Determinants of in-hospital maternal mortality in the Atlantique department of Benin Republic from 2019 to 2022
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20251220Keywords:
Atlantique department, Maternal mortality ratio, Determinant, In-hospital maternal deathAbstract
Background: The decline of the maternal mortality ratio (MMR) in Benin is too slow to achieve the third sustainable development goal by 2030. The aim of the study was to identify the determinants of in-hospital maternal mortality in the Atlantique department of Benin Republic from 2019 to 2022.
Methods: The study was conducted in two district hospitals in the Atlantique department. It was a retrospective case-control study from 2019 to 2022. Cases included all in-hospital maternal deaths, while controls were survivors of obstetric complications. A multivariate analysis was performed with a significance threshold of 0.05.
Results: We identified 92 cases of maternal deaths and 276 controls. The maternal mortality ratio was 386 maternal deaths per 100,000 live births. The mean age of the cases was 28.67±6.54 years, while that of the controls was 26.46±6.60 years. Prenatal care was poorly followed (88.04% versus 79.71%), and most patients were referred (77.20% versus 76.10%). Several factors were associated with maternal death, including: presence of medical history (p=0.030), presence of pregnancy-related pathology (p=0.049), questionable treatment (p<0.001), inadequate monitoring (p<0.001), occurrence of maternal complications (p<0.001), indication for blood transfusion (p<0.001), in-hospital delay in providing emergency obstetric care (p<0.001).
Conclusions: Identifying the main determinants of in-hospital maternal death will help to target appropriate high-impact interventions and optimize their implementation in order to accelerate the reduction of maternal mortality.
Metrics
References
WHO, UNIEF, UNFPA, World Bank and UNDESA Population Division. Trends in maternal mortality from 2000 to 2020: estimates from WHO, UNICEF, UNFPA, World Bank Group and UNDESA Population Division. Policy summary, 2023. Available at: https://www.who.int/publications/i/item/9789240068759. Accessed on 11 March 2025.
Ministry of Planning and Development, National Institute of Statistics and Economic Analysis, Cotonou, Benin. Fifth Demographic and Health Survey 2017-2018, 2025. Available at: https://dhsprogram.com/methodology/survey/survey-display-491.cfm. Accessed on 11 March 2025.
Ministry of Health, Benin. Directory of national health statistics, 2021. Available at: https://data.humdata.org/dataset/who-data. Accessed on 11 March 2025.
WHO. Maternal death monitoring and response. Technical guidelines: Prevention of maternal deaths. Information for action, 2015. Available at: https://www.who.int/publications/i/item/9789241506083. Accessed on 11 March 2025.
WHO. Beyond the Numbers: Examining maternal deaths and complications to reduce pregnancy risks, 2004. Available at: efaidnbmnnnibpcajpcglclefindmkaj/https://iris.who.int/bitstream/handle/106. Accessed on 11 March 2025.
Ministry of Health, Benin. Operational plan to reduce maternal and neonatal mortality in Benin 2018-2022, 2018. Available at: https://www.prb.org/wp-content/uploads/2020/06/BeninPlaOperationetNeonatale-au-Benin.pdf. Accessed on 11 March 2025.
Agballa G, Sossa C, Aguemon B, Damien G, Boyi Hounsou C, Agossou C, et al. Factors associated with maternal deaths in hospitals in Cotonou, Benin. J Maternal and child health. 2023;08(06):735-43. DOI: https://doi.org/10.26911/thejmch.2023.08.06.07
Aboubakar M, Akodjenou J, Echoudina C, Ahounou E, Biaou COA, Zoumenou E. Maternal Mortality at the Teaching Hospital of Mother and Child Lagoon (CHU-MEL) in Benin: A Preventable Drama? Open J Obstetr Gynecol. 2021;11:315-25. DOI: https://doi.org/10.4236/ojog.2021.113032
Tshabu-Aguemon C, Adisso S, Houkpatin B, Obossou A, Bashibirirwa K, Lahami, et al. Identification of dysfunctions in the management of cases of maternal mortality in the maternity ward of the Mènontin hospital in Cotonou. RAMUR 19. 2014;19(1):10-3.
Atade SR, Hounkponou Ahouingnan FMN, Obossou AAA, Gabkika BM, Doha SMI, Sidi RI, et al. Factors associated with maternal deaths at the Zone Saint Jean de Dieu hospital in Tanguiéta from 2015 to 2019. European Scientif J. 2021;17(29):93-105.
Alkassoum I, Djibo I, Hama Y, Abdoulwahabou AM, Amadou O. Risk factors for in-hospital maternal mortality in the region of Maradi, Niger (2008-2010: A retrospective study of 7 regional maternity units. Facteurs de risque de mortalité maternelle intra-hospitalière dans la région de Maradi, Niger (2008-2010). À propos d’une étude rétrospective réalisée dans les 7 maternités régionales. Med Sante Trop. 2018;28(1):86-91. DOI: https://doi.org/10.1684/mst.2018.0770
Ezegwui H, Onoh R, Ikeako L, Oyenbuchi A, Umerao O. Investigating maternal mortality in a public teaching hospital, abakaliki, ebonyi state, Nigeria. Ann Med Health Sci Res. 2013;3(1):75-80. DOI: https://doi.org/10.4103/2141-9248.109511
Zamane H, Sow HE, Kain DP, Bicaba BW, Kiemtoré S, Yameogo I, et al. Maternal mortality at the Dori regional hospital in northern Burkina Faso, 20142016. Int J MCH and AIDS. 2018;7(2):235-41. DOI: https://doi.org/10.21106/ijma.263
Aka KE, Horo A, Koffi A, Seni K, Kone M. Hospital maternal mortality over a decade in Abidjan before the 2015 Sustainable Development Goals. SAGO J. 2021;22(2):31-5.
Thiam M, Dieme M, Gueye L, Niane S, Niang M, Mahamat S, et al. Maternal mortality at the Thiès Regional Hospital Center: etiologies and determining factors, about 239 deaths. SAGO Journal. 2017;18(1):34-9.
Mbeva J-B K, Karemere H, Prudence MN, Nyavanda L, W’Itend J-P M. Explanatory factors of maternal deaths in hospitals: a study in six health areas in the East of the Democratic Republic of Congo. Int J Innov Appl Stud. 2018;23(4):559-68.
National Institute of Health and Medical Research (INSERM). Characteristics of deceased women. In: Maternal deaths in France: Better understanding for better prevention. 5th Report of the Confidential National Survey on Maternal Deaths (ENCMM) 2010-2012. Santé Publique France: Saint-Maurice; 2012: 230.
Kilpatrick SJ. Next steps to reduce maternal morbidity and mortality in the USA. Womens Health (Lond). 2015;11(2):193-9. DOI: https://doi.org/10.2217/WHE.14.80
Nair M, Kurinczuk JJ, Brocklehurst P, Sellers S, Lewis G, Knight M. Factors associated with maternal death from direct pregnancy complications: a UK national case-control study. BJOG. 2015;122(5):653-62. DOI: https://doi.org/10.1111/1471-0528.13279
Bauserman M, Thorsten VR, Nolen TR, Patterson J, Lokangaka A, Tshefu A, et al. Maternal mortality in six low and lower middle income countries from 2010 to 2018: risk factors and trends. Reproductive Health. 2020;17(3):173. DOI: https://doi.org/10.1186/s12978-020-00990-z
Denakpo JL, Zoumenou E, Hounkpatin B, Aguèmon C, Lokossou A. Impact of clinical audits on the quality of emergency obstetric and neonatal care at the Lagune Mother and Child Hospital in Cotonou, Benin. SAGO J. 2010;11:13-7.