Maternal mortality remains a critical public health indicator, reflecting the overall effectiveness of a country's healthcare system. According to the World Health Organization, a maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.
Key metrics used to measure this burden include:
Accurate estimation of maternal mortality is essential for health planning, resource allocation, and policy formulation. Without reliable data, governments and international agencies cannot track progress toward global targets like the Sustainable Development Goals.
Primary objectives for measuring these statistics include:
A well-functioning Civil Registration and Vital Statistics (CRVS) system is the gold standard for capturing all births and deaths in a population continuously. When functioning properly, CRVS registers every maternal death alongside its underlying medical cause.
In many low- and middle-income countries, including Nigeria, civil registration systems are incomplete. Many deaths occur at home and are never officially registered, leading to significant underreporting. Consequently, reliance shifts to alternative methods and statistical modeling to estimate the true burden of maternal mortality.
When vital registration systems are weak, household surveys serve as a vital alternative for gathering health data. Instruments such as the Demographic and Health Surveys utilize full birth histories or sibling history modules to capture mortality data retrospectively.
Censuses can also include specific questions about recent deaths in the household over the past 12 months. While these approaches capture data from communities with low facility-use rates, they suffer from recall bias, large sampling errors, and wide confidence intervals, making year-to-year trend analysis difficult.
The sisterhood method is an indirect technique developed specifically to measure maternal mortality in settings where data is scarce and sample sizes needed for direct surveys are too large. By asking adult respondents about the survival status of all their sisters who reached reproductive age, researchers can calculate estimates reflecting mortality conditions from several years prior to the survey.
The main advantage of the sisterhood method is that it requires a relatively small sample size and avoids complex clinical evaluations. However, it provides a retrospective estimate representing a midpoint time period rather than current annual figures.
Measuring maternal mortality in Nigeria presents unique systemic and cultural hurdles. Many births and deaths occur outside formal healthcare facilities, often attended by traditional birth attendants where events go unrecorded.
Additional challenges include:
Nurses and midwives sit at the frontline of maternal healthcare delivery and data collection. Their day-to-day documentation directly feeds into the Health Management Information System (HMIS) and contributes to national statistics.
Clinical responsibilities for accurate data include: