Abstract
Increasing global health efforts have focused on preventing pregnancy-related maternal deaths, but the factors that contribute to maternal deaths in specific high-burden nations are poorly understood. The aim of this study was to identify factors that influence the occurrence of maternal deaths in a regional maternity hospital in Kuando Kubango province of Angola. The study was a retrospective cross-sectional analysis of case notes of all maternal deaths and deliveries that were recorded from 2010 to 2014. The information collected included data on pregnancy, labor and post-natal period retrieved from case notes and the delivery register. During the period under study, a total of 7,158 live births were conducted out of which 131 resulted in maternal death with an overall maternal mortality ratio of 1,830 per 100,000 live births. The causes of death and their importance was relatively similar over the period reviewed. The direct obstetric causes accounted for 51% of all deaths. The major causes were hemorrhage (15%), puerperal sepsis (13%), eclampsia (11%) and ruptured uterus (10%). In addition, indirect non-obstetric medical causes such as Malaria, Anemia, hepatitis, AIDs and cardiovascular diseases accounted for 49% of all maternal deaths. There is poor documentation of personal data and clinical case management of cases. The factors of mutual instability of statistical significance associated with maternal death are: place of domicile (P=0.0001) and distance to the hospital (P=0.0001). The study demonstrated that the MMR in maternity hospital is very high and is higher than the WHO 2014 estimates and the province is yet to achieve the desired MDG 5 target by the end of 2015. A reversal of the present state requires data driven planning in order to improve access and use of Maternal Health Services (MHS) and ultimately lower the number of pregnancy-related maternal deaths.
Highlights
Childbirth, even though a normal physiological process has been associated with a number of risks, which may, in extreme cases, lead to loss of life. This concern was underscored by the Millennium Development Goal 5 (MDG) which focused on improving maternal health services (MHS) to reduce morbidity, disability, and mortality due to pregnancy and delivery
It has been estimated that 289,000 cases of maternal deaths were recorded in 2013, indicating a raising trend by 2000 deaths compared to the figure obtained in 2011, with 99 % of these deaths occurring in the developing countries.[1,2]
It is the wealthiest nation in the central African sub-region, with an impressive economic growth since the end of the country’s civil war in 2002, the Republic of Angola has a higher life time risk of 1 in 39 women dying as a result of pregnancy and its related complications compared to neighboring Republic of Namibia with a life time risk of 1 in 160.[3]. The current Maternal Mortality Ratio (MMR) for Angola[1] was reported to be 460 per 100,000 live births in 2013, which is still far above the desired MDG 5 goal of 300 per 100,000 live births by the year 2015.[4]. The high MMR (460 per 100,000 live births) is partly due to low utilization of maternal health services.[1]
Summary
Childbirth, even though a normal physiological process has been associated with a number of risks, which may, in extreme cases, lead to loss of life. Increasing global health efforts have focused on preventing pregnancy-related maternal deaths, but the factors that contribute to maternal deaths in specific high-burden nations are poorly understood.The aim of this study was to identify factors that influence the occurrence of maternal deaths in a regional maternity hospital in Kuando Kubango province of Angola
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