Institutional Factors Affecting Maternal Mortality in a Teaching Hospital

Abstract

Objective: To identify the institutional factors causing third delay of maternal mortality in Faridpur Medical College Hospital- a tertiary public health care centre in Bangladesh. Design: Cross-Sectional Study. Study period: January 2001 to December 2005. Methods and Materials: The case notes of all maternal deaths were reviewed at the end of each month during the study period. Various factors causing delay in the proper management of the cases were identified and noted. The data obtained from these reviews formed the basis of this study. Results: During the study period total 202 mothers died giving the maternal mortality 2010.5 per 100,000 deliveries. In 130(64.4%) cases one or more institutional factors were identified those contributed significantly to maternal deaths. The identified factors were: delayed blood transfusion or non availability of blood (40%); delayed or lack of operative interventions (37%); late or nonattendance by senior doctors (24.8%); operative interventions done by junior doctors (9.9%); non availability of ICU (intensive care unit) facility (29.7%) and of medicine (7.4%). Conclusion: There is a steady fall in maternal mortality ratio (MMR) in Bangladesh since 1990. But to reach the Millennium Development Goal for maternal health (MDG-5), the MMR will need to decrease at a much faster rate in the future. Improvement of the infrastructural facilities in the hospital can help to remove the preventable institutional factors causing third delay of maternal mortality. This can be a short term strategy to reduce maternal mortality. Key words: Maternal mortality; Institutional factor; Third delay. DOI: 10.3329/jbcps.v28i1.4636 J Bangladesh Coll Phys Surg 2010; 28: 5-9