Assessing risk factors of maternal mortality using community based maternal death review in Koinadugu District, Sierra Leone Público

Abstract

Assessing risk factors of maternal mortality using community based
maternal death review in Koinadugu District, Sierra Leone

By André Gilbert Boredison
Background:
The 5th Millennium Development Goal (MDG) aspires to reduce by 3/4 the maternal
mortality ratio (MMR) by 2015. Each day about 1000 women die worldwide because of
complications related to pregnancy and childbirth. Developing countries account for 99% of the
deaths and have the highest MMR. The vast majority of these deaths would be avoidable if their
causes were known. In the absence of good vital registration, measuring causes of maternal
mortality is a challenge for most developing countries. Many tools, including maternal
death review and verbal autopsy, have been used to determine the causes of maternal mortality.
Objective:
This study aims to assess predictors and risk factors of maternal mortality among women in
Koinadugu District using the community-based maternal death review model.
Methods:
Verbal autopsy was used for collecting data at seven chiefdoms. Primary data were obtained through the interviews with the relatives of the deceased.
Secondary data were obtained by reviewing maternity records at primary health units. Inclusion
and exclusion criteria were based on the level of involvement of the respondents in providing
care during pregnancy, delivery, and after delivery.
Results:
82 maternal deaths were investigated. 48.8% were attributed to direct causes and 42.7% to
indirect causes. Hemorrhage (29.3%), eclampsia (12.2%), and anemia (37.8%) were identified as
the main causes of deaths. 52.9% of the deceased women were younger than 25 years old and the
age range was between 13 and 42 years old. The majority of the deaths (89%) occurred from the
third trimester of pregnancy to up to 42 days after birth. The 4 delays were the non-clinical
causes of maternal death: recognizing the problem, decision making about seeking medical care,
reaching the health care facility, and receiving prompt and appropriate care at the health facility.
Discussion:
This study provides reliable information about maternal death in Koinadugu district. The study
reveals the challenges in measuring the cause of maternal mortality in community-based
maternal death review. The lack of a second interviewer and a cause-of-death classification
system are the major limitations of the study.

Table of Contents

I .Introduction .........................................................................................................1

II .Literature review...................................................................................................6

III .Methods ............................................................................................................19

A. Introduction ................................................................................................19

B. Study Population ..........................................................................................19
C. Study design ...............................................................................................21
D. Data collection ............................................................................................21
E.Data analysis ................................................................................................27

IV .Results ..............................................................................................................28

Aim # 1: Identifying the risk factors contributing to maternal death ...........................28

Aim # 2: Assessing Non-clinical causes for maternal deaths: the 4 delays ...................34

Aim # 3: Assessing reliability of the methods .........................................................38

V .Discussion ...........................................................................................................44

VI .Recommendations ................................................................................................48

VII.Conclusion ..........................................................................................................50

Appendices ..............................................................................................................51

References ..............................................................................................................73

About this Master's Thesis

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• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Epidemiology
Palabra Clave	community-based maternal death review, Sierra Leone Maternal mortality, verbal autopsy, maternal death review
Committee Chair / Thesis Advisor	McFarland, Deborah A, Emory University
Partnering Agencies	International Non-governmental organization (e.g., CARE, Inc.)

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