Evolution and Risk Factors of Maternal Mortality in Cameroon: A Case Control Study

Background: Maternal mortality is still high in sub-Saharan Africa, especially in Cameroon where more efforts to reduce maternal mortality and provide universal access to reproductive health should be made. This study aims to see the evolution of maternal mortality and identify associated risk factors in Laquintinie hospital in Cameroon. Methods: A manual review of records for 166 maternal deaths (cases) and 322 controls was undertaken using a standard audit form. The sample included pregnant women aged 16 - 46 years admitted at the maternity of Laquintinie Hospital in Douala, Cameroon from January 2017 to December 2022. Software SSPS 3 and Logistic regression analysis were used to analyze data. Results: One hundred and sixty-six (166) maternal deaths were identified during the study period for 14,114 live births, representing a maternal mortality ratio of 1176/100,000 live births. Factors significantly associated with maternal mortality included: young age (15 - 24 years) (aOR 0.11, 95% CI 0.00 - 0.76, p = 0.037), Alcohol intake (aOR 22.79, 95% CI 1.04 - 501.3, p = 0.047), Abortion or ectopic pregnancy (aOR 61.53, 95% CI 1.29 - 2927.3, p = 0.037), having no antenatal visits (aOR 388.3 95% CI 5.6 - 2675.9, p = 0.006), being admitted with hemorrhage (aOR 343.7, 95% CI 16.2 - 7276.0, p ,713.0, 95% CI 128.2 - 5,989,223.3, p CI 0.00 - 0.18, p = 0.016). Conclusion: Despite slight decrease in maternal mortality, early diagnosis of pregnancy and good Antenatal care associated with maternal health education are important factors for reducing maternal mortality. Young women were the most affected. Singles, alcoholics, women with a no or only primary education level, and referred women represented the majority of deceased cases.

Investigation on maternal mortality in Southeast Asia,Europe and Africa using three delays model

Background:Maternal mortality is a prevalent issue in healthcare provision worldwide.It is particularly common in developing and underdeveloped countries,where maternal deaths during childbirth or pregnancy occur frequently.Various internal and external factors contribute to the high maternal mortality rate in specific regions.One model,known as the three delays model approach,examines three distinct causes that contribute to this problem.The first delay is the lack of awareness in seeking timely healthcare,the second delay involves obstacles in reaching healthcare facilities on time,and the third delay relates to poor or inadequate healthcare provision in tertiary care facilities.These delays are responsible for the elevated maternal mortality rates,with the prevalence of each delay varying across regions.Objective:The objective of this literature review is to examine and critically evaluate existing literature on perceptions and investigations regarding maternal mortality in Southeast Asia,Europe and Africa,utilizing the three delays model approach as a categorization framework.Method:This literature review followed BEME guide No.3.A total of 18 articles were included in the sample after conducting a thorough search of various databases and search engines.A Prisma flowchart was created,and the articles were critically appraised.Results:A total of 18 articles focusing on different regions were analyzed.The findings revealed that in countries of Southeast Asia,the primary cause of maternal mortality is the first delay,which refers to the lack of awareness in seeking medical care.On the other hand,in Africa and other European countries,the second and third delays are more prominently associated with maternal mortality.Conclusion:Inadequate care is one of the major causes of maternal mortality in majority of regions acrossthe globe.Multiple factors can hinder access to appropriate healthcare.The three delays model plays a significant role in the higher maternal mortality rate.By raising awareness among women and their families about the importance of seeking healthcare,the risk of fatality can be reduced.Similarly,in developing regions,it is crucial to ensure that healthcare facilities are easily accessible and provide high-quality emergency obstetric care to meet the needs of pregnant women in critical situations.

