Prevalence and Causes of Neonatal Mortality at Chu-Mel, Cotonou in 2023

Introduction: Neonatal mortality represents a global health problem that has been at the core of programs developed by the World Health Organization (WHO) for more than 30 years. In our country, it represents a real scourge and remains high despite the efforts made by the Ministry of Health. The goal of this study was to investigate the prevalence and causes of neonatal mortality at CHU-MEL of Cotonou in 2023. Material and Methods: This was a cross-sectional and descriptive study with retrospective data collection, carried out in the neonatology unit of the Mother and Child Teaching Hospital of Lagune (CHU-MEL) in Cotonou over a period of six months from January 1, 2023 to June 30, 2023. All neonates, premature or full-term, born alive and who died during hospitalization in the unit were included. Results: 211 cases of neonatal deaths were recorded among the 2884 neonates hospitalized in the unit during the study period, representing a hospital prevalence of 7.31%. Early neonatal mortality represented 81.5% of cases. The average age at admission was 4.6 days ± 5.3. The average weight of deceased neonates was 1609.08 ± 798.35 g. The most frequent reasons for hospitalization were represented by prematurity (60.66%) and respiratory distress (23.22%), respectively. Prematurity was the leading cause of neonatal mortality (41.7%), followed by neonatal infections (29.4%) and perinatal asphyxia (10.9%). Conclusion: The prevalence of neonatal mortality in the neonatology unit of CHU-MEL is high. Efforts to improve the quality of perinatal care departments must be intensified to reduce this prevalence.

Perinatal Morbidity, Mortality, and Neurodevelopmental Outcomes of Neonates with Fetal Growth Restriction

Objective: This study aimed to assess perinatal morbidity, mortality rates, and neurodevelopmental outcomes in the management of fetal growth restriction (FGR) at a single tertiary institute. Methods: Among 2465 deliveries between 2013 and 2019, 109 cases of FGR were reviewed retrospectively for causes, indications for pregnancy termination, perinatal death, overall neonatal outcomes, and long-term prognosis. Results: Excluding FGR due to congenital anomalies (n = 17), the mortality rate was 3.3% (3/92). One neonate delivered at 23 weeks developed cerebral palsy (1.1%). Retinopathy of prematurity occurred in four neonates (4.3%). Neurodevelopmental disorders were present in six neonates (6.5%), all of whom were delivered at 32 - 38 weeks. Significantly lower gestational age at delivery, lower birth weight, and higher umbilical artery resistance indices were observed in neonates with neurodevelopmental disorders. Conclusions: Intact survival before 27 weeks of gestation at delivery with FGR is uncommon. Neurodevelopmental disorders may still develop after delivery at 32 - 38 weeks;consideration should be given to the timing of delivery usingfetal ductus venosus Doppler waveforms measurements to reduce neurodevelopmental disorders.

Excess mortality in Northeast Iran caused by COVID-19:Neglect of offset community transformations of health

Objective:To make evidence-based decisions based on broad mortality trends for Razavi Khorasan province,Iran.Methods:In order to determine the baseline number of deaths,we used univariate time series analyses for monthly data from the monthly vital statistics reports(From April 2015 to March 2022).For excess mortalities,these baselines were subtracted from reported deaths with a 95%prediction interval.To compare time and causes,a P-score was calculated.Results:From March 2020 to March 2022,there were 61949 registered deaths,and the estimated deaths with a 95%confidence interval(CI)were 43246.16(35718.28,50774.05).So,in 2020-2021 and 2021-2022,the death counts were 35.15%and 51.33%higher than projected.A total of 18666 cardiovascular diseases were reported and a total of 15704.46(12006.95,19401.96)was estimated.The P-score for this duration was 14.49%and 23.23%higher than expected.Infectious and parasitic diseases plus COVID-19 were 16633 and estimated to be 1044.87(456.77,1632.96).A total of 4420 diseases of the respiratory system were reported,and 4564.94 deaths were predicted(2277.43,6852.43).In the first year of the pandemic,the P-score dropped to-35.28%and in the second year,it jumped sharply to 22.38%.Conclusions:Excess mortality,along with cause-specific mortality,can be helpful for monitoring trends and developing public health policies at the local,national,and international levels.

