Skip to main content
Top
Published in: BMC Pregnancy and Childbirth 1/2020

Open Access 01-12-2020 | Research article

Ratios and determinants of maternal mortality: a comparison of geographic differences in the northern and southern regions of Cameroon

Authors: Catherine Meh, Amardeep Thind, Amanda L. Terry

Published in: BMC Pregnancy and Childbirth | Issue 1/2020

Login to get access

Abstract

Background

While maternal mortality has declined worldwide in the past 25 years, this is not the case for Cameroon. Since there is a predominantly young population in this country, high maternal mortality ratios may persist. Maternal mortality ratios vary within countries, yet it is unknown if the North and South, the most distinct parts of Cameroon, differ in terms of ratios and determinants of maternal mortality.

Methods

This study explored ratios and determinants of maternal mortality in women of childbearing age (15–49 years) and assessed differences between the North and South. We used the Cameroon Demographic and Health Surveys (2004 and 2011) to extract a sample of 18,665 living or deceased women who had given birth. Multivariable logistic regression was used to explore the relationship between maternal mortality and sociocultural, economic and healthcare factors.

Results

Maternal mortality ratios were different for the two regions and increased in the North in 2011 compared to 2004. In the North, any level of education and being Muslim were protective against maternal mortality. Meanwhile, the odds of maternal mortality decreased with increasing age, and having secondary or higher education in the South. Domestic violence and ethnicity were associated with maternal death in the South. Increasing parity was protective of maternal death in both the North and South.

