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From January 1973 to December 1975, 26 018 women were delivered at Edendale Hospital. During the same period, 4 478 patients aborted there. Maternal deaths during this period numbered 118, a mortality of 4,5/1 000 total births. Avoidable factors influencing the mortality may have been present in 28 (2387%).
Developing countries which have somewhat reliable vital statistics but poor or incomplete information about maternal mortality must make the most of the data available. Such data may require modification for maternal mortality analyses. What is important, however, is the decision to use available information and to analyse it properly. The analysis of maternal mortality in Guatemala, using data from 1986 birth and death certificates, identified particular areas, health regions, and particular ethnic groups that had significantly higher maternal mortality ratios than others. Small but disproportionately affected populations that had no available maternal health assistance were identified-a problem found in many developing countries. These groups urgently need the services of traditional birth attendants or other forms of assistance before, during and after delivery. The analysis of vital statistics led to the beginning of operative research and the collection of background information for establishing an epidemiologic surveillance programme for maternal mortality.
This paper examines the association of the sociodemographic characteristics of women and the unobserved hospital factors with maternal mortality in Kenya using multilevel logistic regression. The data analysed comprise hospital records for 58,151 obstetric admissions in sixteen public hospitals, consisting of 182 maternal deaths. The results show that the probability of maternal mortality depends on both observed factors that are associated with a particular woman and unobserved factors peculiar to the admitting hospital. The individual characteristics observed to have a significant association with maternal mortality include maternal age, antenatal clinic attendance and educational attainment. The hospital variation is observed to be stronger for women with least favourable sociodemographic characteristics. For example, the risk of maternal death at high-risk hospitals for women aged 35 years and above, who had low levels of education, and did not attend antenatal care is about 280 deaths per 1000 admissions. The risk for similar women at low-risk hospitals is about 4 deaths per 1000. To complement results from the analysis of individual patient records, the paper includes findings from hospital staff reports regarding the maternal mortality situation at the hospitals.
Estimates of national levels of maternal mortality in sub-Saharan Africa are based on limited and defective data and subject to considerable discussion. In this paper, existing data from several sources are reviewed. The attempt has been made to assess the level of maternal mortality by studying the relative importance of maternal death, health services coverage data, perinatal mortality, causes of maternal death and traditional birth practices. It is concluded that national levels of maternal mortality in sub-Saharan Africa most likely vary from 250 to 700 per 100,000 live births, in proportion to the variation in overall levels of mortality in the countries. There is a need for more studies either based on data from peripheral hospitals or on community surveys. Such studies should analyse coverage of deliveries, coverage of maternal deaths, causes of maternal deaths, socioeconomic differentials, perinatal mortality and should pay special attention to the increasing problem of abortion-related mortality.
BACKGROUND: Population-based estimates of maternal mortality from Pakistan are inadequate to define the magnitude of the problem or provide information on clinical causes and determinants. METHODS: Surveys were conducted in selected clusters in Karachi, Balochistan and North West Frontier Province from 1989-1992. Pre-coded questionnaires were administered to 38,563 households to ascertain household characteristics, complete pregnancy histories and deaths of household members in the five years preceding the survey. Verbal autopsy questionnaires were then conducted to establish cause of death to women in the reproductive age group. Descriptive, bivariate and multivariable analyses were carried out to determine the association between the background variables, biological and women's status indicators and maternal mortality using a nested case-control design. RESULTS: Overall, the estimated maternal mortality ratio combining the data from the different sites was 433 per 100,000 livebirths. The estimated maternal mortality ratios per 100,000 livebirths ranged from a low of 281 in Karachi to a high of 673 in Khuzdar [Balochistan]. Hemorrhage (52.9%), puerperal sepsis (16.3%) and eclampsia (14.4%) were the leading causes for direct maternal deaths. Logistic regression identified the important risk factors as poor housing construction material (OR = 2.1; 95% CI = 1.3,3.2), distance of 40 or more miles from nearest hospital (OR = 1.3; 95% CI = 0.9,1.8), grandmultigravidity (OR = 1.6; 95% CI = 1.1,2.4) and prior fetal losses (OR = 5.3; 95% CI = 3.8,7.4). CONCLUSION: Focusing on special groups of pregnant women with targeted programs such as training, monitoring and supervision of birth attendants for the provision of oxytocics, will go a long way in decreasing the proportion of maternal deaths attributed to direct, avoidable causes.
Maternal mortality in Latin America and the Caribbean is a health problem that reflects the existing inequalities in the Region, as expressed in the loss of more than 28,000 women every year as a result of abortions and complications of pregnancy, childbirth, and the puerperium. This situation is associated with the limited coverage and low quality of health and family planning services and, in particular, with the tremendous unmet need for family planning services in many countries of the Region. The risk approach is proposed as an effective method for enhancing health care, especially in the area of maternal and child health. Systematically applied, this method will help to improve reproductive health.
