Outcomes of a multifaceted intervention to prevent eclampsia and eclampsia-related deaths in Nigerian referral facilities

BACKGROUND

Eclampsia causes maternal mortality in Nigeria. This study presents the effectiveness of multifaceted interventions that addressed institutional barriers in reducing the incidence and case fatality rates associated with eclampsia.

METHODS

The design was quasi-experimental and the activities implemented at intervention hospitals included a new strategic plan, retraining health providers on eclampsia management protocols, clinical reviews of delivery care and educating pregnant women and their partners. Prospective data were collected monthly on eclampsia and related indicators from study sites over 2 y. The results were analysed by univariate, bivariate and multivariable logistic regression.

RESULTS

The results show a higher eclampsia rate (5.88% vs 2.45%) and a lower use of partograph and antenatal care (ANC; 17.99% vs 23.42%) in control compared with intervention hospitals, but similar case fatality rates of <1%. Overall, adjusted analysis shows a 63% decrease in the odds of eclampsia at intervention compared with control hospitals. Factors associated with eclampsia were ANC, referral for care from other facilities and older maternal age.

CONCLUSION

We conclude that multifaceted interventions that address challenges associated with managing pre-eclampsia and eclampsia in health facilities can reduce eclampsia occurrence in referral facilities in Nigeria and potential eclampsia death in resource-poor African countries.

Outcome of interventions to improve the quality of intrapartum care in Nigeria's referral hospitals: a quasi-experimental research design

BACKGROUND

Evidence indicates that Nigeria's high maternal mortality rate is attributable primarily to events that occur during the intrapartum period. This study determines the effectiveness of multifaceted interventions in improving the quality of intrapartum care in Nigeria's referral hospitals.

METHODS

Data collected through an exit interview with 752 women who received intrapartum care in intervention and control hospitals were analyzed. The interventions were designed to improve the quality indicators in the WHO recommendations for positive childbirth and assessed using 12 quality indicators. Univariate, bivariate, Poisson, and logistic regression analyses were used to compare twelve quality indicators at intervention and control hospitals.

RESULTS

The interventions showed a 6% increase in composite score of quality of care indicators at intervention compared with control hospitals. Five signal functions of intrapartum care assessed were significantly (< 0.001) better at intervention hospitals. Quality scores for segments of intervention periods compared to baseline were higher at intervention than in control hospitals.

CONCLUSIONS

We conclude that multiple interventions that address various components of the quality of intrapartum care in Nigeria's referral hospitals have demonstrated effectiveness. The interventions improved five of ten quality indicators. We believe that this approach to developing interventions based on formative research is important, but a process of integrating the implementation activities with the normal maternal health delivery processes in the hospitals will enhance the effectiveness of this approach.

TRIAL REGISTRATION

The study was registered at the Nigeria Clinical Trials Registry. Trial Registration Number NCTR No: 91,540,209 (14/04/2016) http://www.nctr.nhrec.net/ and retrospectively with the ISRCTN. Trial Registration Number 64 ISRCTN17985403 (14/08/2020) https://doi.org/10.1186/ISRCTN17985403 .

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

BACKGROUND

Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres.

METHODS

This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low-middle-income countries.

RESULTS

In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of 'single-use' consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low-middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia.

CONCLUSION

This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high- and low-middle-income countries.

The Case for Early and Universal Screening for Gestational Diabetes Mellitus: Findings from 9314 Pregnant Women in a Major City in Nigeria

INTRODUCTION

Risk-based screening has been replaced by universal screening as the recommended course of care for gestational diabetes mellitus (GDM). As of 2016, no state in Nigeria had implemented a policy of universal screening for GDM. This research aimed to assess findings from a universal screening programme and its implication for scaling up universal and early screening for GDM.

METHODS

This was a descriptive cross-sectional study conducted in Rivers State Nigeria between February 2017 and January 2020. Multistage sampling was used to recruit 9314 pregnant women from 30 primary, secondary, and tertiary health facilities in the state. An interviewer-administered structured questionnaire was used by trained healthcare workers to collect socio-demographic, obstetric and medical information. All study participants had a plasma glucose test on their first hospital visit and a diagnosis made using the World Health Organization (WHO) criteria. Data obtained was analysed using the IBM Statistical Package for Social Sciences (SPSS) version 23.

