Factors Associated with Maternal Deaths in Cotonou Hospitals, Benin
DOI:
https://doi.org/10.26911/thejmch.2023.08.06.07Abstract
Background: Maternal mortality remains a major public health issue in Benin. This study aimed to determine the hospital-based maternal mortality ratio and factors related with maternal deaths.
Subjects and Method: We conducted a case-control study over two years from 1st January 2020 to 31 December 2021 in four Cotonou hospitals. It included 264 maternal deaths (case) matched to 264 controls by delivery mode. The dependent variable was the status at discharge. Independent variables included socio-demographic characteristics, gyneco-obstetric information, medical and gynecologic history as well as type of complications. Univariate and multivariate analysis were performed to identify the factors associated with maternal deaths.
Results: The hospital-based maternal mortality ratio was 1403 deaths per 100,000 live births. Age superior than or equal to 30 years old (OR= 3.09; 95% CI= 1.52 to 6.41; p=0.002), admission by a referral from public health facility (OR=4.26; 95% CI= 2.60-7.10; p<0.001) or private health facility (OR= 4.52; 95% CI= 2.49-8.38 ; p<0.001); parity between 1 and 3 (OR=2.72; 95% CI= 1.27 to 6.15; p= 0.012), gestational age less than or equal to 31 weeks (OR=3.77; 95% CI= 2.13 to 6.84 ; p<0.001) and the occurrence of non-infectious (OR= 1.94; 95% CI= 1.27 to 2.97; p= 0.002) and fetal complications (OR= 1.98; 95% CI= 1.13 to 3.54; p=0.018) were the factors associated to maternal deaths.
Conclusion: Strengthening policies aiming to increase access to modern methods of contraception and safe abortion, improving the referral system, and implementing multifaceted contextualized interventions could contribute to reducing maternal mortality.
Keywords: maternal death, maternal mortality, associated factors, Benin.
Correspondence:Gottfried Agballa. Department of Public Health; Faculty of Health Sciences, University of Abomey-Calavi, Benin and Department of Biostatistics, Epidemiology, Population and Diseases Control; Centre de Recherche en Reproduction Humaine et en Démographie, Benin. Email: gottfried.agballa@yahoo.fr Telephone number: +22995278136
References
Aboubakar M, Akodjenou J, Echoudina C, Ahounou E, Biaou C O A, Zoumenou E (2021). Maternal Mortality at the Teaching Hospital of Mother and Child Lagoon (CHUMEL) in Benin: A Preventable Drama? Open Journal of Obstetrics and Gynecology. 11(03): 315–325. doi: 10.4236/ojog.2021.113-032.
Atade RS, Hounkponou NAFM, Obossou AAA, Gabkika BM, Doha ISM, Sidi RI, Vodouhe VM et al (2021). Facteurs associes aux déces maternels à l’hôpital de zone Saint Jean de Dieu de Tanguieta De 2015 à 2019. European Scientific Journal. 17(29) : 93–105. doi : 10.19044/esj.2021.v17n29p93.
Bauserman M, Thorsten VR, Nolen TL, Patterson J, Lokangaka A, Tshefu A, Patel AB et al. (2020). Maternal mortality in six low and lower-middle income countries from 2010 to 2018: risk factors and trends. Reproductive Health. 17. doi:10.1186/s1297802000990z
Dindi NP, Godia P, Allott H, Ameh C (2020). Risk factors for maternal mortality among women who had a caesarean section delivery in Kenya: A case-control study. East African Medical Journal. 97(8) .
Ezegwui H, Onoh R, Ikeako L, Onyebuchi A, Umeorah J, Ezeonu P, Ibekwe P (2013). Investigating Maternal Mortality in a Public Teaching Hospital, Abakaliki, Ebonyi State, Nigeria. Annals of Medical and Health Sciences Research. 3(1): 75-80. Doi: 10.4103/21419248.109511.
Fawole AO, Shah A, Fabanwo AO, Adegbola O, Adewunmi AA, Eniayewun AB, Dara K, et al. (2012). Predictors of maternal mortality in institutional deliveries in Nigeria. African Health Sciences, 12(1): 32–40.