Study of Mortality and Causes of Death in the Service of Stomatology, Maxillofacial and Plastic Surgery of the Face at Cocody Teaching Hospital (RCI)

Introduction: The study of mortality is an indicator that allows a control and a review of the therapeutic measures in the hospital environment. The purpose of this work was to determine the epidemiological profile of the patients who died and analyse the circumstances of the death in a hospital service. Material and Methods: It is a retrospective descriptive study conducted in the service of Stomatology, maxillofacial and plastic surgery of the face over a period of 10 years (from January 1999 to December 2008). Seventy-two cases have been taken into account. Results: The crude death rate was 4.29%. Higher level of male has been noted with a sex ratio of 1.77. The most affected age groups were the 3rd and 2nd decades, respectively with 20.8% and 19.4% with an average age of 39 years. Cellulitis of the face and their complications were responsible for deaths in 58.33% of cases. The majority of deaths occurred between 6 p.m. and 6 a.m. (65.28%). These deaths were preventable in 5.6% of cases. Conclusion: Facing the lack of description of the ultimate circumstances of death in the medical records, the conclusion of this study has been the establishment of a regular medical audit in the service, which would track mortality in order to reduce its rate.

Causes of Maternal Mortality According to Reports of Maternal Death Audits in the University Teaching Hospital Bogodogo (UTH-B) from January to December 2017

Objective: To study causes of maternal mortality according to reports of maternal death audits in the University Teaching Hospital Bogodogo (UTH-B) of Ouagadougou, Burkina Faso. Materials and Method: This was a prospective study that took place over a year from 1 January to 31 December 2017.? It concerned maternal deaths that occurred during this period in the obstetrics and gynecology department of the University Teaching Hospital Bogodogo (UTH-B). All maternal deaths were systematically audited by the audit committee;interviews with providers and families were sometimes conducted. The record books of all patients were analyzed by the audit committee;if necessary, interviews were conducted with care providers and families. The main information collected were recorded on individual files, entered and analyzed using the software Epi-info 7. Result: During the study period, we recorded 32 maternal deaths i.e., 587 per 100,000 live births. Deceased women under age 20 were the most numerous, followed by women aged 20 to 24. The death occurred in most cases in the puerperium in 69.80% of cases. Complications of pregnancy were the most incriminated causes in maternal deaths. Bleeding was the leading cause, accounting for 34.3%. They are followed by hypertensive disorders of pregnancy (21.8%) and infections (18.8%). In the contributing factors, resource factors were incriminated in 56.2% of cases, social factors in 43.7% of cases and medical factors in 25.4% of cases. Death was non-preventable in 76.2% of cases compared to 23.8% of preventable deaths. Conclusion: Maternal mortality is a major public health problem at the maternity hospital of the university hospital Yalgado Ouedraogo. Hemorrhage is the first cause of death. Hypertensive diseases are more and more worrying. Solutions must be found to improve the practice of audits in the obstetrics and gynecology department of UTH-B.

Mortality from chronic liver disease:Recent trends and impact of the COVID-19 pandemic

Prepandemic time trends in mortality from chronic liver disease(CLD)differed according to specific cause of death(decreasing for liver cirrhosis,stable or increasing for liver cancer),etiology(increasing for nonalcoholic fatty liver disease,generally decreasing for other etiologies),and world region(decreasing in areas with the highest burden of hepatitis B virus,increasing in Eastern Europe and other countries).The coronavirus disease 2019(COVID-19)pandemic affected mortality of patients with CLD both directly,with a higher risk for severe illness and death depending on age,stage and etiology of the disease,and indirectly,through social isolation and loss of support,harmful drinking,and difficulties in access to care.Nevertheless,only sparse data are available on variations in CLD as a cause of death during the pandemic.In the USA,in 2020-2021 a growth in mortality was registered for all liver diseases,more marked for alcoholic liver disease,especially among young people aged 25-44 years and in selected ethnic groups.COVID-19 related deaths accounted only for a minor part of the excess.Further data from mortality registers of other countries are warranted,preferably adopting the so-called multiple cause-of-death approach,and extended to deaths attributed to viral hepatitis and liver cancer.

