Transcript A Comparative study of maternal mortality between Al

A Comparative study of maternal mortality
between Al-Abasia Tagali and Juba
by
Mahasin Hamed Haj
Elsiddig
Introduction:

Maternal Mortality:
Is defined by United Nation Population Fund
Action (UNFPA) as the death of a women
during pregnancy or within 42 days after
termination of pregnancy from any causes
related to, or aggravated by the pregnancy or
its management. This includes death as a
complication of abortion at any stage of
pregnancy (UNFPA, WHO, 2006).
Study justification:

Nearly half of all pregnant women in
Sudan deliver their children without the
help of skilled birth attendants and as a
result many of them die in childbirth
UNFPA (2004). The mortality and
morbidity rates among women in Sudan
is among the highest in the region,
UNFPA (2004).
•26000
women die every year in Sudan
while giving birth. 13300 of them in the
south and 12700 in the north. This
means about 71 women die everyday
while giving birth UNICEF(2009). Rates
of pregnancy related deaths in south
Sudan are the highest in the world; it's
actually at 2.030 per 100.000 births.
According to Sudan health facilities,
hemorrhage accounted for 25 percent
of all maternal deaths.
 In north Sudan, rates of maternal
mortality are 509 deaths per 100.000
birth UN (2007).


The importance of the problem is not
always evident from official statistic. In
area where the problem is greatest,
most maternal death go unregistered,
therefore been subject to under
estimation which aggravates the
situation.
Maternal mortality affects not only
women but also their families and
communities. The risk of an infant
dying increases significantly with the
mother's death.
 The death of a woman of reproductive
age brings significant economic
losses and setbacks to community
development.(WHO/UNICEF/UNFPA,
1995)

Objectives:

The aim of this paper is to determine the
causes of maternal mortality among AlAbasia Tageli women compared with
maternal mortality at Juba Teaching Hospital.
It focus on the demographic and socioeconomic status of the deceased women in
these areas, and evaluating the maternity
health care facilities in the study areas.
Materials and methods
Primary data:
Obtained through
questionnaire and personal interviews
of families who had maternal death
beside
information
from
health
providers and retrospective health
services attendants' records.
Secondary
data:
Obtained
from
textbooks, published articles, and
journals and internet sources.
Study areas


Al-Abasia Tagli and Juba Teaching Hospital.
Al- Abasia Tagali, is situated in the eastern
part of South Kordofan state


