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Article ; Online: Outcome of interventions to improve the quality of intrapartum care in Nigeria's referral hospitals: a quasi-experimental research design.

Okonofua, Friday / Ntoimo, Lorretta Favour / Ekezue, Bola / Ohenhen, Victor / Agholor, Kingsley / Imongan, Wilson / Ogu, Rosemary / Galadanci, Hadiza

BMC pregnancy and childbirth

2023 Volume 23, Issue 1, Page(s) 614

Abstract: Background: Evidence indicates that Nigeria's high maternal mortality rate is attributable primarily to events that occur during the intrapartum period. This study determines the effectiveness of multifaceted interventions in improving the quality of ... ...

Abstract	Background: Evidence indicates that Nigeria's high maternal mortality rate is attributable primarily to events that occur during the intrapartum period. This study determines the effectiveness of multifaceted interventions in improving the quality of intrapartum care in Nigeria's referral hospitals. Methods: Data collected through an exit interview with 752 women who received intrapartum care in intervention and control hospitals were analyzed. The interventions were designed to improve the quality indicators in the WHO recommendations for positive childbirth and assessed using 12 quality indicators. Univariate, bivariate, Poisson, and logistic regression analyses were used to compare twelve quality indicators at intervention and control hospitals. Results: The interventions showed a 6% increase in composite score of quality of care indicators at intervention compared with control hospitals. Five signal functions of intrapartum care assessed were significantly (< 0.001) better at intervention hospitals. Quality scores for segments of intervention periods compared to baseline were higher at intervention than in control hospitals. Conclusions: We conclude that multiple interventions that address various components of the quality of intrapartum care in Nigeria's referral hospitals have demonstrated effectiveness. The interventions improved five of ten quality indicators. We believe that this approach to developing interventions based on formative research is important, but a process of integrating the implementation activities with the normal maternal health delivery processes in the hospitals will enhance the effectiveness of this approach. Trial registration: The study was registered at the Nigeria Clinical Trials Registry. Trial Registration Number NCTR No: 91,540,209 (14/04/2016) http://www.nctr.nhrec.net/ and retrospectively with the ISRCTN. Trial Registration Number 64 ISRCTN17985403 (14/08/2020) https://doi.org/10.1186/ISRCTN17985403 .
MeSH term(s)	Female ; Humans ; Pregnancy ; Hospitals ; Nigeria ; Referral and Consultation ; Research Design ; Retrospective Studies
Language	English
Publishing date	2023-08-26
Publishing country	England
Document type	Clinical Trial ; Journal Article
ZDB-ID	2059869-5
ISSN	1471-2393 ; 1471-2393
ISSN (online)	1471-2393
ISSN	1471-2393
DOI	10.1186/s12884-023-05893-y
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Article ; Online: Outcomes of a multifaceted intervention to prevent eclampsia and eclampsia-related deaths in Nigerian referral facilities.

Okonofua, Friday / Ekezue, Bola F / Ntoimo, Lorretta Favour / Ohenhen, Victor / Agholor, Kingsley / Imongan, Wilson / Ogu, Rosemary / Galadanci, Hadiza

International health

2023 Volume 16, Issue 3, Page(s) 293–301

Abstract: Background: Eclampsia causes maternal mortality in Nigeria. This study presents the effectiveness of multifaceted interventions that addressed institutional barriers in reducing the incidence and case fatality rates associated with eclampsia.: Methods! ...

Abstract	Background: Eclampsia causes maternal mortality in Nigeria. This study presents the effectiveness of multifaceted interventions that addressed institutional barriers in reducing the incidence and case fatality rates associated with eclampsia. Methods: The design was quasi-experimental and the activities implemented at intervention hospitals included a new strategic plan, retraining health providers on eclampsia management protocols, clinical reviews of delivery care and educating pregnant women and their partners. Prospective data were collected monthly on eclampsia and related indicators from study sites over 2 y. The results were analysed by univariate, bivariate and multivariable logistic regression. Results: The results show a higher eclampsia rate (5.88% vs 2.45%) and a lower use of partograph and antenatal care (ANC; 17.99% vs 23.42%) in control compared with intervention hospitals, but similar case fatality rates of <1%. Overall, adjusted analysis shows a 63% decrease in the odds of eclampsia at intervention compared with control hospitals. Factors associated with eclampsia were ANC, referral for care from other facilities and older maternal age. Conclusion: We conclude that multifaceted interventions that address challenges associated with managing pre-eclampsia and eclampsia in health facilities can reduce eclampsia occurrence in referral facilities in Nigeria and potential eclampsia death in resource-poor African countries.
MeSH term(s)	Humans ; Female ; Eclampsia/prevention & control ; Eclampsia/mortality ; Pregnancy ; Nigeria/epidemiology ; Adult ; Prenatal Care/methods ; Maternal Mortality/trends ; Referral and Consultation/statistics & numerical data ; Young Adult ; Prospective Studies ; Adolescent
Language	English
Publishing date	2023-06-29
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2526175-7
ISSN	1876-3405 ; 1876-3413
ISSN (online)	1876-3405
ISSN	1876-3413
DOI	10.1093/inthealth/ihad044
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Article ; Online: Assessment of service readiness for maternity care in primary health centres in rural Nigeria: implications for service improvement.

