ICRH Monographs Leonardo Chavane Facility based Maternal Mortality in Mozambique

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Executive Summary

 

Maternal mortality remains a public health problem, particularly in developing countries, despite an impressive advancement worldwide in the recent years with a reduction of 44% from 1990 to 2015.

Several strategies have been implemented to reduce the number of women dying as a consequence of childbirth. Access to skilled birth attendants and delivering within the health facility environment with rapid access to adequate emergency management have both been pointed as very powerful strategies to reduce death following pregnancy complications. Alongside these and other interventions, the access to family planning using modern contraceptive methods is another strategy with high impact in preventing maternal mortality.

In Mozambique, maternal mortality remains high despite the relative increase of institutional deliveries coverage. Findings from the 2007 population census indicated that around half of the maternal deaths occurred within the health institution.

The development of this thesis is aimed to explore the factors that determine the occurrence of health facility-based maternal mortality. We conducted a secondary data analysis from two (2007 & 2012) nationwide maternal health needs assessment in health facilities. This analysis helped to assess the magnitude of health facility-based maternal death in the country, its distribution and the determinants influencing the women´ deaths. Also, we evaluated the causes of institutional maternal deaths. A relationship between the delays in reaching the health facility, as well as difficulties gaining access and receiving adequate care were examined among the causes of death. We also conducted a health facility exit survey targeting women using family planning services to evaluate the level and the determinant factors of their satisfaction and use of family planning services.

Our stud shows a high level of health facility-based maternal deaths in the country, with health facility-based maternal deaths close to the estimated maternal mortality at population level. We found important differences in the distribution of maternal deaths across the country and levels of care. Geographically, maternal mortality is higher in the southern region of the country compared to the central and northern regions. The pattern of mortality distribution coincides with the pattern of the level of utilization of health facilities for childbirth in the country. In the south of the country the coverage of childbirth services is higher compared to the center and north. In south, most of the women delivery within the health facilities and some of them die within those health facilities while in the north of country the utilization of the facilities for childbirth is low comparatively and consequently more women die, and outside the health  facilities.

During the period covered by the two surveys used in this study (2006 to 2012) hemorrhage, hypertensive disorders, and sepsis were the most frequent direct causes of death. In the same period, malaria and HIV/AIDS were the dominant indirect causes of death, though its significance changed over time with relative reduction.

Among the determinants of maternal deaths in the health facilities, human resources were the most important factor that emerged. The availability of Maternal and Child nurses with skills to offer emergency obstetric care services appeared to be the most important cadre in the prevention of deaths due to pregnancy complications.

Delays in accessing timely care, once the women had arrived to the health facility, contributed to maternal deaths due to direct obstetric complications, i.e., postpartum hemorrhage and hypertensive disorders. Women arrive very late at the facilities, already in a critical clinical condition; however, once they arrive in very critical conditions, the emergency response was usually without delay. We believe that the critical condition of the patient triggered a quicker response from the health facilities teams. 

Users satisfaction plays an important role in the use of healthcare services. We found a high satisfaction among women that were exiting the family planning services. Nevertheless, we consider it essential to highlight the factors that were mentioned as reason for some degree of dissatisfaction namely: the contraceptives stock-outs resulting in having to change method of contraception, the long waiting time in the consultation room and poor provider-client interaction perceived by users.

The findings from this research reaffirms the importance and usefulness of facility based information on maternal mortality in a setting where information at population level is scant.

Priority must continue toward the improvement of the health facility and healthcare provider’s readiness to respond to the complications related to pregnancy. Also, the referral system, the health information system, and commodities logistics represent critical components of the healthcare services that need special attention to optimize the maternal health care and contribute to the reduction of health facility-based maternal death and ultimately reduce the level of maternal mortality in the country.

Full text will be published at https://biblio.ugent.be/publication/8576938

Authors & affiliation: 
Leonardo A. Chavane- Facility based Maternal Mortality in Mozambique
Published In: 
ICRH Monographs
Publication date: 
Thursday, October 11, 2018