Risk factors for maternal mortality: a case-control study in Dakar hospitals (Senegal).
This study was conducted in the three main hospitals of Dakar, the capital city of Senegal. Each case of 152 maternal deaths identified over a 12-month period was matched with two controls: a safe delivery in the same clinic, and a safe delivery in the same neighbourhood of residence. Controls were matched on age, birth order, place, and time of delivery. The leading causes of death were: puerperal sepsis and other infections (51 cases), haemorrhage (32 cases), eclampsia (29 cases), ruptured uterus (11 cases), and anaemia (7 cases). Results of the case-control study revealed the major risk factors associated with health system failures: medical equipment failure (odds ratio [OR] = 55.0), late referral (OR = 23.2), lack of antenatal visit (OR = 16.9), and lack of available personnel at time of admission (OR = 6.6). Various indicators of maternal status at time of admission (complications, blood pressure, temperature, oedema, haemoglobin level) and of health history prior to admission (previous complications, previous C-section, lack of treatment) were also strong predictors of survival. Lastly, socio-demographic factors also appeared as correlates of maternal mortality, in particular: first pregnancy (OR = 2.3), pregnancy of high birth order (OR = 1.9), rainy season (OR = 2.4), being unmarried (OR = 2.5), and low level of education (OR = 1.6). Implications for policy are discussed.
Garenne
M
M
CEPED, Paris, France. garenne@ceped.ined.fr
Mbaye
K
K
Bah
M D
MD
Correa
P
P
D016022:Case-Control Studies; D002423:Cause of Death; D005260:Female; D017052:Hospital Mortality; D006786:Hospitals, Urban; D006801:Humans; D008427:Maternal Health Services / Q000592:standards; D008428:Maternal Mortality; D016017:Odds Ratio; D010298:Parity; D011247:Pregnancy; D012307:Risk Factors; D012675:Senegal / Q000453:epidemiology; D012959:Socioeconomic Factors; D016019:Survival Analysis