Risk factors for maternal mortality: a case-control study in Dakar hospitals (Senegal).
Risk factors for maternal mortality: a case-control study in Dakar hospitals (Senegal).
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DOI：
10.2307/3583271
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发表时间：
1997-03-01
影响因子：
1
通讯作者：
Correa, P
中科院分区：
文献类型：
--
作者：
Garenne, M;Mbaye, K;Correa, P
这项研究在塞内加尔首都达喀尔的三家主要医院进行。在12个月期间确定的152例产妇死亡病例中，每例都与两个对照组相匹配：在同一诊所安全分娩，在同一居住区安全分娩。对照组在年龄、出生顺序、地点和分娩时间上相匹配。死亡的主要原因是：产后败血症和其他感染（51例）、出血（32例）、子痫（29例）、子宫破裂（11例）和贫血（7例）。病例对照研究的结果显示，与卫生系统故障相关的主要危险因素包括：医疗设备故障（OR = 55.0）、转诊延迟（OR = 23.2）、缺乏产前访视（OR = 16.9）和入院时缺乏可用人员（OR = 6.6）。入院时母亲状况的各种指标（并发症、血压、体温、水肿、血红蛋白水平）和入院前的健康史（既往并发症、既往剖腹产、缺乏治疗）也是生存率的强预测因素。最后，社会人口学因素也与孕产妇死亡率相关，特别是：首次怀孕（OR = 2.3），怀孕的高出生顺序（OR = 1.9），雨季（OR = 2.4），未婚（OR = 2.5），低教育水平（OR = 1.6）。对政策的影响进行了讨论。
This study was conducted in the three main hospitals of Dakar, the capital city of Senegal. Each case of 152 maternal deaths identified over a 12-month period was matched with two controls: a safe delivery in the same clinic, and a safe delivery in the same neighbourhood of residence. Controls were matched on age, birth order, place, and time of delivery. The leading causes of death were: puerperal sepsis and other infections (51 cases), haemorrhage (32 cases), eclampsia (29 cases), ruptured uterus (11 cases), and anaemia (7 cases). Results of the case-control study revealed the major risk factors associated with health system failures: medical equipment failure (odds ratio [OR] = 55.0), late referral (OR = 23.2), lack of antenatal visit (OR = 16.9), and lack of available personnel at time of admission (OR = 6.6). Various indicators of maternal status at time of admission (complications, blood pressure, temperature, oedema, haemoglobin level) and of health history prior to admission (previous complications, previous C-section, lack of treatment) were also strong predictors of survival. Lastly, socio-demographic factors also appeared as correlates of maternal mortality, in particular: first pregnancy (OR = 2.3), pregnancy of high birth order (OR = 1.9), rainy season (OR = 2.4), being unmarried (OR = 2.5), and low level of education (OR = 1.6). Implications for policy are discussed.