Maternal Mortality: Interesting Comparison between Tertiary, Secondary and Primary Centers in Pakistan

Abstract

OBJECTIVES: To highlight the current situation on maternal mortality rate and to compare maternal mortality at different health levels like Tertiary, Secondary and Primary Centers.

MATERIAL AND METHODS: Data was collected from different Tertiary, Secondary and Primary centers from their respective hospital administration for the year 2016. In our study 60 (20 Tertiary, 20 Secondary and 20 Primary) Hospitals were randomly selected from different districts of Pakistan.

RESULTS: Maternal Mortality Rate reported from different hospitals varies between Tertiary, Secondary and Primary centers. In our study we observed 135 Maternal Mortality Rate in primary, 394 in secondary and being highest in tertiary care center i.e. 452. Each and every tertiary center in Pakistan is serving a large population as Punjab being the biggest and thickly populated province has only 23 Tertiary Care Hospitals, which are serving above 110 million populations. Total Maternal Mortalities reported in these 60 hospitals were 1061. Out of these 1061 deaths 928 (87.46%) were due to direct causes and 133 (12.5%) due to indirect causes. Major contributions in direct causes were haemorrhage, hypertension and sepsis.

CONCLUSION: Our results concluded that increased Maternal Mortality Rate in Tertiary Centers was due to increased referral from Primary and Secondary centers. Regarding these hallmarks our suggestions are to develop strategies which should include increased number of tertiary centers and upgrading of secondary centers with more skilled staff and equipped emergency obstetrics services including blood bank facilities. Government should make pro-active  and aggressive attempts at all health care levels to reduce the need for referral to tertiary centers and minimize maternal mortality.