Maternal Mortality PDF

Topic: causes of maternal mortality rate.
A study of Matero
level one hospital.
CHAPTER 1.
1.0. INTRODUCTION
The case study will be based on the causes of maternal mortality rates. The research will be
conducted at selected hospital. In this chapter the researcher will look at the background of the
problem under investigation, statement of the problem, General objectives, specific objectives,
research questions, scope of the study, significance of the study, definitions of variables,
conceptual frame work/theoretical frame work and literary review.
1.1. Background study
Approximately 52,900 women die from pregnancy- related causes annually and most of all
(99%) of these are maternal death occur in developing nations (UN, authors, UN millennium
development goals website). Accessed in June, 25, 2008. http://www.un org/ millennium goals.
One of the UN millennium development goals is to reduce the maternal mortality rate by 15% by
2020. Causes of maternal mortality include post-partum, hemorrhage, eclampsia, obstructed
labor and sepsis. (World health report 2005 makes every mother and child count: Geneva
Switzerland). http://www.who.int/ whr/2005/ whr 2005-e.
Many development countries lack adequate health care and family planning. Pregnant women
have minimal access to skilled labor and emergency care. Basic emergency interrations, such as
anti-biotic, oxytoccis, anti-consultants, manual removal of placenta and instrumented vaginal
delivery are vital to improve the chances of survival of both the mother and child.
In 1987, the international safe motherhood conference convened in Kenya. The conference
raised global awareness of the devasting maternal mortality rates in developing nations and
formally established the safe motherhood initiative. (Mulama: J: Health Kenya a new report fires
up abortion debate (May 7,200).
1
The goals was of this conference was to reduce maternal mortality rates by 50% by the year 2000
and announced the global community, the plight of pregnant woman initially donors,(UN)
agencies and government focused on 2nd strategies to reduce maternal mortality, increasing anti-
natal care and training for traditional birth conditions. Because most deaths occur during labor or
in the first 24 hours post-partum, recognizing on emergency is not easy.
Most birth occur at home with unskilled attendants and it takes skill to predict or prevent bad
outcomes and medical knowledge to diagnose and immediately act on complications. By the
time the lay midwife or family realizes there is a problem, it is too late, for both the mother and
the child.
The Maternal Mortality Ratio includes deaths during pregnancy, childbirth, or within 42 days of
termination of pregnancy, irrespective of the duration and site of the pregnancy, for a specified
year. Most maternal deaths are preventable, as the health-care solutions to prevent or manage
complications are well known. All women need access to antenatal care in pregnancy, skilled
care during childbirth, and care and support in the weeks after childbirth.
Health policies in Zambia are modelled along the national health vision of “equity of access to,
cost-effective and affordable health services, as close to the family as possible”. The National
Health Policy outlines the country’s commitment to realize the human rights of all. All key
policies and strategies focus on ensuring equitable access to primary health care services and
addressing the social determinants of health.
The major challenges faced by the health system include: inadequate funding; critical shortages
of health workers and sub-optimal distribution of available health workers; inadequate
infrastructures and equipment; and weaknesses in the supply of drugs and other medical items.
These challenges largely affect health service delivery, particularly in rural communities and for
disadvantaged vulnerable population groups, such as women, children, and those that are
differently abled. Primary Health Services in Zambia are free.
1.2 Statement of Problem
Every minute a woman dies during labor or delivery. The higher maternal mortality rates are in
Africa, with a lifetime rise of 1 in 16. The lowest are in Western nation (12 800), with a global
2
rate of 400 maternal deaths per 100,000 live births. The main causes of death are post-partum,
hemorrhage (24%) indirect causes such as anemia, malaria and heart diseases (20%), infection
(15%): unsafe abortions (13%), obstructed labor (18%) and ectopic pregnancy embolism and
anesthesia complications (8%). Forty-five percent (45%) of post- partum deaths occur within the
first 24 hours and 66% occur during first week of the estimated 211 million pregnancies, 46
million resulted in induced abortion sixty percent of these abortions are unsafe and causes 68,000
deaths annually.
According to Abouzahr C, Wardlaw T. (2000). Maternal mortality in resource-poor nations has

been attributed to seet cate, delay reaching care in time and delay in receiving adequate
treatment. The first delay is on the part of the motherhood and family or community not
recognizing the effects.
Maternal health and newborn health are closely linked. It was estimated that approximately 2.7
million newborn babies died in (2015), and an additional 2.6 million are stillborn. It is
particularly important that all births are attended by skilled health professionals, as timely
management and treatment can make the difference between life and death for both the mother
and the baby.
1.3. Significance of the Study/ Rationale of study
This type of information that will be collected offer the research has been conducted will have a
greater impact and will help the relevant authority to come up with measures that will combat or
reduce the maternal mortality rate. For instance the government through the ministry of health
can come up with sensitization programs on TV and radio station as well as other social media to
discernment information which is important to the people.
The potential beneficiaries of information are mainly the women and adolescents girls. This is
because according to the world health organization, everyday approximation 830 women die
from preventable causes related to pregnancy and child birth. According to the definition,
maternal mortality rate is the number of women who die during pregnancy and childbirth per
100,000 live births. Therefore from the above statement it is very clear that the affected people,
3
the skilled health personnel and people in general are potential beneficiaries of the information
that will be collected during the research.
This study will influence women and young girls access to maternal and child health care, as the
causes of maternal mortality rates will be known. They will also know that most of the maternal
deaths are preventable as health-care solutions to prevent or manage complications are well
known. women will know that they need skilled care during childbirth. The effects of maternal
mortality rates are devastating, therefore people in the families will also have information on
how to take care of pregnant women.
The impotence of conducting this research is to have knowledge of what causes maternal
mortality rate, the effects and number of people affected respectively. It is also of significant to
know what theories relevant authorities put in place to combat or reduce maternal mortality rates.
It is also another way of improving lies and supports the truth that surrounds the causes of
maternal mortality rates.
The study is very necessary due to the fact that it helps identify the problems of maternal
mortality rate in Zambia. It aims at identifying the problems that cause maternal mortality rate or
death. When the answers are found as to what makes causes maternal mortality rate and the
effects as well as the theories rated to it. it means that the much intended purpose of the study is
to have knowledge on how we can help women or avert the situation. The study will bring
relevance of maternal mortality rates in Zambia. The study will further research on how health
workers contribute to maternal mortality rates and other theories related to the case study.
It is also a seed to reading, writing and analyzing and sharing of valuable information. After the
research has been conducted, other people will benefit from the information that has been
produced and the researcher will have knowledge of the problem, and it is also a tool for building
knowledge and for facilitating learning. This is also another way to understand the topic of
research and increase public awareness as this can save lives of the affected people.
The study envisioned to provide epidemiologic and characteristics of maternal mortality in