Determinants of Maternal Mortality at the Community University Hospital of Bangui: Central African Republic

Introduction: Pregnancy is a physiological condition that can sometimes end in death. The death of a woman is a constant concern for the obstetrician and is considered a major public health problem in our developing countries. Objective: To identify the determinants that contribute to maternal morbidity and mortality in the Gynaecology and Obstetrics Department of the University Community Hospital. Methodology: We conducted a retrospective study from 1 January 2015 to 31 December 2019 (5 years) in the obstetrics and gynaecology department of the Centre Hospitalier Universitaire Communautaire (CHUC). It focused on the determinants of maternal mortality. Our study population consisted of all women who died during the period and met the World Health Organization (WHO) definition of maternal mortality (MOMA). We used non-probability sampling with the exhaustive choice technique. Results: The study revealed that the number of deaths recorded was 98, while 17,172 live births were registered during the same period. The maternal mortality ratio was 570 per 100,000 live births. The most common age group was 20 to 24, with an average age of 26. The frequency of death among primiparous women was 37.74%, pauciparous women 28.30% and multiparous women 26.42%. Direct causes were dominated by abortion complications (22.41%), followed by infections (9.30%) and haemorrhage (8.19%). Indirect causes were dominated by anaemia with a proportion of 45.16%. The majority of maternal deaths occurred in the post-partum period (34.71%). Most maternal deaths occurred after vaginal delivery, 19 cases (63.33%), while 11 deaths (36.66%) occurred after caesarean section. The occurrence of direct causes was associated with age less than or equal to 25 years, abortion complications and primiparity, with a statistically significant difference. Conclusion: At the end of this study, complications of unsafe abortion and poverty are all factors contributing to the rise in the maternal mortality rate. Emphasis should be placed on promoting family planning, as this would make a major contribution to reducing maternal mortality.

Developing a model for reducing maternal mortality in South Africa

Objective:High maternal mortality ratios(MMRs)remain a concern in many parts of the world,especially in developing countries like South Africa.Different models have been developed,tried,and tested worldwide,in the hope that they will reduce maternal mor tality,but without much success.Methods:A qualitative approach was used to conveniently select a sample of 10 women attending an antenatal clinic in a rural area,in one of the districts of Kwa Zulu-Natal(KZN)Province.Data were collected by means of interviews with the women.Data were analyzed employing Burnard’s content analysis approach.Results:Four themes emerged:(1)age at first pregnancy;(2)birth intervals,risks in pregnancy and hospitalization;(3)the use of contraception;and(4)HIV status.All themes that emerged revealed inattention to reproductive health(RH)needs,resulting in poor RH outcomes as an area of concern.Conclusions:Greater emphasis needs to be placed on meeting the sexual and reproductive health(SRH)needs of South African women,if maternal mor tality rates are to be reduced.An alternative model for reducing maternal mor tality in South Africa is proposed.

Maternal Mortality at the Teaching Hospital of Mother and Child Lagoon (CHU-MEL) in Benin: A Preventable Drama?

Introduction: The maternal mortality ratio in developing countries is 239/ 100,000 live births (LV) in 2015, compared to 12/100,000 live births (LV) in developed countries. This study aims to analyze the avoidability of maternal deaths at the CHU-MEL from 2015 to 2019. Patients and Method: This was a descriptive analytical study with retrospective data collection from January 1st 2015 to August 31st 2019, i.e. 56 months. The data were collected from medical records, maternal death registers, anaesthesia registers. They were entered and analyzed using Epi info version 7 software. The associations between avoidability of death and aetiologies were tested using Chi2 or Fisher’s test as appropriate. The threshold for statistical significance was 5%. Results: The maternal mortality ratio over 5 years was 905 maternal deaths per 100,000 LV. The age of the deceased women ranged from 15 to 44 years, with an average of 29.09 ± 7.04 years. They were illiterate or primary educated (47.02%), married (64.50%) primigravida or paucigravidae (47.02%) and primiparous or pauciparous (59.52%). Of the 151 maternal deaths, (90.73%) were deemed preventable. Delay was the main reason for maternal death, and 82.11% had at least one type of delay. There was no significant difference between the avoidability of death and the main aetiologies of haemorrhage (p = 0.865), infections (p = 0.208) and hypertensive complications (p = 0.438). Conclusion: The maternal mortality ratio during the study period was 905 maternal deaths per 100,000 LV. Deaths were preventable in 90.73% of cases. The avoidability factors found were varied.

