Increasing Women's Access to Skilled Pregnancy Care in Nigeria (IMCHA)
Less than one-third of Nigerian women receive skilled care during delivery. This project will aim to reduce maternal and perinatal deaths by improving vulnerable women's access to healthcare services during and after childbirth.
Access to care in Nigeria
In Nigeria, only 65% of women receive antenatal care during pregnancy. In areas of the country with the highest maternal and perinatal death rates, there are stark disparities in access to health care. For example, less than 10% of pregnant women in Sokoto and Kebbi States receive antenatal care and less than 5% have skilled care during delivery.
For the most part, women's reasons for not accessing maternal health services include a lack of money to pay for health services, lack of transportation, perceptions about the negative attitudes of health workers, and lack of permission from husbands and other family members.
Understanding the problem
This project will provide insight into the issue by identifying the supply and demand factors that influence improved access to maternal health care services in Nigeria, particularly for rural women. With this base, the project will develop an implementation plan to expand the work to six geo-political zones in Nigeria. The goal? To strengthen the availability and use of maternal primary health care services by vulnerable women.
Maternal Health
The Innovating for Maternal and Child Health in Africa program is a seven-year $36 million initiative funded by Global Affairs Canada (GAC), Canada's International Development Research Centre (IDRC), and the Canadian Institutes of Health Research (CIHR).
Project ID
108041
Project Status
Completed
End Date
Duration
12 months
IDRC Officer
Sana Naffa
Total Funding
CA$ 975,000.00
Location
Nigeria
Institution Country
Nigeria
Project Leader
Friday Okonofua
Institution
Incorporated Trustees of Women's Health and Action Research Centre
Institution Website
Institution Country
Canada
Project Leader
Sanni Yaya
Institution
University of Ottawa/Université d'Ottawa
Institution Website
Outputs
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Prevalence and determinants of childhood mortality in Nigeria Article
The study revealed factors associated with childhood mortality: age, region, residence, education, wealth index, age at first birth and religion of father and mother. Mothers living in rural areas experience a 28% increase in childhood mortality. Tackling the death of children, whether during perinatal, early or late neonatal, childhood or adolescent age is posing a difficult task in Nigeria. The study points to the correlation between improved health education campaigns and improvements in access to primary health care as directly effective in increasing life expectancy and economic wellbeing. Author(s): Yaya, Sanni, Ekholuenetale, Michael, Tudeme, Godson, Vaibhav, Shah, Bishwajit, Ghose, Kadio, Bernard Language: English |
Prevalence and risk factors for maternal mortality in referral hospitals in Nigeria : a multicenter study Article
This study determines maternal mortality ratios (MMR) and identifies risk factors for maternal deaths in referral health facilities in Nigeria. Results show an MMR of 2,085 per 100,000 live births in hospital facilities. Efforts to reduce MMR requires the improvement of emergency obstetric care; public health education so that women can seek appropriate and immediate evidence-based pregnancy care; the socioeconomic empowerment of women; and the strengthening of the health care system. In the past ten years contraceptive prevalence rates have remained low at 10%; antenatal attendance has remained at 64%, skilled birth attendance of 33% is one of the lowest in sub-Saharan Africa. Author(s): Ntoimo, Lorretta F., Okonofua, Friday E., Ogu, Rosemary N., Galadanci, Hadiza S., Gana, Mohammed Language: English |
Assessing the knowledge and skills on emergency obstetric care among health providers : implications for health systems strengthening in Nigeria Article
A questionnaire was used to obtain information relating to health providers’ socio-demographic characteristics; respondents’ knowledge and skills in offering specific Emergency Obstetrics Care (EMOC) services (as compared to standard World Health Organization recommendations); and their confidence in transferring the skills to mid-level providers. Findings indicate that knowledge and reported skills in EMOC by health providers was lower than average in referral facilities in Nigeria. Recommendations include in-service training and re-training of health providers along with health policy and programs that address maternal mortality. Author(s): OkonofuaI, Friday, Ntoimo, Lorretta Favour Chizomam, Ogu, Rosemary, Galadanci, Hadiza, Gana, Mohammed Language: English |
Decomposing the rural-urban gap in the factors of under-five mortality in sub-Saharan Africa? : evidence from 35 countries Article
Child mortality under age five is regarded as an indicator of the progress of societal value systems in health care management (or lack thereof). The study showed significant urban-rural differentials in under-5 mortality rates across bio-demographic, socioeconomic and proximate factors. Strengthening maternal and child health (MCH) programmes specifically in rural areas, and improving health care services would help to ensure overall child survival. Disparities in access and utilization of health care services have hampered the target of promoting Universal Health Coverage (UHC), including widespread reduction in childhood mortalities. Author(s): Yaya, Sanni, Uthman, Olalekan A., Okonofua, Friday, Bishwajit, Ghose Language: English |
Maternal near-miss morbidity : is this evidence of maternal health Article
