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  • Title: Guinea-Bissau: maternal mortality assessment.
    Author: Oosterbaan MM.
    Journal: World Health Stat Q; 1995; 48(1):34-8. PubMed ID: 7571708.
    Abstract:
    With more than 40% of all female deaths attributable to pregnancy, delivery, and the puerperium period, the study established a maternal mortality ratio of 914 deaths per 100,000 live births. The principal risk factors for dying from pregnancy-related causes are: no attendance at antenatal care, too great a distance between the home and the nearest hospital facility, home delivery, belonging to specific ethnic/religious groups, and delivery assistance from family members and TBAs. The health policy implications to improve this situation are: increased coverage with appropriate services, increased numbers of rural midwives, in-service training of existing staff in maternity issues and problems, culture-specific educational approaches using the existing value system, educational campaigns to discourage harmful practices and behaviour, continued educational efforts to upgrade the knowledge of TBAs, and a culturally sensitive integration of TBAs into the government programmes. This article reports on an examination of maternal mortality in Guinea-Bissau during 1989-90. Verbal autopsies were conducted and matched to hospital and health center records. The 145 maternal deaths identified in this study were matched to controls. The estimated maternal mortality ratio (MMR) was 914/100,000 live births. The MMR for hospitals was 779/100,000. Few women with infections or hemorrhage received proper medical attention. Cases of obstructed labor usually involved malpresentation of the fetus and cephalopelvic disproportion. The main indirect causes of maternal mortality were anemia and malaria. Almost 70% of deaths were to women younger than 30. 32% of deaths to women younger than 20, 9% of deaths to women 20-29 years old, and 22% of deaths to women 30-39 years old were due to eclampsia. 27% of deaths among 30-39 year old women and 33% of deaths among women 40-49 years old were due to postpartum hemorrhage. The comparison of prepregnancy symptoms among women who died and women who did not showed that death was related to female genital mutilation, specifically excision or infibulation. This practice is common among certain tribes, which also have a young marriage age and slight stature. The highest mortality was among women with no prenatal care (45 deaths). 41 women who died made a few prenatal visits. 33 deaths were to women who made over 3 visits. 71% of the 145 women who died had experienced some complications (anemia, malaria, generalized edema with or without hypertension). Only 20.4% of women who died and 30.2% of living women were temporarily admitted to the hospital for these symptoms during pregnancy. 43% of survivors of a similar condition to those women who died made prenatal visits during the first trimester. Twice as many controls delivered at home compared to the hospital; the reverse held for women who died. 40% of women who died and only 26% of the control group had deliveries attended by family or traditional birth attendants. 14% versus 40% in the control had midwives delivering births. 28% versus 19% of control reached the health facility in over 24 hours. 53.7% versus 86.9% of controls had live births.
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