A Comparative study of maternal mortality between Al-Abasia Tagali and Juba by Mahasin Hamed Haj Elsiddig

Introduction: Maternal Mortality: Is defined by United Nation Population Fund Action (UNFPA) as the death of a women during pregnancy or within 42 days after termination of pregnancy from any causes related to, or aggravated by the pregnancy or its management. This includes death as a complication of abortion at any stage of pregnancy (UNFPA, WHO, 2006).

Study justification: Nearly half of all pregnant women in Sudan deliver their children without the help of skilled birth attendants and as a result many of them die in childbirth UNFPA (2004). The mortality and morbidity rates among women in Sudan is among the highest in the region, UNFPA (2004).

26000 women die every year in Sudan while giving birth of them in the south and in the north. This means about 71 women die everyday while giving birth UNICEF(2009). Rates of pregnancy related deaths in south Sudan are the highest in the world; it's actually at per births.

According to Sudan health facilities, hemorrhage accounted for 25 percent of all maternal deaths. In north Sudan, rates of maternal mortality are 509 deaths per birth UN (2007).

The importance of the problem is not always evident from official statistic. In area where the problem is greatest, most maternal death go unregistered, therefore been subject to under estimation which aggravates the situation.

Maternal mortality affects not only women but also their families and communities. The risk of an infant dying increases significantly with the mother's death. The death of a woman of reproductive age brings significant economic losses and setbacks to community development.(WHO/UNICEF/UNFPA, 1995)

Objectives: The aim of this paper is to determine the causes of maternal mortality among Al- Abasia Tageli women compared with maternal mortality at Juba Teaching Hospital. It focus on the demographic and socio- economic status of the deceased women in these areas, and evaluating the maternity health care facilities in the study areas.

Materials and methods Primary data: Obtained through questionnaire and personal interviews of families who had maternal death beside information from health providers and retrospective health services attendants' records. Secondary data: Obtained from textbooks, published articles, and journals and internet sources.

Study areas Al-Abasia Tagli and Juba Teaching Hospital.  Al- Abasia Tagali, is situated in the eastern part of South Kordofan state

Juba Teaching Hospital:  Established back in the early 1920, as the Central Hospital in the southern Sudan. Maternity Unit: It is established following the Comprehensive Peace Agreement by UNFPA agency. It has 6 wards plus the theater room.

The unit lack access to basic emergency obstetric services, provision for health care is low,about 25% of the population in southern Sudan had access to health care which are organized predominantly by NGOs. The grater part of this health care is provided by unqualified personal who are trained by the NGOs to diagnose and treat cases according to protocols.

Target group: Families whom had maternal deaths during the last10 year taken as sample.

Sample Size: Hundred questionnaires were distributed. Fifty of these questionnaires in Al-Abasia Tagali, 30 were collected from families based information who had maternal deaths, and 20 from health centers selected purposively. In Juba 30 were from Juba Teaching Hospital and the other 20 questionnaires from health centers in the area purposively selected.

Data Analysis: The data were analyzed using the SPSS and the results are presented in the form of tables and figures using frequency and percentage. Study period: 5 May 2009 – 29 September 2009.

Result and discussion

Fig, 1: Percentage of the maternal mortality cases according to demographic data in Juba and Al-Abasia Tagali respectively. 1 - Age Juba Al-Abasia Tagali

2- Education

Juba Al-Abasia Tagali 3- Marital status

Juba Al-Abasia Tagali 4- Economic status

Fig. 2: Percentage of the maternal mortality cases according to birth number and birth status at time of death in Juba and Al-Abasia Tagali respectively. Birth number Juba Al-Abasia Tagali

Birth status

Fig. 3: Percentage of the maternal mortality cases according to health care factors in the area in Juba and Al-Abasia Tagali respectively. Juba Al-Abasia Tagali 1- Availability of health care in the area

2- Availability of maternity unit Juba Al-Abasia Tagali

3- Maternity unit status

Fig. 4: Percentage of the maternal mortality cases according to factors during and post pregnancy, at time of delivery and after delivery in Juba and Al-Abasia Tagali respectively. 1- Pregnancy complications

2- Delivery time span Juba Al-Abasia Tagali

3- Complications after delivery Juba Al-Abasia Tagali

Fig. 5: Percentage of the maternal mortality cases according to probable maternal death factors Juba (column 1) and Al-Abasia Tagali respectively (column 2). 1- Place of delivery Juba Al-Abasia Tagali

2- Way of delivery Juba Al-Abasia Tagali

3- Causes of maternal death Juba Al-Abasia Tagali

4- Maternal death time Juba Al-Abasia Tagali

Fig. 6: The correlation between the demographic variables and the probable maternal death factors in both areas.

Fig. 7: Mean of pregnancy and delivery complications variables vis availability of health services in the both areas.

Conclusion: The present study revealed that most cases of maternal mortality deliver at home by TBA, midwives or alone.

Delivery complications were highly noticed in home delivered cases where heavy bleeding and retained placenta were well noticed. Death from hemorrhage was the predominant cause of maternal mortality among the study cases.

The result of the study explained that the demographic data of the cases are uncorrelated to the medical factors. While the health services in the two areas although different but contribute directly to the high delivery complications and thus elevated maternal mortality rate.

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