Maternal mortality in the third world is fifty to two hundred times higher than in developed countries. Haemorrhage following birth or abortion is one of the leading causes of maternal mortality and a specific analysis of this can clarify the problems. The incidence of maternal death by haemorrhage is not clearly documented and fluctuates between 6 and 90 per cent. Patients predicted to be at high risk for haemorrhage in the third trimester should be automatically referred for a higher level of medical care. In fact, many cases of haemorrhage cannot be predicted and death depends on the rate of blood loss and on the pre-existing anaemia. Better nurses' and mid-wives' training, better ante natal care, and the treatment of anaemia should decrease maternal mortality.
In Canada, maternal mortality reporting is based on information contained on death certificates. To examine the extent to which maternal deaths are under-reported in Canada and whether this is likely to change under the 10th revision of the International Classification of Diseases (ICD), we linked live birth and stillbirth registrations to In Canada death registrations of women aged 10 to 50 for 1988 through 1992. We reviewed the death certificates of women found to have died while pregnant or within a year of the termination of pregnancy. The officially reported maternal mortality ratio for the study years was 3.7 deaths per 100,000 live births. Depending on whether we included deaths not certified as maternal deaths at the time the deaths occurred, revised ratios under ICD-9 ranged from 4.9 to 5.1 per 100,000 live births for deaths from direct obstetric causes and from 0.5 to 1.2 per 100,000 live births for deaths from indirect obstetric causes. Reflecting changes in classification criteria, revised ratios under ICD-10 were lower than those under ICD-9 for deaths from direct obstetric causes - ranging from 3.9 to 4.1 per 100,000 live births - and higher for deaths from indirect obstetric causes ranging from 2.0 to 3.0 per 100,000 live births. Of deaths from direct obstetric causes, those from cerebrovascular disease were the most numerous and also the most likely to be underreported. Deaths from pulmonary embolism and indirect obstetric causes were the next most likely to be underreported. In a companion article we report an investigation of whether deaths from causes not directly related to pregnancy -such as injury, infectious disease and epilepsy - are more or less likely to occur among pregnant and recently pregnant women.
OBJECTIVES: To determine the incidence and causes of maternal mortality as well as its temporal distribution over the last decade (1990-1999). STUDY DESIGN: All maternal deaths recorded within the study period in the State of Kano, Northern Nigeria, were analyzed. Maternal mortality ratios (MMR) were computed using the Poisson assumption to derive confidence intervals around the estimates. A non-linear regression model was fitted to obtain the best temporal trajectory for MMR across the decade of study. RESULTS: A total of 4154 maternal deaths occurred among 171,621 deliveries, yielding an MMR of 2420 deaths per 100,000. Eclampsia, ruptured uterus and anemia were responsible for about 50% of maternal deaths. CONCLUSION: We found one of the highest maternal mortality ratios in the world. Maternal mortality could be reduced by half at study site with effective interventions targeted to prevent deaths from eclampsia, ruptured uterus and anemia.
In recent years maternal mortality in developing countries has become a public health priority for international organizations. However, measuring the true magnitude of this problem is the subject of much methodological debate. In less than a century, the rate of maternal mortality in most industrialized countries has decreased one hundred-fold. In contrast, the rate remains very high in most developing countries, particularly in Africa. In this article based on the studies conducted in Guinea we review various operational proposals which may contribute to improving maternal health and reducing maternal morbidity and mortality, with particular reference to the work of the French speaking organization "Santé Maternelle Internationale".
Between 1955 and 1984 Italian maternal mortality steadily declined by about 90% (from 133.3 per 100,000 live-births in 1955 to 11.4 in 1984). Maternal mortality rose with age and was about tenfold higher in the highest risk group (greater than or equal to 40 years old) compared with the lowest risk group (less than 20 years old). Deaths in pregnancy with abortive outcomes represented about 8% to 10% of maternal mortality as a whole; these percentages were constant throughout the calendar period considered. Geographically, there was no noticeable reduction in the northern/southern mortality ratio, which was constantly about 0.75.
In a 2-year retrospective analysis of 147 maternal deaths in South African urban and rural hospitals, the maternal mortality rate (MMR) was estimated to be 144 per 100,000 live births. MMR was significantly higher (P = 0.025) in urban hospitals (160 per 100,000) and the main causes of death were hypertensive disease in pregnancy (33%), of which eclampsia contributed to 70% of deaths and haemorrhage (18%). Only 49.7% of women who died, attended an antenatal clinic. The MMR in South Africa is lower than sub-Saharan countries but unacceptably high for a country with a mix of private and public medicine. Disparities have been noted in maternal mortality rates within the country due to different study rates within the country due to different study designs and poor documentation, Structural changes in the health care system would only be possible if a common information database system were established and confidential enquiries held into maternal deaths.
