The Epidemiology of Maternal Mortality in Southern Tanzania

With a view to strengthening systems for maternal health, this study presents a comprehensive analysis of determinants of uptake of care and pregnancy-related mortality, with the main emphasis on distance to care. Data on geographical positioning (GIS), socio-demographic information, birth histories and deaths in women of reproductive age were collected during a household census in five rural districts of Southern Tanzania in 2007. Deaths reported as pregnancy-related were followed up by verbal autopsies. Health facility census information collected in the same area in 2009 was used. Data limitations included 30% either missing or low quality GIS data and missing birth histories for 9% of women. The analysis included 507 pregnancy-related deaths and 64,098 live births. Major deficiencies in quality of care provided in health facilities were identified. Although 75% of women lived within a distance of 4.6km to a facility providing delivery care, overall institutional delivery was low with 29% of all births in hospital and 11% in first-line facilities. Seventy-two percent of women living