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Title: Reducing maternal mortality in Kigoma, Tanzania.
Author: Mbaruku G, Bergström S.
Journal: Health Policy Plan; 1995 Mar; 10(1):71-8. PubMed ID: 10141624.
Abstract:
An intervention programme aiming at a reduction of maternal deaths in the Regional Hospital, Kigoma, Tanzania, is analyzed. A retrospective study was carried out from 1984-86 to constitute a background for an intervention programme in 1987-91. The retrospective study revealed gross under-registration of data and clarified a number of potentially useful issues regarding avoidable maternal mortality. An intervention programme comprising 22 items was launched and the maternal mortality ratio was carefully followed in 1987-91. The intervention programme paid attention to professional responsibilities with regular audit-oriented meeting, utilization of local material resources, schedules for regular maintenance of equipment, maintenance of working skills by regular on-the-job training of staff, norms for patient management, provision of blood, norms for referral of severely ill patients, use of antibiotics, regular staff evaluation, public complaints about patient management, travel distance of all essential staff to the hospital, supply of essential drugs, the need of a small infusion production unit, the creation of culture facilities for improved quality of microbiology findings, and to efforts to stimulate local fund-raising. The results indicate that the maternal mortality ratio fell from 933 to 186 per 100,000 live births over the period 1984-91. Thus it is underscored that the problem of maternal mortality can be successfully approached by a low-cost intervention programme aiming at identifying issues of avoidability and focusing upon locally available problem solutions. A review of all 1984-1986 hospital records at the Regional Hospital in Kigoma, Tanzania, aimed to determine the maternal mortality rate and contributory/medical causes of death. Underregistration of data was evident. Contributory causes of maternal death were: a lack of most of the basic equipment, outdated existing basic equipment, no reserve water tank, poor staff attitude, absent hospital staff during office hours, prescriptions without physically seeing the patients, low supply of drugs, acute shortage of blood, and no trained anesthetist. A low-cost intervention program implemented 22 items which focused on professional responsibilities with regular audit-oriented meetings, utilization of local material resources, schedules for regular maintenance of equipment, maintenance of working skills by regular on-the-job training of staff, norms for patient management, provision of blood, norms for referral of severely ill patients, use of antibiotics, regular staff evaluation, public complaints about patient management, travel distance of all essential staff to the hospital, supply of essential drugs, the need for a small infusion production unit, the creation of culture facilities for improved quality of microbiology findings, and efforts to encourage local fund-raising. A 1991 prospective study revealed that the average maternal mortality ratio fell significantly between 1984-1986 and 1987-1991 (849-275/100,000 live births; p 0.001). Specifically, it fell from 933 to 186/100,000 between 1984 and 1991. Causes of maternal death were difficult to determine because relatives refused to allow autopsies in most cases. Based on the unreliable data available, the most common causes of death during the retrospective study were uterine rupture, sepsis, and anemia. The prevalence of uterine rupture, sepsis, and postpartum/ antepartum hemorrhage, as main causes of admission fell somewhat between 1984 and 1991, while anemia, septic abortion, and pelvic infection increased.

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