A protocol to investigate predictors of healthcare workers’ responsiveness in initiating maternal and perinatal death reviews in secondary health facilities
Maternal and perinatal mortality remain unacceptably high in sub-Saharan Africa, yet the systematic surveillance and response mechanisms designed to address them are poorly implemented in many low-resource settings. This research aims to investigate the predictors of healthcare workers’ responsiveness in initiating maternal and perinatal death surveillance and response (MPDSR) across selected secondary health facilities in Kebbi State, Nigeria. Despite global and national efforts to reduce maternal and perinatal mortality, Nigeria continues to experience high rates, with numerous secondary health facilities yet to fully implement MPDSR strategies. This study will adopt a cross-sectional design and will use a mixed-methods approach to explore factors influencing healthcare workers’ responsiveness. Stratified random sampling will be used to select 384 healthcare workers from 28 secondary health facilities. The data will be collected through structured questionnaires and focus group discussions with healthcare professionals, including nurses, midwives, and doctors. The study aims to identify predictors, such as facility capacity, healthcare workers’ knowledge, and training, related to the initiation of MPDSR. Findings from this study will provide evidence-based recommendations for policymakers to improve MPDSR implementation, reduce maternal and perinatal mortality, and enhance healthcare systems in Nigeria. The results will guide the formulation of targeted interventions to foster increased engagement and responsiveness among healthcare workers. Additionally, our protocol will assess the roles of organizational culture, facility infrastructure, and leadership support in shaping healthcare workers’ readiness to initiate MPDSR, thereby contributing to the broader evidence base on health system strengthening in low-resource settings.
Actis Danna, V., Lavender, T., Laisser, R., Chimwaza, A., Chisuse, I., Kasengele, C. T., Kimaro, D., Kuzenza, F. D., Lyangenda, K., Mwamadi, M., Shayo, H., Tuwele, K., Wakasiaka, S., & Bedwell, C. (2023). Exploring the impact of healthcare workers’ communication with women who have experienced stillbirth in Malawi, Tanzania and Zambia: A grounded theory study. Women and Birth, 36(1), e25–e35. https://doi.org/10.1016/j.wombi.2022.04.006
Ajayi, A. I., & Akpan, W. (2020). Maternal health care services utilisation in the context of ‘Abiye’ (safe motherhood) programme in Ondo State, Nigeria. BMC Public Health, 20(1), 474. https://doi.org/10.1186/s12889-020-08512-z
Alene, K. A., Adane, A. A., Yifiru, S., Bitew, B. D., & Koye, D. N. (2019). Knowledge and practice of health workers about control and prevention of multidrug-resistant tuberculosis in referral hospitals, Ethiopia: A cross-sectional study. BMJ Open, 9(2), e022948. https://doi.org/10.1136/bmjopen-2018-022948
Almutairi, R. L., Aditya, R. S., Kodriyah, L., Yusuf, A., Solikhah, F. K., Al Razeeni, D. M., et al. (2022). Analysis of organizational culture factors that influence the performance of health care professionals: A literature review. J Public Health Afr, 13(2), 2415. https://doi.org/10.4081/jphia.2022.2415
Amutah-Onukagha, N., Rodriguez, M., Opara, I., Gardner, M., Assan, M. A., Hammond, R., et al. (2017). Progresses and challenges of utilizing traditional birth attendants in maternal and child health in Nigeria. International Journal of Maternal and Child Health and AIDS, 6(2), 130–138. https://doi.org/10.21106/ijma.216
Balogun, M., Banke-Thomas, A., Gwacham-Anisiobi, U., Yesufu, V., Ubani, O., & Afolabi, B. B. (2022). Actions and adaptations implemented for maternal, newborn and child health service provision during the early phase of the COVID-19 pandemic in Lagos, Nigeria: Qualitative study of health facility leaders. Annals of Global Health, 88(1), 14. https://doi.org/10.5334/aogh.3529
Barattucci, M., Pagliaro, S., Ballone, C., Teresi, M., Consoli, C., Garofalo, A., et al. (2022). Trust in science as a possible mediator between different antecedents and COVID-19 booster vaccination intention: An integration of Health Belief Model (HBM) and Theory of Planned Behavior (TPB). Vaccines (Basel), 10(7), 1099. https://doi.org/10.3390/vaccines10071099
Çağatay, H. T., Demirel, Y., Ertuğrul, B., & Tekinyıldız, E. (2024). The effect of organizational culture in health services on employee flourishing. Work, 79(2), 601–611. https://doi.org/10.3233/WOR-230286
Chin, J. H., & Mansori, S. (2019). Theory of Planned Behavior and Health Belief Model: Females’ intention on breast cancer screening. Cogent Psychology, 6(1). https://doi.org/10.1080/23311908.2019.1647927
Chinwah, V. (2020). PRISMA model for improving maternal-child healthcare outcomes in Rivers State, Nigeria. [Doctoral dissertation, Cardiff Metropolitan University]. https://doi.org/10.25401/cardiffmet.20457240
Domingues, R. M. S. M., Viellas, E. F., Dias, M. A. B., Torres, J. A., Theme-Filha, M. M., Gama, S. G. N., et al. (2015). Maternal indicators to monitor hospitals in the Rede Cegonha (Stork Network). Ciência & Saúde Coletiva. Available from: https://www.scielo.br/j/csc/a/4DMf4t3w5R58jJsNL47dxsz/?lang=en [Last accessed on].
