OPERATIONAL FACTORS OF MATERNAL MORTALITY IN ZIMBABWE

Most studies on maternal mortality have looked at the direct clinical causes and the distribution of actual rates. Much less attention has b een given to prevailing health care systems or community factors assoc iated with such deaths. A case-control study design using incident cas es was used to identify the magnitude of maternal deaths and community and health care operational factors in both an urban and a rural sett ing in Zimbabwe. The maternal mortality ratio for the rural setting wa s 168 per 100 000 live births and that for the urban setting was 85 pe r 100 000 live births. For the rural setting, the major direct causes of death were haemorrhage (24.8%), abortion complications (15.2%), pue rperal sepsis (13.3%), and eclampsia (4.8%). For the urban setting the y were eclampsia (26.2%), abortion complications (23.0%), puerperal se psis (14.8%) and haemorrhage (9.8%). Whereas rural-urban variations in maternal mortality were observed, inter-rural district variations wer e also apparent, especially with poor medical resources, poor communic ation and delayed interventions. Risk factors for maternal mortality w ere present at each of the various levels of care. Lack of antenatal c are (ANC) had a significant Odds Ratio (OR 10.7 rural and 4.6 urban) c ontribution to maternal mortality. When abortions and ectopics were ex cluded the OR for absent ANC was 4.1 (rural) and 2.6 (urban). Lack of timely transport to nearest clinic or hospital adversely affected preg nancy outcome in both rural and urban settings. Despite delivery place planning, predisposing health conditions and some danger signals, few of the women utilized the venue originally planned for delivery. Heal th education, community sensitization and teaching on risk signal awar eness as well as health care delivery system strengthening are recomme nded for reducing the high maternal mortality rates.