Understanding Maternal Deaths from the Family’s Perspective: Verbal Autopsies in Rural Tanzania

Gail C. Webber, Bwire Chirangi

Abstract

Maternal mortality rates in rural Tanzania are high. In preparation for the introduction of an intervention to reduce maternal deaths by distribution of misoprostol and erythromycin to women living in rural Rorya District, Mara Region, Tanzania, we conducted a limited verbal autopsy by surveying family members of women who died in childbirth in the previous five years. The purpose of this survey was to understand the circumstances surrounding these deaths. Thirty six family members were interviewed. The majority of the deaths occurred on the roadside as the women made their way to a health facility (23/36). Most of the women were delivered by a TBA (16/36) or family member (13/36). The majority of the family members attributed the death of their loved one to bleeding or retained placenta (32/36). Maternal deaths are common in this rural district of Tanzania because of long distances from the health facilities, difficulty finding transportation, costs of transport and hospital, and women’s beliefs about being able to deliver at home and fear of medication. There is a need for increased education of women and their families about the benefits of childbirth in a health care facility attended by skilled providers. There is also a role for the community distribution of misoprostol to be used as an alternative uterotonic medication if a facility birth is not possible, as the rates of maternal death from hemorrhage are unacceptably high. (Afr J Reprod Health 2014; 18[3]: 128-132)

 

Keywords: maternal mortality, verbal autopsy, postpartum hemorrhage.

 

Résumé 

Les taux de mortalité maternelle en Tanzanie rurale sont élevés. En préparation pour la mise en place d'une intervention visant à réduire la mortalité maternelle de distribution de misoprostol et l'érythromycine aux femmes domiciliées dans le district rural Rorya, la région de Mara, en Tanzanie, nous avons effectué une autopsie verbale limitée par sondage auprès des membres de la famille des femmes mortes en couches dans les précédentes cinq ans. Le but de cette enquête était de comprendre les circonstances qui entourent ces décès. Trente-six membres de famille ont été interrogés. La majorité des décès ont eu lieu en la route comme les femmes se dirigeaient à un établissement de santé (23/36). La plupart des femmes ont été livrées par un AT (16/36) ou membre de la famille (13/36). La majorité des membres de la famille ont attribué la mort de leur bien aimée à un saignement ou rétention placentaire (32/36). Les décès maternels sont fréquents dans ce district rural de la Tanzanie en raison des longues distances entre les établissements de santé, la difficulté à trouver le transport, les frais de transport et de l'hôpital et les croyances des femmes au sujet d'être en mesure d’accoucher  à domicile et la peur de médicaments. Il est nécessaire de renforcer l'éducation des femmes et de leurs familles sur les avantages de l'accouchement dans un établissement de soins de santé en présence de prestataires qualifiés. Il y a aussi un rôle pour la distribution communautaire de misoprostol  pour être utilisé comme un médicament utérotonique alternatif si une naissance dans un établissement de santé n'est pas possible, comme les taux de mortalité maternelle par hémorragie sont inacceptables. (Afr J Reprod Health 2014; 18[3]: 128-132)

 

Mots-clés: mortalité maternelle, autopsie verbale, hémorragie du post-partum.

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References

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