Introduction
Worldwide, 99% of deaths of women in their reproductive ages are due to childbirth and
pregnancy complications. Maternal mortality is the subject of the fifth United Nations’
millennium development goal: the aim is to reduce the maternal mortality ratio by three
quarters from 1990 to 2015. Although much research has been conducted in recent years,
knowing the spatial pattern of maternal mortality in developing countries will help target
scarce resources and intervention programs to high risk areas for the greatest impact, since
nationwide interventions are costly.
Objective
This study assessed the spatial patterns and trends of, and causes and risk factors associated
with, maternal mortality in the Ifakara Health and Demographic Surveillance Site (IHDSS) in
Tanzania, from 2006 to 2010, with a view to providing information that may help reduce
maternal mortality in this country.
Method
A secondary data analysis of a longitudinal study using data from the IHDSS was conducted.
Inverse distance weighted (IDW) method of interpolation in ArcGIS was used to assess
spatial patterns. Cox proportional hazards regression was used to identify and quantify risk
factors associated with maternal mortality.
Results
A total of 36 792 women aged 15 to 49 were included in the study of which 77 died due to
childbirth or pregnancy related complications. The overall maternal mortality rate for the five
years was 0.79 per 1000 person years. The trend declined from 90.42 per 1000 person years in 2006 to 57.42 per person years in 2010. There were marked geographical differences in
maternal mortality patterns with high levels of mortality occurring in areas with close
proximity to health facilities in some instances. The main causes of maternal death were
eclampsia (23%), haemorrhage (22%) and abortion-related complications (10%). Maternal
age, marital status and socioeconomic status were found to be risk factors. There was a
reduced risk of 82% (HR: 0.18, 95% CI: 0.05-0.74) and 78% (HR: 0.22, 95% CI: 0.05 – 0.92)
for women aged 20-29 and 30-39 years, respectively, compared with those younger than 20
years. While being married had a protective effect of 94% (HR: 0.06, 95% CI: 0.01 - 0.51)
compared to being single, women who were widowed had an increased risk of 813% (HR:
9.13, 95% CI: (1.017 – 81.942). Higher socioeconomic status had a protective effect on
maternal mortality: women who were in the poorer and least poor socioeconomic groups
were 70% (HR: 0.30, 95% CI: 0.11 – 0.81) and 75% (HR: 0.25, 95% CI: 0.06 - 1.09) less
likely to die from maternal causes, respectively, compared to those in the poorest category.
Conclusion
There has been a decline in maternal mortality in rural southern Tanzania, with geographical
differences in patterns of death. Eclampsia, haemorrhage and abortion-related complication
are the three leading causes of maternal death in rural southern Tanzania, with risk factors
being maternal age less than 20 years, marital status (single, widowed), and lower
socioeconomic status.
Keywords: maternal mortality, risk factors, spatial pattern, maternal mortality rate, verbal
autopsy
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/12573 |
| Date | 19 March 2013 |
| Creators | Manyeh, Alfred Kwesi |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf |
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