The writer advances the notion that the incidence of “near misses” is a key indicator of quality of care, because it accounts for all components of emergency obstetric care in referral facilities. The article is in response to “Incidence, causes and correlates of maternal near-miss morbidity: a multi-centre cross-sectional study” [https://doi.org/10.1111/1471-0528.15578], which suggests that although women may experience delays in accessing referral facilities, concentrating efforts on complications through emergency obstetric care can be effective in preventing maternal deaths. As well, the respondent disputes the use of the study controls, arguing for ones that would better enable the identification of specific actions for prevention of maternal deaths. Author(s): Okonofua, Friday Language: English |
Assessment of the quality of antenatal and postnatal care services in primary health centres in rural Nigeria Article
Study findings show predictors of sub-optimal offerings of standard Primary Health Care (PHC) that include: local government area, marital status and previous childbirths. A higher proportion of maternal deaths in Nigeria occur among women living in rural areas, where barriers to maternal health include quality of care in health facilities. There is evidence of continuing under-utilization of primary care by pregnant women in poor and rural communities. Due to the small number of women who use PHC, and the non-availability of accurate records of women who use the facilities for maternal care, a sample size could not be determined beforehand. Author(s): Ntoimo, Lorretta Favour C., Okonofua, Friday E., Yaya, Sanni, Imongan, Wilson, Omorodion, Blessing, Ogungbangbe, Julius Language: English |
Why rural women do not use primary health centres for pregnancy care : evidence from a qualitative study in Nigeria Article
Pregnant women in rural communities in Nigeria often do not use Primary Health Care Centres. Through focus group discussions, the study found four broad categories of reasons underlying non-use: 1) accessibility factors – poor roads and transportation, long distances, and facility not always open; 2) perceptions relating to poor quality of care, inadequate drugs, abusive care by health providers, long wait times, and inappropriate referrals; 3) costs of services, including inability to pay for services even when costs are not excessive; the introduction of informal payments by staff; and 4) partner support (or lack thereof), and misinterpretation of signs of pregnancy complications. Author(s): Ntoimo, Lorretta Favour C., Okonofua, Friday E., Igboin, Brian, Ekwo, Chioma, Imongan, Wilson, Yaya, Sanni Language: English |
Third ECOWAS forum on best health practices : Accra, Ghana, 23-25 October 2018 Report
The third Economic Community of West African States (ECOWAS) forum held in Accra (Ghana, 2018) focused on the theme, “Promoting Multisectoriality to achieve Maternal, Newborn, Child and Adolescent and Youth (MNCAYH) Health-related Sustainable Development Goals.” Subthemes included: Practices of Governance and Sustainability; Public Private Partnership and Information Technology; and Non-Communicable Diseases and Traditional Medicine that impact MNCAYH. This report consists of the conference agenda, participants, and abstracts of presented papers. Author(s): The West African Health Organization Language: English |
Using equitable impact sensitive tool (EQUIST) and knowledge translation to promote evidence to policy link in maternal and child health : report of first EQUIST training workshop in Nigeria Report
A three day intensive training workshop using the equitable impact sensitive tool (EQUIST) and knowledge translation (KT) was held in Edo State (Nigeria) to improve the knowledge and capacity of a maternal, newborn and child health (MNCH) implementation research team and policy makers. A modified "before and after" intervention study design was used, in which outcomes were measured both before the intervention (workshop) and after. Findings show that competence relevant to evidence-informed policymaking can be enhanced through training workshops. Among the most important health policy areas, where decision making is increasingly challenging are those related to maternal, newborn and child health (MNCH). Author(s): Uneke, Chigozie Jesse, Sombie, Issiaka, Uro-Chukwu, Henry Chukwuemeka, Johnson, Ermel, Okonofua, Friday Language: English |
Influence of women’s empowerment indices on the utilization of skilled maternity care : evidence from rural Nigeria Article
This study assessed the association between indices of women’s empowerment and utilization of skilled antenatal, intrapartum and postnatal maternity care in two rural Local Government Areas in Edo State, Nigeria. Findings indicate that female education is a strong predisposing factor for utilization of maternal health services in the study area. Survey respondents’ education and participation in payment for their own health care positively predicted use of all three levels of skilled maternal care. Women who made decisions alone about major household purchases were twice as likely to use all three levels of services than when decisions were made by their partners or others. Author(s): Ntoimo, Lorretta Favour C., Okonofua, Friday E., Aikpitanyi, Josephine, Yaya, Sanni, Johnson, Ermel, Sombie, Issiaka, Aina, Olabisi, Imongan, Wilson Language: English |
Effect of a multifaceted intervention on utilization of primary health care for maternal and child health care in rural Nigeria Article
The study included 2,819 women participants of reproductive age. Among other intervention strategies, the project improved access to transportation while reducing associated expenses, and created a community health fund, both of which address well known barriers to the use of primary health centres (PHC). The study was designed to determine the effectiveness of various interventions in increasing the uptake of skilled maternal and child care in two rural Local Government Areas (LGA) in Edo State, Nigeria. Removal of out-of-pocket payments, and increased public funding of primary health care need to be considered as matters of equity and social justice. Author(s): Okonofua, Friday Ebhodaghe, Ntoimo, Lorretta Favour Chizomam, Yaya, Sanni, Brian, Igboin, Solanke, Ojuolape, Ekwo, Chioma, Johnson, Ermel Ameswue Kpogbe, Sombie, Issiaka, Imongan, Wilson Language: English |