Lusaka, provinces of Zambia. The causes of these deaths are largely preventable by cost effective
high impact interventions, (MoodleyJ, 2012). However, the choice of particular interventions that
4
may have the greatest impact depends on sound information at national level about which places
are mostly affected and which particular causes are important in those areas.
The type of information that will be set at the end of this research will provide an in-depth
analysis of specific people or group that is affected by the problem of maternal mortality rate.
However, while the findings will not be generalized to the overall population. This case study
will provide much needed important information for the future. The research will provide the
reader with critical knowledge about the causes and effects of maternal mortality rates and the
measures government are putting in place to safeguard the life of both the child and mother
before, during and after delivery. The information to be collected will also highlight and expand
upon the foundational studies conducted in the past, important a historical event that informs
why and in what ways the research was conducted.
1.4. general objectives
1. To find out the mortality rate: a case study of matero level one hospital.
2. To find out the effects of maternal mortality rate: a case study of matero level one
hospital.
3. To examine measures put in place to safe guard the life of both the mother and the child
before, during and after delivery. Case study of matero level one hospital.
1.5.Specific objectives
- to find out the causes of maternal mortality; a case study of matero level one hospital.
- to find out measures put in place to safeguard the lives of both the mother and child
before, during and after birth; a case study of matero level one hospital.
- to examine how severe or serious maternal mortality rates is.; a case study of matero level
one hospital.
- to establish measures that can help to address the problem of maternal mortality rates; a
case study of matero level one hospital.
- To find out the effect of maternal mortality rate; a case study of matero level one hospital.
5
2.0.Research Questions
The vital research question is:
1. What are the effects of maternal mortality rate a case study of matero level one hospital; a
case study of a case study of matero level one hospital.
2. What measures are being put to safeguard the lives of both the mother and child before
and after birth; a case study of matero level one hospital.
3. To investigate the most affected and why; a case study of matero level one hospital.
4. Why is it important to come up with measures to reduce the maternal mortality rate; a
case study of matero level one hospital.
2.1. Scope of Study
The research will be conducted at Matero level one hospital in Lusaka, Lusaka province under
the ministry of health. The key informants will be the doctors and nurses and the respondents
will be the general workers from the hospital and the mothers from the hospital.
2.1. Definition Of Variables
Maternal mortality: is the annual number of female deaths per 100,000 live births from any
cause related to or aggravated by pregnancy or its management (excluding accidental or
incidental causes).
Mortality rate, or death rate: is a measure of the number of deaths (in general, or due to a
specific cause) in a particular population, scaled to the size of that population, per unit of time.
Health : According to the world health organization, health is “a state of complete physical,
mental and social well-being and not merely the absence of disease or infirmity.”
pregnancy: the state of carrying a developing embryo or fetus within the female body. This
condition can be indicated by positive results on an over-the-counter urine test, and confirmed
through a blood test, ultrasound, detection of fetal heartbeat, or an x-ray.
6
Violence: is an act of physical force that causes or is intended to cause harm. The damage
inflicted by violence may be physical, psychological, or both. Violence may be distinguished
from aggression, a more general type of hostile behaviour that may be physical, verbal, or
passive in nature.
Excess bleeding: it is unusual bleeding which may be indicated by several different signs and
symptoms. Patients may present with unexplained nosebleeds (epistaxis),excessive or prolonged
menstrual blood flow (menorrhagia), or prolonged bleeding after minor cuts, tooth brushing or
flossing, or trauma.
Post-partum: is the stress disorder which often affects women who experienced a real or
perceived trauma during childbirth or immediately after the baby was born.
Homicide: is the act of one human killing another. A homicide requires only a volitional act by
another person that results in death, and thus a homicide may result from accidental, reckless, or
negligent acts even if there is no intent to cause harm.
Abortion: is when a pregnancy is ended so that it doesn't result in the birth of a child.
Sometimes it is called 'termination of pregnancy.
Obstruct labor: is when, even though the uterus is contracting normally, the baby does not exit
the pelvis during childbirth due to being physically blocked. It increases the risk of the mother
getting an infection, having uterine rupture, or having post-partum bleeding.
2.2. Theoretical Framework
This paper will establish the leading causes of maternal mortality, the theories as well as the
barriers and effects that mortality deaths has caused in societies. It will look at the key
stakeholders in this case such as the Ministry of health, the doctors, nurses and the government.
The study will quantitatively estimate the contextual and community factors and actual causes of
maternal death based on maternal death review data. The results of the study will inform policy
makers, stimulate programmes and direct funding to reduce maternal deaths. The study
envisaged to stimulate further research on this public health problem. These are the health
provider that can help control maternal mortality rate in Zambia.
7
2.3.Literary Review Of Study
This chapter will look at what has been published by other scholars relevant to the research topic
about Maternal mortality, like infant mortality, is a tragic and unnecessary event. It will examine
what has been published concerning the causes of maternal mortality rate. While many of these
deaths are preventable, the US has the highest maternal mortality rate in the developed world.
We have not made much of a difference or a change since the late 1980’s. This literature review
is an attempt to identify some of the risks and causes.
Maternal mortality, while more prevalent in developing countries, some may overlook the
developed countries that are affected by this tragedy. According to Coeytaux, Bingham &
Strauss, “the United Nations place the United States 50th in the world for maternal mortality-
with maternal mortality ratios higher than almost all European countries, as well as several
countries in Asia and the Middle East” (Coeytaux, Bingham & Strauss, 2011).
The deaths are shockingly preventable for the most part. This is due partly to a many faceted
pile of issues that have shortchanged women’s health such as financial, language barriers, lack of
informed decision making, cultural differences, adequate health care in general and access to
adequate facilities and providers (since there is a shortage). The literature shows research that has
already been done.
Maternal mortality, while

