Maternal mortality rate is the annual number of mothers who die per 100000 births from any cause related to or aggravated by pregnancy, management and delivery. This excludes accidental or incidental causes. The MMR includes deaths during pregnancy, childbirth or within 42 days of termination of the pregnancy, irrespective of the duration and the site of the pregnancy for a specified year (UNICEF, 2010). There exists a clear distinction between a direct maternal death that is as a result of a complication of the pregnancy or delivery and an indirect maternal death that is a pregnancy related death in a patient a pre-existing or newly developed health complication. However, in this study, both types of maternal deaths will be considered. According to a report , the MMR in Uganda was 435 deaths per 100000 births in 2006( UBOS,2008),down from 505 deaths per 100000 births in 2002 and Uganda has a millennium development goal target of reducing the maternal mortality rate by three quarters to 131deaths per 100000 births by 2015. However, a national study conducted by Mbonye 2000 at 97 health facilities, including 30 hospitals, found the institutional MMR to be as high as 846 per 100,000 live births.
It is conceivable, however, that institutional mortality rates would be higher than national averages due to the fact that women will tend to seek institutional care when complications arise. High MMR are typical of many countries in sub Saharan Africa and this has further been worsened by the fact that very few pregnant women receive antenatal care and this exposes expectant mothers to the risk of death from pregnancy related causes (Ssengooba, 2004). A report by the population reference bureau indicated that in 2002 only 38% of the births are attended by a skilled personnel, the fertility rate stood at 6.9 children and that 66% of the women in Uganda had given birth by the age of 20(maternal and neonatal effort index, world population bureau,2002).according to the Uganda bureau of statistics, there has been a slight increase in the number of births attended by a skilled personnel to 41.1% in 2006 and the annual health sub sector performance report indicated a decline in the number of deliveries attended to by a skilled personnel from 40% in 2008 to 33% in 2010 and it is highly doubtable if the millennium development goal target of 90%births by 2015 will be attained.
The report adds that only 45% of the health facilities in Uganda provided emergency obstetric care by 2007 and the report further notes that the high maternal mortality rates point to poor or lack of such services which unfortunately the government is giving a deaf ear to. Ssengooba, 2004, observes that the prevailing high rates of fertility (6.7 births per woman), in an environment of poor access to quality maternal and neonatal care, have continued to expose Ugandan mothers and infants to a high risk of death from pregnancy related causes , with an estimated 1 woman in 10 dying from maternal causes in Uganda (the lifetime risk) All pregnant women face some level of maternal risk. According to the WHO, about 40% of pregnant women will experience delivery complications, while about 15% need obstetric care to manage complications which are potentially life threatening to the mother or infant. Despite the importance of antenatal care to predict and prevent some complications, many are sudden in onset and unpredictable (Ssengooba, 2004).
A report by the new York times in 2010 indicated that 80% of the world’s maternal deaths occur in just 21 nations of which 15 nations are located in sub-Saharan Africa ;Uganda inclusive. In 2008, approximately 5200 women died from pregnancy related causes in Uganda and this translates to around 16 women per day. According to Dr Romano Byaruhanga, an obstetrician and gaenacologist at Nsambya hospital, the leading causes of maternal deaths are bleeding, infection of pelvic organs, obstructed labour and pregnancy related high blood pressure with fitting and experts assert that majority of such deaths are avoidable through a range of interventions administered by a skilled health care provider given adequate equipment and supplies which are lacking for most of the health facilities. Its further noted that unsafe abortions accounted for 13% of the maternal deaths, eclampsia accounted for 12% of the maternal deaths, obstetric infections (bacterial infections) accounted for 15%, and severe bleeding accounted for 25% of the maternal deaths(sexual and reproductive health minimum package assessment 1995/6) Background of mityana hospital
The hospital is located in the newly created district of mityana in mityana town council and serves the district and the neighboring districts of gomba and kiboga. It started in the 1920’s on a 20 acre piece of land with a bed capacity of 120 beds (MOH statistical abstract,2008) The hospital came to the lime light in maternal deaths in 2009 when Sylvia Nalubowa died at the hospital shortly after delivery due to negligence from the health workers and this resulted into riots from the local community. However, many other deaths go unnoticed. (New vision, 25/august/2009)
Statement of the problem
Despite the fact that Uganda has continued to experience rapid growth in the economy, the IMR and MMR have not decreased signicantly and remain at alarming levels. There exists a strong positive relationship between the maternal MMR and the IMR. Unless a through study is carried out into the causes of maternal deaths in Uganda, in order to come up with the relevant policy interventions to reduce maternal deaths, the country will continue to lose its mothers in pregnancy related deaths and the attainment of its target pertaining the fifth MDG of reducing the MMR by three quarters to 131deaths per 100000 births will remain a myth and dream beyond actualization.
