title: Puerperal sepsis, the leading cause of maternal deaths at a Tertiary University Teaching Hospital in Uganda.
abstract: Maternal mortality is highest in sub-Saharan Africa. In Uganda, the WHO- MDG 5 (aimed at reducing maternal mortality by 75 % between 1990 and 2015) has not been attained. The current maternal mortality ratio (MMR) in Uganda is 438 per 100,000 live births coming from 550 per 100,000 in 1990. This study sets out to find causes and predictors of maternal deaths in a tertiary University teaching Hospital in Uganda.
  
  
  
  The study was a retrospective unmatched case control study which was carried out at the maternity unit of Mbarara Regional Referral Hospital (MRRH). The sample included pregnant women aged 15-49 years admitted to the Maternity unit between January 2011 and November 2014. Data from patient charts of 139 maternal deaths (cases) and 417 controls was collected using a standard audit/data extraction form. Multivariable logistic regression analysis was used to assess for the factors associated with maternal mortality.
  
  
  
  Direct causes of mortality accounted for 77.7 % while indirect causes contributed 22.3 %. The most frequent cause of maternal mortality was puerperal sepsis (30.9 %), followed by obstetric hemorrhage (21.6 %), hypertensive disorders in pregnancy (14.4 %), abortion complications (10.8 %). Malaria was the commonest indirect cause of mortality accounting for 8.92 %. On multivariable logistic regression analysis, the factors associated with maternal mortality were: primary or no education (OR 1.9; 95 % CI, 1.0-3.3); HIV positive sero-status (OR, 3.6; 95 % CI, 1.9-7.0); no antenatal care attendance (OR 3.6; 95 % CI, 1.8-7.0); rural dwellers (OR, 4.5; 95 % CI, 2.5-8.3); having been referred from another health facility (OR 5.0; 95 % CI, 2.9-10.0); delay to seek health care (delay-1) (OR 36.9; 95 % CI, 16.2-84.4).
  
  
  
  Most maternal deaths occur among mothers from rural areas, uneducated, HIV positive, unbooked mothers (lack of antenatal care), referred mothers in critical conditions and mothers delaying to seek health care. Puerperal sepsis is the leading cause of maternal deaths at Mbarara Regional Referral Hospital. Therefore more research into puerperal sepsis to describe the microbiology and epidemiology of sepsis is recommended.
authors: Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda. jngonzi@gmail.com.
authors: Joseph
authors: J
authors: Ngonzi
authors: Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda.
authors: Yarine Fajardo
authors: YF
authors: Tornes
authors: Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda.
authors: Peter Kivunike
authors: PK
authors: Mukasa
authors: Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda.
authors: Wasswa
authors: W
authors: Salongo
authors: Mbarara University of Science and Technology, Institute of Maternal Newborn Health, Mbarara, Uganda.
authors: Jerome
authors: J
authors: Kabakyenga
authors: Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda.
authors: Masembe
authors: M
authors: Sezalio
authors: Department of Obstetrics and Gynecology, Antwerp University Hospital, Antwerp, Belgium.|International Health Unit Department of Epidemiology, University of Antwerp, Antwerp, Belgium.
authors: Kristien
authors: K
authors: Wouters
authors: Department of Obstetrics and Gynecology, Antwerp University Hospital, Antwerp, Belgium.|International Health Unit Department of Epidemiology, University of Antwerp, Antwerp, Belgium.
authors: Yves
authors: Y
authors: Jacqueym
authors: Department of Obstetrics and Gynecology, Antwerp University Hospital, Antwerp, Belgium.|International Health Unit Department of Epidemiology, University of Antwerp, Antwerp, Belgium.
authors: Jean-Pierre
authors: JP
authors: Van Geertruyden
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002423:Cause of Death; D004522:Educational Status; D005260:Female; D006679:HIV Seropositivity / Q000453:epidemiology; D006784:Hospitals, Teaching; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000401:mortality*; D008288:Malaria / Q000401:mortality; D008428:Maternal Mortality; D006473:Postpartum Hemorrhage / Q000401:mortality*; D011295:Prenatal Care; D011645:Puerperal Infection / Q000382:microbiology / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D012424:Rural Population; D018805:Sepsis / Q000401:mortality*; D061665:Time-to-Treatment; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult
keywords: Maternal mortality; Mbarara University; Obstetrical hemorrhage; Puerperal sepsis; Uganda