Trend and determinants of maternal mortality in Jimma University specialized hospital

Abstract

Background: Loss of a woman from family because of death during pregnancy, delivery and within 6 weeks of postpartum can threaten the survival of the entire family. Child less than 9 year is more likely to be chronically malnourished and die when their mother dies than child who lost his father. Per capita gross domestic product is reduced by US$ 0.36 per year per women in World Health Organization African region. The number of death that occurs in Ethiopia is high as World Health Organization maternal death classification. However, some hospital based studies in the country show-inconsistency in death trend and there is also limited evidence on causes of maternal mortality and associated factors Objective: To assess trends, causes of maternal mortality and its associated factors in Jimma University specialized hospital, Southwest Ethiopia from January 2010 to December 2014. Methods: A matched case control study was conducted on 600 charts, 120 cases and 480controls. Data was collected using checklist adapted from maternal death surveillance review of Ethiopia guide line. Six data collectors were recruited. Data entered into epi data 3 and exported to STATA 13 for analysis. Maternal mortality ratio was calculated for each year to observe trend of maternal death. Conditional logistic regression was done to identify the independent predictors of maternal death. The AMOR with 95%CI was reported and significance was declared at p =<0.05. For causal inference propensity score matching analysis was used. To ensure confidentiality only code was written on the check list. Result: Maternal mortality ratio was 857/105 and has decreasing trend from highest in 2010 of 1873/105 to lowest of 350/105 in 2014. More than two third (68%) of death occurred during postpartum period. The leading cause of maternal death was hemorrhage (54%) (β=0.477, 95%CI (0.307, 0.647) followed by pregnancy induced hypertension (20%) (β=0.232, 95%CI(0.046, 0.419) and anemia (12%)(β=0.110, 95%CI(0.017, 0.204).Predictors of maternal death include: age group of 20 – 34 (AMOR= 0.299, 95% CI (0.113, 0.792)), being from rural area (AMOR = 2.594, 95%CI(1.001,6.726)), prolonged labour (AMOR=37.141,95%CI(13.296, 103.750)), comorbidities (AMOR=9.631,95%CI(3.135, 29.588), referred cases from health center (AMOR=4.011, 95% CI (1.113, 14.464) and other health institution (AMOR=6.029, 95%CI(1.565, 24.626)). Conclusion and recommendation: there is decreasing trend of maternal death. Most of them died in post-partum period. Hemorrhage was major cause of death identified in each year of study. Duration of labour, age, comorbidities, residence and referral were the major factors that affect maternal death. Increasing awareness of the community in rural part - on utilization of maternal health services and avoidance of delays in intervention should be sought