RESULTS

Most women [5683 (61.0%)] were aged 25-34 (mean 29.60 ± 5.64) years. The prevalence of GDM in this study was 5.2% with a prevalence of GDM in the first, second and third trimesters of 4.9%, 4.2% and 6.7%, respectively. The prevalence of GDM among persons with a family history of diabetes was 13.2% (97 persons) while 4.6% (391 persons) without family history were diagnosed with GDM. Gestational age, family history of diabetes and age group were found to be significant predictors of GDM among the study participants after adjusting for confounding variables.

CONCLUSION

The practice of universal screening was useful in identifying GDM in 1 out of 20 pregnant women in the study sample. Screening at all trimesters was useful in identifying GDM. There is an urgent need to scale up early and universal screening for GDM across sub-Saharan Africa.

Effects of multifaceted interventions to prevent and manage primary postpartum haemorrhage in referral hospitals: a quasi-experimental study in Nigeria

INTRODUCTION

Primary postpartum haemorrhage (PPH) is the leading cause of Nigeria's high maternal mortality rate. This study investigated the effectiveness of a set of multifaceted interventions to manage and reduce PPH in selected secondary referral health facilities in Nigeria.

METHODS

This is a quasi-experimental study using an interrupted time-series design to assess a set of multifaceted interventions that address factors identified by stakeholders as associated with PPH. Interventions were implemented at two regional general hospitals, with a general hospital in the same region as the control. Intervention participants were women during antepartum and clinical and administrative staff. Cases of PPH were determined in women at delivery. The outcomes measured were the incidence of primary PPH and related deaths during the study period. Analyses included a comparative description of characteristics of the women, trend of time-series data at intervention and control hospitals, and multivariable analysis of factors associated with PPH occurrence.

RESULTS

Monthly numbers of primary PPH were collected at participating hospitals over 21 months for 18 181 women. Intervention hospitals represent 54% vs 46% in control hospitals. Time-series analyses show a significant downward trend in intervention hospitals. The overall incidence of primary PPH was lower in the intervention hospitals than in the control hospitals. Multilevel regression adjusted for hospital-level effect showed a 68% reduction in odds of PPH cases at intervention compared with control hospitals. There were 12 PPH-related maternal deaths in one of the control hospitals, with no deaths in the intervention hospitals.

CONCLUSION

We conclude that multiple interventions that address identified challenges in the prevention of primary PPH can potentially effectively reduce reported primary PPH in Nigerian referral hospitals. This approach is relevant for scaling the development of policies and programmes to prevent primary PPH and maternal mortality in Nigeria.

Outcomes of a multifaceted intervention to improve maternal satisfaction with care in secondary hospitals in Nigeria

Background: Data in Nigeria suggests a high level of dissatisfaction among women attending maternity care in health facilities due to long wait times, disrespectful care, and poor attention by healthcare personnel.

Objective: To examine the effectiveness of a multifaceted intervention in improving self-reported indicators of maternal healthcare satisfaction by women who use referral facilities in two regions of Nigeria.

Method: The design was quasi-experimental and consisted of two intervention facilities and two control facilities. The interventions included strategic planning, staff re-training, a computerized appointment system, health education/feedback, maternal death reviews and surveillance, and advocacy. A random sample of 2262 women was selected (1205 in the intervention sites and 1057 in the two control sites) to respond to a 24-item questionnaire on service satisfaction as they exited the health facilities. Adjusted Poisson and binary regression analyses were used to assess and compare proportions of reported satisfaction by women between the intervention and control sites.

Results: Women in the intervention sites were 54% more likely than those in control sites to report overall satisfaction with services. They were significantly less likely to report inadequate security arrangements in accessing the health facilities (p < .1); and three times more likely to agree that health workers were extremely thorough and careful in attending to them (p < .1).

Conclusion: The interventions had positive effects on improving women’s satisfaction with care. The findings from this study have implications for the design and implementation of interventions that address women’s concerns relating to the provision of care and consequently improve service utilization.

