Estimation of changes in maternal mortality in a rural district of northern Tanzania during the last 50 years

AbstractObjectiveMaternal mortality remains a major challenge worldwide. Reliable information concerning ratios and trends is essential for resource mobilization and assessment of progress towards the Millennium Development Goals.DesignAssessment of levels and trends in maternal mortality during the last 50 years.SettingSengerema district, rural North Tanzania.PopulationNumber of deliveries, births, admissions, maternal deaths and causes of maternal mortality in the only hospital in the area.MethodsWe compiled a database from the annual hospital reports for the period of 1962–2011 to obtain estimated maternal mortality ratio for each decade.Main outcome measuresMaternal mortality ratio for each decade and classification of maternal deaths.ResultsOf 629 maternal deaths, 490 (77.9%) could be classified as either direct or indirect and causes of mortality ascertained. Of the 361 direct causes (73.7%), hemorrhage (29.8%) and sepsis (20.4%) were the leading causes. Of the 129 indirect causes (26.3%), anemia during pregnancy (6.5%), meningitis (4.1%), HIV‐AIDS (3.5%), malaria (2.9%), heart diseases (2.4%) and relapsing fever (2.0%) were most often diagnosed. Since 1962, a 63% decrease in maternal mortality ratio has been achieved. The hospital‐based maternal mortality ratio decreased from 770/100 000 to 282/100 000 in the last decade (95% confidence interval 244/100 000, 320/100 000). The yearly decline since 1962 was 1.3%.ConclusionsDuring the last 50 years we have witnessed a reduction of maternal mortality and improvements in maternal health. Progress has been made towards improving Millennium Development Goal 5, although only a prospective population‐based survey will provide the ultimate answer.