Operational Factors Affecting Maternal Mortality in Tanzania

Abstract

Identification of the main operational factors in cases of maternal death within and outside the health care system is necessary for safe motherhood programmes. In this study, a follow-up was done of all 117 cases of maternal deaths in Ilala district, Dar es Salaam, 1991-1993, at all levels of care. In all, 79% received some medical care whereas 11% arrived too late for treatment. For each case the major operational factors and all health care interventions were defined through interviews with family members and health care staff and from hospital records, and the avoidability of each case was determined. In the health institutions where the women had consulted, the available resources were assessed. It was found that in most cases the husband (29%) or the mother (31%) of the woman decided on her care in cases of complications, and together with the lack of transport, this often caused delay at home. Also, delay in transfer from the district hospital was common. Cases of abortion complications were often not managed on time because of the delay in reporting to hospital or misleading information. Suboptimal care was identified in 77% of the cases reaching health care. Inadequate treatment was identified by the district health staff in 61% and by the referral centres in 12% of their cases. Wrong decision at the district level and lack of equipment at the referral centre were the main reasons for inadequate care. It is concluded that although community education on danger signs in pregnancy and labour is important, provision of the core resources and supplies for emergency obstetric interventions, as well as clear protocols for management and referral, are absolutely necessary for improvement of maternal survival.

Forensic considerations of pregnancy-related maternal deaths: An overview

“…Similarly, in Dar es Salaam, 72 of 93 maternal deaths in a referral hospital were related to sub-optimal medical care. 31 Phase 3 delay will influence delay in the two other phases. 32 It is even unethical to encourage women to seek treatment for problems related to pregnancy if obstetric services do not exist or do not function.…”

Positive Effects of the Non-pneumatic Anti-shock Garment on Delays in Accessing Care for Postpartum and Postabortion Hemorrhage in Egypt and Nigeria

“…Most studies that have examined the relationship of delays to maternal mortality have used subjective judgments of whether or not a delay occurred or simply specified the type of delay, rather than measuring specific time intervals between events. 9,10,25 The current study also had some limitations. A substantial number of cases in the database had missing data on the time of the start of hemorrhage, particularly for woman transferred into the referral hospital already bleeding; therefore, analyses of hemorrhage start times had a reduced number of cases.…”

Geographic accessibility to obstetric care and maternal mortality in a large metropolitan area of Brazil

“…The distance to be traveled is known to be an important variable in the seeking of health care generally [6,19], and for maternal care poor accessibility is significantly associated with death [4,10,[20][21][22][23][24][25]. Transportation delay has been found to be an important predictor of maternal mortality in highly populated areas [22].…”

“…Transportation delay has been found to be an important predictor of maternal mortality in highly populated areas [22]. A study reported that in Nepal only 32% of the population lived within 5 km of a health unit, and that distance was a strong factor in preventing access to care [23].…”