Background: Maternal mortality ratios in Kasama and Kaputa Districts, two remote rural areas of Northern Province, Zambia, were suspected to be very high. In order to evaluate the impact of a referral system baseline maternal mortality levels and additional maternal mortality risk arising from poor accessibility were estimated.
Methods: The sisterhood method was applied to a random population sample of 3123 respondents in Kasama District and to 2953 in Kaputa District during May and June 1995. For Kasama also hospital-based maternal mortality was calculated from record analysis from 1 January 1991 up to 31 December 1995. Population attributable risk and population etiological fraction were calculated for Kasama District.
Results: Maternal mortality ratio for Kasama District was 764 per 100,000 live births and 1549 for Kaputa District. Kasama hospital-based maternal mortality was 543 per 100,000 live births. In Kasama District population attributable risk of maternal mortality from poor accessibility was 220 maternal deaths per 100,000 live births, and the population etiological fraction was 29%. In Kaputa District population attributable risk was 1006 maternal deaths per 100,000 live births, and the population etiological fraction was 65%.
Conclusions: This study suggests that solving the accessibility problem would decrease the mortality burden from maternal causes with at least 29% in Kasama District and 65% in Kaputa District.
PIP: Two community-based retrospective studies conducted in the northern province of Zambia and a review of mortality data from Kasama General Hospital from 1991 to 1995 confirmed the existence of exceptionally high maternal mortality levels in this area. The sisterhood method was applied to a randomly selected sample of 3123 respondents from Kasama District and 2953 from Kaputa District. The life-time risk of dying from maternal causes was 5.4% in Kasama and 11.0% in Kaputa. The maternal mortality ratio was 764/100,000 live births in Kasama District, 1549/100,000 live births in Kaputa District, and 543/100,000 live births at Kasama District Hospital. 94% of women delivering at the hospital were within two hours' walking distance from the facility. In Kasama District, the population-attributable risk (PAR, "risk in the total population minus risk in the unexposed population") of maternal mortality from poor accessibility (more than 2 hours' walking distance) was 220 maternal deaths/100,000 live births, and the population etiologic fraction (PEF, "PAR/risk in total population") was 29%. In Kaputa District, where there is no hospital, the PAR from poor accessibility was 1006 maternal deaths/100,000 live births and the PEF was 65%. To reduce accessibility-related maternal mortality, both districts have established an ambulance service, set up strategic blood banks, and provided short wave radios to outlying health centers.