Effect of Body Mass Index on All-cause Mortality and Incidence of Cardiovascular Diseases─Report for Meta-Analysis of Prospective Studies on Optimal Cut-off Points of Body Mass Index in Chinese Adults

Objective To verify the optimal cut-off points for overweight and obesity in Chinese adults based on the relationship of baseline body mass index (BMI) to all-cause mortality, and incidence of cardiovascular diseases from pooled data of Chinese cohorts. Methods The prospective study data of existing cohort studies in China were collected, and the age-adjusted all-cause mortality stratified by BMI were estimated. The similar analysis was repeated after excluding deaths within the first three years of follow-up and after excluding smokers. The incidence of age-adjusted coronary heart disease (CHD) and stroke stratified by BMI were also analyzed. Multiple Cox regression coefficients of BMI for the incidence of CHD and stroke after controlling other risk factors were pooled utilizing the methods of weighting by inverse of variance to reveal whether BMI had independent effect and its strength on the incidence of CHD and stroke. Results The data of 4 cohorts including 76 227 persons, with 745 346 person-years of follow-up were collected and analyzed. The age-adjusted all-cause mortality stratified by BMI showed a U-shaped curve, even after excluding deaths within the first three years of follow-up and excluding smokers. Age-adjusted all-cause mortality increased when BMI was lower than 18.5 and higher than 28. The incidence of CHD and stroke, especially ishemic stroke increased with increasing BMI, this was consistent with parallel increasing of risk factors. Cox regression analysis showed that BMI was an independent risk factor for both CHD and stroke. Each amount of 2 kg/m2 increase in baseline BMI might cause 15.4%, 6.1% and 18.8 % increase in relative risk of CHD, total stroke and ischemic stroke. Reduction of BMI to under 24 might prevent the incidence of CHD by 11% and that of stroke by 15 % for men, and 22 % of both diseases for women. Conclusion BMI ≤18.5, 24-27.9 and ≥28 (kg/m2) is the appropriate cut-off points for underweight, overweight and obesity in Chinese adults.

Increased Mortality Risk in Children with Fetal Alcohol Spectrum Disorders: A Scoping Review

Objective: Fetal Alcohol Spectrum Disorders (FASDs) are common, often undiagnosed, lifelong developmental disorders that result from prenatal alcohol exposure. FASD is present at birth and typically identified around seven years of age. The most severe outcome in cases of FASD is mortality. The purpose of this scoping review is to 1) use a systematic review to provide an estimated mortality proportion for children with FASD, and 2) update a study published in 2014 by reviewing published reports of mortality in individuals diagnosed with FASD. Method: A search of PubMed, CINAHL, and Google Scholar for reports published between 2013 and 2023 on mortality in individuals with FASD. Results: Three population-based studies have reported on all-cause mortality rates, finding a combined mortality rate of 10.9%, a 2.63 fold (95% CI: 2.61 to 2.65) increase in mortality risk over the general population. Since 2016, this review identified only eight new cases meeting the study inclusion criteria. The reported causes of death were five cases of pneumonia, and one case each of failure to thrive and dehydration, intestinal dilatation and asphyxiation caused by overeating due to pica, and acute gastric volvulus. Discussion: While current research suggests a diagnosis of FASD is associated with a 2.6-fold increase in mortality risk, this is likely an underestimation, as most cases of FASD-related mortality go unreported. Globally, about 1 new case is reported every 15 months. However, in the United States alone, between 1752 to 4400 FASD related deaths occur annually. Our review suggests that FASD is rarely identified as a causal or contributing factor in deaths of children and adolescents, resulting in a substantial undercount of FASD-related deaths. Increased attention to the role of FASD in infant and child mortality case reviews, child death review committee reports, and mortality reviews is needed.

