Risk factors for maternal mortality in Delhi slums: A community-based case-control study

Background : In order to develop, implement and evaluate policy for reducing maternal mortality, it is essential to study the risk factors associated with maternal deaths.
Aims : The study aims to determine the epidemiological risk factors and its related causes associated with maternal deaths in Delhi slums.
Materials and Methods : A community-based case-control study was designed, wherein snowball-sampling method was used to identify the maternal deaths (cases) in the community, and circular systematic random sampling procedure was used to select the controls from the same area where a maternal death was found.
Statistical Analysis : Data on 70 cases and 384 controls that had live births as the outcome of the pregnancy were analyzed. Logistic regression was applied to identify the risk factors.
Results: In the study population, most of the deliveries were conducted at home by untrained ′dais.′ Cases were mostly illiterate, young, having high parity and no antenatal care taken during pregnancy (P < 0.05) as compared to controls. The distance of health facility from residence was also found to be a significant risk factor for maternal death (P < 0.05). Complications during pregnancy, like jaundice, excessive bleeding and anemia, were also found to be significant. The major causes of maternal death were found to be hemorrhage after delivery, retained placenta and anemia.
Conclusions : The study findings suggest that women should be educated about the importance of antenatal registration and regular checkups. Untrained ′dais′ should be trained to recognize the obstetric complications at an early stage and refer high-risk cases for adequate management. These preventive measures could help in reducing maternal mortality at the community level.

Keywords
Case control study, maternal mortality, risk factors, snowball sampling