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Health Policy Plan. 1997 Mar;12(1):50-7.

Operational factors affecting maternal mortality in Tanzania.

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1
Muhimbili Medical Centre, Dar es Salaam, Tanzania.

Abstract

Identification of the main operational factors in cases of maternal death within and outside the health care system is necessary for safe motherhood programmes. In this study, a follow-up was done of all 117 cases of maternal deaths in Ilala district, Dar es Salaam, 1991-1993, at all levels of care. In all, 79% received some medical care whereas 11% arrived too late for treatment. For each case the major operational factors and all health care interventions were defined through interviews with family members and health care staff and from hospital records, and the avoidability of each case was determined. In the health institutions where the women had consulted, the available resources were assessed. It was found that in most cases the husband (29%) or the mother (31%) of the woman decided on her care in cases of complications, and together with the lack of transport, this often caused delay at home. Also, delay in transfer from the district hospital was common. Cases of abortion complications were often not managed on time because of the delay in reporting to hospital or misleading information. Suboptimal care was identified in 77% of the cases reaching health care. Inadequate treatment was identified by the district health staff in 61% and by the referral centres in 12% of their cases. Wrong decision at the district level and lack of equipment at the referral centre were the main reasons for inadequate care. It is concluded that although community education on danger signs in pregnancy and labour is important, provision of the core resources and supplies for emergency obstetric interventions, as well as clear protocols for management and referral, are absolutely necessary for improvement of maternal survival.

PIP:

All 117 cases of maternal deaths in Ilala district, Dar es Salaam, during 1991-93 at all levels of care were investigated to identify the principal operational factors involved. 79% of the women received some medical care, while 11% arrived too late for treatment. In most cases, the husband or the mother of the woman decided upon her care when complications arose. That decision process combined with a lack of transportation to health care facilities often resulted in the delay of departure from home. Delay in the transfer from the district hospital was also common. Complications of abortion often were not managed in a timely manner due to the delay in reporting to the hospital or the reporting of misleading information. Suboptimal care was identified in 77% of cases reaching health care, with inadequate treatment identified by the district health staff in 61% of cases and by the referral centers in 12% of their cases. Erroneous decisions made at the district level and the lack of equipment at referral centers were the main reasons for inadequate care. Community education on potential danger signs in pregnancy and labor is needed, together with the provision of the necessary resources and supplies for emergency obstetric interventions, as well as clear protocols for management and referral. Study findings are based upon the review of hospital records and interviews with family members and health care staff.

PMID:
10166102
[Indexed for MEDLINE]
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