Maternal Mortality in Two Reference Hospitals in the City of Yaounde (Cameroon): Epidemiological, Clinical and Prognostic Aspects

Objectives: The objective of this work was to determine the epidemiological, clinical and prognostic aspects of maternal mortality (MM) in the city of Yaounde. Methods: We conducted a descriptive cross-sectional study with retrospective data collection of maternal deaths according to the World Health Organization (WHO) definition, from January 1, 2017 to December 31, 2019, in two tertiary centers of Yaounde: The Yaounde Gynaeco-Obstetric and Paediatric Hospital (YGOPH) and the Yaounde Central Hospital (YCH). Results: During the study period, 208 maternal deaths were identified, with 4/5 (78.4%) from referred cases. The MM ratio was 1532.8 per 100,000 live births (LB) vs. 609.5 per 100,000 live births at YCH and YGOPH respectively. The Main causes where haemorrhage (49%) followed by hypertensive diseases and their complications (21.2%), maternal mortality was associated with 50% of cases of foetal or neonatal deaths (57.4% in YCH vs 28.3% in YGOPH, P < 0.001). Health service systems were related to MM. Conclusion: Our study shows a large increase in maternal mortality ratios in YCH and YGOPH maternities since 2017. The main causes of MM found were haemorrhage followed by hypertensive diseases. These causes can be prevented. Our health systems should be improved if we want to significantly reduce the maternal mortality ratio.

The Contribution of Technological Approaches in Reducing Maternal Mortality: An Integrative Review

Aim: To analyze the role of available health technologies and techniques in reducing the number of women dying during pregnancy and childbirth. Background: Health condition of women during pregnancy and childbirth is very sensitive. During this period, proper and timely care plays an important role in reducing maternal mortality. Design: Whitte more and Knal’s framework for integrative reviews was followed in the review. PUBMED/MEDLINE, CINHAL and COCHRANE were searched for published studies between 2008 and 2015. Studies included were systematic reviews, randomized control trials, prospective cohort study, literature review and descriptive studies. Methods: 28 articles were selected to be included in the review. An integrative review approach was followed to analyze data and draw conclusions. Screening of titles and abstracts along with data extraction was completed by two authors independently. Study quality is not reported because of the methodological difficulties. Data synthesis consists of writing descriptive summaries and thematic analysis of the key findings in the included articles. Results: The included studies were based on health technologies and techniques including different devices and tools, medication and drugs, massage techniques, immersion in water, intervention radiology, simulations and training for the health professional. Conclusion: There are numerous health technologies and techniques which are relatively simple to develop, effective to use and safe to apply with no adverse effects. These include simulations and training programs, educational and awareness programs, decision support tools and information systems. Besides these, there are technologies and techniques which show promising results with no or very little adverse effects. These include Active management of the third stage of labour, use of magnesium sulphate, uterine balloon tamponade, wearable cardiac defibrillator and non-pneumatic anti-shock garment. The government, hospitals and care providers should make policies to develop and implement such type of technologies and techniques.

Factors Associated with Maternal Mortality at Gynecology and Obstetrics Department in Departmental University Hospital Center of Borgou

Introduction: Maternal mortality is a robust indicator of human development. Most of it occurs in developing countries. Objectives: This study aims to determine the factors associated with maternal mortality in Gynecology and Obstetrics Department of Borgou Departmental University Hospital Center (CHUD-B). Study method: Our study took place at Gynecology and Obstetrics Department in Borgou Departmental University Hospital Center. This was a descriptive and analytical case-control study, covering a period of 7 years from January 1, 2012 to December 31, 2018. Results: Two hundred and twelve patients have been recruited consisting of 106 deceased women and 106 controls. The intra-hospital mortality ratio was 1100 deaths per 100,000 live births (LB). The mean age of deceased women was 27.06 ± 6.45 years with the extremes of 15 and 45 years. Direct obstetric causes were the most frequent causes of maternal death. They were dominated by immediate postpartum hemorrhage (32.93%), followed by High Blood Pressure (26.83%) and infections (17.07%). The general condition of patients on admission (p-0.000) and inadequate management (p-0.001) was associated with maternal mortality. Conclusion: Patients’ general condition on admission and inadequate management was factors associated with maternal mortality.