Outcome of multifaceted interventions for improving the quality of antenatal care in Nigerian referral hospitals

BACKGROUND

The study was designed as quasi-experimental research to investigate the effectiveness of multifaceted interventions for improving the quality of antenatal care in referral hospitals in Nigeria. Two referral hospitals (the Central Hospital in Benin City, South-South Nigeria, and the General Hospital in Minna) served as intervention sites, while two hospitals in comparable locations, (the Central Hospital Warri and the Suleja Hospital Abuja) were the control hospitals.

METHODS

Intervention activities consisted of the introduction of a strategic plan with the shared vision of reducing maternal mortality by 50% in 1 year in the hospitals; staff training and re-training; the establishment of an automated appointment system; composite health education involving couples and providers; advocacy with policymakers; and the implementation of maternal death reviews and surveillance. These activities were implemented in the intervention hospitals over 21 months (October 2017 to June 2019). Exit interviews of pregnant women at intervention and control sites by trained interviewers were used to assess the quality of antenatal care after their visit, A total of 777 women were interviewed (427 in the intervention sites and 350 in the control sites). Data were analyzed with univariate and multivariate Poisson and logistic regression to determine the extent to which health providers in the clinics completed the 18 signal functions identified in the WHO assessment tool.

RESULTS

The regression analyses showed the interventions were effective in improving six quality indicators (QIs) for counseling and information sharing. The difference between intervention and control sites on these QIs was significant at < 0.05. On the contrary, the interventions were less effective for maternal and fetal measurements; and disease testing and management QIs.

CONCLUSION

The positive effects of the interventions are likely due to the effectiveness of the training and health education components. The lack of intervention impact observed for maternal and fetal measurements may be due to the high workload of care staff and inadequate clinic supplies, which we did not address. We conclude that interventions that address the quality of antenatal care in low-resource settings should focus on improving all elements of care, including adequate staffing and mobilization of material resources.

TRIAL REGISTRATION

This study was registered in the ISRCTN on August 14th, 2020.

TRIAL REGISTRATION NUMBER

SRCTN17985403 . Retrospective registration. The reason for the retrospective registration is the current non-recognition of the Nigeria Clinical Trials Registry (NCTR); which is currently not an ICMJE or WHO ICTRP approved registry. (This study was registered in the Nigeria Clinical Trials Registry on April 14th, 2016. Trial Registration Number NCTR No: 91540209 ).

Prevalence and determinants of stillbirth in Nigerian referral hospitals: a multicentre study

BACKGROUND

In 2015, Nigeria's estimated 317,700 stillbirths accounted for 12.2% of the 2.6 million estimated global stillbirths. This suggests that Nigeria still makes substantial contribution to the global burden of stillbirths. This study was conducted to determine the prevalence and identify the causes and factors associated with stillbirth in eight referral hospitals in Nigeria.

METHODS

This was a cross-sectional study of all deliveries over a period of 6 months in six general hospitals (4 in the south and 2 in the north), and two teaching hospitals (both in the north) in Nigeria. The study population was women delivering in the hospitals during the study period. A pre-tested study protocol was used to obtain clinical data on pregnancies, live births and stillbirths in the hospitals over a 6 months period. Data were analyzed centrally using univariate, bivariate and multivariate logistic regression analyses. The main outcome measure was stillbirth rate in the hospitals (individually and overall).

RESULTS

There were 4416 single births and 175 stillbirths, and a mean stillbirth rate of 39.6 per 1000 births (range: 12.7 to 67.3/1000 births) in the hospitals. Antepartum (macerated) constituted 22.3% of the stillbirths; 47.4% were intrapartum (fresh stillbirths); while 30.3% was unclassified. Acute hypoxia accounted for 32.6% of the stillbirths. Other causes were maternal hypertensive disease (6.9%), and intrapartum unexplained (5.7%) among others. After adjusting for confounding variables, significant predictors of stillbirth were referral status, parity, past experience of stillbirth, birth weight, gestational age at delivery and mode of delivery.

CONCLUSION

We conclude that the rate of stillbirth is high in Nigeria's referral hospitals largely because of patients' related factors and the high rates of pregnancy complications. Efforts to address these factors through improved patients' education and emergency obstetric care would reduce the rate of stillbirth in the country.

TRIAL REGISTRATION

Trial Registration Number NCTR91540209. Nigeria Clinical Trials Registry. http://www.nctr.nhrec.net/ Registered April 14th 2016.

