Trends in maternal mortality for the Greater Harare Maternity Unit: 1976 to 1997.
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Objective: To determine the magnitude, trends and the main causes of maternal death for Harare Maternity Hospital (HMH) and thereby identify potential areas for interventions. Design: A descriptive retrospective analysis of maternal mortality data from the institution included in publications and recent annual reports. Setting: Department of Obstetrics and Gynaecology Greater Harare Maternity Unit, Zimbabwe. Main Outcome Measures: The trends in maternal mortality ratios (MMR) and the relative importance, of different causes of death between 1976 and 1997. Results: There was a decline in MMR between 1976 and the early 1980s but there has been a steady increase in MMR for Harare residents from 50/100 000 in 1988 to 224/100 000 in 1997. Sepsis has remained the leading cause of maternal death. There has been a significant increase in indirect deaths due to meningitis, tuberculosis and pneumonia where HIV infection is an underlying factor. Avoidable factors were identified at patient/ community, local health facility and at the tertiary hospital. There has been a decline in the quality of care in recent years. Conclusion: Maternal mortality for HMH is unacceptably high and could still be rising. HIV infection has contributed to the worsening picture. Interventions to improve access and quality of care at all levels could lead to significant 'reduction in maternal deaths.