Incidence and Predictors of Maternal and Perinatal Mortality among Women with Severe Maternal Outcomes: A Tanzanian Facility-Based Survey for Improving Maternal and Newborn Care

Abstract

Introduction. Maternal and perinatal mortality is still a major public health challenge in Tanzania, despite the ongoing government efforts to improve maternal and newborn care. Among the contributors to these problems is the high magnitude of severe maternal outcomes (maternal near-miss). The current study, therefore, aimed to identify the magnitude and predictors of maternal and perinatal mortality among women with severe maternal outcomes admitted to Dodoma Regional Referral Hospital. Methods. A retrospective cross-sectional study was conducted from October 2015 to January 2016 at Dodoma Regional Referral Hospital in Dodoma City. All maternal deaths and maternal near-misses based on WHO criteria were included in this study. Three outcome variables have been identified: maternal mortality, perinatal mortality, and neonatal complications. To examine the predictors for the three predetermined outcome variables, the three logit models each containing unadjusted and adjusted findings were fitted. A P-value less than 0.05 was considered indicative of statistically significant. Results. A total of 3600 pregnant women were admitted for obstetric reasons during the mentioned period. 140 of them were diagnosed with severe maternal outcomes; hence, they were included in this study. The severe maternal outcome incidence ratio was 40.23 per 1000 live births, the institutional maternal mortality ratio was 459.77 per 100000 live births, and the perinatal mortality rate was 10.83 per 1000 total births. Most of the maternal morbidity and mortality were due to direct causes in which postpartum hemorrhage and hypertensive disorders were the leading causes. In adjusted analysis, per-protocol management, maternal age, and mode of birth were predictors of maternal mortality, perinatal mortality, and neonatal complications, respectively. Conclusion. Establishing and strengthening obstetric ICUs will help reduce maternal mortality as the response time from the onset of obstetric complications, while the provision of high-quality care will be substantially reduced. Furthermore, the study recommends regular provision of in-service refresher training to emphasize the practice and compliance of per-protocol case management through a team approach in order to reduce the burden of maternal and perinatal mortality in Tanzania.

Applicability and comparison of the sub-Saharan Africa and original WHO maternal near-miss criteria in a rural hospital in Western Tanzania

“…[14][15][16] Tanzania is among countries with high maternal mortality. 1,[17][18][19][20] In 2015 and 2016, 98% of pregnant women receive antenatal care (ANC), although only one in four had the first visit in the first three months of pregnancy. Also, slightly more than half made more than four visits, while the latest recommendation of the WHO is eight visits per pregnancy.…”

“…11 Other studies in Tanzania reported a high incidence of the same underlying causes as well. 17,19,30 Severe PPH was the most frequently occurring severe complication in Ndala. In this study, the patients with PPH did fulfill a criterion in the WHO or the SSA -set.…”

Eclampsia at 20 Weeks of Gestation: A Case Report

“…According to WHO estimates, the incidence of preeclampsia in developing countries (2.8% of live births) is seven times higher than in developed countries (0.4% of live births). Eclampsia increases the risk of maternal death both in developed countries (0.4% of live births) and in developing countries (15%) [3][4][5][6][7]. Adequate obstetrical care in developing countries must include clinicians and facilities who are well versed and well prepared to care for preeclamptic and eclamptic patients.…”

“…The second stage, the maternal syndrome, results from the failure of cytotrophoblast remodeling of uterine spiral arteries. This cytotrophoblastic failure is thought to release secreted factors that enter the maternal circulation resulting in the signs and symptoms of preeclampsia [7,8].…”

Determinants of Intention To Use Maternity Waiting Homes in Tanzania: A Study Based on Women Using MWH in Dodoma, Iringa and Morogoro

“…Maternal mortality rate (MMR) in Tanzania is still persistently high. The data from Tanzania has revealed that maternal mortality ratio (MMR) has increased from 454 per 100,000 live births in 2010 to 556 per 100,000 live births by the year 2015 [4]- [7]. Several strategies such as increasing coverage and quality primary health care services for communities in rural and remote areas, timely antenatal care visit, delivery in health facilities and timely postnatal check-up have been adopted by the government in collaboration with the UN agencies and other development partners as a necessary attempt to improve maternal health in the country [5], [8].…”