MATERNAL MORTALITY IN THE MAIN REFERRAL HOSPITAL IN THE GAMBIA, WEST-AFRICA

A retrospective analysis of 78 maternal deaths was performed during 19 91-1992 to estimate maternal mortality at tie maternity unit of the ma in tertiary level hospital in The Gambia. The non-abortion maternal mo rtality ratio (MMR) was 736 per 100000 live births. Among the direct c auses, haemorrhage caused most deaths (24%), followed by hypertensive disorders in pregnancy (HDP) (21%). Sepsis was the main cause of death in 15%. Anaemia led among rhs indirect causes of death (8%) and was a co-factor in 41% of all deaths. Substandard care factors other than m edical causes were determined involving health care facilities, staff, drugs and equipment, and patient-related factors. Well known risk fac tors of low age (less than or equal to 19 years) and nulliparity were highly represented in the maternal death group, and delivery by Caesar ean section occurred more than threefold compared to the overall Caesa rean section rats. Taking haemorrhage as an example, it is demonstrate d that the way diagnoses are grouped significantly affects the statist ical elaboration of maternal deaths.