Objective: To assess the magnitude, causes and associated factors of maternal mortality in Surinam.
Methods: Nationwide confidential enquiry. Maternal deaths were identified using various methods and sources for the period 1991-1993. All cases were examined by a maternal mortality expert committee for substandard care analysis.
Results: The national maternal mortality ratio was 226 per 100,000 live births, which is six times higher than the official maternal mortality ratio of 38 for the preceding three year period. The main causes of death were haemorrhage (30%) and pre-eclampsia (20%). In 95% of analysed cases, substandard care factors which had contributed to the deaths were present at one or more levels of maternity care.
Conclusions: Maternal mortality was found to be several times higher than had been officially reported for Surinam during the previous three decades. Improvement of maternity care services in Surinam is needed, and has to be addressed at all levels, from the community, health centre and hospital to the highest level of organisation.
PIP: This study assessed the extent, causes, and factors associated with maternal mortality (MM) during 1991-93 in Surinam. Data were obtained from a national mortality survey and verified with the doctors who signed death certificates. A single underlying cause was assigned to each death. Findings indicate that the national MM ratio was 226/100,000 live births (64 maternal deaths), which was 6 times higher than the official figures for the same period. 76.6% were due to direct maternal causes; 23.4% to indirect maternal causes. The main causes of death were hemorrhage (29.7%), pre-eclampsia (20.3%), complications from cesarean section (7.8%), sepsis from genital tract infections (6.3%), and other (7.8%). 87.5% died in the densely populated coastal area, 12.5% died inland, 82.8% died in a hospital, 3.1% died in health centers, and 14.1% at home. 71.7% had vaginal deliveries; 28.3% were delivered by cesarean section. Among 59 maternal deaths, 22% had no prenatal care, 45.8% had their first prenatal visit in the second half of the pregnancy, and 32.2% began prenatal care before the 20th week of gestation. 61.9% had uneventful obstetric histories. 12.7% had health risk factors. 95.2% of cases involved substandard care practices by the woman and her family, obstetricians, hospital care, and/or the organization of health care. Deaths from hemorrhage were mostly due to late blood transfusion. Deaths from eclampsia were due to late transport to the hospital.