Analysis of Cause of Death in Inner Mongolia of China, 2008-2014

Objective: The aim of our study was to analyze the character of cause of death in Inner Mongolia of China from 2008 to 2014. Methods: We collected data from monitoring points of the Death Registry System (DRS) in Inner Mongolia. We calculated the mortality rates by gender, year and age-specific. We calculated the proportion, the mortality rate and potential years of life lost (PYLL) of various system deaths. Results: During the period 2008-2014, the average crude mortality rate of all cause of death was 539.33/105. The mortality rate increased semilogarithm linearly with age. The top four system deaths were circulatory system, neoplasm, respiratory system and injury. In 2014, the mortality rates of circulatory system were increased and the mortality rates of certain infectious and parasitic diseases, neoplasms, respiratory system, genitourinary system and injury were decreased compared to those in 2008. Conclusion: Through analysis the indicators of proportion, the mortality rate and PYLL indicated that health status of a population in Inner Mongolia was at a better level.

Influence of Underlying Diseases and Age on the Association between Obesity and All-Cause Mortality in Post-Middle Age

Background: Studies on the association between obesity and all-cause mortality have found that the degree of obesity is directly proportional to all-cause mortality. In contrast, there have been studies indicating that obese people with underlying diseases have a higher survival rate. We hypothesized that age and underlying diseases lead to such contrasting results. Therefore, we conducted a study to clarify the influence of post-middle age obesity and underlying diseases on all-cause mortality. Methods: This study used data from longitudinal studies in the United States, which conducted follow-up for 19 years on 33,708 participants in different age groups: ≥45, 45 - 64, and ≥65 years. Hazard ratio (HR) was determined using the Cox proportional hazards model to analyze a group consisting of all participants, a group of those with underlying diseases, and a group of those without underlying diseases, considering age, gender, education history, marital status, household income, smoking history, and BMI category as covariates. Results: In the group aged ≥65 without underlying diseases, HR was almost 1 in those with BMI 25 - 35 kg/m2. Further, HR was higher in the 45 - 64 age group without underlying diseases if BMI was >35 kg/m2. However, HR was approximately 1 in the ≥65 age group. Conclusions: The study revealed that among individuals aged ≥65 years without underlying diseases, there was no association between obesity and all-cause mortality. Among individuals without underlying diseases, HR was higher in the 45 - 64 age group with BMI > 35 kg/m2 but was approximately 1 among those aged ≥65 years. Therefore, an interaction based on age was detected. These findings may lead to recommendations regarding the need to modify the advice and education provided to obese individuals in different age groups.

Modeling Severity of Tuberculosis as a Multiple Cause of Death in South Africa

The multiple cause of death (MCOD) analysis is used to account for the full contribution of TB as a cause of death to South African mortality in 2008 that were coded using ICD10. Following a review of MCOD methods, a sufficient set of variables for use in MCOD and a new method of quantifying the severity of each cause of death are proposed. The results show that a total of 86,818 (14.3% of all deaths) were TB related, and within all deaths due to natural underlying causes, 86,373 (16.1%) were TB related. Furthermore, 42,581 (7.9%) were due to TB only, 6.0% had TB as an underlying cause along with other contributory causes and 2.0% had TB as a contributory cause. TB was mentioned as the underlying cause of death in 74,863 certificates or 13.9% of deaths due to natural underlying causes. Further analysis using multinomial baseline logit models, reveals that the relative odds of death in any demographic group compared with death in the baseline categories depend on the severity level of TB considered. It is proposed that the severity measure should be adopted when studying the contribution of all main causes of death to total mortality.

Clinical Predictors for Reduced Long-Term Survival and Cause of Death after Curative Resection for Rectal Cancer

