{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T21:51:03Z","timestamp":1792705863282,"version":"4.5.0"},"reference-count":25,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2015,5,14]],"date-time":"2015-05-14T00:00:00Z","timestamp":1431561600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/3.0\/igo\/legalcode"}],"funder":[{"DOI":"10.13039\/100004423","name":"World Health Organization","doi-asserted-by":"publisher","award":["A65745"],"award-info":[{"award-number":["A65745"]}],"id":[{"id":"10.13039\/100004423","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2016,5]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To investigate the burden and causes of life\u2010threatening maternal complications and the quality of emergency obstetric care in Nigerian public tertiary hospitals.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Nationwide cross\u2010sectional study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Forty\u2010two tertiary hospitals.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>Women admitted for pregnancy, childbirth and puerperal complications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>All cases of severe maternal outcome (<jats:styled-content style=\"fixed-case\">SMO<\/jats:styled-content>: maternal near\u2010miss or maternal death) were prospectively identified using the <jats:styled-content style=\"fixed-case\">WHO<\/jats:styled-content> criteria over a 1\u2010year period.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Incidence and causes of <jats:styled-content style=\"fixed-case\">SMO<\/jats:styled-content>, health service events, case fatality rate, and mortality index (% of maternal death\/<jats:styled-content style=\"fixed-case\">SMO<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Participating hospitals recorded 91\u00a0724 live births and 5910 stillbirths. A total of 2449 women had an <jats:styled-content style=\"fixed-case\">SMO<\/jats:styled-content>, including 1451 near\u2010misses and 998 maternal deaths (2.7, 1.6 and 1.1% of live births, respectively). The majority (91.8%) of <jats:styled-content style=\"fixed-case\">SMO<\/jats:styled-content> cases were admitted in critical condition. Leading causes of <jats:styled-content style=\"fixed-case\">SMO<\/jats:styled-content> were pre\u2010eclampsia\/eclampsia (23.4%) and postpartum haemorrhage (14.4%). The overall mortality index for life\u2010threatening conditions was 40.8%. For all <jats:styled-content style=\"fixed-case\">SMO<\/jats:styled-content>s, the median time between diagnosis and critical intervention was 60\u00a0minutes (<jats:styled-content style=\"fixed-case\">IQR<\/jats:styled-content>: 21\u2013215\u00a0minutes) but in 21.9% of cases, it was over 4\u00a0hours. Late presentation (35.3%), lack of health insurance (17.5%) and non\u2010availability of blood\/blood products (12.7%) were the most frequent problems associated with deficiencies in care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Improving the chances of maternal survival would not only require timely application of life\u2010saving interventions but also their safe, efficient and equitable use. Maternal mortality reduction strategies in Nigeria should address the deficiencies identified in tertiary hospital care and prioritise the prevention of severe complications at lower levels of care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable abstract<\/jats:title><jats:p>Of 998 maternal deaths and 1451 near\u2010misses reported in a network of 42 Nigerian tertiary hospitals in 1\u00a0year.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.13450","type":"journal-article","created":{"date-parts":[[2015,5,14]],"date-time":"2015-05-14T07:33:54Z","timestamp":1431588834000},"page":"928-938","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":156,"title":["When getting there is not enough: a nationwide cross\u2010sectional study of 998 maternal deaths and 1451 near\u2010misses in public tertiary hospitals in a low\u2010income country"],"prefix":"10.1111","volume":"123","author":[{"given":"OT","family":"Oladapo","sequence":"first","affiliation":[{"name":"Department of Reproductive Health and Research including UNDP\/UNFPA\/UNICEF\/WHO\/World Bank Special Programme of Research Development and Research Training in Human Reproduction (HRP) World Health Organization Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"OO","family":"Adetoro","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Olabisi Onabanjo University Teaching Hospital Sagamu Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"BA","family":"Ekele","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology University of Abuja Teaching Hospital Gwagwalada Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C","family":"Chama","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology University of Maiduguri Teaching Hospital Maiduguri Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"SJ","family":"Etuk","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology University of Calabar Teaching Hospital Calabar Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"AP","family":"Aboyeji","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology University of Ilorin Teaching Hospital Ilorin Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"HE","family":"Onah","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology University of Nigeria Teaching Hospital Enugu Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"AM","family":"Abasiattai","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology University of Uyo Teaching Hospital Uyo 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