Nigeria has one of the highest rates of maternal mortality in the world. Despite the prevalence, it is insufficient to address this issue with a sample. In order to prevent unnecessary deaths, every single pregnant woman should be reached.

In 2010, CIET launched a comprehensive community-based surveillance system (CSS) in Giade local government authority in the state of Bauchi. Giade lies in the northwest of Bauchi city. Linked to the results of the maternal health cycle of our social audits project, the system strengthens and builds on the existing National Heath Information System (NHIS) which conducts a series of household visits each year, to collect health and demographic information.

The community surveillance system proposes universal contact with all households in Giade to detect all women of child-bearing age, and to make repeated contact with those that are pregnant, focused on specific risk factors that are relevant to current maternal outcomes in Bauchi.

Following the fieldwork protocol, female field workers register all households and all women between the ages of 15 and 49 in their allotted communities. A series of questions identify those who are pregnant and the risk profile of each pregnant woman, including: divorced or widowed, domestic violence, hard work in pregnancy, knowledge of danger signs, lack of support networks and lack of access to facilities or supportive attitudes regarding safe birth.

Using cell phone handsets, field workers collect and relay geo-indexed data to a database in state headquarters or, in the event of a signal failure, download the data at the end of the working day. Geo-indexing of all households assists in quality control and case-specific follow-up. A small state-level team, trained in processing the data, key-off relevant clinical action and consolidate information for policy purposes.

Female workers also engage household members in discussions focusing around the care of pregnant women. Male workers carry out similar discussions with husbands. Repeated visits to pregnant women and their family members are expected to have a positive impact at the household level, increasing awareness of risk factors and danger signs among women, men and families. Visits after delivery also increase the likelihood of appropriate postnatal care.

For this project CIET has trained 130 workers, male and female, in 50 communities in Giade local government authority. Since project inception, field workers have identified 30,000 women of child-bearing age in about 16,000 registered households and have registered and followed up on more than 6,000 pregnancies. We continue to identify more households and enlist pregnant women for follow-up.