Ntoimo, Lorretta Favour Chizomam / Ogungbangbe, Julius / Imongan, Wilson / Yaya, Sanni / Okonofua, Friday Ebhodaghe

The Pan African medical journal

2021 Volume 40, Page(s) 151

Abstract: Introduction: several scientific reports from studies across Nigeria revealed a higher incidence of maternal mortality in rural parts of the country as compared to the urban areas. Part of the reasons is the paucity of health care infrastructure and ... ...

Abstract	Introduction: several scientific reports from studies across Nigeria revealed a higher incidence of maternal mortality in rural parts of the country as compared to the urban areas. Part of the reasons is the paucity of health care infrastructure and personnel. This study was designed as part of an intervention program with the goal to improve the access of pregnant women to skilled pregnancy care in rural Nigeria. The specific objective of the study was to determine the nature and readiness of Primary Health Centres (PHCs) in two Local Government Areas (LGAs) in rural parts of Edo State, Southern Nigeria to deliver effective maternal and child health services. Methods: the study was conducted in 12 randomly selected PHCs in the two LGAs. Data were obtained with a semi-structured questionnaire administered on health workers and through direct observation and verification of the facilities in the PHCs. The results obtained were compared with the national standards established for PHCs in Nigeria by the National Primary Health Care Development Agency (NPHCDA). Descriptive statistics were used to analyze the data. Results: the results showed severe deficits in buildings and premises, rooms, medical equipment, essential drugs, and personnel. Only 40% of items recommended by the NPHCDA were available for buildings; 41% of the PHCs had facilities available in the labour ward; while less than 30% had the recommended facilities in the antenatal care rooms. Only one PHC had a laboratory space, with only one item (a dipstick for urine analysis) identified in the laboratory. None of the PHCs had ambulances, mobile phones, internet or computers. There was no nurse/midwife in 4 PHCs; only one nurse/midwife each were available in 8 PHCs; while there was no Environmental/Medical Records Officer in any PHC. About 26% of the essential drugs were not available in the PHCs. Conclusion: we conclude that PHCs in Edo State, Nigeria have severe deficits in infrastructural facilities, equipment, essential drugs and personnel for the delivery of maternal and child health care. Efforts to improve these facilities will help increase the quality of delivery of maternal and child health, and therefore reduce maternal and child mortality in the country.
MeSH term(s)	Child ; Cross-Sectional Studies ; Female ; Health Facilities ; Health Services Accessibility ; Humans ; Maternal Health Services ; Nigeria ; Pregnancy
Language	English
Publishing date	2021-11-11
Publishing country	Uganda
Document type	Journal Article
ZDB-ID	2514347-5
ISSN	1937-8688 ; 1937-8688
ISSN (online)	1937-8688
ISSN	1937-8688
DOI	10.11604/pamj.2021.40.151.25976
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Article ; Online: Perspectives of policymakers and health providers on barriers and facilitators to skilled pregnancy care: findings from a qualitative study in rural Nigeria.

Udenigwe, Ogochukwu / Okonofua, Friday E / Ntoimo, Lorretta F C / Imongan, Wilson / Igboin, Brian / Yaya, Sanni

BMC pregnancy and childbirth

2021 Volume 21, Issue 1, Page(s) 20

Abstract: Background: The uptake of skilled pregnancy care in rural areas of Nigeria remains a challenge amid the various strategies aimed at improving access to skilled care. The low use of skilled health care during pregnancy, childbirth and postpartum ... ...

