Abstract
BackgroundTanzania has one of the highest maternal mortality ratios in sub-Saharan Africa. Due to the paucity of epidemiological information on maternal deaths, and the high maternal mortality estimates found earlier in the study area, our objective was to assess determinants of maternal deaths in a rural setting in the highlands of northern Tanzania by comparing the women dying of maternal causes with women from the same population who had attended antenatal clinics in the same time period.MethodsA case-control study was done in two administrative divisions in Mbulu and Hanang districts in rural Tanzania. Forty-five cases of maternal death were found through a comprehensive community- and health-facility based study in 1995 and 1996, while 135 antenatal attendees from four antenatal clinics in the same population, geographical area, and time-span of 1995–96 served as controls. The cases and controls were compared using multivariate logistic regression analyses. Odds ratios, with 95% confidence intervals, were used as an approximation of relative risk, and were adjusted for place of residence (ward) and age. Further adjustment was done for potentially confounding variables.ResultsAn increased risk of maternal deaths was found for women from 35–49 years versus 15–24 years (OR 4.0; 95%CI 1.5–10.6). Women from ethnic groups other than the two indigenous groups of the area had an increased risk of maternal death (OR 13.6; 95%CI 2.5–75.0). There was an increased risk when women or husbands adhered to traditional beliefs, (OR 2.1; 95%CI 1.0–4.5) and (OR 2.6; 95%CI 1.2–5.7), respectively. Women whose husbands did not have any formal education appeared to have an increased risk (OR 2.2; 95%CI 1.0–5.0).ConclusionIncreasing maternal age, ethnic and religious affiliation, and low formal education of the husbands were associated with increased risk of maternal death. Increased attention needs to be given to formal education of both men and women. In addition, education of the male decision-makers should be given high priority in the community, especially in matters concerning pregnancy and delivery preparedness, since their choice greatly affects the survival of the pregnant and delivering women.
Highlights
Tanzania has one of the highest maternal mortality ratios in sub-Saharan Africa
Due to the paucity of epidemiological information on maternal deaths, the cultural and societal conditions, and the high estimated maternal mortality ratio, our objective was to assess determinants of maternal mortality in this rural setting in the highlands of northern Tanzania by comparing the women dying of maternal causes with women who had attended antenatal clinics and had not died
In multivariate logistic regression analysis with adjustment for ward, there was a significantly increased risk of maternal death in the age group 35–49 years compared to the group of 25–34 years. This increased risk persisted after adjustment for the variables mentioned above
Summary
Tanzania has one of the highest maternal mortality ratios in sub-Saharan Africa. Due to the paucity of epidemiological information on maternal deaths, and the high maternal mortality estimates found earlier in the study area, our objective was to assess determinants of maternal deaths in a rural setting in the highlands of northern Tanzania by comparing the women dying of maternal causes with women from the same population who had attended antenatal clinics in the same time period. In spite of national efforts, Tanzania has one of the highest maternal mortality ratios (MMR) in Sub-Saharan Africa, with national estimates as high as 1100 in 1995 at the time of the present study, increasing to 1500 per 100 000 live births in 2006 [1,2]. Loudon noted how maternal deaths throughout history have been, and still are, devastating in a way that other causes of death are not [3] He emphasised how maternal care and maternal deaths cannot be divided into neat compartments categorised as social, political, economic, demographic, professional or clinical. His historical and statistical overview reveals the complexity and multi-factorial aspects of maternal mortality. In order to influence and develop public health strategies in the quest for reducing the high mortality rates in many developing countries, research on risk factors is still valid
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