Missing maternal deaths: lessons from Souro Sanou University Hospital in Bobo-Dioulasso, Burkina Faso.

We investigated the location of maternal deaths in the Souro Sanou University Hospital of Bobo-Dioulasso, Burkina Faso. In all, the deaths of 585 women of reproductive age (12-49 years) were reviewed, and 132 (22.6%) were found to be maternal. Of these132, 43 (33.6%) occurred outside of the maternity unit. Some direct causes of death (eclampsia and sepsis) and indirect causes of death (cardiac illness and HIV/AIDS) would be omitted if only cases occurring on the maternity ward are investigated. Alarmingly, 93 (70%) of the 132 maternal deaths would have been missed in this hospital if we had used a narrow search process (excluding non-maternity wards) and narrow definition (excluding indirect causes). In conclusion, the results of this study demonstrate the potential for seriously underestimating the magnitude of maternal mortality within facilities and for neglecting pregnant or recently pregnant women dying in non-maternity wards and from indirect complications.