Factors associated with maternal mortality among women admitted in maternity wards at Mnazi Mmoja hospital - Zanzibar

Abstract

Background: Improving Good Health and Well-being is the third goal among seventeen Sustainable Development goals (SDG) of 2015. The target of these sustainable development goals is to reduce global maternal mortality ratio to less than 70 per 100,000 live births, with no single country having a maternal mortality rate (MMR) greater than 140/100,000 by 2030. Most of maternal deaths are preventable. Zanzibar like other East African countries is experiencing preventable maternal mortality.

Aim: The objective of this study was to determine the factors associated with maternal mortality among women admitted in Maternity wards at Mnazi Mmoja Hospital in Zanzibar.

Methodology: A descriptive retrospective design which employs quantitative approach was utilized. The study was conducted from April to May 2017 involving women admitted at Maternity wards from August 2015 to March 2017 at Mnazi Mmoja hospital. Systematic random sampling was used to select patients’ files of women admitted in Maternity Wards at Mnazi Mmoja Hospital. Data abstraction form was used to collect information from women’s files. Institutional factors (referral status, mode of delivery and birth attendants) and maternal factors (antenatal attendance, conditions of women during admission, gestational age of women during birth, parity, underlying medical and surgical conditions, age and obstetric factors) were extracted. Data were analyzed using Statistical Package for Social Science (SPSS) version 20. Chi square analyses were employed to determine the existence of a relationship between the variables. Multivariate binary logistic regression analysis was used to measure the magnitude of association with prediction of each factor towards maternal mortality.

Results: The proportion of maternal mortality among studied population were 24 (6.2%), N =384. The Chi square results show that; six factors were statistically significantly associated with maternal mortality, these included; Parity (p =0.041), obstetric factors (p =0.000), gestational age during birth (p =0.003), conditions of women’s during admission (0.000), pre-existing health conditions (p =0.000) and birth attendants (0.036). However, in logistic regression, the results revealed that puerperal sepsis had significantly higher risk of deaths as compared to other obstetric factors (OR = 248.95, p value 0.004 with 95% CI from 5.850-10595.03) .Post- partum hemorrhage were twenty times more likely to cause maternal deaths as compared to other obstetric factors (OR =20.112, p value 0.003 with 95% CI from 2.731-149.594). Severe pre-eclampsia were six times more likely to cause maternal deaths as compared to other obstetric factors (OR = 6.744, p value = 0.040 with 95% C.I from 1.092-41.653).

Conclusion: The findings of this study show that most mothers are dying due to preventable conditions. These findings are alarming and more efforts need to be focused in improving such conditions to cut-down the number of maternal deaths in Zanzibar by strengthening ante natal and post natal clinics. Immediate intervention is required to archive the SDG 2030, and to end with reduce preventable maternal mortality.

Recommendations: Most of these conditions are preventable by early detection during antenatal care. Antenatal and postnatal care could provide opportunities for the detection of risk factors for severe pre-eclampsia, postpartum hemorrhage and puerperal sepsis that may put women at risk during birth and puerperal period. There is a need to focus on intergraded care throughout pregnancy and child birth.