Child-bearing, health and social priorities: a survey of 22 774 consecutive hospital births in Zaria, Northern Nigeria.

Abstract

The major aim of this study was to determine maternal health care needs in Nigeria based on the relationship between pregnancy outcome and maternal biosocial variables such as age parity physique and education as well as use of the health care delivery system. Records of all 22774 consecutive pregnancies (22725 deliveries) at the ABU Hospital in Zaria in 1976-79 were analyzed. There were 238 maternal deaths and 2718 perinatal deaths in this series. Both formal education and antenatal care had a significant impact on the results of childbearing. In women who had no formal education and no antenatal care (33% of the study population) maternal mortality was 29/1000 deliveries perinatal mortlity was 258/1000 births and 26% of infants weighed less than 2.5 kg. In women who received both formal education and antenatal care maternal mortality was 2.5/1000 perinatal mortality was 30/1000 and only 8% of infants were of low birthweight. Maternal and fetal survival were poorest among primigravidae aged 15 years or under and in highly parous women aged 30 years or over. Provision of nutritional supplements to a subsample of teenage primigravidae (iron and folic acid) resulted in enhanced growth in both mother and fetus and in a reduction in the prevalence of cephalopelvic disproportion. Significantly poorer maternal and fetal outcomes were noted in multiple pregnancies versus singleton pregnancies (maternal mortality of 2% vs. .8% and fetal loss of 24% vs. 10% respectively). Perinatal health was found to be influenced adversely by lack of antenatal care residence outside Zario early teenage pregnancy and high parity. Although only 9% of live births in the series were 2.5 kg or under 40% of stillbirths and 50% of neonatal deaths involved low birthweight infants. The principal high risk factors in maternal mortality were lack of antenatal care early teenage pregnancy high parity and a high child mortality rate from previous births. Overall these findings suggest that adverse pregnancy outcomes in Northern Nigeria are due to socioeconomic and cultural factors rather than to deficiencies in maternity services. Until there is a fundamental social change beginning with universal formal education emergency obstetric care must continue to make the best of an unsatisfactory situation.