostly Muslims. Dingyadi has two jumu'at mosque

and has a total population of 30000 according to 2006 census.

3.3 Types and Source of Data

According to (Gyong, 2011) Data are pieces of empirical information the

researcher design to collect on a particular subject.

There are basically two types of data namely primary and secondary data.

24
Primary data is usually generated from primary source such as individual, while

secondary type is generated from secondary sources such as medical records from

hospitals. For the purpose of this research, the primary sources of data were

women (literate and non-literate, divorced, separated, widowed and single)within

reproductive age, maternal health care providers, such as Nurses/Midwives,

Chews/Jchews, Doctor as well as married men. Also focus group discussion were

conducted with eighteen participants in each group making total of (72)

participants to generate more primary data alongside four (4) in depth interview. In

addition secondary data from government and non-governmental published

documents were used.

3.4 Population of Study

The population consists of women within reproductive age, their husbands, as well

as medical personal (Doctors, Chews and Midwives) withinDingyadi town of

Bodinga local government.

A total population of 76 peoples were used. 72 participants in focus group

discussion in four groups. The first group consist of married women with age (15-

45), the second group consists of divorced, separated and widowed, and then the

final group consists of married man in the community. And 4 people in depth

interview which consist One (1)medical doctor, one(1)midwife, and two (2)

25
 community health workers. And medical record department was also consulted for

information.

3.5 Instrument for Data Collection

Structured questionnaire drawn, 4 point rating scale with 37 items was use for

students. The questionnaire has three (3) sections.

 Section A :- consist of Causes of maternal mortality

 Section B :- consist of maternal mortality ratio

 Section C: - consist of strategies for reducing maternal mortality.

The scale weight thus: -

Strongly Agree (SA): - 4 point

Agree (A): - 3 point

Disagree (D): - 2 point

Strongly Disagree (SDA): - 1 point

Design research item 4 & 5 of section "B" simple pie was used.

3.6 Validity of the Instrument

The questionnaire was validated by my project supervisor (mal.UmarNagwari PHC

tutor) from Sultan Abdurrahman College of health technology gwadabawa, Sokoto

State to determine the take validity, correction were affected.

26
3.7 Reliability of the Instrument

The test - re test method has been used to determine the internal consistency of the

instrument was administered to five (5) Midwives, two (2) Chews and medical

Doctor at Dingyadi town, at interval of two weeks to determine the interval

constancy of the instrument.

3.8 Method of Data Collection

The researcher distributed the questionnaire and interview to the respondent

personally to ensure proper handling, prompt return in order to avoid loss of the

questionnaire and also have opportunity to clarify questions asked by the

respondents.

3.9 Method of Data Analysis

Data was analyzed during simple mean statistic method.

3.10 Decision Rule

Any item with a mean of 2.50 and above is considered or agreed and any items

with mean of 2.49 and below is disagreed.

27
 CHAPTER FOUR

4.0 Data Presentation and Analysis

The chapter present the findings of research which was set out to find the causes

and strategies in reducing maternal mortality in Dingyadi town. The findings were

based on analysis of responses from 70 respondents in Dingyadi. The researcher

used a simple men X to determine acceptability or non-acceptability.

Mean: - no of respond divided by the total no of respondents.

 RESEARCH QUESTION 1

What are causes maternal mortality among women of childbearing age in Dingyadi

town?

S/N I T E M S 4 3 2 1 T o t a l_ Remark

S AA D AS D A X

1. Hem or r hage ( bl eedi ng )4 01 78 5 7 03 . 8 A g r e e d

2. Unsafe abortion 4 01 01 55 7 03 . 7 A g r e e d

28
3. E c l a m p s i a3 91 98 4 7 03 . 8 A g r e e d

4. L a c k o f c o n t r a c e p t i v e s3 01 51 21 37 03 . 3 A g r e e d

5. Lack of access to health care1 02 21 22 67 02 . 6 A g r e e d

6. S e p s i s2 01 91 91 27 03 . 1 A g r e e d

7. P o o r n u t r i t i o n1 02 21 22 67 02 . 6 A g r e e d

8. M a l a r i a i n p r e g n a n c y2 32 57 1 57 03 . 2 A g r e e d

9. Prolonged/Obstructed labour2 12 91 91 7 03 . 5 A g r e e d

10. P o o r s a n i t a t i o n1 39 1 53 37 02 . 3 Disagreed

11. A n e m i a i n p r e g n a n c y2 92 61 05 7 03 . 6 A g r e e d

12. V i r a l d i s e a s e1 02 01 03 07 02 . 5 A g r e e d

13. D i a b e t e s i n p r e g n a n c y1 21 03 31 57 02 . 6 A g r e e d

14. T e e n a g e p r e g n a n c y5 7 2 23 67 02 . 0 Disagreed

15. I n f e c t i o n ( U T I o r S T I )1 01 41 43 27 02 . 3 Disagreed

Grand total mean is = 2.9

Table 1

This table show the respondents response on the research question one (1), which

is causes of maternal mortality in Dingyadi, where 1,2,11 and 9 have the highest

29
 percentage while 14, 15, 12 and 5 have the least percentage. And the grand total

mean is 2.9 which shown that the respondents agreed with all items in 1st table of

the questionnaire.

