Why more mothers die: confidential enquiries into institutional maternal deaths in the Southern region of Malawi, 2001

Abstract

Purpose: The 2000 Malawi Demographic and Health Survey (MDHS) estimated the Maternal Mortality Ratio (MMR) to be 1120 (95% CI 950-1288), exceeding by 80% the MMR of 620 (95% CI 410-830) from the 1992 MDHS. We studied maternal deaths that occurred in institutions in the Southern region of Malawi to understand why the MMR had increased significantly between 1992 and 2000.

Methods: This is a retrospective observational study involving review of maternal death records from 18 hospitals in the Southern region of Malawi for the year 2001. These hospitals routinely reviewed their maternal deaths and sent their records for 2001 (270 deaths) to the Malawi Safe Motherhood Project. In addition, hospitals that had gaps in their data collection were visited, their records were reviewed and an additional 42 maternal deaths were identified.

Results: The study identified and investigated 312 institutional maternal deaths. The major findings are as follows:

• Puerperal sepsis is the leading cause of institutional death;
• A high proportion of deaths from obstructed labor and ruptured uterus;
• A high proportion of deaths from obstetric hemorrhage;
• High proportions of indirect deaths from anemia and AIDS;
• A decline in abortion-related deaths;
• Substandard care is associated with half of maternal deaths.

Conclusion: The fact that maternal mortality has almost doubled in Malawi over the past decade can be attributed not only to the impact of the AIDS epidemic but also to declining quality of obstetric care in health facilities.

Keywords: maternal mortality, confidential enquiries, Malawi, puerperal sepsis, AIDS, quality of obstetric care

Malawi Medical Journal Vol. 17(3) 2005: 75-80