Patterns and causes of hospital maternal mortality in Tanzania: A 10-year retrospective analysis

Abstract

Background Maternal mortality is among the most important public health concerns in Sub-Saharan Africa. There is limited data on hospital-based maternal mortality in Tanzania. The objective of this study was to determine the causes and maternal mortality trends in public hospitals of Tanzania from 2006–2015. Methods and findings This retrospective study was conducted between July and December 2016 and involved 34 public hospitals in Tanzania. Information on causes of deaths due to pregnancy and delivery complications among women of child-bearing age (15–49 years old) recorded for the period of 2006–2015 was extracted. Data sources included inpatient and death registers and International Classification of Disease (ICD)-10 report forms. Maternal deaths were classified based on case definition by ICD 10 and categorized as direct and indirect causes. A total of 40,052 deaths of women of child-bearing age were recorded. There were 1,987 maternal deaths representing 5·0% of deaths of all women aged 15–49 years. The median age-at-death was 27 years (interquartile range: 22, 33). The average age-at-death increased from 25 years in 2006 to 29 years in 2015. Two thirds (67.1%) of the deaths affected women aged 20–34 years old. The number of deaths associated with teenage pregnancy (15–19 years) declined significantly (p-value<0·001) from 17.8% in 2006–2010 to 11.1% in 2011–2015. The proportion of deaths among 30–34 and 35–39 years old (all together) increased from 13% in 2006–2010 to 15·3% in 2011–2015 (p-value = 0.081). Hospital-based maternal mortality ratio increased from 40.24 (2006) to 57.94/100000 births in 2015. Of the 1,987 deaths, 83.8% were due to direct causes and 16.2% were due to indirect causes. Major direct causes were eclampsia (34.0%), obstetric haemorrhage (24.6%) and maternal sepsis (16.7%). Anaemia (14.9%) and cardiovascular disorders (14.0%) were the main indirect causes. Causes of maternal deaths were highly related; being attributed to up to three direct causes (0.12%). Cardiovascular disorders and anaemia had strong linkage with haemorrhage. While there was a decline in the number of deaths due to eclampsia and abortion, those due to haemorrhage and cardiovascular disoders increased during the period. Conclusions During the ten year period (2006–2015) there was an increase in the number of hospital maternal deaths in public hospitals in Tanzania. Maternal deaths accounted for 5% of all women of child-bearing age in-hospital mortalities. Most maternal deaths were due to direct causes including eclampsia, haemorrhage and sepsis. The findings of this study provide evidence for better planning and policy formulation for reproductive health programmes to reduce maternal deaths in Tanzania.

Determinants for Choice of Home Birth over Health Facility Birth among Women of Reproductive Age in Tanzania: An Analysis of Data from the 2015-16 Tanzania Demographic and Health Survey and Malaria Indicator Survey

“…The main indirect causes of maternal mortality were anemia (14.9%) and cardiovascular disorders (14.0%). The study also reported that there was an increasing trend of maternal deaths due to haemorrhage and cardiovascular disorders during the period [4]. Likewise, neonatal mortality rate in.…”

Determinants for choice of home birth over health facility birth among women of reproductive age in Tanzania: an analysis of data from the 2015-16 Tanzania demographic and health survey and malaria indicator survey

“…A ten-year retrospective study undertaken in Tanzania reported that the leading cause of maternal mortality was eclampsia (34.0%), followed by obstetric haemorrhage (24.6%) and maternal sepsis (16.7%) [4]. The main indirect causes of maternal mortality were anaemia (14.9%) and cardiovascular disorders (14.0%).…”

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

“…Recent research studies conducted in Tanzania highlighted a notable surge of maternal mortality ratio (MMR) (from 454 to 556 maternal deaths per 100 000 live births), while perinatal mortality ratio (PMR) slightly increased (36)(37)(38)(39) perinatal deaths per 1000 all total births) between 2010 and 2016 [6,7]. is incremental is related to some deficiencies in recognizing and managing obstetric complications that range from minor morbidity to lifethreatening conditions which need attention [8,9].…”