Abstract	Background: The uptake of skilled pregnancy care in rural areas of Nigeria remains a challenge amid the various strategies aimed at improving access to skilled care. The low use of skilled health care during pregnancy, childbirth and postpartum indicates that Nigerian women are paying a heavy price as seen in the country's very high maternal mortality rates. The perceptions of key stakeholders on the use of skilled care will provide a broad understanding of factors that need to be addressed to increase women's access to skilled pregnancy care. The objective of this study was therefore, to explore the perspectives of policymakers and health workers, two major stakeholders in the health system, on facilitators and barriers to women's use of skilled pregnancy care in rural Edo State, Nigeria. Methods: This paper draws on qualitative data collected in Edo State through key informant interviews with 13 key stakeholders (policy makers and healthcare providers) from a range of institutions. Data was analyzed using an iterative process of inductive and deductive approaches. Results: Stakeholders identified barriers to pregnant women's use of skilled pregnancy care and they include; financial constraints, women's lack of decision-making power, ignorance, poor understanding of health, competitive services offered by traditional birth attendants, previous negative experience with skilled healthcare, shortage of health workforce, and poor financing and governance of the health system. Study participants suggested health insurance schemes, community support for skilled pregnancy care, favourable financial and governance policies, as necessary to facilitate women's use of skilled pregnancy care. Conclusions: This study adds to the literature, a rich description of views from policymakers and health providers on the deterrents and enablers to skilled pregnancy care. The views and recommendations of policymakers and health workers have highlighted the importance of multi-level factors in initiatives to improve pregnant women's health behaviour. Therefore, initiatives seeking to improve pregnant women's use of skilled pregnancy care should ensure that important factors at each distinct level of the social and physical environment are identified and addressed.
MeSH term(s)	Attitude of Health Personnel ; Clinical Competence ; Female ; Health Personnel/statistics & numerical data ; Health Policy ; Health Services Accessibility/statistics & numerical data ; Humans ; Insurance, Health ; Maternal Death/statistics & numerical data ; Maternal Health Services/economics ; Maternal Health Services/statistics & numerical data ; Midwifery/economics ; Midwifery/statistics & numerical data ; Nigeria ; Pregnancy ; Prenatal Care/economics ; Qualitative Research ; Rural Population/statistics & numerical data ; Women's Rights/economics
Language	English
Publishing date	2021-01-06
Publishing country	England
Document type	Journal Article
ISSN	1471-2393
ISSN (online)	1471-2393
DOI	10.1186/s12884-020-03493-8
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Article ; Online: "We have either obsolete knowledge, obsolete equipment or obsolete skills": policy-makers and clinical managers' views on maternal health delivery in rural Nigeria.

Udenigwe, Ogochukwu / Okonofua, Friday E / Ntoimo, Lorretta F C / Imongan, Wilson / Igboin, Brian / Yaya, Sanni

Family medicine and community health

2021 Volume 9, Issue 3

Abstract: Objective: The objective of this paper is to explore policy-makers and clinical managers' views on maternal health service delivery in rural Nigeria.: Design: This is a qualitative study using key informant interviews. Participants' responses were ... ...

Abstract	Objective: The objective of this paper is to explore policy-makers and clinical managers' views on maternal health service delivery in rural Nigeria. Design: This is a qualitative study using key informant interviews. Participants' responses were audio recorded and reflective field notes supplemented the transcripts. Data were further analysed with a deductive approach whereby themes were organised based on existing literature and theories on service delivery. Setting: The study was set in Esan South East (ESE) and Etsako East (ETE), two mainly rural local government areas of Edo state, Nigeria. Participants: The study participants consisted of 13 key informants who are policy-makers and clinical managers in ESE and ETE in Edo state. Key informants were chosen using a purposeful criterion sampling technique whereby participants were identified because they meet or exceed a specific criterion related to the subject matter. Results: Respondents generally depicted maternal care services in primary healthcare centres as inaccessible due to undue barriers of cost and geographic location but deemed it acceptable to women. Respondents' notion of quality of service delivery encompassed factors such as patient-provider relationships, hygienic conditions of primary healthcare centres, availability of skilled healthcare staff and infrastructural constraints. Conclusion: This study revealed that while some key aspects of service delivery are inadequate in rural primary healthcare centres, there are promising policy reforms underway to address some of the issues. It is important that health officials advocate for strong policies and implementation strategies.
MeSH term(s)	Female ; Humans ; Maternal Health ; Maternal Health Services ; Nigeria ; Policy ; Pregnancy ; Rural Population
Language	English
Publishing date	2021-08-03
Publishing country	England
Document type	Journal Article
ZDB-ID	2986753-8
ISSN	2009-8774 ; 2305-6983
ISSN (online)	2009-8774
ISSN	2305-6983
DOI	10.1136/fmch-2021-000994
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Article ; Online: Effect of a multifaceted intervention on the utilisation of primary health for maternal and child health care in rural Nigeria: a quasi-experimental study.