Dong, L., Neufeld, D., & Higgins, C. (2008). Testing Klein and Sorra’s innovation implementation model: An empirical examination. Journal of Engineering and Technology Management, 25(4), 237–255. https://doi.org/10.1016/j.jengtecman.2008.10.006
Dranove, D., & Burns, L. R. (2022). Big Med: megaproviders and the high cost of health care in America. University of Chicago Press. https://press.uchicago.edu/ucp/books/book/chicago/B/bo44654714.html
Endjala, T. (2022). An Employee Assistance Programme (EAP) to support midwives affected by maternal deaths and stillbirths in Khomas region, Namibia. [Master’s thesis, University of Namibia]. Available from: https://repository.unam.edu. na/server/api/core/bitstreams/1d0908b3-48d6-4852-825a- 6a2c7d47d035/content [Last accessed on].
Ene, B. I. (2020). Human development in Nigeria: A comparative analysis with Ghana, Togo and Mali. [Master’s thesis, Istanbul Aydin University] Available from: https://kezana.ai/Reader/Thesis/WnQ9jrhj3z8489VBfkckjA [Last accessed on].
Esteves-Pereira, A. P., Schilithz, A. O. C., Leal, M. C., & Szwarcwald, C. L. (2024). Perinatal mortality, severe maternal morbidity, and maternal near miss: Protocol of a study integrated with the Birth in Brazil II survey. Cad Saúde Pública. Available from: https://www.scielo.br/j/csp/a/HG4f9TphPscYwtQJjTFzBpL/?lang=en [Last accessed on].
Fasanmade, O. A. (2021). The impact of industrial disharmony in the health system outcomes: a case study of the Nigerian Health Sector. [Master’s thesis, University of Lagos]. Available from: https://ir.unilag.edu.ng/handle/123456789/9849 [Last accessed on].
Fawole, A. O., Shah, A., Fabanwo, A. O., Adegbola, O., Adewunmi, A. A., Eniayewun, A. B., et al. (2012). Predictors of maternal mortality in institutional deliveries in Nigeria. African Health Sciences, 12(1), 32–40. https://doi.org/10.4314/ahs.v12i1.5
Heard, K. (2021). A bridge over troubled water: Insights from aid workers seeking to reduce maternal mortality in the developing world. [Doctoral thesis, Auckland University of Technology] Available from: https://hdl.handle.net/10292/14787 [Last accessed on].
