FACTORS ASSOCIATED WITH MATERNAL DEATHS IN UTTARAKHAND STATE

Maternal death mostly happens as a result of a host of medical factors which are often directly or indirectly affected by various socio-demographic, economic and cultural issues. Delays in decision making, arranging transport services and receiving requisite treatment at a health care facility independently or in combination contribute to maternal mortality in developing countries. OBJECTIVE: To find out medical and socio-cultural factors associated with maternal deaths. MATERIALS AND METHODS: A cross sectional study was undertaken in four High Priority Districts of Uttarakhand State by conducting verbal autopsy of 178 maternal deaths. Household member preferably a close family member sharing the same kitchen was interviewed using pre-tested peer-evaluated questionnaire which captured information pertaining to verbal autopsy along with data on socioeconomic status and other socio demographic variables. Data analysis was done using Microsoft Excel. Results: Approximately one third (31.46%) of deceased women had received three or more ANC services. Almost half of the maternal deaths (47%) occurred at health facilities. The clinical causes reported are mainly Postpartum haemorrhage (42.17%), sepsis (7.23%), prolonged labour (7.23%) and Pregnancy-induced hypertension (6.02%). The study findings pertaining to socio cultural factors reveal that there are delays in decision making, reaching health care facilities on time and initiation of treatment. Most common socio cultural practices include serving food in relatively less quantity during the first trimester of pregnancy (40.45%), avoiding dark green leafy vegetables, pulses, grams during pregnancy (54.49%), discouraging pregnant women to drink much water (64.61%), placing the pregnant women in Gaushala (Cowshed) during and before three days of delivery (35.39 %) and serving strong sugary tea during labour (54.49%). CONCLUSION: Quality ANC services along with nutrition based counseling need to be ensured for each pregnant women by doing rigorous follow up through RCH portal. Maternal deaths occurring at home and during transit can be managed only by timely identification of danger signs and prompt decision making for medi cal consultation. Maternal deaths reported in the postpartum period (up to 42 days) can be averted by ensuring proper post natal follow up through home-based newborn care visits by ASHA. Clinical management needs to be strengthened by ensuring facility readiness at Comprehensive Emergency Obstetric Care (CEmOC) and Basic Emergency Obstetric Care (BEmOC) facilities, competency of staff and availability of essential drugs, supplies and logistics. Sociocultural belief and wrong practices need to be addressed on priority by adopting multisectoral approach like empowering women, improving educational status, accessibility and affordability of health care services along with conducting extensive IEC and IPC activities by Front line Workers.