Analyse des facteurs institutionnels associés à la mortalité maternelle : Une étude nationale dans les maternités chirurgicales au Sénégal
Abstract Objective: To identify which institutional factors are associated to the hospital maternal mortality in surgical maternities in Senegal.  Method: This study is a secondary data analysis of the third National survey of the Surgical-Obstetric Coverage in Senegal in 2001. The hospital statistics data analyzed represent 38,239 admissions in obstetrics in 19 hospitals and 450 maternal deaths. The hospital maternal death rates (TMMH) crude and adjusted were used as dependent variables. The TMMH adjusted on the characteristics of the customers (`cases-mix') was estimated for each health structure by the direct standardization method. The indicators of the structure, resources management’s complexity score quality were used as independent variables to predict hospital MM. The Mann-Whitney and Kruskal-Wallis tests were used to analyze the association between independent variables, the complexity score of quality and MM. A multivariate analysis was used to estimate the impact of quality score on the MM, taking into account the geographical location (Dakar versus other region).   Results: In bivariate analysis, the presence of anaesthetist, the availability of Caesarean kit and supervision of all births by trained personnel are the institutional factors significantly associated with the crude TMMH decreased. For the adjusted TMMH, the presence of Scialytic, the availability of Magnesium Sulphate, the use of clinical guidelines of good practice (GPC) for obstetrical complications are the institutional factors associated to his decreased.  The complexity score quality is significantly associated with the crude TMMH, including multivariate analysis, but not with adjusted TMMH. Conclusion: The availability of the Magnesium Sulphate, and the Scialytic could contribute to the reduction of maternal mortality. In addition, an adequate reorganization of the resources to reduce the geographical rural/urban disparity is essential, as well as a developing the personnel’s awareness for the use of GPC. Moreover, qualified assistance at birth for all women is necessary to improve the quality of care and the treatment obstetrical complications.
Maternal Mortality Surgical maternity Structure indicators Quality of care Emergency Obstetrical care Senegal