{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T00:17:00Z","timestamp":1768436220208,"version":"3.49.0"},"reference-count":24,"publisher":"Wiley","issue":"S3","license":[{"start":{"date-parts":[[2019,5,14]],"date-time":"2019-05-14T00:00:00Z","timestamp":1557792000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100006641","name":"UNICEF","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006641","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004423","name":"World Health Organization","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004423","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000200","name":"United States Agency for International Development","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000200","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003478","name":"Ministry of Health, Labour and Welfare","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003478","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2019,6]]},"abstract":"Objective<\/jats:title>To compare severe maternal outcomes (SMO<\/jats:styled-content>s) from two multi\u2010centre surveys in Nigerian hospitals, and to evaluate how the SMO<\/jats:styled-content> burden affects quality of secondary and tertiary hospital care.<\/jats:p><\/jats:sec>Design<\/jats:title>Two facility\u2010based surveys of women experiencing SMO<\/jats:styled-content> (maternal near\u2010miss or maternal deaths).<\/jats:p><\/jats:sec>Setting<\/jats:title>Sixteen secondary and five tertiary facilities in Nigeria [WHO<\/jats:styled-content> Multi\u2010Country Survey on Maternal and Newborn Health (WHOMCS<\/jats:styled-content>)] and 42 public tertiary facilities in Nigeria (Nigeria Near\u2010Miss and Maternal Death Survey).<\/jats:p><\/jats:sec>Population<\/jats:title>371 women in WHOMCS<\/jats:styled-content>\u2010Nigeria and 2449 women in Nigeria Near\u2010Miss and Maternal Death Survey who experienced SMO<\/jats:styled-content>.<\/jats:p><\/jats:sec>Methods<\/jats:title>Secondary analysis and comparison of SMO<\/jats:styled-content> data from two surveys, stratified by facility level.<\/jats:p><\/jats:sec>Main outcome measures<\/jats:title>Maternal mortality ratio (MMR<\/jats:styled-content>) per 100\u00a0000 livebirths (LB<\/jats:styled-content>), maternal near\u2010miss (MNM<\/jats:styled-content>) ratio per 1000 LB<\/jats:styled-content>, SMO<\/jats:styled-content> ratio per 1000 LB<\/jats:styled-content> and mortality index (deaths\/SMO<\/jats:styled-content>).<\/jats:p><\/jats:sec>Results<\/jats:title>Maternal mortality ratio and mortality indices were highest in tertiary facilities of the WHOMCS<\/jats:styled-content>\u2010Nigeria (706 per 100\u00a0000; 26.7%) and the Nigeria Near\u2010Miss and Maternal Death Survey (1088 per 100\u00a0000; 40.8%), and lower in secondary facilities of the WHOMCS<\/jats:styled-content>\u2010Nigeria (593 per 100\u00a0000; 17.9%). The MNM<\/jats:styled-content> ratio and SMO<\/jats:styled-content> ratio were highest in secondary WHOMCS<\/jats:styled-content>\u2010Nigeria facilities (27.2 per 1000 LB<\/jats:styled-content>; 33.1 per 1000 LB<\/jats:styled-content>).<\/jats:p><\/jats:sec>Conclusions<\/jats:title>Tertiary\u2010level facilities in Nigeria experience unacceptably high maternal mortality rates, but secondary\u2010level facilities had a proportionately higher burden of severe maternal outcomes. Common conditions with a high mortality index (postpartum haemorrhage, eclampsia, and infectious morbidities) should be prioritised for action. Surveillance using SMO<\/jats:styled-content> indicators can guide quality improvement efforts and assess changes over time.<\/jats:p><\/jats:sec>Tweetable abstract<\/jats:title>2820 Nigerian women with severe maternal outcomes: high mortality in tertiary level hospitals, higher burden in secondary level.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.15698","type":"journal-article","created":{"date-parts":[[2019,5,15]],"date-time":"2019-05-15T01:54:18Z","timestamp":1557885258000},"page":"49-57","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["The burden of severe maternal outcomes and indicators of quality of maternal care in Nigerian hospitals: a secondary analysis comparing two large facility\u2010based surveys"],"prefix":"10.1111","volume":"126","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3214-7096","authenticated-orcid":false,"given":"JP","family":"Vogel","sequence":"first","affiliation":[{"name":"Maternal and Child Health Program Burnet Institute Melbourne Vic. Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B","family":"Fawole","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology University College Hospital Ibadan Oyo State Nigeria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8042-9269","authenticated-orcid":false,"given":"AS","family":"Adeniran","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology University of Ilorin Teaching Hospital Ilorin Kwara State Nigeria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5026-2330","authenticated-orcid":false,"given":"O","family":"Adegbola","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Lagos University Teaching Hospital Idi Araba Lagos State Nigeria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3371-5892","authenticated-orcid":false,"given":"OT","family":"Oladapo","sequence":"additional","affiliation":[{"name":"UNDP\/UNFPA\/UNICEF\/WHO\/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) Department of Reproductive Health and Research World Health Organization Geneva Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,5,14]]},"reference":[{"key":"e_1_2_6_2_1","volume-title":"World Population Prospects: Key Findings and Advance Tables","author":"United Nations","year":"2017"},{"key":"e_1_2_6_3_1","volume-title":"Trends in Maternal Mortality: 1990 to 2015. 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