Sociodemographic, obstetric and referral determinants of adverse foetal and perinatal outcomes in obstetric emergencies: evidence from referral hospitals in Benin city, Nigeria
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20261737Keywords:
Foetal outcome, Perinatal outcomes, Determinants, Nigeria, Obstetric emergencyAbstract
Background: Perinatal mortality remains unacceptably high in many low-resource settings, with a substantial proportion of these deaths occurring among women presenting with obstetric emergencies. This study assessed the sociodemographic, obstetric and referral predictors of adverse foetal and perinatal outcomes among women managed for obstetric emergencies in Benin City, Edo State, Nigeria.
Methods: This cross-sectional study was conducted across the four largest referral hospitals in Benin City using clinical data obtained from women who received EmONC services. Binary logistic regression was applied to assess associations between patient characteristics and outcome. Multivariable logistic regression models were fitted to estimate adjusted odds ratios (AOR) with 95% CIs for the association between explanatory variables and adverse foetal outcomes. To assess potential effect modification, interaction terms were specified between key maternal risk factors (booking status and referral status) and selected EmONC interventions.
Results: Among 526 women presenting with obstetric emergencies, 171 (32.6%) experienced adverse perinatal outcomes. The most frequently provided EmONC interventions were caesarean section (70.0%), parenteral antibiotics (66.4%), and uterotonics (41.4%). After controlling for potential confounders, referral status (AOR 2.11; 95% CI: 1.39–3.20) and booking status (AOR 0.25; 95% CI: 0.15–0.44) were strongly associated with adverse outcomes. Interaction analyses assessing modification of the associations between referral or booking status and adverse foetal and perinatal outcomes, showed no significant effects across any of the interventions evaluated.
Conclusions: Strengthening antenatal care utilisation and improving the efficiency and coordination of referral pathways for women requiring EmONC are essential for improving perinatal survival.
References
United Nations Inter-Agency Group for Child Mortality Estimation. Standing Up For Stillbirth: Current estimates and key interventions. Report of the United Nations Inter-Agency Group for Child Mortality Estimation, New York: United Nations Children’s Fund (UNICEF). 2024. Available at: https://data.unicef.org/resources/standing-up-for-stillbirth-report/. Accessed on 19 November 2025.
Hug L, You D, Blencowe H, Lawn JE, Wang J, Say L, et al. Global, regional, and national estimates and trends in stillbirths from 2000 to 2019: a systematic assessment. Lancet. 2021;398:772-85.
Flenady V, Sexton J. Epidemiology of fetal and neonatal death. In: Keeling’s fetal and neonatal pathology. 5th ed. Cham (CH): Springer. 2022;131–57.
Federal Ministry of Health and Social Welfare of Nigeria (FMoHSW), National Population Commission (NPC) [Nigeria], and ICF. 2025. Nigeria Demographic and Health Survey 2024. Abuja, Nigeria, and Rockville, Maryland, USA: FMoHSW, NPC, and ICF. Available at: https://dhsprogram.com/publications/publication-FR395-DHS-Final-Reports.cfm. Accessed on 19 November 2025.
Oladapo OT, Adetoro OO, Ekele BA, Onakewhor CO, Ochejele AO, Abubakar MA, et al. When getting there is not enough: a nationwide cross-sectional study of 998 maternal deaths and 1451 near-misses in public tertiary hospitals in a low-income country. BJOG. 2016;123:928-38.
Pacagnella RC, Cecatti JG, Osis MJ, Faúndes A, Sousa MH, Gama SF, et al. The role of delays in severe maternal morbidity and mortality: expanding the conceptual framework. Reprod Health Matters. 2012;20(39):155-63.
He Q, Abdureyim M, He Z, Liu X, Zhang X, Wang Y, et al. Factors associated with age-specific maternal health-seeking behaviours among women: A Multiple Indicator Cluster Survey-based study in 10 African countries. J Glob Health. 2022;12:04095.
Oriji PC, Briggs DC, Ubom AE, Nwafor NN, Okon EJO, Etuk SE, et al. A five-year review of perinatal and maternal outcomes and their predisposing socio-demographic factors in a tertiary hospital in South-South Nigeria. Int J Adv Med. 2022;9(2):405-14.
Edo State Ministry of Health. Edo State Strategic Health Development Plan (2010-2015). Available at: http://ngfrepository.org.ng:8080/jspui/handle/123456789/3240. Accessed on 19 November 2025.
Okojie OH, Ogboghodo EO, Omoijuanfo EA. Maternal and neonatal outcomes of booked and unbooked pregnancies in Benin City, southern Nigeria: a comparative study. J Community Med Prim Health Care. 2022;34(2):109-27.
John-Abebe RO. Maternal mortality in tertiary health facilities in Edo State, southern Nigeria. Tanzan J Popul Stud Dev. 2024;31(1):72-89.