Maternal Hospital Mortality in Cotonou: Incidence, Care-Associated Adverse Events and Causes

Introduction: Despite the many efforts made to combat preventable maternal deaths, these still remain high in Benin. It was therefore important to revisit the causes but especially the adverse events associated with care (EIS) in maternity. Objective: Determine the incidence, adverse events associated with care and causes of intra hospital maternal mortality in cotonou. Methods: This was a cross-sectional maternal mortality review study with retrospective data collection. It covered all cases of maternal death recorded between 2017 and 2021 in two (2) reference university maternities in Cotonou. Adverse events associated with care and the patient were analyzed using the maternal death audit grid validated for Benin. SPSS.26 software was used for data analysis. Results: The in-hospital maternal mortality ratio in Cotonou was 2028 maternal deaths per 100,000 live births in 2021. Only 7.2% (n = 36) of deaths were audited. The deceased mothers were 29.8 ± 7.4 years old, with no fixed monthly income in 82.7% (n = 420). Serious adverse events associated with care were: delay in decision to refer in 37% (n = 188), non-medical referral in 85.8% (n = 436) of cases, inadequate pre-referral treatment in 25.7% of cases. In receiving maternities, delay in diagnosis and inappropriate treatment at the receiving maternity were noted respectively in 22.9% and 28.6% of cases of maternal death. The direct causes of maternal death were dominated by serious obstetric hemorrhage in 43.9% (n = 223). As for the indirect causes, they were dominated by anemia excluding obstetric hemorrhages in 21.5% (n = 109). Conclusion: The in-hospital maternal mortality ratio was very high in Cotonou. The main cause was severe obstetric hemorrhage. There were several serious healthcare-associated adverse events whose correct management would significantly reduce the incidence of maternal deaths.

Mistreatment during Childbirth: Impact on Maternal Outcomes and Importance of Provider Perspectives

Background: Dying in childbirth is one of the most common causes of death for women. While maternal mortality rates, defined as deaths per 100,000 live births, have been steadily dropping in most countries worldwide, maternal mortality rates have doubled in the United States in the last twenty years. This commentary examines the various contributing factors to this trend. Methods: A literature review was performed using the keywords: maternal mortality, United States, disrespectful maternity care, obstetric violence, provider perspectives, and disparities. Maternal mortality statistics were obtained from the World Health Organization website. Results: Medical factors associated with maternal mortality include increased maternal age and cardiovascular conditions. Social factors include barriers to healthcare access, delays in receiving medical care, reduction in reproductive health services in some states, and non-obstetrical deaths such as accidents, domestic violence, and suicide. Racial inequities and disparities of care are reflected in higher maternal mortality rates for minorities and people of color. Disrespectful maternity care or obstetric violence has been reported worldwide as a factor in delay of lifesaving obstetrical care and reluctance by a pregnant person to access the healthcare system. About one in five US women has reported experiencing mistreatment, varying from verbal abuse to lack of privacy, from coerced procedures to neglect during childbirth. Conclusion: This commentary highlights the importance of inclusion of providers in research on respectful maternity care. Provider burnout, moral distress, limited time, and burden of clinical responsibilities are known challenges to respectful and comprehensive medical care. The association of disrespectful care with poor maternal outcomes needs to be studied. Exploring root causes of disrespectful childbirth care can empower nurses, midwives, and physicians to improve their environment and find solutions to reduce a potential cause of maternal mortality.

