Maternal and reproductive health in Zamfara State of Northwest Nigeria : an impact evaluation of health promotion in the community

Abstract

Northern Nigeria has one of the highest maternal mortality ratios in the world, including the Zamfara State. Zamfara State has a maternal mortality ratio of 1,029 per 100,000 live births as compared to the national average of 576 per 100,000 live births in 2013. The northern states also have several of the worst maternal and reproductive health indices and even worst in the Zamfara State, including family planning uptake (3% for all methods), antenatal care (ANC) visits (22%), delivery by a skilled provider (6%) and hospital deliveries (5%). This three phases study aimed at: 1. An ecological review of maternal and reproductive health indicators and the major causes of maternal mortality in Zamfara State using secondary data from the State Ministry of Health; 2. Exploratory analysis of the perception of Muslim religious leaders in Zamfara regarding Islamic perspectives on maternal and reproductive health and their roles on maternal and reproductive health improvement in Zamfara; 3. Evaluation on the impact of health promotion intervention in improving the selected maternal and reproductive health indicators in the selected communities in Gusau Local Government (LGA). In phase 1, desk review of secondary data was used to answer the objective 1, while in-depth interviews and focus-group discussions were used to answer objective 2 in the qualitative study of the second phase. For objective 3 in third phase, an intervention study was carried out where data was collected pre and post-intervention using a validated questionnaire administered to the pregnant mothers who were randomly selected from the health facilities in the study area. The secondary data from the health facilities was also compared. The analysis using MANCOVA and RM ANOVA were done with SPSS software version 22.0, to assess the effect and impact of the intervention given. Findings from the study highlighted the changes in maternal mortality statisitics in Zamfara State from 2013-2017 and a similar trend was observed in Gusau LGA where the maternal mortality dropped from 1017 per 100,000 live births in 2014 to 480 per 100,000 live births in 2017, which was post-intervention period. The Muslim religious leaders were able to identify their roles and the Islamic perspectives in maternal and reproductive health, thereby encouraged the followers and community members, especially men, to allow their wives to attend ANC visits and to deliver at health facility. There was a significant increase in ANC visits and skilled birth attendant deliveries between 2013 and 2016 (pre-intervention) with 2016 and 2017 (post intervention). This study also showed a statistically significant difference in the attendance of ANC and awareness regarding illness among pregnant women in the intervention as compared to the control communities. There was an improvement and increased uptake of family planning and postnatal care compared in absolute numbers. Also, the study witnessed significant changes in the intervention community in terms of infrastructural development including renovations of health facilities, supplies of ambulances and medicines and community participation. Overall, the health promotion and community level intervention showed an effect and able to improve the uptake and utilization of maternal health services. Key Words: Maternal and reproductive health; health promotion; Islamic perspectives; community intervention; Zamfara State.