Okonofua, Friday / Ntoimo, Lorretta Favour / Yaya, Sanni / Igboin, Brian / Solanke, Ojuolape / Ekwo, Chioma / Johnson, Ermel Ameswue Kpogbe / Sombie, Issiaka / Imongan, Wilson

BMJ open

2022 Volume 12, Issue 2, Page(s) e049499

Abstract: Objective: The objective of this study was to determine the effectiveness of a set of multifaceted interventions designed to increase the access of rural women to antenatal, intrapartum, postpartum and childhood immunisation services offered in primary ... ...

Abstract	Objective: The objective of this study was to determine the effectiveness of a set of multifaceted interventions designed to increase the access of rural women to antenatal, intrapartum, postpartum and childhood immunisation services offered in primary healthcare facilities. Design: The study was a separate sample pretest-post-test quasi-experimental research. Setting: The research was conducted in 20 communities and primary health centres in Esan South East and Etsako East Local Government Areas in Edo State in southern Nigeria PARTICIPANTS: Randomly selected sample of ever married women aged 15-45 years. Interventions: Seven community-led interventions implemented over 27 months, consisting of a community health fund, engagement of transport owners on emergency transport of pregnant women to primary health centres with the use of rapid short message service (SMS), drug revolving fund, community education, advocacy, retraining of health workers and provision of basic equipment. Primary and secondary outcome measures: The outcome measures included the number of women who used the primary health centres for skilled pregnancy care and immunisation of children aged 0-23 months. Results: After adjusting for clustering and confounding variables, the odds of using the project primary healthcare centres for the four outcomes were significantly higher at endline compared with baseline: antenatal care (OR 3.87, CI 2.84 to 5.26 p<0.001), delivery care (OR 3.88, CI 2.86 to 5.26), postnatal care (OR 3.66, CI 2.58 to 5.18) and childhood immunisation (OR 2.87, CI 1.90 to 4.33). However, a few women still reported that the cost of services and gender-related issues were reasons for non-use after the intervention. Conclusion: We conclude that community-led interventions that address the specific concerns of women related to the bottlenecks they experience in accessing care in primary health centres are effective in increasing demand for skilled pregnancy and childcare in rural Nigeria.
MeSH term(s)	Adolescent ; Adult ; Child Health ; Female ; Humans ; Infant ; Infant, Newborn ; Maternal Health Services ; Middle Aged ; Nigeria ; Pregnancy ; Pregnant Women ; Prenatal Care ; Rural Population ; Young Adult
Language	English
Publishing date	2022-02-08
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2021-049499
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Article ; Online: Texting for life: a mobile phone application to connect pregnant women with emergency transport and obstetric care in rural Nigeria.

Okonofua, Friday / Ntoimo, Lorretta / Johnson, Ermel / Sombie, Issiaka / Ojuolape, Solanke / Igboin, Brian / Imongan, Wilson / Ekwo, Chioma / Udenigwe, Ogochukwu / Yaya, Sanni / Wallis, Anne B / Adeniran, Joy

BMC pregnancy and childbirth

2023 Volume 23, Issue 1, Page(s) 139

Abstract: Background: Difficulty in transportation to access skilled providers has been cited repeatedly as a major barrier to utilization of emergency obstetric care in Nigeria.: Objective: The objective of this paper is to describe the design, implementation, ...