Aikpitanyi J, Ohenhen V, Ugbodaga P, Omoigberale EE, Akoria SE, Egboh GO, et al. Maternal death review and surveillance: the case of Central Hospital, Benin City, Nigeria. PLoS One. 2019;14(12):e0226075.
World Population Review. Benin City. Available at: https://worldpopulationreview.com/cities/nigeria/benin-city. Accessed on 19 November 2025.
WHO. WHO recommendations on antenatal care for a positive pregnancy experience. World Health Organization. 2016. Available at: https://www.who.int/. Accessed on 19 November 2025.
WHO. Monitoring emergency obstetric care: a handbook. World Health Organization. 2009. Available at: https://www.who.int/. Accessed on 19 November 2025.
Banke-Thomas A, Avoka CK, Gwacham-Anisiobi U, Omololu O, Balogun M, Wright K, et al. Travel of pregnant women in emergency situations to hospital and maternal mortality in Lagos, Nigeria: a retrospective cohort study. BMJ Global Health. 2022;7:e008604.
Banke-Thomas A, Avoka CK, Gwacham-Anisiobi U, Benova L. Influence of travel time and distance to the hospital of care on stillbirths: a retrospective facility-based cross-sectional study in Lagos, Nigeria. BMJ Global Health. 2021;6:e007052.
Banke-Thomas A, Balogun M, Wright O, Ajayi B, Abejirinde IO, Olaniran A, Giwa-Ayedun RO, Odusanya B, Afolabi BB. Reaching health facilities in situations of emergency: qualitative study capturing experiences of pregnant women in Africa's largest megacity. Reprod Health. 2020;17(1):145.
Ofosu B, Ofori D, Ntumy M, Ansong SO, Amoah EK, Mensah LA, et al. Assessing the functionality of an emergency obstetric referral system and continuum of care among public healthcare facilities in a low resource setting: an application of process mapping approach. BMC Health Serv Res. 2021;21:402.
Mengist B, Semahegn A, Yibabie S, Alemu MD, Teshome AT, Kassa NA, et al. Barriers to proper maternal referral system in selected health facilities in Eastern Ethiopia: a qualitative study. BMC Health Serv Res. 2024;24:376.
Dahiru T, Aliyu A. Stillbirth in Nigeria: Rates and Risk Factors Based on 2013 Nigeria DHS. Open Access Library J. 2016;3(8):1-12.
Okonofua FE, Ntoimo LFC, Ogu R, Galadanci H, Mohammed G, Adetoye D, et al. Prevalence and determinants of stillbirth in Nigerian referral hospitals: a multicentre study. BMC Pregnancy Childbirth. 2019;19(1):533.
Gwacham-Anisiobi U, Opondo C, Cheng TS, Kurinczuk JJ, Anyaegbu G, Nair M. Rates and risk factors for antepartum and intrapartum stillbirths in 20 secondary hospitals in Imo state, Nigeria: A hospital-based case control study. PLOS Glob Public Health. 2024;4(10):e0003771.
Awoyesuku PA, Ohaka C, Kua PL, George EE, Amadi IC, Amieyeofori EK, et al. Prevalence and determinants of singleton stillbirths at a tertiary hospital in Port-Harcourt, Nigeria. Niger Med J. 2024;65(5):632-46.
Babah OA, Oluwole AA, Afolabi BB. Prevalence and Causes of Stillbirths at Lagos University Teaching Hospital, Lagos, Nigeria: A five year review. Nig Q J Hosp Med. 2018;28(2):56-61.
Mukherjee A, Di Stefano L, Blencowe H, Mee P. Determinants of stillbirths in sub-Saharan Africa: A systematic review. BJOG. 2024;131(2):140-50.
Terefe B, Jembere MM, Abrha NN, Woldemichael TG, Tadesse AM, Kebede YA, et al. Pooled prevalence and multilevel determinants of stillbirths in sub-Saharan African countries: implications for achieving sustainable development goal. Glob Health Res Policy. 2025;10:11.
Bhutta ZA, Darmstadt GL, Haws RA, Lawn JAK, Lawn JE, Baqui AH, et al. Delivering interventions to reduce the global burden of stillbirths: improving service supply and community demand. BMC Pregnancy Childbirth. 2009;9(1):1-37.
Whaley B, Butrick E, Sales JM, Goodman CA, Hurst EK, Bullock EL, et al. Using clinical cascades to measure health facilities’ obstetric emergency readiness: testing the cascade model using cross-sectional facility data in East Africa. BMJ Open. 2022;12:e057954.
Wilunda C, Putoto G, Riva DD, Manenti A, Dall’Oglio MTC, Boccuzzi L, et al. Assessing coverage, equity and quality gaps in maternal and neonatal care in sub-saharan Africa: an integrated approach. PLoS One. 2015;10:e0127827.
Kruk ME, Gage AD, Arsenault C, Jordan H, Leslie AT, Roder-DeWan F, et al. High-quality health systems in the Sustainable Development Goals era: time for a revolution. Lancet Glob Health. 2018;6:e1196-252.
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