more prevalent in
developing countries,
some may over look
the developed countries
that are affected by this
8
tragedy. According to
Coeytaux, Bingham &
Strauss, “the United
Nations place the United
States 50th in the world
for maternal mortality-
with maternal mortality
ratios higher than almost
all European countries, as
well as several
countries in Asia and the
Middle East” (Coeytaux,
Bingham & Strauss,
2011). The deaths are
9
shockingly preventable
for the most part. This is
due partly to a many
faceted pile of issues that
have shortchanged
women’s health such as
financial, language
barriers, lack of informed
decision making, cultural
differences, adequate
health care in general
and access to adequate
facilities and providers
(since there is a
shortage). The literature
10
shows research that has
already
been done.
1) Maternal Mortality in
the United States: A
Human Rights Failure by
Francine
Coeytaux, Debra
Bingham & Nan Strauss:
This article researches
the present issue of
maternal mortality. As in
infant mortality,
African-Americans are at
higher risk. There is not
11
a clear reason as to why.
It has been said that
even a Caucasian high
school dropout female is
at lower risk of both
infant and maternal
mortality than an
educated African-
American. The overall
health of the female from
birth to
child bearing age is said
to have profound impact
on the health of not only
the female but the
12
child she is carrying.
Stress, for example,
rewires a body and sets
the infant up for life-long
health issues. Women of
unintended pregnancies
are at far greater risk for
adverse health
MATERNAL MORTALITY
LITERATURE REVIEW 4
outcomes than those that
have planned
pregnancies. Those that
have short interval
pregnancies
13
are at higher risk for long
term health risks, higher
maternal mortality rates
and those of higher
infant mortality rates,
preterm births and higher
instances of SIDS. Many
maternal deaths are
preventable. The issue is
a political system that
inhibits the action to
prevent women from
dying
of preventable diseases.
14
2) Recent Increases in
the US Maternal Mortality
Rate: Disentangling
Trends From
Measurement Issues By
Marian MacDorman,
Eugene Declercq, Howard
Cabral & Christine
Morton.
The health of our nation
is measured by the
health of our people.
Due to the enormity of
the data, the US has not
published any data on
15
maternal mortality in
many years. According
to
MacDorman, Derlercq,
Cabral & Morton, “the
Pregnancy Mortality
Surveillance System
collects
data on pregnancy
related deaths (within 1
year of pregnancy) and
has found recent
increases in
these deaths...provide an
overview of trends in U.S.
16
from 200-2014”
(MacDorman, Declercq,
Cabral & Morton, 2016).
This has caused many
states to revisit death
certificates to include a
pregnancy question of
whether the death was in
conjunction with a
pregnancy within 1 year
of death. This is getting
states to update their
systems to get a better
and
17
more accurate number of
the real problem. With
this question and the
question of the actual
cause of death such as
hypertension or
hemorrhage. The only
two states that were not
included
were California and
Texas. Texas had
interesting data in that
from 2000 to 2010, there
was a
18
gradual slope in maternal
mortality rates. In the 2
years following, the rate
almost doubled.
3) Maternal Mortality and
Morbidity in the United
States of America by
Pryia Agrawal
Morbidity and Mortality,
although not a new issue,
continues to be an issue
in the US.
Almost one-half of the
deaths that occur are
preventable. Agrawal
19
attributes this to three
factors
MATERNAL MORTALITY
LITERATURE REVIEW 5
“Inconsistent obstetric
practice...increasing
number of women who
present at antenatal
clinics
with chronic
conditions...the lack of
good data and related
analysis” (Agrawal,
2015). The lack
20
of obstetric practice or
just plain bad practice
run the US. This can
range from providers that
cannot figure out how to
care for our patients to
the lack of knowledge in
how to deal with
obstetric emergencies.
This with complications
being identified too late.
With the increasing
number of chronic
conditions such as
21
obesity, hypertension,
and bad
life-style choices many
women are not staring
their pregnancy out with
a clean bill of health.
These are the women
who are in most need of
case management,
primary care and other
services to bridge the
gap between health and
social disparities. “In the
USA, women who lack
22
health insurance are
three to four times to die
of pregnancy-related
complications than their
insured counterparts”
(Agrawal, 2015).
As far as the data, only
“half of the USA’s states
have maternal mortality
review boards
and the data that are
collected and are not
systematically used to
guide changes that could
reduce
23
morbidity and mortality”
(Agrawal, 2015). There
have been some changes
on the local level as
far as implementations of
different programs and
other approaches to
obstetric care and pre
gestational diseases that
can affect the health and
longevity of not only the
infant but the
mother.
4) U.S has the highest
maternal death rate
24
among developed
countries by Andis
Robeznieks
Women are more likely to
die in the US after
pregnancy than any
other developed
country in the world. Of
course there are racial
and ethnic disparities
when it comes to these
numbers as established
in an earlier review. “The
maternal death rate is
42.8 per 100,000 live
25
births for black women”
(Robeznieks, 2015). The
most common disease is
cardiovascular
MATERNAL MORTALITY
LITERATURE REVIEW 6
disease that account for
about 15% of the deaths.
This can be caused by
many other factors such
as obesity, diabetes (puts
us at a higher risk for
heart disease), life style
factors and other high
26
risk factors one of them
being stress. Taking care
of these pre-existing
chronic conditions from
the moment of birth until
a female reaches child
bearing age, can reduce
the risk of maternal
deaths.
the United States by
Christopher Lang &
Jeffrey King
Maternal mortality has
always been an ongoing
27
problem. However, since
about 1982 no
major steps have been
taken to change any of
that. Two major issues
exist. One is the major
underestimation of the
problem of maternal
mortality itself and the
other is the racial
disparity.
“Pregnancy-related
mortality is largely
accounted for by
28
thromboembolitic
disease, hemorrhage,
hypertension and its
associated complications
and infections” (Lang &
King, 2007). This also
takes into consideration
Caesarean births versus
that of a vaginal birth
and compares that to the
complications of a
vaginal birth.
In conclusion, the
maternal mortality rate is
29
rising. More so among
that of the African-
American population. It
is also known that pre-
existing chronic
conditions such as
hypertension
and diabetes put mothers
at higher risk of
pregnancy related
deaths. Many of which
are
preventable with the
right support prior to
pregnancy and child
30
bearing age. While of the
rise,
maternal mortality, in
part can be prevented
and can be accounted
for. Many states already
track
maternal mortality, but
all of them need to be
tracking and sharing
information so that
others can
compare the trends that
are rising in the United
States
31
more prevalent in
some may over look
Coeytaux, Bingham &
32
well as several
Bingham & Strauss,
have shortchanged
financial, language
33
(since there is a
already
been done.
Francine
34
Coeytaux, Debra
infant mortality,
infant and maternal
35
mortality than an
educated African-
birth to
the female but the
36
adverse health
MATERNAL MORTALITY
LITERATURE REVIEW 4
have planned
have short interval
pregnancies
and those of higher
37
maternal deaths are
prevent women from
dying
Rate: Disentangling
Trends From
Marian MacDorman,
38
Cabral & Christine
Morton.
is measured by the
to
Pregnancy Mortality
39
Surveillance System
collects
data on pregnancy
has found recent
increases in
from 200-2014”
40
conjunction with a
and
hypertension or
41
included
were California and
Texas. Texas had
was a
almost doubled.
42
Pryia Agrawal
in the US.
factors
MATERNAL MORTALITY
LITERATURE REVIEW 5
43
number of women who
clinics
with chronic
2015). The lack
44
how to deal with
With the increasing
number of chronic
conditions such as
and bad
45
These are the women
case management,
USA, women who lack
(Agrawal, 2015).
46
review boards
reduce
47
other approaches to
infant but the
mother.
maternal death rate
among developed
countries by Andis
Robeznieks
die in the US after
48
pregnancy than any
other developed
42.8 per 100,000 live
cardiovascular
49
MATERNAL MORTALITY
LITERATURE REVIEW 6
50
deaths.
Christopher Lang &
Jeffrey King
about 1982 no
51
problem of maternal
other is the racial
disparity.
accounted for by
thromboembolitic
52
complications of a
vaginal birth.
In conclusion, the
existing chronic
53
conditions such as
hypertension
at higher risk of
pregnancy related
are
pregnancy and child
rise,
54
track
information so that
others can
States
more prevalent in
some may over look
55
Coeytaux, Bingham &
well as several
56
Bingham & Strauss,
have shortchanged
financial, language
57
(since there is a
already
been done.
Francine
Coeytaux, Debra
58
infant mortality,
infant and maternal
mortality than an
educated African-
birth to
59
the female but the
adverse health
MATERNAL MORTALITY
LITERATURE REVIEW 4
60
have planned
have short interval
pregnancies
and those of higher
maternal deaths are
61
prevent women from
dying
Rate: Disentangling
Trends From
Marian MacDorman,
Cabral & Christine
Morton.
is measured by the
62
to
Pregnancy Mortality
Surveillance System
collects
data on pregnancy
63
has found recent
increases in
from 200-2014”
conjunction with a
64
and
hypertension or
included
65
were California and
Texas. Texas had
was a
almost doubled.
Pryia Agrawal
66
in the US.
factors
MATERNAL MORTALITY
LITERATURE REVIEW 5
number of women who
clinics
67
with chronic
2015). The lack
how to deal with
68
With the increasing
number of chronic
conditions such as
and bad
These are the women
69
case management,
USA, women who lack
(Agrawal, 2015).
70
review boards
reduce
other approaches to
71
infant but the
mother.
maternal death rate
among developed
countries by Andis
Robeznieks
die in the US after
pregnancy than any
other developed
72
42.8 per 100,000 live
cardiovascular
MATERNAL MORTALITY
LITERATURE REVIEW 6
73
74
deaths.
Christopher Lang &
Jeffrey King
about 1982 no
75
problem of maternal
other is the racial
disparity.
accounted for by
thromboembolitic
76
complications of a
vaginal birth.
In conclusion, the
existing chronic
conditions such as
hypertension
77
at higher risk of
pregnancy related
are
pregnancy and child
rise,
track
78
information so that
others can
State maternal death reviews has led to improvements in quality of care. Where no
improvements were made, barriers and challenges to improvement were considered. While there
is a large body of knowledge focusing on implementation and set up of MDR systems, few
studies report how the systems have contributed to quality improvements. Of the 14 studies and
reports considered in this review, 11 studies discussed specific actions undertaken to improve
quality of care as a result of MDRs (4, 5, 7 – 15); three studies discussed facilitating factors to
taking action for improvement (2, 3, 5); and three studies linked the impact of quality
improvements to health outcomes (5, 10, 13). Seven of the studies and reports reviewed
identified and discussed barriers to implementing recommendations based on MDR findings.
Maternal mortality, like

