Maternal mortality in Dar es Salaam; Tanzania: Socio-economic; obstetric history and accessibility of health care factors

ABSTRACT

A community-based incident case-referent study was performed in Ilala district; Dar es Salaam; Tanzania to estimate the social; obstetric history and accessibility of health care factors for maternal death. From February 1991 to January 1993 all female deaths in the reproductive ages were identified through the existing administrative information system. For every maternal death three live mothers was selected as referents matched for age. In cases a relative to the deceased mother and in referents the live mother herself was interviewed using a pretested questionnaire. Socio-economic factors were strongly related to the risk of maternal death. Single and divorced women were at an increased risk (odds ratio (OR) =5.1; 95 per cent confidence interval (CI) 2.8-9.3 and OR=28; 95 per cent CI 6.5-118). Women with less than 3 years' education had a 3 fold higher risk than women with more than 7 years' schooling. Also women who were peasants and unskilled workers were at higher risk when compared with professionals and peasants and unskilled workers were at higher risk when compared with professionsls and skilled workers (OR=20; 95 per cent CI7.4-51). An obstetric history with no previous live births (OR=36; 95 per cent CI 8.239); more than one induced abortion (OR=36; 95 per cent CI; 9.7-132) or stillbirth (OR=4.8; 95 per cent CI1.6-14) and unwanted pregnancy (OR=4.0; 95 per cent CI 2.2-7.3) were; as expected; statistically significant risk factors for maternal death. Factors reflecting living standards such as type of housing; access to tap-water and electricity; availability of a toilet and the living standard as estimated by the interviewer were all statiscally significant for the risk of maternal death (OR=7.2; 2.7; 2.1; 8.3 and 6.2; respectively). Increased distance in meters from the house to a road and increased time in minutes taken to reach the nearest transport; clinic and hospital in minutes increased the risk for a maternal death significantly. The preventive activities require efforts from the whole community. The health care system can contribute by early identification of risk cases. e.g. women with previous stillbirths and miscarriages in the antenatal care