OPERATIONAL FACTORS AFFECTING MATERNAL MORTALITY IN TANZANIA

Identification of the main operational factors in cases of maternal de ath within and outside the health care system is necessary for safe mo therhood programmes. In this study, a follow-up was done of all 117 ca ses of maternal deaths in Ilala district, Dar es Salaam, 1991-1993, at all levels of care. ln all, 79% received some medical care whereas 11 % arrived too late for treatment. For each case the major operational factors and all health care interventions were defined through intervi ews with family members and health care staff and from hospital record s, and the avoidability of each case was determined. In the health ins titutions where the women had consulted, the available resources were assessed. It was found that in most cases the husband (29%) or the mot her (31%) of the woman decided on her care in cases of complications, and together with the lack of transport, this often caused delay at ho me. Also, delay in transfer from the district hospital was common. Cas es of abortion complications were often not managed on time because of the delay in reporting to hospital or misleading information. Subopti mal care was identified in 77% of the cases reaching health care. Inad equate treatment was identified by the district health staff in 61% an d by the referral centres in 12% of their cases. Wrong decision at the district level and lack of equipment at the referral centre were the main reasons for inadequate care. It is concluded that although commun ity education on danger signs in pregnancy and labour is important, pr ovision of the core resources and supplies for emergency obstetric int erventions, as well as clear protocols for management and referral, ar e absolutely necessary for improvement of maternal survival.