Unmet Obstetric Need Indicator for Estimating Maternal Mortality by Severe Obstetric Complications in Tambacounda Region, Senegal / 国際保健医療

ABSTRACT

<b>Introduction</b><br> Maternal mortality ratio is widely used to provide a general sense of size of the problem of maternal deaths. However, it cannot be used to measure progress of maternal health programme on an annual basis and to compare geographic areas, because of its wide range of errors. This research estimates maternal mortality in six districts by using “unmet obstetric need” indicator in Tambacounda region, Senegal and describes possible application of the indicator to monitor, evaluate and facilitate maternal mortality reduction.<br><b>Methods</b><br> We used data on caesarean sections performed in seven health facilities in Tambacounda and Kaolack regions in 2005, and calculated rates of the intervention for the residents of Tambacounda. We estimated maternal mortality ratios for selected severe obstetric complications in six districts by calculating the number of deficits for the caesarean sections for absolute maternal indications, which were the number of women who developed life-threatening events but could not receive the appropriate interventions for the diseases.<br><b>Results</b><br> The rates of caesarean sections for all indications and for absolute maternal indications in the six districts ranged from 0.3 to 2.0% and from 0.1 to 0.9%, respectively. The estimated maternal mortality ratio for the absolute maternal indications in Tambacounda region was 651 (95%CI 554-761). Statistically significant differences in the ratios were observed between Koumpentoum district (maternal mortality ratio 966, 95%CI 741-1239) and Goudiry (877, 588-1260), and Kédougou (249, 119-457) and Bakel (296, 128-584).<br><b>Conclusions</b><br> This study method enabled us to distinguish the difference in maternal mortality ratios for the selected severe obstetric complications between the small districts. It implies that the “unmet obstetric need” indicator can be used to compare geographic areas, to monitor trends, and to evaluate programme impact as well as baseline data to establish necessary measures to decrease maternal deaths.