Review of maternal deaths in Lofa County, Liberia, 2015- 2017

Abstract

Introduction: Globally, 830 women die from pregnancy and childbirth daily. The maternal mortality ratio (MMR) in Liberia is 1072/100,000 live births. Maternal death is a priority event in Liberia, requiring immediate reporting. The causes and contributing factors of county-specific MMR are unknown. Therefore, data was analyzed to establish county MMR, and identify major causes and contributing factors of maternal death. Methods: A retrospective record review was conducted in Lofa County. Lofa has an estimated population of 358,612 inhabitants. We extracted data on age, marital status, educational status, place of death, cause of death, and contributing factors to maternal deaths from Maternal and Neonatal Death Surveillance Review Forms (MNDSR) for 2015-2017. Descriptive analysis was done using proportions and ratios. Results: Of the 46 maternal deaths reported, median age was 28 (range 12 - 50) years and age group 25-34 years accounted for 39% (18/46) of the deaths. Women at risk for maternal death were 7,427. The Lofa County MMR was 142/100,000 live births. About 86.9% (40/46) of deaths occurred in health facilities with and MMR was highest between April-June each year. Post-partum hemorrhage (PPH) accounted for 37% (17/46) of maternal deaths in Lofa County which is higher than the WHO target estimated at 15%. The decrease of MMR in Lofa County below the WHO estimate may be due to institutional factors and shortage of supplies towards the end of the fiscal year. Conclusion: The MMR of Lofa County is higher than expected with Post-Partum Hemorrhage being the leading cause of death due to poor management in health facilities We recommended provision of emergency stock to health facilities to be used at the end of fiscal period. We further recommend the inclusion of the type of cesarean section (CS) on the death review forms in order to determine the association between MMR and the type of CS.