Temporal Trends of Maternal Mortality Due to Obstetric Hemorrhage in Chinese Mainland: Evidence from the Population-Based Surveillance Data Between 2000 and 2019

Objective:To analyze the temporal trends of maternal mortality ratio(MMR)due to obstetric hemorrhage and its specific causes in Chinese mainland from 2000 to 2019,to identify whether the rate of change has accelerated or slowed down during this period,and to find the prior cause of obstetric hemorrhage that needs to be intervened in the future.Methods:Individual information on maternal deaths and total number of live births from 336 surveillance sites across 31 provinces in Chinese mainland was collected from the National Maternal and Child Health Surveillance System between 2000 and 2019.Maternal death was defined according to the World Health Organization’s criterion.The final underlying cause of death was confirmed by the national review and was coded according to International Classification of Diseases-10.Linear trends for changes in characteristics of maternal deaths were assessed using linear or logistic models with the year treated as a continuous variable.The MMR and 95%confidence intervals(CI)for regions or causes were estimated by Poisson’s distribution.Joinpoint regression was used to assess the accurate temporal patterns.Results:The national MMR due to obstetric hemorrhage was 18.4 per 100,000 live births(95%CI:15.0–22.2)in 2000.It peaked in 2001(22.1 per 100,000 live births,95%CI:18.3–26.4)and was lowest in 2019(1.6 per 100,000 live births,95%CI:1.0–2.3).For specific regions,the MMR due to obstetric hemorrhage in rural areas and western regions both experienced a slight rise,followed by a rapid decline,and then a slow decline.For specific causes,no change point was found in joinpoint analysis of the national MMR caused by placenta previa,postpartum uterine atony,and retained placenta(the annual percent change was12.0%,10.5%,and21.0%,respectively).The MMR caused by postpartum hemorrhages(PPH)significantly declined by 8.0%(95%CI:1.9–13.6)per year from 2000 to 2007.The annual percent change of MMR caused by PPH accelerated further to25.0%between 2007 and 2011,and then decreased to7.8%between 2011 and 2019.The proportion of maternal deaths due to antepartum hemorrhages increased from 7.6%(8/105)in 2000 to 14.3%(4/28)in 2019.The changes in the proportion of causes were different for maternal deaths due to PPH.The proportion of postpartum uterine atony increased from 39.0%(41/105)in 2000 to 60.7%(17/28)in 2019,and the proportion of uterine rupture also increased from 12.3%(13/105)in 2000 to 14.3%(4/28)in 2019.However,the proportion of retained placenta decreased from 37.1%(39/105)in 2000 to 7.1%(2/28)in 2019.Conclusion:Over the last 20 years,the intervention practice in China has proved that targeted interventions are beneficial in reducing the MMR due to obstetric hemorrhage.However,the MMR has reached a plateau and is likely to increase for some specific causes such as uterine rupture.China needs to develop more effective interventions to reduce maternal deaths due to obstetric hemorrhage,especially for postpartum uterine atony and uterine rupture.

Maternal diaphragmatic hernia in pregnancy:A systematic review with a treatment algorithm

BACKGROUND Diaphragmatic hernia(DH)is extremely rarely described during pregnancy.Due to the rarity,there is no diagnostic or treatment algorithm for DH in pregnancy.AIM To summarize and define the most appropriate diagnostic methods and therapeutic options for DH in pregnancy based on scarce literature.METHODS Literature search of English-,German-,Spanish-,and Italian-language articles were performed using PubMed(1946–2021),PubMed Central(1900–2021),and Google Scholar.The PRISMA protocol was followed.The search terms included:Maternal diaphragmatic hernia,congenital hernia,pregnancy,cardiovascular collapse,mediastinal shift,abdominal pain in pregnancy,hyperemesis,diaphragmatic rupture during labor,puerperium,hernie diaphragmatique maternelle,hernia diafragmática congenital.Additional studies were identified by reviewing reference lists of retrieved studies.Demographic,imaging,surgical,and obstetric data were obtained.RESULTS One hundred and fifty-eight cases were collected.The average maternal age increased across observed periods.The proportion of congenital hernias increased,while the other types appeared stationary.Most DHs were left-sided(83.8%).The median number of herniated organs declined across observed periods.A working diagnosis was correct in 50%.DH type did not correlate to maternal or neonatal outcomes.Laparoscopic access increased while thoracotomy varied across periods.Presentation of less than 3 days carried a significant risk of strangulation in pregnancy.CONCLUSION The clinical presentation of DH is easily confused with common chest conditions,delaying the diagnosis,and increasing maternal and fetal mortality.Symptomatic DH should be included in the differential diagnosis of pregnant women with abdominal pain associated with dyspnea and chest pain,especially when followed by collapse.Early diagnosis and immediate intervention lead to excellent maternal and fetal outcomes.A proposed algorithm helps manage pregnant women with maternal DH.Strangulated DH requires an emergent operation,while delivery should be based on obstetric indications.

