Abstract
BackgroundThe paper’s primary purpose is to determine changes in magnitude and causes of institutional maternal mortality in Mozambique. We also describe shifts in the location of institutional deaths and changes in availability of prevention and treatment measures for malaria and HIV infection.MethodsTwo national cross-sectional assessments of health facilities with childbirth services were conducted in 2007 and 2012. Each collected retrospective data on deliveries and maternal deaths and their causes. In 2007, 2,199 cases of maternal deaths were documented over a 12 month period; in 2012, 459 cases were identified over a three month period. In 2007, data collection also included reviews of maternal deaths when records were available (n = 712).ResultsInstitutional maternal mortality declined from 541 to 284/100,000 births from 2007 to 2012. The rate of decline among women dying of direct causes was 66 % compared to 26 % among women dying of indirect causes. Cause-specific mortality ratios fell for all direct causes. Patterns among indirect causes were less conclusive given differences in cause-of-death recording. In absolute numbers, the combination of antepartum and postpartum hemorrhage was the leading direct cause of death each year and HIV and malaria the main non-obstetric causes. Based on maternal death reviews, evidence of HIV infection, malaria or anemia was found in more than 40 % of maternal deaths due to abortion, ectopic pregnancy and sepsis. Almost half (49 %) of all institutional maternal deaths took place in the largest hospitals in 2007 while in 2012, only 24 % occurred in these hospitals. The availability of antiretrovirals and antimalarials increased in all types of facilities, but increases were most dramatic in health centers.ConclusionsThe rate at which women died of direct causes in Mozambique’s health facilities appears to have declined significantly. Despite a clear improvement in access to antiretrovirals and antimalarials, especially at lower levels of health care, malaria, HIV, and anemia continue to exact a heavy toll on child-bearing women. Going forward, efforts to end preventable maternal and newborn deaths must maximize the use of antenatal care that includes integrated preventive/treatment options for HIV infection, malaria and anemia.
Highlights
The paper’s primary purpose is to determine changes in magnitude and causes of institutional maternal mortality in Mozambique
The east African country of Mozambique fits a paradigm of obstetric transition where maternal mortality and fertility remain high, and access to care and health system infrastructure continue to be a challenge
Magnitude of maternal mortality and changes in causes of maternal death Based on the summaries of service statistics for each assessment, the institutional maternal mortality ratio (MMR) declined by 47 % between 2007 and 2012, from 541/100,000 births to 284/ 100,000 (Table 2)
Summary
The paper’s primary purpose is to determine changes in magnitude and causes of institutional maternal mortality in Mozambique. The east African country of Mozambique fits a paradigm of obstetric transition where maternal mortality and fertility remain high, and access to care and health system infrastructure continue to be a challenge These characteristics define Stage 2 of the obstetric transition, where direct causes of maternal mortality predominate but a sizeable number of deaths are linked to infectious diseases [1]. Indirect maternal deaths are linked to previously existing diseases that are aggravated during pregnancy, or to diseases developed during pregnancy but are not due to direct obstetric causes [3] They account for 27.5 % of maternal deaths worldwide according to the most recent systematic review for 2003–09; the percentage in sub-Saharan Africa is 28.6 % [4]. Both the first systematic review (1998–2002) and the 2003–2009 review highlighted the importance of indirect deaths in sub-Saharan Africa [5]
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