Objectives: The objective of this work was to analyze the etiologies of maternal deaths occurring in a tertiary hospital. Methodology: This is a descriptive cross-sectional study with retrospective data collection of maternal deaths that occurred in the reference provincial hospital Jason Sendwe from 2013 to 2015. All cases of maternal deaths in line with the definition of World Health Organization have been included. Data were analyzed by the software Epi info and Excel 2010 7.1.4.0. Results: Seventy seven (77) maternal deaths were identified during the study period. 74.03% of deaths occurred direct obste tric causes. Bleeding with 61.04% was the leading cause of maternal death followed by eclampsia (31.58%). Indirect causes were dominated by heart disease (30.0%). Note that 75.32% of deaths had occurred within 24 hours of admission. Conclusion: haemorrhage, eclampsia and infections are the main causes of maternal deaths in our study. The reduction of maternal deaths happens through access to emergency medication, transfusion and anesthetic and surgical teams in hospitals but also through the involvement of religious leaders, traditional and any community to better understand the population obstacles to reducing maternal mortality.
During the high-level meeting in September 2010 on the Millennium Development Goals, world leaders had expressed concern at the slow progress in improving maternal and reproductive health and reduce maternal mortality. The maternal mortality rate, which is the most common measure of maternal health remained a major challenge for Africa, especially in comparison with the rest of the world [
Maternal mortality is defined according to the World Health Organization (WHO) as the death of a woman while pregnant or of within 42 days after delivery, regardless of length or location, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes [
According to WHO, more than 85% of maternal deaths occur in sub-Saharan Africa and South Asia. In European countries and the United States, although maternal mortality is low, a number of studies have highlighted disparities by ethnicity of the mother [
Maternal mortality is the health indicator showing the greatest disparity between developing countries and developed countries. Maternal death should probably be avoided if good quality care and quick were insured [
In developing regions, the maternal mortality ratio is 450 maternal deaths per 100,000 live births, against 9 in developed regions. In total, 14 countries have a rate exceeding 1000 and, with the exception of Afghanistan, all of them are in sub-Saharan Africa: Angola, Burundi, Cameroon, Guinea-Bissau, Liberia, Malawi, Niger, Nigeria, Democratic Republic of Congo, Rwanda, Sierra Leone, Somalia and Chad. Apart from the differences between states, there are also wide variations in the countries themselves, between rich and poor and between urban and rural populations [
The Democratic Republic of Congo, our country had the 36th highest rate of overall mortality in the world: 11.06 deaths/1000 people in 2011. With regard to maternal mortality, she had the MMR 16th most high, with 670 deaths/100,000 births in 2008 [
Worldwide, about 80% of maternal deaths are due to direct causes while 20% are related to indirect causes. In order of importance, the four major direct causes of maternal death in Africa are: Haemorrhage, infection, hypertensive disorders during pregnancy and clandestine abortions. Among the indirect causes of maternal deaths (20%), HIV/AIDS, anemia, malaria, cardiovascular diseases are the most common [
We proposed to analyze the etiology of maternal mortality in the Provincial Janson Sendwe Hospital, hospital structure tertiary service.
This cross-sectional descriptive study was conducted in the city of Lubumbashi precisely in the gynecology and obstetrics department of the reference hospital Provincial Jason Sendwe, the largest hospital structure du Haut Katanga and the only third level. The study population consisted of any woman who died during pregnancy or within 42 days of delivery. All maternal deaths recorded and identified by the gynecology and obstetrics department of the provincial hospital reference Jason Sendwe from 2013 until 2015 and meeting the definition of the World Health Organization has been included in this study and woman brought dead was excluded. The literature review of the different registers by using a pre-established questionnaire was conducted to collect data and related socio-demographic variables, the concept of antenatal monitoring, gestational age, circumstances and time of occurrence of death.
Prior authorization had been obtained from the Lubumbashi University Medical Ethics and the management of the Hospital Committee. The data were coded and analyzed using the software Excel 2010 and Epi-Info 7.1.4.0.
Being a retrospective study, this study did not take into account all the factors that may be at the basis of the occurrence of maternal mortality because not being able to be listed in the archives but also it cannot determine the risk factors of this mortality in our study environment.
