Changes in causes of pregnancy-related and maternal mortality in Zimbabwe 2007-08 to 2018-19: findings from two reproductive age mortality surveys

Reuben Musarandega; Solwayo Ngwenya; Grant Murewanhema; Rhoderick Machekano; Thulani Magwali; Lennarth Nystrom; Robert Pattinson; Stephen Munjanja; Zimbabwe Maternal and Perinatal Mortality Study Group

doi:10.1186/s12889-022-13321-7

Changes in causes of pregnancy-related and maternal mortality in Zimbabwe 2007-08 to 2018-19: findings from two reproductive age mortality surveys

BMC Public Health. 2022 May 10;22(1):923. doi: 10.1186/s12889-022-13321-7.

Authors

Reuben Musarandega^{1

2}, Solwayo Ngwenya³, Grant Murewanhema⁴, Rhoderick Machekano⁵, Thulani Magwali⁴, Lennarth Nystrom⁶, Robert Pattinson⁷, Stephen Munjanja⁴; Zimbabwe Maternal and Perinatal Mortality Study Group

Collaborators

Zimbabwe Maternal and Perinatal Mortality Study Group:
Admire Chikutiro, Agnes Mahomva, Aveneni Mangombe, Bernard Madzima, Bothwell Guzha, Chipo Chimamise, Chipo Gwanzura, Davidzoyashe Makosa, Enesia Ziki, Esther Ngaru, Eunice Tahuringana, Gerald Madziyire, Grant Murewanhema, Gwendoline Chimhini, Jonathan Kasule, Julius Chirengwa, Lucia Gondongwe, Margaret Nyandoro, Maxwell Chirehwa, McMillan Parirenyatwa, Mercy Gaza, Michael Nyakura, Nhamo Gona, Reuben Musarandega, Ronald Mataya, Rumbidzai Makoni, Sarah Gunguwo, Thulani Magwali, Tsitsi Magure, Velda Mushangwe, Vongai Dondo, Winston Chirombe

Affiliations

¹ School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa. rmusara@gmail.com.
² Unit of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe. rmusara@gmail.com.
³ Department of Obstetrics and Gynaecology, National University of Science and Technology, and Mpilo Central Hospital, Bulawayo, Zimbabwe.
⁴ Unit of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe.
⁵ Biostatistics and Epidemiology Department, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
⁶ Department of Epidemiology and Global Health, Umea University, Umea, Sweden.
⁷ Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, University of Pretoria, Pretoria, South Africa.

Abstract

Background: Reducing maternal mortality is a priority of Sustainable Development Goal 3.1 which requires frequent epidemiological analysis of trends and patterns of the causes of maternal deaths. We conducted two reproductive age mortality surveys to analyse the epidemiology of maternal mortality in Zimbabwe and analysed the changes in the causes of deaths between 2007-08 and 2018-19.

Methods: We performed a before and after analysis of the causes of death among women of reproductive ages (WRAs) (12-49 years), and pregnant women from the two surveys implemented in 11 districts, selected using multi-stage cluster sampling from each province of Zimbabwe (n=10); an additional district selected from Harare. We calculated mortality incidence rates and incidence rate ratios per 10000 WRAs and pregnant women (with 95% confidence intervals), in international classification of disease groups, using negative binomial models, and compared them between the two surveys. We also calculated maternal mortality ratios, per 100 000 live births, for selected causes of pregnancy-related deaths.

Results: We identified 6188 deaths among WRAs and 325 PRDs in 2007-08, and 1856 and 137 respectively in 2018-19. Mortality in the WRAs decreased by 82% in diseases of the respiratory system and 81% in certain infectious or parasitic diseases' groups, which include HIV/AIDS and malaria. Pregnancy-related deaths decreased by 84% in the indirect causes group and by 61% in the direct causes group, and HIV/AIDS-related deaths decreased by 91% in pregnant women. Direct causes of death still had a three-fold MMR than indirect causes (151 vs. 51 deaths per 100 000) in 2018-19.

Conclusion: Zimbabwe experienced a decline in both direct and indirect causes of pregnancy-related deaths. Deaths from indirect causes declined mainly due to a reduction in HIV/AIDS-related and malaria mortality, while deaths from direct causes declined because of a reduction in obstetric haemorrhage and pregnancy-related infections. Ongoing interventions ought to improve the coverage and quality of maternal care in Zimbabwe, to further reduce deaths from direct causes.

Keywords: CRVS; Causes of death; Civil registration and vital statistics; ICD-10; ICD-MM; International classification of diseases; Maternal death; Maternal mortality; Pregnancy-related deaths; Sustainable development goals; Women of reproductive ages; Zimbabwe.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Acquired Immunodeficiency Syndrome*
Adolescent
Adult
Cause of Death
Child
Female
Humans
Live Birth
Malaria*
Male
Maternal Mortality
Middle Aged
Pregnancy
Young Adult
Zimbabwe / epidemiology