Hussain, S. T., Lei, S., Akram, T., Haider, M. J., Hussain, S. H., & Ali, M. (2018). Kurt Lewin’s change model: A critical review of the role of leadership and employee involvement in organizational change. Journal of Innovation & Knowledge, 3(3), 123–127. https://doi.org/10.1016/j.jik.2016.07.002
Iroanya, A. C. (2024). Poverty Reduction in Nigeria: A Religious Imperative. African Journal of Politics and Administrative Studies (AJPAS), 17(1), 857–881. https://doi.org/10.4314/ajpas.v17i1.42
Kassie, A., Wale, A., Girma, D., Amsalu H., & Yechale M. (2022). The role of traditional birth attendants and problem of integration with health facilities in remote rural community of West Omo Zone: Exploratory qualitative study. BMC Pregnancy and Childbirth, 22, 425. https://doi.org/10.1186/s12884-022-04753-5
Miranda Theme Filha M., Baldisserotto M.L., Leite T.H., Mesenburg M.A., Fraga, A.C.S.A., Bastos, M.P., et al. (2024). Birth in Brazil II (Nascer no Brasil II): A postpartum maternal, paternal, and child health research protocol. Cad Saúde Pública. https://doi.org/10.1590/0102-311xen249622
Leung, C., Olufunlayo, T., Olateju, Z., MacArthur, C., & Taylor, B. (2022). Perceptions and experiences of maternity care workers during COVID-19 pandemic in Lagos State, Nigeria: A qualitative study. BMC Health Services Research, 22(1), 606. https://doi.org/10.1186/s12913-022-08009-y
Lu, L., Ko, Y.-M., Chen, H.-Y., Chueh, J.-W., Chen, P.-Y., & Cooper, C. L. (2022). Patient safety and staff well-being: Organizational culture as a resource. International Journal of Environmental Research and Public Health, 19(6), 3722. https://doi.org/10.3390/ijerph19063722
Mary, M., Tappis, H., Scudder, E., & Creanga, A. A. (2024). Implementation of maternal and perinatal death surveillance and response and related death review interventions in humanitarian settings: A scoping review. J Glob Health, 14, 04133. https://doi.org/10.7189/jogh.14.04133
Mbada, K. A. (2020). Human rights-based approach to maternal health policy and implementation: An analysis of Abiye Safe-Motherhood Policy of Ondo State, Nigeria. Journal of Public Administration and Governance, 10(4), 315. https://doi.org/10.5296/jpag.v10i4.18218
Mohammed, A., Agwu, P., & Okoye, U. (2020). When primary healthcare facilities are available but mothers look the other way: Maternal mortality in Northern Nigeria. Social Work in Public Health. Social Work in Public Health, 35(1-2), 11–20. https://doi.org/10.1080/19371918.2020.1726850
Mukuru, M., Kiwanuka, S. N., Gibson, L., & Ssengooba, F. (2021). Challenges in implementing emergency obstetric care (EmOC) policies: perspectives and behaviors of frontline health workers in Uganda. Health Policy and Planning, 36(3), 260–272. https://doi.org/10.1093/heapol/czab001
Nasir, N., Aderoba, A. K., & Ariana, P. (2022). Scoping review of maternal and newborn health interventions and programmes in Nigeria. BMJ Open, 12(2), e054784. https://doi.org/10.1136/bmjopen-2021-054784
Njoku, E. (2021). Youth Development in Nigeria: A Means to Poverty Alleviation and the Promotion of Peace, Justice and Security. Lit Verlag GmbH & Co.
Nkwo, P. O., Lawani, L. O., Ubesie, A. C., Onodugo, V. A., Obu, H. A., & Chinawa, J. M. (2015). Poor availability of skilled birth attendants in Nigeria: A case study of Enugu State primary health care system. Annals of Medical and Health Sciences Research, 5(1), 20–25. https://doi.org/10.4103/2141-9248.149778
Ogide-Alaeze, T. (2020). Perceptions on Maternal Mortality Among the Ekpeye Community. [Doctoral dissertation, Walden University]. Available from: https://search.proquest.com/openview/c8fdd25d74298c41f14a779017eda9d7/1. pdfproquest.com [Last accessed on].
