Abstract:

A major challenge to global health systems is maternal mortality. The vast majority of these deaths are preventable. This research is aimed at investigating sociocultural and economic determinants of maternal health in Ado-Ekiti, south-west geopolitical zone of Nigeria. It was a cross sectional epidemiological study which determined the association between the independent variables (maternal educational status, maternal religion, maternal occupation, decision maker for the commencement of ANC, and health care availability/accessibility) and the dependent variable (maternal health as represented by choice of ANC provider). The respondents were 418 females of reproductive age group.

The modal age group was '51 years and above' (24.4%). The majority of the participants (45.5%) were married. A total number of 50(12.0%) respondents had primary education only, 110(26.3%) secondary education, 130(31.1%) tertiary, while those without any formal education were 16(3.8%). There were 112(26.8%) who did not indicate their educational status and did not give reasons for it. On religion, 216(51.7%) were self-identified as Christians and 188(45.0%) as Muslims. Traditional faith constituted 14(3.3%). Those employed were 178(42.6%), while 102(24.4%) were unemployed. Students constituted 82(19.6%) and Apprentice 56(13.4%) of the respondents. All the variables tested gave a statistically significant value of p<0.05. The selected variables for multivariate logistic regression also gave a statistically significant value of p<0.05.

Strategies targeted at improving maternal educational status, making employment available, and encouraging accessibility to health care facilities, may make a significant impact in reducing Maternal Mortality Rates in the studied population.

Keywords: Maternal, health, mortality, economic, sociocultural, determinants.

References:

[1].     Abbas, A. A., and Walker, G.J.A. (1986) ‘Determinants of the utilization of maternal and child health services in Jordan’, International Journal of Epidemiology, 15 (3), pp.404-407.

[2].     Ameh, C. A. (2009) An Analysis of the Recognised Determinants of Maternal Mortality, in sub-Saharan African and South-Asian Countries, [Online]. Available at: University of Liverpool/Laureate Online Education VLE (Accessed: 22 March 2012).

[3].     Bruce, N., Pope, D., and Stanistreet, D. (2008). Quantitative Methods for Health Research: A Practical Interactive Guide to Epidemiology and Statistics, Ed. England: John Wiley & Sons Ltd.

[4].     Coggon, D., Barker, D., and Rose, G. (2003) Epidemiology for the uninitiated: Case-control and cross-sectional studies, 5th ed. London: British Medical Journal Publishing.

[5].     Dao, M. Q. (2008) ‘Human capital, poverty, and income distribution in developing countries’, Journal of Economic Studies, 35(4), pp.294-303.

[6].     DHHS/AHRQ/COE, Department of Health and Human Services/Agency for Healthcare Research and Quality/Center for Outcomes and Evidence (2009) ‘AHRQ developing prospective practice-based comparative effectiveness research clinical registries: Orthopedic devices, drugs, and procedures’ (P50), [Online]. Available at: http://grants.nih.gov/grants/guide/rfa-files/RFA- HS-10-008.html (Accessed: 27 July 2015).

[7].     Ekiti state government (2015) ‘Population figures of Ekiti state’, [Online]. Available at: www.ekitistate.gov.ng (Accessed: 27 July 2015).

[8].     Fotso, J. C., Ezeh, A. and Oronje, R. (2008) ‘Provision and use of maternal health services among urban poor women in Kenya: What do we know and what can we do?’ Journal of Urban Health, 85(3), pp.428-442.

[9].     Grady, C. (1977) Human immunodeficiency disease: Ethical considerations for clinicians. In V. T. DeVita, Jr, S. Hellman, and S. A. Rosenberg, 4th ed, AIDS: etiology, diagnosis, treatment and prevention. New York: Lippincort-Raven, pp.633-642.

[10].  Graham, C. (2016) ‘What is the impact of child marriage?’ [Online]. Available at: http://www.girlsnotbrides.org/themes/education/ (Accessed: 2 July 2016).

[11].  Harrison, K. A. (1985) ‘Child-bearing, health and social priorities: A survey of 22 774 consecutive hospital births in Zaria, northern Nigeria’, British Journal of Obstetrics and Gynaecology, 92(5), pp.1-119.

[12].  Harrison, K. A. (1988) ‘Maternal mortality--a sharper focus on a major issue of our time’, Tropical Journal of Obstetrics and Gynaecology, 1(1).

[13].  Harrison, K. A. (1989) ‘Maternal mortality in developing countries’, British Journal of Obstetrics and Gynaecology, 96(1),pp.1-3.

[14].  Harrison, K. A., John, C. T., Ojoo, S., and Harry, T. C. (1996) ‘Maternal health in developing countries [11]’, Lancet, 347(8998), pp.400.

[15].  Irwin, L. Siddiqi, A. and Hertzman, C. (2007). Early child development: A powerful equalizer. Final Report for the World Health Organisation’s Commission on Social Determinants of Health. Geneva: World Health Organisation.

