Perinatal Mortality and Associated Factors Among Deliveries in Three Municipal Hospitals of Dar Es Salaam, Tanzania

Abstract

Introduction Perinatal mortality is used as one of the indicators of the quality of health provided during the ante natal and perinatal period. 1 Globally about 136million births occur every year, and of these approximately 3.7million die during the neonatal period and 3.3million are stillbirths. 2. Perinatal mortality in developing countries is five times higher than in developed countries at 10 deaths per 1000 total births in developed regions, and 50 per 1000 in developing regions and over 60 per 1000 in least developed countries. In the African region perinatal mortality is estimated at 62 deaths per 1000 births which is the highest. 1,2 Approximately 38% of deaths among children younger than 5years of age occur during the first 28 days of life (neonatal deaths), and 75% of these neonatal deaths occur within the first 7 days. 2 Causes and determinants of early neonatal deaths and stillbirths are attributed to poor maternal health, inadequate care during pregnancy, inappropriate management of complications during pregnancy and delivery, poor hygiene during delivery and in the first critical hours after birth, as well as lack of newborn care. 2,3 In Tanzania, it is estimated that more than 1.6million babies are born every year and of these 51,000 die within the first one month of life. Perinatal mortality in Tanzania has remained unacceptably high for the past decade at 26/ 1000 live births. 4 On recognition of the challenge in reaching the MDG 4, the African union declaration by heads of states and governments in September 2004 urged all countries in the region to accelerate reduction of maternal and newborn deaths. In response to this, Tanzania developed the National road map strategic plan to accelerate reduction in maternal and newborn deaths in Tanzania (2006-2010) which stipulates strategies to guide stakeholders including the government, development partners, NGOs, civil society Organization and communities among others, in working together towards attainment of the health Millennium Development goals. 5 Further support for in-cooperating child health interventions into the one plan was voiced by various stake holders and partners following the launching of the Tanzania partnership for maternal newborn and child health (TPMHCH) in April 2004. Subsequently, the New Delhi declaration 2005 further re-emphasizes the efforts and strategies in attaining the Millennium development goals in which countries including Tanzania committed to develop national ONE PLAN for maternal, newborn and child health for accelerating the reduction of maternal, newborn and child deaths in order to improve coordination, align resources and standardize monitoring. 6 Tanzania has instituted several interventions which aim at addressing both maternal and child health such as, doubling public expenditure on health, increased coverage of key maternal, newborn and child survival interventions; Improving the quality of antenatal care through provision of Focused Antenatal Care (FANC), screening and treatment of syphillis, prevention of mother to child transmission of HIV, use of insecticide treated bed nets and training of health care Abstract Introduction: Perinatal mortality is one of the indicators used to measure the health status of women, newborns and the quality of health provided during antenatal and perinatal period. In Tanzania, Neonatal mortality has remained high (26/ 1000 live births) and it is estimated that more than 1.6 million babies are born every year of which 51,000 die within the first 28days of life. The objective of this study was to determine the causes and factors associated with perinatal deaths among women delivering in the three municipal hospitals in Dar es Salaam, Tanzania. Materials and methods: The study employed an unmatched case control study design and was conducted between November 2010 and February 2011. A pretested and structured data abstraction tool was used to collect information from labour ward registers and the antenatal cards of mothers of the study participants. Data was entered into the computer, cleaned and analyzed using EPI INFO 3.5.1 software. Bivariate analysis was done using the Chi-square test and multiple logistic regression was used to determine the variables which are independent predictors of perinatal mortality. Results: A total of 600 babies (200 cases and 400 controls) were included in the study. Major causes of perinatal mortality included prolonged/ obstructed labour (22%), pre-eclampsia/ eclampsia (23%), and prematurity accounting for 18.5% of the perinatal deaths. Mothers of the cases were more likely to have a history of previous adverse pregnancy outcome (AOR 2.35, 95%CI 1.15-4.79), hypertensive disorder (AOR, 6.67, 95%CI=3.55-12.64), and premature delivery (AOR 12.18, 95%CI=6.60-67.95). Conclusion: Pre-eclampsia/ eclampsia, prolonged/ obstructed labour, and prematurity were found to be the main causes of perinatal mortality. Hypertension during pregnancy, a history of previous adverse pregnancy outcome and prematurity, were significantly associated with increased risk of perinatal death. We recommend active screening for risk factors during ANC and timely management of hypertension and obstructed/ prolonged labour.