title: Estimation of changes in maternal mortality in a rural district of northern Tanzania during the last 50 years.
abstract: OBJECTIVE
  Maternal mortality remains a major challenge worldwide. Reliable information concerning ratios and trends is essential for resource mobilization and assessment of progress towards the Millennium Development Goals.
  
  
  METHODS
  Assessment of levels and trends in maternal mortality during the last 50 years.
  
  
  METHODS
  Sengerema district, rural North Tanzania.
  
  
  METHODS
  Number of deliveries, births, admissions, maternal deaths and causes of maternal mortality in the only hospital in the area.
  
  
  METHODS
  We compiled a database from the annual hospital reports for the period of 1962-2011 to obtain estimated maternal mortality ratio for each decade.
  
  
  METHODS
  Maternal mortality ratio for each decade and classification of maternal deaths.
  
  
  RESULTS
  Of 629 maternal deaths, 490 (77.9%) could be classified as either direct or indirect and causes of mortality ascertained. Of the 361 direct causes (73.7%), hemorrhage (29.8%) and sepsis (20.4%) were the leading causes. Of the 129 indirect causes (26.3%), anemia during pregnancy (6.5%), meningitis (4.1%), HIV-AIDS (3.5%), malaria (2.9%), heart diseases (2.4%) and relapsing fever (2.0%) were most often diagnosed. Since 1962, a 63% decrease in maternal mortality ratio has been achieved. The hospital-based maternal mortality ratio decreased from 770/100,000 to 282/100,000 in the last decade (95% confidence interval 244/100,000, 320/100,000). The yearly decline since 1962 was 1.3%.
  
  
  CONCLUSIONS
  During the last 50 years we have witnessed a reduction of maternal mortality and improvements in maternal health. Progress has been made towards improving Millennium Development Goal 5, although only a prospective population-based survey will provide the ultimate answer.
authors.affiliation: Sengerema Hospital, Mwanza region, Tanzania; PHC-Laboratory, Amstelveen, the Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: Melkert
authors.forename: Dennis
authors.initials: D
authors.lastname: Melkert
authors.forename: Leonard
authors.initials: L
authors.lastname: Kahema
authors.forename: Koos
authors.initials: K
authors.lastname: van der Velden
authors.forename: Jos
authors.initials: J
authors.lastname: van Roosmalen
mesh_terms: D000293:Adolescent; D000328:Adult; D002423:Cause of Death / Q000639:trends; D005260:Female; D006801:Humans; D008428:Maternal Mortality / Q000639:trends*; D008875:Middle Aged; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality; D012423:Rural Health / Q000706:statistics & numerical data / Q000639:trends*; D013636:Tanzania / Q000453:epidemiology; D055815:Young Adult
keywords: Africa; Maternal mortality - trends; Millennium Development Goals; Tanzania; maternal welfare