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Preventability of Maternal Deaths: Comparison Between Zambian and American Referral Hospitals

From the Department of Obstetrics and Gynecology, The University of Illinois at Chicago, Chicago, Illinois; and the Department of Obstetrics and Gynecology, Chinle Indian Health Services Hospital, Chinle, Arizona.

Address reprint requests to: Sarah J. Kilpatrick, MD, PhD, University of Illinois, Department Obstetrics and Gynecology, 820 S. Wood Street, Chicago, IL 60612; E-mail: sarahk{at}uic.edu.

OBJECTIVE: To compare causes and preventability of maternal deaths between a Zambian and an American referral hospital.

METHODS: All pregnancy-related deaths were reviewed for cause, potential preventability, and identified preventability factors for 1998–1999 at a Zambian hospital and for 1992–2000 at an American hospital network. Preventability factors were categorized as system, provider, or patient. The maternal mortality ratio (MMR) was determined for each hospital. Causes of death, rates of preventability, and preventability factors were compared.

RESULTS: There were 108 and 33 deaths making the MMRs, 1540 and 20.4 per 100,000 live births, at the Zambian and American hospitals, respectively. Causes of death were significantly different between hospitals (P < .001). Infection, the leading cause of death in the Zambian hospital, was associated with over half of direct and indirect deaths. Hemorrhage was the leading cause of direct deaths (28%) in the American hospitals, whereas cardiac and intracerebral events were associated with 42% each of indirect deaths. Eighty-two percent of deaths were deemed preventable at the Zambian hospital compared with 42% at the American hospitals (P < .001). In 73% of the Zambian preventable deaths, system factors were identified as likely contributing factors, whereas provider factors were so identified in 86% of the preventable American deaths (P < .001).

CONCLUSION: The MMRs in each hospital were higher than their corresponding national MMRs and rates of likely preventable deaths were unacceptably high. Attention, education, and intervention must be focused on system and provider factors to reduce worldwide maternal mortality.

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