Maternal Mortality Ratio: The three delays models

Question 1

Maternal mortality remains a major public health challenge worldwide
especially in low- and middle-income countries. The Maternal Mortality Ratio (MMR) is a key indicator that reflects the risk associated with pregnancy and childbirth, measuring the number of maternal deaths per 100,000 live births.
Despite advances in healthcare, many women still die from preventable causes related to pregnancy and childbirth.
Understanding the reasons behind these deaths is essential to developing effective interventions.

Answer 1

Maternal mortality remains a major public health challenge worldwide
especially in low- and middle-income countries. The Maternal Mortality Ratio (MMR) is a key indicator that reflects the risk associated with pregnancy and childbirth, measuring the number of maternal deaths per 100,000 live births.
Despite advances in healthcare, many women still die from preventable causes related to pregnancy and childbirth.
Understanding the reasons behind these deaths is essential to developing effective interventions.

Question 2

The Maternal Mortality Ratio (MMR) is a key indicator that reflects the _________ associated with _________ and _________, measuring the number of maternal deaths per _________ live births.

Answer 2

risk ; pregnancy

childbirth ; 100,000

Question 3

Maternal mortality, or maternal death is defined as the death of a woman while _________ or within ____________ of termination of pregnancy, irrespective of the __________ and _______ of the pregnancy, from any cause related to or aggravated by the __________ or its __________ but not from _________ or _____________ causes.

Answer 3

pregnant ; 42 days

duration ; site ; pregnancy

management ; accidental

incidental

Question 4

The lifetime risk of a Nigerian woman dying during pregnancy, childbirth, postpartum or post-abortion is 1 in
______ . in contrast to the litetime risk in developed counties estimated at 1 in __________.

Answer 4

4900.

Question 5

> Maternal Mortality Ratio (MMR):The number of maternal deaths during ___________ , ___________, or within ___________ of termination of pregnancy, per ___________ ___________ in a given time period.

Answer 5

pregnancy ; childbirth

42 days

100,000 live births

Question 6

Maternal mortality ratio

It measures the __________ per __________ and is widely used to assess the quality of maternal health care.

Answer 6

risk of death

live birth

Question 7

Maternal Mortality Rate: The number of __________ in a population per ________________—— in a given time period.

Answer 7

maternal deaths

1000 women of reproductive age

Question 8

Maternal Mortality Rate

> It reflects the ________ of maternal death in the overall population of _______________ , regardless of whether they are _________.

Answer 8

risk

in the overall population of women of reproductive age, regardless of whether they are pregnant.

Question 9

Global prevalence of MMR

> The global MMR in 2017 was about ________ maternal deaths per ________________.

Answer 9

211

100,000 live births

Question 10

______________ has the highest burden, accounting for nearly two-thirds of all maternal deaths, with MMR exceeding 500 deaths per 100,000 live births in some countries.

Answer 10

Sub-Saharan Africa

Question 11

The Sustainable Development Goal (SDG) target is to reduce the global MMR to less than ________ per 100,000 live births by 2030.

Answer 11

70

Question 12

Causes of Maternal Deaths in Africa Region (WHO, 2021)

Top 5 accordingly from lowest to highest

Answer 12

Pregnancy with abortive outcomes
Pregnancy related infections
Non Obstetric complications
Hypertensive disorders in pregnancy
Obstetric Hemorrhage

Question 13

Maternal Mortality Ratio in Nigeria
> Nigeria’s MMR is around _______ to _______ maternal deaths per 100,000 live births (2023) depending on the source and specific data year.

Answer 13

512

814

Question 14

Nigeria accounts for about _____% of global maternal deaths, making it the country with the highest absolute number of maternal deaths worldwide.
>

Answer 14

20

Question 15

The Nigerian MMR has declined somewhat from over _________ deaths per 100,000 live births in the early 2000s, but progress has been slow and uneven.

Answer 15

1000

Question 16

(northern or southern?) states generally have higher MMR compared to the (North or South?) due to differences in health service coverage, education, and socioeconomic factors.

Answer 16

Northern

South

Question 17

Key factors influencing MM in Nigeria

›Inadequate _________ to skilled birth attendants and emergency obstetric care, especially in rural areas.
Poor ______________ and shortages of __________ medicines and equipment.
High rates of __________ and low female __________ levels limiting access to quality care.
Sociocultural factors, including early marriage and gender inequality.
Security challenges in certain regions affecting access to healthcare services.

Answer 17

access

health infrastructure ; essential

poverty ; education

Question 18

Regional Disparities Within Nigeria

> Southern Nigeria: Generally reports __________ MMRs

›Northern Nigeria: Regions like the North-West, North-East, and North-Central have _________ MMRs, with some states like ______ reporting over 1,000 deaths per 100,000 live births.

