Maternal mortality in Kassala State - Eastern Sudan: community-based study using Reproductive age mortality survey (RAMOS)
Maternal mortality in Kassala State - Eastern Sudan: community-based study using Reproductive age mortality survey (RAMOS)
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DOI：
10.1186/1471-2393-11-102
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发表时间：
2011-12-16
影响因子：
3.1
通讯作者：
Abdelfattah, Ahmed I.
中科院分区：
文献类型：
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作者：
Mohammed, Abdalla A.;Elnour, Mahgoub H.;Abdelfattah, Ahmed I.
背景：苏丹的孕产妇死亡率估计为每100,000名活产中有750人死亡。根据世界卫生组织(WHO)最近的一项估计，苏丹是造成全球孕产妇死亡65%的11个国家之一。在全国人口调查中，卡萨拉州的产妇死亡率很高。本研究旨在调查卡萨拉州孕产妇死亡的原因和影响因素，找出不同地区孕产妇死亡率和原因的差异。方法：采用育龄死亡率调查(RAMOS)对卡萨拉州孕产妇死亡率进行研究。结果：在3年的时间里，26066名育龄妇女中有168人死亡。其中148例(88.1%)进行了口头尸检。其中，(43.2%)为妊娠和分娩并发症。孕产妇死亡率和比率分别为80.6/10万活产和713.6/100,000活产。城乡孕产妇死亡率差异很大(分别为369和872/10万)。直接产科原因占死亡总数的58.4%。重度贫血(20.3%)和急性发热(9.4%)是孕产妇死亡的主要间接原因，产科出血(15.6%)、难产(14.1%)和产后败血症(10.9%)是主要产科原因。在影响因素中，我们发现73.4%的病例转介延迟，尽管问题识别率很高(75%)。67.2%的死亡发生在家里，表明卫生设施未得到充分利用，54.7%的死亡存在交通问题，死者及其丈夫的文盲率较高(分别为62.5%和48.4%)。结论：孕产妇死亡率和死亡率比例较高，城乡差异较大。产妇死亡的直接原因与发展中国家的类似。为了降低这一高孕产妇死亡率，我们建议改善所有卫生设施的紧急产科护理，扩大助产培训和覆盖面，特别是在农村地区。
Background: The maternal mortality ratio in Sudan was estimated at 750/100,000 live births. Sudan was one of eleven countries that are responsible for 65% of global maternal deaths according to a recent World Health Organization (WHO) estimate. Maternal mortality in Kassala State was high in national demographic surveys. This study was conducted to investigate the causes and contributing factors of maternal deaths and to identify any discrepancies in rates and causes between different areas.Methods: A reproductive age mortality survey (RAMOS) was conducted to study maternal mortality in Kassala State. Deaths of women of reproductive age (WRA) in four purposively selected areas were identified by interviewing key informants in each village followed by verbal autopsy.Results: Over a three-year period, 168 maternal deaths were identified among 26,066 WRA. Verbal autopsies were conducted in 148 (88.1%) of these cases. Of these, 64 (43.2%) were due to pregnancy and childbirth complications. Maternal mortality rates and ratios were 80.6 per 100,000 WRA and 713.6 per 100,000 live births (LB), respectively. There was a wide discrepancy between urban and rural maternal mortality ratios (369 and 872\100,000 LB, respectively). Direct obstetric causes were responsible for 58.4% of deaths. Severe anemia (20.3%) and acute febrile illness (9.4%) were the major indirect causes of maternal death whereas obstetric hemorrhage (15.6%), obstructed labor (14.1%) and puerperal sepsis (10.9%) were the major obstetric causes. Of the contributing factors, we found delay of referral in 73.4% of cases in spite of a high problem recognition rate (75%). 67.2% of deaths occurred at home, indicating under utilization of health facilities, and transportation problems were found in 54.7% of deaths.There was a high illiteracy rate among the deceased and their husbands (62.5% and 48.4%, respectively).Conclusions: Maternal mortality rates and ratios were found to be high, with a wide variation between urban and rural populations. Direct causes of maternal death were similar to those in developing countries. To reduce this high maternal mortality rate we recommend improving provision of emergency obstetric care (Emoc) in all health facilities, expanding midwifery training and coverage especially in rural areas.