 RESEARCH QUESTION (2)

What are factors that contribute to maternal mortality in Dingyadi town?

SS/N I T E M S4 3 2 1 TOTAL Remark

S AA D AS D A X

1 1 6 Harmful cultural practices3 01 08 2 27 04 . 2 A g r e e d

1 1 7 Availability of health facility2 01 91 81 37 04 . 2 A g r e e d

1 1 8 Interval between twoconsecutive pregnancies1 91 01 93 27 04 . 0 A g r e e d

1 1 9 Lower access to ante-natal care1 82 02 21 07 04 . 2 A g r e e d

2 2 0 I l l i t e r a c y / i g n o r a n c e2 72 01 58 7 04 . 6 A g r e e d

2 2 1 High rate of unsafe abortion among teenage2 02 41 61 07 04 . 0 A g r e e d

2 2 2 P o v e r t y5 1 03 02 57 03 . 0 A g r e e d

2 2 3 A g e o f m o t h e r1 55 2 03 07 03 . 2 A g r e e d

2 2 4 Man power, working hours1 7 2 63 67 02 . 5 A g r e e d

2 2 5 Poor access to mass media2 92 51 15 7 04 . 9 A g r e e d

2 2 6 Pre-existing of health conditions1 05 1 54 07 02 . 8 A g r e e d

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 Grand total mean is = 3.7

Table 2

This table show the respondents responses on the research question two (2) which

is factors that contribute to maternal mortality in Dingyadi town? Where 25, 20 and

16 have the highest percentage while 24, 26 and 22 have the least percentage. And

the grand total mean is 3.7 which shown that respondents agreed with all the items

in 2nd table of the questionnaire.

 RESEARCH QUESTION THREE (3)

What are the strategies in reducing maternal mortality in Dingyadi town?

SS/N I T E M S4 3 2 1 Total REMARK

S AA D AS D A X

2 7 A t t e n d i n g A n t e - n a t a l c a r e2 92 41 06 7 04 . 8 A g r e e d

2 8 Prevention and treatment of malaria2 71 11 02 27 04 . 1 A g r e e d

2 9 V i t a m i n s s u p p l e m e n t s6 1 12 72 67 03 . 1 A g r e e d

3 0 Arranging skilled birth attendant9 6 1 63 97 02 . 8 A g r e e d

3 1 Avoiding/limiting alcohol consumption2 01 91 81 37 04 . 2 A g r e e d

3 2 Avoidance of early marriage or teenage pregnancy2 31 42 01 37 04 . 2 A g r e e d

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3 3 Not r epr oduce af t er 35year s1 82 22 28 7 04 . 3 A g r e e d

3 4 F a m i l y e d u c a t i o n2 02 41 61 07 04 . 4 A g r e e d

3 5 U s e o f c o n t r a c e p t i v e s1 7 2 24 07 02 . 4 Disagreed

3 6 E a t i n g h e a l t h y d i e t2 03 01 01 07 04 . 5 A g r e e d

3 7 Recognizing and acting promptly on sign of complicated delivery1 12 81 12 07 03 . 8 A g r e e d

Grand total mean is = 3.8

Table 3

This table show the respondents response on the research question three (3), which

is what are the strategies in reducing maternal mortality among women of

childbearing age in Dingyadi town? Where 27, 36 and 34 have the highest

percentage while 3, 30 and 29 have the least percentage. And the grand total mean

is 3.8 which shown that the respondents agreed with all the items in 3rd table of the

questionnaire.

Therefore, the respondents agreed with all the items listed in the questionnaire as

showed in the result of each questionnaire which present that the respondents

agreed with most part of the questionnaire.

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CHAPTER FIVE

5.0 Re-statement of the Problems

5.1 Summary of the Procedure Used

5.2 Discussion of Findings

5.3 Recommendations

5.4 Implications of Study

5.5 Suggestions for Further Study

5.6 Limitations of the Study

5.7 Conclusion

There is growing concern about the causes and prevention maternal mortality in

Dingyadi town of Bodinga local government. Despite the sterile procedure

maintained by health care providers in Dingyadi health centers.

This research is carryout in order to investigate the strategies in reducing maternal

mortality among women of childbearing age in Dingyadi town. With a view of

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 providing useful suggestive on how it can prevent across Dingyadi, Sokoto and

Nigeria in general.

