Retrospective follow-up of maternal deaths and their associated risk factors in a rural district of Tanzania

OBJECTIVE To determine the maternal mortality rate in a rural district of Tanzania and to measure the incidence of causes of maternal mortality; the presence of risk factors and the relationship with social and demographic factors. METHOD From January to December 1993 a retrospective recording of maternal deaths was completed using verbal autopsy and networking. RESULTS A total of 76 deaths were found which is equivalent to a maternal mortality ratio of 961 per 100,000 live births for this 12-month period of time. The leading causes of death were postpartum haemorrhage with retained placenta, anaemia, postpartum haemorrhage without retained placenta, AIDS complex and obstructed labour (in descending order of frequency), Maternal deaths were seen irrespective of group factors such as access to a main road, presence of antenatal risk factors and contact with health care personnel or a nearby facility before death. Mortality was also present both in home and hospital deliveries (excluding hospital referrals). Antenatal care had been received by 97.2% of the mothers who died after the second trimester. The referral rate even in the presence of a known antenatal risk factor was 34.6%. Patient compliance to the referral was only 44.4%. Mothers and their families followed strong cultural beliefs even when they were detrimental to the mother's health. Maternal deaths were proportionately higher among women >40 who were also gravid greater than or equal to 5, but there was no significant increase in deaths in women <19 years of age. CONCLUSION Effective antenatal care, appropriate emergency treatment of complications, access to transportation and competent referral level care with adequate equipment encompass the most effective answers to reduction of maternal deaths at a district level.