MATERNAL MORTALITY HIGHEST IN LINDI RURAL, SURVEY SAYS.

Dr Joanna Schellenberg, who is one of the members of the study team and works with the London School of Hygiene and Tropical  Medicine, presents results of a maternal health study in southern Tanzania during a meeting in Dar es Salaam recently.  

Photo | David Mbulumi  

By David Mbulumi

Posted  Saturday, May 17  2014

Ifakara. 

A reduction in maternal deaths  is one of the main goals of the Poverty Reduction Strategy and the health sector’s reform programme, but progress has been slow. There was a decline of 100 deaths per 100,000 live births from 2004-2007 to 2010-2013 (equivalent to 2.3 per cent) per year. This decline is slower than the Millennium Development Goal Target of 5.5 per cent per year.

Findings of a survey conducted by Ifakara Health Institute (IHI) in six districts of southern Tanzania indicate that home-based newborn care can prevent 30 to 60 per cent of newborn deaths. 


 The survey, which ended in 2013 under a project called “Improving Newborn Survival in Southern Tanzania”, was conducted in Lindi Rural, Ruangwa, Nachingwea, Newala, Tandahimba and Mtwara Rural and found out that despite marked improvements in health service delivery and in newborn care, infant mortality remains high. 

The quality of child care in health facilities must improve to reduce newborn deaths.

Risk of death by district, poverty, education and age

The study, led by Dr Claudia Hanson, Dr Godfrey Mbaruku, Dr Fatuma Manzi and Dr Joanna Schellenberg (from IHI and the London School of Hygiene and Tropical Medicine),  found that maternal mortality in Lindi Rural, Ruangwa, Nachingwea, Newala and Tandahimba was as high as 712 deaths per 100,000 live births during a three-year period from June 2005 to May 2007.

 Maternal mortality was highest in Lindi Rural District (959 deaths per 100,000 live births), and lowest in Tandahimba District (573 deaths per 100,000 live births).

Maternal mortality was 796 per 100,000 in the poorest wealth group and 581 per 100,000 live births in the highest wealth group.

Mortality was only around 27 per cent lower in the richest areas compared to the poorest wealth quintile (MMR of 581 compared to 796). This was surprising against the background that 57 per cent of women in the highest wealth group delivered in a health facility and 6 per cent delivered by Caesarean section.


 In comparison, only 34 per cent of women in the lowest wealth group delivered in a health facility and 3.5 per cent by Caesarean section. 

Mortality was almost twice as high in women if the household head had no education compared to those who had completed secondary school.

Women aged 17 to 25 years were at the lowest risk of maternal death compared to those older or younger. Very young women - those aged 13 or 14 years - had very high risk of dying. 

Women in their thirties and forties were more likely to die than women in their twenties. 

It is important to note 18 per cent of births are to mothers aged 35 and above which is why many more deaths occur in older women.

Causes of maternal death

The three most common obstetric causes of death, according to the study, were severe bleeding (32 per cent), eclampsia (hypertensive disorders; 9 per cent) and puerperal sepsis (6 per cent). 

Abortion related complications were mentioned in 4 per cent of deaths, but since abortion is a taboo subject and induced abortion is illegal in Tanzania, this is likely to be under-reported.

One-third of all women died because of diseases which might get worse during pregnancy and childbirth, known as “indirect causes”, such as malaria (12 per cent), anaemia (10 per cent) or HIV/Aids (8 per cent).

These results should be viewed with some caution, because the ‘verbal autopsy’ interviews with bereaved relatives are likely to be more prone to error for deaths due to infectious diseases than for severe bleeding. Still, a 2008 study, An Autopsy  Study of Maternal Mortality in Mozambique: 


The Contribution of Infectious Diseases in Mozambique by Menendez C, also reported a broadly comparable distribution of deaths due to infection. 

Child birth care in hospitals and risk of maternal death

The study area has a relatively good network of six hospitals, with a further two just outside the district borders. A total of 76 per cent of births were to women living within 25 kilometres of a hospital. 

Within 25 kilometres, mortality was fairly constant at about 600–700 deaths per 100,000 live births. Beyond 25 kilometres from a hospital, levels increased to 900 per 100,000.

Mortality was also high within 5km of a hospital, despite 72 per cent of women living within 5km giving birth in a hospital and 8 per cent delivered by Caesarean section.

Conclusion

The study found that despite marked improvements in health facility delivery and in newborn care behaviours, newborn mortality remains high. Quality of childbirth care in health facilities must improve in order to reduce the burden of newborn deaths. 

Speaking at a meeting where the researchers shared the findings in Dar es Salaam on April 29, 2014, the Acting Director of Preventive Services in the Ministry of Health and Social Welfare Dr Neema Rusibamayila applauded IHI and partners for conducting the project in southern parts of Tanzania. “We will have a lot of added value from lessons learnt in this to inform us as we plan for further for the national programme,” said Dr Rusibamayila. 

Drawing from the presentations made by IHI scientists in collaboration with London School of Hygiene and Tropical Medicine, Dr Rusibamayila said the government will continue to improve the quality of health care as a necessary step to reducing newborn deaths in the country. 

The author is a development communications specialist.

Credit. The citizen