Factors associated with maternal deaths among women with severe pregnancy complications in Malawi: a case of Mangochi District

Abstract

Maternal deaths remain a major health issue in low and middle-income countries. These deaths have a direct impact on the wellbeing of the family members especially infants. Addressing the issues that contribute to the occurrence of maternal deaths can help to reduce their incidence and prevalence. The purpose of this study was to assess the factors associated with facility based maternal deaths among women with severe pregnancy complications in Mangochi district, Malawi. A total of 332 case notes were included in the study between January 2016 and December 2017 preceeding the study. Controls were selected based on WHO maternal near miss criteria that uses clinical criteria, laboratory-based criteria and management-based criteria. A questionnaire was used to extract data from patient records and the analysis was made using frequency distribution, McNemar chi-square statistic and logistic regression. The level of significance was established at 95% confidence level. In the results, majority of maternal deaths and near misses resulted from heamorrhage (36.3%) followed by pre-eclampsia (21.5%), sepsis (11.7%), ruptured uterus (9.0%%) and abortion (2.4%). Maternal deaths were predicted by individual factors (OR:4.17, CI: 1.08-15.71) such as delay in decision making and failure to recognise danger signs; and health systems factors (OR:6.59, CI: 3.31 - 13.14) such as lack of blood transfusion services, transport problem between health facilities, lack of essential obstetric drugs, delay in deciding to refer, inadequate monitoring and incomplete initial assessment. In conclusion, maternal deaths were more likely to occur among mothers who experienced delays at individual level and at health facility level. Therefore, the study recommends the necessity of empowering women by giving maternal health information so that they can be able to make informed decisions, sensitizing the community on blood donation, provision of ambulances to the district to ease the referral system, strengthening the supply chain system to make sure that all obstetric drugs and supplies are readily available in health facilities.