OBJECTIVE: Maternal mortality remains a major challenge worldwide. Reliable information concerning ratios and trends is essential for resource mobilization and assessment of progress towards the Millennium Development Goals. DESIGN: Assessment of levels and trends in maternal mortality during the last 50 years. SETTING: Sengerema district, rural North Tanzania. POPULATION: Number of deliveries, births, admissions, maternal deaths and causes of maternal mortality in the only hospital in the area. METHODS: We compiled a database from the annual hospital reports for the period of 1962-2011 to obtain estimated maternal mortality ratio for each decade. MAIN OUTCOME MEASURES: Maternal mortality ratio for each decade and classification of maternal deaths. RESULTS: Of 629 maternal deaths, 490 (77.9%) could be classified as either direct or indirect and causes of mortality ascertained. Of the 361 direct causes (73.7%), hemorrhage (29.8%) and sepsis (20.4%) were the leading causes. Of the 129 indirect causes (26.3%), anemia during pregnancy (6.5%), meningitis (4.1%), HIV-AIDS (3.5%), malaria (2.9%), heart diseases (2.4%) and relapsing fever (2.0%) were most often diagnosed. Since 1962, a 63% decrease in maternal mortality ratio has been achieved. The hospital-based maternal mortality ratio decreased from 770/100,000 to 282/100,000 in the last decade (95% confidence interval 244/100,000, 320/100,000). The yearly decline since 1962 was 1.3%. CONCLUSIONS: During the last 50 years we have witnessed a reduction of maternal mortality and improvements in maternal health. Progress has been made towards improving Millennium Development Goal 5, although only a prospective population-based survey will provide the ultimate answer.
OBJECTIVE: Maternal mortality remains a major challenge worldwide. Reliable information concerning ratios and trends is essential for resource mobilization and assessment of progress towards the Millennium Development Goals. DESIGN: Assessment of levels and trends in maternal mortality during the last 50 years. SETTING: Sengerema district, rural North Tanzania. POPULATION: Number of deliveries, births, admissions, maternal deaths and causes of maternal mortality in the only hospital in the area. METHODS: We compiled a database from the annual hospital reports for the period of 1962-2011 to obtain estimated maternal mortality ratio for each decade. MAIN OUTCOME MEASURES: Maternal mortality ratio for each decade and classification of maternal deaths. RESULTS: Of 629 maternal deaths, 490 (77.9%) could be classified as either direct or indirect and causes of mortality ascertained. Of the 361 direct causes (73.7%), hemorrhage (29.8%) and sepsis (20.4%) were the leading causes. Of the 129 indirect causes (26.3%), anemia during pregnancy (6.5%), meningitis (4.1%), HIV-AIDS (3.5%), malaria (2.9%), heart diseases (2.4%) and relapsing fever (2.0%) were most often diagnosed. Since 1962, a 63% decrease in maternal mortality ratio has been achieved. The hospital-based maternal mortality ratio decreased from 770/100,000 to 282/100,000 in the last decade (95% confidence interval 244/100,000, 320/100,000). The yearly decline since 1962 was 1.3%. CONCLUSIONS: During the last 50 years we have witnessed a reduction of maternal mortality and improvements in maternal health. Progress has been made towards improving Millennium Development Goal 5, although only a prospective population-based survey will provide the ultimate answer.