infant mortality, is a
tragic and unnecessary
79
event. While many of
these
deaths are preventable,
the US has the highest
maternal mortality rate in
the developed world.
We have not made much
of a difference or a
change since the late
1980’s. This literature
review
is an attempt to identify
some of the risks and
causes
80
Maternal mortality, like
infant mortality, is a
tragic and unnecessary
event. While many of
these
deaths are preventable,
the US has the highest
maternal mortality rate in
the developed world.
We have not made much
of a difference or a
change since the late
1980’s. This literature
review
81
is an attempt to identify
some of the risks and
causes
1) Maternal Mortality in the United States: A Human Rights Failure by Francine
Coeytaux, Debra Bingham & Nan Strauss: This article researches the present issue of maternal
mortality. As in infant mortality, African-Americans are at higher risk. There is not a clear reason
as to why. It has been said that even a Caucasian high school dropout female is at lower risk of
both infant and maternal mortality than an educated African-American. The overall health of the
female from birth to child bearing age is said to have profound impact on the health of not only
the female but the child she is carrying. Stress, for example, rewires a body and sets the infant up
for life-long health issues. Women of unintended pregnancies are at far greater risk for adverse
health outcomes than those that have planned pregnancies.
Those that have short interval pregnancies are at higher risk for long term health risks, higher
maternal mortality rates and those of higher infant mortality rates, preterm births and higher
instances of SIDS. Many maternal deaths are preventable. The issue is a political system that
inhibits the action to prevent women from dying of preventable diseases.
2) Recent Increases in the US Maternal Mortality Rate: Disentangling Trends From
Measurement Issues By Marian MacDorman, Eugene Declercq, Howard Cabral & Christine
Morton. The health of our nation is measured by the health of our people. Due to the enormity of
the data, the US has not published any data on maternal mortality in many years. According to
MacDorman, Derlercq, Cabral & Morton, “the Pregnancy Mortality Surveillance System collects
data on pregnancy related deaths (within 1 year of pregnancy) and has found recent increases in
these deaths...provide an overview of trends in U.S. maternal mortality rates from 200-2014”
(MacDorman, Declercq, Cabral & Morton, 2016). This has caused many states to revisit death
certificates to include a pregnancy question of whether the death was in conjunction with a
pregnancy within 1 year of death.
This is getting states to update their systems to get a better and more accurate number of the real
problem. With this question and the question of the actual cause of death such as hypertension or
82
hemorrhage. The only two states that were not included were California and Texas. Texas had
interesting data in that from 2000 to 2010, there was a Sgradual slope in maternal mortality rates.
In the 2 years following, the rate almost doubled.
3) Maternal Mortality and Morbidity in the United States of America by Pryia Agrawal
Morbidity and Mortality, although not a new issue, continues to be an issue in the US. Almost
one-half of the deaths that occur are preventable. Agrawal attributes this to three factors
“Inconsistent obstetric practice...increasing number of women who present at antenatal clinics
with chronic conditions...the lack of good data and related analysis” (Agrawal, 2015). The lack
of obstetric practice or just plain bad practice run the US. This can range from providers that
cannot figure out how to care for our patients to the lack of knowledge in how to deal with
With the increasing number of chronic conditions such as obesity, hypertension, and bad life-
style choices many women are not staring their pregnancy out with a clean bill of health. These
are the women who are in most need of case management, primary care and other services to
bridge the gap between health and social disparities. “In the USA, women who lack health
insurance are three to four times to die of pregnancy-related complications than their insured
counterparts” (Agrawal, 2015).
As far as the data, only “half of the USA’s states have maternal mortality review boards and the
data that are collected and are not systematically used to guide changes that could reduce
morbidity and mortality” (Agrawal, 2015). There have been some changes on the local level as
far as implementations of different programs and other approaches to obstetric care and pre
gestational diseases that can affect the health and longevity of not only the infant but the
mother.
4) U.S has the highest maternal death rate among developed countries by Andis Robeznieks
Women are more likely to die in the US after pregnancy than any other developed country in the
world. Of course there are racial and ethnic disparities when it comes to these numbers as
established in an earlier review. “The maternal death rate is 42.8 per 100,000 live births for black
women” (Robeznieks, 2015). The most common disease is cardiovascular disease that account
for about 15% of the deaths. This can be caused by many other factors such as obesity, diabetes
(puts us at a higher risk for heart disease), life style factors and other high risk factors one of
83
them being stress. Taking care of these pre-existing chronic conditions from the moment of birth
until a female reaches child bearing age, can reduce the risk of maternal deaths.
5) Maternal Mortality in the United States by Christopher Lang & Jeffrey King Maternal
mortality has always been an on-going problem. However, since about 1982 no major steps have
been taken to change any of that. Two major issues exist. One is the major underestimation of the
problem of maternal mortality itself and the other is the racial disparity. “Pregnancy-related
mortality is largely accounted for by thromboembolitic disease, hemorrhage, hypertension and its
associated complications and infections” (Lang & King, 2007). This also takes into consideration
Caesarean births versus that of a vaginal birth and compares that to the complications of a
vaginal birth.
More so among that of the African- American population. It is also known that pre-existing
chronic conditions such as hypertension and diabetes put mothers at higher risk of pregnancy
related deaths. Many of which are preventable with the right support prior to pregnancy and child
bearing age. While of the rise, maternal mortality, in part can be prevented and can be accounted
for. Many states already track maternal mortality, but all of them need to be tracking and sharing
information so that others can compare the trends that are rising in the United States.
According to Washington state department of health (2015) nineteen percent of pregnancy
associated maternal mortalities occurred during pregnancy,15% occurred within 42 days of
pregnancy, and 66% were pregnant between 43 and 365 days of death. Thirty-four women who
died of a cause not related to pregnancy delivered a live birth, eight deliveries resulted in a fetal
death, and for 11 deaths the pregnancy outcome wasn’t known, was due to e topic pregnancy or
fetal demise before 2o weeks gestation.
The majority of pregnancy- associated maternal deaths occurred among Non-Hispanic (NH)
white women 15%, followed by Hispanic / Latina women 13% and NH black women 11%. The
highest pregnancy-associated maternal mortality ratios were observed among NH American
Indian/Alaska native women, with 1962 maternal deaths per 100,000 live births (95% cl:63.7,
457.8) and among NH America black women with78.4 per 100,000 live birth (95%
CL:28.8,170.7).
The major causes of the 20 (71%) direct maternal deaths were obstructed labor and sepsis.
Substandard hospital care factors (primarily inappropriate choice and/or lack of antibiotics, poor
84
monitoring of vital signs, and poor provision of blood products by the laboratory) contributed to
71% of maternal deaths.
Delay in seeking care played a role in 29% of all maternal deaths, and poor accessibility to the
hospital was implicated in at least 25% of cases. These findings indicate that maternal mortality
in rural Zambia is among the highest in the world.
According to Graham W. (2006 sep;25–37). He described the age, educational attainment,

