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2017 ANNUAL REPORT

ON

MATERNAL AND PERINATAL DEATH SURVEILLANCE

AND RESPONSE (MPDSR) IN ADAMAWA STATE

PRESENTED TO;

THE HON. COMMISSIONER FOR HEALTH

(DR. FATIMA ATIKU ABUBAKAR)

BY

MPDSR STATE STEERING COMMITTEE

12th April, 2018

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2017 ANNUAL REPORT ON MATERNAL AND PERINATAL DEATH

SURVEILLANCE AND RESPONSE (MPDSR) ACTIVITIES IN ADAMAWA

STATE

Introduction

Maternal and Perinatal Deaths in Nigeria is continually increasing with maternal

mortality ratio of 545/100,000 live births (NDHS 2008) and 576/100,000 live births

(NDHS 2013). In 2010, a WHO survey showed that Nigeria had the second highest

number of annual maternal death rates after India. Nigeria has 14% of the global

maternal deaths despite contributing to only 2% of the global population.

Adamawa State has a maternal mortality ratio of 848/100,000 live births way above

the National average of 576/100,000 live births with fertility rate of 5.8 and

contraceptive use of 4% (NDHS 2013). The State MPDSR Committee reported 78,222

total deliveries in 2016 with Perinatal Mortality Rate (PMR) of 24.5/1000 deliveries

and Maternal Mortality Ratio (MMR) 207.1/100,000 live births. The Annual Report

for 2017 (DHIS/MPDSR, 2017) showed 458 maternal deaths with MMR of

340/100,000 and 2,597 perinatal deaths with PMR of 19/1,000 deliveries.

Methods Employed by the Committee to Achieve Results

Since Inauguration in 2016, a lot has been achieved and some of the activities and

methods used to achieve results during the year 2017 includes;

1. Four days Scale up Training of 16 Secondary/Tertiary Health Facilities in

the State.

Four (4) days Training of 16 Secondary/Tertiary Health Facilities in the State was

conducted on the 20th – 23rd September, 2017 and it was funded by UNFPA. The

purpose was to facilitate a training workshop on Maternal and Perinatal Death

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Surveillance and Response (MPDSR); to equip health workers in Secondary/Tertiary

health facilities in the State with skills to efficiently provide notification of maternal

and perinatal death and causes of death in the Secondary/Tertiary facilities in

Adamawa State.

During the training, 64 participants were targeted (64 attended) comprising of

Principal Medical Officers, Head of Maternity, Head of MCH and Record Officers

from the 16 secondary health care facilities namely; Federal Medical Centre Yola,

State Specialist Hospital, General Hospitals Mubi, Numan, Ganye, Garkida, Michika,

Gulak, Hong, Mayo-belwa, Song, Guyuk, Fufore, Toungo, Jada and Maiha were the

facilities trained in the State.

Group picture of participants and facilitators after the 4-day training

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Picture of participants during the training in hall one

2. Refresher Training of Health Workers from 226 PHCs of the 21 LGAs in

the State

Two (2) days Maternal and Perinatal Death Surveillance and Response (MPDSR)

refresher training was conducted in October 23rd to 31st, 2017 in all the 21 LGAs. The

refresher training which was funded by EU-UNICEF, was organized by the State

Ministry of Health (SMoH) to refresh the capacity of participants earlier trained so as to

notify and collect accurate data on all maternal and perinatal deaths, analyze and interpret

data collected, use the data to make evidence-based recommendations for action to

decrease maternal and perinatal mortality in Adamawa State.

A total of 904 Health Workers (Facility Managers, Head of MCH, Record officers and

one other Staff) were trained in all the 226 Political wards of the State. At the end of the

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training, participants’ skills on all key aspects of the MPDSR national guideline as it

pertained to reporting using the data tools, systems building, technical capacity was

strengthened and enhanced.

