Maternal deaths in South Africa
AbstractData collection for the triennium 1999-2001 was much improved from the 1998 report. There has been a change in the pattern of maternal deaths, with AIDS becoming the leading cause among the notified deaths. The deficiency of the health information system makes it impossible to determine the total number of live births, and thus it is not possible to compute the Maternal Mortality Ratio. The data has also no been subjected to statistical analysis. The “big five” causes of death are non-pregnancy related infections (mainly AIDS), complications of hypertension in pregnancy, obstetric haemorrhage, pregnancy-related sepsis and pre-existing medical conditions. Women 35 years and older were at greater risk of dying than younger women, and women in their first pregnancy or with 5 or more pregnancies were also at greater risk. The proportion of the various causes of maternal deaths varied between the
levels of care. Obstetric haemorrhage was the most common cause of death at level 1 hospitals, whereas AIDS was at level 2 hospitals and hypertension at level 3 hospitals. The vast majority of anaesthetic deaths occurred at level 1 hospitals. Non-attendance and delayed attendance at the health institutions were the most common patient orientated problems. Poor transport facilities and a lack of intensive care facilities were the major administrative problems. Problems in the care of women occurred in more than half the cases of maternal deaths, the majority occurring at primary level of care. Poor initial assessment and misdiagnosis of cases especially at primary level of care, failure to follow standard protocols at primary and secondary levels and poor monitoring of patients at all
levels of care were the common health worker related problems. Ten key recommendations have been made by the NCCEMD that address some of these problems and each if implemented should result in a reduction of maternal deaths.