Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Apr 9;14(4):e0214807.
doi: 10.1371/journal.pone.0214807. eCollection 2019.

Patterns and causes of hospital maternal mortality in Tanzania: A 10-year retrospective analysis

Veneranda M Bwana  1 , Susan F Rumisha  2 , Irene R Mremi  2   3 , Emanuel P Lyimo  2 , Leonard E G Mboera  2   3
Affiliations

Patterns and causes of hospital maternal mortality in Tanzania: A 10-year retrospective analysis

Veneranda M Bwana et al. PLoS One. .

Abstract

Background: Maternal mortality is among the most important public health concerns in Sub-Saharan Africa. There is limited data on hospital-based maternal mortality in Tanzania. The objective of this study was to determine the causes and maternal mortality trends in public hospitals of Tanzania from 2006-2015.

Methods and findings: This retrospective study was conducted between July and December 2016 and involved 34 public hospitals in Tanzania. Information on causes of deaths due to pregnancy and delivery complications among women of child-bearing age (15-49 years old) recorded for the period of 2006-2015 was extracted. Data sources included inpatient and death registers and International Classification of Disease (ICD)-10 report forms. Maternal deaths were classified based on case definition by ICD 10 and categorized as direct and indirect causes. A total of 40,052 deaths of women of child-bearing age were recorded. There were 1,987 maternal deaths representing 5·0% of deaths of all women aged 15-49 years. The median age-at-death was 27 years (interquartile range: 22, 33). The average age-at-death increased from 25 years in 2006 to 29 years in 2015. Two thirds (67.1%) of the deaths affected women aged 20-34 years old. The number of deaths associated with teenage pregnancy (15-19 years) declined significantly (p-value<0·001) from 17.8% in 2006-2010 to 11.1% in 2011-2015. The proportion of deaths among 30-34 and 35-39 years old (all together) increased from 13% in 2006-2010 to 15·3% in 2011-2015 (p-value = 0.081). Hospital-based maternal mortality ratio increased from 40.24 (2006) to 57.94/100000 births in 2015. Of the 1,987 deaths, 83.8% were due to direct causes and 16.2% were due to indirect causes. Major direct causes were eclampsia (34.0%), obstetric haemorrhage (24.6%) and maternal sepsis (16.7%). Anaemia (14.9%) and cardiovascular disorders (14.0%) were the main indirect causes. Causes of maternal deaths were highly related; being attributed to up to three direct causes (0.12%). Cardiovascular disorders and anaemia had strong linkage with haemorrhage. While there was a decline in the number of deaths due to eclampsia and abortion, those due to haemorrhage and cardiovascular disoders increased during the period.

Conclusions: During the ten year period (2006-2015) there was an increase in the number of hospital maternal deaths in public hospitals in Tanzania. Maternal deaths accounted for 5% of all women of child-bearing age in-hospital mortalities. Most maternal deaths were due to direct causes including eclampsia, haemorrhage and sepsis. The findings of this study provide evidence for better planning and policy formulation for reproductive health programmes to reduce maternal deaths in Tanzania.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Percentage of birth, total women deaths and hospital maternal deaths by age category (Total women hospital deaths = 40,052; Hospital maternal deaths = 1,987).
Fig 2
Fig 2
The percentage of hospital maternal associated deaths (A) and percentage of total women in-hospital deaths (B) by age category.
Fig 3
Fig 3. Proportion of all maternal related deaths by age comparison between 2006–2010 and 2011–2015 (2006–2010: n = 755; 2011–2015:n = 1,235).
Fig 4
Fig 4. Annual crude birth rate per 1000 people and hospital-based MMR per 100,000.
Fig 5
Fig 5. Age-specific hospital-based maternal mortality rates, 2006–2015.
Fig 6
Fig 6. The proportion of major direct and indirect causes of maternal deaths, 2006–2015 (n = 1,987).
Fig 7
Fig 7
The relationship between main causes of maternal deaths indicating A) individual level network, B) related causes with no direction and C) related causes with direction.
Fig 8
Fig 8. Comparison of the proportion of all major causes of maternal related deaths between the 2006–2010 and 2011–2015 periods (2006–2010: n = 755; 2011–2015:n = 1,235).
Fig 9
Fig 9. The trend of the major causes of maternal death over the 10 year period, 2006–2015.
Fig 10
Fig 10. Percentage distribution for mortality patterns by age and geographical area comparing 2006–2010 and 2011–2015 (n = 1,987).
Fig 11
Fig 11. The distribution of major causes of maternal deaths by zone (n = 1,987).
See this image and copyright information in PMC

References

    1. Alkema L, Chou D, Hogan D, Zhang S, Moller AB, Gemmill A, et al. Global, regional, and national trends in maternal mortality between 1990–2015 with scenario based projections to 2013: a systematic analysis by the UN Maternal Mortality Estimation Interagency Group. Lancet 2016; 387: 462–474. 10.1016/S0140-6736(15)00838-7 - DOI - PMC - PubMed
    1. World Health Organization. Trends in Maternal Mortality: 1990–2015. Estimates by WHO, UNICEF, UNFPA, World Bank Group and United Nations 2015, World Health Organization. Available from: http://www.who.int/reproductivehealth/publications/monitoring/maternal-m... (cited 15 May 2018)
    1. Tanzania Demographic and Health Survey and Malaria Indicator Survey. Ministry of Helath, Community Development, Gender, Elderly and Children (Tanzania Mainland), Ministry of Health (Zanzibar), National Bureau of Statistics, Office of the Chief Government Statistician, and ICF 2016. Dar es Salaam, Tanzania and Rockville, Maryland, USA.
    1. Shija A, Msovela J, Mboera LEG. Maternal mortality in fifty years of Tanzania independence: challenges and opportunities of reducing maternal mortality. Tanzania J Health Res 2011; 13: 352–364. - PubMed
    1. Mboera LEG, Ipuge Y, Kumalija J, Rubona J, Perera S, Masanja H. et al. Mid-term review of national health plans: an example from the United Republic of Tanzania. Bull Wld Health Organ 2015; 93: 271–278. - PMC - PubMed

Publication types