Assessment of maternal mortality rate and associated risk factors at tertiary hospitals in Burundi (2020-2021): A retrospective cohort study

Abstract

Abstract Background: Burundi continues to struggle with maternal mortality (MM). It has been demonstrated that other variables, whether direct or indirect, contribute to the majority of maternal deaths that take place in healthcare institutions. Early risk factor identification is crucial for thorough intervention measures to be developed to prevent pregnancy-related problems. Objective: To investigate maternal mortality rate (MMR) and identify its associated risk factors among women aged 15 to 49 years at four tertiary hospitals in Burundi. Methods: We collected data describing all pregnancies from January 2020 to December 2021 among women enrolled in Centre Hospital-University of Kamenge (CHUK), Military Hospital of Kamenge (MHK), Prince Regent Charles Hospital (PRCH), and Clinical Hospital Prince Louis Rwagasore (CHPLR) referral hospitals. We reported the proportion of mothers who died per pregnancy and the MMR. Multivariate regression models were used to determine the maternal, pregnancy-related, delivery, and postpartum factors that were associated with maternal death. Results: There were 31,968 deliveries in total in CHUK, MHK, PRCH, and CHPLR referral hospitals, 125 of which resulted in maternal fatalities that could be verified. The total live births were 31,067, yielding an MMR of 402 per 100,000 live births. The mean age of women with maternal deaths was 33 years. When adjusted for study site and the other variables, our findings suggest a significant association between MMR and direct and indirect causes of maternal death, (F (8, 116) = 2.18, p < .05). There was a significant association between MMR and haemorrhage and uterine rupture, where in both cases p is less than 0.05. There was a significant association between MMR and community-level characteristics, (F (7, 117) = 9.91, p < .05). Additionally, there was a significant association between MMR and type of delay, (F (3, 121) = 2.76, p < .05). Whereas, second delay (delayed identification and arrival at the referral hospitals for treatment) was significantly associated with MMR, with p = 0.005. Conclusion: The main contributing factors to MM in 2020-2021 were haemorrhage, uterine rupture, and second delay. Reducing maternal fatalities in CHUK, MHK, PRCH, and CHPLR requires the implementation of ANC programs on the management of obstetric problems.