Conclusions

Maternal mortality ratios and determinants varied between women of childbearing age in the North and South of Cameroon. These reinforce recommendations for region specific strategies that will improve health communication, community education programs, curb domestic violence and train more community health workers to connect pregnant women with the health system. Programs to reduce maternal death among women with low parity and little or no education should be national priority.
Literature
1.
2.
go back to reference Iqbal K, Shaheen F, Begum A. Risk factors of maternal mortality. J Rawalpindi Med Coll. 2014;18:136–8. Iqbal K, Shaheen F, Begum A. Risk factors of maternal mortality. J Rawalpindi Med Coll. 2014;18:136–8.
3.
go back to reference McCarthy J, Maine D. A framework for analyzing the determinants of maternal mortality. Stud Fam Plan. 1992;23:23.CrossRef McCarthy J, Maine D. A framework for analyzing the determinants of maternal mortality. Stud Fam Plan. 1992;23:23.CrossRef
4.
go back to reference Alvarez JL, Gil R, Hernández V, Gil A. Factors associated with maternal mortality in sub-Saharan Africa: an ecological study. BMC Public Health. 2009;9:462.CrossRef Alvarez JL, Gil R, Hernández V, Gil A. Factors associated with maternal mortality in sub-Saharan Africa: an ecological study. BMC Public Health. 2009;9:462.CrossRef
5.
go back to reference Illah E, Mbaruku G, Masanja H, Kahn K. Causes and risk factors for maternal mortality in rural Tanzania -case of Rufiji Health and Demographic Surveillance Site (HDSS). Matern Heal Rufiji HDSS African J Reprod Heal Priv Bag. 2013;17. Illah E, Mbaruku G, Masanja H, Kahn K. Causes and risk factors for maternal mortality in rural Tanzania -case of Rufiji Health and Demographic Surveillance Site (HDSS). Matern Heal Rufiji HDSS African J Reprod Heal Priv Bag. 2013;17.
6.
go back to reference Filippi V, Chou D, Ronsmans C, Graham W, Say L. Levels and causes of maternal mortality and morbidity. The International Bank for Reconstruction and Development / The World Bank; 2016. Filippi V, Chou D, Ronsmans C, Graham W, Say L. Levels and causes of maternal mortality and morbidity. The International Bank for Reconstruction and Development / The World Bank; 2016.
7.
go back to reference Ronsmans C, Graham WJ. Maternal survival 1: maternal mortality: who, when, where, and why. Lancet. 2006;368:1189–200.CrossRef Ronsmans C, Graham WJ. Maternal survival 1: maternal mortality: who, when, where, and why. Lancet. 2006;368:1189–200.CrossRef
8.
go back to reference United Nations. Goal 3: sustainable development knowledge platform. 2015. United Nations. Goal 3: sustainable development knowledge platform. 2015.
9.
go back to reference INS, ORC Macro. Enquete Demographique et de Sante du Cameroon 2004. Calverton, Maryland, USA; 2004. INS, ORC Macro. Enquete Demographique et de Sante du Cameroon 2004. Calverton, Maryland, USA; 2004.
10.
go back to reference MINSANTE. Planification familiale: Plan operationnel du Cameroon 2015-2020. 2015. MINSANTE. Planification familiale: Plan operationnel du Cameroon 2015-2020. 2015.
11.
go back to reference Mangham LJ, Cundill B, Achonduh OA, Ambebila JN, Lele AK, Metoh TN, et al. Malaria prevalence and treatment of febrile patients at health facilities and medicine retailers in Cameroon. Trop Med Int Health. 2012;17:330–42.PubMed Mangham LJ, Cundill B, Achonduh OA, Ambebila JN, Lele AK, Metoh TN, et al. Malaria prevalence and treatment of febrile patients at health facilities and medicine retailers in Cameroon. Trop Med Int Health. 2012;17:330–42.PubMed
12.
go back to reference Tchinda VHM, Socpa A, Keundo AA, Zeukeng F, Seumen CT, Leke RGF, et al. Factors associated to bed net use in Cameroon: a retrospective study in Mfou health district in the Centre region. Pan Afr Med J. 2012;12:112.PubMedPubMedCentral Tchinda VHM, Socpa A, Keundo AA, Zeukeng F, Seumen CT, Leke RGF, et al. Factors associated to bed net use in Cameroon: a retrospective study in Mfou health district in the Centre region. Pan Afr Med J. 2012;12:112.PubMedPubMedCentral
14.
go back to reference UNFPA. The state of the world’s midwifery 2011: Delivering health, saving lives 2011. UNFPA. The state of the world’s midwifery 2011: Delivering health, saving lives 2011.
15.
