Student Dissertation

Agency : Maternal Death; Cause of Maternal Death; Maternal Mortality; Delay Model

Objective : • To identify the cause of maternal mortality using maternal death review technique in Kutch district. • To ascertain the delay leading to maternal mortality in Kutch district according to 3 delay model.

Background : The high level of maternal mortality in the developing world is an issue of public health. India accounts for over 15% of the world’s maternal death. Maternal mortality is ascribed usually to a complication that generally occurs during or around labor and cannot be accurately predicted. The major cause of maternal mortality is hemorrhage, sepsis, hyper tensile disorder, obstructed labor, and abortion. All these causes are mostly preventable through proper understanding, diagnosis, and management of labor complication. Maternal mortality ratio is dependent upon general socio-economic status, nutrition level of maternal healthcare in the community. Approximately 5 lakh women die from pregnancy-related cause annually and almost (99%) of these maternal deaths occur in developing nations. One of United Nations, millennium development goal is reduced to maternal mortality rate by 75% by 2015. Causes of maternal mortality include post-partum hemorrhage, eclampsia, obstructive labor, and sepsis. Many developing nation lack adequate healthcare and family planning and pregnant women have minimal access to skilled labor and emergency care. Basic emergency obstructive intervention, such as an antibiotic, oxytocics, anticonvulsants, manual removal of placenta and instrumented vaginal delivery and vital to improving the chance of survival. Research Question: What are major causes of the Maternal Mortality using 3- delays Model along with other factors as a framework in Kutch district.

Methodology : Methodology: Study design- Cross-Sectional Study Study area – 10 blocks in Kutch district Sample size- forty-eight deaths recorded in the year 2017-2018 Data Collection: • Primary data: structured questionnaire (verbal autopsy form for maternal death). • Secondary data: verbal autopsy reports. Data analysis: MS-EXCEL to be used to analyze the data.

Findings : The ‘3-Delays Model’ proposes that the pregnancy-related mortality is awesomely due to delays in deciding, reaching and receiving adequate care. Despite widespread educational programs and legal pressure, the majority of women in the study area were found married before the age of 20 years. Early marriage may be the reason for more than half of maternal deaths had taken place in the age group of 20 to 24 year in that particular area. Illiteracy among female gender was still found a major concern as nearly 6 out of 10 died women were illiterate. About sixty-six percent of the mothers have died while they were admitted to the health facility which points out our health care system. More than half of the mothers were died due to some other Medical Complications and Anemia, and also from the Post-Partum Hemorrhage (PPH) was found a major cause of maternal death. As far as the routine laboratory and clinical investigations are concerned their practice was found lacking in the district along with receiving antenatal care was also half of the practice in the Kutch District. Private/ personal and Ambulance (108) vehicles were a major mode of transportation at the time of emergency. Average distances to the reach the nearest health facility (/PHCs/CHCs/DH) for maternal services were lies between 11-20 km from the house of patient. Less than half of the ANMs were visiting their correspondence village once in a week. Satisfaction levels for the cleanliness of ward, cleanliness of the bathroom and the behavior of the staff and timely attention provided in the health facilities were very poor. This is supported by the finding that poor quality of maternal services at health facilities was found as the main reason for not going to a health facility for delivery. Main causes responsible for the first delay were unawareness of danger signs related to pregnancy, time taken in decision making for seeking maternal services, beliefs and customs at the time of pregnancy. Delay in mobilizing funds for treatment and delay in getting transportation were found as the main causes responsible for the second delay. The third delay was mainly due to lack of blood, equipment and lack of blood storage facility.