Facility-based maternal death review in three districts in the central region of Malawi: an analysis of causes and characteristics of maternal deaths

Womens Health Issues. 2009 Jan-Feb;19(1):14-20. doi: 10.1016/j.whi.2008.09.008.


Purpose: We sought to determine the causes and characteristics maternal deaths that occur in health facilities in Malawi.

Methods: Forty-three maternal deaths were reviewed in 9 hospitals in 3 districts in Central Malawi over a 1-year period. Causes and avoidable factors of maternal deaths were identified during the review, and recommendations made and implemented.

Main findings: There were 28 (65.1%) direct obstetric deaths and 15 (34.9%) indirect obstetric deaths. The major causes of maternal deaths were postpartum hemorrhage (25.6%), postpartum sepsis (16.3%), HIV/AIDS (16.3%), ruptured uterus (7.0%), complications of abortion (7.0%), anemia (7.0%), antepartum hemorrhage (4.7), and eclampsia (4.7). Two thirds of the women were referred either from another health facility (51.2%) or by a traditional birth attendant (TBA; 11.6%), and up to 79.1% were critically ill on admission. Four groups of factors that contributed to maternal deaths were identified: 1) health worker factors, 2) administrative factors, 3) patient/family factors, and 4) TBA factors. The major health worker factors were inadequate resuscitation (69.8%), lack of obstetric life-saving skills (60.5%), inadequate monitoring (55.8%), initial assessment incomplete (46.5%), and delay in starting treatment (46.5%). The most common administrative factor was lack of blood for transfusion (20.9%). The major problems encountered include shortage of staff and other resources, difficulty in maintaining anonymity, poor quality of data, and difficulty in implementing recommendations.

Conclusion: Adequate training on obstetric life-saving skills, addressing HIV/AIDS, and raising community awareness could be important factors for reducing maternal mortality in Malawi and countries with similar socioeconomic profiles.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abortion, Spontaneous / mortality
  • Adolescent
  • Adult
  • Bacterial Infections / mortality
  • Cause of Death
  • Cesarean Section / mortality
  • Female
  • Hospital Mortality*
  • Humans
  • Malawi / epidemiology
  • Male
  • Maternal Mortality*
  • Maternal Welfare / statistics & numerical data*
  • Obstetric Labor Complications / mortality
  • Postpartum Hemorrhage / mortality
  • Pregnancy
  • Pregnancy Complications / mortality*
  • Pregnancy Complications / prevention & control
  • Prenatal Care / statistics & numerical data
  • Risk Factors
  • Women's Health*
  • Young Adult