Chairman
Prof. Jack Moodley
Editor of Report
Prof. Bob Pattinson
Chapter Authors
Foreword
Preface
Aims of Enquiry and Definitions of Maternal Mortality
Summary of Key Recommendations
Chapter 1: Overview - Prof. Pattinson and Moodley
Chapter 2: Epidemiology - Drs Makubalo, and Mulumba, Ms Mahlasela and Prof. Pattinson
Chapter 3: Hypertensive disorders of pregnancy - Prof. Moodley,
Mrs D Nyasulu
Chapter 4: Obstetric Haemorrhage - Prof. Theron and Ms Mangate
Chapter 5: Early pregnancy deaths - Prof. Pattinson and Mrs Nyasulu
Chapter 6: Pregnancy related sepsis - Prof. de Groot and Ms Makopo
Chapter 7: Anaesthetic-related deaths - Prof. Rout
Chapter 8: Acute collapse and embolism - Prof. Cronje and Mrs
Nyathikazi
Chapter 9: AIDS and Non-pregnancy related infections - Drs
Mhlanga, Mulumba and Simelela
Chapter 10: Pre-existing Medical Disease - Dr Desai, Naidoo, Prof. Moodley
Chapter 11: Non-obstetric causes of deaths - Prof. Cronje
Chapter 12: Provincial problems and solutions - MCWH Co-ordinators, edited Prof. Pattinson
Pregnancy and childbirth are normal processes yet, WHO estimates that 582 000 women die world-wide each year due to pregnancy related conditions most of which could have been prevented or are preventable. Most deaths occur in developing countries - and a variety of reasons (in most instances poverty) are the underlying cause of all the suffering.
A few direct causes of maternal mortality (hypertensive disorders, haemorrhage and pregnancy related sepsis, mainly septic abortion) account for the large proportion of the deaths, despite increasing medical knowledge on the prevention of these deaths. The challenge is to implement strategies to improve maternal health and safe motherhood in developing countries. Obstetric complications and maternal deaths are the highest amongst the women who have not attended antenatal care. Five to ten percent of women still do not avail themselves of antenatal care in our country despite "free" maternity services, thus not giving the health service an opportunity to intervene. Home deliveries are still prevalent in some parts of the country. Even with a skilled attendant present and with appropriate management of the third stage, five percent of women will still have a severe postpartum haemorrhage. Providing safe delivery sites in the health service and then persuading the population to use them in preference to their homes is a great challenge. The Department of Health is addressing these issues by establishing clinics at appropriate sites.
Furthermore, we are faced with the HIV/AIDS pandemic that is affecting all facets of our lives. It is not surprising, therefore, that this report of the NCCEMD includes non-pregnancy related sepsis as a major cause of maternal deaths in 1998. The promotion of measures to reduce the burden of disease caused by HIV/AIDS is already a high priority of the government.
The Department of Health established the NCCEMD to help advise on the way to improve women and child health. The NCCEMD has, in its report effectively identified where the greatest problems in the health services lie. The recommendations when implemented will include protocols of management, an assessment on staffing norms, establishing consensus on guidelines for rational approach to an holistic management of HIV/AIDS, promotion of contraceptive services for women 30 years and older, and the expansion of termination of pregnancy services. These steps will go some way to immediately rectify the major problems in the provision of care for women during pregnancy, childbirth and puerperium. However, much more will need to be done, if we are to reduce maternal deaths to the minimum. Subsequent reports of the NCCEMD will point out any progress and highlight problems.
Finally, I would like to thank all health professionals in our country for helping reduce the burden of disease in our country and all the members of the NCCEMD for their untiring efforts, into producing this first report and its recommendations. It is, I understand, probably the only report on Confidential Enquiries into Maternal Deaths outside that of the triennial United Kingdom report and hope that it will show the rest of the developing world, where maternal deaths are greatest, that audits into maternal deaths in developing countries are possible and result in improvement in health services. Let us use the report to improve our health services, as well as increase efforts at community participation, particularly the prevention of HIV transmission.
Dr Manto Tshabala-Msimang
Minister of Health
Date: 1st October 1999