Abstract	Background: Difficulty in transportation to access skilled providers has been cited repeatedly as a major barrier to utilization of emergency obstetric care in Nigeria. Objective: The objective of this paper is to describe the design, implementation, and outcomes of a mobile phone technology aimed at rapidly reaching rural Nigerian women who experience pregnancy complications with emergency transportation and access to providers. Method: The project was implemented in 20 communities in two predominantly rural Local Government Areas (LGAs) of Edo State, in southern Nigeria, as part of a larger implementation project aimed at improving the access of rural women to skilled pregnancy care. The digital health innovation named Text4Life, allowed women to send a brief message from their mobile phone to a server linked to Primary Health Care (PHC) facilities and to access pre-registered transport owners. Pregnant women were registered and taught to text short messages to a server from their mobile phones or those of a friend or relative when they experience complications. Results: Over 18 months, 56 women out of 1620 registered women (3.5%) texted the server requesting emergency transportation. Of this number, 51 were successfully transported to the PHC facilities, 46 were successfully treated at the PHC, and five were referred to higher-level care facilities. No maternal deaths occurred during the period, while four perinatal deaths were recorded. Conclusion: We conclude that a rapid short message sent from a mobile phone to a central server and connected to transport providers and health facility managers is effective in increasing the access of pregnant women to skilled emergency obstetric services in rural Nigeria.
MeSH term(s)	Pregnancy ; Female ; Humans ; Text Messaging ; Pregnant Women ; Nigeria ; Cell Phone ; Telephone
Language	English
Publishing date	2023-03-08
Publishing country	England
Document type	Journal Article
ZDB-ID	2059869-5
ISSN	1471-2393 ; 1471-2393
ISSN (online)	1471-2393
ISSN	1471-2393
DOI	10.1186/s12884-023-05424-9
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Article ; Online: Why women utilize traditional rather than skilled birth attendants for maternity care in rural Nigeria: Implications for policies and programs.

Ntoimo, Lorretta Favour Chizomam / Okonofua, Friday Ehbodaghe / Ekwo, Chioma / Solanke, Tosin Ojuolape / Igboin, Brian / Imongan, Wilson / Yaya, Sanni

Midwifery

2021 Volume 104, Page(s) 103158

Abstract: Objective: Data from the Nigeria Demographic and Health Survey indicate that many pregnant women in rural Nigeria use traditional birth attendants (TBAs) rather than skilled birth attendants (SBAs) for maternal health care. This is one factor that ... ...

Abstract	Objective: Data from the Nigeria Demographic and Health Survey indicate that many pregnant women in rural Nigeria use traditional birth attendants (TBAs) rather than skilled birth attendants (SBAs) for maternal health care. This is one factor that accounts for the persistently high rate of maternal mortality in Nigeria. The objective of this study was to identify the pervading reasons that women use TBAs for pregnancy care in rural Nigeria and to make recommendations for policy and programmatic reform. Design: Qualitative research design consisting of focus group discussions, key informant interviews, and community conversations, followed by inductive thematic analysis. Setting: Twenty rural communities (villages) in Etsako East, and Esan South East Local Government Areas of Edo State, South-South, Nigeria. Participants: Twenty focus group discussions with men and women in a marital union; 15 key informant interviews with policymakers, senior health providers, and women leaders; and 10 community conversations with key community leaders. Findings: Some reasons proffered for using TBAs included perceptions of higher efficacy of traditional medicines; age-long cultural practices; ease of access to TBAs as compared to SBAs; higher costs of services in health facilities; and friendly attitude of TBAs. Key conclusions and implications for practice: The continued use of TBA is a major challenge in efforts to achieve the Sustainable Development Goal 3 in Nigeria. We conclude that efforts to address the factors identified by community stakeholders as inhibiting the use of SBAs will promote skilled birth attendance and reduce maternal mortality in rural Nigeria.
MeSH term(s)	Female ; Humans ; Male ; Maternal Health Services ; Midwifery ; Nigeria ; Policy ; Pregnancy ; Rural Population
Language	English
Publishing date	2021-10-07
Publishing country	Scotland
Document type	Journal Article
ZDB-ID	1036567-9
ISSN	1532-3099 ; 0266-6138
ISSN (online)	1532-3099
ISSN	0266-6138
DOI	10.1016/j.midw.2021.103158
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Article ; Online: Why rural women do not use primary health centres for pregnancy care: evidence from a qualitative study in Nigeria.

Ntoimo, Lorretta Favour C / Okonofua, Friday E / Igboin, Brian / Ekwo, Chioma / Imongan, Wilson / Yaya, Sanni

BMC pregnancy and childbirth

2019 Volume 19, Issue 1, Page(s) 277

Abstract: Background: While Primary Health Care has been designed to provide universal access to skilled pregnancy care for the prevention of maternal deaths in Nigeria, available evidence suggests that pregnant women in rural communities often do not use Primary ...

