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A Community-based Investigation of Avoidable Factors for Maternal Mortality in Zimbabwe

1996; Wiley; Volume: 27; Issue: 6 Linguagem: Inglês

10.2307/2138027

1728-4465

Susan Fawcus, Michael T. Mbizvo, Gunilla Lindmark, Lennarth Nyström,

Child Nutrition and Water Access

A community-based investigation of maternal deaths was undertaken in a rural province (Masvingo) and an urban area (Harare) of Zimbabwe in order to assess their preventability. Avoidable factors were identified in 90 percent of the 105 rural deaths and 85 percent of 61 urban deaths. Delay in seeking treatment contributed to 32 percent and 28 percent of rural and urban deaths, respectively. Lack of transportation delayed or prevented access to healthy facilities in the rural area, a major problem in 28 percent of the cases studied. Suboptimal clinic and hospital management was identified in 67 percent and 70 percent of rural and urban deaths, respectively. Lack of appropriately trained personnel contributed to suboptimal care. In both settings, the severity of patients' conditions was frequently unrecognized, leading to delays in treatment and referral, and inadequate treatment. Appropriate community and health-service interventions to reduce maternal mortality are discussed.A community-based survey of maternal deaths in a rural province (Masvingo) and urban area (Harare) of Zimbabwe in 1989-90 revealed a high incidence of avoidable factors, both within and outside the health sector. During the 2-year study period, 109 maternal deaths were identified in Masvingo (168/100,000 live births) and 66 in Harare (85/100,000 live births). In Masvingo, the three leading causes of death were hemorrhage (25%), postabortion sepsis (15%), and puerperal sepsis (13%); in Harare, these causes were eclampsia (26%), postabortion sepsis (23%), and puerperal sepsis (15%). In Masvingo, the locations of maternal deaths included rural hospitals (50%), provincial hospitals (13%), home (13%), and travelling to or between health facilities (11%); all deaths in Harare occurred in central hospitals. One or more avoidable factors were identified for 90% of maternal deaths in Masvingo and 85% of those in Harare; these factors occurred at the community level in 47% and 38% of deaths, respectively. Among patient-related factors, delay in the decision to seek care for symptoms was most widespread (32% of deaths in Masvingo and 28% of those in Harare). Problems of access to transportation from home to health facility were implicated in 28% of deaths in Masvingo and 3% in Harare. Avoidable factors within the health sector were identifiable in 67% of Masvingo deaths and in 70% of Harare deaths. Notable was failure of health personnel to assess the severity of postabortion conditions and puerperal sepsis and initiate aggressive treatment. Recommended, to reduce maternal mortality in Zimbabwe, are community awareness of risk factors for pregnancy and delivery, collective emergency transportation mechanisms, maternity waiting shelters, appropriate obstetric management protocols, more effective identification and treatment of emergency conditions, and liberalization of existing abortion legislation.