Women are 75 times more likely to die as a result of pregnancy in sub-Saharan Africa than in developed regions. Reducing maternal mortality is therefore high on the international health agenda. But how effective are current efforts to improve maternal health in developing countries?

What factors cause and contribute to maternal mortality? How can they be more successfully addressed? A demographic study by the Medical Research Council Laboratories in rural Gambia suggest that maternal mortality ratios are often reduced following the introduction of better obstetric care. The authors also suggest further action to improve maternal survival.

A Primary Health Care programme was introduced into the study area in 1983 with a strong mother and child health component. Antenatal clinics were also well-established by this time. The researchers analysed all deaths among women aged 15 to 49 years in 40 rural villages and hamlets around Farafenni over a six year period. They used previous estimates of maternal mortality in the area from 1982-3 and 1984-7 for comparison.

Of the 79 deaths recorded, 18 were classified as maternal. This gives a maternal mortality ratio of 424 per 100,000 live births suggesting a major improvement over the last 15-20 years. The study also found that:

• Haemorrhage is the most common cause of death.
• The village with the highest mortality is the most isolated in the study area.
• The lack of blood transfusion services at the referral level may contribute to nearly a third of maternal deaths.
• Other contributory factors include a low standard of care for obstetric referrals, poor quality primary care and a delay in starting the decision-making process.

Maternal mortality rates have continued to fall since the start of the maternal programme in the Farafenni area. Despite this, they are still 50 times greater than those in industrialised nations. The authors recommend that health policy-makers attempting to reduce maternal mortality levels further should:

• consider the introduction of the drug misoprostol to prevent postpartum haemorrhage - if this is proven to be safe and effective it could greatly increase the safety of home births
• improve the effectiveness of anti-anaemia programmes by intensifying malaria-prevention efforts among pregnant women
• introduce campaigns to recruit more blood donors
• increase the accessibility and availability of high-quality essential obstetric services and primary healthcare
• implement community-based education to increase recognition of possible severe maternity problems and the need to take prompt action.

Source(s):
'Maternal mortality in rural Gambia: levels, causes and contributing factors' by G. Walraven, M. Telfer, J. Rowley and C. Ronsmans, Bulletin of the World Health Organisation 78 (2000)

Funded by: European Commission

id21 Research Highlight: 25 October 2002

Further Information:
Carine Ronsmans
Maternal Health Programme
Infectious Disease Epidemiology Unit
London School of Hygiene and Tropical Medicine
Keppel Street
London WC1E 7HT
UK

Tel: +44 (0) 207 927 2190
Fax: +44 (0) 207 299 4720
Contact the contributor: carine.ronsmans@lshtm.ac.uk

Medical Research Council Laboratories, Gambia

London School of Hygiene and Tropical Medicine, UK

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