Abstract	Background: While Primary Health Care has been designed to provide universal access to skilled pregnancy care for the prevention of maternal deaths in Nigeria, available evidence suggests that pregnant women in rural communities often do not use Primary Health Care Centres for skilled care. The objective of this study was to investigate the reasons why women do not use PHC for skilled pregnancy care in rural Nigeria. Methods: Qualitative data were obtained from twenty focus group discussions conducted with women and men in marital union to elicit their perceptions about utilisation of maternal and child health care services in PHC centres. Groups were constituted along the focus of sex and age. The group discussions were tape-recorded, transcribed verbatim and analyzed thematically. Results: The four broad categories of reasons for non-use identified in the study were: 1) accessibility factors - poor roads, difficulty with transportation, long distances, and facility not always open; 2) perceptions relating to poor quality of care, including inadequate drugs and consumables, abusive care by health providers, providers not in sufficient numbers and not always available in the facilities, long waiting times, and inappropriate referrals; 3) high costs of services, which include the inability to pay for services even when costs are not excessive, and the introduction of informal payments by staff; and 4) Other comprising partner support and misinterpretation of signs of pregnancy complications. Conclusion: Addressing these factors through adequate budgetary provisions, programs to reduce out-of-pocket expenses for maternal health, adequate staffing and training, innovative methods of transportation and male involvement are critical in efforts to improve rural women's access to skilled pregnancy care in primary health care centres in the country.
MeSH term(s)	Adult ; Ambulatory Care Facilities ; Birth Setting ; Facilities and Services Utilization ; Female ; Focus Groups ; Health Care Costs ; Health Services Accessibility ; Humans ; Male ; Maternal Health Services ; Middle Aged ; Midwifery ; Nigeria ; Pregnancy ; Primary Health Care ; Qualitative Research ; Quality of Health Care ; Rural Population ; Transportation
Language	English
Publishing date	2019-08-05
Publishing country	England
Document type	Journal Article
ZDB-ID	2059869-5
ISSN	1471-2393 ; 1471-2393
ISSN (online)	1471-2393
ISSN	1471-2393
DOI	10.1186/s12884-019-2433-1
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Article: Effects of multifaceted interventions to prevent and manage primary postpartum haemorrhage in referral hospitals: a quasi-experimental study in Nigeria.

Okonofua, Friday Ebhodaghe / Ekezue, Bola / Ntoimo, Lorretta Favour Chizomam / Ekwo, C / Ohenhen, V / Agholor, K / Igboin, Brian / Imongan, Wilson / Galadanci, H / Ogu, R

BMJ global health

2022 Volume 7, Issue 4

Abstract: Introduction: Primary postpartum haemorrhage (PPH) is the leading cause of Nigeria's high maternal mortality rate. This study investigated the effectiveness of a set of multifaceted interventions to manage and reduce PPH in selected secondary referral ... ...

Abstract	Introduction: Primary postpartum haemorrhage (PPH) is the leading cause of Nigeria's high maternal mortality rate. This study investigated the effectiveness of a set of multifaceted interventions to manage and reduce PPH in selected secondary referral health facilities in Nigeria. Methods: This is a quasi-experimental study using an interrupted time-series design to assess a set of multifaceted interventions that address factors identified by stakeholders as associated with PPH. Interventions were implemented at two regional general hospitals, with a general hospital in the same region as the control. Intervention participants were women during antepartum and clinical and administrative staff. Cases of PPH were determined in women at delivery. The outcomes measured were the incidence of primary PPH and related deaths during the study period. Analyses included a comparative description of characteristics of the women, trend of time-series data at intervention and control hospitals, and multivariable analysis of factors associated with PPH occurrence. Results: Monthly numbers of primary PPH were collected at participating hospitals over 21 months for 18 181 women. Intervention hospitals represent 54% vs 46% in control hospitals. Time-series analyses show a significant downward trend in intervention hospitals. The overall incidence of primary PPH was lower in the intervention hospitals than in the control hospitals. Multilevel regression adjusted for hospital-level effect showed a 68% reduction in odds of PPH cases at intervention compared with control hospitals. There were 12 PPH-related maternal deaths in one of the control hospitals, with no deaths in the intervention hospitals. Conclusion: We conclude that multiple interventions that address identified challenges in the prevention of primary PPH can potentially effectively reduce reported primary PPH in Nigerian referral hospitals. This approach is relevant for scaling the development of policies and programmes to prevent primary PPH and maternal mortality in Nigeria.
MeSH term(s)	Female ; Hospitals ; Humans ; Male ; Maternal Mortality ; Nigeria/epidemiology ; Postpartum Hemorrhage/epidemiology ; Postpartum Hemorrhage/prevention & control ; Pregnancy ; Referral and Consultation
Language	English
Publishing date	2022-04-20
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2059-7908
ISSN	2059-7908
DOI	10.1136/bmjgh-2021-007779
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