Gender inequity as a barrier to women’s access to skilled pregnancy care in rural Nigeria : a qualitative study Article
Gendered intrahousehold power structures, gendered dynamics of resource allocation, and women’s limited ability in decision-making impact maternal health-seeking behaviour and overall health status. Using a gender lens, this study explores causes of women’s limited access to and utilisation of maternal healthcare services in rural areas of Edo State, Nigeria. Interventions geared towards supporting women’s financial independence are important for improving their access to skilled healthcare, as well as those that improve women’s decision-making capacities. A man’s financial status determines the type of care his spouse or partner sought. Approximately 58,000 Nigerian women die from pregnancy-related complications yearly. Author(s): Yaya, Sanni, Okonofu, Friday, Ntoimo, Lorretta, Udenige, Ogochukwu, Bishwajita, Ghose Language: English |
A qualitative study of community elders’ perceptions about the underutilization of formal maternal care and maternal death in rural Nigeria Article
Many rural Nigerian women use local childbirth services that are unsafe. Community elders’ perceptions and opinions traditionally influence reproductive health decisions, such as the decision to seek hospital delivery methods. Elders believe underuse of maternal health services in health facilities are due to poor quality of care, difficulty getting to health facilities, high costs, and lack of knowledge about maternal health. Findings show they believe medical illnesses, poor availability of services, and poor awareness and reliance on native maternal care are causes of death. Increasing accessibility, promoting positive health behaviors, community support, and help from God were suggested as solutions. Author(s): Fantaye, Arone Wondwossen, Okonofua, Friday, Ntoimo, Lorretta, Yaya, Sanni Language: English |
Maternal death review and outcomes : an assessment in Lagos State, Nigeria Article
Strong political will by hospital management and supervising government agencies are a prerequisite for effectively addressing the human and infrastructural deficits that predispose to maternal mortality in Lagos State. Failure to address the patients and facility-related causes of maternal mortality could account for the persistently high maternal mortality ratio (MMR) in the hospitals. Interventions aimed at redressing all causes identified in the reviews will likely reduce MMRs. The study investigates results of Maternal and Perinatal Death Surveillance and Response (MPDSR) conducted in three referral hospitals in Lagos State, Nigeria over a two-year period and reports outcomes and lessons learned. Author(s): Okonofua, Friday, Imosemi, Donald, Igboin, Brian, Adeyemi, Adegboyega, Chibuko, Chioma, Idowu, Adewale, Imongan, Wilson Language: English |
Increasing women’s access to skilled pregnancy care to reduce maternal and perinatal mortality in rural Edo State, Nigeria : a randomized controlled trial Article
Based on the urgency for increased access to maternity care through Primary Health Care (PHC) the project intends to identify supply and demand factors that prevent Nigerian women from using PHCs for maternal and early new-born care, and to test innovative and community relevant interventions for improving women’s access to PHC services. Nigeria has the second highest absolute number of maternal deaths and perinatal deaths (stillbirth and neonatal deaths) in the world. The proposal outlines the study design and benefits of research. Recently, the Nigerian government has passed a bill providing a better funding strategy for PHCs. Author(s): Sanni, Yaya, Okonofua, Friday, Ntoimo, Lorretta, Kadio, Bernard, Deuboue, Rodrigue, Imongan, Wilson, Balami, Wapada Language: English |
Predictors of women’s utilization of primary health care for skilled pregnancy care in rural Nigeria Article
The study identifies factors that lead pregnant women to use or not use existing primary health care (PHC) facilities for antenatal and delivery care. A total of 1408 randomly selected women of reproductive age were interviewed in their households using a pre-tested structured questionnaire. Findings indicate that addressing the limiting factors (distance, costs and poor quality of care) through innovative approaches will increase the utilization of skilled pregnancy care in PHCs and reduce maternal mortality in rural Nigeria. Author(s): Okonofua, Friday, Ntoimo, Lorretta, Ogungbangbe, Julius, Anjorin, Seun, Imongan, Wilson, Yaya, Sanni Language: English |
Men’s perception of barriers to women’s use and access of skilled pregnancy care in rural Nigeria: a qualitative study Article
Despite evidence that male involvement increases uptake of maternal and child services, studies show that few men are participating in maternal, newborn, and child health (MNCH) programs in Nigeria. Men tend to have exclusive control of their household’s economic resources and are decision makers in all aspects of women’s reproductive health. The study indicates that male involvement is rooted in gender roles where men continue to be viewed as financial providers and decision makers. Nigeria is the second largest contributor to maternal mortality worldwide and has a birth rate of five children per woman. Author(s): Yaya, Sanni, Okonofua, Friday, Ntoimo, Lorretta, Udenigwe, Ogochukwu, Bishwajit, Ghose Language: English |