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More than half of our sample consisted of women aged 20 to 34 years. These results agree with those of Tebeu et al who found that in 2007 women aged 25 to
Characteristic of the woman | Effective | Percentage |
---|---|---|
age range | ||
20 to 34 | 41 | 53.25% |
Under 20 | 7 | 9.09% |
35 and over | 29 | 37.66% |
Civil status | ||
Married | 59 | 76.62% |
unmarried | 18 | 23.38% |
Origin | ||
Annex | 12 | 15.58% |
Kamalondo | 7 | 9.09% |
Kampemba | 13 | 16.88% |
Katuba | 2 | 2.60% |
Kenya | 17 | 22.08% |
Lubumbashi | 15 | 19.48% |
Rwashi | 11 | 14.29% |
Monitoring of pregnancy | workforce | Percentage |
---|---|---|
CPN followed | ||
Unknown | thirty | 38.96% |
No | 17 | 22.08% |
Yes | thirty | 38.96% |
Age Pregnancy | ||
prematurely | 20 | 25.97% |
Unknown | 22 | 28.57% |
Term | 34 | 44.16% |
term exceeds | 1 | 1.30% |
Type of case | Effective (n = 77) | Percentage |
---|---|---|
direct Causses | 57 | 74.03% |
indirect Causses | 20 | 25.97% |
direct causes | ||
Eclampsia | 18 | 31.58% |
Hemorrhage | 35 | 61.40% |
Infection | 4 | 7.02% |
indirect Causses | ||
---|---|---|
Anemia | 3 | 15.00% |
Other | 1 | 5.00% |
heart disease | 6 | 30.00% |
Diabetes | 1 | 5.00% |
Renal failure | 2 | 10.00% |
OAP | 4 | 20.00% |
Malaria | 1 | 5.00% |
Tuberculosis | 1 | 5.00% |
HIV | 1 | 5.00% |
duration | Effective (n = 77) | Percentage |
---|---|---|
24 to 48 hours | 5 | 6.49% |
Beyond 48 hours | 14 | 18.18% |
before 24 h | 58 | 75.32% |
34 were more likely to die of causes related to pregnancy in Maroua in northern Cameroon [
Direct obstetric causes, as described elsewhere in other studies [
Hypertensive diseases were the second leading cause of maternal deaths (31.58%) in our study when they were in first or last position in other studies in Africa [
On the other hand Foumane P et al noted aprevalence of hypertension in pregnancy in their series, which is supported by several African works including a multicenter study conducted in Benin, Ivory Coast and Senegal where 29% of maternal deaths are due to hypertension. Similarly, preeclampsia is recognized to be the leading cause of maternal mortality in Latin America and the Caribbean [
The causes of death in our study are diverse, but in the majority of preventable cases almost 100%. This result is comparable to those of Traore et al. [
In our study, 75.32% of deaths were occurring before 24 hours. Our numbers are similar to other studies in other African countries: Nayama et al. [
Maternal mortality remains a public health problem in the Democratic Republic of Congo in general and in the province of Haut Katanga in particular.
Haemorrhage, eclampsia and infections are the main causes of maternal deaths in the reference provincial hospital Jason Sendwe. The majority of these deaths occurred within 24 hours of admission. It is then possible to make the bleeding a minor cause of maternal mortality in hospitals in Black Africa in strengthening its fight by facilitating access to emergency medication, transfusion and surgical and anesthetic teams in middle hospital.
Reducing the maternal mortality rate is not only through political decisions but also through the involvement of religious and traditional authorities or community to better understand the population obstacles to reducing maternal mortality. It means strengthening awareness on prenatal care, screening for high-risk pregnancy, family planning and assignment of qualified staff in general hospitals reference may contribute to the improvement of maternal health. Medical transport means as well as a hotline would also have an impact on the effective management of emergencies. It is also vital to strengthen the fight against obstetric haemorrhage by facilitating access to Emergency drugs, transfusion and Surgical and anesthetic surgeries in hospitals.
Odette, K.M., Moise, K.K., Blood, B.N.D., Mukendi, C.P., Réne, J.M.M., Kennedy, N.M., Benjamin, K.K., François, K.K., Michel, K.N. and Prosper, K.M. (2017) Etiologies of Maternal Mortality in the Hospital Provincial Janson Sendwe in Lubumbashi (DR. Congo). Open Access Library Journal, 4: e3502. https://doi.org/10.4236/oalib.1103502