Maternal mortality in a teaching hospital in Sudan

OBJECTIVE: Although there is a great advances in obstetrics in recent years, a hard core of maternal mortality still lingers and is considered to be an irreducible minimum. Nevertheless there has been worldwide decline in maternal mortality over the past decades. Yet maternal mortality is still the major public health problem throughout the world.

METHODS: A retrospective study carried out at the Medani Teaching Hospital, Medani City, Sudan. Case notes were reviewed for all the 877 women died during the period 1985-1999. All parturients were followed for at least 6 weeks after delivery so that deaths due to sequel of delivery and puerperium were also included. The data was analyzed and the literature was reviewed to compare the results of similar studies.

RESULTS: Out of the total number of deliveries in that period (N = 44,605), 877 women died with a rate of 1,966 per 100,000. This rate showed a decline each year, being 2,661 per 100,000 during the period 1985-1989. The mortality rate during 1990-1994 was 2,021 per 100,000 and 1,363 per 100,000 during the last period of 1995-1999. Sepsis was the cause of death in almost one third of cases, while malaria accounted for 37.2%. The number of preventable deaths had decreased steadily.

CONCLUSION: The study highlighted the existence of a serious and preventable obstetrical problem. Sepsis, malaria hemorrhage and hypertensive disorders are the main contributory factors. Poor antenatal care, poor intranatal care, and poor provision of health services add more to the problem. Research into the problem of malaria, sterilization, anesthesia, vascular accidents, and indication for cesarean section together with social and medical improvements will definitely reduce the maternal morbidity and mortality.