Determinants of Maternal Mortality in Mezam Division in the North West Region of Cameroon: A Community-based Case Control Study

Abstract

Background: Since 2008, an average of 358,000 women die annually worldwide of pregnancy-related causes. About 99% of these deaths occur in developing countries, 43% of which occur in Sub-Saharan Africa alone. In Cameroon, the rate has increased from 669 maternal deaths/100,000 live births in 2005 to 1000/100,000 live births in 2010. Socio-economic, cultural, and obstetric factors have been found to account for this jump. Objectives: The aims of this study were 1) to identify the causes, both direct and indirect, of maternal mortality, 2) to investigate the factors associated with maternal deaths, and 3) to describe the age distribution of maternal mortality in Mezam Division in the North West Region of Cameroon. Materials and Methods: We carried out a retrospective, community-based case-control study from January 1, 2011 to November 30, 2014 on 89 maternal deaths (cases), and 178 women who survived delivery (controls). Cases were identified with the aid of key community leaders. A questionnaire for maternal death review or verbal autopsy was administered and controls effected among the sisters or neighbours of the cases. Microsoft Excel, Epi Info and InterVA-4 were used for data analysis. Results: A total of 89 maternal deaths (cases) were identified during the study period, sixty-nine (77.53%) of which were from direct causes, mainly post-partum haemorrhage (30.43%), unsafe abortion (26.09%), and hypertensive disorders of pregnancy (14.49%); 21.35% from indirect causes, while 1.12% were incidental deaths, mainly severe malaria (5.6%), HIV/AIDS (5.6%). Among the risk factors of maternal death were inadequate antenatal care (RR=1.87: 95% CI; 1.33-2.63, P=0.0003), pre-existing co-morbidities(RR=1.45: 95% CI; 1.03-2.03, P =0.03), place of delivery(RR= 2.44: 95% CI; 1.79-3.32,P<0.0001), healthcare provider qualification(RR= 2.87: 95% CI 2.17-3.79; P<0.0001), and delays in arrival at health facilities(RR=1.420: 95% CI 1.01-2.0; P=0.04). The peak age of maternal death ranged from 20-24 years (24.72%). Conclusion: Post-partum haemorrhage, unsafe abortion and hypertensive disorders of pregnancy were the leading causes of maternal death. Effectively combating the factors associated with maternal deaths will reduce if not eliminate maternal morbidity.