A health systems' perspective of maternal deaths: a five-year review in Muhammad Abdullahi Wase Teaching Hospital, Kano

Nigeria is the third ranking country with the highest maternal mortality indices, with a lopsided distribution tilting to Northern Nigeria. Kano is amongst the states with the highest maternal mortality in the country. Despite all efforts by the government and various nongovernmental organizations at curbing maternal deaths, we are still a far cry from the ideal. This study was conducted to identify health system related factors that significantly contribute to maternal mortality in our centre. Case folders, maternal and perinatal death surveillance and response records were reviewed to identify health services related factors contributing to maternal mortality in our institution. A total of 21,108 deliveries was recorded over the study period, out of these, there were 17,867 live births. One hundred and sixty-eight women died from pregnancy related events, thus a maternal mortality ratio of 940/105 live births. Identified factors were booking status, condition on admission and types 3 and 4 delays. The unbooked/booked elsewhere accounted for 151 (89.9%), while critical patients for 160 (95.2%) and types III and IV delays for 117 (69.6%). More than 70% of the referrals were from primary health centres, 73.5% of which were booked there. In-facility delay was mostly due to anaesthesia-related complications, 12 (48%). There is a need to fully equip peripheral hospitals, address delays in referrals of patients and for regulatory bodies to check the activities of primary healthcare givers. Residency training in anaesthesiology should be commenced in the state. Generally, there needs to be a more proactive change in emergency responsiveness across all the levels of healthcare delivery within the state.