go back to reference Every Woman Every Child. Cameroon – every woman every Child. 2016. Every Woman Every Child. Cameroon – every woman every Child. 2016.
16.
go back to reference Egbe TO, Dingana TN, Halle-Ekane GE, Atashili J, Nasah BT, Halder A, et al. Determinants of maternal mortality in Mezam division in the north west region of Cameroon: a mommunity-based case control study. Int J Trop Dis Heal. 2016;15:1–15. Egbe TO, Dingana TN, Halle-Ekane GE, Atashili J, Nasah BT, Halder A, et al. Determinants of maternal mortality in Mezam division in the north west region of Cameroon: a mommunity-based case control study. Int J Trop Dis Heal. 2016;15:1–15.
17.
go back to reference Fouelifack FY, Tameh TY, Mbong EN, Nana PN, Fouedjio JH, Fouogue JT, et al. Outcome of deliveries among adolescent girls at the Yaoundé central hospital. BMC Pregnancy Childbirth. 2014;14:102.CrossRef Fouelifack FY, Tameh TY, Mbong EN, Nana PN, Fouedjio JH, Fouogue JT, et al. Outcome of deliveries among adolescent girls at the Yaoundé central hospital. BMC Pregnancy Childbirth. 2014;14:102.CrossRef
18.
go back to reference Spedini G, Destro-Bisol G, Mondov S, Kaptué L, Taglioli L, Paoli G. The peopling of sub-Saharan Africa: The case study of Cameroon. Am J Phys Antrhopol. 1999:143–62. Spedini G, Destro-Bisol G, Mondov S, Kaptué L, Taglioli L, Paoli G. The peopling of sub-Saharan Africa: The case study of Cameroon. Am J Phys Antrhopol. 1999:143–62.
19.
go back to reference ICF International. The DHS program: demographic and health surveys. DHS Model Questionnaires. 2016. ICF International. The DHS program: demographic and health surveys. DHS Model Questionnaires. 2016.
20.
go back to reference Corsi DJ, Neuman M, Finlay JE, Subramanian SV. Demographic and health surveys: a profile. Int J Epidemiol. 2012;41:1602–13.CrossRef Corsi DJ, Neuman M, Finlay JE, Subramanian SV. Demographic and health surveys: a profile. Int J Epidemiol. 2012;41:1602–13.CrossRef
22.
go back to reference Graham W, Brass W, Snow RW. Estimating maternal mortality: the sisterhood method. Stud Fam Plan. 1989;20:125.CrossRef Graham W, Brass W, Snow RW. Estimating maternal mortality: the sisterhood method. Stud Fam Plan. 1989;20:125.CrossRef
24.
go back to reference El Ayadi AM, Hill K, Langer A, Subramanian SV, McCormick M. Comparability of sociodemographic and pregnancy characteristics of pregnancy-related deaths identified via the sisterhood method versus the household/verbal autopsy method. Int J Gynecol Obstet. 2015;129:251–5.CrossRef El Ayadi AM, Hill K, Langer A, Subramanian SV, McCormick M. Comparability of sociodemographic and pregnancy characteristics of pregnancy-related deaths identified via the sisterhood method versus the household/verbal autopsy method. Int J Gynecol Obstet. 2015;129:251–5.CrossRef
25.
go back to reference Graham WJ, Fitzmaurice AE, Bell JS, Cairns JA. The familial technique for linking maternal death with poverty. Lancet. 2004;363:23–7.CrossRef Graham WJ, Fitzmaurice AE, Bell JS, Cairns JA. The familial technique for linking maternal death with poverty. Lancet. 2004;363:23–7.CrossRef
26.
go back to reference Little RJA. Missing-data adjustments in large surveys. J Bus Econ Stat. 1988;6:287–96. Little RJA. Missing-data adjustments in large surveys. J Bus Econ Stat. 1988;6:287–96.
27.
go back to reference StataCorp. Stata Statistical Software: Release 13. 2013. 2013. StataCorp. Stata Statistical Software: Release 13. 2013. 2013.
28.
go back to reference Institut National de la Statistique, ICF International. Enquête Démographique et de Santé et à Indicateurs Multiples du Cameroun 2011. Calverton, Maryland; 2012. Institut National de la Statistique, ICF International. Enquête Démographique et de Santé et à Indicateurs Multiples du Cameroun 2011. Calverton, Maryland; 2012.
29.
go back to reference The World Bank. Health system performance reinforcement project. 2016. The World Bank. Health system performance reinforcement project. 2016.
30.
go back to reference Tatah L, Delbiso TD, Rodriguez-Llanes JM, Cuesta JG, Guha-Sapir D. Impact of refugees on local health systems: a difference-in-differences analysis in Cameroon. PLoS One. 2016;11. Tatah L, Delbiso TD, Rodriguez-Llanes JM, Cuesta JG, Guha-Sapir D. Impact of refugees on local health systems: a difference-in-differences analysis in Cameroon. PLoS One. 2016;11.
31.
