Estimation of changes in maternal mortality in a rural district of northern Tanzania during the last 50 years.

OBJECTIVE: Maternal mortality remains a major challenge worldwide. Reliable information concerning ratios and trends is essential for resource mobilization and assessment of progress towards the Millennium Development Goals. DESIGN: Assessment of levels and trends in maternal mortality during the last 50 years. SETTING: Sengerema district, rural North Tanzania. POPULATION: Number of deliveries, births, admissions, maternal deaths and causes of maternal mortality in the only hospital in the area. METHODS: We compiled a database from the annual hospital reports for the period of 1962-2011 to obtain estimated maternal mortality ratio for each decade. MAIN OUTCOME MEASURES: Maternal mortality ratio for each decade and classification of maternal deaths. RESULTS: Of 629 maternal deaths, 490 (77.9%) could be classified as either direct or indirect and causes of mortality ascertained. Of the 361 direct causes (73.7%), hemorrhage (29.8%) and sepsis (20.4%) were the leading causes. Of the 129 indirect causes (26.3%), anemia during pregnancy (6.5%), meningitis (4.1%), HIV-AIDS (3.5%), malaria (2.9%), heart diseases (2.4%) and relapsing fever (2.0%) were most often diagnosed. Since 1962, a 63% decrease in maternal mortality ratio has been achieved. The hospital-based maternal mortality ratio decreased from 770/100,000 to 282/100,000 in the last decade (95% confidence interval 244/100,000, 320/100,000). The yearly decline since 1962 was 1.3%. CONCLUSIONS: During the last 50 years we have witnessed a reduction of maternal mortality and improvements in maternal health. Progress has been made towards improving Millennium Development Goal 5, although only a prospective population-based survey will provide the ultimate answer.

Maternal mortality in a rural Tanzanian hospital: fatal Jarisch-Herxheimer reaction in a case of relapsing fever in pregnancy.

Relapsing fever is a disease caused by one of the species of Borrelia. It is often misdiagnosed as malaria and can have fatal complications such as the Jarisch-Herxheimer reaction (JHR) after the commencement of treatment with antibiotics. A 19-year-old Tanzanian woman was admitted after a term home delivery that day. She presented with a 2 day history of fever, headache, general body malaise and vomiting. She was misdiagnosed as having severe malaria and was treated with quinine. The blood slide showed Borrelia duttoni. The patient continued treatment with procaine penicillin fortified for relapsing fever. Several hours later the woman died, probably due to JHR. This case of a patient with relapsing fever who died from a JHR stresses the importance of adequate diagnosis and treatment which should include careful monitoring, especially for the first hours after starting antibiotics.