Operational factors of maternal mortality in Zimbabwe

Most studies on maternal mortality have looked at the direct clinical causes and the distribution of actual rates. Much less attention has been given to prevailing health care systems or community factors associated with such deaths. A case-control study design using incident cases was used to identify the magnitude of maternal deaths and community and health care operational factors in both an urban and a rural setting in Zimbabwe. The maternal mortality ratio for the rural setting was 168/100000 live births. For the rural setting the major direct causes of death were hemorrhage (24.8%) abortion complications (15.2%) puerperal sepsis (13.3%) and eclampsia (4.8%). For the urban setting they were eclampsia (26.2%) abortion complications (23.0%) puerperal sepsis (14.8%) and hemorrhage (9.8%). Whereas rural-urban variations in maternal mortality were observed inter-rural district variations were also apparent especially with poor medical resources poor communication and delayed interventions. Risk factors for maternal mortality were present at each of the various levels of care. Lack of antenatal care (ANC) had a significant odds ratio (OR 10.7 rural and 4.6 urban) contribution to maternal mortality. When abortions and ectopics were excluded the OR for absent ANC was 4.1 (rural) and 2.6 (urban). Lack of timely transport to nearest clinic or hospital adversely affected pregnancy outcome in both rural and urban settings. Despite delivery place planning predisposing health conditions and some danger signals few of the women utilized the venue originally planned for delivery. Health education community sensitization and teaching on risk signal awareness as well as health care delivery system strengthening are recommended for reducing the high maternal mortality rates. (authors)