The tip of the iceberg: evidence of seasonality in institutional maternal mortality and implications for health resources management in Burkina Faso.
OBJECTIVE
The aims of this study were to investigate seasonal patterns of institutional maternal deaths and complications, and to test for an association with malaria seasons, rainfall, and household income.


METHODS
A systematic case review of hospital records in the Boucle du Mouhoun health region (Burkina Faso) was conducted over a 2-year period. A statistical smoothing procedure (T4253H) and Freedman's test were used to investigate seasonality and association with malaria, rainfall or household income variations.


RESULTS
The data consistently showed the greatest rates of maternal deaths, eclampsia and haemorrhage cases during the dry season, which is the low malaria transmission season, and the period of the year when households have most money available and the lowest opportunity cost of travelling to seek medical attention, suggesting that financial and geographical barriers may be major underlying factors.


CONCLUSIONS
The management both of health resources in hospital and of referral systems should accommodate cyclical variations in the presentation of maternal complications. Effective mechanisms are needed to help reduce the significant barriers to uptake faced by women and their families at particular times of the year.
Department of HIV/AIDS and Reproductive Health, Centre MURAZ, Burkina Faso. shounton.muraz@fasonet.bf
Sennen H
SH
Hounton
Issiaka
I
Sombie
John
J
Townend
Thomas
T
Ouedraogo
Nicolas
N
Meda
Wendy J
WJ
Graham
D002050:Burkina Faso / Q000453:epidemiology; D003906:Developing Countries; D004461:Eclampsia / Q000401:mortality; D005260:Female; D006801:Humans; D008288:Malaria / Q000150:complications; D008427:Maternal Health Services; D008428:Maternal Mortality; D007744:Obstetric Labor Complications / Q000401:mortality*; D006473:Postpartum Hemorrhage / Q000401:mortality; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality*; D040841:Resource Allocation; D012189:Retrospective Studies; D012621:Seasons; D012959:Socioeconomic Factors; D014887:Weather