Group picture of participants and facilitators in Ganye LGA

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Group picture of facilitators during the 2-day refresher training in Lamurde LGA

Mr. Solomon (Dir. Nursing) facilitating in Song LGA during the refresher training

3. Monthly MPDSR Review Meeting in all the 21 LGAs of Adamawa State

The monthly review meeting is a qualitative, in-depth investigation into the causes of,

and circumstances surrounding maternal and perinatal deaths which occur in health

care facilities. Recorded information and interviews conducted to re-create and

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understand the series of events that occur leading to a maternal or perinatal death, with

a view to identifying avoidable and remediable factors that will prevent maternal and

perinatal deaths and improve maternal and perinatal health in future. The state

MPDSR committee has conducted LGA monthly review meetings for three months

supported by EU-UNICEF where all the 904 Health Workers trained on MPDSR

during the Refresher training come together for a review meeting at the LGA

headquarters. The monthly review meeting at LGAs was done in the presence of state

supervisors who are members of the MPDSR state steering committee. Reports gotten

from the PHCs were being reviewed and corrections made during the meetings and it

was a success.

Mr. Mike (Coordinator SFH) addressing health workers in Mubi North LGA

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Dr. Bwalki reviewing report at Demsa MPDSR LGA meeting

4. Monthly MPDSR Meetings at Secondary/Tertiary Health Care Facilities

The 16 Secondary/Tertiary Health Care facilities that were trained in September, 2017,

had three meetings i.e for October, November and December, 2017. Principal Medical

Officers of all the facilities are the chairmen of the committee at the facility level. All

maternal and perinatal death cases were audited at the facilities before submitting the

reports to the state MPDSR committee through the secretary. These meetings were

also supported by EU-UNICEF.

5. MPDSR State Steering Committee Monthly Meetings

The state steering committee members conducted series of meetings from July-

December, 2017. Most of the meetings were done to revive the committee which has

gone into silence for long due to secretariat issues and also to make preparations

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concerning the scale up and refresher training that were conducted. The last meeting

was conducted on the 21/12/2017 and the committee reviewed the maternal and

perinatal deaths gotten from State Specialist Hospital Yola, General Hospital Fufore

and Song. PMOs of these three hospitals were invited by the state committee during

the review. The committee reviewed three cases and were able to come up with

contributory factors leading to these deaths in the facilities and recommendations.

Pictures of MPDSR State Steering Committee Monthly Review Meetings

RESULT OF MATERNAL AND PERINATAL DEATH IN ADAMAWA

STATE

In 2017, three thousand and fifty-five (3,055) maternal and perinatal deaths were

recorded (DHIS/MPDSR, 2017). Among these deaths, 458 were maternal deaths with

Mortality ratio of 340/100,000 live births and 2,597 were perinatal deaths with

mortality rate of 19/1,000 deliveries. From the perinatal deaths, 1,585 were Macerated

still births and 514 were fresh still births. Perinatal asphyxia, neonatal sepsis, Jaundice

and neonatal tetanus accounted for 238, 195, 35 and 30 respectively. Overall here,

there is a slight improvement with PMR, however, MMR further peaked. The table

below shows the maternal mortality ratio and perinatal deaths for 2017;

Table 1: Maternal and Perinatal Deaths Reports for 2017

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S/NO 2017 Report Maternal Death/MMR Perinatal

Death/PMR

1 Total Deaths 458 2,597

2 MMR/PMR 340/100,000 LB 19/1,000 Del

MMR= Maternal Mortality Ratio, PMR= Perinatal Mortality Rate, Del= Delivery, LB= Live

Birth. N.B PMR dipped, whereas MMR soar.

Breaking the maternal and perinatal deaths into Quarters showed that, 3rd Quarter,

2017 was with the highest incidence of deaths followed by 1st and 4th Quarter

respectively, (Table 2).

Table 2: Quarterly Reports of Maternal and Perinatal Deaths in 2017

Quarter Maternal

Deaths

Perinatal

Deaths

Total

still birth

Totallive

births

Total

Delivery

1st 108 689 616 37,821 38,437

2nd 65 511 425 31,036 31,461

3rd 204 756 571 32,483 33,054

4th 81 641 487 33,452 33,939

Total 458 2,597 2,099 134,792 136,891

MMR 340/100,000 LB 19/1,000 Del

MMR= Maternal Mortality Ratio, Del= Deliveries, LB= Live birth

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Reports from the Steering Committee shows that, Anaemia in pregnancy was the

leading cause of maternal deaths with a total of 29 deaths followed by Haemorrhage

17. Prolonged/Obstructed labour was the least cause of death with a total of 3 cases

(Fig. 2). Intrauterine Foetal Death (IUFD) with unknown reason was the highest cause

of perinatal deaths with a total number of 164 deaths followed by

prolonged/obstructed labour 68 and Perinatal Asphyxia, 67. Neonatal tetanus and

Abruption placenta recorded 1 cause of deaths which were the least during the year

under review (Fig. 1).