marital status, rural/urban status, insurance coverage, pre-pregnancy BMI and prenantal care
initiation of the pregnancy-related maternal deaths. All but one pregnancy-related death was
among women aged 20-39, the remaining women was less than 20 years at death. Thirty-one
percent (5 deaths) of pregnancy-related deaths had less than a 12 th grade education, and the
remaining 69% (11) had attained a high school or post-secondary education. Seventy-five
percent(12) of women who had died from a cause related to pregnancy-related were married at
the time of their death, fifty-six percent (9) of the pregnancy-related deaths lived in designated as
urban cores,6% (1) lived in a large rural community and 38% lived in suburban (3).
seventy-five percent (12 deaths) of women who died from pregnancy-related causes received
medical benefits during their pregnancy, other insurance coverage includes 13% (2) who had
Tricare/ department of defense insurance coverage and 13% (2) who had private health insurance
at the time of their death. One (6%) women who died of a pregnancy-related cause was classified
as normal weight by her pre-pregnancy BMI score. The remaining 15 women were over-weight
(4) or obese (9).
Overall Washington state maternal mortality and pregnancy-related mortality ratios have
historically been lower than the national ratios. The review of 2014 and 2015 deaths indicates
that the Washington state pregnancy-related maternal mortality ratio of 0.9 per 100,000 for 2014-
2015 remains lower than rational estimates.
Two recent articles have estimated rational pregnancy-related maternal mortality ratio between
17.3 per 100,000 live births in 2013 and 23.8 per 100,000 live birth in 2014, while the
Washington MMRP methods aren’t directly comparable to the methods used by McDorman et al
(2916), the Washington state estimate, determined using similar methodology 12.4 between 2005
and 2014.
85
Maternal mortality rates and ratios are difficult and expensive to obtain and are often inaccurate
because of under-reporting and misclassification. Maternal mortality tends to be under-reported
because people in developing countries often die outside the health system, which makes
accurate registration of deaths difficult (www.immpact-international). Maternal mortality is also
misclassified, because health workers may not know why a woman died, or whether she was or
had recently been pregnant.
Deaths are sometimes intentionally misclassified, especially if they are associated with
clandestine abortions. Methods used to calculate maternal death rates are often complex and
costly to use. The actual number of maternal deaths in a specific place at a specific time is
relatively small. Therefore, very large populations must be surveyed in order to get accurate
estimates, which is costly.
The relative infrequency of maternal deaths over a short period also means that the rates will
appear to jump around, making interpretation of trends over time difficult (WHO,2007).
Addition, in Zambia most of the provinces/districts do not have provincial or district estimates of
maternal mortality. There is need that each health center keeps such data to be fed into Districts,
Provincial and National data bank
3.0. CHAPTER 2
3.1.0.Methodology
3.1.1.Introduction
Methodology refers to the methods that will be used by the researcher to carry out the research
and collect data from respondents successfully. This chapter will focus on the study design, study
population, sample size, sampling techniques, and instrument of data collection, data analysis
tool, limitation of study, ethical issues, bibliography and appendices.
3.2.study design
The study under investigation will be conducted using the cross-sectional research design to
effectively collect data. It will take both qualitative and quantitative collection of data examine
and analyze the problem under investigation. Collection of data will basically rely on interviews
and the use of questionnaires.
86
3.3.study population
This refers to a place where the study will be conducted. This research will be conducted in
Lusaka province, in Matero level 1 hospital. This is because the hospital is near and accessible to
the researcher.
3.4.Sample size
This is the representative number from the study population from where data will be collected.
This study will collect data using random sampling to select 50 respondents of matero level one
hospital and study will also use the purposive sampling to select key informants and this include
(2) doctors , (1) general nurse and (1) mid wife.
3.5.Sampling techniques
These are methods used by the researcher to come up with sample size. This study will use
simple random sampling to select 50 respondents at Matero level one hospital and the study will
also use the purposive sampling to select key informants at matero level one hospital and the key
informants include (2) doctors , (1) general nurse and (1) mid wife.
3.6.Instrument of data collection
The researcher in this study will use questionnaires. This questionnaire will be administered to
doctors, nurses, pregnant women (patients), general workers and people that will be found at the
hospital. It consists of a series of questions and questionnaires will be used because they are
cheaper and simple to use.
The study will also use the interview guide to collect data to find out the opinions of women who
might be victims or have experienced maternal mortality rate or the affected women’s
perspectives on the issue.
3.7.Data analysis tool
The data collected in this study will be analyzed by statistical package for the social science. This
data analysis tool will be used to analyses survey data so the researcher can get the most out of
the research project.
3.8.Limitation of the study
87
Limitation of study tends to focus on the potential weaknesses of the study. The study will be
limited only to the selected hospital and area which is Matero level one(1) hospital. Not only is
that but the time frame in which the research will be conducted not good enough for the study.
Money is also another factor to carry out the research and some respondents may not be willing
to answer questions set in the questionnaires. More badly some respondents may not return the
questionnaires on time which may asses the findings.
3.9.Ethical issues
Ethics will be observed in this study as follows.
- No obtaining of information using dubious ways e.g. recording someone without their
consent.
- No forcing of respondents to answer questions.
- No manipulation of respondents. They should be knowingly, voluntarily and intelligently,

