Abstract
BackgroundMaternal mortality is highest in sub-Saharan Africa. In Uganda, the WHO- MDG 5 (aimed at reducing maternal mortality by 75 % between 1990 and 2015) has not been attained. The current maternal mortality ratio (MMR) in Uganda is 438 per 100,000 live births coming from 550 per 100,000 in 1990. This study sets out to find causes and predictors of maternal deaths in a tertiary University teaching Hospital in Uganda.MethodsThe study was a retrospective unmatched case control study which was carried out at the maternity unit of Mbarara Regional Referral Hospital (MRRH). The sample included pregnant women aged 15–49 years admitted to the Maternity unit between January 2011 and November 2014. Data from patient charts of 139 maternal deaths (cases) and 417 controls was collected using a standard audit/data extraction form. Multivariable logistic regression analysis was used to assess for the factors associated with maternal mortality.ResultsDirect causes of mortality accounted for 77.7 % while indirect causes contributed 22.3 %. The most frequent cause of maternal mortality was puerperal sepsis (30.9 %), followed by obstetric hemorrhage (21.6 %), hypertensive disorders in pregnancy (14.4 %), abortion complications (10.8 %). Malaria was the commonest indirect cause of mortality accounting for 8.92 %. On multivariable logistic regression analysis, the factors associated with maternal mortality were: primary or no education (OR 1.9; 95 % CI, 1.0–3.3); HIV positive sero-status (OR, 3.6; 95 % CI, 1.9–7.0); no antenatal care attendance (OR 3.6; 95 % CI, 1.8–7.0); rural dwellers (OR, 4.5; 95 % CI, 2.5–8.3); having been referred from another health facility (OR 5.0; 95 % CI, 2.9–10.0); delay to seek health care (delay-1) (OR 36.9; 95 % CI, 16.2–84.4).ConclusionsMost maternal deaths occur among mothers from rural areas, uneducated, HIV positive, unbooked mothers (lack of antenatal care), referred mothers in critical conditions and mothers delaying to seek health care. Puerperal sepsis is the leading cause of maternal deaths at Mbarara Regional Referral Hospital. Therefore more research into puerperal sepsis to describe the microbiology and epidemiology of sepsis is recommended.
Highlights
Maternal mortality is highest in sub-Saharan Africa
Direct maternal death is the death of a woman resulting from obstetric complications of pregnancy, labor and puerperium; from interventions, omissions or incorrect treatment; or from a chain of events resulting from any of the above while indirect maternal death is the death of a woman resulting from a previously existing disease or a disease that developed during pregnancy and was not due to direct obstetric causes but was aggravated by the physiological effects of pregnancy [1, 2]
Low resource countries account for 99 % (286,000) of the global maternal mortalities with sub- Saharan Africa responsible for the bulk of the maternal deaths and accounting for 62 % followed by southern Asia at 24 %
Summary
Maternal mortality is highest in sub-Saharan Africa. The current maternal mortality ratio (MMR) in Uganda is 438 per 100,000 live births coming from 550 per 100,000 in 1990. The global Maternal Mortality Ratio (MMR) is 210. The MMR reported for low resource settings such as subSaharan Africa is 500 while the developed countries, the rates are 16 maternal deaths per 100,000 live births. Low resource countries account for 99 % (286,000) of the global maternal mortalities with sub- Saharan Africa responsible for the bulk of the maternal deaths and accounting for 62 % followed by southern Asia at 24 %. In Uganda, there has been a slow decline in maternal mortality ratio (MMR) between 1990 and 2010 (from 550 in 1990 to 438 in 2012). About 47 % of women attend at least 4 Antenatal Care (ANC) visits: while the adolescent birth rate is 134.5/1,000 births while the ANC HIV prevalence rate stands at 6.5 % [7, 8]
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