Maternal Deaths in Patients Evacuated to the Fousseyni Daou Hospital in Kayes over a Decade

Introduction: Evacuation refers to the rapid transfer of a patient in an emergency, from one health center to another more equipped and better specialized. The objective of this study was to study maternal mortality in patients evacuated to the gynecology and obstetrics department at the Fousseyni Daou Hospital in Kayes over a period of 10 years. Materials and Methods: This was a descriptive, cross-sectional, retrospective study over nine years from January 1, 2011 to December 31, 2019 and prospective over one year from January 1, 2020 to December 31, 2020 involving all patients or parturients evacuated for obstetrical causes and died in the gynecology-obstetrics department of the Fousseyni Daou Hospital. Confidentiality and anonymity were respected. The processing and analysis of the statistical data was carried out using SPSS 20.0 software. Results: during our study period we identified 38,854 obstetric admissions including 6758 evacuations or 17.4%, among the 6758 cases of obstetric evacuations 284 died, a frequency of 4.2%. The maternal death audit committee of the Fousseyni Daou hospital in Kayes audited 101/284 cases (files) or 35.5% of which 64 maternal deaths (63.4%) were considered inevitable. In our study the 20 - 29 age group was more represented with 38%. 85% of the deceased patients lived in rural areas. In our series, 63.7% of the deceased patients had not had antenatal consultations (NPC). Eclampsia accounted for 26.8% of admissions diagnoses and 30.9% of causes of death. Seventy-two (72%) of deaths occurred postpartum, 15% perpartum and 13% prepartum. Direct obstetric causes were predominant at 65.1%. Conclusion: Indicators of maternal deaths among evacuated patients remain poor in our work. Maternal deaths were driven by socio-economic and cultural factors, but also by factors related to the health system.

Determinants of Maternal Morbidity and Mortality Related to Anesthesia in Course of Cesarean Section in a Low-Income Country: Experience from the Centre Hospitalier Mère-Enfant Monkole

Objective: The role of anesthesia in maternal mortality is unknown in the Democratic Republic of Congo (DRC). This study was conducted with the objective of analyzing the determinants of morbidity and maternal mortality linked to anesthesia in course of cesarean section. Methods: This is a prospective, analytical and mono-centric study carried out on women who underwent cesarean section at the Centre Hospitalier Mère-Enfant Monkole from January 1st, 2011 to December 31st, 2018. The variables analyzed were socio-demographic, clinical, biological and anesthetic as well as the maternal issues. Data analysis was performed with SPSS 21.0 software. The determinants of mortality were sought by logistic regression with p Results: During this period, 1954 cesarean sections were performed. The mean age of the women was 31 years (range 14 to 47), 1549 women (79.3%) had completed prenatal consultation in Monkole and 405 (20.7%) elsewhere. The emergency was extreme in 192 cases (9.82%), absolute in 445 (22.77%) and relative in 1317 (67.4%). Locoregional anesthesia (LRA) was performed in 1811 cases (92.68%). The main complications were marked by arterial hypotension (22.9%) due to spinal anesthesia, and mortality was 0.56%. In multivariate analysis, only extreme emergency (aOR 7.62 95% CI: 2.80 - 71.23 p = 0.007), coma on admission (aOR 10.44 95% CI: 1.81 - 60.13 p = 0.009), general anesthesia (aOR 15.41 95% CI: 2.11 - 40.21 p = 0.007) and intraoperative transfusion due to anemia/hemorrhage (aOR 8.63 95% CI: 1.07 - 69.55 p = 0.043) persisted as determinants of maternal death. Conclusion: Maternal mortality (0.56%) in this series was relatively low for a low-income country and no death was directly related to anesthesia. General anesthesia, extreme urgency, intraoperative transfusion due to anemia/bleeding, and coma on admission were the major determinants of mortality.

