44-year temporal trends and causes of maternal mortality at the Lagos University Teaching Hospital, LUTH, Lagos, Nigeria (1976-2019)

Background: Nigeria has committed to global initiatives aimed at improving maternal and child health. Institutional audit of maternal mortality over a long period can provide useful information on the trends in maternal death and the impact of interventions. Aim: To evaluate the trends in annual deliveries, maternal mortality ratio and causes of maternal death at a tertiary institution in Nigeria over a period of 44 years (1976-2019). Materials and Methods: We conducted a temporal trend analysis of annual births, maternal deaths, maternal mortality ratio (MMR), and ranking of causes of maternal deaths at a Teaching Hospital, in Southwest Nigeria using available data from 1976 to 2019. Overall and segmental annual percent change (APC) of the observed trends were conducted using Joinpoint version 4.5.0.1 software. Results: Over the 44-year study period, 1323 maternal deaths occurred at approximately 30 maternal deaths per annum. There was a four-fold increase in MMR from 881/100,000 total births in 1976 to 3389.8/100,000 total births in 2019, at an average increase of 3.1% per annum. (APC: 3.1%; P value < 0.001). The leading causes of maternal mortality were hypertension, sepsis, haemorrhage, and abortion, which together contributed to more than 70% of maternal deaths. All the leading causes of maternal deaths except abortion had constant ranking during the study period. Conclusion: The four-fold increase in MMR at our hospital from 1976-2019 is worrying and may suggest that previous efforts at reducing maternal mortality in our institution did not lead to significant improvement toward the attainment of Sustainable Development Goal 3 (SDG3). The hospital increasingly managed complex cases especially the unbooked patients who were referred to the hospital as a last resort.