Operational factors affecting maternal mortality in Tanzania.

ABSTRACT

PIP: All 117 cases of maternal deaths in Ilala district, Dar es Salaam, during 1991-93 at all levels of care were investigated to identify the principal operational factors involved. 79% of the women received some medical care, while 11% arrived too late for treatment. In most cases, the husband or the mother of the woman decided upon her care when complications arose. That decision process combined with a lack of transportation to health care facilities often resulted in the delay of departure from home. Delay in the transfer from the district hospital was also common. Complications of abortion often were not managed in a timely manner due to the delay in reporting to the hospital or the reporting of misleading information. Suboptimal care was identified in 77% of cases reaching health care, with inadequate treatment identified by the district health staff in 61% of cases and by the referral centers in 12% of their cases. Erroneous decisions made at the district level and the lack of equipment at referral centers were the main reasons for inadequate care. Community education on potential danger signs in pregnancy and labor is needed, together with the provision of the necessary resources and supplies for emergency obstetric interventions, as well as clear protocols for management and referral. Study findings are based upon the review of hospital records and interviews with family members and health care staff.