Modeling Maternal Mortality Data of Some Selected Health Facilities in Rivers State using Poisson Regression Model : ( 2013-2017 )

The risks associated with pregnancy have been of the greatest challenges that have drawn the attentions of researchers, statisticians, medical practitioners, families and even the pregnant women themselves. These challenges has called for concern among stakeholders, therefore, this study was targeted at modeling maternal mortality data of some selected health facilities in Rivers state using Poisson Regression model. To achieve this target, the study aim of the study was to model maternal mortality rate in some selected Health in Rivers State, while the specific objectives of the study include to: assess factors that contribute to high rate of maternal mortality rate in Rivers State. Secondly, was to fit an appropriate model to data on maternal mortality rate in Rivers State and to select an appropriate fitted model in estimating and modeling of maternal mortality rate in Rivers State. The data for the study was source for and extracted from the Rivers State Hospital Management Board. The data extracted was analyzed using statistical software called STATA version 14. The results obtained revealed that the Poisson regression, Poisson Generalized Regression, the Negative Binomial Regression and truncated Regression model cannot actually captured the excess Zeros contain in the data and the issue of over dispersion. So, other form of Poisson Regression models such as Zero-inflated Poisson Regression and Zero-inflated Negative Binomial Regression were also used in the estimation. However, zero-inflated Negative Binomial Regression has the least Akaike Information Criterion (AIC) based on the selections of the overall best fitted model. Hence, recommendation were made base on the results from the findings. Keyword: Modeling, Maternal, Mortality Health, Facility Introduction 1.1 Background to the Study Maternal mortality has become a very significant determinant of human and social development. It is particularly exposes women’s overall status, access to health care, and the responsiveness of government to the health care system needs of her citizens. Therefore, awareness of maternal mortality levels is very important not only for identifying the risks associated with pregnancy and childbearing, but also for what it says about women’s health and, indirectly, their economic and social status. Determining the level maternal mortality and the associated risk factors is necessary in order to be able to diagnosed issues and assessing the advancement and effectiveness of existing maternity programs in Rivers state and Nigeria at large. Also, in life women having pregnant and giving birth to children are two physiological events that comes with joy to the women, the husband, family and the society in general as it is a fulfillment of God’s commandment that we should go into the world and multiply. However, sometimes in life, the reverse is case as it is occasionally a source of sorrow. According to International Journal of Applied Science and Mathematical Theory ISSN 2489-009X Vol. 5 No. 1 2019 www.iiardpub. org IIARD – International Institute of Academic Research and Development Page 2 Salifu (2004) for some women in certain parts of the world specifically in developing countries, the reality of giving birth to children is often grim. For those women, giving birth to children is often marred by unforeseen challenges that sometimes lead to loss of lives (mother and child). Some women loss the fetus even before being given birth to or immediately after birth, whiles others loss both their lives and the fetus. In Nigeria today maternal period is prone to crises due to so many factors such as Socio – economic, religious and biological factors all theses interact as well interface with each other. A culmination of these factors couple with other cultural beliefs and practices such gender biasness, low status of women in the society, and high fertility affect child delivery in Nigeria. According to the WHO (2012), maternal mortality could be referred to as the death of women from any cause related to or attributed to pregnancy or its management (excluding) accidental or incidental causes during pregnancy and child bearing or within 42 days of termination of the pregnancy, irrespective of the duration and size of the pregnancy. According to the current estimation by the world health organization (WHO), the United Nation Children Fund (UNICEF) and the World Bank about size hundred thousand (600,000) women die yearly as a result of pregnancy-related complications and 99% of it occur mostly in less developed countries in the world. Sequel to the above, this situation makes maternal mortality an indicator in the health sector that shows the largest disparity between developed and developing countries in the world. According to MCA lister and Basket (2006), in sub – Saharram Africa one out of every 13 women that gave birth during child bearing dies of pregnancy-related causes during their life time as compare to one in 4085 women in most globalized countries. Also, WHO, UNICEF and World Bank (2008) estimated the number of women that die as a result of pregnancyrelated causes to be in the ratio of one is to 45. They further to suggested that for every maternal death an approximated number of 30 women suffer one form of injuries, complications, infections and disabilities during pregnancy or child bearing in at least in 15 Million women in a year. It is therefore very obvious that developing countries in the world continue to have the highest number of cases of women that dies as a result of pregnancyrelated issues. Sahfu (2014) attributed the causes of these challenges to lack of access to skilled delivery care that will reduce maternal, prenatal mortality and morbidity. The need for reduction in maternal mortality has actually generated a lot of concern among corporate organizations, Non – government organization (NGOS), international community and researchers alike especially in view of its spontaneous increase with a corresponding devastating effects on the women, their families and society in general. The importance of this condition resulted to most notably the launching of the Millennium development goals (specifically) NDG 5: Improving material health), global strategy for women’s and children Health in the year 2010 by the United Nations (UN). Secretary – General which was greeted with high profile Global pronouncement. Subsequently, the high – level commission on information and accountability to determine the most effective and international institution arrangement for global reporting oversight and accountability on women and their children’s health, one women and their children’s health. One among the ten recommendations of the commission was specifically to improve measure on now to reduce maternal (and children) death. The recommendation required that by 2015 all countries should take steps to establish a system for the registration of births, deaths and causes of death and have well – functioning health information systems that combine data from International Journal of Applied Science and Mathematical Theory ISSN 2489-009X Vol. 5 No. 1 2019 www.iiardpub. org IIARD – International Institute of Academic Research and Development Page 3 facilities, administrative sources and survey (WHO, 2014). This provided an opportunity to ensure risk of material mortality is minimized for all concern. The Government of Rivers State has not done much in this area except the introduction of free antenatal care for all pregnant women from November, 2014 and the exception Laws that was pass which makes child delivery care free that was also put in place. The driving force of these polices have been to improve uptake, quality financial and geographical access to child delivery care services. According to the Rivers State Government, these services as reflected in the policy covered assisted deliveries such as caesarean section and management of medical complications; normal deliveries and surgical complications due to deliveries for the repair of Visio-vaginal and recto – Vaginal fistulae. Although, this exemption policy (Laws) does not covered delivery services in private and faith – based health facilities (Hospital own by Churches). In spite of these initiatives by government, corporate and international communities there are still challenges facing women during pregnancy and child bearing. Actually, from the existing literature in this area must emphasis has not been done on the statistical approach to solving this problem using Poisson regression, Negative Binomial Regression, Zero – inflation Poisson and Binomial regression, and truncated regression models. According to Ayumanda et al, (2013), all these models fall under the category of the count models those are suitable for analyzing discrete data rate whereby the mean of the distribution is equal to the variance process. Although, there are avalanched of models in modeling maternal mortality rate but most of these models exhibit some limitations. This study, therefore target at filling the existing gaps in literature related to the study, it is against this background that this study among other things was targeted at developed model for modeling material mortality rate in selected Health facilities in Rivers State. 3.1 Methodology This chapter shall be discussed under the following sub-headlines; Research Design, model specification, justification for the model specification, sources of data, estimation technique and procedures. 3.2 Model Specification In line with the purpose of the study, the models adopted in the study are Poisson regression, Generalized Poisson Regression, Negative Binomial Regression, Zero-Inflated Poisson ZeroInflated Generalized Poisson, Zero-Inflated Negative Binomial and The truncated Poisson Regression Model and they are stated as thus; 3.2. 1. Poisson Regression Model According to Nwanko and Nwaigwe (2016), Poisson regression models are generalized linear