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. 2022 Jul 22:12:04051.
doi: 10.7189/jogh.12.04051.

Why mothers die: Analysis of verbal autopsy data from Kersa Health and Demographic Surveillance System, Eastern Ethiopia

Merga Dheresa  1   2 , Tesfaye Assebe Yadeta  1 , Tariku Dingeta  3 , Hirbo Shore  3 , Yadeta Dessie  3 , Gamachis Daraje  2   4 , Abera Kenay Tura  1   5
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Why mothers die: Analysis of verbal autopsy data from Kersa Health and Demographic Surveillance System, Eastern Ethiopia

Merga Dheresa et al. J Glob Health. .

Abstract

Background: Despite registering tremendous improvement as part of the Millennium Development Goals, Ethiopia has still one of the highest numbers of maternal mortality. Although maternal mortality is one of the commonest indicators for comparison or measuring progress, its measurement remained a challenge. In a situation where, vital registration is not in place and only few women gave birth in facilities, alternative data sources from population-based surveys are essential to describe maternal deaths. In this paper, we reported estimates of maternal mortality and causes in a predominantly rural setting in eastern Ethiopia.

Methods: Data were used from the ongoing prospective open cohort of Kersa Health and Demographic Surveillance System (HDSS), located in eastern Ethiopia. At enrolment, detailed sociodemographic and household conditions were recorded for every member, followed by household visit every six months to identify any vital events: births, deaths, and migration. Whenever a death was reported, additional information about the deceased - age, sex, pregnancy status, and perceived cause of deaths - were collected through interview of the closest family member(s). Then, the probable cause of death was assigned using an automated verbal autopsy system (InterVA). In this paper, we included all deaths among women during pregnancy, childbirth or within 42 days of termination of pregnancy. To describe the trends, we calculated annual maternal mortality ratio (MMR) along with their 95% Confidence Interval (CI).

Results: From 2008 to 2019, a total of 32 680 live births and 720 deaths among reproductive age women were registered. Of the 720 deaths, 158 (21.9%) were during pregnancy or within 42 days of termination of pregnancy, corresponding with an MMR of 484 per 100 000 live births. The three leading causes of deaths were pregnancy related sepsis, obstetric haemorrhage and anaemia of pregnancy. There was non-significant reduction in the MMR from 744 in 2008 to 665 in 2019, with three lowest ratios recorded in 2013 (172 per 100 000 live births), 2009 (280 per 100 000 live births) and 2016 (285 per 100 000 live births).

Conclusions: There was no significant decrement of MMR during the study period. Most deaths occurred at home from pregnancy related sepsis and haemorrhage implicating the unfinished agenda of ensuring skilled delivery and appropriate postnatal management.

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Conflict of interest statement

Competing interests: The authors completed the ICMJE Unified Competing Interest form (available upon request from the corresponding author), and declare no conflicts of interest.

Figures

Figure 1
Figure 1
Trends in maternal mortality ratio from 2008 to 2019 in Kersa HDSS, Eastern Ethiopia. MMR – maternal mortality ratio
Figure 2
Figure 2
Percentage distribution of the top ten cause-specific mortality fractions as per the WHO 2012 VA cause of death categories in eastern Ethiopia (n = 158). CSMF – Cause Specific Mortality Fraction
See this image and copyright information in PMC

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