Assessment of Maternal Mortality and its Associated Causes at Shinyanga Regional Hospital in Tanzania

Mapunda, Oscar; Msuya, Sia E.; Kapologwe, Ntuli; John, Beatrice; Damian, Damian J.; Mahande, Michael Johnson

doi:10.17795/whb-38976

Cited by 9 publications

(16 citation statements)

References 10 publications

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“…Similar findings were recorded in a retrospective analysis of causes of health facility maternal deaths in Ogun state, Nigeria, and central regions of Kenya where haemorrhage was the leading cause accounting for 40% and 43.3%, respectively [ 6 , 11 ]. A study conducted at Shinyanga Regional Referral Hospital, Tanzania, also correlates to the above findings that haemorrhage was the leading cause of maternal deaths by 50% [ 12 ]. In another study, also conducted in Tanzania, Bwana et al found that haemorrhage was second to eclampsia in causing deaths at 24.6% [ 13 ].…”

Section: Discussionmentioning

confidence: 63%

Maternal Deaths due to Obstetric Haemorrhage in Dodoma Regional Referral Hospital, Tanzania

Nassoro¹,

Chiwanga²,

Lilungulu

et al. 2020

Obstetrics and Gynecology International

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Background. Despite the availability of comprehensive emergency obstetric care at Dodoma Regional Referral Hospital, deaths due to obstetric haemorrhage are still high. This study was carried out to analyse the circumstances that had caused these deaths. Methods. A retrospective review of all files of women who had died of obstetric haemorrhage from January 2018 to December 2019 was made. Results. A total of 18,296 women gave birth at DRRH; out of these, 61 died of pregnancy-related complications of the deceased while 23 (38%) died of haemorrhage, with many of them 10 (44%) between the age of 30 and 34. Many were grand multiparous women 8 (35%) and almost half of them (11 (48%)) had stayed at DRRH for less than 24 hours. More than half (12 (52%)) had delivered by caesarean section followed by laparotomy due to ruptured uterus (8 (35%)). The leading contributing factors to the deaths of these women were late referral (6 (26%)), delays in managing postpartum haemorrhage due to uterine atony (4 (17%)), inadequate preparations in patients with the possibility of developing PPH (4 (17%)), and delay in performing caesarean section (3 (13%)). Conclusion. Maternal mortality due to obstetric haemorrhage is high at Dodoma Regional Referral Hospital where more than one-third of women died between 2018 and 2019. Almost all of these deaths were avoidable. The leading contributing factors were late referral from other health facilities, inadequate skills in managing PPH due to uterine atony, delays in performing caesarean section at DRRH, and inadequate preparation for managing PPH in patients with abruptio placentae and IUFD which are risk factors for the condition. There is a need of conducting supportive supervision, mentorship, and other modes of teaching programmes on the management of obstetric haemorrhage to health care workers of referring facilities as well as those at DRRH. Monitoring of labour by using partograph and identifying pregnant women at risk should also be emphasized in order to avoid uterine rupture.

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Section: Discussionmentioning

confidence: 63%

Maternal Deaths due to Obstetric Haemorrhage in Dodoma Regional Referral Hospital, Tanzania

Nassoro¹,

Chiwanga²,

Lilungulu

et al. 2020

Obstetrics and Gynecology International

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“…In this analysis, 15 of the deceased were women who were para 5 and above. However, this finding does not correlate with those of Shinyanga Regional Referral Hospital and Muhimbili National Hospital (MNH) where the grand multipara made up 28.3 and 12.1, respectively [9,10]. This difference could be due to numbers of grand multipara becoming pregnant, especially for big cities like Dar es Salaam.…”

Section: Discussionmentioning

confidence: 83%

“…Many of the deceased were 35 years old and above, married, and peasants with no formal education. There were15 grand multipara followed by primigravida (9). Majority of them were admitted as referrals from other health facilities (32) (Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…This ratio is almost similar to that of other referral hospitals such as Shinyanga with the rate 449 per 100,000 live births in 2014 and Kilimanjaro Christian Medical Centre which was 492.1/100,000 as a ten-year trend. Comparably, the national hospital, Muhimbili, has even a higher ratio of 1541/100,000 for the year 2011 [9][10][11]. These ratios are high and reflect poor quality of obstetric care.…”

