Abstract:
BACK GROUND: Maternal mortality in Tanzania continues to be unacceptably high. By Identifying the avoidable factors, as well as direct and indirect causes of maternal mortality from both obstetrics and gynaecology units and by determining the current MMR, will help to establish areas of improvement and this may help in fighting to reduce the maternal mortality in this institution . The objective of this study was to determine the maternal mortality ratio and identify causes and avoidable factors of maternal deaths at Muhimbili National Hospital.
METHODS: A retrospective review of all maternal death records of cases that occurred from 1st January to 31st December 2011 was done. Data entry was done using Epi info version 3.5.1 and was analyzed using SPSS version 15.0.
RESULTS: There were 10,057 live births, 155 maternal deaths and hence MMR of 1541 per 100,000 live births. Of direct causes eclampsia and pre eclampsia were major causes of deaths (19.9%), followed by post partum haemorrhage (14.9%), abortion complications (9.9%), sepsis (9.2%), ante partum hemorrhage (7.1%), ruptured uterus (5.0%) and obstructed labour (3.5%). Among the indirect causes anaemia was the leading cause (11.3%), followed by HIV/AIDS (9.9%), heart diseases (5.7%), malaria (2.8%) and tuberculosis (0.7%). Avoidable factors contributing to deaths were identified in 83% of all reviewed maternal deaths. Personal avoidable factor was found in 33.8% while medical service factor was seen in 66.2% of the total factors identified. The common personal avoidable factors included delay in seeking care (73.3%) and completely lack of antenatal care (11.1%). Of the medical service factors inadequate blood transfusion (26.1%) completely no transfusion due to lack of blood (19.3%), delay in receiving treatment (18.3%) and poor or mismanagement (17%) were the common factors.
CONCLUSION: There is a high maternal mortality ratio in Muhimbili National Hospital. Hypertensive disorders of pregnancy (eclampsia and pre eclampsia), post partum hemorrhage and anaemia are the leading causes of maternal deaths in this institution. There were multiple factors identified both at individual level and at facility level that contributed to maternal deaths which were avoidable. There is a need for increasing efforts in the fight to reduce maternal deaths in this institution.
