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Changes in maternal and newborn health care in Gombe State, Nigeria

Informed Decision for Actions in Maternal and Newborn Health (IDEAS) has produced this report on changes in maternal and newborn health care between 2012-2015 in Gombe State, Nigeria.  

Background

The IDEAS project works in Ethiopia, North-Eastern Nigeria and Uttar Pradesh State in India, using measurement, learning and evaluation to understand what works, why and how in maternal and newborn health programmes.  The aim of this study was to estimate changes in maternal and newborn health care in areas where Bill & Melinda Gates Foundation projects were operating. 

This report focuses on Gombe State in Nigeria. 

Methods

The study design was to collect data in 2012 and 2015 to analyse change over time.  This included three components:

  1. Household survey (population-level survey interviewing women who had a live birth in the 12 months preceding the survey)
  2. Facility survey (assessment of the availability of equipment and supplies)
  3. Frontline worker survey (interviews with traditional birth attendants and the Federation of Muslim Women’s Association in Nigeria working in communities, junior community health extension workers and community health officers working between primary health facilities and communities, and auxiliary nurse midwives and doctors working primary health facilities) 

The surveys in 2012 and 2015 used the same methodology.  Each year, a representative sample of households from the state was taken.  Due to changes in the funding strategy in 2015, the number of sampled clusters was doubled in 2015.

  • In 2012, 40 clusters were sampled and 1,844 households and 349 women with a recent birth were interviewed.  61 frontline health workers and 25 primary health facilities were surveyed.
  • In 2015, 80 clusters were sampled and 5,939 households  and 1,100 women with a recent birth were interviewed.  292 frontline health workers and 106 primary health facilities were surveyed. 

Key Findings

  • The frequency of routine interactions between women and health workers remained unchanged.  In addition, large inequalities persisted between the poorest and the richest households.
  • In 2015, 60% of women had at least one antenatal care visit, 29% delivered in a health facility, 10% had a postnatal check, and 7% reported that their newborn had a health check
  • In 2015, coverage of deliveries in a health facility ranged from 17% amongst the most poor women to 61% amongst the least poor
  • The content of routine antenatal care improved between 2012 and 2015, with more women having blood tests, urine tests, and receiving counselling during pregnancy
  • There was no evidence that the quality of delivery of postnatal care improved
  • There were positive changes in access to emergency care.  In 2015, 55% women who were advised to seek extra care actually did seek this care, as compared to 25% in 2012.
  • Coverage of some newborn interventions increased, including increased hand washing with soap by birth attendants and clean cord care for the newborn 

Conclusions and recommendations

There have been some positive improvements in maternal and newborn care, including improved access to emergency care and increased coverage of some newborn interventions.  However, survey findings suggest that coverage of routine care across the continuum did not increase and there remains a need for a marked increase in the coverage of life saving behaviours.  As noted, there is a crucial need to address the “considerable and persistent inequality in the state”. 

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Informed Decision for Actions in Maternal and Newborn Health (IDEAS). (2016). Changes in maternal and newborn health care in Gombe State, Nigeria.   London: IDEAS.

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