Causes and contributing factors of maternal mortality in Bosaso District of Somalia. A retrospective study of 30 cases using a Verbal Autopsy approach

Abstract

Background: Somali women suffer from one of the highest maternal mortality rates in the world. Somalia characterises a specific low-income country situation with a mix of newly urbanized and nomadic culture combined with a frail health care infrastructure set in a postconflict era. Very little is known about the effects that these contextual factors can have on maternal mortality. Objectives: To explore and describe causes and contributing factors concerning maternal deaths in the Bosaso District, Puntland State of Somalia. Methods: Data was collected using an adapted Verbal Autopsy tool. In 2017 30 cases of maternal deaths occurring in 2016 in the Bosaso District were reviewed. Information was assessed by three independent reviewers who classified the cause of death and the contributing factors. The Three Delay Model was employed to identify socio-cultural and economic and health system factors that may have contributed to these maternal deaths. Results: Direct obstetric deaths accounted for 28 cases. Among these, haemorrhage was the leading cause, followed by eclampsia, sepsis and obstructed labour. Two cases were indirect obstetric deaths, caused by anaemia. All three types of delay were frequent among the studied cases. Delay in deciding to seek care was found in 25 cases, delay in reaching care in 22 cases and delay in receiving health care in 24 cases. Lack of knowledge, money, transportation, poor access and availability of adequate services, as well as substandard management by health care providers, were all underlying the delays. Conclusion: A comprehensive intervention programme is needed in order to decrease maternal mortality among Somali women. Such a programme must include health education, improved referral systems and strategic upgrading of care services.

Investigating Maternal Mortality of the Year 2019 at Bay Regional Hospital in Baidoa

“…We raise this point because factors like anemia and malaria, which have higher frequency rates in the category of indirect causes, attract more attention and equal concern since these are treatable illnesses which should not cause fatalities to the extent of their current state. The findings discussed here support the literature review above that in many African countries, people become victims either of treatable diseases or due to lack of appropriate care and drugs (Pheage 2017;Aden et al 2019). Concerning the direct causes, a timely arrival at a medical facility, enhanced obstetric as well as midwifery training for medical personnel and for traditional birth attends (TBAs) could extensively reverse the situation.…”

“…Together, these factors are described to be among the most common causes of maternal mortality. However, there is need to note that sometimes death of an expecting mother may occur due to mismanagement by the medical personnel or the patients themselves, as Aden et al (2019) found out in their study undertaken in Bosasso District in the State of Puntland, Somalia.…”

“…Maternal mortality in some of the world's poorest nations such as Somalia, and others in Sub-Saharan Africa as well as in a vast majority of African and Asian nations, may be a serious problem to mothers for reasons including, but not limited to: 1. Lack of or inadequacy of appropriate hospitals and well-trained medical personnel (Aden et al 2019; CARE 2020) who can provide the health services the community so desperately requires and seeks; 2. The fact that many, if not most, of the health facilities do not have the necessary medicines the citizens need.…”

“…However, although the TBAs' services may be helpful in situations of normal delivery, that alone should not drift us from the reality that they may nonetheless worsen the situation due to inadequacy of the training they undergo and therefore the poor knowledgebase that does not respond adequately and urgently during an emergency. In addition, their lack of sufficient modern skills and basic medical supplies to deal with complications that arise during childbirth (Aden et al 2019) should be considered as a factor that poses another threat to mothers.…”

Associated Factors with Pre-eclampsia Among Pregnant Women Attending Antenatal Care in SOS Hospital Mogadishu, Somalia: A Hospital-based Study

“…The causes of maternal morbidity and mortality are multifactorial. An in-deeply analysis on the trends of maternal health in Somalia related to demographic, social behavioral, nutritional, and health services related factors are associated with poor maternal health outcomes [13].…”