Purpose: To identify clinical predictors for reduced long-term survival and describe the cause of death after surgical treatment for rectal cancer. Methods: A retrospective follow-up study of 442 consecutive, unselected patients treated for rectal cancer at a tertiary centre from 1990 until 2000 and followed for 17 years or until death. Predictors for death were assessed by Cox regression analysis. The cause of death was obtained from the Norwegian Cause of Death Registry. Results: 254 men and 188 women with a median age of 71 years (21 - 95 years) were resected for rectal cancer with low anterior resection (n = 266), abdominoperineal resection (n = 125), Hartmann’s procedure (n = 19) or diverting stoma only (n = 32). Median follow-up was 5 years (0 - 17 years). The relative five-year survival rates for stages I, II, III and IV was 83.9%, 65.2%, 41.1% and 9.3%, respectively. The proportion of deaths due to recurrence from colorectal cancer in stages I, II, III and IV was 23.5%, 55.8%, 72.3% and 98.0%, respectively. Heart, lung and cerebrovascular disease and other malignancies were the cause of death in the other patients. Higher age, abdominoperineal resection compared to low anterior resection, lack of lymph node dissection compared to total mesorectal excision (TME), postoperative reoperations, TNM stages II and III compared to stage I and residual tumours after surgery were all significant independent predictors of reduced survival in the adjusted Cox regression model. Conclusions: Age, tumour stage, type of surgery, lymph node dissection, residual tumour after surgery and reoperations are predictors for survival after surgery for rectal cancer. In the patients who died, the cause of death was due to a condition other than colorectal cancer recurrence in 32.3% of the patients. The five-year relative survival rate was related to tumour stage.

Causes of Maternal Mortality in 2020 in the Kara Region (Togo)

Objective: Determine the maternal mortality rate, the epidemiological profile, the causes of death and the dysfunctions noted. Patients and method: This was a cross-sectional and descriptive study from January 1 to December 31, 2020. All maternal deaths during pregnancy or within 42 days after its termination fitting the World Health Organisation definition criteria that occurred in the seven districts of Kara region were included. The data were processed using Excel microsoft. Results: A total of 41 maternal deaths occurred among 23,456 live births, accounting for a maternal mortality ratio of 174.8 deaths per 100,000 live births. The followings were observed: the average age of 30 years;88% married;39% multiparous;78% housewives without income; 5% students. Hemorrhage, preeclampsia, and complications of abortion were the main direct obstetric causes, while anemia was the main indirect obstetric cause. Factors related to deaths were inadequate quality of health care and lack of universal health insurance. The various maternal death audit reports found that 94.4% of deaths were preventable. Conclusion: Most maternal deaths would be prevented in the Kara region if women during pregnancy and the postpartum period received quality health care and the community was involved in decision-making about their health.

Morbidity and Mortality of Inpatients in the Department of Infectious Diseases of the University Hospital of Bobo-Dioulasso, Burkina Faso

Background: Infectious Diseases are responsible for nearly 17 million annual deaths worldwide. Burkina Faso, like the majority of poor countries, remains vulnerable to infectious diseases. The objective of the present study was to analyze the profile of inpatients, including the mortality and causes of death, in the Infectious Diseases Department of SourôSanou teaching hospital (Bobo-Dioulasso, Burkina Faso). Methods: We carried out a cross-sectional study based on medical records of all inpatients from 2011 to 2015. Results: We included 1169 patients. The gender ratio was 0.8. The age group 30 to 39 was more represented (30.2%) as well as housewives and farmers (73.7%). Over one-thirds of the patients (35.3%) were consulted within an average of 7 days. The most common reason for consultation was fever (65.1%). Around 62.0% of inpatients were infected by the Human Immunodeficiency Virus (HIV). Digestive diseases ranked first (21.8%) followed by nervous system disorders (19.4%) and tuberculosis (17.8%). Overall morbidity rate was 31.3%. About 42% were admitted to the emergency ward while 83.3% already arrived with poor health condition. And 82.1% of deaths occurred on pathological grounds of which 66.7% were related to HIV. Main causes of death included nervous system diseases (28.6%), tuberculosis (21.9%) and gastrointestinal diseases (18.3%). Conclusion: Infectious diseases remain a major public health issue. Further efforts are needed to improve their management in Burkina Faso.

