The Effect of the Introduction of Emergency Obstetric Drills on Maternal Mortality Trends in a Low-Resource Setting: A 5-Year Review at Mpilo Central Hospital, Bulawayo, Zimbabwe

Abstract

Background: Maternal deaths are very distressing to the healthcare givers and devastating to surviving family members. They decimate young, healthy women at the peak of their reproductive lives. The deaths result in orphaned children. Globally maternal deaths remain high on the agenda of the World Health Organisation (WHO) and the United Nations (UN) with the aim to reduce them. Developing nations with low/middle incomes contribute the majority of global deaths. Pregnant women in these settings face far greater risks of dying in pregnancy compared to their counterparts in rich-resourced countries. In this unit, there was an introduction of emergency obstetric drills (PROPMT®-Practical Obstetric Multi-Professional Training courses) from November 2011. These drills involved on-site training of doctors and midwives on a regular basis. This study aims to determine the effects of the introduction of such training on maternal mortality. Maternal mortality is high in the Sub-Saharan region and any reduction of the figures is welcomed.
Aims: The aims of the study are: 1) To determine the effect of the introduction of on-site  emergency obstetric training on maternal mortality trends. 2) To document trends in maternal mortality in a low-resource setting. 3) To document the current maternal mortality ratio for the Mpilo Central Hospital.
Methods: This was a retrospective descriptive cohort study carried out at Mpilo Central Hospital, a tertiary teaching referral government hospital in a low-resource setting in Bulawayo, Zimbabwe. Data was obtained from the maternal mortality register of patients that had died during the period January 1, 2012 to December 31, 2016. The register contains all the demo graphic, clinical and outcome data. The Statistical Package for the Social Sciences (SPSS) Version 21 (IBM Corp., Armonk, NY, USA) statistical tool was used to calculate the mean and standard deviation (SD) figures. Simple statistical tests were used on absolute numbers to calculate percentages.
Results: During the period 1 January 2012 to 31 December 2016 there were 49,501 live births at Mpilo Central Hospital. There were 246 maternal deaths during that period. The mean age of  the maternal deaths mothers was 29.6 years (SD±2.8) and the mean parity was 1.7 (SD±1.6). Tables 1-2 show most of the results. Maternal mortality has fallen since 2012 at the unit both interms of direct obstetric deaths and the maternal mortality ratio (MMR) since the introduction of on-site emergency obstetric training for doctors and nurses in 2011. There was a 45.1% drop in direct obstetric deaths in the last 5 years. The MMR fell from 612 to 429 maternal deaths per 1,00,000 live births.
Conclusion: The trends in maternal mortality are that direct obstetric deaths and the MMR have been falling since 2012 in this unit, a year after the introduction of emergency obstetric drills. The current MMR for Mpilo Central Hospital is 429 maternal deaths per 1,00,000 live births. The Sustainable Development Goal of achieving an MMR of less than 70 maternal deaths per 100 000 live births by 2030 should be achieved.