Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2014

Open Access 01-12-2014 | Research article

Maternal mortality at muhimbili national hospital in Dar-es-Salaam, Tanzania in the year 2011

Authors: Andrea B Pembe, Chetto Paulo, Brenda S D’mello, Jos van Roosmalen

Published in: BMC Pregnancy and Childbirth | Issue 1/2014

Login to get access

Abstract

Background

Improving maternal health is one of the eight millennium development goals adopted at the millennium summit in the year 2000. Within this frame work, the international community is committed to reduce the maternal mortality ratio by 75% between 1990 and 2015. The objective of this study was to determine the maternal mortality ratio, classify causes of maternal deaths and assess substandard care factors at Muhimbili National Hospital (MNH), Dar-es-Salaam in Tanzania.

Methods

A retrospective review of all maternal death records of cases that occurred from 1st January to 31st December 2011 was done.

Results

There were 10,057 live births, 155 maternal deaths and hence MMR of 1,541 per 100,000 live births. Direct causes of maternal deaths were classified in 69.5% of the maternal deaths. Of the direct causes, preeclampsia/eclampsia was the major cause (19.9% of all deaths), followed by post partum haemorrhage (14.9%), abortion complications (9.9%) and sepsis (9.2%). Among the indirect causes anaemia was the leading cause (11.3%) of all deaths, followed by HIV/AIDS (9.9%). Substandard care factors contributing to deaths were identified in 116 (82.3%) of all cases. Among these 28 had patient factors only, 71 medical service factors while 17 had both patient and medical service substandard care factors. The common factors from the woman’s side included delay in seeking care (73.3%) and complete lack of antenatal care (11.1%). Of the medical service factors, inadequate (26.1%) or no blood for transfusion (19.3%), delay in receiving treatment (18.3%) and mismanagement (17%) were the common factors.

