Trends in maternal mortality for the Greater Harare Maternity Unit: 1976 to 1997.

A CAJM article on trends in maternal death in a Harare, Zimbabwe hospital.Objective: To determine the magnitude, trends and the main causes of maternal death for Harare Maternity Hospital (HMH) and thereby identify potential areas for interventions. Design: A descriptive retrospective analysis of maternal mortality data from the institution included in publications and recent annual reports. Setting: Department of Obstetrics and Gynaecology Greater Harare Maternity Unit, Zimbabwe. Main Outcome Measures: The trends in maternal mortality ratios (MMR) and the relative importance, of different causes of death between 1976 and 1997. Results: There was a decline in MMR between 1976 and the early 1980s but there has been a steady increase in MMR for Harare residents from 50/100 000 in 1988 to 224/100 000 in 1997. Sepsis has remained the leading cause of maternal death. There has been a significant increase in indirect deaths due to meningitis, tuberculosis and pneumonia where HIV infection is an underlying factor. Avoidable factors were identified at patient/ community, local health facility and at the tertiary hospital. There has been a decline in the quality of care in recent years. Conclusion: Maternal mortality for HMH is unacceptably high and could still be rising. HIV infection has contributed to the worsening picture. Interventions to improve access and quality of care at all levels could lead to significant 'reduction in maternal deaths

Systematic review of effect of community-level interventions to reduce maternal mortality

<p>Abstract</p> <p>Background</p> <p>The objective was to provide a systematic review of the effectiveness of community-level interventions to reduce maternal mortality.</p> <p>Methods</p> <p>We searched published papers using Medline, Embase, Cochrane library, CINAHL, BNI, CAB ABSTRACTS, IBSS, Web of Science, LILACS and African Index Medicus from inception or at least 1982 to June 2006; searched unpublished works using National Research Register website, metaRegister and the WHO International Trial Registry portal. We hand searched major references.</p> <p>Selection criteria were maternity or childbearing age women, comparative study designs with concurrent controls, community-level interventions and maternal death as an outcome. We carried out study selection, data abstraction and quality assessment independently in duplicate.</p> <p>Results</p> <p>We found five cluster randomised controlled trials (RCT) and eight cohort studies of community-level interventions. We summarised results as odds ratios (OR) and confidence intervals (CI), combined using the Peto method for meta-analysis. Two high quality cluster RCTs, aimed at improving perinatal care practices, showed a reduction in maternal mortality reaching statistical significance (OR 0.62, 95% CI 0.39 to 0.98). Three equivalence RCTs of minimal goal-oriented versus usual antenatal care showed no difference in maternal mortality (1.09, 95% CI 0.53 to 2.25). The cohort studies were of low quality and did not contribute further evidence.</p> <p>Conclusion</p> <p>Community-level interventions of improved perinatal care practices can bring about a reduction in maternal mortality. This challenges the view that investment in such interventions is not worthwhile. Programmes to improve maternal mortality should be evaluated using randomised controlled techniques to generate further evidence.</p