and in a clear and manifest way give their consent.
4.0. conclusion.
Maternal mortality in rural Zambia is among the highest as reported in the world. Official
hospital data tend to underestimate maternal mortality in the community due to underreporting.
The sisterhood method survey is an efficient indirect method to assess maternal mortality in rural
areas of developing countries.
REFERENCES
Abouzahr C, Wardlaw T. (2000). Maternal Mortality In: Estimates Developed By WHO,
UNICEF And UNFPA.
Chitalu Chilufya. (30 September 2018). Maternal Deaths. Mortality rate in Zambia and violence.
Lusaka: Zambia: Zambia daily mail.
88
Christopher Lang & Jeffrey King. (1982). Maternal Mortality .United States : California
Graham W. (2006 sep;:25–37). Strategies For Reducing Maternal Mortality. London: university
Press.
Lewis, J.(12Aug, 2004).United Nations Implementation Of The United Nations Millennium
Declaration: Report Of The Secretary General. USA.
Moodley, J .( 2012). Reproductive Health And Family Planning Survey. Pakistan .
Maternal mortality, wishington. (2011). Estimated Rational Pregnancy-Related Maternal
Mortality Ratio. London: university press.
MacDorman, Declercq, Cabral & Morton. ( 2016). Maternal Mortality Rates . USA.
Sanfransico.
Rosenfield A. (2006 sep;5–6) freedman l. Meeting mdg-5: an impossible dream? The
lancet maternal survival.
Robeznieks, ( 2015). The Maternal Death Rate. London : oxford university press.
Smith Jb, Et Al. (2001) Estimates of maternal mortality ratio . zambia: Lusaka province.
Starrs, A.( 2006: page 368:1132) safe motherhood initiative. Pakistan : Islamabad.
APPENDIX
1.1.PROPOSED TIME FRAME:
ACTIVITY DEC JA FEB MAR APR MAY, JUN JULY AUGUS

