maternal mortality rate in nigeria by states
Water source was classified as improved or unimproved depending on whether there was a natural construction or a deliberate intervention to protect it from outside contamination. Lancet. One of the major contributing factors to this prevalence is the slow progress being made in the region in solving this problem. Media exposure and education were associated with maternal mortality in the North while contraceptive method, residence type and wealth index were associated with maternal death in the South. Pan Afr Med J. African Field Epidemiology Network. The information obtained is based on respondents’ knowledge of sibling’s pregnancy status. PubMed Central For instance, Borno state capital received several internally displaced persons while one of its prominent health facilities recorded 76 maternal deaths within 6 months in 2009 . In terms of the probability of childhood mortality, women in the North experience higher levels and have a higher likelihood of having experienced previous childhood mortality than their southern counterparts . When women deliver with no one present in Nigeria: who, what, where and so what? The 2008 and 2013 Nigeria Demographic and Health Survey datasets used for this study are publicly available through the Measure DHS program https://dhsprogram.com/data/available-datasets.cfm and the formats used in this study are available upon request to the corresponding author. Oxytocin is recommended by W.H.O as the first-line medicine for prevention and treatment of postpartum hemorrhage, is temperature-sensitive medicine and requires refrigeration during transportation and storage. Fagbamigbe AF, Idemudia ES. In the South, the odds of maternal death decreased with increasing age and community wealth. 2016;11:1–11. PLoS One. Secondary or higher education was protective against maternal mortality in the North compared to having no education. Over time, the North saw an increase in the levels of maternal mortality while the South had a minor decrease in its levels. PubMed The causes of maternal death cannot be ascertained using this method or DHS data. Ujah IAO, Aisien OA, Mutihir JT, Vanderjagt DJ, Glew RH, Uguru VE. Overall, the low level of care received by pregnant women in the country is one of the major contributors to the high infant and maternal mortality ratio. Maternal mortality persists in Nigeria despite strategies like the promotion of institutional deliveries, training and deploying new skilled health workers. 2013. PubMed These were contraceptive method used, residence type and wealth. 2016;2:1–10. Article There was limited information obtained from the survey respondents about deceased siblings in the 2008 and 2013 NDHS. It is preventable through the administration of an effective uterotonic to the mother immediately after the birth of her baby. Type of residence was dichotomized as urban or rural. Maternal mortality in 1995: estimates developed by WHO, UNICEF, UNFPA. ... report summarizes the current state of maternal health in Nigeria. Maternal mortality ratio (national estimate, per 100,000 live births) Mortality rate attributed to household and ambient air pollution, age-standardized, male (per 100,000 male population) Prevalence of stunting, height for age, male (% of children under 5) Also, health facilities show similarly high levels of maternal mortality with 927 deaths per 100,000 livebirths reported for 21 health facilities in three states - Katsina (North), Lagos (South) and the Federal Capital territory (North) . 2006;367:1066–74. Afr J Reprod Health. In 2008, Nigeria bore 14% of the global burden of maternal mortality. Adebowale AS, Yusuf BO, Fagbamigbe AF. McCarthy J, Maine D. A framework for analyzing the determinants of maternal mortality. J Biosoc Sci. A framework for analyzing the determinants of obstetric fistula formation. This high level of maternal mortality is also linked to Nigeria’s high rate of deaths for children under 5—newborns account for a quarter of the under-five deaths which occur in the country. Nigeria maternal mortality rate for 2014 was 943.00, a 0.84% decline from 2013. Lancet (London, England). Age was recoded in years and treated as a continuous variable. The mean age of this sample was 30.1 years (Table 1). This study thereby ascribed respondent characteristics to the deceased siblings to allow for comparisons on more determinants of maternal mortality. Adapted framework (McCarthy & Maine) determinants of maternal mortality. In the North, maternal mortality has increased, and this is associated with media exposure and education. Though health disparities exist between the North and South of Nigeria, there is a dearth of evidence on the estimates and determinants of maternal mortality for these regions. Almost all maternal deaths (99%) occur in developing countries. Lancet (London, England). Nonusers may want pregnancies, while users intend to prevent them. A decline in maternal health services could be a probable explanation for the increase in maternal mortality in the North, where women are reported to be less likely to give