Operational factors of maternal mortality in Zimbabwe

Most studies on maternal mortality have looked at the directclinical causes and the distribution of actual rates. Much lessattention has been given to prevailing health care systems orcommunity factors associated with such deaths. A case-controlstudy design using incident cases was used to identify the magnitudeof maternal deaths and community and health care operationalfactors in both an urban and a rural setting in Zimbabwe. Thematernal mortality ratio for the rural setting was 168 per 100000 live births and that for the urban setting was 85 per 100000 live births. For the rural setting, the major direct causesof death were haemorrhage (24.8%), abortion complications (15.2%),puerperal sepsis (13.3%), and eclampsia (4.8%). For the urbansetting they were eclampsia (26.2%), abortion complications(23.0%), puerperal sepsis (14.8%) and haemorrhage (9.8%). Whereas rural-urban variations in maternal mortality were observed,inter-rural district variations were also apparent, especiallywith poor medical resources, poor communication and delayedinterventions. Risk factors for maternal mortality were presentat 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 ectopicswere excluded the OR for absent ANC was 4.1 (rural) and 2.6(urban). Lack of timely transport to nearest clinic or hospitaladversely affected pregnancy outcome in both rural and urbansettings. Despite delivery place planning, predisposing healthconditions and some danger signals, few of the women utilizedthe venue originally planned for delivery. Health education, community sensitization and teaching on risksignal awareness as well as health care delivery system strengtheningare recommended for reducing the high maternal mortality rates. ⁴Includes: Dr F Ashworth, Prof Mtimavalye, Dr Chatora, Dr PNhindiri, Dr Chiwora, Sister Nyangani, Sister Mujaji, SisterMakahamadzem, Mr Mandisodza, Mr Mashu, Sister Nyoni, Mr Dauramanzi,Mrs Dengu and the late Dr Chimbira