Towards data-driven models for diverging emerging technologies for maternal,neonatal and child health services in Sub-Saharan Africa:a systematic review

Sub-Saharan Africa(SSA)has the highest maternal and under-five mortality rates in the world.The advent of the coronavirus disease 2019 exacerbated the region's problems by overwhelming the health systems and affecting access to healthcare through travel restrictions and rechanelling of resources towards the containment of the pandemic.The region failed to achieve the Millenium Development Goals on maternal and child mortalities,and is poised to fail to achieve the same goals in the Sustainable Development Goals.To improve on the maternal and child health outcomes,many SSA countries introduced digital technologies for educating pregnant and nurs-ing women,making doctors'appointments and sending reminders to mothers and expectant mothers,as well as capturing information about patients and their illnesses.However,the collected epidemiological data are not being utilised to inform patient care and improve on the quality,efficiency and access to maternal,neonatal and child health(MNCH)care.To the researchers'best knowledge,no review paper has been published that focuses on digital health for MNCH care in SSA and proposes data-driven approaches to the same.Therefore,this study sought to:(1)identify digital systems for MNCH in SSA;(2)identify the applicability and weaknesses of the dig-ital MNCH systems in SSA;and(3)propose a data-driven model for diverging emerging technologies into MNCH services in SSA to make better use of data to improve MNCH care coverage,efficiency and quality.The PRISMA methodology was used in this study.The study revealed that there are no data-driven models for monitoring pregnant women and under-five children in Sub-Saharan Africa,with the available digital health technologies mainly based on SMS and websites.Thus,the current digital health systems in SSA do not support real-time,ubiquitous,pervasive and data-driven healthcare.Their main applicability is in non-real-time pregnancy moni-toring,education and information dissemination.Unless new and more effective approaches are implemented,SSA might remain with the highest and unacceptable maternal and under-five mortality rates globally.The study proposes feasible emerging technologies that can be used to provide data-driven healthcare for MNCH in SSA,and the recommendations on how to make the transition successful as well as the lessons learn from other regions.

Analysis of Maternal Deaths in Suburban of Dakar, Senegal

Objective: Maternal mortality remains a major concern in developing countries. This survey aims to suggest strategic plans that would help decrease maternal and perinatal mortality in the suburbs. It is a descriptive study that shows the different causes of maternal deaths during pregnancy and puerperium period. Methods: It is a retrospective descriptive study done between January 1st 2016 and the 31st of December 2018. We have collected information on all deaths due to mortality issues in Five (5) maternity clinics around Dakar. The record shows that teach centre have an average of 4000 deliveries per year. The data collected from the hospital records were inputted using Sphinx software (version 5). These data were analysed using Epi Info software (version 3.5). After analysing these data, recommendations were made to minimize the different causes of maternal deaths. Results: We recorded 154 maternal deaths out of 32,420 live births. The direct causes of maternal deaths were a result of preeclampsia and its complications (31.2%), postpartum haemorrhage (24.7%), abruption placentae (20.8%) and obstructed labour (7.8%). The indirect causes were mainly sickle cell disease (1.3%), heart disease (1.3%) and gynaecological cancers (1.3%). Maternal deaths were also associated with fetal loss in 47.4% of 153 maternal deaths, need for blood transfusion 59% while none of the reference structures in the suburbs of Dakar has a blood bank;with a need for admission in intensive care unit was noted as 40%. Conclusion: Thus, preeclampsia and its complications are the leading cause of maternal deaths in suburban settings. Timely availability of resuscitation units and liable blood products could drastically reduce maternal deaths from direct obstetric complications.