Objectives of the study
To critically analyse the significant causes of maternal mortality in the rural areas of Uganda Specific objectives
To analyse the relationship between maternal mortality and the place of delivery of the mother To establish the relationship between maternal mortality and access to antenatal care during pregnancy To establish the relationship between maternal mortality and the income levels of the parent To establish the relationship between maternal mortality an domestic violence during pregnancy To establish the relationship between maternal mortality and the distance to the nearest health centre To assess the relationship between maternal mortality and child spacing To investigate the relationship between maternal mortality and the age of the mother To investigate the relationship between maternal mortality and the HIV/AIDS status of the mother
There exists no relationship between maternal mortality and place of delivery There is no relationship between maternal mortality and access to antenatal care during pregnancy There is no relationship between maternal mortality and income levels There is no relationship between maternal mortality and domestic violence There is no relationship between maternal mortality and distance from the nearest health center There is no relationship between maternal mortality and child spacing There is no relationship between maternal mortality and the age of the mother There is no relationship between maternal mortality and the HIV/AIDS status of the mother
Significance of the study
the research findings will be of great importance to the various stake holders in the health sector like MOH, MoFPED, NPA,UBOS and mityana district department of health to know the significant causes of maternal mortality in the mityana district in order to find solutions and other policy interventions to reduce maternal mortality if Uganda is to achieve its target pertaining the fifth MDG of reducing MMR by three quarters from the current rate of 345 deaths per 100000 births to 131 deaths per 100000 births by 2015 and improve its score on the HDI index.
The research findings will be used by other people carrying out research in the health sector especially on infant and maternal mortality
The research study is a partial fulfillment of the requirements for the award of the bachelors’ degree in economics and statistics of Kyambogo University Limitations of the study Cost. The study has so many monetary costs that include travels to the field during the data collection process, the purchase of stationery used in the study, the printing of questionnaires, to mention but a few. Time. The study requires a lot of time right from the development of the research proposal to data collection to data analysis and finally the making of the research report Difficulty in access to information. Some of the data required in the study was not readily available at time and at times it required a lengthy procedure to access some of the files of the patient from the hospital which requires clearance from the director of the hospital.
Freddie Ssengooba et al, 2004, maternal health review Uganda, Makerere University Kampala
MOH, 2001, the paradox of Uganda’s poor and worsening health indicators in the areas of economic growth, poverty reduction and health sector reform Uganda health bulletin vol. 7 numbers 3 and 4,.
Mbonye A.K, 2000, Abortion in Uganda: magnitude and implications African journal of reproductive health 4(2) 104-108.
World population bureau 2002, maternal and neonatal program effort index, a
tool for maternal health advocates.
WHO, 2002, advising safe motherhood through Human rights
Population reference bureau, 2001 world population sheet, Washington DC. Mbonye AK. Abortion in Uganda: Magnitude and Implications. African Journal of Reproductive Health 4(2): 104-108, 2000.
UBOS, 2008, millennium development goals Uganda country profile, Uganda Bureau of Statistics.