A study of maternal mortality at the University Teaching Hospital, Lusaka,Zambia: the emergence of tuberculosis as a major non-obstetric cause of maternal death

SETTING: The Department of Obstetrics and Gynaecology, University Teaching Hospital, Lusaka, Zambia. OBJECTIVES: TO ascertain 1) the non-obstetric causes of maternal mortality, 2) the importance of tuberculosis as a cause of maternal deaths, and 3) th e trends in the aetiology of non-obstetric causes of maternal deaths during the past decade in the light of the human immunodeficiency virus epidemic. DESIGN: A 2-year retrospective study of the aetiology of all maternal death s occurring at the University Teaching Hospital (UTH), Lusaka, Zambia betwe en 1 January 1996 and 31 December 1997. Comparison of these data with avail able data published between 1974 and 1389. RESULTS: There were 251 maternal deaths recorded during the study period. O f these, 106 (42%) were due to direct (obstetric) causes and 145 (58%) were due to indirect (non-obstetric) causes. Malaria (30%), tuberculosis (25%) and unspecified chronic respiratory tract infections (22%) accounted for 77 % of non-obstetric causes of maternal deaths and 44% of all causes of mater nal deaths. The diagnosis of AIDS was closely linked with that of tuberculo sis (92% of cases), and unspecified chronic respiratory illnesses (97%), bu t not with malaria (37%). The maternal mortality ratio for UTH was calculat ed at 321 per 100000 live births, a significant increase from the 118 noted in 1982 and 667 in 1989. CONCLUSIONS: Despite improved obstetric services, the maternal mortality ra tios at UTH, Lusaka, have increased eight-fold over the past two decades. T his dramatic increase is mainly due to non-obstetric causes of death. Malar ia and AIDS-associated tuberculosis and unspecified 'chronic respiratory il lnesses' are now major causes of maternal death in Zambia. Greater emphasis is urgently required on early detection, accurate diagnosis, treatment and prevention of malaria and tuberculosis in pregnancy. Further definition of chronic 'unspecified' respiratory illnesses is also required.