Assessment of maternal mortality and late maternal mortality among a cohort of pregnant women in Bamako, Mali

Objective Few prospective studies have been undertaken of maternal mortality in sub-Saharan Africa. National statistics are inadequate, and data from hospitals are often the only source of information available. Reported maternal mortality ratios may therefore show large variations within the same country, as in Mali. This study was designed to produce an estimate of the maternal mortality ratio for the population of Bamako. Design Prospective cohort study. Setting Bankoni (population 59,000), a district of Bamako (population 700,000). Population 5782 pregnant women identified during quarterly household visits. Methods After enrolment, two follow up visits, at six weeks and one year after delivery, were performed to collect information on the pregnancy, its outcome, the method of delivery, the puerperium and the first year after birth. Detailed inquiries on deaths were undertaken in the community, the maternity units and the reference hospital. Main outcome measures Maternal mortality ratio, late maternal mortality, likely cause of death. Results Complete data at follow up were available on 4717 women (82%) (4653 single and 64 twin pregnancies). Most of the women had antenatal care were and delivered in a district maternity hospital. There were 4580 live births (96%). Fifteen maternal deaths were recorded, yielding an overall maternal mortality ratio of 327 per 100,000 live births. Hypertensive disorders and haemorrhage were the main causes of death. Five more deaths occurred within 42 days or one year after delivery. Conclusions This study gave an estimate of the maternal mortality ratio for the population of Bamako, and stressed the need of better emergency obstetric care and the importance of late maternal mortality.