Epidemiologic Profile of Maternal Deaths in Two Referral Hospitals in Cameroon

Introduction: Our objective was to compare the epidemiologic profile of maternal mortality in two structures serving as referral levels of care in Cameroon. Methodology: This cross-sectional, comparative study took place at the maternities of the Yaoundé Central Hospital (YCH) and the Bamenda Regional Hospital (BRH) from December 1st 2014 to May 31st 2015, a 6 months’ period. The medical records of deceased women over 5 years, from January 2010 to December 2014, were collected. We calculated the MMR (Maternal mortality rate) and studied the causes and risk factors associated with maternal death. The Epi info software 3.5.4 was used to analyze data with a significance level of P < 0.05. Results: The maternal mortality ratio (MMR) was 964 and 247 per 100,000 live births for YCH and BRH, respectively. More deaths occurred within the aged group range 20 to 34 years, 76.8% at YCH and 64.7% at BRH. At YCH, 70.7% of these patients were referrals versus 32.4% at BRH. Complication from abortion was often implicated at BRH (P = 0.007;OR = 0.31;CI = 0.13 - 0.74). Others causes were hemorrhage (YCH = 43.4%;BRH = 35.5%), hypertensive diseases (YCH = 17.2%;BRH = 14.7%) and infections (YCH = 8.1%;BRH = 17.6%). At YCH time elapsed from admission to death was <3 h (P = 0.005;OR = 6.63;CI = 1.49 - 29.5). Conclusion: Both hospitals have similar causes of maternal deaths, differing only in the context within which the deaths occurred. Improving access to good quality health care, satisfying unmet needs for family planning, availability of blood products and the establishment of health insurance could decrease the maternal mortality rate.

Maternal Sepsis in Intensive Care Unit at Omdurman New Hospital-Tertiary Obstetric Facility, Khartoum-Sudan

Introduction: Sever sepsis and septic shock contributes to maternal morbidity and mortality. The etiology of sever sepsis and septic shock during pregnancy and postpartum result from obstetric related or non-obstetric related conditions. Objectives: It aimed to determine rate, characters, morbidity and mortality of septic obstetric cases at Omdurman New Hospital. Methods: It was a descriptive, prospective, analytic, cross-sectional hospital based total coverage study;conducted at Omdurman New Hospital (ONH), Khartoum-Sudan. Results: Sever sepsis and septic shock rate 1.16 (13/1124 = 1.16%) of hospital pregnancy complication admission. Hyperthermia, Tachycardia and hypotension are the main presenting clinical findings and uterine infection is the main focus of sepsis. The mean average Intensive Care Unit (ICU) stay is 6.3-day. Organs dysfunctions are the main morbidity and mortality is reported in five cases. Conclusion: Sever sepsis and septic shock contributes in maternal morbidity and mortality. Safe obstetric care prevents maternal sepsis and improves the outcome. Management of sever sepsis and septic shock remains a challenge in obstetric medicine.

Maternal and Fetal Outcomes of 179 Traumatised Pregnants in Teritary Referral Center

Objective: The aim of this study was to evaluate the clinical characteristics, maternal and fetal outcomes of trauma in pregnants. Methods: This is a retrospective analysis of all traumatised pregnants who admitted to Yüzüncü Yil University teritary referral hospital from June 2010 and December 2012. One hundred seventy-nine pregnants in whom referred for trauma analysed for the data about mechanism of trauma, demographic and obstetric parameters on admission, diagnostic and surgical procedures performed, maternal and fetal outcomes. The SAS statistical package version 9.2 was used in data analysis. Results: Overall, the medical records of 179 patients were reached and included in the study. The mean age was 27.5 ± 5.8. Gestational age ranged from 6 to 39 weeks (mean, 26.2 weeks), with most trauma (49.1%) being in the third trimester. Road trrafic accident (RTA) was the main mechanism of trauma (41.5%) followed by falls (26.4%). Trauma due to animal recoil was seen in three patients. The most injured body area was extremity (34.2%). Traumatised pregnants resulted in metarnal (4 cases) and fetal (16 cases) loss. Most of the fetal loss (49.1%) was seen third trimester, with the main cause detected as placental abruption (8 cases). When compared the complicated pregnancy according to trauma site, abdominal trauma (33.3%) was significantly related to complication in pregnancy than non-abdominal trauma (21.9%) (p = 0.014). Conclusions: Trauma in pregnancy carries risks for both mother and baby. Trauma to abdominal region and trauma in second or third trimester pregnancy is associated with significantly higher maternal and fetal complications.