Answer 18

lower ; higher

Kebbi

Question 19

Contributing factors to higher MMRs in Kebbi include:
> Low __________________
> High __________ rates (e.g., 91% in Kebbi)
>Limited access to ________________
> Cultural and socio-economic barriers.

Answer 19

antenatal care attendance

home delivery rates

skilled birth attendants.

Question 20

Ongoing Interventions and Initiatives

> _________________ (MSS)
_________________ Project
_________________(Mamii)
_________________ Program

Answer 20

Midwives Service Scheme (MSS)
Abiye (Safe Motherhood) Project
> Maternal Mortality Reduction Innovation Initiative (Mamii)
>Lagos State’s MamaBase Program

Question 21

Ongoing Interventions and Initiatives

> Midwives Service Scheme (MSS): Launched in 2009, MSS deploys _________ to ____________ areas to improve __________________________.

Abiye (Safe Motherhood) Project: Implemented in ________, this initiative includes the establishment of ______________ Hospitals and the _________________________ (MDSR) system to monitor and address maternal deaths.

Answer 21

midwives ; underserved rural areas

access to skilled birth attendance.

; Mother and Child ; Maternal Death Surveillance and Response

Question 22

Ongoing Interventions and Initiatives

> Maternal Mortality Reduction Innovation Initiative (Mamii): A _______wide program aiming to identify and support ___________ through pregnancy, childbirth, and postpartum care.

> Lagos State’s MamaBase Program: A ________-driven intervention that registered 7,883 pregnant women across 20 local councils, achieving a 99.9% reduction in maternal deaths in the targeted areas.

Answer 22

nationwide ; pregnant women

data

Question 23

The Path Forward

To achieve the Sustainable Development Goal of reducing MMR to below ______ per 100,000 live births by 2030, Nigeria must:

> Increase Healthcare _________
Expand _____________________
Improve Healthcare _____________
Address ___________ Barriers
Strengthen Security and Accessibility

Answer 23

70 ; Funding

Skilled Birth Attendance ; Infrastructure

Socio-Cultural

Question 24

The three delays Model

The Three Delays Model:
Overview
Developed by Thaddeus and Maine in 1994, this model explains how _______ at different stages during _________________ can lead to maternal deaths.

Answer 24

delays

obstetric emergencies

Question 25

The three delays model It identifies three critical delays: Phases of Delay PHASEI:?? PHASE II:?? PHASE III: Receipt of ???

Answer 25

Decision to Seek Care Identifying and Reaching Medical Facility Adequate and Appropriate Treatment

Question 26

First Delay: Delay in Decision to Seek Care -This delay happens when the pregnant woman or ________ does not recognize the ________ of the problem or decides _________ to seek medical help.

Answer 26

her family; severity; late

Question 27

Factors causing delay in decision to seek care include: > Lack of ____________ about danger signs in pregnancy or childbirth > Socio-cultural ______ and ______ > Low ______ of women in decision-making > _____________ and fear of costs > Previous ________________ with healthcare services

Answer 27

knowledge beliefs ; traditions autonomy ; Financial constraints bad experiences

Question 28

Delay in Reaching a Health Facility Once the decision to seek care is made, delays can still occur in ________________________________

Answer 28

physically getting to a facility that can provide emergency obstetric care.

Question 29

Causes of Delay in Reaching a Health Facility >_________ to the nearest equipped health facility >Poor ____________________ and lack of emergency transport > ___________ barriers such as rivers, mountains, or poor roads >Security concerns or conflict zones preventing safe travel

Answer 29

Distance transportation infrastructure Geographic

Question 30

Delay in Receiving Adequate Care at the Facility After reaching a health facility, further delays may occur before the woman receives appropriate and timely care. Reasons include: _________ of trained healthcare personnel (midwives, doctors) Lack of __________ drugs, supplies, or equipment Poor facility organization and long ___________ Inadequate triage and referral systems __________ barriers at the point of care

Answer 30

Shortage; essential waiting times Financial

Question 31

The Impact of Policy on the Three Delays > Policy plays a crucial role in addressing the three delays that affect timely maternal care. It shapes the environment in which decisions are made, access is gained, and care is delivered. >By promoting ____________ and ____________ women, policies help reduce delays in _______________________.

Answer 31

health education ; empowering deciding to seek care.

Question 32

Within health facilities, policies related to workforce, resource allocation, and quality assurance ensure that women receive ________ and ————————care, reducing treatment delays.

Answer 32

timely and adequate

Question 33

Public health significance The public health significance of addressing the three delays lies in its potential to _________________________.

Answer 33

substantially reduce maternal mortality and morbidity