Institutional factors associated with maternal mortality in Senegal: A national survey in 2001

Objective: To identify which institutional factors are associated to the hospital maternal mortality in surgical maternities in Senegal.
Method:  This study is a secondary data analysis of the third National survey of the Surgical-Obstetric Coverage in Senegal in 2001. The hospital statistics data analyzed represent 38,239 admissions in obstetrics in 19 hospitals and 450 deaths. The hospital maternal death rates (TMMH) crude and adjusted were used as dependent variables. The TMMH adjusted on the characteristics of the customers (`cases-mix') was estimated for each health structure by the direct standardization method. The indicators of the structure’s and resources management’s quality were used like independent variables to predict hospital maternal mortality. The Mann-Whitney test was used to analyze association between the independent variables and maternal mortality. Binomial negative regression models were used to estimate the impact of these variables on maternal mortality by taking account of geographical and financial accessibility to emergency obstetrical care. Results: The presence of anaesthetist, the availability of Caesarean kit and the assistance of all childbirthing women by qualified personnel are the institutional factors which are associated to a decrease in the crude TMMH. For the adjusted TMMH, the presence of Scialytic, the availability of Magnesium Sulphate, the use of clinical guidelines of good practice (GPC) for obstetrical complications are the institutional factors associated to his decreased. Conclusion: The availability of the Magnesium Sulphate, and the Scialytic could contribute to the reduction of maternal mortality. In addition, an adequate reorganization of the resources to reduce the geographical rural/urban disparity is essential, as well as a developing the personnel’s awareness for the use of GPC. Moreover, qualified assistance at birth for all women is necessary to improve the quality of care and the treatment obstetrical complications.