Maternal mortality in rural Zambia
Vork, F.C.; Kyanamina, S.; Van Roosmalen, J.
Acta Obstetricia Et Gynecologica Scandinavica 76(7): 646-650
1997
ISSN/ISBN: 0001-6349 PMID: 9292638 DOI: 10.3109/00016349709024604Document Number: 268803
The only prospective population-based study of maternal mortality in rural Zambia recorded a ratio of 889 per 100,000 births, about 8 times higher than that found in an urban hospital-based study. To obtain an accurate assessment of maternal mortality in Zambia's rural Kalabo district, both the sisterhood survey method and a review of hospital data were utilized. The maternal mortality ratio derived from the sisterhood survey (August-September 1994) of 1978 respondents was 1238 per 100,000 live births. Data from Kalabo Hospital on 2474 deliveries during 1990-94 revealed a ratio of 548 per 100,000 live births; however, when the latter ratio was corrected for an additional 15 maternal deaths that were not recorded as such, it rose to 1179 per 100,000 live births. The major causes of the 20 (71%) direct maternal deaths were obstructed labor and sepsis. Substandard hospital care factors (primarily inappropriate choice and/or lack of antibiotics, poor monitoring of vital signs, and poor provision of blood products by the laboratory) contributed to 71% of maternal deaths. Delay in seeking care played a role in 29% of all maternal deaths, and poor accessibility to the hospital was implicated in at least 25% of cases. These findings indicate that maternal mortality in rural Zambia is among the highest in the world. The sisterhood method survey appears to be an efficient indirect means of assessing maternal mortality in rural areas of developing countries.