2018 N , , , 2019 , 2019 T
, 201 2019 2019 2019 2019 2019
9
SEARCHING FOR
RELEVANT
LITERATURE
89
WRITING
RESEARCH
PROPOSAL
FINAL EDITING
PRESENTATION
QUESTIONNARE
TESTING
CONDUCTING
INTERVIEWS
DATA ANALYSIS
DATA
INTERPRETATIO
N
REPORT
WRITING
DEFENDING
RESEARCH
FINDINGS
1.2.PROPOSED BUDGET
ITEM QUANTITY UNIT PRICE TOTAL COST

Ream of paper 1 K 65.00 K 65.00
Ball pens 5 K 1.00 K 5.00
Typing and printing 25 copies K 5.00 K 110.00
-questionnaires
1 copy K1 K 100.00
-draft research report
-final report
Transport K20.00 K20.00 k20.00
Lunch K25.00 K25.00
Photocoping 25 copies K1.00 K25.00
-questionnaires
Miscellaneous K 100.00
SUB- K 450.00
1.3.QUESTIONNAIRE
Department Of Education Research
An interview guide for doctors and nurses
90
An investigation on the causes of maternal mortality rates in matero, Lusaka district of Lusaka
province.
Introduction
I am a second year student pursuing secondary teacher’s diploma at North End State University,
conducting a research on the causes of maternal mortality rates; A case study of Matero Level
One Hospital.
Kindly answer all the questions to the best of your knowledge and confidentiality is guaranteed.
Dear respondent, the following questions are meant for research and every piece of data given
will be treated in a very confidential manner and the name of the respondent will not be
disclosed. Therefore, please, do not write your name anywhere in this questionnaire.
Thank you in advance.
CHUMBU
SECTION A.
Instructions:
Tick in the appropriate box only.
Strictly for general workers
Interview guide for doctors and nurses
Answer all the questions:
1. Gender: male female
2. Name of the hospital
Matero level one hospital
91
3. Marital status: married single any other
4. How many years in service?
a. 1-3 b. 3-5 5-7 any other
5. Area of specialization
……………………………………………………………………………………………
6. Residential area
…………………………………………………………………………………………..
7. Working hours
………………………………………………………………………………………………
………………………………………………………………………………………………
8. What challenges do you find in handing cases of maternal health care?
……………………………………………………………………………………………..
9. What is the attitude of your fellow health practioners towards sick pregnant women here
at the hospital?
………………………………………………………………………………………………
10. Do you like working here at this hospital?
…………………………………………………………………………………………….
11. If not; why and where would you like to work from and why?
……………………………………………………………………………………………
12. What have you done as a health practioners to important the service offered to pregnant
women at this hospital?
92
……………………………………………………………………………………………….
Section b
1. What is maternal mortality rate?
………………………………………………………………………………………..
2. What are the causes of maternal mortality rate?
......................................................................................................................................
3. How severe is maternal mortality rates at this hospital?
…………………………………………………………………………………………
4. What is the major causes of maternal mortality rate?
…………………………………………………………………………………………
5. Who are the most affected age group?
………………………………………………………………………………………….
6. How are the causes of maternal mortality rate detected in this hospital?
…………………………………………………………………………………………
7. How many cases of maternal mortality cases have you handed so far here at the
hospital?
…………………………………………………………………………………………
…………………………………………………………………………………………..
8. Mention the successful and unsuccessful of question 7 above.
………………………………………………………………………………………..
93
9. What are the main goals of the hospital to reduce the maternal mortality rates.
………………………………………………………………………………..
10. What has the government done to safeguard the life of both the mother and child
before, during and after delivery since you joined the service?
…………………………………………………………………………………………..
11. What is the best way of taking care of pregnant women?
…………………………………………………………………………………………..
12. What care and treatment is giving to pregnant women who are detected with life
threatening illness before, during and after birth?
…………………………………………………………………………………………
13. Is the government doing enough to prevent maternal mortality rates?
………………………………………………………………………………………………
…………………………………………………………………………………………….
Section c
Questions for mothers
1. Did u receive medical care during pregnancy?
Yes No
2. How much time did you visit the clinic during your pregnancy?
a) 1-3 visits
b) More than 3 times
94
3. What health services did you receive when you visited the clinic during your pregnancy?
a. Physical examination (including, weight, blood pressure, heart rate)

