Maternal mortality at muhimbili national hospital in Dar-es-Salaam, Tanzania in the year 2011
Maternal mortality at muhimbili national hospital in Dar-es-Salaam, Tanzania in the year 2011
复制标题
DOI：
10.1186/1471-2393-14-320
复制
发表时间：
2014-09-13
影响因子：
3.1
通讯作者：
van Roosmalen, Jos
中科院分区：
文献类型：
--
作者：
Pembe, Andrea B.;Paulo, Chetto;van Roosmalen, Jos
背景：改善产妇保健是2000年千年首脑会议通过的八项千年发展目标之一。在这一框架内，国际社会承诺在1990年至2015年期间将孕产妇死亡率降低75%。这项研究的目的是确定坦桑尼亚达累斯萨拉姆Muhimbili国立医院（MNH）的产妇死亡率，对产妇死亡原因进行分类，并评估护理不合格的因素。方法：对2011年1月1日至12月31日发生的所有孕产妇死亡病例进行回顾性分析。结果：有10,057例活产，155例产妇死亡，因此产妇死亡率为每100,000例活产1,541例。产妇死亡的直接原因占产妇死亡的69.5%。在直接原因中，子痫前期/子痫是主要原因（占所有死亡的19.9%），其次是产后出血（14.9%）、流产并发症（9.9%）和败血症（9.2%）。在间接原因中，贫血是所有死亡的主要原因（11.3%），其次是艾滋病毒/艾滋病（9.9%）。在所有病例中，116例（82.3%）确定了导致死亡的不合格护理因素。其中仅存在患者因素的有28例，存在医疗服务因素的有71例，同时存在患者和医疗服务不良因素的有17例。来自妇女方面的常见因素包括寻求护理的延迟（73.3%）和完全缺乏产前护理（11.1%）。在医疗服务因素中，输血不足（26.1%）或无血（19.3%）、延误治疗（18.3%）和管理不善（17%）是常见的因素。结论：妇产医院产妇死亡率高。妊娠高血压疾病、产后出血和贫血是该机构产妇死亡的主要原因。在个人和保健服务水平上发现了导致产妇死亡的多种不合格护理因素。有必要加大努力，减少该机构的产妇死亡率。需要该地区的转诊机构发挥更积极主动的作用。
Background: Improving maternal health is one of the eight millennium development goals adopted at the millennium summit in the year 2000. Within this frame work, the international community is committed to reduce the maternal mortality ratio by 75% between 1990 and 2015. The objective of this study was to determine the maternal mortality ratio, classify causes of maternal deaths and assess substandard care factors at Muhimbili National Hospital (MNH), Dar-es-Salaam in Tanzania.Methods: A retrospective review of all maternal death records of cases that occurred from 1st January to 31st December 2011 was done.Results: There were 10,057 live births, 155 maternal deaths and hence MMR of 1,541 per 100,000 live births. Direct causes of maternal deaths were classified in 69.5% of the maternal deaths. Of the direct causes, preeclampsia/eclampsia was the major cause (19.9% of all deaths), followed by post partum haemorrhage (14.9%), abortion complications (9.9%) and sepsis (9.2%). Among the indirect causes anaemia was the leading cause (11.3%) of all deaths, followed by HIV/AIDS (9.9%). Substandard care factors contributing to deaths were identified in 116 (82.3%) of all cases. Among these 28 had patient factors only, 71 medical service factors while 17 had both patient and medical service substandard care factors. The common factors from the woman's side included delay in seeking care (73.3%) and complete lack of antenatal care (11.1%). Of the medical service factors, inadequate (26.1%) or no blood for transfusion (19.3%), delay in receiving treatment (18.3%) and mismanagement (17%) were the common factors.Conclusion: There is a high maternal mortality ratio at MNH. Hypertensive disorders of pregnancy, post partum haemorrhage and anaemia are the leading causes of maternal deaths in this institution. Multiple substandard care factors identified both at individual and health care service levels that contributed to maternal deaths. There is a need for increasing efforts in the fight to reduce maternal deaths at the institution. A more pro-active role from the referring facilities in the region is needed.