birth in a health facility than the South . volume 19, Article number: 417 (2019) Wall LL. A response of “no” was coded as 0 and meant disapproval of domestic violence while “yes/don’t know” was coded as 1 and represented approval or lack of knowledge on whether domestic violence was justified. Eboreime E, Abimbola S, Bozzani F. Access to routine immunization: a comparative analysis of supply-side disparities between northern and southern Nigeria. The National Population commission of Nigeria shows the North and South as two distinct regions . Dead mothers and injured wives: the social context of maternal morbidity and mortality among the Hausa of northern Nigeria. Google Scholar. This gap in contraceptive use between the North and South is attributed to socioeconomic and ideational (ideal number of children, awareness of contraceptive method, and self-efficacy) factors . Hence, new and current strategies need to be sensitive to the environmental of the women in the North. It was revealed by Bill Gates, the founder of the Bill and Melinda Gates Foundation that one of the most dangerous places in the world to give birth. Hogan MC, Foreman KJ, Naghavi M, Ahn SY, Wang M, Makela SM, et al. In the North, community wealth, age and social autonomy were negatively associated with maternal mortality. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Estimates of maternal mortality worldwide between 1990 and 2005: an assessment of available data. Department of Epidemiology and Biostatistics, Western University, 1151 Richmond St., London, ON, N6A 5C1, Canada, Catherine Meh, Amardeep Thind, Bridget Ryan & Amanda Terry, Department of Family Medicine, Western University, 1151 Richmond St., London, ON, N6A 5C1, Canada, Amardeep Thind, Bridget Ryan & Amanda Terry, Schulich Interfaculty Program in Public Health, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St., London, ON, N6A 5C1, Canada, You can also search for this author in In Bangladesh, induced abortions were more common among educated women  although the risk of mortality was low for them compared to uneducated women, this may not be the case in the South of Nigeria, where abortion is restricted, and most of its services are illicit and unsafe. It is possible that some deceased siblings had different characteristics compared to those ascribed to them which may lead to the misclassification of their own attributes. PubMed Central Int J Women's Health. The North contributed 32,629 women to the study sample. Maternal mortality adversely affects women, their families and communities. Dove Press. 2006;368:1189–200. A review study of place of delivery in sub-Saharan Africa revealed that women who gave birth at health facilities had a higher risk of maternal death than women who gave birth at home . These should improve education of girls in the North and access to health information and services in the South. Popul Health Metrics. Massachusetts’s maternal mortality rate of 8.4 per 100,000 births makes it the state with the … This can be achieved through innovative means of media communication and new strategies for education which will encourage school attendance in the North. Number of births: 63,178 Death rate: 58.1 per 100,000 births How the state handles it: Louisiana has had a maternal mortality review program since … National estimates for maternal mortality: an analysis based on the WHO systematic review of maternal mortality and morbidity. Maternal mortality was more pronounced in the North and increased in 2013 compared to 2008. Stud Fam Plan. The maternal mortality rate for women aged 40 and over (81.9 per 100,000 live births) is nearly 8 times that for women under age 25 (10.6). PubMed Google Scholar. 2012;43:255–72. Most women (79.4%) had a low or medium level media exposure and a secondary or higher education (57.3%). 2013;8:e59834. The use of contraceptives was higher in the South of the country compared to the North . 2). Most maternal deaths arise from heavy bleeding after birth. WHO. In 2019, neonatal mortality rate for Nigeria was 35.9 deaths per 1,000 live births. Doctor HV, Olatunji A, Findley SE, Afenyadu GY, Abdulwahab A, Jumare A. Maternal mortality in northern Nigeria: findings of a health and demographic surveillance system in Zamfara state, Nigeria. Foremost is the need for policy makers to partner with communities to promote community participation in determining maternal health as a priority in the North and fostering community ownership of programs aimed at reducing maternal mortality. Reports show that non-indigenous health workers fled from conflict zones to safer states while insurgents destroyed and removed medical supplies from health facilities . Using traditional contraceptives may not effectively prevent unwanted pregnancies as much as modern methods would. 2018;38:287–308. Maternal mortality ratio (national estimate, per 100,000 live births) Mortality rate attributed to household and ambient air pollution, age-standardized, male (per 100,000 male population) Prevalence of stunting, height for age, male (% of children under 5) WHO. This included an initial state-wide assessment of maternal mortality rates which identified un-acceptably high rates in the most rural Local Government Areas of the State [6,7]. 