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Maternal mortality in rural and urban Zimbabwe: Social and reproductive factors in an incident case-referent study

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  • Mbizvo, Michael T
  • Fawcus, Susan
  • Lindmark, Gunilla
  • Nyström, Lennarth

Abstract

A community-based incident case-referent study was undertaken in a rural and an urban setting in Zimbabwe in order to define risk factors associated with maternal deaths at family, community, primary and referral health care levels. Referent subjects were drawn from place or area of delivery for each consecutive maternal death. Using a multiple source confidential reporting network for all maternal deaths, the maternal mortality rate for the rural setting was 168/100,000 live births and that for the urban setting was 85/100,000 live births. A model for interacting factors contributing to maternal mortality was designed. Haemorrhage and abortion sepsis were the major direct causes while malaria was the leading indirect cause in the rural setting. In the urban setting, eclampsia, abortion and puerperal sepsis were the leading causes of maternal deaths. It was found that all situations associated with diminished, or absent social support, that is, being single (OddsRatio = 4.7, 95% CI = 2.2-9.8) divorced, widowed, one of several wives, cohabiting, or self-supporting carried an increased risk for maternal mortality, especially in the rural area. Income and level of education for index and referent subjects were comparable, probably because of the limited part of the population under study that belonged to a more affluent class. Distribution of cases and referents by religious-affiliation was also comparable. Age > 35 years and parity > 6 were significant risk factors for maternal mortality in the rural setting, whereas bad reproductive history with reported stillbirth or abortion constituted a high risk both in the city and in the rural areas (Odds Ratios 4-6). Especially dramatic was the risk increase for mothers with no reported live births (Odds Ratio 20 and 22). The pregnancy was reported as unwanted for nearly half of both index cases and referents, with four suicides resulting, clearly illustrating the large unmet need for family planning and its tragic consequences.

Suggested Citation

  • Mbizvo, Michael T & Fawcus, Susan & Lindmark, Gunilla & Nyström, Lennarth, 1993. "Maternal mortality in rural and urban Zimbabwe: Social and reproductive factors in an incident case-referent study," Social Science & Medicine, Elsevier, vol. 36(9), pages 1197-1205, May.
    • Handle: RePEc:eee:socmed:v:36:y:1993:i:9:p:1197-1205
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    Cited by:

    1. Alfred Kwesi Manyeh & Rose Nathan & Gill Nelson, 2018. "Maternal mortality in Ifakara Health and Demographic Surveillance System: Spatial patterns, trends and risk factors, 2006 – 2010," PLOS ONE, Public Library of Science, vol. 13(10), pages 1-19, October.

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