Objective. Maternal mortality remains a major challenge worldwide. Reliable
information concerning ratios and trends is essential for resource mobilization
and assessment of progress towards the Millennium Development Goals.
Design. Assessment of levels and trends in maternal mortality during the last
50 years. Setting. Sengerema district, rural North Tanzania. Population. Number
of deliveries, births, admissions, maternal deaths and causes of maternal
mortality in the only hospital in the area. Methods. We compiled a database
from the annual hospital reports for the period of 1962–2011 to obtain estimated
maternal mortality ratio for each decade. Main outcome measures.
Maternal mortality ratio for each decade and classification of maternal
deaths. Results. Of 629 maternal deaths, 490 (77.9%) could be classified as
either direct or indirect and causes of mortality ascertained. Of the 361 direct
causes (73.7%), hemorrhage (29.8%) and sepsis (20.4%) were the leading
causes. Of the 129 indirect causes (26.3%), anemia during pregnancy (6.5%),
meningitis (4.1%), HIV-AIDS (3.5%), malaria (2.9%), heart diseases (2.4%)
and relapsing fever (2.0%) were most often diagnosed. Since 1962, a 63%
decrease in maternal mortality ratio has been achieved. The hospital-based
maternal mortality ratio decreased from 770/100 000 to 282/100 000 in the last
decade (95% confidence interval 244/100 000, 320/100 000). The yearly decline
since 1962 was 1.3%. Conclusions. During the last 50 years we have witnessed a
reduction of maternal mortality and improvements in maternal health. Progress
has been made towards improving Millennium Development Goal 5,
although only a prospective population-based survey will provide the ultimate
answer.