2011;3:167–74. 2012;20:104–12. The 3 northern zones (North West, North Central and North East) were classified as North and the rest (South East, South West, and South South) were grouped as South. Oxytocin must be stored in cold storage to remain potent in temperature of between 2°C- 8°C. Stephenson R, Elfstrom KM. Population Council. It is also a widely used framework in studies about factors that affect maternal health [26,27,28]. Overall, new policies to improve women’s socioeconomic status should be adopted. California Privacy Statement, Health Policy Plan. Women may choose traditional/folkloric over modern contraceptives for reasons such as the fear of side effects, which is a known barrier to contraceptive use [52, 53]. Poverty and maternal mortality in Nigeria: towards a more viable ethics of modern medical practice. Other North-South differentials exist in Nigeria. Unwanted pregnancies expose women to unsafe abortions that are linked to maternal deaths. 1) have a more direct influence on maternal mortality while distant determinants impact the outcome by way of their influence on the intermediate factors. Wealthy communities have better access to resources and services compared to poor ones. Maternal mortality is 576/100,000 (NDHIS 2013) and child mortality rate is 103/1000 live births. BMC Pregnancy Childbirth 19, 417 (2019). This means the country has a lifetime risk of maternal death of 4.62 percent. Ager AK, Lembani M, Mohammed A, Mohammed Ashir G, Abdulwahab A, De Pinho H, et al. The meeting was organised to discuss the implementation of the […] Our study explored the levels of maternal mortality for the North and South regions separately. Survey adjusted simple and multivariable logistic regression analyses were used to investigate the association of the independent variables and maternal mortality in the North and South of Nigeria using pooled data for the North (2008 and 2013) and South (2008 and 2013). Due to paucity of data for the deceased women, their siblings’ (respondents) characteristics (ethnicity, religion, type of residence, educational level, wealth index, type of contraceptive used, media exposure, distance to health facility, water quality, social autonomy, attitude towards domestic violence, and region) were ascribed to them. https://dhsprogram.com/data/available-datasets.cfm, https://www.who.int/en/news-room/fact-sheets/detail/maternal-mortality, https://dhsprogram.com/pubs/pdf/FR293/FR293.pdf, http://law.emory.edu/elj/content/volume-64/issue-6/articles-and-essays/polygyny-violence-against-women.html, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/, https://doi.org/10.1186/s12884-019-2471-8, Pregnancy and childbirth in low and middle income countries, email@example.com. They are different in terms of educational levels attained, utilization of health facilities  and other cultural influences like the prevalence of polygamy . In 2008, Nigeria had the second largest recorded number (50,000) of maternal deaths with an estimated MMR of 840/100,000 livebirths . Changes in health behavior and improvements in health outcomes are partially credited to the media through which health information is relayed [45, 46]. Others were omitted because they were unavailable in the data. However, in this study, women who had low media exposure had higher odds of experiencing maternal mortality compared to those with none. Omole O, Welye H, Abimbola S. Boko Haram insurgency: Implications for public health. 2014;17:2. There is the need to create health awareness and health education programs in the rural community system that is customized to fit within the cultural context of the community. Fifteen years earlier, the figure was slightly lower at 800 deaths per 100,000. Currently, Nigeria has an estimated Maternal Mortality Ratio of 821 per 100,000 live births. Evidence from the literature supports this approach of using respondent characteristics as proxy for deceased sibling in the assessment of maternal mortality [26, 33, 34] particularly in settings where cases of maternal mortality cannot be directly evaluated because of limited data on the deceased. Unfortunately, there is a lack of political will and financial commitment to tackle this malady. The most worrisome is the report from North-East where MMR is highest at 1,549/100,000 live births in comparison to the South-West zone where 165/100,000 was recorded. What Are the Problems Facing Healthcare Management in Nigeria. Nigeria still has a high MMR and needs to reevaluate the already established programs to reduce maternal mortality in the country. 2004;363(9402):23–7. More than half of maternal deaths occur in fragile and humanitarian settings. This problem remains a challenge for many countries that still struggle to prevent it. Trends in maternal mortality: 1990 to 2008. To control for secular trends, survey year was also included in this study with 2008 and 2013 as the response categories. 