Factors causing maternal deaths at level one hospitals and midwife obstetric units in the Western Cape

Louw, Hestelle (2016-03)

Thesis (MCur)--Stellenbosch University, 2016.

Thesis

ENGLISH ABSTRACT: Background: Maternal deaths in South Africa remain a concern as the target of maternal mortality ratio (MMR) of 38 maternal deaths per 100,000 live births not being reached as anticipated in 2015. The Western Cape has the lowest MMR in South Africa. However, there is a lack of or inadequate information with regard to maternal deaths in the Western Cape at level one hospitals and midwife obstetric units (MOUs). Strategies to reduce maternal deaths at level two and three hospitals in the Western Cape are not necessarily appropriate for level one hospitals or MOUs. The aim of this study was to determine the factors causing maternal deaths at level one hospitals and MOUs in the Western Cape. Methods: A retrospective quantitative study with a descriptive design was performed. Records of 86 maternal deaths out of the 92 which occurred at level one hospitals and MOUs between 2008 and 2012 were reviewed. The data was extracted from the electronic database of the National Committee for Confidential Enquiries into Maternal Deaths (NCCEMD). Data was analysed separately for the level one hospitals and MOUs. Additional analysis was done to determine the factors for the Cape Town Metropole separately from the other health districts which are Cape Winelands, Eden, Klein Karoo, Overberg and West Coast. The researcher used an existing validated tool. The 2008 version of the NCCEMD’s assessors’ form was used as the data collection tool. Ethics approval was sought from the Stellenbosch University Health Research Ethics Committee, the Western Cape Department of Health and the NCCEMD. Results: The most common primary cause category of maternal death at level one hospitals was non-pregnancy-related infections, specifically tuberculosis and pneumonia. While the most common primary cause category of maternal death at MOUs was hypertension. The most common final causes of death at both level one hospitals and MOUs were cardiac and respiratory failure. Analysis of the avoidable factors at both levels of care showed that medical related factors such as management of the patient at an inappropriate level of care and problem recognition/diagnosis were most common. Conclusion: The primary causes of maternal deaths differed according to levels of care. Therefore strategies to decrease maternal deaths should be specific for particular levels of care. In particular, level one hospitals must screen and treat pregnant women for tuberculosis and pneumonia, while MOUs must improve the management of acute, severe hypertension.

AFRIKAANSE OPSOMMING: Agtergrond: Moedersterftes in Suid-Afrika, met die moedersterftes-verhouding teiken van 38 moedersterftes per 100,000 lewende babas, wat nie soos verwag in 2015 bereik gaan word nie, is nog steeds ’n bekommernis. Die Wes-Kaap is die provinsie met die laagste moedersterftes-verhouding in Suid-Afrika. Daar is egter ’n gebrek aan of onvoldoende inligting ten opsigte van moedersterftes by vlak een hospitale en vroedvrou verlossingseenhede. Strategieë om moedersterftes by vlak twee en drie hospitale te verminder, is nie noodwendig toepaslik vir vlak een hospitale of vroedvrou verlossingseenhede nie. Die doel van die studie was om die faktore wat moedersterftes by vlak een hospitale en vroedvrou verlossingseenhede in die Wes-Kaap veroorsaak, te bepaal. Metode: ’n Retrospektiewe kwantitatiewe studie met ’n beskrywende ontwerp was gedoen. Rekords van 86 moedersterftes uit 92 sterftes wat by vlak een hospitale and vroedvrou verlossingseenhede gedurende 2008 en 2012 plaasgevind het, is bestudeer. Die data is vanaf die elektroniese databasis van die “Committee for Confidential Enquiries into Maternal Deaths” (NCCEMD), verkry. Hierdie data is apart vir vlak een hospitale and vroedvrou verlossingseenhede geanaliseer. Addisionele analise is gedoen om die faktore vir Kaapstad Metropool afsonderlik van dié vir die ander gesondheidsdistrikte te bepaal. Die navorser het ‘n bestaande gevalideerde instrument gebruik. As instrument vir data versameling, is die 2008 weergawe van die assessorsvorm van die NCCEMD gebruik. Etiese goedkeuring is van Stellenbosch Universiteit Gesondheidnavorsingsetiekkomitee, die Wes-Kaapse Departement van Gesondheid en die NCCEMD verkry. Resultate: Die mees algemene primêre oorsaak kategorie van moedersterfte by vlak een hospitale was nie-swangerskap verwante infeksies, spesifiek tuberkulose en pneumonie. Terwyl die mees algemene primêre oorsaak kategorie van moedersterfte by vroedvrou verlossingseenhede hipertensie was. Die mees algemene finale oorsake van sterftes by beide vlak een hospitale and vroedvrou verlossingseenhede was kardiale en respiratoriese versaking. Analise van die voorkombare faktore het aangedui dat medies-verwante faktore soos hantering van die pasiënt by ’n ontoepaslike vlak van sorg en die herkenning van die probleem/diagnose die algemeenste was. Slotsom: Die primêre oorsake van moedersterftes verskil volgens die vlak van sorg. Gevolglik moet strategieë vir die vermindering van moedersterftes spesifiek vir sekere vlakke van sorg wees. Swanger vroue moet by vlak een hospitale spesifiek vir tuberkulose en pneumonie gesif en behandel word, terwyl die hantering van akuut, ernstige hipertensie by MOUs verbeter moet word.

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