Maternal Mortality Over a Seven-Year Period of Conflict at Jiblah Referral Hospital in Ibb City, Yemen: A Retrospective Observational Study.

Abstract

Background Fragile and conflict-affected states contribute to more than 60% of the global burden of maternal mortality. There is an alarming need for research exploring maternal health service access, quality, and adaptive responses during armed conflict. This study aims to review all cases of maternal mortality during a seven-year period of conflict at Jiblah Referral Hospital, Ibb, Yemen. Methodology A retrospective, observational study was conducted between 2011 and 2017, including all maternal deaths that occurred at Jiblah Referral Hospital, Ibb, Yemen. Data on maternal demographics, characteristics, intrapartum care, and cause of death were collected. Additionally, we compared patient characteristics according to residency (rural versus urban). Results During the study period, of the 2,803 pregnant women admitted to our hospital, 52 maternal deaths occurred. Their mean age was 29.0 ± 6.2 years, and most (63.5%) were aged less than 30 years. Most (88.5%) did not have a regular antenatal care visit, were referred cases (86.5%), were residents of rural areas (63.5%), and had a low socioeconomic condition (59.6%). The majority of maternal deaths were reported among women with gestational age (GA) of 24-34 weeks (57.7%) and primiparas women (42.3%). At hospital arrival, the majority of cases were in shock (69.2%). The majority of the mothers died during the intrapartum period (46.2%). The main cause of death was severe bleeding (32.7%), followed by eclampsia (25.0%). The mean time from admission to death was 3.0 ± 1.2 days (range = 1-6). Among all maternal deaths, 76.9%, 75.0%, and 26.9% had delays in seeking care, delays in reaching first-level health facilities, and delays in receiving adequate care in a facility, respectively. Additionally, most patients had at least two delays (57.7%). These delays were due to unawareness of danger signs in 57.7% and illiteracy and ignorance in 78.8% of cases. In comparison, according to residency, maternal mortality was statistically significant among mothers living in a rural area with GA of 25-34 weeks (24 vs. 6, p = 0.015). Additionally, maternal mortality due to delay in seeking care, unawareness of danger signs, and having at least two delays were statistically significant among rural mothers (p < 0.05). Conclusions Our study demonstrates that maternal deaths occurred among young women, referred cases, with no regular antenatal care visits, low socioeconomic conditions, and who were residents of rural areas. Delays in seeking care and delays in reaching first-level health facilities were the most common causes of maternal death due to unawareness of danger signs, illiteracy, and ignorance. We recommend that imparting basic skills and improving awareness in the community about the danger signs of pregnancy can be effective measures to detect maternal complications at an earlier stage, especially in rural areas.