KASSEP
Nigeria accounted for over one-quarter of global maternal deaths in 2020 with an MMR of 1,047 per 100,000 live births. The recent Nigeria Demographic Health Survey of 2018 (NDHS) estimated MMR of 512 per 100,000 live births, even though within the country, there is a large variation: MMR is higher in the northern region of the county as compared to the southern region. Various studies have shown MMR increasing in the north of Nigeria and decreasing in the south, for example, Meh et al found that while MMR increased from 620 to 709 per 100,000 live births between 2008 and 2013 in northern Nigeria, it decreased in the south from 401 to 365 per 100,000 live births during the same period. Galadanci et al found that Kano State, one of the states in Northern Nigeria had an MMR of 2,100 and 2,150 per 100,000 live births in 2008 and 2013 respectively. There is no doubt that efforts will have to be made to enable Nigeria to achieve an MMR of 70 per 100,000 live births, which is the goal of the SDG Target 3.1
• Data and evidence consistent with the policy framework of Kano State Ministry of Health (KSMoH) that generates reliable estimates on the MMR, the number of maternal deaths and the number of live births in the state. These measures will form the basis for assessing the impact of subsequent policy and program actions adopted by KSMoH.
• Understand the causes and the contextual factors associated with maternal deaths to provide Kano State with insights on program/policy intervention.
• Understand the causes and the contextual factors associated with stillbirths to provide Kano State with insights on program/policy intervention.
• The government of Kano State utilizes the findings of this research to speedily implement policy/actions that specifically:
• Accelerate the reduction of preventable maternal deaths by intensifying the scale of proven low-cost interventions via its structures and institutions (whether these be publicly or privately-owned).
• Increased quality of care of the mother and baby-in-conception dead to accelerate the reduction of preventable stillbirths.
• the accelerated reduction of preventable neonatal deaths by scaling up proven newborn care interventions (such as, Chlorhexidine-CHX for cord care, breastfeeding initiation, handwashing, Kangaroo Mother Care) in the first 24-48 hours in tandem with enhanced quality of care of the mother and baby-in-conception dyad.
• the establishment of optimal functioning surveillance (as part of a larger surveillance system that includes pandemic preparedness) systems throughout the state to monitor and inform progress on reduction of MMR, stillbirth rates and neonatal mortality rate (NMR).
• Understand the factors and drivers of (the lack or under-deployment of) women's agency in so far as these aggravate adverse maternal outcomes and deaths and use this evidence to shape policy and programs to drive reduction in preventable maternal deaths.
• Kano State has utilized evidence from this research towards its goal of introducing as well as systematically utilizing machine learning and artificial intelligence platforms to regularly derive insights to guide future policy analysis and decision-making to deliver health impact for its residents.
• Use(s) of infrastructure of this research activity to establish a surveillance system to prospectively track MMR progress throughout Kano State.
Kano State is in the northwest of Nigeria and is one of the most populous states in the country. It is divided into three senatorial zones consisting of 44 local government areas (LGA). Each LGA is further divided into enumeration areas (EAs). Figure 1 below shows a map of Kano State.
This will comprise two groups of individuals:
• Husbands/ Male partners/ Relatives and/or caregivers of women who died while pregnant or six weeks after the termination of a pregnancy and the maternal death occurred any time during the 12 months before the study.
• Fathers/ Mothers (or a relative and/or caregiver of the mother) who delivered dead babies whose gestational age was 7 or more months, and the still birth occurred any time during the 12 months before the study
• Health care providers (if available) that participated in the care of the maternal death and/or the stillbirth.
The study will employ a mixed methods approach to establish a sample registration system (SRS) that will be named Kano State Surveillance for Evidence and Policy (KASSEP) in the LGAs of Kano state. The team will coordinate with Nigeria Bureau of Statistics (NBS) to determine the sample of households that will be surveyed for selected vital events such as pregnancies, births, and deaths. The current EAs developed by the National Population Commission (NPC) will be used as the sampling frame for the study. A representative sample of clusters will be drawn randomly to ensure representativeness across senatorial districts, urban and rural settings. Probability proportionate to size will be considered in selecting the number of EAs per LGA. Each EAs will serve as a cluster and according to the NPC Census of 2006 have an average household size of 30. Households in selected clusters will serve as SRS study units.
Qualitative arm: This will entail qualitative interviews (Focus Group Discussion, Key Informant Interviews, and In-depth Interviews) to explore factors that affect women agency in Kano as well as interviews using the social autopsy questionnaire. Using the maximum variation sampling, we will explore the perspectives of relevant stakeholders in women’s health in Kano.
Quantitative arm: The use of the VASA tool will form the quantitative arm of this work.
Establishing the SRS will enable the study to engage in both a retrospective study (maternal deaths and stillbirths that occurred within the last 12 months before the study state date) and prospective study (maternal deaths and stillbirths that occurred with two years after the study start date).
