Levels and causes of maternal mortality in Senegal.
OBJECTIVE
To report the findings of a direct, community-based, assessment of maternal mortality and medical causes of death using verbal autopsy in three unique cohorts in rural Senegal.


METHODS
Methods from ongoing demographic surveillance systems. We obtained records of all deaths and births in women of age 15-49 over a period of 14 years in Niakhar, 10 years in Bandafassi and 13 years in Mlomp. Relatives of all women who died were interviewed using a standard questionnaire. Causes of death were assigned by three physicians independently. Maternal deaths were defined according to the ninth and tenth revisions of the International Classification of Diseases.


RESULTS
The maternal mortality ratio was similar in Mlomp [436 per 100 000 live births (95% confidence interval 209-802)] and Niakhar [516 per 100 000 (413-636)] but significantly higher in the more remote area of Bandafassi [852 (587-1196)] [relative risk compared with Niakhar 1.6 (1.0-2.4)]. Two-thirds of the maternal deaths were from direct obstetric causes, haemorrhage being the most common. Abortion was rare.


CONCLUSIONS
Demographic surveillance systems are useful tools for the measurement of maternal mortality provided special studies are carried out to arrive at the levels and causes of maternal death. The estimates of maternal mortality reported here are lower than those published by the WHO and UNICEF but remain extremely high, particularly in the very remote areas with very limited health infrastructure, where as many as one in 19 women may be expected to die as a consequence of childbirth.
Kodio
Belco
B
Institut de Recherche pour le Développement, Dakar, Senegal.
de Bernis
Luc
L
Ba
Mariame
M
Ronsmans
Carine
C
Pison
Gilles
G
Etard
Jean-François
JF
D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008428:Maternal Mortality; D008875:Middle Aged; D011159:Population Surveillance; D006473:Postpartum Hemorrhage / Q000453:epidemiology* / Q000401:mortality; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data; D012424:Rural Population; D012675:Senegal / Q000453:epidemiology