An audit of maternal deaths from a referral university teaching hospital in Nigeria: the emergence of HIV/AIDS as a leading cause.
OBJECTIVE
To analyse the characteristics and causes of maternal death in a referral tertiary health facility in Southern Nigeria.


METHODS
This is a facility- based review of 184 maternal deaths that occurred from January 2005 to June 2009. Primary causes of death and factors that contributed to maternal death including delay in accessing health care were identified.


RESULTS
During the study period, the Maternal Mortality Ratio (MMR) was 2230/100,000 live births. There was a progressive reduction in the annual MMR from 2901/100,000 live birth in 2005 to 1459/100,000 live birth in 2009. More than four fifth (84.9%) of the maternal deaths occurred among women of low socio-economic class (IV and V). The leading causes of direct maternal deaths (64.1%) were Puerperal sepsis (17.8%), Pre-eclampsia/Eclampsia (15.8%) and complications of unsafe abortion (11.4%). HIV/AIDS was the third commonest overall cause of maternal death (15.2%). Half of the women experienced Type 1 delay (50%), Type 2 and 3 delay occurred in 7.6% and 18.5% of maternal deaths respectively. About two thirds of the women (58.2%) experienced more than one form of delay.


CONCLUSIONS
Although direct obstetric deaths remain the leading cause of maternal mortality, HIV/AIDS is becoming an important primary cause of maternal mortality in our environment. Organization of health service delivery with an effective referral system and the provision of optimal care for HIV infected women are recommended.
Department of Obstetrics and Gynaecology, University of Benin Teaching Hospital, Benin City, Edo state, Nigeria. anibaba15@yahoo.co.uk
Adedapo
A
Ande
Biodun
B
Olagbuji
Michael
M
Ezeanochie
D000028:Abortion, Induced / Q000401:mortality; D000163:Acquired Immunodeficiency Syndrome / Q000401:mortality; D000293:Adolescent; D000328:Adult; D002423:Cause of Death / Q000639:trends; D004461:Eclampsia / Q000401:mortality; D005260:Female; D015658:HIV Infections / Q000401:mortality*; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D008427:Maternal Health Services; D008428:Maternal Mortality / Q000639:trends*; D008485:Medical Audit; D008875:Middle Aged; D009549:Nigeria / Q000453:epidemiology; D006473:Postpartum Hemorrhage / Q000401:mortality; D011225:Pre-Eclampsia / Q000401:mortality; D011247:Pregnancy; D011645:Puerperal Infection / Q000401:mortality; D012189:Retrospective Studies; D018805:Sepsis / Q000401:mortality; D012959:Socioeconomic Factors; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D014597:Uterine Rupture / Q000401:mortality; D055815:Young Adult