Factors Associated with Maternal Death in Lundazi District: A Case Control Study Analysing Maternal Death Reviews

Abstract

Background Factors associated with maternal death are important to understand because they are an essential measure of women’s health and indicative of the performance of health care systems in any community globally. This study aimed to analyse the risk factors for maternal death in Lundazi district using secondary data obtained from maternal death reviews and Lundazi district hospital delivery registers. Methods This was a case-control study with cases being recorded maternal deaths for Lundazi district (n = 100) while controls were randomly selected Lundazi District Hospital deliveries (n = 300) for the period 2010 to 2015. Stata version 12 was used to make bivariate comparisons and multiple logistic regression analyses. Results Women with pre-existing risk conditions from the cases were 2.5 times more likely to be a maternal death than from control group (95% CI: 1.4 - 4.3; p = 0.0006). The likelihood of experiencing maternal death was 0.06 less among women who completed their scheduled antenatal visits than those who never attended antenatal care (95 % CI: 1.4 to 4.3 p = 0.001). Thirty one percent of women (31) from the cases died of complication arising from haemorrhage (postpartum or intra-partum) followed by 17 % (17) who died from infections while 14 (14%) died from anaemia. Delayed referral was recorded as the most frequent factor associated with maternal deaths and complications at 30% (30) for cases, 12.3% (37) for the controls and 16.7% (67) for both cases and controls. Multiparity accounted for 12.7% (51) of all complications with 21% (21) among cases and 10% (30) among the controls. Unskilled deliveries was a factor at 3 %,( 13) for both cases and controls with 13% (13) for cases and 0.7% (2) for controls. Inadequate antenatal care was a factor for 7% of both cases and controls. Discussion Delay in seeking care by pregnant women was the leading factor associated with maternal deaths and complications. The delays seem to have been worsened by the long distances women have to cover in order to access health services from the nearest health facilities which in most cases were beyond 5km radius. Presence of pre-existing risk condition or illness such as anaemia, previous caesarean section, tuberculosis and multiparity was significantly associated with increased maternal complications or maternal death. Our findings showed that making more antenatal care visits was protective and beneficial. This could be because adequate antenatal care services may have also lead to women having improved uptake of skilled health facility delivery and attendance. Conclusion We conclude that antenatal care is important in screening for pre-existing risk conditions and illnesses as well as complications in the early stages of pregnancy that could impact adversely during pregnancy and childbirth. Delay in seeking health care by most women during pregnancy could be minimised if health facilities and services are brought closer to the communities to cut down on distances covered by pregnant women. It is women whose literacy levels are low who seem not to appreciate the importance of antenatal care and maternal education in preventing maternal death. Therefore, there is need for Lundazi District Health Office to scale up interventions that motivate women to make at least four scheduled visits during pregnancy as recommended by the World Health Organization.