title: Severe acute maternal morbidity and associated deaths in conflict and post-conflict settings in Africa.
abstract: METHODS
  Five hospitals in four conflict and post-conflict countries (Democratic Republic of Congo, Somaliland, Sierra Leone and Burundi).
  
  
  OBJECTIVE
  To report among hospital deliveries: 1) the proportion of severe acute maternal morbidity (SAMM), 2) the pattern of SAMM, and 3) maternal deaths according to type of SAMM.
  
  
  METHODS
  An audit of data from a standardised database implemented in all the sites in the study.
  
  
  RESULTS
  Of the 18 675 deliveries, there were 6314 (34%) known SAMM cases with 63 associated deaths, implying that for every 100 SAMM cases there was one maternal death. In descending order, the death-to-SAMM ratios per 1000 deliveries were: 1:7 for sepsis, 6 for haemorrhage 1:70 for hypertensive disorder and 1:398 for obstructed labour. A substantial proportion of deaths (38%) that occurred in hospitals could not be categorised into the standardised SAMM conditions available in the database.
  
  
  CONCLUSIONS
  As this is the first study using multi-centre data from conflict and post-conflict countries, these findings are relevant to improving maternal health in such settings. Findings, implications and possible ways forward in addressing various challenges are discussed.
authors.affiliation: Médecins Sans Frontières (MSF), Operational Centre Brussels, Brussels, Belgium.
authors.forename: M
authors.initials: M
authors.lastname: Tamura
authors.affiliation: International Union Against Tuberculosis and Lung Disease, Paris, France ; The Centre for International Health, University of Bergen, Norway.
authors.forename: S G
authors.initials: SG
authors.lastname: Hinderaker
authors.affiliation: Medical Department (Operational Research), Operational Centre Brussels, MSF-Luxembourg, Luxembourg.
authors.forename: M
authors.initials: M
authors.lastname: Manzi
authors.affiliation: Medical Department (Operational Research), Operational Centre Brussels, MSF-Luxembourg, Luxembourg.
authors.forename: R
authors.initials: R
authors.lastname: Van Den Bergh
authors.affiliation: Medical Department (Operational Research), Operational Centre Brussels, MSF-Luxembourg, Luxembourg.
authors.forename: R
authors.initials: R
authors.lastname: Zachariah
keywords: conflict; maternal morbidity; mortality; operational research; post-conflict