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Reducing maternal mortality in Kigoma, Tanzania


, : Reducing maternal mortality in Kigoma, Tanzania. Health Policy and Planning 10(1): 71-78

A review of all 1984-1986 hospital records at the Regional Hospital in Kigoma, Tanzania, aimed to determine the maternal mortality rate and contributory/medical causes of death. Underregistration of data was evident. Contributory causes of maternal death were: a lack of most of the basic equipment, outdated existing basic equipment, no reserve water tank, poor staff attitude, absent hospital staff during office hours, prescriptions without physically seeing the patients, low supply of drugs, acute shortage of blood, and no trained anesthetist. A low-cost intervention program implemented 22 items which focused on professional responsibilities with regular audit-oriented meetings, utilization of local material resources, schedules for regular maintenance of equipment, maintenance of working skills by regular on-the-job training of staff, norms for patient management, provision of blood, norms for referral of severely ill patients, use of antibiotics, regular staff evaluation, public complaints about patient management, travel distance of all essential staff to the hospital, supply of essential drugs, the need for a small infusion production unit, the creation of culture facilities for improved quality of microbiology findings, and efforts to encourage local fund-raising. A 1991 prospective study revealed that the average maternal mortality ratio fell significantly between 1984-1986 and 1987-1991 (849-275/100,000 live births; p 0.001). Specifically, it fell from 933 to 186/100,000 between 1984 and 1991. Causes of maternal death were difficult to determine because relatives refused to allow autopsies in most cases. Based on the unreliable data available, the most common causes of death during the retrospective study were uterine rupture, sepsis, and anemia. The prevalence of uterine rupture, sepsis, and postpartum/ antepartum hemorrhage, as main causes of admission fell somewhat between 1984 and 1991, while anemia, septic abortion, and pelvic infection increased.

US$29.90

PMID: 10141624


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