Assessing the knowledge and skills on emergency obstetric care among health providers: Implications for health systems strengthening in Nigeria

OBJECTIVE

To assess the existing knowledge and skills relating to Emergency Obstetrics Care (EMOC) among health providers in eight referral maternity hospitals in Nigeria.

STUDY DESIGN

A cross-sectional study of skilled health providers (doctors, nurses and midwives) working in the hospitals during the period.

SETTING

Six general hospitals (4 in the south and 2 in the north), and two teaching hospitals (both in the Northern part) of the country.

POPULATION

All skilled providers offering EMOC services in the hospitals during the study.

METHODS

A pre-tested self-administered questionnaire was used to obtain information relating to socio-demographic characteristics, the respondents' knowledge and skills in offering specific EMOC services (as compared to standard World Health Organization recommendations), and their confidence in transferring the skills to mid-level providers. Data were analyzed with univariate, bivariate, binary and multinomial logistic regression analyses. Main outcome measures: knowledge and skills in EMOC services by hospital and overall.

RESULTS

A total of 341 health providers (148 doctors and 193 nurses/midwives) participated in the study. Averagely, the providers scored less than 46% in a composite EMOC knowledge score, with doctors scoring considerable higher than the nurses/midwives. Similarly, doctors scored higher than nurses/midwives in the self-reporting of confidence in carrying out specific EMOC functions. Health providers that scored higher in knowledge were significantly more likely to report confidence in performing specific EMOC functions as compared to those with lower scores. The self-reporting of confidence in transferring clinical skills was also higher in those with higher EMOC knowledge scores.

CONCLUSION

The knowledge and reported skills on EMOC by health providers in referral facilities in Nigeria was lower than average. We conclude that the in-service training and re-training of health providers should be included in national policy and programs that address maternal mortality prevention in referral facilities in the country.

TRIAL REGISTRATION

Nigeria Clinical Trials Registry 91540209.

Association of the client-provider ratio with the risk of maternal mortality in referral hospitals: a multi-site study in Nigeria

BACKGROUND

The paucity of human resources for health buoyed by excessive workloads has been identified as being responsible for poor quality obstetric care, which leads to high maternal mortality in Nigeria. While there is anecdotal and qualitative research to support this observation, limited quantitative studies have been conducted to test the association between the number and density of human resources and risk of maternal mortality. This study aims to investigate the association between client-provider ratios for antenatal and delivery care and the risk of maternal mortality in 8 referral hospitals in Nigeria.

METHODS

Client-provider ratios were calculated for antenatal and delivery care attendees during a 3-year period (2011-2013). The maternal mortality ratio (MMR) was calculated per 100,000 live births for the hospitals, while unadjusted Poisson regression analysis was used to examine the association between the number of maternal deaths and density of healthcare providers.

RESULTS

A total of 334,425 antenatal care attendees and 26,479 births were recorded during this period. The client-provider ratio in the maternity department for antenatal care attendees was 1343:1 for doctors and 222:1 for midwives. The ratio of births to one doctor in the maternity department was 106:1 and 18:1 for midwives. On average, there were 441 births per specialist obstetrician. The results of the regression analysis showed a significant negative association between the number of maternal deaths and client-provider ratios in all categories.

CONCLUSION

We conclude that the maternal mortality ratios in Nigeria's referral hospitals are worsened by high client-provider ratios, with few providers attending a large number of pregnant women. Efforts to improve the density and quality of maternal healthcare providers, especially at the first referral level, would be a critical intervention for reducing the currently high rate of maternal mortality in Nigeria.

TRIAL REGISTRATION

Trial Registration Number: NCTR91540209 . Nigeria Clinical Trials Registry. Registered 14 April 2016.

