All 192 United Nations Member States and Worlds Leading Development Institutions agreed to the eight MDGs in 2000: two of the Millennium Development Goals, MDG 4 and MDG 5, are aiming to reduce the under-five mortality ratio by two thirds and maternal mortality ratio by three quarters between 1990 and 2015. Nigeria has one of the worst records of maternal and child deaths in the world until present time. Reasons and main strategies for reducing maternal mortality and morbidity are well known. They include antenatal care, labor and delivery management by qualified personnel and availability of emergency obstetric care. All these strategies are also reflected by the generally known three delays, which preclude pregnant women from receiving the right care in time. The project of Rotary International Improvement of Maternal Health - Prevention and Treatment of Obstetric Fistulae was first established in 2005 with the aim of improvement of maternal and fetal health in northern Nigeria. The model for reduction of high maternal and child mortality and prevention and treatment of obstetric fistula in the north of Nigeria was focused by the Rotary International project mainly on first and on third delay of pregnant women seeking care with the aim to reduce maternal mortality by using a multifaceted system of interventions. In order to create a consciousness of the population on existing problems of maternal and fetal morbidity and mortality Rotary International established different activities to inform the population on household, community and district levels about reasons and existing problems causing maternal and fetal mortality and morbidity with the aim of reducing first delay. An effective way of reaching women and their families, especially in rural areas of Nigeria, is the conduction of community dialogues. Between October 2007 and July 2009 a total number of 323 fistula patients were treated in Rotary Fistula Centre Wudil and in Rotary Fistula Centre Zaria, which were established by Rotary International in two hospitals in Kano State and Kaduna State in northwest of Nigeria. Documentation takes place of every surgery using patient s reports and treatment of vesico-vaginal and recto-vaginal fistula, which are carried out in one of the two fistula centers. A detailed characteristic of patient s details, i.e. age, residence, number of pregnancies, number of living children and height of women; and diagnosis with side, type and classification of fistula was assessed on the basis of these data. In 2008 an Institute of Quality Assurance was established at Aminu Kano Teaching Hospital in Kano State. Ten selected hospitals, five in Kano State and five in Kaduna State, participate in data collection and were introduced in quality assurance in obstetrics. In December 2009 a detailed status of equipment of hygienic conditions of each room of the maternity units (operating theatre, delivery room, neonatal unit, obstetrical ward and general conditions) was assessed in the ten participating hospitals of the project. The collected data were related to the maternal mortality in the hospitals and a critical analysis whether the quality of care were carried out. Besides, health care workers in hospitals were trained, e.g. in using fetal Doppler or anti-shock garment, for a better management of obstetric cases (quality of process). For measuring the quality of outcome in all hospitals data of obstetric care were regularly collected, half-yearly data were demonstrated and analyzed in review meetings . Under the guidance of the Institute of Quality Assurance these data can be discussed regularly with health workers of all participating hospitals. This gives a possibility of improvement in single hospitals by introducing new standards with the encouragement of all involved health workers in the hospitals.The analyses of collected data in all participating hospitals demonstrate the achievement of reduction of maternal mortality and morbidity, which could be reached within five half-years. The main outcome indicator of quality assurance, i.e. maternal mortality, could be reduced from 1790 MD per 100,000 deliveries in first half-year 2008 to 790 MD per 100,000 deliveries first half-year 2010. This is a decrease of maternal mortality of more than 55% from January 2008 to June 2010 in participating health care facilities in northern Nigeria.
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