The tip of the iceberg: Evidence of seasonality in institutional maternal mortality and implications for health resources management in Burkina Faso

Abstract

Aims: The aims of this study were to investigate seasonal patterns of institutional maternal deaths and complications, and to test for an association with malaria seasons, rainfall, and household income. Methods: A systematic case review of hospital records in the Boucle du Mouhoun health region (Burkina Faso) was conducted over a 2-year period. A statistical smoothing procedure (T4253H) and Freedman's test were used to investigate seasonality and association with malaria, rainfall or household income variations. Results: The data consistently showed the greatest rates of maternal deaths, eclampsia and haemorrhage cases during the dry season, which is the low malaria transmission season, and the period of the year when households have most money available and the lowest opportunity cost of travelling to seek medical attention, suggesting that financial and geographical barriers may be major underlying factors. Conclusions: The management both of health resources in hospital and of referral systems should accommodate cyclical variations in the presentation of maternal complications. Effective mechanisms are needed to help reduce the significant barriers to uptake faced by women and their families at particular times of the year.

Keywords

Determinants eclampsia haemorrhage maternal deaths resources management seasonality

Get full access to this article

View all access options for this article.

References

Graham WJ , Fitzmaurice AE , Bell JS , Cairns JA The familial technique for linking maternal death with poverty. Lancet 2004;373:23-7.

Bullough C. , Meda N. , Makowiecka K. , Ronsmans C. , Achadi EL , Hussein J. Current strategies for the reduction of maternal mortality. Br J Obstet Gynaecol 2005;112:1180-8.

Liljestrand J. Strategies to reduce maternal mortality worldwide . Current Opin Obstet Gynecol 2000;12:513-17.

Boerma JT Maternal mortality in sub-Saharan Africa: levels, causes and interventions . Ann IFORD 1988;12:49-68.

Bouvier-Colle MH , Ouedraogo C. , Dumont A. , Vangeenderhuysen C. , Salanave B. , Decam C. Maternal mortality in West Africa. Rates, causes and substandard care from a prospective survey . Acta Obstet Gynecol Scand 2001;80:113-19.

Anya SE Seasonal variation in the risk and causes of maternal death in the Gambia: malaria appears to be an important factor. Am J Trop Med Hyg 2004;70:510-13.

Etard JF , Kodio B. , Ronsmans C. Seasonal variation in direct obstetric mortality in rural Senegal: role of malaria? Am J Trop Med Hyg 2003;68:503-4.

Granja AC , Machungo F. , Gomes A. , Bergstrom S. , Brabin B. Malaria-related maternal mortality in urban Mozambique. Ann Trop Med Parasitol 1998;92:257-63.

Hammerich A. , Campbell OM , Chandramohan D. Unstable malaria transmission and maternal mortality - experiences from Rwanda. Trop Med Int Health 2002;7:573-6.

10.

Bergstöm S. , Povey G. , Songane F. , Ching C. Seasonal incidence of eclampsia and its relationship to meteorological data in Mozambique. J Perinat Med 1992;20:153-8.

11.

Sauerborn R. , Nougtara A. , Hien M. , Diesfeld HJ Seasonal variations of household costs of illness in Burkina Faso. Soc Sci Med 1996 ;43:281-90.

12.

Undp. Available at: http://hdr.undp.org/reports/global/2004/pdf/hdr04_HDI.pdf (accessed 2 May 2006).

13.

Hill K. , AbouZahr C. , Wardlaw T.

Estimates of maternal mortality for

1995. Bull World Health Organ 2001;79:182-93.

14.

National Institute of Statistics and Demography (INSD) and Macro International Inc. Demographic and Health Survey, Burkina Faso 2003. Calverton, MD: Macro International Inc.; 2004.

15.

Velleman PF Definition and comparison of robust nonlinear data smoothing algorithms . J Am Statist Assoc 1980;75:609-15.

16.

Freedman LS The use of a Kolmogorov-Smirov type statistic in testing hypotheses about seasonal variation. J Epidemiol Community Health 1979;33:223-8.

17.

Gemmell I. , McLoone P. , Boddy F. , Dickinson G. , Watt G. Seasonal variation in mortality in Scotland . Int J Epidemiol 2002;29:274-9.

18.

Becker S. , Weng S. Seasonal patterns of deaths in Matlab, Bangladesh . Int J Epidemiol 1998;27:814-23.

19.

Kynast-Wolf G. , Hammer GP , Muller O. , Kouyate B. , Becher H. Seasons of death and birth predict patterns of mortality in Burkina Faso. Int J Epidemiol 2005;35: 427-35.

20.

Ministry of Health. Annual health statistics. Burkina Faso; 2002 .

21.

Meda N. , Kanki B. , Cousens S. , Graham W. Identifying strategies to control anemia among women of reproductive age: findings of an in-depth study in Bobo-Dioulasso, Burkina Faso. MotherCare Matters 1994;4:8-11.

22.

Neela J. , Raman L. Seasonal trends in the occurrence of eclampsia. Natl Med J India 1993;6:17-18.

23.

Makhseed M. , Musini VM , Ahmed MA , Monem RA Influence of seasonal variation on pregnancy-induced hypertension and/or preeclampsia. Aust NZ J Obstet Gynaecol 1999;39:196-9.