Maternal Death Review in Sudan (2010 – 2012): Achievements and Challenges

摘要

Background: Despite the worldwide commitment to improving maternal health, measuring, monitoring and comparing mortality estimates remain a challenge. Maternal death review (MDR) is a tool used to measure maternal mortality ratio (MMR) and to improve quality of obstetric care. Objectives: This study was done to assess maternal mortality and to identify underlying causes during 2010-2013. Materials and Methods: Facility and community- based maternal death review was conducted during three years in Sudan to study maternal mortality. National and states’ maternal death review committees were established. A focal person for each state, health facility and locality was nominated. Notification of maternal deaths was done by telephone, followed by review of all notified maternal deaths using a structured format. Data was analyzed using microcomputer, with SSPS, version 18.0. Results: Over three years, 2933 maternal deaths were notified, out of 1509354 Live births (LB). MMR was 194/ 100000 LB, with different variation between states. Facility maternal deaths were 2503 (85.3%) and community deaths were 430 (14.7%), reviewed formats were 2859 (97.5%). Direct obstetric deaths were 1845 (64.5%), mainly due to haemorrhage 884 (30.9%), eclampsia 383 (13.4%) and sepsis 321 (11.2%). Indirect causes were 1014 (35.5%), 363 (12.7%) due to hepatitis and 197 (6.9%) to anemia. Most of hospital deaths 1947 (77.9%); admitted late from home, 2462 (73.4%) were critically ill and 1484 (60.3%) died within 24 hours. Conclusion: Home delivery, late presentation, unavailability of blood and poor referral system, are the main factors behind maternal deaths. Maternal death review has to be integrated within the health management information system (HMIS) with strong commitment of various stakeholders.