A synopsis of maternal deaths in Zambia based on maternal death review data

Abstract

Introduction and background: Maternal Mortality (MM) is defined as those deaths that occur due to complications of pregnancy or child birth and in women dying within 42 days after delivery. The 5th millennium development goal (MDG5) was fashioned to mitigate the burden due to Maternal Deaths. Maternal mortality Ratio (MMRatio) is high in Zambia currently standing at 591/ 100, 000 live births in 2007. This study aimed to aggregate available notified and reviewed maternal deaths in 4 provincial medical offices in Zambia. This descriptive study examined causes of maternal deaths, characteristics of the dead women and features of the facilities they died in, based on Maternal Death Review (MDR) data. Methods: The study used the 3 tools used during maternal death reviews. These included the notification, health facility and the community interview tools. Data was entered from the completed forms from year 2008 to January 2014 available at the provincial health offices in western, north western, copperbelt and central provinces. Results and discussion: In the four provinces, 329 notifications were found. Based on the MDR data, Western province had the largest maternal mortality ratio of 166/ 100,000 live births. The lowest MMRatio was for the copperbelt province at 24 deaths per 100, 000 live births. Collectively the bleeding conditions accounted for 48% of all the pregnancy related deaths. There were also deficiencies in the referral system, supplies, skills and equipment in some health facilities. In some cases the diagnosis was missed or the appropriate management was delayed altogether. Notwithstanding, factors outside the health system such as the sparse geographic distribution and poor road communication during referrals were noted. Conclusion and Recommendation: Gaps in the human resources for health, blood and other supplies and equipment for emergence obstetric care, the low rate of referred patients and competencies by service providers to manage and resuscitate emergencies contributed to the maternal mortality in the 4 provinces. Factors in the 3 delay model, especially the delay to receive appropriate care in the face of obstetric emergencies, were observed to be an important and common phenomenon. Emergence Obstetric care may need to be scaled up to all Health Posts (HP) and Rural Health Centres (RHC). Maternal Death Review data may be quantified regularly at national level to provide real time feedback to policy makers.