Mainstreaming youth-friendly health services into existing primary health care facilities: experiences from South-South Nigeria

Background Youth friendly services, an evidence based approach to overcome the barriers experienced by youths in accessing care, is poorly implemented. The Medical Women's Association of Nigeria (MWAN) Rivers State chapter, was supported by Ford Foundation to mainstream youth-friendly health services (YFHS) into existing primary health care facilities in two hard-to-reach communities. This paper presents the interventions, findings, challenges and recommendations. Methods This study project was implemented in stages: design, baseline survey, interventions and evaluation, between 2014 and 2016. Interventions included facility modifications, health worker capacity building, school and community outreaches, peer group activities, and interpersonal communication. Pre-and-post-intervention surveys were carried out among in- and out-of-school youths to determine the effects of the interventions. Results The most commonly stated barriers to uptake of youth friendly health services included: unavailability of services (154; 33.1%), unavailability of health care workers (167; 38.9%), unaffordability of services (108; 45.8%) and difficulty in communicating with health workers (85; 36.0%). Post-intervention, utilization improved across all services while the perception of barriers to utilization of services reduced (p < 0.05). The interventions implemented increased the odds of youths utilizing YFHS 1.81 times (95% CI = 1.39-2.37). Conclusion Facility modifications, capacity building of health workers, school and community outreaches, peer group activities, and interpersonal communication improved utilization across all services while the perception of barriers to utilization of services reduced. Implementation of YFHS is impacted by external factors often beyond the control of project implementers. Innovative solutions outside of routine health care delivery systems are critical for success. Further evaluation to explore the effect of these interventions is needed. Strengthening of health systems remains a vital strategy for scale-up of YFHS.

Views of senior health personnel about quality of emergency obstetric care: A qualitative study in Nigeria

BACKGROUND

Late arrival in hospital by women experiencing pregnancy complications is an important background factor leading to maternal mortality in Nigeria. The use of effective and timely emergency obstetric care determines whether women survive or die, or become near-miss cases. Healthcare managers have the responsibility to deploy resources for implementing emergency obstetric care.

OBJECTIVES

To determine the nature of institutional policies and frameworks for managing obstetric complications and reducing maternal deaths in Nigeria.

METHODS

Thirty-six hospital managers, heads of obstetrics department and senior midwives were interviewed about hospital infrastructure, resources, policies and processes relating to emergency obstetric care, whilst allowing informants to discuss their thoughts and feelings. The interviews were audiotaped, transcribed and analyzed using Atlas ti 6.2software.

RESULTS

Hospital managers are aware of the seriousness of maternal mortality and the steps to improve maternal healthcare. Many reported the lack of policies and specific action-plans for maternal mortality prevention, and many did not purposely disburse budgets or resources to address the problem. Although some reported that maternal/perinatal audit take place in their hospitals, there was no substantive evidence and no records of maternal/perinatal audits were made available. Respondents decried the lack of appropriate data collection system in the hospitals for accurate monitoring of maternal mortality and identification of appropriate remediating actions.

CONCLUSION

Healthcare managers are handicapped to properly manage the healthcare system for maternal mortality prevention. Relevant training of healthcare managers would be crucial to enable the development of strategic implementation plans for the prevention of maternal mortality.

Qualitative assessment of women's satisfaction with maternal health care in referral hospitals in Nigeria

Background

Available evidence suggests that the low use of antenatal, delivery, and post-natal services by Nigerian women may be due to their perceptions of low quality of care in health facilities. This study investigated the perceptions of women regarding their satisfaction with the maternity services offered in secondary and tertiary hospitals in Nigeria.

Methods

Five focus group discussions (FGDs) were held with women in eight secondary and tertiary hospitals in four of the six geo-political zones of the country. In all, 40 FGDs were held with women attending antenatal and post-natal clinics in the hospitals. The questions assessed women’s level of satisfaction with the care they received in the hospitals, their views on what needed to be done to improve patients’ satisfaction, and the overall quality of maternity services in the hospitals. The discussions were audio-taped, transcribed, and analyzed by themes using Atlas ti computer software.

Results

Few of the participants expressed satisfaction with the quality of care they received during antenatal, intrapartum, and postnatal care. Many had areas of dissatisfaction, or were not satisfied at all with the quality of care. Reasons for dissatisfaction included poor staff attitude, long waiting time, poor attention to women in labour, high cost of services, and sub-standard facilities. These sources of dissatisfaction were given as the reasons why women often preferred traditional rather than modern facility based maternity care. The recommendations they made for improving maternity care were also consistent with their perceptions of the gaps and inadequacies. These included the improvement of hospital facilities, re-organization of services to eliminate delays, the training and re-training of health workers, and feedback/counseling and education of women.

Conclusion

A women-friendly approach to delivery of maternal health care based on adequate response to women’s concerns and experiences of health care will be critical to curbing women’s dissatisfaction with modern facility based health care, improving access to maternal health, and reducing maternal morbidity and mortality in Nigeria.

