Maternal Health Outcomes in Facilities at Baseline and Endline in Uganda and Zambia SMGL-Supported Districts

Maternal Health OutcomesUgandaZambia
BaselineEndline% ChangeSig. LevelaBaselineEndline% ChangeSig.Levela
Number of live births – all facilities33,49257,355+71N/A21,91438,174+74N/A
Institutional delivery rate – all facilities (%)45.566.8+47***62.690.2+44***
Institutional delivery rate – EmONC facilities (%)28.241.0+45***26.029.1+12***
Number of obstetric complications treatedb5,2568,458+61N/A1,8441,979+7N/A
Cesarean delivery rate as a proportion of all births (%)5.39.0+71***2.74.8+79***
Met need for emergency obstetric care – all facilities (%)46.364.7+40***34.130.6−10***
Met need for emergency obstetric care – EmONC facilities (%)39.262.1+58***25.823.1−11***
Direct obstetric case fatality rate – all facilities (%)2.61.7−37***3.73.2−12NS
Direct obstetric case fatality rate – EmONC facilities (%)2.91.6−45***2.93.8+31NS
Facility MMR, overall (per 100,000 live births)534300−44***370231−38***
Direct obstetric causes MMR415244−41***310168−46***
    Obstetric hemorrhage MMRc13177−42***11942−65***
    Puerperal infection/sepsis MMRd7547−37NSNANAN/AN/A
    Obstructed labor MMRe7256−22NS5931−47NS
    Abortion-related MMRf6323−64***NANAN/AN/A
    Preeclampsia/eclampsia MMR4526−42NSNANAN/AN/A
    Other major direct obstetric causes MMRg3016−47NS13294−29NS
Indirect obstetric causes MMRh11956−53***5963+6NS
Facility perinatal mortality (per 1,000 births)39.334.4−13***37.928.2−26***
Total stillbirth rate (per 1,000 births)31.227.0−13***30.519.6−36***
Intrapartum stillbirth rate (per 1,000 births)22.414.3−36***NANAN/AN/A
Predischarge neonatal mortality rate (per 1,000 live births)8.47.6−10NS7.78.7+14NS
  • 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.