Title : Analysis of maternal death surveillance data in the NAWA health region, Cote d'Ivoire, 2021-2023

Abstract:

Background:
According to the WHO, the maternal mortality ratio (MMR) is 216 per hundred thousand live births.  In Côte d'Ivoire, the MMR is estimated at 385 deaths per hundred thousand live births, leading to the strengthening of the country's strategic plan through several methods, including epidemiological surveillance. Implementing this surveillance requires periodic analysis of epidemiological trends. This study aimed to analyze the maternal death data in the Nawa health region.

Methods:
A descriptive cross-sectional study was conducted. Data were drawn from the national MAGPI surveillance database covering the period 2021-2023. Tools such as delivery registers and maternal death audit reports were used to establish a dataset for analysis. Sociodemographic, clinical and risk factor characteristics were taken into account. The data were cleaned and analyzed using Excel and Epi info 7.2, calculating measures of central tendency, proportions and rates.

Results:
102 maternal deaths were recorded. The median age was 29 years (15-45). Women aged 25-34 accounted 45% of deaths. Only 20.6% (21/102) of women attended the recommended 4 antenatal clinics (ANCs). Paucigravida and multigravida represented 34.3% (35/102) and 31.4% (32/102) of deaths respectively. 62 (63/102) of maternal deaths were due to obstetric hemorrhage and 38.2% (39/102) to hypertensive disorders. Deaths in the immediate post-partum period accounted for 56.8% (58/102), followed by late post-partum with 15.7% (16/102). Between 2021 and 2023, the MMR was 43, 61 and 69 per 100,000 live births respectively. The health districts of Buyo, Gueyo, and Soubre had MMRs of 83, 89 and 97 per 100,000 live births.

Conclusion:
Most deaths occur in young paucigest and pauciparous women. Intra-hospital postpartum hemorrhage is the leading cause of death. Increase in maternal deaths from 2022 to 2023, with a predominance in the Soubré health district. Efforts must be made to inform and educate women and improve also the organization of healthcare systems.