Maternal Health Outcomes in Facilities at Baseline and Endline in Uganda and Zambia SMGL-Supported Districts
| Maternal Health Outcomes | Uganda | Zambia | ||||||
|---|---|---|---|---|---|---|---|---|
| Baseline | Endline | % Change | Sig. Levela | Baseline | Endline | % Change | Sig.Levela | |
| Number of live births – all facilities | 33,492 | 57,355 | +71 | N/A | 21,914 | 38,174 | +74 | N/A |
| Institutional delivery rate – all facilities (%) | 45.5 | 66.8 | +47 | *** | 62.6 | 90.2 | +44 | *** |
| Institutional delivery rate – EmONC facilities (%) | 28.2 | 41.0 | +45 | *** | 26.0 | 29.1 | +12 | *** |
| Number of obstetric complications treatedb | 5,256 | 8,458 | +61 | N/A | 1,844 | 1,979 | +7 | N/A |
| Cesarean delivery rate as a proportion of all births (%) | 5.3 | 9.0 | +71 | *** | 2.7 | 4.8 | +79 | *** |
| Met need for emergency obstetric care – all facilities (%) | 46.3 | 64.7 | +40 | *** | 34.1 | 30.6 | −10 | *** |
| Met need for emergency obstetric care – EmONC facilities (%) | 39.2 | 62.1 | +58 | *** | 25.8 | 23.1 | −11 | *** |
| Direct obstetric case fatality rate – all facilities (%) | 2.6 | 1.7 | −37 | *** | 3.7 | 3.2 | −12 | NS |
| Direct obstetric case fatality rate – EmONC facilities (%) | 2.9 | 1.6 | −45 | *** | 2.9 | 3.8 | +31 | NS |
| Facility MMR, overall (per 100,000 live births) | 534 | 300 | −44 | *** | 370 | 231 | −38 | *** |
| Direct obstetric causes MMR | 415 | 244 | −41 | *** | 310 | 168 | −46 | *** |
| Obstetric hemorrhage MMRc | 131 | 77 | −42 | *** | 119 | 42 | −65 | *** |
| Puerperal infection/sepsis MMRd | 75 | 47 | −37 | NS | NA | NA | N/A | N/A |
| Obstructed labor MMRe | 72 | 56 | −22 | NS | 59 | 31 | −47 | NS |
| Abortion-related MMRf | 63 | 23 | −64 | *** | NA | NA | N/A | N/A |
| Preeclampsia/eclampsia MMR | 45 | 26 | −42 | NS | NA | NA | N/A | N/A |
| Other major direct obstetric causes MMRg | 30 | 16 | −47 | NS | 132 | 94 | −29 | NS |
| Indirect obstetric causes MMRh | 119 | 56 | −53 | *** | 59 | 63 | +6 | NS |
| Facility perinatal mortality (per 1,000 births) | 39.3 | 34.4 | −13 | *** | 37.9 | 28.2 | −26 | *** |
| Total stillbirth rate (per 1,000 births) | 31.2 | 27.0 | −13 | *** | 30.5 | 19.6 | −36 | *** |
| Intrapartum stillbirth rate (per 1,000 births) | 22.4 | 14.3 | −36 | *** | NA | NA | N/A | N/A |
| Predischarge neonatal mortality rate (per 1,000 live births) | 8.4 | 7.6 | −10 | NS | 7.7 | 8.7 | +14 | NS |
Abbreviations: EmONC, emergency obstetric and newborn care; MMR, maternal mortality ratio; Sig., signficance.
↵a Asterisks indicate significance level of the difference between baseline and endline outcomes for all facilities combined, using a z statistic to calculate the P value of the difference, as follows: ***P<.01, **P<.05, NS = not significant. NA = data not available. N/A = not applicable.
↵b Excludes early pregnancy complications (e.g., abortion-related complications and ectopic pregnancy).
↵c Includes antepartum, intrapartum, and postpartum hemorrhage.
↵d Infection of the genital tract occurring at any time between the onset of the rupture of membranes or labor and the day of death in facility; in Zambia, these maternal deaths were classified as deaths due to “other major direct complication.”
↵e Obstructed and prolonged labor including rupture of the uterus.
↵f Deaths after induced and spontaneous abortions.
↵g In Uganda, it includes deaths due to embolism, anesthesia, and ruptured ectopic pregnancy; in Zambia, it includes these conditions plus deaths due to puerperal infections, eclampsia/preeclampsia, and abortion.
↵h Includes HIV-, TB-, and malaria-related maternal deaths and those due to other medical conditions aggravated by pregnancy or postpartum.