[16].  Ith, P., Dawson, A., Homer, C.S, and Klinken-Whelan, A. (2012) ‘Practices of skilled birth attendants during labour, birth and the immediate postpartum period in Cambodia’, Midwifery, [Online]. Available at: http://dx.doi.org/10.1016/j.midw.2012.01.010 (Accessed: 30 January 2016).

[17].  Kucharski, M. (2013) ‘Maternal mortality in Nigeria: reducing rates through Education’, prospect journal.org, [Online]. Available at: http://prospectjournal.org/2013/07/29/maternal-mortality-in-nigeria-reducing-rates-through-education (Accessed: 20 August 2015).

[18].  Kwast, B. E., Kidane-Mariam, W., Saed, E. M., and Fowkes, F. G. (1985) ‘Epidemiology of maternal mortality in Addis Ababa: A community-based study’, Ethiopian Medical Journal, 23(1), pp.7-16.

[19].  Kwast, B. E., and Liff, J. M. (1988) ‘Factors associated with maternal mortality in Addis Ababa’, Ethiopia. International Journal of Epidemiology, 17 (1), pp. 115-121.

[20].  Kwast, B. E., Rochat, R. W., and Kidane-Mariam, W. (1986) ‘Maternal mortality in Addis Ababa, Ethiopia’, Studies in Family Planning, 17(6), pp. 288-301.

[21].  Lee, K. S., Park, S. C., Khoshnood, B., Hsieh, H. L., and Mittendorf, R. (1997) ‘Human development index as a predictor of infant and maternal mortality rates’, Journal of Pediatrics, 131(3),pp.430-433.

[22].  McClure, E. M., Goldenberg, R. L., and Bann, C. M. (2007) ‘Maternal mortality, stillbirth and measures of obstetric care in developing and developed countries’ International Journal of Gynaecology and Obstetrics, 96(2), pp. 139-146.

[23].  McTavish, S., Moore, S., Harper, S., and Lynch, J. (2010) ‘National female literacy, individual socio-economic status, and maternal health care use in sub-Saharan Africa’, Social Science & Medicine, 71(11), pp. 1958–1963, doi:10.1016/j.socscimed.2010.09.007.

[24].  Neuman, L. (2000) Social Research Methods: Qualitative and Quantitative Approach, 7th Ed. Sydney: Allyn and Bacon.

[25].  Nigeria Masterweb (2015) Nigeria 2006 census figures, [Online]. Available at: www.nigeriamasterweb.com (Accessed: 27 July 2015).

[26].  Ogungbade, G. O. (2010) ‘Social Capital Variables as Predictors of HIV Risk-Taking Behaviors among Sub- Saharan African Immigrants in the United States’, [Online]. Available at: http://scholarworks.waldenu.edu/cgi/viewcontent.cgi?article=1814&context=dissertations (Accessed: 27 July 2015).

[27].  Public Health Association of Australia (2012) .Policy-at-a-glance – ‘Maternal Mortality, Social Determinants of Health, Millennium Development Goals in Asia Policy’, [Online]. Available at: http://www.phaa.net.au/documents/130201_Maternal%20Mortality,%20Social%20Determinants (Accessed: 28 March 2015).

[28].  Shilling, S., and Lalich, N. R. (1984) ‘Maternal occupation and industry and the pregnancy outcome of U.S. married women, 1980’, Public Health Reports 99(2), pp. 152-161.

[29].  Stokoe, U. (1991) ‘Determinants of maternal mortality in the developing world’, Australian and New Zealand Journal of Obstetrics and Gynaecology, 31(1), pp. 8-16.

[30].  Trochim, W. M. K. and Donnelly, J. P. (2006). The research methods knowledge base. 3rd ed. New York: Atomic Dog.

[31].  UNFPA (2011) Response to the note verbale, A/61/338: 2 (para. 21).

[32].  United Nations (2000). ‘Investing in the health of Africa’s mothers’, [Online]. Available at: www.un.org/africarenewal/magazine/special-edition-women (Accessed: 26 March 2015).

[33].  United Nations (2000). The millenium declaration: Resolution of the general assembly. New York: United Nations, SS/2.A/Res/SS/2.

[34].  United Nations (2008). The millenium development goals report 2008. New York: United Nations.

[35].  Wong, E. L., Popkin, B. M., Guilkey, D. K., and Akin, J. S. (1987) ‘Accessibility, quality of care and prenatal care use in the Philippines’, Social Science and Medicine, 24(11),pp.927-944.

[36].  World Health Organisation (2007) Global and regional estimates of the incidence of unsafe abortion and associated mortality in 2003. Geneva: World Health Organisation.

[37].  World Health Organization (2007). Maternal mortality in 2005. Estimates Developed by WHO, UNICEF, UNFPA and the World Bank. Geneva: World Health Organisation.

[38].  World Health Organization and UNICEF (2010). Countdown to 2015 decade report (2000–2010): taking stock of maternal, newborn and child survival (PDF). Geneva: WHO and UNICEF.