BMI and BMI Changes to All-cause Mortality among the Elderly in Beijing： a 20-year Cohort Study

Objective To explore the association between body mass index （BMI） and all-cause mortality among the elderly in Beijing. Methods This analysis was based on the Beijing multidimensional longitudinal study of aging （BLSA）, which included 2,090 subjects over 55 years old and was followed-up from 1992 to 2012. BMI-mortality curves were drawn to find the optimal BMI range with the lowest mortality. Cox proportional hazard models were used to obtain the hazard ratios （HRs） for BMI and BMI changes in the overall population and in specific stratified populations. Results During follow-up, 2,264 deaths were recorded; BMI-mortality curve was U-shaped, with the lowest mortality at a BMI of approximately 25 kg/m2. After adjusting for gender, age, smoking, drinking and some pre-existing diseases, HRs for underweight, overweight and obesity compared with normal weight were 2.372 （95% C/： 2.254-2.632）, 0.767 （95% CI： 0.666-0.884） and 0.872 （95% CI： 0.830-1.246）, respectively. HR for BMI drop was 3.245 （95% CI： 0.824-22.772） in the underweight group and 1.892 （95% C/： 0.830-1.246） in the normal weight group, HR for BMI rise was 1.795 （95% CI： 1.243-2.591） in normal weight group and 2.962 （95% CI： 2.202-3.203） in the overweight group. Conclusion Keeping BMI in an overweight status and stable is related to a reduced mortality

Prediction of mortality among patients with chronic kidney disease:A systematic review

BACKGROUND Chronic kidney disease(CKD)is a common medical condition that is increasing in prevalence.Existing published evidence has revealed through regression analyses that several clinical characteristics are associated with mortality in CKD patients.However,the predictive accuracies of these risk factors for mortality have not been clearly demonstrated.AIM To demonstrate the accuracy of mortality predictive factors in CKD patients by utilizing the area under the receiver operating characteristic(ROC)curve(AUC)analysis.METHODS We searched Ovid MEDLINE,EMBASE,and the Cochrane Library for eligible articles through January 2021.Studies were included based on the following criteria:(1)Study nature was observational or conference abstract;(2)Study populations involved patients with non-transplant CKD at any CKD stage severity;and(3)Predictive factors for mortality were presented with AUC analysis and its associated 95%confidence interval(CI).AUC of 0.70-0.79 is considered acceptable,0.80-0.89 is considered excellent,and more than 0.90 is considered outstanding.RESULTS Of 1759 citations,a total of 18 studies(n=14579)were included in this systematic review.Eight hundred thirty two patients had non-dialysis CKD,and 13747 patients had dialysis-dependent CKD(2160 patients on hemodialysis,370 patients on peritoneal dialysis,and 11217 patients on non-differentiated dialysis modality).Of 24 mortality predictive factors,none were deemed outstanding for mortality prediction.A total of seven predictive factors[N-terminal pro-brain natriuretic peptide(NT-proBNP),BNP,soluble urokinase plasminogen activator receptor(suPAR),augmentation index,left atrial reservoir strain,C-reactive protein,and systolic pulmonary artery pressure]were identified as excellent.Seventeen predictive factors were in the acceptable range,which we classified into the following subgroups:predictors for the non-dialysis population,echocardiographic factors,comorbidities,and miscellaneous.CONCLUSION Several factors were found to predict mortality in CKD patients.Echocardiography is an important tool for mortality prognostication in CKD patients by evaluating left atrial reservoir strain,systolic pulmonary artery pressure,diastolic function,and left ventricular mass index.

Cancer mortality in Inner Mongolia of China, 2008-2010

Objective: The aim of our study was to determine the status of the common cancer in Inner Mongolia of China. Methods: We obtained data from the Centers for Disease Control in the Inner Mongolia from five monitoring points of DRS in Inner Mongolia from 2008 to 2010. We calculated the crude mortality, the proportion of all cause of death during the three years, further calculated cancer mortality, the proportion of cancer death and PYLL by genders. Results: During the period 2008-2010, the crude mortality of all cause of death is 518.02 per million in Inner Mongolia. As the second most common cause of death, the mortality dying from cancer is 127.11 per million, accounting for over one fifth of all deaths. Among all deaths from cancer, the lung cancer had the highest mortality rates (46.25 per million in males and 17.95 per million in females) and PYLL (0.72 in males and 0.41 in females), followed by the liver cancer (23.76 per million) and the gastric cancer (16.15 per million). The female breast cancer is the fourth leading cancer from mortality and PYLL for 7.65 per million and 0.17. Conclusion: Our analysis determined the severity of cancer death in Inner Mongolia of China from 2008 to 2010.Our study found that the cancer mortality in Inner Mongolia is lower than Chinese average level and most west countries, higher than some Africa countries. Our results will guide future cancer control strategies in Inner Mongolia of China.

