Maternal mortality is a major health concern in Namibia as it is the case in most
countries. The rate at which women are dying due to pregnancy related causes is high
and the cause as well as risk factors are not well explored. The main objective of this
research was to identify the causes and risk factors associated with maternal
mortality in Namibia and thus the study described the socio-demographic
characteristics and three delays that lead to maternal deaths in Namibia. The paper
also aims to propose strategies for midwifery practice, in order to prevent maternal
deaths in future.
Data on health facility based review of maternal records from 13 regions in the
country during the period of 2008-2012 was used. This was then complemented by
the 2011 Namibia Population and Housing census data. For the health facility data, a
case control study design was applied, with a total number of 154 maternal deaths
included in the study as cases and 770 women of reproductive ages who fell pregnant
during the study period and survived as controls. A logistic regression model was
used to assess the risk factors associated with maternal deaths. For the Census data,
measures of maternal mortality, such as maternal mortality ratio, maternal mortality
rate, lifetime risk of maternal death, and proportion of maternal deaths among
women of reproductive age were estimated.
Based on the health facility data, of the 154 maternal deaths reviewed, 58.4% were
from direct maternal deaths and 41.6% were from indirect maternal deaths.
Haemorrhage (37.8%), eclampsia (24.4%) and puerperal sepsis (23.3%) were the
ii
leading causes for direct maternal deaths. About 65% of the haemorrhage cases; 64%
of the eclampsia cases and 53% of the puerperal sepsis occurred to women who lived
in rural areas. The predominant recognizable indirect causes were HIV (45.3%);
pneumonia (23.4%) and tuberculosis (17.2%). Maternal deaths are less likely to
occur to women living together with their partner than those who are not living
together (OR = 0.53). Most women experienced first (51.3%) and third delays
(51.9%). Only few women experienced a second delay (12.9%). However it is
important to note that some women experienced more than one delay and in some
cases all delays were experienced.
Using the 2011 Census data, maternal mortality ratio was 547 deaths per 100 000
live births. The highest ratio of 1954 deaths per 100,000 live births is recorded for
women in the age group of 45-49 years. Maternal Mortality Ratio is also observed to
be high among the teenage mothers between the age group of 15-19 years with an
estimate of 421 deaths per 100,000 live births as compared to 318 deaths per 100,000
live births estimated for women aged 20-24
This analysis reinforced previous findings pointing to the fact that haemorrhage and
eclampsia are the leading causes of maternal mortality in Namibia and other
developing countries. This indicates the need for better obstetric care, particularly for
women over thirty years of age.