Abstract:

Background: Maternal death refers to death of women during pregnancy, child birth or 42 days post-delivery. It is a catastrophic event that can occur in a health facility or in the community. Tanzania’s national maternal mortality rate stands at 524 per 100,000 as per WHO report of 2017(1) much lower than the facility based MMR. Facility-based reviews have shown hypertensive disorders of pregnancy to lead followed by hemorrhage as causes of death(2). Timely access to emergency obstetric services is an important aspect to reduce maternal deaths especially in those referred from lower health facilities. The fate of facility referred cases has not been documented despite the high number of maternal deaths in the past 3years. This study aimed at identifying the causes, maternal characteristics and factors associated with maternal death among facility referred cases at BMC.

Methodology: This was a registry based 3-year retrospective cross-sectional study from 1st January 2017 to 31st December 2019 involving all facility referred maternal cases seen at BMC, 551 case files were reviewed and data was collected, entry and analysis was done using SPSS version 13 and p value of <0.05 was found to be significant.

Results: During the study period there were a total of 19092 live births therefore MMR was 879/100,000 live births. Total number of referred patients were 3123 from which 551 case files were reviews out of which 147 maternal deaths were documented. Direct causes attributed 89.12% and indirect causes were 10.88%. Hypertensive disorders of pregnancy were the most common 40.5% of the direct causes, while cardiomyopathy 62.5% was the leading indirect cause. Most patients came in unstable condition and were admitted to ICU, and most deaths occurred in the post-partum period. Delay in any of the levels was associated with death (COR 23.73[2.85-197.48]) whereby delay at individual level was the most common.

Conclusion: The MMR within the hospital was high. Presence of any of the three delays were associated with death of the mothers. Most of the deaths were from preventable causes where the leading was hypertensive disorders of pregnancy. Therefore, different level intervention like at hospital level, community and national-level approaches are needed to improve the MMR.