Risk factors for maternal mortality at two national reference maternity hospitals in Djibouti City, 2019-2023

Maternal mortality is a global public health challenge, particularly in developing countries. Objective:To analyze the risk factors associated with maternal death in hospitals at the level 3 maternity hospitals of Djibouti City. A case-control analytical study from January 1, 2019, to December 31,2023, in Dar El Hanan maternity hospital and the Cheiko Hospital maternity.All maternal deaths that occurred in these periods in two maternity wards were included.A descriptive analysis is performed,thenconditional logistic regression univariate and multivariate analysis was used to assess factors associated with maternal mortality. The analysis focused, on a total of 515 women,103 cases, and 412 controls selected. The main causes of maternal death are hemorrhagic shock (26.2%); preeclampsia and its complications (20.4%) and then malaria(17.5%).After multivariate logistic regression analyses, we identified several factors associated with in-hospital mortality, such as, the level of education (woman not in school) with OR: 51.4 [6.75;114.8] and p<0.001;clinical status at admission with OR:4.12 [1.86;9.39]and p<0001;presence of thrombocytopenia with OR:2.97[1.21;7.30] and p:0.017; patientrequiring transfusions with OR:3.47 [1.55,7.93] and p<0.003;also the extreme,lengthofstay(LOS)≤24HwithOR:2.98[0.96,9.5]and LOS>14d OR:2.05[0.45,9.25] ,andp:0.012. The factors identified by this study show the need to strengthen preventive strategies during pregnancy(prenatal follow-ups,early detection of anemia and malaria as well as high-risk pregnancies);improve care during childbirth and the perinatal period.