Omer, S., Zakar, R., Zakar, M. Z., & Fischer, F. (2021). The influence of social and cultural practices on maternal mortality: A qualitative study from South Punjab, Pakistan. Reproductive Health, 18(1), 97. https://doi.org/10.1186/s12978-021-01151-6
Omoleke, S. A., Alabi, O., Shuaib, F., Braka, F., Tegegne, S. G., Umeh, G. C., et al. (2018). Environmental, economic and socio-cultural risk factors of recurrent seasonal epidemics of cerebrospinal meningitis in Kebbi State, Northwestern Nigeria: A qualitative approach. BMC Public Health, 18(S4), 1318. https://doi.org/10.1186/s12889-018-6196-9
Omoleke, S. A., Usman, N., Kanmodi, K. K., & Ashiru, M. M. (2021). Medical waste management at the primary healthcare centres in a northwestern Nigerian State: Findings from a low-resource setting. Public Health in Practice, 2, 100092. https://doi.org/10.1016/j.puhip.2021.100092
Onwuka, G., Babyemi, W., Ajala, S., & Shehu, B. (2021). Evaluation of demographic data of Kebbi State, North-West Nigeria using the Nigerian census. Journal of Mathematical Sciences & Computational Mathematics, 2(3), 452–466. https://doi.org/10.15864/jmscm.2311
Ope, B. W. (2020). Reducing maternal mortality in Nigeria: Addressing maternal health services’ perception and experience. Journal of Global Health Reports, 4, e2020028. https://doi.org/10.29392/001c.12733
Reed, H. E., & Mberu, B. U. (2014). Capitalizing on Nigeria’s demographic dividend: Reaping the benefits and diminishing the burdens. African Population Studies, 27(2), 319–330. https://doi.org/10.11564/27-2-477
Robinson, R. S., & Adams, T. (2022). Building social accountability to improve reproductive, maternal, newborn, and child health in Nigeria. International Journal for Equity in Health, 21(S1), 10. https://doi.org/10.1186/s12939-022-01643-2
Sageer, R., Kongnyuy, E., Adebimpe, W. O., Omosehin, O., Ogunsola, E. A., & Sanni, B. (2019). Causes and contributory factors of maternal mortality: Evidence from maternal and perinatal death surveillance and response in Ogun State, Southwest Nigeria. BMC Pregnancy and Childbirth, 19(1), 63. https://doi.org/10.1186/s12884-019-2202-1
Smith, H., Ameh, C., Roos, N., Mathai, M., & van den Broek, N. (2017). Implementing maternal death surveillance and response: A review of lessons from country case studies. BMC Pregnancy and Childbirth, 17(1), 233. https://doi.org/10.1186/s12884-017-1405-6
Sreepathy, P., Kim, Y. J., Ahuja, Z., Shroff, A. R., & Nazir, N. T. (2022). The association between implementation of multidisciplinary rounds and clinical outcomes. Front Cardiovasc Med, 9, 1005150. https://doi.org/10.3389/fcvm.2022.1005150
van de Water, B. J., Wilson, M., le Roux, K., Gaunt, B., Gimbel, S., & Ware, N. C. (2023). Healthcare worker perceived barriers and facilitators to implementing a tuberculosis preventive therapy program in rural South Africa: A content analysis using the consolidated framework for implementation research. Implement Sci Commun, 4(1), 107. https://doi.org/10.1186/s43058-023-00490-8
Wali, S. U., Gada, M. A., Hamisu, I., Kabiru, J. U., & Isa, G. A. (2022). Evaluation of shallow groundwater in rural Kebbi State, NW Nigeria, using multivariate analysis: Implication for groundwater quality management. MOJ Eco Environ Sci, 7(3), 65–75. https://doi.org/10.15406/mojes.2022.07.00249
Willcox, M. L., Okello, I. A., Maidwell-Smith, A., Tura, A. K., van den Akker, T., & Knight, M. (2023). Maternal and perinatal death surveillance and response: A systematic review of qualitative studies. Bull World Health Organ, 101(1), 62–75G. https://doi.org/10.2471/BLT.22.288703
Wurster, F., Di Gion, P., Goldberg, N., Hautsch, V., Hefter, K., Herrmann, C., et al. (2024). Roger’s diffusion of innovations theory and the adoption of a patient portal’s digital anamnesis collection tool: Study protocol for the MAiBest project. Implement Sci Commun, 5(1), 74. https://doi.org/10.1186/s43058-024-00614-8
Yisa, S. S., Ogunniyi, T. J., and Dine, R. D. (2025). Strengthening primary health care in Nigeria: A means to achieve universal health coverage. BMJ Global Health, 10(10), e018486. https://doi.org/10.1136/bmjgh-2024-018486