ArticleReproductive health2018
Association of the client-provider ratio with the risk of maternal mortality in referral hospitals: a multi-site study in Nigeria.
Article in Reproductive health, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
10 citing papers in PubMed.
- The Six Delays Model: expanding the three delays model with evidence from Madagascar for maternal referrals in LMICs.BMJ global health · 2026Review
- Enhancing General Practitioners' Compliance with Antenatal Care Standards and Pregnant Women's Satisfaction Through Point-of-Care Quality Improvement in Indonesian Community Health Centers.Patient preference and adherence · 2025Article
- Attitude of postpartum women towards multiple postnatal clinic schedule in south-west Nigeria.European journal of obstetrics & gynecology and reproductive biology: X · 2023Article
- Association of workload and practice of respectful maternity care among the healthcare providers, before and during the early phase of COVID-19 pandemic in South Western Nepal: a cross-sectional study.BMC health services research · 2023Article
- Metrics for maternity unit staffing in low resource settings: Scoping review and proposed core indicator.Frontiers in global women's health · 2023Article
- A Strategy for Reducing Maternal Mortality in Rural Kenya.International journal of women's health · 2023Article
- Antenatal Clinic Waiting Time, Patient Satisfaction, and Preference for Staggered Appointment-A Cross-Sectional Study.Journal of patient experience · 2021Article
- Outcomes of a multifaceted intervention to improve maternal satisfaction with care in secondary hospitals in Nigeria.Global health action · 2020Article
- Outcome of multifaceted interventions for improving the quality of antenatal care in Nigerian referral hospitals.Reproductive health · 2020Article
- Men's perception of barriers to women's use and access of skilled pregnancy care in rural Nigeria: a qualitative study.Reproductive health · 2019Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
12 authors.
Funding
Abstract
backgroundThe 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.
methodsClient-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.
resultsA 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.
conclusionWe 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 registrationTrial Registration Number: NCTR91540209 . Nigeria Clinical Trials Registry. Registered 14 April 2016.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.