title: Lessons learned from maternal deaths at an East African health center.
abstract: OBJECTIVE
  To analyze maternal deaths occurring at the Mikumi Health Center in Tanzania, East Africa, to discuss causes for the high maternal mortality rate at the Health Center, and to define possible strategies for the reduction of maternal deaths.
  
  
  METHODS
  Between 2002 and 2003, a total of nine maternal deaths were identified and analyzed from hospital records of the East-African Mikumi Health Center.
  
  
  RESULTS
  During the two-year period, the total number of deliveries was 977 including two maternal deaths during pregnancy and seven deaths during labor or postpartum (0.7% of total deliveries). The maternal mortality ratio (MMR) was 921 per 100,000 live births. The maternal average age was 27 years (range 18-37). The average interval between the first contact with the Health Center and maternal death was 3.5 days.
  
  
  CONCLUSIONS
  The main cause for maternal complications and subsequent deaths might have been the patient's delayed presentation at the Health Center. Aggravating circumstances such as long distance from the health services and hospital fees hinder patients from a timely and eventually life-saving presentation. The womens' low educational level affects their health as well as their nutritional state and thus increases the maternal death rate. Strategies to prevent maternal deaths at the Mikumi Health Center include measures to raise awareness about consequences of poor maternal health, to improve general education especially for young women, to increase the number of professional birth attendants in the region, to improve family planning services and sexual education with special reference to HIV/AIDS. Additionally, improvement of the first referral facilities around the Mikumi Health Center according to the "essential obstetric functions" recommended by the WHO seems crucial.
authors.affiliation: Department of Obstetrics and Gynecology, Medical University Graz, Austria. willibald.zeck@meduni-graz.at
authors.forename: Willibald
authors.initials: W
authors.lastname: Zeck
authors.forename: Ingrid
authors.initials: I
authors.lastname: Kelters
authors.forename: Uwe
authors.initials: U
authors.lastname: Lang
authors.forename: Edgar
authors.initials: E
authors.lastname: Petru
mesh_terms: D000293:Adolescent; D000328:Adult; D000351:Africa, Eastern / Q000453:epidemiology; D002423:Cause of Death; D005260:Female; D006297:Health Services Accessibility / Q000592:standards; D006801:Humans; D008427:Maternal Health Services / Q000592:standards; D008428:Maternal Mortality; D008430:Maternal-Child Health Centers; D010353:Patient Education as Topic; D011247:Pregnancy; D012959:Socioeconomic Factors