5.1 Summary of the Procedure Used

A descriptive survey research design was used for the research. This design was

chosen because it was effective in seeking the opinion of the people regarding

issues that concerns them.Nwergu in (1991) opinionated that descriptive survey

research is one in which a group of people or items are studied by collecting and

analyzing data from only few people or items considered to be representative of the

entire group

5.2 Discussion of Findings

Discussion followed the orders of research question on causes, factors contribute

and strategies in reducing maternal mortality.

RESEARCH QUESTION 1

Table 1 shows the causes of maternal mortality in Dingyadi town. Maternal

mortality can be cause through Eclampsia, lack of access to health care,

hemorrhage, sepsis, prolonged labour, poor nutrition and viral disease, among

others

 RESEARCH QUESTION 2

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 Table 2 shows the factors that contribute to maternal mortality. Which are harmful

cultural practices, lower access to ante-natal care, availability of health facility,

poor access to mass media, illiteracy/ignorance and pre-existing of health

conditions etc.

 RESEARCH QUESTION 3

Table 3 shows the strategies involved in reducing maternal mortality. Maternal

mortality can be reduced through preventing and treatment of malaria, attending

ante-natal care arranging for skilled birth attendant at labour and delivery,

avoidance or limiting alcohol consumption, eating healthy diet, recognizing and

acting promptly on sign of complicated delivery, and vitamins supplements. The

preventive measure to take is by creating awareness during ante-natal care (ANC)

and ascertain the ward development committee (WDC) members by teaching them

the danger sign of pregnancy which may lead to maternal mortality.

5.3 Recommendations of the Study

After the review of the findings of the research the following recommendations are

drawn

 Government should provide enough and modern equipment to the health centers

in order t improve service delivery.

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 The hospital or health centers management should encourage the Chews/Jchews

and midwives to attend seminars and workshops in order to refresh and update

their knowledge.

 The health care providers should encourage or mobilize community member’s

particularly pregnant women the important of attending ante-natal care (ANC).

 The health care providers also should give health education on important of

good dietary intake, use of contraceptives and avoidance or limiting of alcohol

consumption.

5.4 Implications of the Study

From the findings seen above if the government failed to provide such equipment

and requirements, health care providers failed to give good health care to the

expectant mothers and if the women failed to follow the rules and regulation there

may be some implications. However, when the mother dies or disable from causes

related to pregnancy and childbirth, the implications/Consequences of maternal

mortality are as follows: -

 Mortality among children whose mother died was one of the key issues

identified: - the research shows that newborn whose mother died in childbirth are

less likely to reach their first birthday than those whose mother do not die

 It is difficulty in managing household was also identified as key ripple effects of

maternal mortality father and surviving children are often hard pressed to take on

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 myriad task performed by one woman. To ease burden of care, children may send

away to live with other families and this separation can further damage family

integrity.

 Finally, these are some implications of maternal deaths: -

 Malnutrition

 Children torture began

 Lack of good education to children

 Early marriage to female child.

5.5 Suggestions for Further Study

a. Strategies use to improve female education

b. Strategies uses in preventing early marriage and teenage pregnancy

c. Mechanism helps in preventing the practice of female genital mutation (FGM)

5.6 Limitations of the Study

The researcher is aimed in finding out the causes and how to reduce maternal

mortality.

The research was limited in general hospital Bodinga, general hospital

Binji,primary health centerDingyadi and Nasiha clinic Dingyadi.

5.7 Conclusion

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Our findings revealed that high risk pregnancies we're major contributory factor to

the high rate of maternal mortality in Dingyadi town.

Early pregnancies were found to be associated with high risk due to obstetric

factors, medical conditions and unpredicted outcomes. Social factors like non-

attendance of ante-natal care, poverty, illiteracy/lack of education, lack of

knowledge of practicing family planning and poor nutrition predispose respondents

to having high risk pregnancies and maternal mortality. Also, early pregnancy was

more common as compared to late pregnancy in Dingyadi. This suggest that most

women marry early and give birth before age 34. Very young mother experience

difficult pregnancies and delivery because of their physical immaturity. Older also

experience age related problems during pregnancy and delivery: poor birth spacing

can lead to anemia among morbidities, which lead to maternal mortality. High risk

pregnancies are therefore one of the major causes of maternal mortality in

Dingyadi town. However, since late pregnancy (34 years and above) is not

commonly practice it is evident that early pregnancy is most practiced. This is the

thesis of this research. Abraham Liliented (1980), a prominent epidemiology, very

appropriately remarked, the better we know the cause of problem, the better we are

in position to address the problem and his book, foundation of epidemiology. Cities

Benjamin Disraeli’s, the more extensive a man's knowledge of what has been done,

the greater will be his power of knowing what to do.

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This marks the end of this conclusion.

Alhamdulillah.

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