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Graphical Presentation;

Fig. 1. Causes of Perinatal deaths

Total Death 420

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Fig. 2. Causes of Maternal deaths

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4th Quarter, 2017 Facility Reports

Reports from the 16 Secondary Health care facilities shows that, Mubi and Fufore

General Hospital has the highest perinatal mortality with a total death of 93 and 57

respectively. For maternal deaths, General Hospital Mubi (7) and State Specialist

Hospital (6) recorded the highest deaths while General Hospital Michika recorded 0

maternal death in the Quarter (Fig. 3).

2 5 1 1 2 1 3 1 1 0 3 2 6 4 4 70 2 3 4 5 6 7 7 7

15 17 19

34 36

57

93

Secondary Health Care Facilities 4th Quarter Report

Total Maternal 43 Total Perinatal 315

Fig. 3. Secondary health care facility 4th quarter, 2017 report

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From the 226 PHCs that were trained and are reporting, report of perinatal death from

the 21 LGAs showed highest rates in Guyuk (21), Shelleng (20), Ganye (19) and Hong

(18). Hong and Gombi recorded the highest number of maternal deaths which were

15 and 10 respectively.

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Primary Health Care Facilities Nov. 2017 – Jan. 2018 Report

Total Maternal 54 Total Perinatal 178

Fig. 4. Primary health care facility 4th quarter, 2017 LGA report

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Contributory Factors to Maternal and Perinatal Death in Adamawa State

1. Inadequate number of Skilled Manpower in the Health Facilities

2. Ineffective blood bank services in the hospitals

3. Passive attendance to ANC services by Pregnant mothers and service providers

4. Delayed hospital presentation and sometimes delay in initiating care at the

facilities

5. Lack of New born care skill services such as helping baby breech (HBB) and

other essential New born care services

6. Poverty

Challenges

1. Not all facilities were trained on MPDSR and therefore, reports generated does

not cover the entire state.

2. Inadequate deployment of tools early enough for MPDSR data capture in

facilities.

3. Lack of financial support for LGA MCH directors to monitor facilities reporting

on MPDSR.

Recommendations

1. As a matter of urgency, the State Ministry of Health through the Hon.

Commissioner should initiate the process of employment through recruitment

by the state government, recruiting voluntary services from the institution

producing health man power e.g. those awaiting result and retired but active

health care workers. Partnership with other Health Facilities with more number

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of Health Workers and also allocating health care man power from where there

is low incidence of deaths to facilities with high incidences. The committee will

ask for progress report in this regards by the end of 2018.

2. The director laboratory services from the ministry of health and hospital service

management board should liaise with the Hon. Commissioner and chairman

H.S.M.B. within 6 months towards initiating the process of providing effective

blood bank services in the hospitals. A round table meeting with Haematologist

towards improving hospital blood bank services in the state should also be held.

3. The Hon. Commissioner should mandate the directors of public health from the

ministry and community health from the agency to carry out mass education

campaign on the need for pregnant women to attend ANC services and relevant

health needs to the grass roots through the media houses. This advocacy should

be conducted within 6 months.

4. State Ministry of Health through the director planning should liaise with

relevant stakeholders within 6 months on the scale up training of Health

workers on Emergency Obstetric and new born care services.

5. The Hon. Commissioner and executive secretary ADSPHCDA should liaise

with poverty alleviation agency and other partners to carry out mass education

and sensitization of grass root population. Train women or intending mothers

on trade and small scale businesses within one year.

6. The ministry of health through the director planning should ensure biannual

monitoring of facilities with the state MPDSR committee and quarterly

monitoring by the LGA directors of MCH.

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7. The ministry of health through the Hon. Commissioner should establish

community health insurance plat form to address the issue of delay from home

and in initiating care at the facility.

8. The Hospital Service Management Board should within one year conduct

managerial business training to principal medical officers (PMO) aimed at

opening their horizon on how to create and maximized profit from the little

resources generated in the facility. This can be done through a consortium of

experts in the field.

Conclusion

The committee wishes to thank the Hon. Commissioner of health, executive secretary

ADSPHCDA, chair H.S.M.B. and partners particularly EU-UNICEF and UNFPA for

their support towards the success of the committee and in reducing maternal and

perinatal deaths in the state.