SHORT REPORT Lack of antenatal care, education, and high maternal mortality in Kassala hospital, eastern Sudan during 2005–2009 ABDEL AZIEM A. ALI 1 & ISHAG ADAM 2 1 Department of Obstetrics and Gynecology, Faculty of Medicine, Kassala University, Sudan and 2 Department of Obstetrics and Gynecology, Faculty of Medicine, University of Khartoum, Sudan Abstract The aim of this study was to investigate the incidence and causes of maternal deaths at Kassala maternity hospital, eastern Sudan during 2005–2009. All maternal deaths during this period were reviewed and classified retrospectively. The medical file of consequent women who were discharged from the same ward in the hospital was reviewed to act as control for the maternal death. There were 132 maternal deaths and 20,485 (644/100,000) live births. Septicemia, preeclampsia/eclampsia, hemorrhage, anemia, viral hepatitis, and malaria were the causes for maternal mortality. Primipare (OR ¼ 3.3, CI ¼ 1.6–6.9, p ¼ 0.001), lack of antenatal care (OR ¼ 3.9, CI ¼ 1.6–9.5, p ¼ 0.002), illiteracy (OR ¼ 2.6, CI ¼ 1.4–4.8, p ¼ 0.002), and rural residence (OR ¼ 2.2, CI ¼ 1.2– 4.1; p ¼ 0.008) were the predictors for maternal death. The levels of maternal education and antenatal attendance should be raised to reduce the high maternal mortality. Keywords: Maternal mortality, preeclampsia, anemia, pregnancy, malaria, Sudan Introduction Maternal mortality is an important indicator for obstetric care and health status. The reduction of maternal deaths is high priority for the international community, especially in view of the increased attention on the Millennium Development Goals. Effective services to improve overall maternal health need targeted health and social policies and valid current epidemiological data. Thus, investigating the magnitude and distribution of the causes of maternal deaths and stillbirths are crucial to inform reproductive health policy-makers and program managers, especially in developing countries where the vast majority of these events occur. There is wide regional and interregional variation in the causes of maternal death. Few data exist concerning maternal mortality in Sudan, which is the biggest African country with 40 million inhabitants [1,2]. Moreover, these were only reports without investigating the risk factors; there were no published data concerning maternal mortality in the eastern part of Sudan. Thus, the current study was conducted to investigate the incidence and causes of maternal deaths in Kassala hospital, eastern Sudan. Methods All maternal deaths at Kassala hospital during 2005–2009 were reviewed and classified retrospectively. The medical file of consequent women who were discharged from the same ward in the hospital was reviewed to act as control for the maternal death. Kassala Hospital provides tertiary care for women who receive antenatal care at the hospital, as well as for referrals from other clinics and hospitals, and for women who live close to the hospital facility. All women with risk factors or obstetric complications are referred to this hospital. However, the referral criteria are not strictly adhered to and many patients without any significant complications deliver at the hospital. A maternal death was defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause [3]. The medical files of all women of maternal deaths and controls were reviewed; patients’ records retrieved and the age, parity, residence, antenatal care, educational level, time and cause of death were recorded. Table I. Cause of maternal mortality in Kassala hospital, Sudan. Factor Numbers of women died Percentage of the total Septicemia/infections 31 23.5 Eclampsia/preeclampsia 24 18.1 Hemorrhage 21 15.9 Anemia 13 9.8 Jaundice (viral hepatitis) 9 6.8 Malaria 7 5.3 Rupture uterus 4 3.0 Rupture ectopic pregnancy 3 2.2 Heart disease 3 2.2 Renal failure 2 1.5 Uncertain 5 3.7 Others, e.g. asthma, tuberculosis 10 7.5 Total 132 100 (Received 11 March 2010; revised 15 May 2010; accepted 19 November 2010) Correspondence: Ishag Adam, Department of Obstetrics and Gynecology, Faculty of Medicine, University of Khartoum, P.O. Box 102, Khartoum, Sudan. Tel: þ249912168988. Fax: þ249183771211. E-mail: ishagadam@hotmail.com The Journal of Maternal-Fetal and Neonatal Medicine, 2011; Early Online, 1–2 Ó 2011 Informa UK, Ltd. ISSN 1476-7058 print/ISSN 1476-4954 online DOI: 10.3109/14767058.2010.545908 J Matern Fetal Neonatal Med Downloaded from informahealthcare.com by 196.205.192.46 on 01/13/11 For personal use only.