ABSTRACT
Introduction: Severe pregnancy-induced hypertension (severe pre-eclampsia and eclampsia) is a major cause of fetal and maternal morbidity and mortality. Pregnancy induced hypertension occurs in 7.7 – 8.2% of pregnancies and causes 17.5% of maternal deaths in Cameroon. However, few descriptive studies have been published in the last decade to demonstrate the gravity of adverse maternal and perinatal outcomes of these disorders in the Fako Division of the South West Region, Cameroon. Objectives: This study was aimed at determining the prevalence, risk factors and the maternal and perinatal outcomes associated with severe PIH in the two Regional Hospitals in the South West Region of Cameroon. Methods: This was a cross-sectional and case-control study conducted at the maternities of the two Regional Hospitals of the South West region. Of the 2112 files of parturients that had childbirth in these hospitals between 16th July 2013 and 16th January 2015, 94 case files were selected. These files were classified according to the National High Blood Pressure Education Program Working Group (2000) as severe preeclampsia (64 files) or eclampsia (30 files). A reference group of 188, age, gravidity and parity-matched parturients files with normal blood pressures (BPs) was also selected. Structured questionnaires were used to obtain demographic data, risk factors, gestational age, symptoms and signs of severity, neonatal and maternal morbidity and mortality. Data was analyzed using Epi InfoTM 7.0.8.3, odds ratios and their 95% confidence intervals were recorded and p<0.05 was considered statistically significant. Results: The prevalence of severe PIH was 5.02%. Parturients aged 21 – 25 years 30.9% (29) and primiparous 57.5% (54) were most affected. Severe PIH was associated with family history of chronic HBP [44.7% (42) versus14.9% (28)] and pre-tertiary level of education [62.8% (59) versus 44.2% (83)] both with p<0.001 and p≤0.031 respectively. The maternal mortality ratio in cases was 1887/100,000 live births but no maternal death occurred in the reference population. Severe PIH was associated with certain maternal outcomes, the most frequent being caesarean delivery [68.1% (64) versus 16.5% (31)], p<0.001. Others included visual impairment [11.7% (11) versus 0.0% (0)] and Placenta abruptio [5.3% (5) versus 0.0% (0)]. Similarly, severe PIH was associated with perinatal outcomes; low birth weight [50.0% (47) versus 10.6% (20)], prematurity [46.8% (44) versus 9.6% (19)] and perinatal death [27.7% (26) versus 5.3% (10)] all p≤0.001. Conclusion: The prevalence of severe PIH was high (5.02%). It was common in age group 21-25, primiparous and women with family history of chronic HBP and low level of Education. Parturients with a severe PIH had significantly more maternal and perinatal complications. These data suggest a gap in maternal health in Cameroon. Hence there is need to do complete evaluation (clinical and laboratory) to better assess patients; encourage early patient referral and prompt management of complications; more mid- wives and creation of adult and neonatal intensive care units in the Buea and Limbe Regional Hospitals.
ABSTRACT
One of the objectives of the fifth Millennium Development Goal [MGD] is to decrease annually by 5.5% the maternal mortality so as to attain a three- quarter’s reduction of the world’s burden by the year 2015. The health care referral system has been shown to play an important role if this objective is to be attained. The aim of this study was to evaluate the referral system and other contributing factors to maternal deaths. This was a retrospective, descriptive study carried out in the Douala General Hospital, a tertiary referral hospital in Douala, Cameroon. The records of cases of maternal deaths that occurred between 1st January, 2002 and 31st December, 2011 were reviewed. Patients who died on arrival at the hospital were excluded from the study. Data was collected using pre-structured questionnaire and analyzed with EPI-Info version 3.5.1. There were 25 maternal deaths during this period with a maternal mortality ratio of 275 per 100.000 live births. Sixteen (64%) maternal deaths were referred cases from; government health institutions 4 (25%) and private 12 (75%) hospitals in Douala. Most of the patients were between 30-40 years 12 (48%), married 17 (68%), primigravida 12 (48%). The triad of hemorrhage 12 (48%), hypertensive disease in pregnancy 10 (40%) and infection 3 (12%) was responsible for the maternal deaths. Using two indicators to evaluate the referral system, it was observed that only 3 (18, 8%) exploited the referral information system and barely 4(25 %) were transported to the hospital by an ambulance. Maternal mortality remains high in our setting. Most of the causes of maternal death are due to direct obstetric causes which are preventable. The role of referral system in providing health care is poor. Therefore, this aspect of providing health care has to be properly implemented if it is to make an impact in reducing maternal morbidity and mortality.