Maternal mortality in the Thyolo District of southern Malawi

Abstract

The Sisterhood Method, a community-based survey technique, was used to estimate the Life Time Risk of a woman dying a maternal death in Southern Malawi. With this figure, the maternal mortality ratio for that area was calculated to be 409 deaths per 100,000 live births. The 4124 adults interviewed reported 150 maternal deaths in sisters. An in-depth questionnaire was then used to determine that 56% of these deaths occurred outside a health facility, largely due to lack of transportation or poor access to fixed health care facilities; 25% died from excessive hemorrhage; 20% from obstructed labour; 18% from abortion; 13% from sepsis; while eclampsia accounted for only 4% of the maternal deaths. This field experience with the Sisterhood Method technique combined with an in-depth questionnaire for determining causes of maternal deaths has provided useful information in a simple and cost-effective manner for use in planning intervention strategies designed to decrease maternal mortality.

PIP: In September 1989 in Thyolo district in southern Malawi, 5 field teams used the Sisterhood Method to interview 4124 people older than 15 in 7 traditional authorities to estimate the lifetime risk (LTR) of maternal death and the maternal mortality ratio (MMR) in this area. The teams also administered an in-depth questionnaire to respondents who knew about 140 of the 150 maternal deaths to determine the causes of maternal death. The LTR of maternal death stood at 1 in 36 (1/.0282). The MMR was 409/100,000 live births. 22% of all maternal deaths occurred within the last 5 years. The field team was able to accurately determine the cause of death in 98 (65%) cases. The leading causes of death were excess hemorrhaging (25%), obstructed labor (20%), abortion (18%), sepsis (13%), cesarean section (7%), and eclampsia (4%). 56% of all reported maternal deaths and 45% of maternal deaths within the last 5 years occurred outside a health facility. 99% of maternal death cases did not receive medical attention while their health deteriorated because the health facility was far away and therefore not accessible or there was no way to transport the women to the health facility. 87% of abortion-related deaths took place outside a health facility as did 67% of eclampsia cases, 56% of hemorrhage cases, 50% of obstructed labor cases, and 47% of sepsis cases. These findings should prove useful to community and health leaders in designing intervention strategies to reduce maternal mortality in the area. Further, key locations should have adequate transportation, e.g., bicycle ambulances of stretchers, to transport pregnant women to a primary or referral center.