Objective: To analyze maternal deaths, identify causes and dysfunctions leading to these deaths in order to contribute to the implementation of strategies to reduce maternal mortality at CHU Kara. Method: Cross-sectional descriptive study involving 65 cases of maternal deaths recorded at CHU-Kara from January 1, 2018 to June 30, 2021. Results: Our study focused on 65 cases of maternal deaths recorded at the maternity ward of CHU-Kara. The average age was 30 years, with a range of 15 to 45 years. They were mostly housewives (52.3%), uneducated (38.5%), multiparous (41.5%), and referred (86.2%). The causes were mainly direct obstetric causes (81.54%), with preeclampsia and its complications (28.30%) and immediate postpartum hemorrhage (20.75%) being the most common. However, uterine rupture (20.5%) and post-abortion sepsis (16.4%) were the most lethal etiologies. Delayed evacuation (46.43%), inadequate transportation (91%), and insufficient prenatal care (72.31%) were the dysfunctions before referral. Within the CHU Kara, delays in management (58.46%), unavailability of blood and labile products (18%), and insufficient monitoring were the dysfunctions identified. Ninety-five point four percent (95.4%) of the deaths were preventable. Conclusion: The magnitude of intrahospital maternal deaths, the various dysfunctions observed in the occurrence of maternal deaths before referral/evacuation and within the hospital highlight the importance of effectively implementing recommendations from audits in the fight against maternal mortality. The majority of the deaths were preventable (95.38%).
References
[1]
OMS (1995) Classification Statistique Internationale des Maladies et des Problèmes de santé Connexes, Dixième révision. Organisation Mondiale de la Santé, Vol. 2, 139-141.
[2]
Organisation Mondiale de la Santé (2023) Mortalité Maternelle. https://www.who.int/fr/news-room/fact-sheets/detail/maternal-mortality
[3]
Direction Générale de la Statistique et de la Comptabilité Nationale (DGSCN) du Ministère togolais de la Planification, du Développement et de l’Aménagement du Territoire, Ministère Togolais de la Santé. Troisième enquête démographique et de santé (EDST-III 2013-2014).
[4]
Banque Mondiale (2020) Ratio de Décès Maternel. https://donnees.banquemondiale.org/indicator/SH.STA.MMRT
[5]
Organisation mondiale de la santé (OMS) (2004) Au-delà des nombres: examiner les morts maternelles et les complications pour réduire les risques liés à la grossesse. 164 p.
[6]
Aboubakari, A.S., Agbetra, N., Baeta, S. and Adama, A. (2006) La mortalité maternelle au CHU de Kara: incidence, causes et facteurs de risque. Journal de la SAGO, 7, 21-25.
[7]
Raoul, A.S., Hounkponou, A.F.M.N., Obossou, A.A.A., Gabkika, B.M., Doha, S.M.I, Sidi, R.I., et al. (2021) Facteurs associes aux décès maternels à l’hôpital de zone saint jean de Dieu de Tanguieta de 2015 à 2019. European Scientific Journal, ESJ, 17, 93-105. https://doi.org/10.19044/esj.2021.v17n29p93
[8]
Ajavon, D.R.D., Logbo-akey K.E., Yendoube, K., Sibabe, A., Hélène, A., Christine, B., Tchilalo, A., Pouzouwè, S., Louise, G. and Samadou, A.A. (2022) Causes of Maternal Mortality in 2020 in the Kara Region (Togo). Open Journal of Obstetrics and Gynecology, 12, 104-111. https://doi.org/10.4236/ojog.2022.121010
[9]
Saucedo, M. and Deneux-Tharaux, C. (2021) Mortalité Maternelle, Fréquence, causes, profil des femmes et évitabilité des décès en France 2013-2015. Gynécologie Obstétrique Fertilité & Sénologie, 49, 9‑26. https://doi.org/10.1016/j.gofs.2020.11.006
[10]
UNFPA (2013) La santé maternelle en Afrique. https://www.unfpa.org
[11]
Ahmed, S., Li, Q., Liu, L. and Tsui, A.O. (2012) Maternal Deaths Averted by Contraceptive Use: An Analysis of 172 Countries. The Lancet, 380, 111-125. https://doi.org/10.1016/S0140-6736(12)60478-4
[12]
World Health Organization (2016) WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience. World Health Organization. https://iris.who.int/handle/10665/250796
[13]
Diallo, S., Camara, Y.B. and Daffe, M. (2000) Consultation prénatale et état de santé des nouveau-nés à l’Institut de Nutrition et de Santé de l’Enfant (INSE) à Conakry (Guinée). Médecine d’Afrique Noire, 47, 233-235.
[14]
Mbeva, J.B., Karemere, H., Ndeba, M., Nyavanda, L., Mundama W’Itende, J.-P. (2018) Facteurs explicatifs des décès maternels en milieu hospitalier: une étude au niveau de six zones de santé dans l’est de la RDC Congo. International Journal of Innovation and Applied Studies, 23, 559-568.
[15]
Bouhoussou, M.K., Djanhan, Y., Boni, S., Kone. N. and Toure, C.K. (1992) La Mortalité maternelle à Abidjan en 1988. Médecine d’Afrique Noire, 39, 480-484.
[16]
WHO (2020) Worldwide Prevalence of Anemia 1993-2005. https://www.who.int/publications/i/item/9789241596657
[17]
Galiba Atipo Tsiba, F.O., Ngolet, L., Itoua, C., Bintsene-Mpika, G., Malanda, F., Boukinda Doukaga, D., et al. (2019) Drépanocytose et Grossesse: Expérience du Centre National de Référence de la Drépanocytose de Brazzaville. Health Sciences and Disease, 20, 92-96.
[18]
Diassana, M., Dembele, S., Macalou, B., Ndaou, K., Sidibe, A., Bocoum, A., et al. (2020) Audits de Décès Maternels dans un Hôpital Régional du Mali (Kayes), Place des 3 Retards et Impact sur le Service de Gynécologie-Obstétrique. Health Sciences and Disease, 21, 59-63.
[19]
Fawcus, S., Mbizvo, M., Lindmark, G. and Nystrom, L. (1996) A Community-Based Investigation of Avoidable Factors for Maternal Mortality in Zimbabwe. Studies in Family Planning, 27, 319‑327. https://doi.org/10.2307/2138027