Institutional Factors Associated with Maternal Mortality That Occurred from 1 January to 31 December 2013 at Major Admitting Health Facilities in Midlands Province, Zimbabwe

Introduction: In Midlands Province, Zimbabwe during the period 1st January to 30th September 2013, 43 (80%) maternal mortality had occurred in health facilities raising questions on the quality and timeliness of care rendered to maternity cases when they arrive at health facilities. Methods: A facility based cross-sectional study was conducted from February to April 2013 to determine institutional factors associated with maternal mortality that occurred in nine major admitting health facilities from 1st January to 31st December 2013. Data was collected using self administered questionnaires on knowledge and skills from 65 HCWs, interview guide on availability of life saving interventions from 18 managers and checklist on 38 maternal mortality cases. Results: Sixteen (25%) health care workers (HCWs) were trained in Emergency Obstetric Care (EmOC). Only 13(20%) were able to perform vacuum extraction delivery and 57% can perform manual removal of placenta and Manual Vacuum Aspiration (MVA). Incomplete documentation, inadequate investigations and monitoring, delays in getting appropriate care and transportation, lack of blood and blood products, not following guidelines, inappropriate attitudes and lack of follow up of HIV clients were identified as gaps in the care rendered to maternal mortality cases before death. Unavailability and inadequacy of life saving interventions was identified. Discussion: With these major findings, reduced number of skilled HCWs to perform life saving procedures, substandard quality of care and unavailability and inadequate life saving interventions at the nine major admitting health facilities were associated with maternal mortality that occurred from 1st January to 31st December 2013 in Midlands Province. Scaling up of EmOC training, follow up sessions on EmOC trained HCWs, upgrading of major health facilities to offer all life saving interventions and ensure availability of adequate resources is recommended so as to reduce maternal with the aim of achieving Millennium Development Goal five.