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Association of the client-provider ratio with the risk of maternal mortality in referral hospitals: a multi-site study in Nigeria

Overview of attention for article published in Reproductive Health, February 2018
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  • In the top 25% of all research outputs scored by Altmetric
  • High Attention Score compared to outputs of the same age (80th percentile)
  • Above-average Attention Score compared to outputs of the same age and source (54th percentile)

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1 blog
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98 Mendeley
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Title
Association of the client-provider ratio with the risk of maternal mortality in referral hospitals: a multi-site study in Nigeria
Published in
Reproductive Health, February 2018
DOI 10.1186/s12978-018-0464-0
Pubmed ID
Authors

Friday Okonofua, Lorretta Ntoimo, Rosemary Ogu, Hadiza Galadanci, Rukiyat Abdus-salam, Mohammed Gana, Ola Okike, Kingsley Agholor, Eghe Abe, Adetoye Durodola, Abdullahi Randawa, The WHARC WHO FMOH MNCH Implementation Research StudyTeam

Abstract

The paucity of human resources for health buoyed by excessive workloads has been identified as being responsible for poor quality obstetric care, which leads to high maternal mortality in Nigeria. While there is anecdotal and qualitative research to support this observation, limited quantitative studies have been conducted to test the association between the number and density of human resources and risk of maternal mortality. This study aims to investigate the association between client-provider ratios for antenatal and delivery care and the risk of maternal mortality in 8 referral hospitals in Nigeria. Client-provider ratios were calculated for antenatal and delivery care attendees during a 3-year period (2011-2013). The maternal mortality ratio (MMR) was calculated per 100,000 live births for the hospitals, while unadjusted Poisson regression analysis was used to examine the association between the number of maternal deaths and density of healthcare providers. A total of 334,425 antenatal care attendees and 26,479 births were recorded during this period. The client-provider ratio in the maternity department for antenatal care attendees was 1343:1 for doctors and 222:1 for midwives. The ratio of births to one doctor in the maternity department was 106:1 and 18:1 for midwives. On average, there were 441 births per specialist obstetrician. The results of the regression analysis showed a significant negative association between the number of maternal deaths and client-provider ratios in all categories. We conclude that the maternal mortality ratios in Nigeria's referral hospitals are worsened by high client-provider ratios, with few providers attending a large number of pregnant women. Efforts to improve the density and quality of maternal healthcare providers, especially at the first referral level, would be a critical intervention for reducing the currently high rate of maternal mortality in Nigeria. Trial Registration Number: NCTR91540209 . Nigeria Clinical Trials Registry. Registered 14 April 2016.

X Demographics

X Demographics

The data shown below were collected from the profiles of 5 X users who shared this research output. Click here to find out more about how the information was compiled.
Mendeley readers

Mendeley readers

The data shown below were compiled from readership statistics for 98 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 98 100%

Demographic breakdown

Readers by professional status Count As %
Student > Master 21 21%
Researcher 13 13%
Student > Ph. D. Student 7 7%
Student > Bachelor 6 6%
Student > Postgraduate 6 6%
Other 15 15%
Unknown 30 31%
Readers by discipline Count As %
Medicine and Dentistry 26 27%
Nursing and Health Professions 19 19%
Social Sciences 8 8%
Psychology 3 3%
Arts and Humanities 2 2%
Other 7 7%
Unknown 33 34%
Attention Score in Context

Attention Score in Context

This research output has an Altmetric Attention Score of 11. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 16 March 2018.
All research outputs
#2,943,752
of 23,025,074 outputs
Outputs from Reproductive Health
#322
of 1,424 outputs
Outputs of similar age
#63,432
of 330,913 outputs
Outputs of similar age from Reproductive Health
#23
of 51 outputs
Altmetric has tracked 23,025,074 research outputs across all sources so far. Compared to these this one has done well and is in the 87th percentile: it's in the top 25% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 1,424 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 12.1. This one has done well, scoring higher than 77% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 330,913 tracked outputs that were published within six weeks on either side of this one in any source. This one has done well, scoring higher than 80% of its contemporaries.
We're also able to compare this research output to 51 others from the same source and published within six weeks on either side of this one. This one has gotten more attention than average, scoring higher than 54% of its contemporaries.