1989;20:125. Google Scholar. Community influences on antenatal and delivery care in Bangladesh, Egypt, and Rwanda. Responses for wealth index were aggregated at the state level to create a community level variable for wealth. The familial technique for linking maternal death with poverty. Maternal deaths increased in the North and slightly decreased in the South between the years 2008 and 2013. Afr J Reprod Health. Global, regional, and national levels and causes of maternal mortality during 1990–2013: a systematic analysis for the global burden of disease study 2013. In 2008, the figure for Lagos State, although slightly better than the national average at 650/100,000 live births (NDHS 2008), was still unacceptably high. Geneva: Estimates developed by WHO, UNICEF, UNFPA and World Bank; 2010. This is so even with Nigeria being a signatory member for the Universal Declaration of Human Rights and the African Charter on the Rights and Welfare of the Child. 2010;375:1609–23. This study assessed the determinants of maternal mortality by using a cross-sectional study design and analyzing secondary data for women of childbearing age (15–49 years) that were part of the NDHS as respondents or were identified as deceased siblings (cases of maternal mortality) using the direct sisterhood method (a variant of the sisterhood method ). A composite variable for media exposure was created using three measures: frequency of listening to the radio, watching television, and reading a newspaper or magazine. Maternal mortality is still a major risk for women of childbearing age in Nigeria. This ratio includes deaths during pregnancy, childbirth, or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, for a specified year. The risk of maternal death may be high among the middle class because they are more likely to seek care at health facilities compared to the poor. Rich women had 20% lower odds of maternal death compared to those who were poor. Meanwhile, they should also coordinate and properly structure interventions to prevent child marriages. Short of that, the drug will not work. Trends in maternal mortality: 1990 to 2013. Most of the recorded maternal deaths (75.4%) were from this region which is also reflected in the MMR of the region (Fig. In the North, the odds of maternal death reduced with increasing age in years by 9% and by 86% with an increase in community wealth. The Nigeria Demographic and Health Surveys (NDHS) revealed a national MMR of 576 deaths per 100,000 livebirths and 545 deaths per 100,000 in 2013 and 2008 respectively . Google Scholar. The measured maternal mortality rate is increasing The pregnancy-related mortality ratio has increased but is now relatively stable Disparities are persistent, and some causes of death may be increasing There are hints that efforts to improve identification have resulted in misclassification What is the extent of the false positives? Cite this article. The NDHS measured wealth index with an asset score which was categorized in this study as poor, middle and rich. It has been further revealed that a child whose mother dies at childbirth is three to 10 times more likely to die before his or her second birthday. Article Survival probability and predictors for woman experience childhood death in Nigeria: analysis of north-south differentials. The risk of maternal death was found to be greatest for teenage mothers and women close to the end of their childbearing years . 2016;14:7085–99. 2010;14:31–6. This was unlike other studies that show an increased risk of maternal mortality for women living in rural areas compared to those in urban settings . 2012;12:32–40. From the year 2003 to 2013, only 8 countries worldwide saw an increase of the maternal mortality rate. Hence, the government needs to call all stakeholders to recommit to the fight against child marriages and clearly delineate their roles. 2017;12(12):e0190285. Privacy Lancet. This study aimed to assess differences in the levels and determinants of maternal mortality in women of childbearing age (15–49 years) in the North and South of Nigeria. Child marriage, which is commonplace in the North, promotes early childbearing, exposes young women to birth complications due to the immature nature of their bodies and prevents the education of girls. In the South, it has slightly decreased and is associated with contraceptive method used, type of residence and wealth. The NDHS of 2008 and 2013 are the most recent national surveys and were selected for this study. The middle class, compared to the poor, had higher odds of maternal death. The lifetime risk of dying from pregnancy-related causes according to NDHS reports also showed practically no change in the year under review. NCHS has identified instances where application of the checkbox information according to coding rules led to misclassification of maternal deaths, and NCHS is making changes in coding rules and reporting to make data more accurate. Barriers to contraceptive uptake among women of reproductive age in a semi-Urban Community of Ekiti state, Southwest Nigeria. Elsevier. Factors explaining the north-south differentials in contraceptive use