Concept of infant and maternal mortality: Studies have been reported in different part of the world and in some parts of Nigeria regarding to factor responsible for high infant and maternal mortality. However, literature related to the study is hereby presented under the following headings;
vConcept of infant and maternal mortality
vInfant and maternal mortality trend in developed/ developing countries.
vCauses and risk factors of infant and maternal mortality.
vPrevious studies on maternal and infant mortality.
vSummary of literature
Concept of infant and maternal mortality
Maternal mortality rate for any year is the number of death attributed to pregnancy and child bearing per 1000 registered total births, (Benneth and Brown, 1999). Maternal death occurring more than 42 days after pregnancy or childbirth are no longer included in the figure, this is in line with the international definition of maternal death, which states that maternal death is the one occurring during pregnancy or labour or as a consequence of pregnancy within 42days after delivery or abortion.
The international classification of diseases, injuries and caused of death (ICD, 1994) defined a maternal death as the death of a woman within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes. This definition is in accordance with the definition adapted by the international federation of Gynaecology and obstetrics.
Child bearing kills so many women in the developing world of which Nigeria is one. In many developing countries, complication of pregnancy and childbirth are leading causes of death among women of reproductive age. According to WHO (1996) more than one women died every minutes from such cause, and 585,000 women die every year from the causes, less than one percent of thee deaths occur in developed countries demonstrating that they could be avoided in developing countries, Nigeria, if resources and services are available.
Davies (2005) stated that maternal mortality is a measure of the risk to the mother connected with childbirth. Maternal deaths are only counted if they are directly related to pregnancy. Or example, death from renal failure, which had commenced with a severe toxaemia of pregnancy and pyeblonephritis, would be counted as a maternal death even if the woman died years later.
However, deaths from completely unrelated cause, such as road accident, medical or surgical emergency, would not be counted as maternal death even if it took place during pregnancy. Thus maternal deaths due to associated cause are recorded where death I due to a disease (e.g. cardiax disease, pulmonary tuberculosis, malaria, pyelonephriti, raised blood pressure and diabetes mellitus) and a maternal condition (e.g. pregnancy) I given as a secondary cause of death. It is well known (Benneth and Brown, 1999) in the medical profession that cardiac disease may be aggravated by pregnancy.
Neonatal death (death of infants within the first 28 days of life) in Nigeria is 48 per 1000 live birth (NDHS, 200) and almost half of infant death per annum results from poor maternal health and poor care at time of delivery (compass project: making motherhood safe in Nigeria). According to the National Demographic health survey 200, the highest neonatal rates were recorded in the North-East and North-West zones while the lowest rates (34 per 1000) were seen in the South-East zone. Most of these deaths occur in the first week of life and it is a reflection of the link with quality of maternal care (FMDH, 2007). About 5.3 million children are born annually in Nigeria, that is, 11,000 per day. One million of these children die before the age of five (5). Nigeria’s children new born death rate (28 per day) is one of the highest in the world.
Infant and Maternal Mortality Trend in Developed/ Developing Counties
The 2006 census estimated that there are about 65 million females in Nigeria out of which 30 million are of reproductive age (15-49 years). Each year about 6 million women become pregnant, 5 million of these pregnancies result in child birth (WHO, UNICEF, UNFPA, 2007). Available data indicate that 59,000 women die yearly as a result of complications in child birth (WHO, 2007). A Nigeria woman is 500 times more likely to die in childbirth than European counterpart.
Mortality ratio is about 800-1,500 per 100,000 live births (NDHS, 2003) with marked variation between geo-political zones- 165 in South west compares with 1549 in the North-east and between urban and rural area (NPC, 2008) and the second number of absolute maternal deaths, only outranked by India in the world (NARHS, 2005). More disturbing is the SOGON study that revealed a maternal mortality of 3,380 in Lagos state 783 in Enugu, 2977 in Cross River state, 846 in Pleateau state, 727 in Borno state and 7523 in Kano state indicating very serious health system failure. One in 20 Nigerian women died of pregnancy delivery related causes (Advocacy Brief, 2007) compares to 29,800 for Sweden and Finland.
Thus for all human development indictor, maternal mortality ratios show the greatest disparity between developed and developing countries. These deaths are largely preventable. Equally of concern is that yearly, about 1,080,000-1,620,000 Nigerian women and girls will suffer disabilities caused by complication during pregnancy and child birth (Hill, world law, 2001).
For every one that dies 20-30 more suffer long term and short term disabilities such as chronic anawmia maternal exhaustion or physical weakness vesico-vaginal or Rector-vaginal fistula, stress incontinence, chronic pelvic pain, PID infertility Ectopic pregnancy and Emotional Depression. The UNFPA estimates that 2 million women suffer vesico vaginal fistulae globally, 40% of these (800,000) women are in Nigeria, majority due to prolonged obstructed labour that often terminate in still birth or neonatal death (UNFPA, 2003).
Child survival is equally affected too as the chances of survival of a child in the absence of his or her mother is greatly reduced. In Nigeria, 340,000 infant die annually during delivery and shortly after delivery especially if the mother dies in child birth. These deaths are not unconnected with the poor maternal death services in the country and could be avoided through provision of quality and effective maternal and child health service.