[Preventable maternal mortality in an urban area in Niamey (Niger)]

Maternal mortality is a particularly serious public health problem in Niger. A number of studies suggest that the average rate is 650 to 700 maternal deaths for every 100,000 live births. However, in rural areas, the figure is probably nearer 1,300 and in urban areas 450. We report an analysis of 25 maternal deaths in hospitals or medical centers among patients living in the urban community of Niamey. For nine of these cases, no accurate diagnosis was established, and for twelve others, the death could probably have been avoided. Although this study was not quantitative, it suggests that risk factors for maternal mortality include multiparity, and being a single or primiparous mother. The absence of diagnosis for nine cases was due to the insufficient clinical detail in the medical files (which were scarcely usable), the rarity of paraclinical investigations for economic and organizational reasons, and the absence of post-mortem examination. The avoidable factors leading to death in twelve cases were: negligence on the part of the health service, inappropriate therapy, lack of blood transfusion, lack of vigilance by the patient, absence of medical care for abortion, erroneous diagnosis and transport problems. The patients' relatives appeared to be relatively resigned to the deaths for religious reasons. Further studies are required to understand prevalent attitudes. Numerous studies have concluded that many maternal deaths are often avoidable, both in developing and industrialized countries. This study in Niamey identified various deficiencies and dysfunctions of the system which allow this situation to continue. We propose seven recommendations which could help reduce the incidence of maternal deaths in Niamey.