Recording of maternal deaths in an East African university hospital.

OBJECTIVE: To trace all maternal deaths at a tertiary East African university hospital with a systematic registration of all births. DESIGN: Descriptive study. SAMPLE: One hundred and nineteen cases of maternal death which occurred in the period from 2000 to 2007 (including). METHODS: Identification through the birth registry and separate manual tracing of all case records. Account of practical problems concerning identification of cases and analysis of time trends, mothers' domicile, occurrence by phase of pregnancy, birth and puerperium, and diagnoses. RESULTS: There was considerable under-reporting of deaths in the medical birth registry. Twenty of 119 mothers died before 23 weeks' gestational age, most of them of unsafe abortion. Other prevalent direct causes of death were hemorrhage, eclampsia and other hypertensive complications. HIV/AIDS was primary cause in 20 cases. CONCLUSION: Even with relatively complete ascertainment of births, single hospital-based medical birth registries have limitations in studies of maternal deaths. They may identify risks among women who arrive for delivery at the hospital, but are not well suited for estimation of total maternal mortality within the hospital walls. This would require additional data. Extending the birth registry monitoring system to all health institutions with obstetrical services in a region will give more reliable estimates to be followed over time and serve as a basis for regular auditing, to the benefit of mothers and their children.

Birthweight and perinatal mortality among singletons and twins in north-eastern Tanzania.

BACKGROUND: Low birthweights as well as high perinatal mortality rates are common in most African populations. Little is known, however, about how low birthweight corresponds with higher mortality rates within African populations. Twins are known to have lower birthweights and higher perinatal mortality rates than singletons. If lower birthweights represent higher perinatal risk per se, small twins within a population with generally lower birthweights should have critically increased risks. METHODS: In total, 15,255 births in a Tanzanian hospital during 1999-2006 were analysed to determine birthweight distribution and examine perinatal mortality rates (including stillbirths and neonatal deaths within 24 hours) by birthweight in twins and singletons. Referral births from outside the district where the hospital was situated were excluded from analysis. RESULTS: The mean birthweight for births within an estimated normal distribution was 3,172 g, with a standard deviation of 462 g. The overall perinatal mortality rate was 43.9 per 1,000 births (95% confidence interval: 40.7-47.2). Perinatal mortality rates among twins and singletons were 91.0 and 41.1 per 1000 babies respectively, corresponding to a relative risk of 2.2 (95% confidence interval: 1.7-2.8). The birthweight distribution for twins was shifted to lower birthweights. Twins had a generally lower birthweight and an excess of extremely small births as compared to singletons. The increased mortality rate for twins appeared to be independent of birthweight. CONCLUSIONS: The two-fold increased risk of perinatal death for twins was observed across the whole birthweight distribution, and very small twins appeared to have an excess perinatal risk that was almost similar to that of larger twins.