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  • Title: Maternal mortality in sub-Saharan Africa: levels, causes and interventions.
    Author: Boerma JT.
    Journal: Ann IFORD; 1988 Jun; 12(1):49-68. PubMed ID: 12178525.
    Abstract:
    Increasing interest is being shown in maternal mortality as a public health problem in developing countries, especially under the prompting of the Family Health Division of the World Health Organization. This paper assesses the data on maternal mortality in sub-Saharan Africa and provides estimates for different countries. It also discusses causes and possible interventions. The observed relationship between the risks of maternal death, the fertility rate, and the general mortality level among women of reproductive age can be used to estimate maternal mortality in countries lacking reliable data. Between 15-30% of all deaths in fertile-aged women are believed to be associated with pregnancy, labor, or the puerperium in most countries of Africa. The most important causes of maternal death are hemorrhage, sepsis, eclampsia, obstructed labor and uterine rupture, and aggravation of preexisting conditions. Quality and accessibility of medical care are the main determinants of the impact of treatment on maternal survival. Fertility-related factors are the most important influence on the frequency of complications. Maternal mortality can be reduced by reducing fertility, avoiding pregnancies at the extreme reproductive ages and higher parities, or reducing the number of unwanted births. General improvements in the health and nutritional status of women, adequate training of traditional birth attendants and medical staffs, and prenatal care can help reduce the occurrence of complications and provide better management if they occur. Most studies of maternal mortality are hospital-based and thus affected by selectivity. Vital registration systems are incomplete and unlikely to play a role in assessing maternal mortality in Africa for some time. Population-based surveys of different kinds are increasingly being used to assess the magnitude of maternal mortality, but such studies remain rare in Africa. Estimates of maternal mortality in sub-Saharan Africa based on its relationship to general mortality varied from 217/100,000 live births in Kenya to 827 in Chad. Some 80,000 women were estimated to have died each year between 1980-85. The maternal mortality ratio was estimated at 460. Maternal mortality data from studies conducted in Africa give widely varying results on levels, medical causes, and differentials. They are difficult to interpret and compare because of selection biases of different kinds. Only 34% of births occur in health facilities in Africa as a whole. Studies evaluating the effects of different interventions on maternal mortality are also lacking in Africa. It has been suggested that the best strategy for reducing maternal mortality in sub-Saharan Africa would involve providing better health services, training traditional birth attendants to improve their skills and eliminate harmful practices, and providing family planning programs.
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