Factors causing maternal deaths at level one hospitals and midwife obstetric units in the Western Cape

[摘要] ENGLISH ABSTRACT: Background: Maternal deaths in South Africa remain a concern as the target of maternal mortality ratio (MMR) of 38 maternal deaths per 100,000 live births not being reached as anticipated in 2015. The Western Cape has the lowest MMR in South Africa. However, there is a lack of or inadequate information with regard to maternal deaths in the Western Cape at level one hospitals and midwife obstetric units (MOUs). Strategies to reduce maternal deaths at level two and three hospitals in the Western Cape are not necessarily appropriate for level one hospitals or MOUs. The aim of this study was to determine the factors causing maternal deaths at level one hospitals and MOUs in the Western Cape.Methods: A retrospective quantitative study with a descriptive design was performed. Records of 86 maternal deaths out of the 92 which occurred at level one hospitals and MOUs between 2008 and 2012 were reviewed. The data was extracted from the electronic database of the National Committee for Confidential Enquiries into Maternal Deaths (NCCEMD). Data was analysed separately for the level one hospitals and MOUs. Additional analysis was done to determine the factors for the Cape Town Metropole separately from the other health districts which are Cape Winelands, Eden, Klein Karoo, Overberg and West Coast. The researcher used an existing validated tool. The 2008 version of the NCCEMD's assessors' form was used as the data collection tool. Ethics approval was sought from the Stellenbosch University Health Research Ethics Committee, the Western Cape Department of Health and the NCCEMD.Results: The most common primary cause category of maternal death at level one hospitals was non-pregnancy-related infections, specifically tuberculosis and pneumonia. While the most common primary cause category of maternal death at MOUs was hypertension. The most common final causes of death at both level one hospitals and MOUs were cardiac and respiratory failure. Analysis of the avoidable factors at both levels of care showed that medical related factors such as management of the patient at an inappropriate level of care and problem recognition/diagnosis were most common.Conclusion: The primary causes of maternal deaths differed according to levels of care. Therefore strategies to decrease maternal deaths should be specific for particular levels of care. In particular, level one hospitals must screen and treat pregnant women for tuberculosis and pneumonia, while MOUs must improve the management of acute, severe hypertension.

[发布机构] Stellenbosch University