The Burden of Severe Maternal Outcomes: Insights from a Seven-Month Survey of Obstetric Admissions at Bugando Medical Centre, Mwanza, Tanzania

Abstract

Background: Severe Maternal Outcomes (SMOs), including Maternal Near-Miss (MNM) and Maternal Deaths (MD), are critical indicators of maternal healthcare quality and remain a significant public health challenge in low-resource settings. Sub-Saharan Africa (SSA) bears the highest global burden of maternal mortality, often driven by delays in care and inadequate healthcare resources. This study analyzed SMOs among women admitted with Obstetric-Related Conditions (ORC) over seven months at Bugando Medical Centre (BMC), Mwanza, Tanzania, to provide insights into the burden, causes, and associated case fatality rates.
Methods: A retrospective cross-sectional census was conducted from November 2021 to May 2022. All women admitted with eligible obstetric-related conditions during the study period were consecutively included, resulting in 287 participants. Maternal near-miss cases and MD were identified using the WHO SMO tool. Data were summarized using frequencies and percentages. Cause-specific case fatality rates were calculated as the proportion of maternal deaths among severe maternal outcomes attributed to each condition.
Results: Out of 3,149 obstetric admissions during the study period, 287 women with obstetric-related conditions were included in the analysis. Among these, 175 (61.0%) experienced SMOs, comprising 138 maternal near-miss cases and 37 maternal deaths. Women aged 20–34 years and urban residents constituted the majority of cases, although higher proportions of deaths were observed among adolescents, rural residents, and women with no formal education. Severe maternal outcomes were frequently observed among women with parity 1–3 and those who delivered outside BMC. A relatively higher proportion of MD was observed among women who underwent operative delivery than among those who had spontaneous vaginal delivery. Direct obstetric causes accounted for most SMOs (88.0%), with hypertensive disorders (45.1%) and obstetric hemorrhage (28.0%) being the leading causes. Indirect causes accounted for 12.0%, mainly anemia. The highest case fatality rates were observed for anemia (46.2%), abortion complications (33.3%), and sepsis (28.6%).
Conclusion: Severe maternal outcomes remain a major burden at Bugando Medical Centre. Strengthening early detection of obstetric complications, improving emergency response systems, and addressing indirect conditions such as anemia are critical to reducing preventable maternal deaths.