Maternal mortality studies in Ethiopia--magnitude, causes and trends

Reduction of maternal mortality is a global public health priority. Periodic maternal mortality studies are required to monitor changing trends. Both direct and indirect methods of maternal mortality measurement are used in different settings.

To study the geographic coverage, study base, type, maternal mortality ratio level and proportion of different causes of maternal deaths identified by maternal mortality studies conducted in Ethiopia.

Electronic databases search coupled with search in local journals of health as well as interview with relevant university departments for unpublished literatures on maternal mortality studies was conducted. Structured questionnaire was used to extract relevant data which was analyzed using SPSS 13 statistical package.

Twelve maternal mortality studies were identified from 1980 to 2008. Eight were hospital based and four community based studies. Only two were based on a national sample. Maternal mortality ratios ranged from 567 to 2600 per hundred thousand live births. Hospital studies had nearly double ratios compared to community studies. Maternal mortality ratios from hospitals outside Addis were nearly double or more compared to Addis hospital ratios. Abortion complications, ruptured uterus, puerperal sepsis, postpartum hemorrhage and preeclampsia/ eclampsia were the five major causes of maternal mortality. The only study conducted since 2000 has shown a marked reduction in abortion related mortality; compared to findings of earlier studies.

Only four of the country's nine regions were covered by the hospital studies. The large pastoralist community has not been adequately addressed by any of the studies. There is a need to conduct national health facility based studies to gather representative data on the proportion of different causes of maternal deaths and their predisposing factors. Inclusion of verbal autopsy techniques to demographic and health surveys and the decennial census can increase the power of these studies to define maternal mortality in more detail. In general, there is a paucity of information on maternal mortality.