Horwood G, Opondo C, Choudhury SS, Rani A, Nair M (2020). Risk factors for maternal mortality among 1.9 million women in nine empowered action group states in India: secondary analysis of Annual Health Survey data. BMJ Open. 10(8): e038910. doi: 10.1136/bmjopen2020038910.
Institut National de la Statistique et de l’Analyse Économique et ICF (2019). Enquête Démographique et de Santé 2017-2018, Bénin. Cotonou, Bénin et Rockville, Maryland, USA.
Institute for Health Metrics and Evaluation (2023). Retrieved from: https://vizhub.healthdata.org/gbdcompare/
Lawrence ER, Appiah-Kubi A, Lawrence HR, Lui MY, Owusu-Antwi R, Konney T, Moyer CA (2022). “There is no joy in the family anymore”: a mixed-methods study on the experience and im-pact of maternal mortality on families in Ghana. BMC Pregnancy and Childbirth. 22(1). doi: 10.1186/s12884022050061
Ministère de la Santé du Bénin (2021). Rapport annuel de la surveillance des décès maternels/néonatals et riposte au Bénin en 2020. Cotonou. 95p.
Ministère de la Santé du Bénin (2022) Rapport annuel de la surveillance des décès maternels/néonatals et riposte au Bénin en 2021. Cotonou. 95p.
Ntoimo LF, Okonofua FE, Ogu RN, Galadanci HS, Gana M, Okike ON, Agholor KN et al (2018). Prevalence and risk factors for maternal mortality in referral hospitals in Nigeria: a multicenter study. Int J Women’s Health. 10: 69–76. doi: 10.2147/IJWH.S151784
Ouédraogo AM, Ouédraogo HG, Baguiya A, Millogo T, Somé A, Kouanda S (2016). A case-control study of risk factors for maternal mortality in Burkina Faso in 2014. Int J Gynecol Obstet. 135(S1): S79–S83. doi: 10.1016/j.ijgo.2016.08.015
Pande RP, Ogwang S, Karuga R, Rajan R, Kes A, Odhiambo FO, Laserson K et al. (2015). Continuing with ...a heavy heart Consequences of maternal death in rural Kenya. Reproductive Health, 12(1): S2. doi: 10.1186/1742475512S1S2
Rafamatanantsoa JF, Razafindraibe AF, Rakotondraisoa JM, Rakotonirina ELCJ, Andrianampanalinarivo HR, Ranjalahy Rasolofomanana J (2017). Facteurs de risque de décès maternels au Centre Hospitalier de référence de district Itaosy (Antananarivo). Journal malgache de Gynécologie-obstétrique. 1 : 11–15.
Sonneveldt E, Decormier Plosky W, Stover J (2013). Linking high parity and maternal and child mortality: What is the impact of lower health services coverage among higher order births? BMC Public Health. 13 (3):S7. doi: 10.1186/1471245813S3S7
Stabnick A, Yeboah M, Arthur-Komeh J, Ankobea F, Moyer CA, Lawrence ER (2022). Once you get one maternal death, it’s like the whole world is dropping on you: experiences of managing maternal mortality amongst obstetric care providers in Ghana. BMC Pregnancy and Childbirth, 22(1):206. doi: 10.1186/s1288402204535z
Thiam M, Dieme M, Gueye L, Niane S, Niang M, Mahamat S, Gueye S (2017). Mortalité maternelle au Centre Hospitalier Régional de Thiès : étiologies et facteurs déterminants, à propos de 239 décès. J de la SAGO. 18(1):34-39.
World Health Organization (2023). Trends in Maternal Mortality: 2000 to 2020. Estimates by WHO, UNICEF, UNFPA, World Bank Group and the UNDESA/ Population Group.
Zamané H, Sow HE, Kain DP, Bicaba BW, Kiemtoré S, Yameogo I, Bonané-Thieba B et al. (2018). Maternal Mortality at the Dori Regional Hospital in Northern Burkina Faso, 2014-2016. Int J MCH and AIDS, 7(2): 235–241.