OBJECTIVE: To review factors contributing to a 52% drop in Egypt's maternal mortality ratio (MMR) per 100,000 live births from 174 in 1992-93 to 84 in 2000. METHODS: Data on maternal mortality were collected from all 27 governorates in Egypt between 1 January and 31 December 2000. This round of maternal mortality data is compared with the earlier nation wide maternal mortality study in 1992. Health care interventions that may account for the decrease were reviewed. RESULTS: MMR decreased by 51.7% nation wide. This decrease was greater in the less-developed parts of Upper Egypt (59%), than in Lower Egypt (30%). A multifaceted set of interventions were concentrated in Upper Egypt. The greatest decrease in maternal mortality was associated with the area of highest intervention, greatest need, and during the time period of the implementation of this program. There were increases in use of health services; use of modern contraceptives; hospital deliveries; and use of trained birth attendants. For most indicators, the changes were greater in Upper than Lower Egypt. CONCLUSION: Since 1992-93, efforts by the Government of Egypt and donors to improve access to and the quality and utilization of services can be linked to a greatly reduced MMR.
Maternal mortality is one of the great neglected problems of health care in developing countries. The World Health Organization estimates that approximately 500,000 women die each year from pregnancy-related causes, more than 98% of these deaths occurring in the developing world. Maternal mortality rates in developing countries are as much as 100 times higher than those seen in industrialized countries. The most common causes include obstructed labor and ruptured uterus, postpartum hemorrhage, eclampsia, postpartum infection, and complications of illegal abortion. It is suggested that no new or costly technologies are needed; rather that appropriate priority-setting and allocation of needed resources are essential to the solution of the problem. There are few interventions that hold much hope of success at the village level, although antibiotics, ergonovine maleate, and sedatives might be usefully utilized, after appropriate training. Overall, however, networks of maternity care facilities, trained personnel, and means of transport are necessary to provide needed emergency maternity care services.
This article describes maternal mortality trends in São Paulo, Brazil, from 1960 through 1990. In so doing, it compares mortality rates derived from death certificate data with rates suggested by three independent surveys conducted in the city of São Paulo in 1962-1963, 1974-1975, and 1986. In general, these data indicate that a substantial share of all maternal deaths in the city have been ascribed to other causes on death certificates, that prevailing maternal mortality levels are far higher than those found in the urban areas of most developed countries, and that in recent years levels of maternal mortality in the city have been rising. Various measures are suggested for improving the accuracy of available data and reducing the maternal mortality they describe.
The authors report retrospective investigation of causes for maternal mortality in the Department of Obstetric and Gynecology in Hospital in Pleven for the period 1977-2001 and comparison between indexes for a different period of time. Objects of investigation were patient histories necropsy report and forensic expertise. Vital births were 73922 for a period of 25 years in Pleven. Dead pregnant and materinity were 45 and the rate of maternal mortality was 60,07/per 100 000 vital births. Causes of maternal mortality were divided in immediate 40 cases (88,88%) and indirect - 5 cases (11,11%). The hemorrhage was the most common cause of maternal mortality - 18 cases (45%). The authors mention that the absolute number of maternal losses is comparatively constant but the rate of maternal mortality in creases because of tendency of decrease of birthrate and concentration of pathology in Department of Obstertic and Gynecology in Pleven.
In Miyun County in China the medical authorities registered an elevated maternal mortality ratio which needed to be verified in order to design corrective changes. A decision was taken in 1988 to start a project of pilot interventions in the organization of maternal health services and access for obstetric emergencies. A control and pilot area were chosen in order to test the validity of the interventions. The reduction in maternal mortality from the main complications (postpartum haemorrhage and eclampsia) was impressive and no more maternal deaths were registered in the pilot area with reference to these causes. The overall maternal mortality ratio per 100,000 live births dropped by more than 75% in the pilot area throughout the three-year implementation period. It was therefore shown that the synergistic effect of additional training of medical workers and traditional birth attendants, improved health education, the provision of easier access to emergency care services, the establishment of obstetric rescue teams at the county level, generally improved MCH services, and strengthened management capacity for high risk pregnancies were the most appropriate interventions to lower maternal mortality.
This paper described the trend of official maternal mortality rate in Serbia excluding provinces for the last 30 years and it was investigated whether it was underregistered. Data for calculation of the official rate of maternal mortality were obtained from the publications of the official health statistics. Five hundred and three death certificates of women in reproductive period, that died in the period May-December 1992 in central Serbia, were examined to investigate underregistration. Notable decrease of the official rate of maternal mortality found in the period of 30 years, could be the basis for satisfaction if the results of investigation did not suggest that the significant number of maternal deaths was underregistered.