Juba Teaching Hospital:
Established back in the early 1920, as the
Central Hospital in the southern Sudan.
Maternity Unit:
It
is
established
following
the
Comprehensive Peace Agreement by
UNFPA agency. It has 6 wards plus the
theater room.
The unit lack access to basic emergency
obstetric services, provision for health care is
low ,about 25% of the population in southern
Sudan had access to health care which are
organized predominantly by NGOs.
The grater part of this health care is
provided by unqualified personal who are
trained by the NGOs to diagnose and treat
cases according to protocols.
Target group:
Families whom had maternal deaths
during the last10 year taken as sample.
Sample Size:
Hundred questionnaires were distributed .
Fifty of these questionnaires in Al-Abasia
Tagali, 30 were collected from families based
information who had maternal deaths, and 20
from health centers selected purposively. In
Juba 30 were from Juba Teaching Hospital
and the other 20 questionnaires from health
centers in the area purposively selected.
Data Analysis:
The data were analyzed using the SPSS
and the results are presented in the form of
tables and figures using frequency and
percentage.
Study period:
5 May 2009 – 29 September 2009.
Result and discussion
Fig, 1: Percentage of the maternal mortality cases according to
demographic data in Juba and Al-Abasia Tagali respectively.
Age
Age
60
50
30
50
32
40
28
Percent
Percent
1 - Age
40
22
20
30
18
24
20
10
10
10
10
6
0
0
19-24
19-24
25-30
Juba
31-36
25-30
31-36
37-42
Al-Abasia Tagali
37-42
42+
Education
Education
60
60
56
50
50
40
40
Percent
Percent
2- Education
50
36
30
30
28
20
20
14
10
10
8
8
0
0
uneducated
Juba
basic
secondary
uneducated
khalwa
basic
Al-Abasia Tagali
secondary
Marital status
Marital status
120
90
100
80
100
80
60
Percent
status
3- Marital
Percent
100
60
40
40
20
20
10
0
0
married
Juba
unmarried
married
Al-Abasia Tagali
Economic status
Economic status
100
74
92
80
60
Percent
status
4- Economic
Percent
80
40
60
40
20
20
14
10
0
0
6
self employed
employed
self employed
Juba
house wife
house wife
others
Al-Abasia Tagali
others
Fig. 2: Percentage of the maternal mortality cases according to birth
number and birth status at time of death in Juba and Al-Abasia Tagali
respectively
.
Number of births
Number of births
30
40
29
34
25
30
23
23
first
second
20
Percent
Birth number
Percent
36
20
16
10
14
10
0
0
first
second
Juba
third
third
above third
Al-Abasia Tagali
above third
Birth status
Birth status
50
50
41
40
38
Percent
status
BirthPercent
44
40
30
33
30
22
20
20
19
10
10
0
healthy infant
dead infant
abortion
healthy infant
dead infant
abortion
Fig. 3: Percentage of the maternal mortality cases according to
health care factors in the area in Juba and Al-Abasia Tagali
respectively.
Availability of health care in the area
Availability of health care in the area
60
56
50
32
30
40
24
22
20
22
Percent
1- Availability of health
area
care in the
Percent
40
30
20
24
10
16
10
0
4
0
hospital
health center
Juba
Both
none
hospital
health center
Both
Al-Abasia Tagali
none
Availability of maternity unit
Availability of maternity unit
60
45
53
50
40
40
37
Percent
2- Availability of
Percent
maternity unit
50
30
20
39
30
20
14
10
10
0
4
0
yes
Juba
4
yes no facilities
no
yes no facilities
no
4
yes
yes unfunctioning
Al-Abasia Tagali
yes unfunctioning
Maternity unit status
Maternity unit status
50
48
45
40
40
37
34
30
Percent
3- Maternity unit
Percent
status
50
30
20
20
18
18
10
10
0
0
no gynecologist
Juba
no faciloties
contamminated rooms
no gynecologist
no faciloties
contamminated rooms
Al-Abasia Tagali
Fig. 4: Percentage of the maternal mortality cases according to
factors during and post pregnancy, at time of delivery and after
delivery in Juba and Al-Abasia Tagali respectively.
Pregnancy complications
Pregnancy complications
60
50
44
40
48
40
Percent
1- Pregnancy
Percent
complications
50
30
20
30
20
19
17
15
15
10
10
17
14
10
0
0
headache
headache
abdominal pain
fever
edema
urinary pain
abdominal pain
fever
edema
urinary pain
Delivery time span
Delivery time span
50
40
35
40
30
30
Percent
2- Delivery time
Percent span
46
30
26
20
19
22
20
10
8
10
5
3
0
7
within 24hr
0
within 24hr
after48hrs
Juba
after72hrs
more than
after72hrs
after48hrs
5
more than
Al-Abasia Tagali
6
Complications after delivery
50
50
46
40
40
40
35
30
Percent
3- Complications after
delivery
Percent
Complications after delivery
20
33
30
20
20
19
10
10
5
0
0
3
infection
infection
Juba
retained placenta
heavy bleeding
heavy bleeding
retained placenta
haemorrhage
Al-Abasia Tagali
postpartum
Fig. 5: Percentage of the maternal mortality cases according to
probable maternal death factors Juba (column 1) and Al-Abasia
Tagali respectively (column 2).
Place of delivery
Place of delivery
100
56
50
40
80
85
44
Percent
Percent
delivery
1- Place of
60
30
60
40
20
20
10
0
0
home
Juba
hospital
home
8
8
hospital
health center
Al-Abasia Tagali
Way of delivery
Way of delivery
40
60
30
63
32
30
50
26
Percent
delivery
2- Way of
Percent
70
20
40
30
29
20
12
10
10
7
0
0
midwife
Juba
doctor
alone
TBA
midwife
doctor
Al-Abasia Tagali
TBA
Causes of maternal death
Causes of maternal death
80
76
34
30
60
30
27
Percent
3- Causes of
Percent death
maternal
40
20
40
10
9
20
18
0
haemorrhage
pelvic disproportion
abortion
eclampsia
4
0
haemorrhage
Juba
abortion
pelvic disproportion
Al-Abasia Tagali
other
Maternal death time
50
100
80
40
82
Percent
death time
4- Maternal
Percent
Maternal death time
60
41
30
20
31
22
40
10
20
6
12
0
6
during pregnancy immediately after de
Juba
after two days
0
during pregnancy
after two days
immediately after de
Al-Abasia Tagali
after a week
Fig. 6: The correlation between the demographic variables and the
probable maternal death factors in both areas.
Age vis probable death factors
Education vis probable death factors
Place of delivery
Place of delivery
Way of delivery
Age
Way of delivery
Educated
42+
37-42
Causes of maternal d
31-36
secondary
Causes of maternal d
basic
25-30
khalwa
19-24
uneducated
Economic status vis probable death factors
Place of delivery
Place of delivery
Way of delivery
Way of delivery
Economic status
Causes of maternal d
Marital status
Causes of maternal d
house wife
self employed
unmarried
employed
married
Fig. 7: Mean of pregnancy and delivery complications variables vis
availability of health services in the both areas.
3.5
3.5
3.0
Mean of variables
3.0
2.5
2.0
Variables
Variables
2.5
Causes of maternal d
Causes of maternal d
eath
eath
2.0
Pregnancy complicati
Pregnancy complicati
1.5
ons
ons
1.5
Complications after
Complications after
1.0
birth
hospital
health center
Both
none
Availability health care in the area
birth
1.0
yes no facilities
yes
no
yes unfunctioning
Availability of Maternity unit
Conclusion:

The present study revealed that most cases
of maternal mortality deliver at home by TBA,
midwives or alone.

Delivery complications were highly noticed in
home delivered cases where heavy bleeding
and retained placenta were well noticed.
Death
from
hemorrhage
was
the
predominant cause of maternal mortality
among the study cases.

The result of the study explained that the
demographic data of the cases are
uncorrelated to the medical factors. While
the health services in the two areas although
different but contribute directly to the high
delivery complications and thus elevated
maternal mortality rate.
Thank you
Any Questions, Please