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Maternal Mortality in Bosaso District of Somalia Retrospective Case Study on Causes and Contributing Factors

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Maternal Mortality in Bosaso District of Somalia Retrospective Case Study on Causes and Contributing Factors Maternal Mortality in Bosaso District of Somalia Retrospective Case Study on Causes and Contributing Factors Jamila Ahmed Aden Department of Medicine, Faculty of Medicines and Health Sciences, East Africa University. Professor Hinda Jama Ahmed, A member of Somali-Swedish Researchers’ Association (SSRA), Bosaso, Puntland, Somalia Professor Per-Olof Ostergren, Lund University, Sweden Maternal Mortality in Bosaso District of Somalia 2018 TABLE OF CONTENT ABBREVIATIONS................................................................................................................................................................... 3 ABSTRACT .............................................................................................................................................................................. 4 INTRODUCTION .......................................................................................................................................... 6 PROFILE OF SOMALIA ....................................................................................................................................................... 7 Geography ............................................................................................................................................................................... 7 Population and Demographic Characteristics ................................................................................................................. 7 Political Context ..................................................................................................................................................................... 7 Economy .................................................................................................................................................................................. 7 Health Services in Somalia .................................................................................................................................................. 9 BACKGROUND AND AIMS OF THE STUDY.......................................................................................... 12 EPIDEMIOLOGY AND BURDEN ..................................................................................................................................... 12 DEFINITION, CAUSES AND MEASURES OF MATERNAL MORTALITY ................................................................ 13 MEASURING MATERNAL MORTALITY ......................................................................................................................... 13 Vital Registration ................................................................................................................................................................. 13 House-hold Surveys............................................................................................................................................................. 14 Sisterhood Method ............................................................................................................................................................... 14 Reproductive Age Mortality Studies ................................................................................................................................. 14 MATERNAL MORTALITY IN SOMALIA .......................................................................................................................... 15 MATERNAL DEATH REVIEW/AUDIT ............................................................................................................................. 15 MODEL .................................................................................................................................................................................. 16 PURPOSE OF THE STUDY................................................................................................................................................ 16 OBJECTIVES OF THE STUDY .......................................................................................................................................... 16 MATERIALS AND METHODS .................................................................................................................. 17 STUDY AREA ........................................................................................................................................................................ 17 Population and Demographic Characteristics of the study area ................................................................................ 17 Health Facilities in the study area ................................................................................................................................... 18 Selection of Study Area ...................................................................................................................................................... 19 SAMPLE SIZE AND SELECTION...................................................................................................................................... 19 STUDY DESIGN ................................................................................................................................................................... 20 DATA COLLECTION........................................................................................................................................................... 20 Data Collection Tools ......................................................................................................................................................... 21 Classification by Reviewers ............................................................................................................................................... 21 Jamila Ahmed Aden Thesis Page 1 Maternal Mortality in Bosaso District of Somalia 2018 DATA HANDLING ............................................................................................................................................................... 22 PILOTING ............................................................................................................................................................................. 22 ETHICAL CONSIDERATION ............................................................................................................................................ 23 DATA ANALYSIS .................................................................................................................................................................. 23 RESULTS ..................................................................................................................................................... 24 QUANTITATIVE ................................................................................................................................................................... 24 Social and demographic characteristics of the women ................................................................................................ 24 Pregnancy and birth characteristics of the cases .......................................................................................................... 25 Medical causes of direct and indirect obstetric deaths ................................................................................................. 25 Outcome of the pregnancy ................................................................................................................................................. 25 Road to death ........................................................................................................................................................................ 26 Contributing Factors ........................................................................................................................................................... 31 QUALITATIVE RESULTS ................................................................................................................................................... 32 Delay in Deciding to Seek Health Care (Phase 1)......................................................................................................... 32 Delay in Reaching Obstetric Care Facility (Phase 2) ................................................................................................... 34 Delay in Actually Receiving Health Care after Reaching the Hospital (Phase 3) .................................................. 35 DISCUSSION ............................................................................................................................................... 37 GENERAL CONCLUSION, RECOMMENDATIONS AND DISSEMINATION ..................................... 42 CONCLUSION ...................................................................................................................................................................... 42 RECOMMENDATIONS....................................................................................................................................................... 43 RESEARCH DISSEMINATION .......................................................................................................................................... 44 ACKNOWLEDGEMENTS ................................................................................................................................................... 45 REFERENCES: ....................................................................................................................................................................
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