Perinatal Mortality In Nigeria The State Of The Nation

Keywords: Perinatal mortality, Nigeria.

Perinatal mortality is the death of a fetus in utero after the age of viability (still births) and deaths within the first seven days of life (early neonatal death)1. It is an important vital statistics and an indicator of not only the level of foetal and maternal care but also of a nation’s socio-economic advancement. Factors responsible for both still births and early neonatal deaths are similar and are those operating before and during birth respectively2. There are more deaths occurring in the perinatal period than during the next 30 to 40 years of life in many developing countries such as Nigeria. The perinatal mortality rate is a better indicator of quality of maternal care than neonatal health2. There are two different definitions of perinatal mortality. Perinatal mortality definition I includes infant deaths of less than 7 days of age and fetal deaths of 28 weeks or more gestation. Perinatal mortality definition I is preferred for international comparisons due to differences among countries in completeness of reporting of fetal deaths of 20–27 weeks of gestation. Perinatal mortality definition II is the most inclusive definition, and includes infant deaths of less than 28 days of age and fetal deaths of 20 weeks or more gestation. Perinatal mortality definition II is useful for monitoring perinatal mortality throughout the gestational age spectrum, as the majority of fetal deaths occur before 28 weeks of gestation2. Nigeria is the most populous black nation in the world with alarming perinatal mortality rates.  Nigeria is among the top ten countries which together contribute 54% of total world births and unfortunately also account for 67% of all Stillbirths3. The perinatal mortality rate is a very useful index for assessing the quality of antenatal care, the utilization of such services and the availability and development of maternity or obstetric services in any community. The quality and utilization of antenatal services in Nigeria is poor4. Majority of deliveries takes place in rural Nigeria where skilled attendants are lacking and where patronage of traditional birth attendants is high4. 

 The perinatal mortality rate of a nation or community can only be accurately stated where registration of all births (still-births and live-births) is maintained. In Nigeria, there are no accurate data for the community as most births and deaths are not registered4. Most of the data available are institutional data.

Registration of births and deaths is the practice in all developed countries of the world2. In developing countries where registration of births is not mandatory and therefore statistics are not accurately maintained, only hospital or institutional figures may be obtained. The value of the perinatal mortality rate in such countries is therefore rather restricted in its application. Only 23% of births are registered in Nigeria4. Perinatal mortality in 2 Northern Nigerian institutions were 58.6/10005 and 81.6/10006 respectively. Perinatal mortality rates from South Western and South Eastern Nigeria were 84.6/10007and 133.94/1000 respectively8. 

Developed nations in the world have rates as low as 10 per 10009, 10; Nigeria has rates as high as 39 to 130 per 10005, 7, 8. The 2003 and 2008 National demographic and health survey carried out in Nigeria revealed perinatal mortality rates of 72 and 39 per 1000 live births11, 12. Perinatal mortality in the 2008 survey was highest among teenage mothers and mothers age 40-49 (50 and 55 percent, respectively). Short birth interval with pregnancy occuring at an interval less than 15 months have the highest perinatal mortality rates (76 deaths per 1000 pregnancies12. 

There are a number of socio-biological variables that are associated with perinatal mortality in Nigeria. These factors also put the life of the mother at risk causing morbidity and mortality. Risk factors for perinatal deaths are low socioeconomic status, high maternal age (35 years or more), low maternal age (under 16 years), high parity mostly with short birth intervals, malnutrition and severe anaemia. Others are maternal height with respect to short stature when compared with the mean for the community and bad obstetric history such as one or more previous still births and neonatal deaths and one or more preterm births. 

Perinatal deaths like maternal deaths are determined from clinical findings and post mortem findings. Post mortem examinations are not commonly done in Nigeria because of the very few pathologist available13. There are not many pathologist and paediatricians in Nigeria and the available ones are concentrated in the Cities and in the tertiary health institutions4. Most deliveries in occur in rural Nigeria meaning that high risk babies are born largely unattended to by paediatricians and are left at the mercy of traditional birth attendants13,4. 

Maternal conditions such as hypertension, heart diseases, diabetes mellitus, HIV/AIDS, tuberculosis, malaria and anaemia all cause perinatal deaths. Others are anatomic defects such as cervical incompetence and uterine anomalies. Malnutrition, advanced maternal age, congenital defects, blood group incompatibility and intrauterine growth restriction are also implicated.

During the intrapartum period, birth asphyxia, birth injuries and obstetric complications such as prolonged obstructed labour are causes of perinatal deaths. Statistics has it that 25% of fetal deaths in Nigeria occur during the intrapartum period14. The causes of perinatal mortality in the postnatal period are prematurity, respiratory distress syndrome, sepsis and congenital abnormalities.