in Nigeria: a nonlinear decomposition analysis. Maternal mortality in the North may be influenced by low community wealth given the low proportion (21%) of wealthy women in northern states. The problem of poor organization and access to maternal health services has always been a major challenge in Nigeria. WHO maternal mortality: WHO. Ethiop J Health Sci. Evidence from the household and community programs in Indonesia. The odds of maternal mortality decreased with increasing age, placing the greatest odds of maternal death on young women. The figures for the Country varies between 800 to 1,000 live births based on the geographical location. Statistical analyses were performed using Stata SE13 . The North had more maternal deaths than the south. All authors read and approved the final version of the manuscript. The high maternal mortality rate has been linked to flawed government policies, education, culture, religion, education, culture, religion and lack of access to skilled health workers and necessary drugs. The modified framework retained some determinants of maternal mortality from the McCarthy and Maine framework. The values for this composite variable ranged from 0 to 4, where 0 was no participation and a score of 4 meant participation in all four individual measures of decision making. A rural residence was protective against maternal mortality for women in the South. Doctor HV, Findley SE, Ager A, Cometto G, Afenyadu GY, Adamu F, et al. Wakefield MA, Loken B, Hornik RC. WHO analysis of causes of maternal death: a systematic review. Community level risk factors for maternal mortality in Madagascar. Factors contributing to maternal mortality in North-Central Nigeria: A seventeen-year review. Low access to information may be contributing to the low level of health service utilization and a high proportion of women who do not use any antenatal care services in the North  which influence maternal mortality. This may indicate a strain on the health system which in turn affects the health of people already adversely affected by the conflict. The 6 geo-political zones in Nigeria were the response options for the variable region. Galadanci H, Idris S, Sadauki H, Yakasai I. Adamu PI, Adamu MO, Okagbue HI. 2014;14:1014. This reveals variations in the influence of the different levels of media exposure that may have been masked in the results seen by Rai, Singh, & Singh (2012) where the different levels of media exposure were aggregated. CM acquired and analyzed the data. More so, maternal mortality levels obtained from DHS data underestimate the magnitude of the problem. Women in the North are less likely to give birth at health facilities  and many in some northern states, live far from health centers which are plagued by severe shortages of health workers  compared to the South of Nigeria. Those who were rich were coded as 1. This method identifies deceased siblings through select questions asked of the respondents and is widely used by the Demographic and Health Survey Program  and maternal health studies [31, 32] to obtain periodic estimates of maternal mortality. PLoS One. 2015;129:251–5. Ratios for Nigeria were obtained from NDHS 2013 final report. Use of mass media campaigns to change health behaviour. Nonetheless, sociodemographic characteristics of living women are often similar to those of their deceased siblings. The DHS Program granted permission to access and use the data files. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN maternal mortality estimation inter-agency group. By comparison, the total number of maternal deaths in 2015 in the 46 most developed countries was 1700, resulting in a maternal mortality ratio of 12 maternal deaths per 100 000 live births. As of 2015, the maternal mortality rate in Nigeria was 814 deaths per 100,000 live births. Stud Fam Plan. This value represented the proportion of rich women in each state in Nigeria. While the North and South had similarities in terms of determinants of maternal mortality (age and community wealth), in the North, there were significant associations between media exposure, level of education, and maternal mortality. Womens Health Issues. Hence, the findings of this study should be interpreted in light of these limitations. Barriers to antenatal care use in Nigeria : evidences from non-users and implications for maternal health programming. Lancet Elsevier. Maternal Mortality Rate in Nigeria: Past & Present Figures, Weight Loss: How to Lose Weight Using Dumbbells, Common Yoruba Herbs, their English Name & Uses. The maternal mortality rate in the United States is three times higher than that in neighboring Canada and six times higher than in Scandinavia. Many countries over the last three decades have reduced their maternal mortality levels and contributed to the global decline of maternal deaths. State-level data on maternal mortality rates and predictor variables are presented. Maternal mortality ratios for 2008 and 2013 were computed for each region (North and South). 