MATERNAL MORTALITY IN TANZANIA - MEDICAL CAUSES ARE INTERRELATED WITHSOCIOECONOMIC AND CULTURAL-FACTORS

Objective. To estimate the magnitude and the immediate and underlying causes of maternal mortality, as well as the demographic, socio-econom ic and reproductive factors related to different causes of maternal mo rtality. Design. A community-based incident case-referent study. Setti ng. Ilala district, Dar es Salaam, Tanzania. Participants. During the 2-year period, February 1991 - January 1993, 645 female deaths were id entified, of which 117 (18%) were maternal deaths. Main results. Direc t obstetric causes accounted for 62%, indirect causes 35% and in 3% cl assification was not possible because of insufficient information, Abo rtion-related complications were the most common cause of maternal dea th, followed by haemorrhage, hypertensive diseases, anaemia and sepsis , Twenty-four per cent of the teenage maternal deaths as well as one-t hird of those in single women were due to abortion, and 61% occurred i n cases where pregnancy was reported as unwanted, Most women (75%) saw a doctor before they died, but 21% had used local medicine, The perin atal outcome is poor, Only 40% of the deceased women left a live baby. Conclusions. There is a need to make family planning more accessible, particularly to single and divorced women who may lack social support , Traditional patterns for decision-making in the family and the use o f local medicines still play an important role in maternal mortality, both because of the medical side-effects and by delaying hospital trea tment.