Factors Associated with Maternal Mortality at the Gyneco-Obstetric and Pediatric Hospital of Yaounde

Abstract

Purpose: Our study aims at analyzing the factors associated with maternal mortality that occurred at the Gyneco-Obstetric and Pediatric Hospital of Yaounde (YGOPH) from the 1st January 2018 to the 31st December 2021.

Problem: WHO and UNICEF estimate that around half millions of women die every year, that is more than one woman die every minute from complications of pregnancy and delivery; almost 99% of these deaths occurred in developing countries [1]. Their statistics reveals that, the average risk for a woman of dying from complications linked to pregnancy and delivery is 300 times higher in developing countries than those in developed countries [1]. Out of Asia, Sub-Saharan Africa is the region of the world which scores the high rates of maternal deaths. These staggering figures show that maternal mortality is an urgent problem of public health in developing countries. Cameroon is one of the developing country who moved forwards in the fight against maternal deaths, but he still so far in the achievement of the Sustainable Development Goals (SDGs) which stipulate that the global maternal mortality ratio should be less than 70 per 100000 live births by 2030. For instance, the maternal mortality rate has dropped by 40% after 7 years, that was from 782 /100000 live births in 2011 to 406/100000 live births in 2018 [2]. Looking onto it, we realize unfortunately that 8 years are remaining to reach 2030, but yet the mortality rate is still far away to reach this target.

Moreover, a rapid evaluation of epidemiological progress in the Center region, specifically at YGOPH, a tertiary hospital and a reference center for maternal and child care showed a sudden rise in the maternal mortality ratio, that is from 6/100000 live births in 2018 to 7/100000 live births in 2021. This prompted the researcher to investigate on the situation in this heath institution.

Methods:  We conducted an analytical case control study with a retrospective data collection, using medical files of 210 participants (for 1 case, 2 survivors, totally 70 cases and 140 survivors). Data were collected using a questionnaire and analyzed with SPSS 25.0. A multivariate analysis was done to determine the independent factors associated with maternal mortality at YGOPH.

Results: Maternal mortality at YGOPH was explained by the followings: Hypertensive disorders (AHR=3.304; P-value=0.019; 95%; CI=[1.401; 5.020]), Co-morbidities (AHR=3.01; P-value = 0.003; 95%; CI= [2.059; 3.900]), mode of delivery (AHR=2.900; P-value=0.002; 95%; CI=[4.652; 8.549]), Postpartum hemorrhage (AHR=3.700; P-value = 0.011; 95%; CI= [1.730; 4.002]), Infections (AHR=9.489; P-value=0.004; 95%; CI=[3.552; 12.519]), Maternal cardiac arrest (AHR=16.000; P-value = 0.000; 95%; CI= [8.039; 79.510]), delay in decision making (AHR=3.015; P-value = 0.009; 95%; CI= [1.506; 7.010]), delay in reaching the heath facility (AHR=2.417; P-value = 0.009; 95%; CI= [1.152; 5.147]), delay in receiving treatment (AHR=2.931; P-value = 0.016; 95%; CI= [1.245; 3.538]), in-hospital patient circuit (AHR=1.710; P-value = 0.044; 95%; CI= [1.005; 3.455])) and health care management (AHR=4.810; P-value = 0.002; 95%; CI= [2.148; 10.043]).

Conclusion: The above results suggest the importance of adequate provision of care and proper follow-up of women by the qualified health professionals from pregnancy till the postpartum period. All these thanks to the harmonization in the health care system: that is through both an effective communication inside (in between services) and outside (in between health facilities) and a strong collaboration in between health professionals and their patients. This should be done consistently for a sustained effect.