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Rotary International President Elect Gary Huang Addresses RFPD Membership at Annual General Meeting in Lisbon2232 days ago
RFPD and MCH Area of Focus - VTT2232 days ago
2013 Nafis Sadik Award for Courage 2232 days ago
A Letter From Our Chairperson2232 days ago
Rotary Project In Nigeria is a MASTERPIECE2232 days ago
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Maternal & Child Health Project Dissertation by Stefanie Adams
Category: Population | By RFPD, 14-Dec-2012 | Viewed 3285  Comments 0
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Former fistula patients

Maternal and fetal mortality and morbidity in hospitals in Kano and Kaduna States, Nigeria:
Considerations of prevention and management


Dissertation by Stefanie Adams,University Giessen, Germany

All 192 United Nations Member States and Worlds Leading Development Institutions agreed to the eight MDGs in 2000. Two Millennium Development Goals, MDG 4 and MDG 5, are aimed at reducing the under-five mortality rate by two-thirds and maternal mortality ratio by three quarters between 1990 and 2015. Nigeria has one of the highest rates of maternal and child deaths in the world today.

Causes of and strategies for reducing maternal mortality and morbidity are well known. They include antenatal care, labor and delivery management by qualified personnel and availability of emergency obstetric care. All these strategies are also reflected by the generally known three delays, which preclude pregnant women from receiving the right care in time.

The Rotary project "Improvement of Maternal Health - Prevention and Treatment of Obstetric Fistulae," was established in 2005 with the aim of improvement of maternal and fetal health in northern Nigeria. The model for reduction of high maternal and child mortality, and prevention and treatment of obstetric fistula in the north of Nigeria, was the focus of the Rotary project.  It focused mainly on first and third delays of pregnant women seeking care, with the aim to reduce maternal mortality by using multiple interventions.

In order to create a consciousness of the population on existing problems of maternal and fetal morbidity and mortality, Rotary established different ways of informing the community on household, community and district levels of reasons and existing problems causing maternal and fetal mortality and morbidity.  An aim was reducing the first delay. An effective way of reaching women and their families, especially in rural areas of Nigeria, is conducting community dialogues and radio serials.

Between October 2007 and July 2009, a total number of 323 fistula patients were treated in Rotary Fistula Centers in Wudil and Zaria, which were established by Rotary International in two hospitals in Kano State and Kaduna State in northwest of Nigeria. Documentation takes place with every surgery using patient reports and treatment of vesico-vaginal and recto-vaginal fistula.  They are carried out in one of the two fistula centers. We gather patient's details, i.e. age, residence, number of pregnancies, number of living children and height ; and diagnosis with size, type and classification of fistula is assessed on the basis of this data.

In 2008, the Institute of Quality Assurance was established at Aminu Kano Teaching Hospital in Kano State. Ten selected hospitals, five in Kano State and five in Kaduna State, participate in data collection and were introduced to quality assurance in obstetrics.

In December 2009, the status of equipment of hygienic conditions of each room of the maternity units (operating theater, delivery room, neonatal unit, obstetrical ward and general conditions) was assessed in the ten participating hospitals of the project. The data was related to the maternal mortality in the hospitals and a critical analysis of the quality of care was carried out. Health care workers in hospitals were trained, e.g. in using fetal Doppler or anti-shock garment, for a better management of obstetric cases (quality of process). For measuring the quality of outcome in all hospitals, data of obstetric care were regularly collected, semi-yearly data was analyzed in "review meetings". Under the guidance of the Institute of Quality Assurance, this data is discussed regularly with health workers from all participating hospitals. This lead to improvement in single hospitals, by introducing new standards with the encouragement of all involved health workers in the hospitals.

The analyses of collected data in participating hospitals demonstrates the achievement of reduction of maternal mortality and morbidity, which could be reached within five years. The main outcome indicator of quality assurance, i.e. reduction of maternal mortality, changed from 1790 maternal deaths per 100,000 deliveries in first half of 2008 to 790 maternal deaths per 100,000 deliveries in the first half of the year 2010. This is a decrease of maternal mortality of more than 55% from January 2008 to June 2010 in participating health care facilities in northern Nigeria.
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