b. Gynaecological examination
c. HIV/STD testing
d. Blood tests
e. Nutritional supplements
f. Ultra sound
g. Tetanus vaccine
4. Were there any complications detected during your pregnancy?
a. Yes
b. NO
5. If yes were you referred to a secondary hospital for treatment of that complication?
a. Yes
b. No
6. During delivery, were you attended to by a skilled birth attendant?
a. Doctor
b. Nurse
c. Mid wife
d. Any other
7. How satisfied were you with the care you received from the skilled birth attendant?
a. Completely satisfied
b. Partially satisfied
c. Neither satisfied nor dissatisfied
95
d. Dissatisfied
8. What were the reasons for your dissatisfaction?
…………………………………………………………………………………………….
……………………………………………………………………………………………..
9. Did you receive medical care after delivery?
a. Yes
b. No
10. What health services did you receive when you visited the clinic after your delivery?
a. Physical examination
b. Counseling on breast feeding
c. Contraceptives
d. Blood test for anemia
11. Has the number of women who die during pregnancy and delivery increased or
decreased?
a. Increased
b. Decreased
12. If increased what is the main cause of maternal mortality rates?
……………………………………………………………………………………………………………………………………………………
13. If decreased, what has been done by the government to improve the maternal m health
care?
96
……………………………………………………………………………………………………………………………………………………..
14. Did you experience any problem after delivery?
a. Yes
b. No
15. In total how much did your household spend on maternal health services during you last
pregnancy?
a. K 100
b. K 300
c. K 500
d. K 1,000
e. K 1,500
16. Did you pay any bribes for maternal health services?
a. Yes
b. No
17. For what purpose was the bribe paid?(open ended)
……………………………………………………………………………………….
………………………………………………………………………………………..
18. Was it demanded or did you pay it on your own?
a. Demanded
97
b. Paid on my own
19. Overall, how satisfied were you with the maternal health service you received?
a. Completely satisfied
b. Partially satisfied
c. Dissatisfied
20. What are your suggestions for improving maternal health service in government
hospitals?
………………………………………………………………………………………………
………………………………………………………………………………………………
Questions for general worker
1. Have you or any woman in your household given birth in the last two years?
a. Yes
b. No
2. If yes, did she give birth here at matero level one hospital.
a. Yes
b. No
3. If not, where did she give birth to?
a. Private clinic/ hospital

b. Traditional birth attendant
4. If she did not use the government hospital what was the primary reason?
a. Service not satisfactory
98
b. Long waited period
c. Doctors are not available
d. Long distance
5. Did she receive medical care during pregnancy at government hospital/ clinic?
a. Yes
b. No
6. Did she experience any pregnancy complication?
a. Yes
b. No
7. What kind of treatment were you given?
……………………………………………………………………………………………………………………………………………………
8. Were you admitted at the hospital?
a. Yes
b. No
9. Were the complications severe?
a. Yes
b. No
10. Did you deliver safely?
a. Yes
b. No
11. If not, what happened during delivery?
99
……………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………
12. Did the baby survive during birth?
a. Yes
b. No
13. What challenges are you facing in taking care of the baby?
a. financial difficulties
b. clothing and shelter
c. feeding
14. What do you think caused the death to the mother of the child?
…………………………………………………………………………………………………………………………………………………….
15. What could have been done better to prevent the death?
……………………………………………………………………………………………………………………………………………………..
16. What do you think is the major cause of death in pregnant women?
a. Heomorrhage
b. High blood pressure
c. Anemia
d. Violence
17. Is the shortage of skilled birth attendants in health facilities contributed to the maternal
mortality rate?
a. Yes
b. No
18 . Has the number of women who die during pregnancy and delivery increased or
decreased?
a. Increased
b. decreased
19. If increased , what are the main cause of maternal mortality rates?
……………………………………………………………………………………………..
100
20. If decreased, what has been done by the government to improve the maternal health care?
………………………………………………………………………………………………
21. Are u satisfied with the services being offered by the government especially maternal
health care?
a. Yes
b. No
Thank you for your time to respond to the questions above.
101

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Topic: causes of maternal mortality rate.

1.1. Background study

1.2 Statement of Problem

According to Abouzahr C, Wardlaw T. (2000). Maternal mortality in resource-poor nations has

1.3. Significance of the Study/ Rationale of study

The study envisioned to provide epidemiologic and characteristics of maternal mortality in

1.4. general objectives

The vital research question is:

2.1. Scope of Study

2.1. Definition Of Variables

2.2. Theoretical Framework

Maternal mortality, while

Maternal mortality, like

According to Graham W. (2006 sep;25–37). He described the age, educational attainment,

3.6.Instrument of data collection

3.7.Data analysis tool

3.8.Limitation of the study

Ethics will be observed in this study as follows.

- No forcing of respondents to answer questions.

- No manipulation of respondents. They should be knowingly, voluntarily and intelligently,

Abouzahr C, Wardlaw T. (2000). Maternal Mortality In: Estimates Developed By WHO,

UNICEF And UNFPA.

Lusaka: Zambia: Zambia daily mail.

Lewis, J.(12Aug, 2004).United Nations Implementation Of The United Nations Millennium

Declaration: Report Of The Secretary General. USA.

Moodley, J .( 2012). Reproductive Health And Family Planning Survey. Pakistan .

Maternal mortality, wishington. (2011). Estimated Rational Pregnancy-Related Maternal

Mortality Ratio. London: university press.

Rosenfield A. (2006 sep;5–6) freedman l. Meeting mdg-5: an impossible dream? The

lancet maternal survival.

1.1.PROPOSED TIME FRAME:

ACTIVITY DEC JA FEB MAR APR MAY, JUN JULY AUGUS

ITEM QUANTITY UNIT PRICE TOTAL COST

Department Of Education Research

An interview guide for doctors and nurses

Thank you in advance.

Tick in the appropriate box only.

Strictly for general workers

Interview guide for doctors and nurses

Answer all the questions:

1. Gender: male female

2. Name of the hospital

Matero level one hospital

4. How many years in service?

a. 1-3 b. 3-5 5-7 any other

8. What challenges do you find in handing cases of maternal health care?

10. Do you like working here at this hospital?

1. What is maternal mortality rate?

2. What are the causes of maternal mortality rate?

3. How severe is maternal mortality rates at this hospital?

4. What is the major causes of maternal mortality rate?

5. Who are the most affected age group?

8. Mention the successful and unsuccessful of question 7 above.

11. What is the best way of taking care of pregnant women?

13. Is the government doing enough to prevent maternal mortality rates?

Questions for mothers

1. Did u receive medical care during pregnancy?

b) More than 3 times

a. Physical examination (including, weight, blood pressure, heart rate)

4. Were there any complications detected during your pregnancy?

6. During delivery, were you attended to by a skilled birth attendant?

c. Neither satisfied nor dissatisfied