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The Northeast of Nigeria has some of the highest maternal and newborn death rates globally. Ensuring women have access to a skilled birth attendant is seen as a key intervention to improve health and survival for both mothers and newborns. Efforts have therefore focused on encouraging women to deliver their babies in a health facility.

This IDEAS-led study, authored by Josephine Exley et al and published in BMJ Open, offers unique insights into the quality of care provided to women and newborns in primary health care facilities in Gombe state, Nigeria.

Observations of 1875 women admitted to 10 primary health care facilities in Gombe state, provide a detailed picture of the frequency of birth attendant behaviours and interventions received during childbirth. Findings from this study point to clear areas for action to ensure all women receive evidence-based quality care and are applicable far beyond the Northeast Nigerian setting.

A newborn in Gombe State, Northeast Nigeria

The study, highlights substantial variation in the implementation of recommended evidence-based interventions both within and across the different stages of childbirth. Implementation was highest for clinical interventions at the time of birth that have received international attention, for example, the provision of prophylactic uterotonic and newborn thermal and clean cord care. Implementation was lowest for measures designed as risk assessments, for example, history-taking or checking vital signs. This points to a need for the focus in health care provider training, both pre- and in-service, to include risk assessment measures.

The low implementation of evidence-based care measures during the initial assessment and during the postpartum period indicate that there are potential missed opportunities to identify and manage complications. Proper risk assessment at the time of birth is a priority, even more so in this setting as only 37 percent of women attended at least four ANC visits and only 10 percent of women and seven percent of newborns received a postnatal check within two days of birth.

With this study authors highlight that some evidence-based care is already provided routinely, but that the focus now needs to be extended to also include basic risk assessment to reduce cases of avoidable morbidity and mortality for mothers and babies alike.  Incorporating measures of quality in measurement, known as effective coverage, is critical to understand the potential health gain that women get from attending health facilities.

Ongoing work by the IDEAS team is examining population-level effective coverage of childbirth care.


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Josephine Exley

Research Fellow

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Dr Nasir Umar

IDEAS Nigeria Country Coordinator and Assistant Professor

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Dr Barbara Willey

Assistant Professor in Epidemiology

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Professor Tanya Marchant

IDEAS Principal Investigator and Professor

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