Risk Factors for Maternal Mortality: a Case-Control Study in Dakar Hospitals (Senegal)

Michel Garenne, Khadidiatou Mbaye, Mohamed Diawo Bah, Paul Correa

Abstract

This study was conducted in the three main hospitals of Dakar, the capital city of Senegal. Each case of 152 maternal deaths identified over a 12-month period was matched with two controls: a safe delivery in the same clinic, and a safe delivery in the same neighbourhood of residence. Controls were matched on age, birth order, place, and time of delivery. The leading causes of death were : puerperal sepsis and other infections (51 cases), haemorrhage (32cases), eclampsia (29 cases), ruptured uterus (11 cases), and anaemia (7 cases). Results of the case-control study revealed the major risk factors associated with health system failures: medical equipment failure (odds ratio fOR] = 55.0), late referral (OR 23.2), lack of antenatal visit (OR = 16.9), and lack of available personnel at time of admission (OR = 6.6). Various indicators of maternal status at time of admission (complications, blood pressure, temperature, oedema, haemoglobin level) and of health history prior to admission (previous complications, previous C-section, lack of treatment) were also strong predictors of survival. Lastly, socio-demographic factors also appeared as correlates of maternal mortality, in particular: first pregnancy (OR = 2.3), pregnancy of high birth order (OR = 1.9), rainy season (OR = 2.4), being unmarried (OR 2.5), and low level of education (OR = 1.6). Implications for policy are discussed. (AfrJ Rep rod Health 1997;l(1):14—24)

KEY WORDS: Maternal mortality, cause of death, risk factors, case-control study, health system, Senegal, Africa

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