Factors associated with maternal survival in a low-resource setting
Description
Maternal mortality is a global concern and a consensus has been reached that the health of mothers and children is an important indicator of national health and the socio-economic development of countries. In 2015 the reduction of maternal mortality was adopted in the global and national initiatives for improving maternal health under Sustainable Development Goals(SDG). Despite the commitment set out in SDGs maternal mortality remains high, Zimbabwe is among the 40 countries in the world with high maternal mortality rate. There was need to analyse the causes for such high maternal mortalityhence the need for this research.The objective of the study was to determine the factors associated with maternal survival of pregnant mothers at Mpilo Central Hospital. The results of the study could help reduce maternal mortality. Data were entered into Stata12.1 statistical package. Univariate statistics were performed and presented as frequencies and percentages for categorical variables. We used Variance Inflated Factor (VIF) to test for multi-collinearity for all the candidate explanatory variables. Binary logistic regression was used to calculate the probability of maternal death given different variables. A p value < 0.05 was taken as statistically significant. 95% Confidence Interval (CI) was used. The Cox proportional hazard model was used on the factors which were found to be statistically significant in maternal mortality to analyze if they have an effect on the survival time of patients. The p-value of our model was <0.0001 which identified that the model fits the data and can be used to predict survival. Kaplain Meir survival curves were used to compare survival of patients with respect to their booking status. Using binary logistic regression, the following were statistically significant associated with maternal death: age (OR 3.434, 95% CI 1.508-7.819, p=0.003), education level (OR 0.114, 95% CI 0.018-0.724, p=0.021), booking status (OR 29.547, 95% CI 8.016-111.290, p=0.001), ANC visits (OR 2.549, 95% CI 1.732-3.750, p = 0:001), PPH (0R 3.302, 95% CI 1.291-8.447, p=0.013), PIH(OR 0.010, 95% CI 0.001-0.112, p=0.001), APH (OR 3.941, 95% CI 1.371-11.329, p=0.011), sepsis (OR 5.358, 95% CI 1.792-16.022, p=0.003), retroviral infection (OR 8.466, 95% CI 1.921-37.320, p=0.005), anaemia (OR 5.647, 95% CI 1.491-21.383, p=0.011), other mode of deliveries which includes vacuum and forceps (OR 21.751, 95% CI 2.305-205.276, p=0.007) and miscarriages (OR 6.995, 95% CI 1.813-26.987, p=0.005). Using Cox regression, the following were found to be statistically significant; patients who did not book their pregnancies (HR 5.196, 95% CI 2.342-11.527, p=0.001), PPH (HR 1.790, 95% CI 1.097-2.919, p=0.020), PIH (HR 0.071, 95% CI 0.010-0.515, p=0.009), APH (HR 2.153, 95% CI 1.345-3.447, p=0.001) and ANC visits (HR 1.379, 95% CI 1.039-1.739, p=0.006)