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PubMed2001

Trends in maternal mortality for the Greater Harare Maternity Unit: 1976 to 1997.

OBJECTIVE: To determine the magnitude, trends and the main causes of maternal death for Harare Maternity Hospital (HMH) and thereby identify potential areas for interventions. DESIGN: A descriptive retrospective analysis of maternal mortality data from the institution included in publications and recent annual reports. SETTING: Department of Obstetrics and Gynaecology Greater Harare Maternity Unit, Zimbabwe. MAIN OUTCOME MEASURES: The trends in maternal mortality ratios (MMR) and the relative importance of different causes of death between 1976 and 1997. RESULTS: There was a decline in MMR between 1976 and the early 1980s but there has been a steady increase in MMR for Harare residents from 50/100,000 in 1988 to 224/100,000 in 1997. Sepsis has remained the leading cause of maternal death. There has been a significant increase in indirect deaths due to meningitis, tuberculosis and pneumonia where HIV infection is an underlying factor. Avoidable factors were identified at patient/community, local health facility and at the tertiary hospital. There has been a decline in the quality of care in recent years. CONCLUSION: Maternal mortality for HMH is unacceptably high and could still be rising. HIV infection has contributed to the worsening picture. Interventions to improve access and quality of care at all levels could lead to significant reduction in maternal deaths.

Cause of Death↗
PubMed1991

Maternal mortality and its prevention.

Maternal mortality rates in developed countries have declined steeply during the last 50 years. The introduction of sulphonamides and blood transfusion techniques contributed much to lowering maternal mortality rates. The maternal mortality rate in The Netherlands in 1983-1988 was 8.8/100,000 livebirths. In 57% substandard care factors could be identified. This suggests that further improvement in preventing maternal mortality is possible. Maternal mortality rates in developing countries are still unacceptably high as a result of high fertility and a high risk of dying each time a woman becomes pregnant. Complications of illegal abortion are responsible for 25-50% of maternal deaths. Safe contraception could probably result in an important reduction in the number of maternal deaths, but also the provision of accessible maternal health services is essential to reduce maternal mortality in developing countries.

Cause of Death↗
PubMed1991

[Maternal mortality in France. Frequency and reasons for its under-estimation in the statistics of medical cause of death. Group of Experts on Maternal Mortality].

All deaths of women of reproductive age notified in France over four months were the subject of an enquiry carried out through the post to the doctors who had written the certificates of death. The objective was to try to evaluate the true maternal mortality on a national scale. This enquiry was carried out on 4,102 female deaths and showed that 68 of these (1.6%) were in pregnant or puerperal women. 45 of these deaths were classified as maternal which was twice the number that showed up on the official statistics of the causes of death. On one hand the under notification--due to failure to realise that the patient was pregnant at the time of certification, and on the other hand the under registration because of the complexity of the pathological states explain this under estimation. The frequency of maternal mortality has been evaluated at 18 per 100,000 live births and 60% of these deaths are considered as due to a direct obstetric cause. The most frequent causes are embolisms, then haemorrhages and hypertension of pregnancy.

Adolescent↗
PubMed1998

Contextual determinants of maternal mortality in rural Pakistan.

Maternal mortality is high in Pakistan, particularly in the rural areas which have poor access to health services. We investigated the risk factors associated with maternal mortality in sixteen rural districts of Balochistan and the North-West Frontier (NWFP) provinces of Pakistan. We designed a nested case-control study comprising 261 cases (maternal deaths reported during last five years) and 9135 controls (women who survived a pregnancy during last five years). Using contextual analysis, we estimated the interactions between the biological risk factors of maternal mortality and the district-level indicators of health services. Women under 19 or over 39 yr of age, those having their first birth, and those having a previous history of fetal loss were at greater risk of maternal death. Staffing patterns of peripheral health facilities in the district and accessibility of essential obstetric care (EOC) were significantly associated with maternal mortality. These indicators also modified the effects of the biological risk factors of maternal mortality. For example, nulliparous women living in the under-served districts were at greater risk than those living in the better-served districts. Our results are consistent with several studies which have pointed out the role of health services in the causation of maternal mortality. Many such studies have implicated distance to hospital (an indicator of access to EOC) and lack of prenatal care as major determinants of maternal mortality. We conclude that better staffing of peripheral health facilities and improved access to EOC could reduce the risk of maternal mortality among women in rural Balochistan and the NWFP.

Adolescent↗
PubMed2003

Which health services reduce maternal mortality? Evidence from ratings of maternal health services.

We report cross-national regressions for maternal mortality in 49 developing countries, using indices of the adequacy of maternal health services derived from ratings by at least 10 experts per country. As in previous such regressions, a socioeconomic factor - in this case per capita income - has a significant effect, but having a trained attendant at delivery does not. Instead, the ratings index for access to services has a consistent, significant effect regardless of which estimates of maternal mortality ratios are predicted. Further analysis suggests that access to treatment for pregnancy complications and to services that help avoid pregnancy and birth are most closely related to lower mortality. Service ratings are interdependent, however, so that focusing only on individual services may not be productive.

Developing Countries↗
PubMed2000

[Maternal mortality in the maternity ward of Befelatanana. University Hospital of Antananarivo].

OBJECTIVE: A retrospective study was conducted to assess mortality rates at the Befelatanana Women's Hospital from January 1st 1988 through December 31st 1997, define trends, study causes and identify problems encountered during treatment and those related to the referral system, in order to improve prevention and patient management MATERIAL: and method. Birth and death registries, operation reports and patient charts were analyzed. All maternal deaths wether of direct or indirect obstetrical origin were considered. RESULTS: There were 997 cases of maternal death among 91, 032 births, i.e. 1.09% or 1,245 maternal deaths per 100,000 live births. Among direct obstetrical causes of death (93%), 65.8% involved infectious complications and 22.9% renal and vascular complications.Other causes were anesthesia accidents and thrombolic events. Among the direct obstetrical causes, complicated delivery was responsible for 57.4% of the deaths and 42.6% of the abortions. Indirect obstetrical causes were due to malaria (68.6%), heart disease (21.4%) and asthma (10%). DISCUSSION: This high rate of maternal death illustrates the serious situation of obstetrics in our region. Our aim is to reduce this rate by promoting the Birth Place Without Risk program and improving management conditions. Implementation of this ambitious program requires implication of political decisions makers convinced of the importance of improving women's conditions and the health care system in Madagascar.

Asthma↗