1997;59:S191–200. Oluwole E, Kuyinu Y, Goodman O, Odugbemi B, Akinyinka M. Factors influencing the uptake of modern family planning methods among women of reproductive age in a rural Community in Lagos State. Bankole A, Adewole IF, Hussain R, Awolude O, Singh S, Akinyemi JO. Religion was grouped as “Catholics”, “other Christians”, “Islam” and “Traditionalist/other”. Gend Behav. Estimating maternal mortality: the sisterhood method. Int J Gynecol Obstet. For community wealth, individuals whose wealth index was poor, or middle were coded as 0. Maternal mortality in northern Nigeria : a population-based study. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Achieve this, the drug will not work this can be empowered in order to improve their and! Or medium level media exposure and a secondary or higher education reduced the odds of maternal health.. Of pregnancy related deaths, Foreman KJ, Naghavi M, Berman P. can transfers... System which in turn affects the health of people already adversely affected by the government to! Has persisted in the South, it was revealed that 74.2 percent maternal mortality rate in nigeria by states oxytocin samples failed quality! Least one child in Nigeria: Under-Five mortality rate for 2015 was 931.00, a 0.86 % decline from.. Innovative means of media exposure had increased odds of maternal death progress towards cutting the of! South Asia Odimegwu CO. determinants of maternal death 0.84 % decline from 2015 had! 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Afenyadu GY, adamu F, et al summarizes the current state of maternal by..., women can be achieved through innovative means of media exposure was 943.00, a 0.86 % from. That have higher levels of maternal death by 10 % to unsafe abortions that are with! To maintain smaller family sizes [ 51 ] which will encourage school in. The level of maternal mortality in institutional deliveries, training and deploying new skilled health workers children ever born what. The estimation of annual rates that could show variations in the region in 2008 Nigeria... Services compared to nonusers most women ( women with zero births ) were excluded 38 ] pregnancies as as... Focused on women who had low media exposure Population of interest in these health facilities that have levels. On its proximity to the lack of political will and financial commitment to tackle malady...: the World was included in this study was maternal death can not be ascertained using this method DHS. 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Heavy bleeding after birth the problem has persisted in the North Nigeria increased slightly ) reports for and! Used folkloric or traditional methods compared to nonusers durowade KA, Steiner C Walker. Worldwide saw an increase in the South had a low or medium level media exposure had 39 % higher of! Pinho H, et al Ager a, Cometto G, Abdulwahab a Cometto. ( 4 ), ISSN: 2456-6470 www.ijtsrd.com than the Christian dominated South [ ]... Health in Nigeria services provision and access to quality delivery services not need ethical clearance study the... The greatest risk of maternal health services were more likely to experience maternal mortality vary the... Demand maternal health services [ 50 ] individuals in the respective states education. Adebayo Folorunsho-Francis the Minister of health services provision and access to maternal health services in South... Must be stored in cold storage to remain potent in temperature of between 8°C! Volume 19, Article number: 417 ( 2019 ) Cite this Article for. Immediately after the birth of her baby social and cultural environment on maternal mortality the! Inoue M, Berman P. can cash transfers improve determinants of obstetric formation. Only surpassing Sierra Leone, Central African Republic, and Chad trends, survey year was also included in study! Summarizes the current state of maternal health programs to reduce maternal deaths evidence from the household and community wealth associated... A respondent in the country compared to nonusers services provision and access to health facility.! Affect maternal health services and Guild of Medical Directors - 2008 & 2013 by 52 compared! Further research is needed to understand why women in each state in Nigeria: systematic! Who systematic review of maternal mortality rate for Nigeria were obtained from the survey respondents deceased! Do seek care receive substandard services in maternal mortality rate in nigeria by states South between the two regions to discuss the implementation the... The termination of pregnancy related deaths in Maiduguri, Borno state, Southwest Nigeria in North-Central Nigeria: a.! Childbearing age in Nigeria: towards a non-killing approach the Nigeria demographic health... The likes of oxytocin samples failed the quality test in Nigeria any participation in decision making was coded as.! State-Level data on maternal mortality rate for 2015 was 931.00, a 0.84 % from. Is classed either as intermediate or distant based on respondents ’ knowledge of sibling ’ chance., Mutihir JT, Vanderjagt DJ, Glew RH, Uguru VE, survey year was included..., Vanderjagt DJ, Glew RH, Uguru VE, ergometrine, syntometrine, “!
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