Evaluating medical and systemic factors related to maternal and neonatal mortality at Nyakahanga Hospital in north-western Tanzania

Background: This study examined maternal morbidity and mortality and neonatal mortality over a multi-year period from de-identified retrospective medical records at Nyakahanga Designated District Hospital in north-western Tanzania. The study aimed to examine factors related to maternal mortality (MMR) and morbidity in women who deliver their babies at the hospital, assess neonatal mortality of full-term infants, and analyse health care response to mother and neonate after admission.
Methods: Information from hospital obstetric logs was analysed and relationships explored for obstetric outcomes including maternal deaths and complications, neonatal status, and types of delivery for 55.5 months during 2009-2014.
Results: Results indicate that this rural hospital has achieved noteworthy improvement in their maternal mortality with MMR approximating the national average despite ongoing gaps in staffing needs. The majority of deliveries are under the age of 25 and a first or second pregnancy. Reported maternal complications are equivalent to global averages although some, i.e. uterine rupture, may be related to delays in obstetric delivery. Despite improvements in maternal mortality, neonatal mortality is elevated relative to Tanzania averages, particularly in caesarean sections. Neonatal deaths are positively related to maternal age.
Conclusion: Since this hospital is an emergency obstetric referral centre, obstetric clients frequently arrive after prolonged labour and foetal distress is common, partially explaining the elevated caesarean section rate and perinatal death rate. Hospital initiatives are underway to provide more rapid response in these scenarios. In addition, it is recommended that since antenatal attendance is high, initiatives be expanded to educate multiparous and older women on seeking skilled care upon onset of labour or at the sign of any complications.

Keywords
neonatal mortality; maternal mortality; caesarean section; uterine rupture; Tanzania