go back to reference Tandi TE, Cho Y, Akam AJ-C, Afoh CO, Ryu SH, Choi MS, et al. Cameroon public health sector: shortage and inequalities in geographic distribution of health personnel. Int J Equity Health. 2015;14:43.CrossRef Tandi TE, Cho Y, Akam AJ-C, Afoh CO, Ryu SH, Choi MS, et al. Cameroon public health sector: shortage and inequalities in geographic distribution of health personnel. Int J Equity Health. 2015;14:43.CrossRef
32.
go back to reference Pierre-Marie T, Gregory HE, Maxwell DI, Robinson EM, Yvette M, Nelson FJ. Maternal mortality in Cameroon: A university teaching hospital report. Pan Afr Med J. 2015;21. Pierre-Marie T, Gregory HE, Maxwell DI, Robinson EM, Yvette M, Nelson FJ. Maternal mortality in Cameroon: A university teaching hospital report. Pan Afr Med J. 2015;21.
33.
go back to reference Chowdhury ME, Botlero R, Koblinsky M, Saha SK, Dieltiens G, Ronsmans C. Determinants of reduction in maternal mortality in Matlab, Bangladesh: a 30-year cohort study. Lancet. 2007;370:1320–8.CrossRef Chowdhury ME, Botlero R, Koblinsky M, Saha SK, Dieltiens G, Ronsmans C. Determinants of reduction in maternal mortality in Matlab, Bangladesh: a 30-year cohort study. Lancet. 2007;370:1320–8.CrossRef
34.
go back to reference Mbassi SM, Mbu R, Bouvier-Colle MH. Use of routinely collected data to assess maternal mortality in seven tertiary maternity centers in Cameroon. Int J Gynecol Obstet. 2011;115:240–3.CrossRef Mbassi SM, Mbu R, Bouvier-Colle MH. Use of routinely collected data to assess maternal mortality in seven tertiary maternity centers in Cameroon. Int J Gynecol Obstet. 2011;115:240–3.CrossRef
35.
go back to reference Aremu O, Lawoko S, Dalal K. Neighborhood socioeconomic disadvantage, individual wealth status and patterns of delivery care utilization in Nigeria: a multilevel discrete choice analysis. Int J Women's Health. 2011;3:167–74.CrossRef Aremu O, Lawoko S, Dalal K. Neighborhood socioeconomic disadvantage, individual wealth status and patterns of delivery care utilization in Nigeria: a multilevel discrete choice analysis. Int J Women's Health. 2011;3:167–74.CrossRef
36.
go back to reference Thaddeus S, Maine D. Too far to walk: maternal mortality in context. Soc Sci Med. 1994;38:1091–110.CrossRef Thaddeus S, Maine D. Too far to walk: maternal mortality in context. Soc Sci Med. 1994;38:1091–110.CrossRef
37.
go back to reference Karlsen S, Say L, Souza J-P, Hogue CJ, Calles DL, Gülmezoglu AM, et al. The relationship between maternal education and mortality among women giving birth in health care institutions: analysis of the cross sectional WHO global survey on maternal and perinatal health. BMC Public Health. 2011;11:606.CrossRef Karlsen S, Say L, Souza J-P, Hogue CJ, Calles DL, Gülmezoglu AM, et al. The relationship between maternal education and mortality among women giving birth in health care institutions: analysis of the cross sectional WHO global survey on maternal and perinatal health. BMC Public Health. 2011;11:606.CrossRef
38.
go back to reference Pemunta NV, Fubah MA. Socio-cultural determinants of infant malnutrition in Cameroon. J Biosoc Sci. 2015;47:423–48.CrossRef Pemunta NV, Fubah MA. Socio-cultural determinants of infant malnutrition in Cameroon. J Biosoc Sci. 2015;47:423–48.CrossRef
39.
go back to reference Kongnyuy EJ, Wiysonge CS, Mbu RE, Nana P, Kouam L. Wealth and sexual behaviour among men in Cameroon. BMC Int Health Hum Rights. 2006;6:11.CrossRef Kongnyuy EJ, Wiysonge CS, Mbu RE, Nana P, Kouam L. Wealth and sexual behaviour among men in Cameroon. BMC Int Health Hum Rights. 2006;6:11.CrossRef
40.
go back to reference Popova S, Lange S, Probst C, Shield K, Kraicer-Melamed H, Ferreira-Borges C, et al. Actual and predicted prevalence of alcohol consumption during pregnancy in the WHO African region. Trop Med Int Heal. 2016;21:1209–39.CrossRef Popova S, Lange S, Probst C, Shield K, Kraicer-Melamed H, Ferreira-Borges C, et al. Actual and predicted prevalence of alcohol consumption during pregnancy in the WHO African region. Trop Med Int Heal. 2016;21:1209–39.CrossRef
41.
go back to reference Asamoah BO, Agardh A. Alcohol consumption in relation to maternal deaths from induced-abortions in Ghana. Reprod Health. 2012;9:10.CrossRef Asamoah BO, Agardh A. Alcohol consumption in relation to maternal deaths from induced-abortions in Ghana. Reprod Health. 2012;9:10.CrossRef
42.
