A Review of Maternal Deaths at Douala General Hospital, Cameroon: The Referral System and Other Contributing Factors

Abstract

One of the objectives of the fifth Millennium Development Goal [MGD] is to decrease annually by 5.5% the maternal mortality so as to attain a three- quarter’s reduction of the world’s burden by the year 2015. The health care referral system has been shown to play an important role if this objective is to be attained. The aim of this study was to evaluate the referral system and other contributing factors to maternal deaths. This was a retrospective, descriptive study carried out in the Douala General Hospital, a tertiary referral hospital in Douala, Cameroon. The records of cases of maternal deaths that occurred between 1st January, 2002 and 31st December, 2011 were reviewed. Patients who died on arrival at the hospital were excluded from the study. Data was collected using pre-structured questionnaire and analyzed with EPI-Info version 3.5.1. There were 25 maternal deaths during this period with a maternal mortality ratio of 275 per 100.000 live births. Sixteen (64%) maternal deaths were referred cases from; government health institutions 4 (25%) and private 12 (75%) hospitals in Douala. Most of the patients were between 30-40 years 12 (48%), married 17 (68%), primigravida 12 (48%). The triad of hemorrhage 12 (48%), hypertensive disease in pregnancy 10 (40%) and infection 3 (12%) was responsible for the maternal deaths. Using two indicators to evaluate the referral system, it was observed that only 3 (18, 8%) exploited the referral information system and barely 4(25 %) were transported to the hospital by an ambulance. Maternal mortality remains high in our setting. Most of the causes of maternal death are due to direct obstetric causes which are preventable. The role of referral system in providing health care is poor. Therefore, this aspect of providing health care has to be properly implemented if it is to make an impact in reducing maternal morbidity and mortality.