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Levels and causes of maternal mortality in Senegal

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OBJECTIVES  To report the findings of a direct, community-based, assessment of maternal mortality and medical causes of death using verbal autopsy in three unique cohorts in rural Senegal.

METHODS  Methods from ongoing demographic surveillance systems. We obtained records of all deaths and births in women of age 15–49 over a period of 14 years in Niakhar, 10 years in Bandafassi and 13 years in Mlomp. Relatives of all women who died were interviewed using a standard questionnaire. Causes of death were assigned by three physicians independently. Maternal deaths were defined according to the ninth and tenth revisions of the International Classification of Diseases.

RESULTS  The maternal mortality ratio was similar in Mlomp [436 per 100 000 live births (95% confidence interval 209–802)] and Niakhar [516 per 100 000 (413–636)] but significantly higher in the more remote area of Bandafassi [852 (587–1196)] [relative risk compared with Niakhar 1.6 (1.0–2.4)]. Two-thirds of the maternal deaths were from direct obstetric causes, haemorrhage being the most common. Abortion was rare.

CONCLUSIONS  Demographic surveillance systems are useful tools for the measurement of maternal mortality provided special studies are carried out to arrive at the levels and causes of maternal death. The estimates of maternal mortality reported here are lower than those published by the WHO and UNICEF but remain extremely high, particularly in the very remote areas with very limited health infrastructure, where as many as one in 19 women may be expected to die as a consequence of childbirth.
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Keywords: Senegal; maternal mortality; obstetric care; verbal autopsy

Document Type: Research Article

Affiliations: 1: Institut de Recherche pour le Développement, Dakar, Senegal, 2: Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland, 3: Clinique de Gynécologie et Obstétrique, Hôpital Le Dantec, Dakar, Senegal, 4: Infectious Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, London, UK, 5: Unité `Population et développement', INED, Paris, France

Publication date: June 1, 2002

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