go back to reference Al-Mujtaba M, Cornelius LJ, Galadanci H, Erekaha S, Okundaye JN, Adeyemi OA, et al. Evaluating religious influences on the utilization of maternal health services among Muslim and Christian women in north-Central Nigeria. Biomed Res Int. 2016;2016:3645415.CrossRef Al-Mujtaba M, Cornelius LJ, Galadanci H, Erekaha S, Okundaye JN, Adeyemi OA, et al. Evaluating religious influences on the utilization of maternal health services among Muslim and Christian women in north-Central Nigeria. Biomed Res Int. 2016;2016:3645415.CrossRef
43.
go back to reference Kassebaum NJ, Bertozzi-Villa A, Coggeshall MS, Shackelford KA, Steiner C, Heuton KR, et al. Global, regional, and national levels and causes of maternal mortality during 1990–2013: a systematic analysis for the global burden of disease study 2013. Lancet. 2014;384:980–1004.CrossRef Kassebaum NJ, Bertozzi-Villa A, Coggeshall MS, Shackelford KA, Steiner C, Heuton KR, et al. Global, regional, and national levels and causes of maternal mortality during 1990–2013: a systematic analysis for the global burden of disease study 2013. Lancet. 2014;384:980–1004.CrossRef
44.
go back to reference Hoj L, da Silva D, Hedegaard K, Sandstrom A, Aaby P. Factors associated with maternal mortality in rural Guinea-Bissau. A longitudinal population-based study. Bjog-an Int J Obstet Gynaecol. 2002;109:792–9.CrossRef Hoj L, da Silva D, Hedegaard K, Sandstrom A, Aaby P. Factors associated with maternal mortality in rural Guinea-Bissau. A longitudinal population-based study. Bjog-an Int J Obstet Gynaecol. 2002;109:792–9.CrossRef
45.
go back to reference Raj A, Boehmer U. Girl child marriage and its association with national rates of HIV, maternal health, and infant mortality across 97 countries. Violence Against Women. 2013;19:536–51.CrossRef Raj A, Boehmer U. Girl child marriage and its association with national rates of HIV, maternal health, and infant mortality across 97 countries. Violence Against Women. 2013;19:536–51.CrossRef
46.
go back to reference Parmar P, Agrawal P, Greenough PG, Goyal R, Kayden S. Sexual violence among host and refugee population in Djohong District. Eastern Cameroon Glob Public Health. 2012;7:974–94.CrossRef Parmar P, Agrawal P, Greenough PG, Goyal R, Kayden S. Sexual violence among host and refugee population in Djohong District. Eastern Cameroon Glob Public Health. 2012;7:974–94.CrossRef
47.
go back to reference Alio AP, Salihu HM, Nana PN, Clayton HB, Mbah AK, Marty PJ. Association between intimate partner violence and induced abortion in Cameroon. Int J Gynecol Obstet. 2011;112:83–7.CrossRef Alio AP, Salihu HM, Nana PN, Clayton HB, Mbah AK, Marty PJ. Association between intimate partner violence and induced abortion in Cameroon. Int J Gynecol Obstet. 2011;112:83–7.CrossRef
48.
go back to reference Say L, Chou D, Gemmill A, Tunçalp Ö, Moller A-B, Daniels J, et al. Global causes of maternal deaths: a WHO systematic analysis. Lancet Glob Heal. 2014;2:1–14. Say L, Chou D, Gemmill A, Tunçalp Ö, Moller A-B, Daniels J, et al. Global causes of maternal deaths: a WHO systematic analysis. Lancet Glob Heal. 2014;2:1–14.
49.
go back to reference Kongnyuy EJ, Wiysonge CS. Alcohol use and extramarital sex among men in Cameroon. BMC Int Health Hum Rights. 2007;7:6.CrossRef Kongnyuy EJ, Wiysonge CS. Alcohol use and extramarital sex among men in Cameroon. BMC Int Health Hum Rights. 2007;7:6.CrossRef
50.
go back to reference Defo BK. Areal and socioeconomic differentials in infant and child mortality in Cameroon. Soc Sci Med. 1996;42:399–420.CrossRef Defo BK. Areal and socioeconomic differentials in infant and child mortality in Cameroon. Soc Sci Med. 1996;42:399–420.CrossRef
51.
go back to reference Azevedo MJ, Prater GS, Lantum DN. Culture, biomedicine and child mortality in Cameroon. Soc Sci Med. 1991;32:1341–9.CrossRef Azevedo MJ, Prater GS, Lantum DN. Culture, biomedicine and child mortality in Cameroon. Soc Sci Med. 1991;32:1341–9.CrossRef
Metadata
Title
Ratios and determinants of maternal mortality: a comparison of geographic differences in the northern and southern regions of Cameroon
Authors
Catherine Meh
Amardeep Thind
Amanda L. Terry
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2020
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-020-02879-y

Other articles of this Issue 1/2020

BMC Pregnancy and Childbirth 1/2020 Go to the issue