Trial registration

Trial Registration Number NCTR No: 91540209. Nigeria Clinical Trials Registry. http://www.nctr.nhrec.net/. Registered April 14th 2016.

Engendering the Attainment of the SDG-3 in Africa: Overcoming the Socio Cultural Factors Contributing to Maternal Mortality

At the conclusion of the Millennium Development Goals (MDGs), the Sustainable Development Goals (SDGs) provide an opportunity to ensure healthy lives, promote the social well-being of women and end preventable maternal death. However, inequities in health and avoidable health inequalities occasioned by adverse social, cultural and economic influences and policies are major determinants as to whether a woman can access evidence-based clinical and preventative interventions for reducing maternal mortality. This review discusses sociocultural influences that contribute to the high rate of maternal mortality in Nigeria, a country categorised as having made -no progress‖ towards achieving MDG 5. We highlight the need for key interventions to mitigate the impact of negative sociocultural practices and social inequality that decrease women's access to evidence-based reproductive health services that lead to high rate of maternal mortality. Strategies to overcome identified negative sociocultural influences and ultimately galvanize efforts towards achieving one of the tenets of SDG-3 are recommended.

Management of aplastic anaemia in pregnancy in a resource poor centre

Aplastic anaemia occurring in pregnancy is a rare event with life threatening challenges for both mother and child. We present a successful fetomaternal outcome despite the challenges in the management of this rare condition in a tertiary but resource poor centre. This is case of a 37 year old Nigerian woman G6P0+5managed with repeated blood transfusions from 28 weeks of gestation for bone marrow biopsy confirmed aplastic anaemia following presentation with weakness and gingival bleeds. She had a cesarean section at 37 weeks for pre-eclampsia and oligohydraminous with good feto-maternal outcome. She was managed entirely with fresh whole blood and received 21 units. Aplastic Anaemia in Pregnancy is a rare event with poor feto maternal prognosis. Successful management is possible with good multi-disciplinary approach and availability of supportive comprehensive obstetric care.

Community based interventions for the reduction of maternal mortality - the role of professional health associations, non-governmental organisations and community-based organisations in delta state, Nigeria

AIMS AND OBJECTIVES

This study was conducted to examine the contributions of professional health associations, non-governmental organisations, government ministries, and community-based organisations in implementing community-based interventions for the reduction of maternal mortality in Delta State Nigeria. It also seeks to demonstrate the challenge of coordinating activities of several stakeholders and quantifying the impact on reduction of maternal mortality.

MATERIALS AND METHODS

Various publications, reports, public presentations and policy documents on activities of professional health associations, non- governmental organisations, government ministries, and community-based organisations in Delta State of Nigeria were collected and analysed by the authors.

RESULTS

Professional health associations, non-governmental organisations and community-based organisations in Delta State have contributed to the reduction of maternal mortality through advocacy, awareness creation, and sensitisation programmes on reproductive health using behaviour change communication materials. Participation in programmes organised by the Delta State Ministry of Health has also contributed to some positive outcomes. These include the successful implementation of Delta State Free Maternal Health Care Programme since November 2007 and increase in contraceptive utilisation.

CONCLUSION

Professional health associations, non-governmental organisations, government ministries and community-based organisations have impacted positively in the quest for reduction of maternal mortality. The challenge is in coordination of interventions and tracking indicators to measure desired impact.

Outcome of an intervention to improve the quality of private sector provision of postabortion care in northern Nigeria

The outcomes of an intervention aimed at improving the quality of postabortion care provided by private medical practitioners in 8 states in northern Nigeria are reported. A total of 458 private medical doctors and 839 nurses and midwives were trained to offer high-quality postabortion care, postabortion family planning, and integrated sexually transmitted infection/HIV care. Results showed that among the 17009 women treated over 10 years, there was not a single case of maternal death. In a detailed analysis of 2559 women treated during a 15-month period after the intervention was established, only 33 women experienced mild complications, while none suffered major complications of abortion care. At the same time, there was a reduction in treatment cost and a doubling of the contraceptive uptake by the women. Building the capacity of private medical providers can reduce maternal morbidity and mortality associated with induced abortion in northern Nigeria.