Section: Discussionmentioning

confidence: 99%

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Maternal Mortality in Dodoma Regional Referral Hospital, Tanzania

Nassoro¹,

Chetto²,

Chiwanga³

et al. 2020

International Journal of Reproductive Medicine

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Background. Maternal mortality has remained a challenge in Tanzania. The Tanzania Demographic and Health Survey 2015-16 has shown that the problem has been increasing despite various strategies instituted to curb it. It has been shown that most of the maternal deaths occurring in health facilities, whether direct or indirect, have other contributing factors. The objective of this study was to analyse causes and associated factors for maternal deaths in Dodoma Regional Referral Hospital (DRRH). Methods. A retrospective review of all files of the women who died in 2018 and were classified as maternal deaths. Results. A total of 8722 women gave birth in DRRH, out of which 35 died and were confirmed as maternal deaths. The number of live births was 8404 making the maternal mortality ratio of 417 per 100,000 live births. The leading causes of maternal death were eclampsia (9), sepsis (6), ruptured uterus (5), and haemorrhage (5). The third-phase delay was the leading contributing factor to 19 maternal deaths. This includes delays in referral from another facility as well as delays in getting treatment at DRRH and inadequate skills of providers at both the referring facilities and DRRH. The first-phase and second-phase delays contributed to 7 and 6 deaths, respectively. Furthermore, poor antenatal care contributed to 2 deaths. Conclusion. Maternal mortality is still high in Dodoma Regional Referral Hospital. Eclampsia was the leading cause of maternal deaths in 2018 followed by sepsis and obstetric haemorrhage. Delays associated with health system factors (third-phase delay) contributed much more to maternal mortality than the first-phase delay. Mentorship programmes on management of obstetric complications need to be instituted in order to reduce maternal deaths in Dodoma Regional Referral Hospital.

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“…The finding shows that overall pregnancy-related mortality was high at 712 deaths per 100,000 live births. Nevertheless (Mapunda et al, 2016) conducted a study in Shinyanga regional referral hospital. The result indicated that maternal mortality ratio declined from 635/100,000 live births in 2010 to 449/100,000 live births in 2014 however observed maternal mortality ratio was higher compared to the national average.…”

Section: Maternal Mortality Situation In Tanzaniamentioning

confidence: 99%

The Regression Model of Risk Factors Associated with Maternal Mortality in Tanzania

2019

JHMN

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Maternal mortality is one of the statistics showing the largest degree of disparity between the developed and developing countries. According to literature up to 2016 Tanzania was among the countries with unacceptably maternal mortality ratio and claimed to be still very far from reaching the Millennium developing goals. This study aimed at modeling of risk factors for maternal mortality using pre collected data Based on Tanzania Demographic Health Survey (TDH 2015-16. Therefore secondary data were used to build the model. Data were reanalyzed by descriptive statistics using statistical software package STATA version 13. Based on data the result indicates that mortality was about 345 per 100,000 live births. The contributing factor was identified as education [OR= 0.81), Age group between 20 to 24 (OR = 2.84), distance to the health center (OR = 0.89), Marital status (OR = 1.39). It is concluded that, the risk factor of maternal death is age groups 20-24 and 25-29 years especially in the mainland rural.

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Assessment of Maternal Mortality and its Associated Causes at Shinyanga Regional Hospital in Tanzania

Abstract: Background: Maternal mortality remains a public health concern in low income countries particularly in sub-Saharan Africa where majority (62%) of maternal deaths occurs. In Tanzania maternal mortality ratio is as high as 432 deaths per 100,000 live births.

Cited by 9 publications

References 10 publications

Maternal Deaths due to Obstetric Haemorrhage in Dodoma Regional Referral Hospital, Tanzania

Maternal Deaths due to Obstetric Haemorrhage in Dodoma Regional Referral Hospital, Tanzania

Maternal Mortality in Dodoma Regional Referral Hospital, Tanzania

The Regression Model of Risk Factors Associated with Maternal Mortality in Tanzania

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