Conclusion

There is a high maternal mortality ratio at MNH. Hypertensive disorders of pregnancy, post partum haemorrhage and anaemia are the leading causes of maternal deaths in this institution. Multiple substandard care factors identified both at individual and health care service levels that contributed to maternal deaths. There is a need for increasing efforts in the fight to reduce maternal deaths at the institution. A more pro-active role from the referring facilities in the region is needed.
Literature
1.
WHO, UN Children’s fund, UN Population fund, Bank. TW: Trends in Maternal Mortality: 1990 to 2008 Estimates Developed by WHO, UNICEF, UNFPA and The World Bank. 2010, Geneva: World Health Organization
2.
Friberg IK, Kinney MV, Lawn JE, Kerber KJ, Odubanjo MO, Bergh AM, Walker N, Weissman E, Chopra M, Black RE, Science in Action: Saving the lives of Africa’s mothers, newborn and children working group: Sub-Saharan Africa’s mothers, newborns, and children: how many lives could be saved with targeted health interventions?. PLoS Med. 2010, 7 (6): e1000295-10.1371/journal.pmed.1000295.CrossRefPubMedPubMedCentral
3.
NBS: Tanzania Demographic and Health Survey 2004/5. 2005, Dar es Salaam, Tanzania: National Bureau of Statistics (NBS) and ORC Macro
4.
NBS: Tanzania Demographic and Health Survey 2010. 2010, Dar es Salaam, Tanzania: National Bureau of Statistics (NBS) and ORC Macro
5.
Urassa E, Lindmark G, Nystrom L: Maternal mortality in Dar es Salaam, Tanzania: Socio-economic, obstetric history and accessibility of health care factors. Afr J Health Sci. 1995, 2 (1): 242-249.PubMed
6.
Thaddeus S, Maine D: Too far to walk: maternal mortality in context. Soc Sci Med. 1994, 38 (8): 1091-1110. 10.1016/0277-9536(94)90226-7.CrossRefPubMed
7.
Urassa E, Massawe S, Mgaya H, Lindmark G, Nystrom L: Female mortality in reproductive ages in Dar es Salaam, Tanzania. East Afr Med J. 1994, 71 (4): 226-231.PubMed
8.
Nyamtema AS, Urassa DP, Pembe AB, Kisanga F, van Roosmalen J: Factors for change in maternal and perinatal audit systems in Dar es Salaam hospitals, Tanzania. BMC Pregnancy Childbirth. 2010, 10: 29-10.1186/1471-2393-10-29.CrossRefPubMedPubMedCentral
9.
WHO: Beyond the numbers: Reviewing maternal deaths and complications to make pregnancy safer. 2004, Geneva: World Health Organization
10.
Jashnani KD, Rupani AB, Wani RJ: Maternal mortality: an autopsy audit. J Postgrad Med. 2009, 55 (1): 12-16. 10.4103/0022-3859.48435.CrossRefPubMed
11.
Okusanya BO, Okogbo FO, Momoh MM, Okogbenin SA, Abebe JO: Maternal mortality and delay: socio-demographic characteristics of maternal deaths with delay in Irrua, Nigeria. Niger J Med. 2007, 16 (1): 38-41.CrossRefPubMed
12.
Shah N, Hossain N, Shoaib R, Hussain A, Gillani R, Khan NH: Socio-demographic characteristics and the three delays of maternal mortality. J Coll Physicians Surg Pak. 2009, 19 (2): 95-98.PubMed
13.
Ujah IA, Aisien OA, Mutihir JT, Vanderjagt DJ, Glew RH, Uguru VE: Factors contributing to maternal mortality in north-central Nigeria: a seventeen-year review. Afr J Reprod Health. 2005, 9 (3): 27-40. 10.2307/3583409.CrossRefPubMed
14.
Yego F, Stewart Williams J, Byles J, Nyongesa P, Aruasa W, D’Este C: A retrospective analysis of maternal and neonatal mortality at a teaching and referral hospital in Kenya. Reprod Health. 2013, 10: 13-10.1186/1742-4755-10-13.CrossRefPubMedPubMedCentral
15.
Ngwan SD, Swende TZ: International Journal of Biological & Medical Research. Int J Biol Med Res. 2011, 2 (2): 565-568.
16.
Kavatkar AN, Sahasrabudhe NS, Jadhav MV, Deshmukh SD: Autopsy study of maternal deaths. Int J Gynaecol Obstet. 2003, 81 (1): 1-8. 10.1016/S0020-7292(02)00402-2.CrossRefPubMed
17.
Oladapo OT, Lamina MA, Fakoya TA: Maternal deaths in Sagamu in the new millennium: a facility-based retrospective analysis. BMC Pregnancy Childbirth. 2006, 6: 6-10.1186/1471-2393-6-6.CrossRefPubMedPubMedCentral
18.
Thonneau PF, Matsudai T, Alihonou E, De Souza J, Faye O, Moreau JC, Djanhan Y, Welffens-Ekra C, Goyaux N: Distribution of causes of maternal mortality during delivery and post-partum: results of an African multicentre hospital-based study. Eur J Obstet Gynecol Reprod Biol. 2004, 114 (2): 150-154. 10.1016/j.ejogrb.2003.12.004.CrossRefPubMed
19.
Massawe S, Urassa E, Lindmark G, Moller B, Nystrom L: Anaemia in pregnancy: a major health problem with implications for maternal health care. Afr J Health Sci. 1996, 3 (4): 126-132.PubMed
20.
Brabin BJ, Hakimi M, Pelletier D: An analysis of anemia and pregnancy-related maternal mortality. J Nutr. 2001, 131 (2S-2): 604S-614S. discussion 614S-615SPubMed
21.
Kalaivani K: Prevalence & consequences of anaemia in pregnancy. Indian J Med Res. 2009, 130 (5): 627-633.PubMed
22.
Cham M, Sundby J, Vangen S: Maternal mortality in the rural Gambia, a qualitative study on access to emergency obstetric care. Reprod Health. 2005, 2 (1): 3-10.1186/1742-4755-2-3.CrossRefPubMedPubMedCentral
23.
Ozumba BC, Nwogu-Ikojo EE: Avoidable maternal mortality in Enugu, Nigeria. Public Health. 2008, 122 (4): 354-360. 10.1016/j.puhe.2007.04.018.CrossRefPubMed
24.
Hendriks J, Zwart JJ, Briet E, Brand A, van Roosmalen J: The clinical benefit of blood transfusion: a hypothetical experiment based on a nationwide survey of severe maternal morbidity. Vox Sang. 2013, 104 (3): 234-239. 10.1111/j.1423-0410.2012.01654.x.CrossRefPubMed
25.
Urassa E, Massawe S, Lindmark G, Nystrom L: Operational factors affecting maternal mortality in Tanzania. Health Policy Plan. 1997, 12 (1): 50-57. 10.1093/heapol/12.1.50.CrossRefPubMed
Metadata
Title
Maternal mortality at muhimbili national hospital in Dar-es-Salaam, Tanzania in the year 2011
Authors
Andrea B Pembe
Chetto Paulo
Brenda S D’mello
Jos van Roosmalen
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2014
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/1471-2393-14-320

Other articles of this Issue 1/2014

BMC Pregnancy and Childbirth 1/2014 Go to the issue

Research article

On speaking terms: a Delphi study on shared decision-making in maternity care

Research article

Estimation of high risk pregnancy contributing to perinatal morbidity and mortality from a birth population-based regional survey in 2010 in China

Research article

Birth setting, transfer and maternal sense of control: results from the DELIVER study

Research article

Ancillary benefits of antenatal ultrasound: an association between the introduction of a low-cost ultrasound program and an increase in the numbers of women receiving recommended antenatal treatments

Study protocol

Maternal positioning to correct occipito-posterior fetal position in labour: a randomised controlled trial

Research article

The prevalence of severe maternal morbidity and near miss and associated factors in Sergipe, Northeast Brazil