Attainment of the Fifth Millennium Development Goal: Utopia or Reality Based on Trends in Maternal Mortality in 12 Years in Two Regional Hospitals in Fako Division, Cameroon? A Retrospective Study

Introduction: According to WHO, globally an estimated 585,000 women die each year from complications of pregnancy and childbirth. One of the targets of Millennium Development Goal 5 (MDG 5) is to reduce maternal mortality by three quarters of the 1999 value by the year 2015. However, three years to 2015, very little is known on the trends in maternal mortality ratio, causes of maternal deaths and their associated factors in the Tiko Cottage Hospital (TCH) and Limbe Regional Hospital (LRH) in the South-West Region, Cameroon. Methods: This was a retrospective, analytical cross-sectional study that was carried out from 1st January 2000 to December 2012. After obtaining ethical clearance, the records of cases of maternal deaths and a reference group of women who survived after a pregnancy during the same period were carefully reviewed. The data were analyzed with SPSS 10 and EPI 3.5.1. Results: There were 14,480 live births and 132 maternal deaths during the study period, giving an adjusted Maternal Mortality Ratio (MMR) of 892/100,000 live births. Patients’ age ranged from 15 - 40 years (SD 2.3). We observed a downwards trend of Maternal Mortality Ratio (MMR). Seventy-eight percent of the maternal deaths were due to direct causes. The triad of hemorrhage (54.5%), abortions (17.4%), and eclampsia (10.6%) was the leading cause of death. HIV-related complications and hepatitis constituted the main indirect causes of maternal death. In 85.4% of cases, maternal deaths were avoidable. Lack of blood for transfusion and late referral of cases were the main avoidable factors. Patients less than 35 years (p = 0.01), no antenatal care (ANC) (p = 0.001), unemployment [OR = 1.52;95% CI: (1.38 - 48.28);p = 0.02] were significantly associated with maternal deaths while grand multiparity [OR = 1.20;95% CI (0.30 - 4.86);p = 0.79], marital status [OR = 1.20;95% CI: (0.70 - 2.07);p = 0.51] and education level were not significantly associated with maternal deaths. Conclusion: The trend shows that there was no appreciable decline in maternal mortality, implying that attaining the objectives of MDG 5 is very unlikely. Therefore, to meet the MDG 5 target, we recommend that, there should be amelioration towards obstetric emergencies care and health education by health care providers.

Mortality and motivations: Clinicians’ integrity engaging death within complex cultural context

This broad ranging discussion examines the clinical encounter and deconstructs psychological and cultural context and implications, finally honoring the comprehensive awareness that the clinician requires for best practice in encountering mortality. Clinicians engage client disease and dying presentions, and ultimate mortality. Communicating mortality openly or subliminally is not always conscious. Mortality awareness can produce stress and untoward behaviors. Psychological mortality avoidance, citing Kierke-gaard’s existential paradox, and the death (in both senses) of Joseph Campbell’s cultural hero illumine socio-cultural elements including the elusive “good death”, sequestration of death from society, and the concept of managing death in volume. Cultural diversity awareness and the concept of transcendence clarify outlier and hybrid cultural client presentations demanding maximal clinician flexibility. Mortality Salience Theory predicts contracted world view when confronted with mortality, demanding sensitivity to a variety of responses. A hospice approach may not be best for some, despite a lack of new alternative to that paradigm. Managing mortality awareness and dying stresses the clinician by the weight and loneliness of perhaps unpopular decisions, by responsibility to community in managing death, and by the take-home exposure of the clinician’s family to the concept of death and mortality. Aptitude for managing death depends on clinician self awareness and a good match with practice venue. Clinician integrity and consciousness of motives and responses allows engagement or deferral as necessary without threat to identity.