Elsevier

Obstetrics & Gynecology

Volume 100, Issue 2, August 2002, Pages 321-326
Obstetrics & Gynecology

Original research
Preventability of maternal deaths: comparison between Zambian and American referral hospitals1

https://doi.org/10.1016/S0029-7844(02)02065-3Get rights and content

Abstract

OBJECTIVE:

To compare causes and preventability of maternal deaths between a Zambian and an American referral hospital.

METHODS:

All pregnancy-related deaths were reviewed for cause, potential preventability, and identified preventability factors for 1998–1999 at a Zambian hospital and for 1992–2000 at an American hospital network. Preventability factors were categorized as system, provider, or patient. The maternal mortality ratio (MMR) was determined for each hospital. Causes of death, rates of preventability, and preventability factors were compared.

RESULTS:

There were 108 and 33 deaths making the MMRs, 1540 and 20.4 per 100,000 live births, at the Zambian and American hospitals, respectively. Causes of death were significantly different between hospitals (P < .001). Infection, the leading cause of death in the Zambian hospital, was associated with over half of direct and indirect deaths. Hemorrhage was the leading cause of direct deaths (28%) in the American hospitals, whereas cardiac and intracerebral events were associated with 42% each of indirect deaths. Eighty-two percent of deaths were deemed preventable at the Zambian hospital compared with 42% at the American hospitals (P < .001). In 73% of the Zambian preventable deaths, system factors were identified as likely contributing factors, whereas provider factors were so identified in 86% of the preventable American deaths (P < .001).

CONCLUSION:

The MMRs in each hospital were higher than their corresponding national MMRs and rates of likely preventable deaths were unacceptably high. Attention, education, and intervention must be focused on system and provider factors to reduce worldwide maternal mortality.

Section snippets

Materials and methods

Using the World Health Organization (WHO) criteria, a maternal death was defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, and only pregnancy-related (direct and indirect) maternal deaths were evaluated. Direct maternal deaths were defined as deaths from diseases or complications that occur only during pregnancy such as abortion, eclampsia, or ectopic pregnancy. Indirect deaths were defined as deaths resulting from a disease process not directly

Results

At KGH, 108 maternal deaths occurred between 1998 and 1999. Total live births during this time were 7014, resulting in an institution-derived MMR of 1540 per 100,000 live births. From 1992 to 2000, within the UIC Perinatal Network, 33 pregnancy-related maternal deaths were identified, and 161,814 live births occurred, resulting in an MMR of 20.4 per 100,000 live births.

In the UIC network, the maternal age distribution of the deaths was as follows: 64% of women were aged 20–34 years, 24% were 35

Discussion

The most striking difference in maternal deaths between the Zambian and American referral hospitals was the staggering difference in rate of deaths. The MMR (1540) for KGH is likely to be elevated because many births occur at home in Zambia. However, although these MMRs were determined from single referral institutions, their justification is supportable. In Zambia, the published MMRs were derived from the Sisterhood method, which is an indirect way of estimating maternal deaths from the

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1

The authors wish to thank Jordan Greenberg, PhD, for providing statistical assistance.

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